Exercise and Strength Training Linked to Lower Cardiovascular Risk and Mortality

Three studies published in the Journal of the American College of Cardiology, JAMA Network Open, and Hypertension provide new evidence linking exercise and muscular strength to lower risks of cardiovascular disease and mortality in women and in patients with hypertension.

In one prospective cohort study involving 117,025 women from the Nurses' Health Study and Nurses' Health Study II, resistance training was associated with a lower risk for major cardiovascular disease (CVD). During a mean follow-up of 14.5 years, 5,459 incident major CVD events occurred. Women who performed at least 2 hours per week of resistance training had a significantly lower risk for major CVD compared with those performing no resistance training (hazard ratio, 0.80), and each additional hour per week was associated with a 5 percent lower risk (hazard ratio, 0.95). Women who met aerobic activity recommendations (≥15 metabolic equivalent of task hours per week), low sedentary television viewing recommendations (<2 hours/day), and resistance training recommendations (≥1 hour/week) had a lower risk for major CVD compared with those meeting aerobic and low sedentary television viewing recommendations but not resistance training recommendations (hazard ratios, 0.60 versus 0.73). Stronger inverse associations were seen with greater consistency in maintaining resistance training and engaging in both upper- and lower-limb training. The editor-in-chief of the Journal of the American College of Cardiology said in a statement, "We have long encouraged resistance training, and this study provides strong evidence to reinforce that message."

Another study, published in JAMA Network Open, assessed muscular strength in 5,472 women aged 63 to 99 years. During a mean of 8.4 years, there were significant inverse trends in mortality across quartiles of grip strength and chair stand time. For grip strength, the hazard ratio for the highest versus lowest quartile was 0.67 (95% CI, 0.58 to 0.78; P for trend <0.001), and for chair stand time, the hazard ratio was 0.63 (95% CI, 0.54 to 0.73; P for trend <0.001). Associations were attenuated but similar after controlling for sedentary time and moderate-to-vigorous physical activity, and remained when controlling for walking speed and the inflammatory marker C-reactive protein. Associations were similar across subgroups defined by age, race and ethnicity, body mass index, moderate-to-vigorous physical activity, sedentary time, or timed walk. The study author noted that healthy aging probably is best pursued through adequate amounts of both aerobic and muscle-strengthening physical activities.

A third study, published in Hypertension, used UK Biobank data to examine exercise patterns in 45,068 participants with hypertension. Participants were stratified into active weekend warrior (41.43%), active regular (spread-out activity) (20.09%), or inactive (38.48%) groups. Over a median follow-up of 7.5 years, there were 2,636 all-cause deaths, 161 stroke deaths, 875 strokes, and 716 ischemic strokes. Compared with the inactive group, both active groups had approximately 30% lower risk of all-cause mortality: weekend warrior hazard ratio 0.70 (95% CI, 0.64 to 0.77) and active regular hazard ratio 0.73 (95% CI, 0.65 to 0.82). Risk reduction trends for stroke mortality, stroke, and ischemic stroke were not statistically significant. The investigators concluded that both weekend warrior and regular moderate-to-vigorous physical activity patterns meeting guideline recommendations confer mortality benefits in patients with hypertension, and that these protective effects extend to active patterns below guideline-recommended thresholds and remain consistent across diverse subgroups, including different age groups, sex, body mass index categories, blood pressure control status, and antihypertensive medication use.