Following more than 147,000 adults for up to three decades, researchers found that moderate resistance training was linked to lower risks of death, while pairing it with aerobic exercise delivered the strongest overall survival benefits.
Study: Long-term resistance training with all-cause and cause-specific mortality: assessing dose-response and joint associations with aerobic physical activity. Image credit: Arsenii Palivoda/Shutterstock.com
A recent study in the British Journal of Sports Medicine examined whether resistance training, alone and combined with aerobic activity, affects all-cause and cause-specific mortality.
Aerobic and resistance training effects
Aerobic activity, such as walking, running, or cycling, is well established to improve cardiovascular health, build 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 weekly. While some evidence links resistance training two or more times per week to lower mortality, this may not fully capture the influence 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 assess resistance training only at baseline, which can 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 indicate that combining both provides the greatest benefit, though resistance training alone may not always confer additional survival advantages, especially when aerobic activity is low. This distinction is important for public health recommendations.
Tracking 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), which were followed for over 30 years to analyze how weekly resistance training and aerobic activity relate to all-cause and cause-specific mortality. Collectively, these cohorts enrolled over 289,000 US health professionals and nurses beginning in the late 1970s through the late 1980s.
After excluding individuals with prior cancer (except 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 updates and over 90% follow-up rates 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 indicated their average weekly time spent in activities such as weight training, walking, running, cycling, and other aerobic exercises. Weekly duration and intensity were used to calculate cumulative averages that reflect long-term activity patterns. Validation studies demonstrated good reliability and accuracy of these measures.
Deaths and causes were determined using medical records, death certificates, and national registries, with over 98% ascertainment. Covariates considered 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-varying variables.
Combined exercise habits linked to the lowest death risk
Participants had a median age of 54 years. Researchers observed that those who performed more resistance training were generally younger, had lower BMI, smoked less, ate healthier, and were more aerobically active than those who did not engage in resistance training.
Over the follow-up period, 74% achieved more than 7.5 metabolic equivalent (MET) hours per week of aerobic activity, while 46% participated in some resistance training. Resistance training was the least common among those with low aerobic activity, but became more frequent as aerobic activity increased. A moderate positive association between resistance and aerobic activity was observed.
A total of 35,798 deaths occurred over a follow-up of up to 30 years. Individuals engaged in 90–119 minutes of resistance training per week had a 13% lower risk of dying from any cause. However, those who did more than 120 minutes did not gain 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 affected by BMI. For cancer, risk reduction was most notable at 1–59 minutes per week. Supplementary analyses suggested this pattern may have been driven largely by lower mortality from colorectal, bladder, and breast cancers, although case numbers were small.
Resistance training for 90–119 minutes per week also lowered 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 may be imperfect.
These findings were consistent in men and women and remained so when the first 8 years of follow-up were excluded. The associations were generally similar across groups defined by BMI, age, and diet quality. The protective effect was most evident among those who never smoked or quit more than 10 years ago. In people younger than 55, resistance training was also linked to lower mortality, though the number of cases was limited.
When considering both resistance and aerobic exercise, those who did some resistance training but little aerobic activity had a slightly lower risk of death than those who did neither. However, meeting aerobic activity guidelines led to a much larger reduction in mortality.
The lowest risk was observed in individuals with high levels of both aerobic and resistance training, or with very high aerobic activity alone. This trend was consistent for deaths from heart disease, cancer, and neurological diseases. Importantly, having low resistance and low aerobic activity did not increase risk beyond having either at low levels, indicating no extra harm from lacking both.
Moderate resistance training offers 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. Likewise, among people performing very high levels of aerobic activity, adding more resistance training was not linked to further reductions in mortality risk.
