Highlight
This large prospective cohort study of over 117,000 U.S. women discerned that consistent resistance training of at least 2 hours per week is independently associated with a 20% reduced risk of major cardiovascular disease (CVD), notably myocardial infarction (MI). Integration of resistance training with adequate aerobic exercise and limited sedentary television viewing further lowers CVD risk by 40%. The protective effect is strengthened by maintaining resistance training consistency and including both upper and lower body exercises.
Study Background
Cardiovascular disease remains the leading cause of morbidity and mortality among women globally. While aerobic physical activity has well-established benefits for cardiovascular health, the role of resistance training—particularly among women—and its interplay with aerobic exercise and sedentary behavior has been less extensively studied. Sedentary lifestyles, often characterized by prolonged television viewing, further exacerbate cardiovascular risk. Hence, elucidating the independent and combined effects of resistance training alongside other physical activity and sedentary patterns is vital for comprehensive preventive strategies tailored for women.
Study Design
The study harnessed data from two large U.S. cohorts: Nurses’ Health Study (NHS) with 45,669 women (2002-2020) and Nurses’ Health Study II (NHS II) with 71,356 women (2003-2017), totaling 117,025 participants. Participants underwent up to five repeated assessments of physical activity over an average follow-up of 14.5 years. Resistance training was self-reported every four years, and cumulative averages were used to capture long-term exposure. Major cardiovascular disease events—a composite endpoint—were defined as incident nonfatal or fatal myocardial infarction, stroke, coronary artery bypass grafting, or percutaneous coronary intervention. Aerobic activity levels and sedentary television viewing time were also assessed and analyzed for joint associations with resistance training.
Key Findings
During 1,630,964 person-years, 5,459 major CVD events occurred. Women engaging in ≥2 hours per week of resistance training had a 20% lower risk of major CVD compared to those reporting none (HR 0.80; 95% CI 0.69-0.92; p-trend=0.007). Each additional hour per week was associated with a 5% risk reduction (HR 0.95 per 1 h/wk; 95% CI 0.92-0.99). This inverse relationship was particularly pronounced for myocardial infarction, with a 44% lower risk among women training ≥2 hours weekly (HR 0.56; 95% CI 0.41-0.76), whereas no significant association was found for stroke risk (HR 0.99; 95% CI 0.80-1.23).
Importantly, women meeting combined criteria for aerobic activity (≥15 metabolic equivalent task hour/week), resistance training (≥1 h/wk), and low sedentary television viewing (<2 h/day) had the greatest reduction in major CVD risk (HR 0.60; 95% CI 0.53-0.69). This was a substantial 40% risk reduction compared to those who met aerobic and low sedentary recommendations but did not undertake resistance training (HR 0.73; 95% CI 0.67-0.80).
Long-term consistency in resistance training (i.e., maintaining ≥75% of the follow-up period) and engaging the entire body by training both upper and lower limbs were associated with notably stronger inverse associations with CVD risk, underscoring the importance of regularity and balanced strength training routines.
Expert Commentary
The findings build upon mounting evidence that resistance training confers cardiovascular benefits beyond aerobic exercise alone, particularly in reducing myocardial infarction risk. Mechanistically, resistance training improves vascular function, reduces blood pressure, and enhances insulin sensitivity, which collectively augment cardiometabolic health. The differential effect on MI versus stroke suggests site-specific vascular and metabolic adaptations warranting further mechanistic exploration.
Considering sedentary behavior independently exacerbates cardiometabolic risk, the combined protective effect observed when resistance training, aerobic activity, and limited sedentary time are integrated is both biologically plausible and clinically imperative. Yet, reliance on self-reported physical activity may introduce recall bias, and the cohort’s primarily white, health-professional population may limit generalizability. Future randomized controlled trials and diverse population studies would be valuable.
Conclusion
Consistent resistance training is a vital, yet often underutilized, component of cardiovascular prevention in women. When combined with sufficient aerobic exercise and minimized sedentary television viewing, resistance training significantly lowers the risk of major cardiovascular events, particularly myocardial infarction. Clinicians should encourage tailored physical activity regimens that integrate resistance exercises targeting both upper and lower limbs, emphasizing regular adherence. Public health guidelines should further underscore the cardioprotective synergy of combined exercise modalities and reduction of sedentary time among women.
Funding and Clinical Trials
This observational study leveraged existing data from the Nurses’ Health Study cohorts funded by the National Institutes of Health. There was no interventional trial registration as this was a prospective cohort analysis.
References
1. Zhang T, Zhang Y, Lee DH, et al. Resistance Training, Aerobic Activity, Television Viewing, and Risk of Major Cardiovascular Events in U.S. Women. J Am Coll Cardiol. 2026 Jun 17;88(17):1946-1960. PMID: 42307492.
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