Acute Effects of Maximal Arm, Leg, and Combined Cycling Tests on Aerobic Capacity and Related Outcomes: A Meta-Analysis

ABSTRACT Context Combined (arm + leg) cycling ergometry engages more muscle mass than isolated limb modalities, likely producing greater physiological responses. However, differences in key cardiometabolic outcomes across maximal arm, leg, and arm + leg ergometry have not been systematically quantified in healthy adults. Objective This systematic review and meta-analysis compared maximal arm, leg, and arm + leg cycling ergometry on peak oxygen uptake (V̇O 2peak ), heart rate, blood lactate, and power output. Design Acute studies were sourced from PubMed/Medline, Web of Science, SPORTDiscus, Scopus, Embase, and CINAHL (earliest records to November 23, 2024). The search strategy included keywords related to arm, leg, and arm + leg cycle ergometry. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Eligibility Criteria Acute studies on healthy adults (≥18 yr old) comparing maximal ergometer-based arm, leg, and arm + leg exercises. Study Selection Two reviewers independently screened 12,211 abstracts. Main Outcome Measures Means and standard deviations for V̇O 2peak , heart rate, blood lactate, and power output were extracted to calculate standard mean differences. Hedges’ g effect size analyzed differences between isolated limb and arm + leg cycling. Subgroup analyses examined training status, sex, and arm position. Results Fourteen studies (187 healthy adults) met the eligibility criteria. Twelve studies were rated high quality, and two studies were medium quality. Arm + leg cycling showed significantly greater V̇O 2peak compared to arm ( g = −2.43, P < 0.001) or leg cycling ( g = −0.82, P < 0.001), with moderate heterogeneity. Heart rate and power output were higher in arm + leg compared to isolated limb conditions ( P < 0.001), and blood lactate was higher in arm + leg compared to only arm ( P = 0.005). Conclusion Arm + leg cycling elicits higher V̇O 2peak , heart rate, and power output than isolated limb cycling, supporting its use as a robust and inclusive non-weight-bearing cardiopulmonary testing modality. This synthesis quantifies normative responses in healthy adults and reinforces its clinical relevance.