Effects of combined training on glycemic control and lipid profiles in middle-aged and older adults: A three-level meta-analysis of randomized controlled trials

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Abstract

Whether combined training (aerobic plus resistance training) improves glucose and lipid metabolism in middle-aged and older adults and provides additional benefits over aerobic or resistance training alone for glucose and lipid metabolism remains unclear. This study conducted a systematic review and three-level meta-analysis of randomized controlled trials (RCTs) to examine the effects of combined training on glucose and lipid metabolism compared with control conditions, aerobic training, or resistance training. PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to February 2026. A total of 21 RCTs involving 1853 participants aged ≥45 years were included, and three-level meta-analysis and subgroup analyses were performed. Compared with control conditions, combined training significantly improved HbA1c (Hedges' g = -0.44, p < 0.01), HOMA-IR (Hedges' g = -0.59, p = 0.01), and glucose (Hedges' g = -0.81, p = 0.03). Evidence for insulin and lipid outcomes was inconclusive because these analyses were underpowered and the prediction intervals were wide. Current evidence does not establish a clear additional benefit of combined training over aerobic training. Compared with resistance training, combined training produced a small additional improvement in HbA1c, although this finding should be interpreted cautiously because of limited statistical power and potential differences in total exercise volume. Subgroup analyses suggested greater improvements in HOMA-IR among overweight and obese individuals. HbA1c showed the most robust findings, with moderate-certainty evidence, whereas the certainty of evidence for other outcomes ranged from low to very low. Overall, combined training was associated mainly with improvements in glycemic outcomes, but current evidence does not support a consistent advantage over single-modality exercise (e.g., aerobic training alone or resistance training alone) in middle-aged and older adults.

Abstract as published, via PubMed.