Optimizing Exercise for Health: The Impact of Aerobic and Resistance Training Order in Postmenopausal Women with Type 2 Diabetes

Background and Objectives

Postmenopausal women are at an increased risk for cardiovascular diseases and metabolic dysfunction, particularly when compounded by Type 2 Diabetes Mellitus (T2DM). This demographic often experiences heightened cardiometabolic risk factors, including irregular glycemic patterns, hypertension, and autonomic dysfunction, attributed to both estrogen decline and several metabolic disturbances.

While exercise has been shown to be beneficial for managing these risks, the most efficient approach combining aerobic and resistance training—specifically, whether the execution order of these modalities affects cardiovascular and metabolic outcomes—remains underexplored. This study aimed to elucidate the impacts of acute aerobic and resistance exercise execution order on glycemia, blood pressure (BP), and heart rate variability (HRV) in postmenopausal women diagnosed with T2DM.

Methods

A randomized crossover clinical trial was conducted involving 15 postmenopausal women with T2DM. Participants were subjected to three different experimental conditions in a random order: (I) aerobic exercise followed by resistance exercise (AR), (II) resistance exercise followed by aerobic exercise (RA), and (III) a control resting session (CON). Each participant underwent each condition on different days, allowing for individual comparisons.

Glycemic levels were evaluated pre-exercise, midway, and immediately post-exercise, in addition to follow-ups at 20, 40, and 60 minutes post-exercise. Blood pressure measurements were taken pre-exercise and at 20, 40, and 60 minutes post-exercise, while HRV was assessed pre-exercise and at 10, 30, and 50 minutes following exercise sessions.

Results

The findings of the study demonstrated significant distinctions among the different exercise orders. Following the AR protocol, participants exhibited significantly lower blood glucose levels immediately post-exercise compared to the CON session (p = 0.01). Notably, the AR session showed a reduced area under the glycemic curve during the combined exercise compared to both the RA and CON sessions (p < 0.05).

Post-exercise assessments revealed that all exercise conditions led to a notable decrease in glycemia (p 0.05). Systolic BP was similarly reduced across both exercise conditions (p < 0.05). However, diastolic BP only saw a notable reduction in the AR session (p = 0.01).

Regardless of execution order, time-domain indices of HRV were reduced in all exercise sessions (p < 0.05), suggesting that both aerobic and resistance exercise contributes to this measure of autonomic function.

Expert Commentary

The results of this study underscore the importance of exercise sequencing, particularly for postmenopausal women with T2DM, who face complex and multifaceted health challenges. The AR order not only provided superior immediate glycemic control but also demonstrated potential benefits concerning BP regulation.

However, it is important to consider the limitations of this investigation. The relatively small sample size may affect the generalizability of the findings. Additionally, the short-term nature of the exercise sessions may not capture the long-term physiological adaptations associated with regular training. Further studies with larger cohorts and longer observation periods are warranted to substantiate these findings and investigate more comprehensive cardiovascular and metabolic outcomes.

Moreover, restoring hormonal levels through tailored exercise regimens and understanding individual differences in response to exercise can significantly enhance rehabilitation strategies in this population.

Conclusion

The execution order of aerobic and resistance exercise is impactful in managing glycemia and BP among postmenopausal women with T2DM, with the AR session yielding significant advantages. While HRV responses remained consistent across both exercise orders, the distinct effects on glycemia and BP highlight the need for personalized exercise programs. Future research should aim to investigate long-term outcomes and explore mechanisms behind the observed effects.

References

Garcês CP, Silva JC, Sisconeto TM, Mariano IM, Cunha ACR, Cheik NC, Puga GM. Effects of acute aerobic and resistance exercise execution order on glycemia, blood pressure, and heart rate variability in postmenopausal women with type 2 diabetes mellitus: A randomized controlled trial. J Bodyw Mov Ther. 2025 Sep;43:310-317. doi: 10.1016/j.jbmt.2025.05.009. Epub 2025 May 5. PMID: 40483141.