Developing a comprehensive exercise prescription: the optimal order for cardiorespiratory, resistance, flexibility, and neuromotor exercise

Introduction: Exercise professionals can follow readily available published guidelines, provided from major health organisations, when designing comprehensive exercise programs consisting of cardiorespiratory, resistance, flexibility, and neuromotor exercise. Paradoxically, when combining these types of exercise into the same exercise session, there are no current recommendations for the most appropriate exercise order. The purpose of this study was to provide preliminary evidence for establishing an optimal exercise order of cardiorespiratory, resistance, flexibility, and neuromotor exercise. Methods: A total of 20 participants performed an exercise prescription (ExRx) consisting of all possible sequences (24 combinations) of cardiorespiratory, resistance, flexibility, and neuromotor exercise. Physiological and psychological responses to exercise were measured throughout each exercise session. Repeated-measures ANOVA and polynomial trend analysis were performed to determine if physiological and psychological responses to exercise differed according to exercise order. Results: The mean heart rate (HR) response to cardiorespiratory exercise was significantly different (p<0.05) across all exercise sequence positions. When cardiorespiratory exercise was performed first the HR response equated to 56% heart rate reserve (i.e., moderate-intensity exercise). In contrast, the mean HR response equated to 66.7% heart rate reserve (i.e., vigorous-intensity exercise) when cardiorespiratory exercise was sequenced last in the exercise session. Mean resistance exercise rating of perceived exertion (RPE) was similar (p>0.05) when resistance exercise was positioned either first or second in the ExRx; however, post hoc tests showed mean resistance exercise RPE was significantly higher (p<0.05) when the resistance exercise component was positioned third or fourth in the ExRx when compared to either first or second. No significant differences (p>0.05) were found in the physiological responses to either neuromotor or flexibility exercise across all exercise sequence positions. Conclusion: Results of this novel study provide important preliminary evidence towards formulating recommendations for an optimal sequence of cardiorespiratory, resistance, flexibility and neuromotor exercise for the ExRx. Findings from the present study suggest cardiorespiratory exercise should always be performed first followed next by resistance exercise. Flexibility and neuromotor exercise can be positioned at a later point in the ExRx.