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Associations of Resistance Exercise with Cardiovascular Disease Morbidity and Mortality

Liu, Yanghui1; Lee, Duck-chul2; Li, Yehua3; Zhu, Weicheng4; Zhang, Riquan1; Sui, Xuemei5; Lavie, Carl J.6; Blair, Steven N.7

Medicine & Science in Sports & Exercise: October 29, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1249/MSS.0000000000001822
Original Investigation: PDF Only

Purpose Resistance exercise (RE) can improve many cardiovascular disease (CVD) risk factors, but specific data on the effects on CVD events and mortality are lacking. We investigated the associations of RE with CVD and all-cause mortality, and further examined the mediation effect of body mass index between RE and CVD outcomes.

Methods We included 12,591 participants (mean age 47 years) who received at least two clinical examinations 1987-2006. RE was assessed by a self-reported medical history questionnaire.

Results During a mean follow-up of 5.4 and 10.5 years, 205 total CVD events (morbidity and mortality combined) and 276 all-cause deaths occurred, respectively. Compared with no RE, weekly RE frequencies of one, two, three times or total amount of 1-59 minutes were associated with approximately 40-70% decreased risk of total CVD events, independent of aerobic exercise (AE) (all p-values <0.05). However, there was no significant risk reduction for higher weekly RE of more than four times or ≥60 minutes. Similar results were observed for CVD morbidity and all-cause mortality. In the stratified analyses by AE, weekly RE of one time or 1-59 minutes was associated with lower risks of total CVD events and CVD morbidity regardless of meeting the AE guidelines. Our mediation analysis showed that RE was associated with the risk of total CVD events in two ways: RE had a direct U-shape association with CVD risk (p-value for quadratic trend <0.001) and RE indirectly lowered CVD risk by decreasing BMI.

Conclusion Even one time or less than one hour/week of RE, independent of AE, is associated with reduced risks of CVD and all-cause mortality. BMI mediates the association of RE with total CVD events.

1Department of Statistics, East China Normal University, Shanghai, China;

2Department of Kinesiology, College of Human Sciences, Iowa State University, Ames, IA;

3Department of Statistics, University of California, Riverside, CA;

4Department of Statistics, Iowa State University, Ames, IA;

5Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC;

6Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA;

7Departments of Exercise Science and Epidemiology/Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC

Correspondence: Dr. Duck-chul Lee, Department of Kinesiology, College of Human Sciences, Iowa State University, 103H Forker Building, Ames, IA 50011; Phone: 515-294-8042; Fax: 515-294-8740; E-mail:

This study was supported by the National Institutes of Health grants (AG06945, HL62508, DK088195, and HL133069). Steven N. Blair has received unrestricted research grants from The Coca-Cola Company, but the grants were not used to support this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of Interest: The authors report no conflicts of interest. The results of the study are presented clearly, honestly, without fabrication, falsification, or inappropriate data manipulation, and do not constitute endorsement by the American College of Sports Medicine.

Accepted for publication October 2018.

© 2019 American College of Sports Medicine