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Vol.:(0123456789)
Sports Medicine (2022) 52:601–612
https://doi.org/10.1007/s40279-021-01587-7
SYSTEMATIC REVIEW
Compatibility ofConcurrent Aerobic andStrength Training
forSkeletal Muscle Size andFunction: AnUpdated Systematic Review
andMeta‑Analysis
MoritzSchumann1 · JoshuaF.Feuerbacher1· MarvinSünkeler1· NilsFreitag1,2· BentR.Rønnestad3· KenjiDoma4·
TommyR.Lundberg5,6
Accepted: 16 October 2021 / Published online: 10 November 2021
© The Author(s) 2021
Abstract
Background Both athletes and recreational exercisers often perform relatively high volumes of aerobic and strength training
simultaneously. However, the compatibility of these two distinct training modes remains unclear.
Objective This systematic review assessed the compatibility of concurrent aerobic and strength training compared with
strength training alone, in terms of adaptations in muscle function (maximal and explosive strength) and muscle mass.
Subgroup analyses were conducted to examine the influence of training modality, training type, exercise order, training
frequency, age, and training status.
Methods A systematic literature search was conducted according to the PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses) guidelines. PubMed/MEDLINE, ISI Web of Science, Embase, CINAHL, SPORTDiscus, and
Scopus were systematically searched (12 August 2020, updated on 15 March 2021). Eligibility criteria were as follows.
Population: healthy adults of any sex and age; Intervention: supervised concurrent aerobic and strength training for at least
4weeks; Comparison: identical strength training prescription, with no aerobic training; Outcome: maximal strength, explo-
sive strength, and muscle hypertrophy.
Results A total of 43 studies were included. The estimated standardised mean differences (SMD) based on the random-effects
model were − 0.06 (95% confidence interval [CI] − 0.20 to 0.09; p = 0.446), − 0.28 (95% CI − 0.48 to − 0.08; p = 0.007),
and − 0.01 (95% CI − 0.16 to 0.18; p = 0.919) for maximal strength, explosive strength, and muscle hypertrophy, respectively.
Attenuation of explosive strength was more pronounced when concurrent training was performed within the same session
(p = 0.043) than when sessions were separated by at least 3h (p > 0.05). No significant effects were found for the other mod-
erators, i.e. type of aerobic training (cycling vs. running), frequency of concurrent training (> 5 vs. < 5 weekly sessions),
training status (untrained vs. active), and mean age (< 40 vs. > 40years).
Conclusion Concurrent aerobic and strength training does not compromise muscle hypertrophy and maximal strength devel-
opment. However, explosive strength gains may be attenuated, especially when aerobic and strength training are performed
in the same session. These results appeared to be independent of the type of aerobic training, frequency of concurrent train-
ing, training status, and age.
PROSPERO: CRD42020203777.
* Moritz Schumann
m.schumann@dshs-koeln.de
Extended author information available on the last page of the article
1 Introduction
Performing aerobic and strength training concurrently is
an integrative part of physical training aimed at improving
both athletic performance and health. The recommendation
to perform both aerobic and strength training is important
because these activities to some extent induce distinct adap-
tations and health benefits [1, 2]. For example, aerobic train-
ing promotes increased aerobic capacity (i.e. central adap-
tations) and metabolic changes in skeletal muscle, such as
increased mitochondrial density and capillarisation [3]. Con-
versely, regular strength training results in muscle hyper-
trophy and increased strength and power [4] but may also
improve bone mineral density [5]. The role of skeletal mus-
cle in health maintenance has received increased attention
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602 M.Schumann et al.
Key Points
Concurrent aerobic and strength training is recom-
mended to improve physical fitness and health; however,
the compatibility of these two distinct training modes
remains unclear.
In this meta-analysis, we report that concurrent training
does not interfere with adaptations in maximal strength
and muscle hypertrophy, regardless of the type of aero-
bic training (cycling vs. running), frequency of concur-
rent training (> 5 vs. < 5 weekly sessions), training status
(untrained vs. active), mean age (< 40 vs. > 40years),
and training modality (same session vs. same day vs. dif-
ferent day training).
However, concurrent training may attenuate gains in
explosive strength, which is exacerbated when aerobic
and strength training are performed within the same
training session.
To date, few attempts have been made to quantitatively
synthesise the literature concerning concurrent aerobic and
strength training. The first meta-analysis conducted a decade
ago by Wilson etal. [14] showed that peak power was attenu-
ated with concurrent training compared with strength train-
ing alone, whereas the development of muscle hypertrophy
and maximal strength were not compromised. A more recent
meta-analysis aimed to compare the effect of concurrent aero-
bic and strength training with strength training alone on the
development of maximal strength in untrained, moderately
trained, and trained individuals [15]. The results suggested
that concurrent training may have a negative effect on lower
body strength development in trained individuals but not in
moderately trained or untrained individuals. While this study
updated information on the effect of training status on maxi-
mal strength development, several other important outcome
variables related to muscle mass and function have not been
examined in a meta-analysis since 2012. Therefore, the aim of
the current study was to systematically assess the compatibility
of concurrent aerobic and strength training on adaptations in
maximal strength, explosive strength, and muscle hypertrophy
by means of pooled analyses. Subgroup analysis was also con-
ducted to examine the influence of aerobic training type, train-
ing modality, exercise order, concurrent training frequency,
age, and training status. An updated literature synthesis on this
topic is relevant to physicians, physiotherapists, exercise sci-
entists, and sports practitioners designing programmes aimed
at developing both aerobic and strength qualities for health
purposes, rehabilitation, and/or fitness performance.
2 Methods
2.1 Systematic Literature Search
A systematic literature search was conducted according
to the PRISMA (Preferred Reporting Items for System-
atic Reviews and Meta-Analyses) guidelines and was reg-
istered with PROSPERO (the International Database of
Prospectively Registered Systematic Reviews in Health
and Social Care; CRD42020203777). The PubMed/MED-
LINE, ISI Web of Science, Embase, CINAHL, SPORTDis-
cus, and Scopus databases were systematically searched
using a search string specifically adapted to the search
requirements of each database (TableS1 in the electronic
supplementary material [ESM]).
The search was conducted on 12 August 2020 and
updated on 15 March 2021. The literature search process
was performed independently by two researchers and
included saving the online search, removing duplicates,
and screening titles, abstracts, and full texts. Potential
conflicts were resolved by consulting with a third author.
In addition, a grey literature search was performed by
in the last decade, with muscle tissue being understood as
a secretory organ that releases several hundred myokines
related to the function of other organs, such as the brain, adi-
pose tissue, bone, liver, gut, pancreas, vascular bed, and skin
[6]. In addition, the role of muscle power has recently been
highlighted as being strongly associated with a lower risk of
fall-related injuries in older adults [7, 8], further underlining
the importance of both muscle mass and muscle function as
indicators of physical health and independence in daily life.
Aside from the health perspective, many sports require
the athlete to simultaneously incorporate divergent training
modalities, including aerobic and strength training, into their
training regimen. Considering that both athletes and recrea-
tional exercisers often perform relatively high volumes (and/
or frequencies) of aerobic training alongside resistance-type
training, it is pertinent to revisit the compatibility of aerobic
and strength training. Aerobic training has been shown to
interfere with the development of maximal strength when the
overall training volume is high [9]. In contrast, no interfer-
ence in maximal strength was observed when training volume
was reduced to two weekly aerobic and strength training ses-
sions, respectively [10–12]. Importantly, however, even low
volumes of concurrent aerobic training have been shown to
decrease gains in rapid force production [10, 13], which could
translate into reduced muscle power-related benefits. Identi-
fying additional moderators hypothesised in the literature to
potentially influence neuromuscular adaptations to concurrent
aerobic and strength training (such as type of aerobic training,
concurrent training modality, age, and training status) could
further aid in fine-tuning exercise guidelines for health and/or
fitness performance.
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603
Compatibility of Concurrent Aerobic and Strength Training
screening Google Scholar and the reference lists of previ-
ously identified eligible full texts. Figure1 is a flowchart
of the search process and study selection.
2.2 Eligibility Criteria
Inclusion criteria were defined based on the PICO (Popu-
lation, Intervention, Control and Outcomes) criteria [16].
The population included healthy adults with no restrictions
in terms of sex and age. The intervention had to consist
of supervised combined aerobic and strength training for
at least 4weeks. As a comparator, eligible studies had to
include a group receiving the identical strength-training
prescription with no aerobic training. Outcomes of interest
included maximal strength, explosive strength, and mus-
cle hypertrophy. The exercise tests had to be specific to the
training performed. For maximal strength, both isometric
and isoinertial measurements were accepted. For explo-
sive strength, any form of jump test, isometric rate of force
development (RFD), or dynamic power measurements
were considered eligible. For muscle hypertrophy, objec-
tive measurements of whole-muscle cross-sectional area or
muscle thickness (e.g. ultrasound, computed tomography
[CT] or magnetic resonance imaging [MRI]) were required.
In addition, segmental lean mass as determined by dual-
energy X-ray absorptiometry (DXA) was accepted if values
were reported separately for segments that were engaged in
training.
Fig. 1 Flowchart of the search process and the study selection
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604 M.Schumann et al.
Exclusion criteria included language other than English
or German, abstracts and dissertations, cross-sectional stud-
ies assessing only acute exercise responses, and observa-
tional studies.
2.3 Data Extraction
Data extraction was performed independently by two
authors. The following data were extracted from each
included study: (1) general characteristics (e.g. author[s],
year of publication and aim of the study), (2) participant
information (e.g. sample size, training status, and age), (3)
intervention data for all groups (e.g. intervention duration,
type of intervention), and (4) specific outcomes (e.g. meas-
ures of maximal and explosive strength and hypertrophy).
If the mean and standard deviation of each group were not
specified, we requested baseline and post-intervention data
from the authors of the primary studies. If data were pre-
sented within a graph and no additional data were provided
upon request, mean and standard deviation were extracted
using WebPlotDigitizer version 4.4 (Pacifica, CA, USA)
[17].
2.4 Data Synthesis andAnalyses
Standardised mean differences (SMD) were calculated, and
an inverse variance-weighted random-effects model was
fitted to the effect sizes (ES). Additionally, log variability
ratios were calculated, and an inverse variance-weighted
random-effects model was fitted to the ES. Meta-analyses
were performed using R (3.6.2), RStudio (1.2.5033), and
the metafor package (version 2.4.0) [18]. ES were calculated
for pre-test post-test control group designs using the previ-
ously recommended raw score standardisation [19, 20]. Fur-
thermore, the exact sampling variance of ES was computed
according to recommendations [19].
Heterogeneity (i.e. τ2) was estimated using the restricted
maximum-likelihood estimator [21]. To complete the hetero-
geneity analyses, the Q-test for heterogeneity [22] and the
I2 statistic [23] were also calculated. Studentised residuals
and Cook’s distances were examined to assess whether stud-
ies might be outliers and/or overly influential [24]. Studies
with a studentised residual greater than the 100 × (1–0.05/
(2 × k))th percentile of a standard normal distribution were
declared potential outliers (i.e. using a Bonferroni correction
with two-sided α = 0.05 for k studies included in the meta-
analyses). Studies with a Cook’s distance larger than the
median plus six times the interquartile range of the Cook’s
distances were considered overly influential. If a study was
identified as a potential outlier or overly influential, a sensi-
tivity analysis was performed. A trim-and-fill-contour funnel
plot was created to estimate the number of studies that may
be missing from the meta-analysis (Fig. S1 in the ESM). We
used the rank correlation test [25] and regression test [26]
using the standard error of observed outcomes as predictor
to check for funnel plot asymmetry.
ES from studies with more than two intervention or con-
trol groups were combined according to the Cochrane hand-
book recommendations [27], except for subgroup analysis
when different interventions from individual studies were
included in separate subgroups. If there were multiple meas-
urements for the same outcome, only one measurement was
included in the analysis, based on the following hierarchies:
• Maximal strength: (1) dynamic bilateral leg press, (2)
squat, (3) unilateral isometric torque (knee extension),
and (4) bilateral dynamic knee extension.
• Explosive strength: (1) jump height and (2) other meas-
ures of rapid force production as well as squat jump
power and leg press power at 50% of maximal strength.
• Muscle hypertrophy: (1) whole-muscle cross-sectional
area of the quadriceps femoris muscles (i.e. panoramic
ultrasound, CT, MRI), (2) muscle thickness of the vastus
lateralis, and (3) segmental DXA of the lower extremi-
ties.
Thus, each study was included in the final analyses with
only one parameter to avoid inflating the weighting of indi-
vidual studies.
Because of a lack of systematic reporting, subgroup
analyses were only performed for aerobic training type (i.e.
cycling vs. running), concurrent training frequency (i.e.
low frequency of 4.1 ± 0.3 vs. high frequency of 6.1 ± 1.6
weekly sessions, based on 2.0 ± 0.3 vs. 3.1 ± 0.6 weekly
sessions in the comparison training group), training status
(i.e. untrained vs. active), mean age of the study population
(18–40 vs. > 40years), and training modality (i.e. concur-
rent training on different days vs. on the same day vs. in the
same session). For studies comparing concurrent training in
the same session, when a sufficient number of studies were
available, training order was also compared (i.e. aerobic
before strength exercise vs. strength before aerobic exercise).
Studies were divided into subgroups based on the descrip-
tion in the manuscript. This was particularly true for training
status, with studies classified as ‘untrained’ if participants
were clearly described as ‘sedentary’, ‘previously untrained’,
or ‘inactive’. Conversely, all other studies were classified as
‘active’ (i.e. ‘recreationally active’, ‘trained’, ‘well-trained’,
etc.). Specific rationale for the exclusion of individual stud-
ies can be found in TableS2 in the ESM.
2.5 Assessment ofMethodological Quality
Risk of bias for the included studies was assessed indepen-
dently by two reviewers using the Physiotherapy Evidence
Database (PEDro) scale. The PEDro scale has previously
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605
Compatibility of Concurrent Aerobic and Strength Training
been assessed as a valid measure of the methodological
quality of randomised trials [28]. Studies scoring > 6 were
classified as ‘high quality’, studies scoring 4–5 were classi-
fied as ‘medium quality’, and studies scoring < 4 were clas-
sified as ‘low quality’. The following sources of bias were
considered: selection (sequence generation and allocation
concealment), performance (blinding of participants/per-
sonnel), detection (blinding outcome assessors), attrition
(incomplete outcome data), reporting (selective reporting),
and other potential biases (e.g. recall bias). The risk-of-bias
scores for the included studies are presented in TableS3
in the ESM. The mean score for scale criteria 2–11 of the
PEDro scale was 4.3/10, i.e., medium quality.
3 Results
3.1 Study Characteristics
The database search identified 15,729 potentially eligible
articles. After further screening and eligibility assessment, a
total of 43 studies were included in the final analysis (Fig.1).
The characteristics of the studies, participants, and training
interventions are summarised in TableS1 in the ESM. The
meta-analysis included a total of 1090 participants, of whom
590 performed supervised combined aerobic and strength
training and 500 performed strength training alone. In the
included studies, cycling was the most common type of aero-
bic training (24 studies), followed by running (16 studies). In
addition, the combination of running and cycling [9], rowing
[29], and continuous repeated leg extensions [30] were each
evaluated by one study.
3.2 Maximal Strength
The final analysis included 37 studies [9–11, 29–62], with
525 participants performing combined aerobic and strength
training and 442 participants performing strength training
alone. The observed SMD ranged from − 1.37 to 1.99, and
the estimated average SMD based on the random-effects
model was − 0.06 (95% confidence interval [CI] − 0.20 to
0.09; p = 0.446), indicating no interference effect of aerobic
training (Fig.2). The estimated log variability ratio based
on the random-effects model was 0.05 (95% CI − 0.05 to
0.15; p = 0.311). According to the Q-test, there was no sig-
nificant heterogeneity in the true outcomes (Q(36) = 32.591,
p = 0.632,
̂𝜏 2
= 0.000, I2 = 0.00%). An examination of the
studentised residuals showed no evidence of outliers within
this model, and none of the studies were overly influential.
Subgroup analyses showed no statistical differences
(p > 0.05) (Figs. S2–S7 in the ESM).
3.3 Explosive Strength
The final analyses included 18 studies [11, 31, 34, 38, 39,
42, 49, 51–54, 56, 58–60, 62–64], with 270 participants per-
forming combined aerobic and strength training and 208 per-
forming strength training alone. The observed SMD ranged
from − 1.60 to 0.22, and the estimated mean SMD based
on the random-effects model was − 0.28 (95% CI − 0.48
to − 0.08; p = 0.007), indicating an interference effect of
aerobic training (Fig.3). The estimated log variability ratio
based on the random-effects model was 0.04 (95% CI − 0.09
to 0.18; p = 0.533). According to the Q test, there was no sig-
nificant heterogeneity in the true outcomes (Q(17) = 26.675,
p = 0.068,
̂𝜏 2
= 0.068, I2 = 35.81%). The studentised residuals
highlighted Mikkola etal. [31] as a potential outlier that may
have been overly influential. Sensitivity analyses revealed
that excluding this study reduced the amount of observed
heterogeneity to I2 = 0.00% (Q(16) = 13.860, p = 0.061,
̂𝜏 2
=
0.061).
Subgroup analyses showed no statistical differences
(p > 0.05) (Figs. S8–S11 in the ESM). When studies were
grouped by type of aerobic training, the SMD was signifi-
cantly in favour of strength training for cycling − 0.44 (95%
CI − 0.86 to − 0.01; p = 0.043) but not for running (Fig. S8
in the ESM). However, after the overly influential study by
Mikkola etal. [31] was removed, this effect was no longer
observed (SMD − 0.27; 95% CI − 0.58 to 0.04; p = 0.086).
A similar effect was also seen for low concurrent training
frequency, with an initial SMD of − 0.45 (95% CI − 0.87
to − 0.02; p = 0.039) in favour of the strength training group
(Fig. S9 in the ESM). After the study by Mikkola etal. [31]
was removed, this reduced to − 0.25 (95% CI − 0.50 to 0.01;
p = 0.059). Conversely, when studies were grouped by train-
ing modality, a significant interference effect was observed
for studies that performed concurrent training within the
same session (≤ 20min between aerobic and strength train-
ing; SMD − 0.31; 95% CI − 0.62 to − 0.01; p = 0.043) but not
when concurrent training was separated by at least 3h (Fig.
S11 in the ESM).
3.4 Muscle Hypertrophy
The final analyses included 15 studies [10, 11, 33, 45–47,
49, 54, 55, 59, 62, 65–68], with 201 participants perform-
ing combined aerobic and strength training and 188 per-
forming strength training alone. The observed SMD in
each trial ranged from − 0.67 to 0.28, and the estimated
mean SMD based on the random-effects model was − 0.01
(95% CI − 0.16 to 0.18; p = 0.919), indicating no interfer-
ence effect of aerobic training (Fig.4). The estimated log
variability ratio based on the random-effects model was 0.04
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606 M.Schumann et al.
(95% CI − 0.11 to 0.19; p = 0.567). According to the Q test,
there was no significant heterogeneity in the true outcomes
(Q(14) = 4.687; p = 0.990,
̂𝜏 2
= 0.000, I2 = 0.00%). An exami-
nation of the studentised residuals showed no potential out-
lier within this model. According to the Cook’s distances,
no study could be considered overly influential. Subgroup
analyses revealed no statistical differences (p > 0.05) (Figs.
S12–S14 in the ESM).
4 Discussion
The aim of this study was to provide a systematic and evi-
dence-based appraisal of whether aerobic training interfered
with adaptations to strength training in terms of muscle func-
tion (maximal and explosive strength) and whole-muscle
hypertrophy. In addition, the impact of important mediating
covariates such as type of aerobic training, training modal-
ity, exercise order, concurrent training frequency, age, and
training status were assessed. The main finding was that con-
current aerobic and strength training did not interfere with
the development of maximal strength and muscle hypertro-
phy compared with strength training alone. However, the
development of explosive strength was negatively affected
by concurrent training. Our subgroup analysis showed that
this negative effect was exacerbated when concurrent train-
ing was performed within the same session, compared with
when aerobic and strength training were separated by at least
3h. No significant effects were found for other moderators,
such as type of aerobic training (cycling vs. running), fre-
quency of concurrent training (> 5 vs. < 5 weekly sessions),
training status (untrained vs. active), and mean age (< 40
vs. > 40years).
An important goal of this meta-analysis was to provide
evidence that can be translated into optimised and fine-tuned
exercise recommendations for fitness and health purposes.
Although our results are generally consistent with those
reported by Wilson etal. [14] a decade ago, these authors
Fig. 2 Forest plot of studies comparing differences in maximal strength. CI confidence interval, RE random effects, SMD standardised mean dif-
ference
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607
Compatibility of Concurrent Aerobic and Strength Training
considered anaerobic power measures such as Wingate per-
formance as indicators of explosive strength. Since we inten-
tionally included only direct measures of explosive strength
(i.e. jump performance, isometric RFD, and dynamic leg
press power), our findings reinforce that concurrent aerobic
and strength training can compromise strength qualities that
require rapid neural activation.
The mechanism for compromised explosive but not maxi-
mal strength is interesting and requires further research. Our
findings are supported by an early study showing that muscle
hypertrophy and maximal strength were unaffected by con-
current training, whereas RFD was blunted, likely because
of interference with rapid voluntary neural activation [10].
More specifically, although the maximal neural activation
was not compromised, the increase in the integrated elec-
tromyographic signal during the first 500ms was attenuated
in the group performing both aerobic and strength training.
Since the rate of recruitment and maximal discharge of
motor neurons largely determines the maximal RFD [69], it
appears that the rate of recruitment and discharge of motor
units is particularly sensitive to the interference effect of
aerobic training. It could be speculated that residual fatigue
induced by aerobic training affects the corticospinal inputs
received by the motor neurons before force is generated,
which would subsequently compromise rapid force genera-
tion. The latter could potentially reduce the quality but not
the quantity of strength training sessions performed concur-
rently with aerobic training, thereby potentially reducing the
development of explosive strength but not maximal strength
or muscle hypertrophy. This, in turn, could have implications
for programme design, as it is apparent that concurrently
improving both cardiorespiratory fitness and rapid force pro-
duction through rather generic exercise recommendations
presents a physiological challenge.
Consistent with this, our subgroup analysis indicated that
the magnitude of interference in explosive strength devel-
opment was dependent on the programming of the exer-
cise sessions, with significant interference observed when
aerobic and strength training were performed within the
same training session. Previous studies have indicated that
Fig. 3 Forest plot of studies comparing differences in explosive strength. CI confidence interval, RE random effects, SMD standardised mean dif-
ference
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608 M.Schumann et al.
neuromuscular interference may be more pronounced when
strength training is immediately preceded by aerobic train-
ing in both young [70] and older individuals [71]. However,
our pooled analysis did not provide evidence for an order-
specific effect but rather highlights that combining aerobic
and strength training in close proximity attenuates adapta-
tions in explosive strength regardless of exercise order. Other
studies have suggested that, apart from limitations in rapid
neural drive [10], adaptations in pennation angle and fascicle
length [54] or patella tendon cross-sectional area [72] could
be possible mechanistic explanations for these findings.
The moderators, including frequency of concurrent
training, type of training, age, and training status, did
not significantly influence adaptations in maximal and
explosive strength, nor muscle hypertrophy. Similarly, no
significant effects were observed in our analysis of log
variability, indicating no within-group differences in vari-
ability after concurrent training compared with strength
training alone. Our results differ from the recently pub-
lished meta-analysis that focused exclusively on the effect
of training status on maximal strength during concurrent
training [15]. In this study, the one-repetition maximum
for leg press and squat was negatively affected by concur-
rent training in trained individuals but not in moderately
trained or untrained individuals compared with strength
training alone. Moreover, their subgroup analysis sug-
gested that the negative effect observed in trained indi-
viduals occurred only when aerobic and strength training
were performed within the same training session. How-
ever, given the lack of consistent reporting, we chose not
to divide the active participants into moderately or well-
trained athletes, which may have diluted potential signifi-
cant effects. Furthermore, albeit the exact calculations of
Petré etal. [15] were not published, their analysis appears
to differ from our approach. Apart from the smaller num-
ber of studies included (27 vs. 37 studies), studies consist-
ing of multiple intervention groups with only one com-
parator were included multiple times in the same analysis,
potentially inflating power [73]. Although the results did
not reach statistical significance, our subgroup analysis for
Fig. 4 Forest plot of studies comparing differences in muscle hypertrophy. CI confidence interval, CSA cross-sectional area, DXA dual energy
X-ray absorptiometry, RE random effects, SMD standardised mean difference
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609
Compatibility of Concurrent Aerobic and Strength Training
training status showed a similar direction for the SMD in
trained versus untrained participants as reported by Petré
etal. [15].
In other concurrent training research, numerous stud-
ies have focused on the possible interference mechanisms
related to muscle hypertrophy [74]. The rationale for these
studies stems from rodent and cellular models indicating
possible inhibition of mechanistic target of rapamycin sig-
nalling through activation of AMP-activated protein kinase
(AMPK) following aerobic exercise [75–78]. However,
subsequent human studies failed to confirm these find-
ings when examining physiological mechanisms such as
metabolic stress and AMPK activation [67, 79] or protein
synthesis [80] following concurrent exercise. Based on our
systematic review, this is not surprising as none of the
identified studies reported a significant interference effect
on muscle hypertrophy. Although Wilson etal. [14] con-
cluded from their subgroup analysis that there was a nega-
tive relationship between the ES for hypertrophy and both
aerobic training frequency and duration, our results do
not confirm these observations. There are several possible
explanations for this inconsistency, apart from the obvi-
ous fact that our analysis was conducted almost a decade
later and therefore included more studies. First, the inclu-
sion criteria differed since Wilson etal. [14] included fibre
hypertrophy as an outcome parameter and also included
studies without a strength training control group. Second,
we conducted our analysis based on an inverse variance-
weighted random-effects model in a pre-test post-test
control group design [18], whereas Wilson etal. [14] esti-
mated the ES of each individual group, resulting in a total
of 72 ES for muscle hypertrophy. The reported aerobic
training duration and intensity were then correlated with
ES, potentially leading to significant positive correlations.
Although the current meta-analysis provides updated
and novel information, some limitations should be acknowl-
edged. First, it should be noted that the majority of the
included studies were only classified as of medium quality
(mean PEDro score 4.3 ± 0.9), and seven studies were of low
quality. However, it is important to note that it may not be
possible to achieve all items related to blinding in exercise
trials. In addition, poor reporting quality may have biased the
outcome of this ranking. Thus, more importance can possi-
bly be given to the studentised residuals and the Cook’s dis-
tance [24]. Furthermore, meta-analyses are generally limited
to the information provided within the included individual
studies. Even though we contacted authors to request addi-
tional information, the response rate was low. Therefore, to
avoid speculation, we decided to include only clearly defined
moderators. For example, aerobic exercise intensity was
not included because the included studies did not provide
consistent information. However, it is possible that aerobic
exercise intensity may impact on the compatibility of aerobic
and strength training. A meta-analysis examining the effects
of concurrent high-intensity interval training (HIIT) and
strength training reported that lower body strength develop-
ment was compromised by concurrent training compared
with strength training alone, even though the authors noted
that a possible negative effect on lower body strength may
be ameliorated by the inclusion of running-based HIIT and
longer intermodal rest periods [81]. This was further sup-
ported by a recent narrative review reporting that HIIT could
minimise the risk of neuromuscular interference and that this
effect was even more pronounced when HIIT was replaced
with sprint-interval training [82]. However, it should be
acknowledged that previous research appears to indicate that
the overall health benefits of concurrent training, apart from
muscle function and size, appear to be greater than those
obtained with isolated training of either aerobic or strength
training [83, 84] and that the overall risk of interference
effects is rather low. Therefore, most individuals, includ-
ing recreational athletes, can enjoy complementary benefits
from incorporating both aerobic and strength training into
their training programme.
5 Conclusion
This updated meta-analysis shows that concurrent aerobic
and strength training does not interfere with the develop-
ment of maximal strength and muscle hypertrophy compared
with strength training alone. This appears to be independent
of the type of aerobic training (cycling vs. running), fre-
quency of concurrent training (> 5 vs. < 5 weekly sessions),
training status (untrained vs. active), and mean age (< 40
vs. > 40years). However, the evidence of reduced develop-
ment of explosive strength with concurrent training, particu-
larly when aerobic and strength training are performed in
the same session, suggests that practitioners who prioritize
explosive strength may benefit from separating aerobic and
strength training to achieve optimal adaptations.
Supplementary Information The online version contains supplemen-
tary material available at https:// doi. org/ 10. 1007/ s40279- 021- 01587-7.
Acknowledgements The authors thank Dr. James Steele (Solent Uni-
versity, UK) for his valuable input concerning the data analysis.
Declarations
Funding Open Access funding enabled and organized by Projekt
DEAL. No funding sources were used in the preparation of this article.
Conflict of interest Moritz Schumann, Joshua F. Feuerbacher, Marvin
Sünkeler, Nils Freitag, Bent R. Rønnestad, Kenji Doma and Tommy
Lundberg have no conflicts of interest relevant to the content of this
review.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
610 M.Schumann et al.
Availability of data and material Not applicable.
Code availability The code will be available upon reasonable request.
Author contribution Design of the study: MS, JFF, MSü, NF, KD,
BRR, TL. Literature search: MS, JFF, MSü. Data screening and extrac-
tion: JFF, MSü. Statistical analyses: MS, JFF, MSü, NF, TL. Manu-
script preparation and editing: MS, JFF, TL. All authors have read and
agreed to the submitted version.
Ethics approval Not applicable.
Consent to participate Not applicable.
Consent for publication Not applicable.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
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otherwise in a credit line to the material. If material is not included in
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permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
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Authors and Aliations
MoritzSchumann1 · JoshuaF.Feuerbacher1· MarvinSünkeler1· NilsFreitag1,2· BentR.Rønnestad3· KenjiDoma4·
TommyR.Lundberg5,6
1 Department ofMolecular andCellular Sports Medicine,
Institute ofCardiovascular Research andSports Medicine,
German Sport University, Am Sportpark Müngersdorf 6,
50933Cologne, Germany
2 Olympic Training Centre Berlin, Berlin, Germany
3 Section forHealth andExercise Physiology, Department
ofPublic Health andSport Sciences, Inland Norway
University ofApplied Sciences, Elverum, Norway
4 Sport andExercise Science, College ofHealthcare Sciences,
James Cook University, Townsville, QLD, Australia
5 Division ofClinical Physiology, Department ofLaboratory
Medicine, Karolinska Institutet, Stockholm, Sweden
6 Unit ofClinical Physiology, Karolinska University Hospital,
Stockholm, Sweden
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
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