Does strength-promoting exercise confer unique health benefits? A pooled analysis of data on 11 population cohorts with all-cause, cancer, and cardiovascular mortality endpoints
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Public health guidance includes recommendations to engage in strength-promoting exercise (SPE), but there is little evidence on its links with mortality. Using data from the Health Survey for England and the Scottish Health Survey from 1994-2008, we examined the associations between SPE (gym-based and own-body-weight strength activities) and all-cause, cancer, and cardiovascular disease mortality. Multivariable-adjusted Cox regression was used to examine the associations between SPE (any, low-/high-volume, and adherence to the SPE guideline (≥2 sessions/week)) and mortality. The core sample comprised 80,306 adults aged ≥30 years, corresponding to 5,763 any-cause deaths (736,463 person-years). Following exclusions for prevalent disease/events occurring in the first 24 months, participation in any SPE was favorably associated with all-cause (hazard ratio (HR) = 0.77, 95% confidence interval (CI): 0.69, 0.87) and cancer (HR = 0.69, 95% CI: 0.56, 0.86) mortality. Adhering only to the SPE guideline was associated with all-cause (HR = 0.79, 95% CI: 0.66, 0.94) and cancer (HR = 0.66, 95% CI: 0.48, 0.92) mortality; adhering only to the aerobic activity guideline (equivalent to 150 minutes/week of moderate-intensity activity) was associated with all-cause (HR = 0.84, 95% CI: 0.78, 0.90) and cardiovascular disease (HR = 0.78, 95% CI: 0.68, 0.90) mortality. Adherence to both guidelines was associated with all-cause (HR = 0.71, 95% CI: 0.57, 0.87) and cancer (HR = 0.70, 95% CI: 0.50, 0.98) mortality. Our results support promoting adherence to the strength exercise guidelines over and above the generic physical activity targets.
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Observational studies suggest that combined exercise provides somewhat larger risk reductions in developing clinical endpoints such as metabolic syndrome, hypercholesterolaemia, obesity, and CVD morbidity and mortality.
“Observational studies also suggest that combined exercise provides somewhat larger (although generally not statistically different compared with either resistance or aerobic exercise alone) risk reductions in developing clinical endpoints such as metabolic syndrome,33 hypercholesterolaemia,34 obesity,35 and CVD morbidity and mortality.36–38”
From Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial (2024) · cites this paper as [38]
The 'Adherence to strength exercise and aerobic guidelines' results (p. 4) report lower CVD mortality with aerobic exercise alone and say an alternative analysis provided clearer evidence of lower CVD mortality among those meeting both guidelines. They do not establish that combined exercise produced a larger CVD risk reduction than either type alone. The study assessed CVD mortality, not CVD morbidity. (LLM, conf=0.84)
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- Authors
- Stamatakis, E., Lee, I. M., Bennie, J., Freeston, J., Hamer, M., O’Donovan, G., Ding, D., Bauman, A., & Mavros, Y.
- Affiliations
- The University of Sydney (AU)
- Brigham and Women's Hospital (US)
- Victoria University (AU)
- Loughborough University (GB)
- Corresponding author
- Stamatakis, Emmanuel
- ORCID
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-10-31
- Volume
- 187
- Issue
- 5
- Pages
- 1102-1112
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2766901730
- Cited by
- 198
- References
- 48
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 17 · 2023: 16 · 2022: 32 · 2021: 29 · 2020: 33 · 2019: 17 · 2018: 18
- FWCI
- 13.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Victoria University Research Repository (Victoria University) (submittedVersion)
- Loughborough University Institutional Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- Loughborough University Research Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute for Health Research
- National Health and Medicine Research Council
- National Institute for Health Research Leicester Biomedical Research Center
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Keywords
- resistance training, all-cause mortality, cancer mortality, cardiovascular mortality, physical activity guidelines, exercise adherence, gym-based exercise, aerobic exercise, Health Survey for England, Scottish Health Survey
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cause of Death, England, Female, Health Promotion, Health Surveys, Humans, Male, Middle Aged, Neoplasms, Population Surveillance, Scotland, Cohort Studies, Resistance Training
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