Following more than 147,000 adults for up to three decades, researchers found that moderate resistance training was associated with lower risks of death, while combining it with aerobic exercise produced the strongest overall survival benefits.
Study: Long-term resistance training with all-cause and all-cause mortality: evaluation of dose-response and joint associations with aerobic physical activity. Image credit: Arsenii Palivoda/Shutterstock.com
A recent study in British Journal of Sports Medicine examined whether resistance training, alone and in combination with aerobic activity, affects all-cause and cause-specific mortality.
Effects of aerobic and resistance training
Aerobic activity, such as walking, running or cycling, is well established to improve cardiovascular health, develop endurance and reduce the risk of chronic disease and mortality. In contrast, the long-term benefits of resistance training are less clear.
Guidelines recommend 150–300 minutes of moderate or 75–150 minutes of vigorous aerobic activity per week, plus muscle-strengthening activities at least twice per week. While some evidence links resistance training two or more times a week with lower mortality, this may not fully capture the effect of training volume.
Recent data suggest a J-shaped relationship for resistance training: around 40 minutes per week is associated with the lowest risk, with benefits diminishing at higher volumes. Many studies evaluate resistance training only at baseline, which may introduce measurement error and limit understanding of its long-term effects.
Research on how aerobic and resistance training work together to affect mortality remains limited. Most findings suggest that a combination of both provides the greatest benefit, although resistance training alone may not always provide additional survival benefits, especially when aerobic activity is low. This distinction is important for public health recommendations.
Monitoring resistance training and mortality over time
The current study examined three major US cohorts: the Health Professionals Follow-up Study (HPFS), the Nurses’ Health Study (NHS), and the Nurses’ Health Study II (NHSII), followed for more than 30 years to analyze how weekly resistance training and aerobic activity relate to all-cause and all-cause mortality. Collectively, these cohorts enrolled over 289,000 US health professionals and nurses from the late 1970s to the late 1980s.
After excluding subjects with previous cancer (other than non-melanoma skin cancer), heart disease, stroke, missing age data, or withdrawn consent, 147,374 participants (31,540 men and 115,834 women) were considered. Regular biennial renewals and follow-up rates of over 90% ensured reliable, up-to-date assessments of exposure and outcomes.
Resistance and aerobic physical activity were assessed using self-report questionnaires administered every 2 to 4 years. Participants reported their average weekly time spent on activities such as weight training, walking, running, cycling and other aerobic exercise. Weekly duration and intensity were used to calculate cumulative averages reflecting long-term activity patterns. Validation studies have shown good reliability and accuracy of these measures.
Deaths and causes were determined using medical records, death certificates, and national registries, with over 98% confirmation. Covariates examined in this study included race, age, weight, menopausal status, smoking, family history, body mass index (BMI), alcohol intake, total calories, and diet quality, which were updated regularly and modeled as time variables.
Combined exercise habits are associated with a lower risk of death
Participants had an average age of 54 years. The researchers observed that those who did more resistance training were generally younger, had a lower BMI, smoked less, ate healthier and were more aerobically active than those who did not do resistance training.
During the follow-up period, 74% achieved more than 7.5 metabolic equivalent hours (MET) per week of aerobic activity, while 46% participated in some resistance training. Resistance training was least common among those with low aerobic activity, but became more common as aerobic activity increased. A moderate positive correlation was observed between resistance and aerobic activity.
A total of 35,798 deaths occurred over a follow-up of up to 30 years. People who participated in 90-119 minutes of resistance training per week had a 13% lower risk of death from any cause. However, those who did more than 120 minutes gained no additional benefit. This protective association remained after accounting for BMI.
For heart disease, 90–119 minutes of resistance training per week reduced risk by 19%, with the effect only slightly influenced by BMI. For cancer, the risk reduction was most notable at 1-59 minutes per week. Additional analyzes showed that this pattern may be largely due to lower mortality from colon, bladder and breast cancers, although the case numbers were small.
Resistance training for 90-119 minutes per week also reduced the risk of death from neurological diseases by 27%. The authors noted that these findings should be interpreted cautiously because neurodegenerative diseases can develop over decades and cause-of-death classifications can be imperfect.
These findings were consistent in men and women and remained so when the first 8 years of follow-up were excluded. Associations were generally similar between groups defined by BMI, age, and diet quality. The protective effect was most evident among those who had never smoked or quit more than 10 years ago. In people under 55, resistance training was also associated with lower mortality, although the number of cases was limited.
For both resistance and aerobic exercise, those who did resistance training but little aerobic activity had a slightly lower risk of death than those who did no exercise. However, meeting the aerobic activity guidelines led to a much greater reduction in mortality.
The lowest risk was seen in people with high levels of both aerobic and resistance training or very high aerobic activity alone. This trend was consistent for deaths from heart disease, cancer and neurological diseases. Importantly, low resistance and low aerobic activity did not increase risk beyond being at low levels, suggesting no additional harm from lacking both.
Moderate resistance training provides the strongest benefits
The current study highlighted that both moderate resistance and aerobic training are associated with lower all-cause mortality, with the greatest benefit seen when both are performed at high levels.
However, resistance training beyond 120 minutes per week was not associated with additional mortality reductions. Similarly, among people performing very high levels of aerobic activity, adding more resistance training was not associated with further reductions in mortality risk.
