Resistance Training and Long-Term Mortality Risk: Dose-Response Findings From Large Cohort Studies in Sports Medicine Research

Resistance training is widely recommended for musculoskeletal health, yet its long-term impact on survival outcomes has been less clearly defined compared with aerobic exercise. A large prospective analysis published in the British Journal of Sports Medicine provides new evidence on how resistance exercise volume relates to all-cause and cause-specific mortality over decades of follow-up in US cohorts.

This study is particularly relevant for healthcare professionals involved in preventive medicine, rehabilitation, cardiometabolic care, and aging populations. It clarifies dose-response patterns, joint effects with aerobic activity, and potential thresholds where benefits plateau.

Study Design and Population

The research combined data from three major long-running cohorts:

• Health Professionals Follow-up Study (HPFS)
• Nurses’ Health Study (NHS)
• Nurses’ Health Study II (NHSII)

In total, 147,374 participants were followed for up to 30 years, contributing more than 35,000 recorded deaths.

Resistance training and aerobic activity were repeatedly assessed using validated questionnaires, allowing researchers to model long-term habitual behavior rather than single baseline exposure.

Statistical analysis used multivariable Cox proportional hazards models, adjusting for key confounders including diet quality, smoking status, BMI, and aerobic physical activity.

Key Findings: Dose-Response Relationship

A central finding was a non-linear relationship between resistance training duration and mortality outcomes.

All-Cause Mortality

Compared with no resistance training:

• 90–119 min/week was associated with a 13% lower risk of all-cause mortality
• Hazard ratio (HR): 0.87 (95% CI 0.81–0.95)

However, increasing training beyond 120 min/week did not provide additional survival benefit, suggesting a plateau effect.

This pattern indicates that moderate but consistent resistance training may be sufficient to achieve maximal mortality benefit.

Cause-Specific Mortality Outcomes

Cardiovascular Mortality

• 90–119 min/week: 19% lower risk
• HR: 0.81 (95% CI 0.67–0.97)

The relationship appeared generally linear but attenuated after adjustment for BMI, suggesting partial mediation through body composition and adiposity.

Cancer Mortality

The association with cancer mortality was less consistent:

• 1–29 min/week: HR 0.91 (0.86–0.97)
• 30–59 min/week: HR 0.88 (0.81–0.97)
• No clear benefit at higher volumes

This suggests a potential U-shaped or threshold effect requiring further mechanistic exploration.

Neurological Disease Mortality

• 90–119 min/week: 27% lower risk
• HR: 0.73 (0.58–0.92)

This association is notable given the limited prior evidence linking resistance training specifically with neurological disease mortality outcomes.

Joint Effects With Aerobic Physical Activity

One of the most clinically relevant aspects of the study is the interaction between resistance training and aerobic exercise.

Key observations include:

• Aerobic activity alone produced larger mortality reductions than resistance training alone
• Resistance training alone still provided modest protective effects
• Combined high aerobic and resistance training produced the lowest mortality risk

Example combined effect:

• HR 0.55 (0.50–0.60) for individuals performing 30–45 MET-hours/week aerobic activity plus 60–119 min/week resistance training

Importantly, resistance training continued to confer additional benefit across most aerobic activity levels up to very high aerobic volumes (≥45 MET-hours/week), after which the incremental benefit plateaued.

Clinical Interpretation for Healthcare Professionals

These findings support several clinically relevant interpretations:

1. Moderate resistance training appears sufficient for maximal survival benefit

The plateau observed beyond 120 minutes per week suggests diminishing returns at higher volumes in relation to mortality outcomes.

2. Resistance training is independently beneficial

Even after adjusting for aerobic exercise and multiple confounders, resistance training retained a protective association with mortality risk.

3. Aerobic exercise remains the dominant driver

Aerobic activity showed stronger associations with mortality reduction, reinforcing current physical activity guidelines prioritizing aerobic volume.

4. Combined training is optimal

The lowest mortality risk occurred in individuals engaging in both modalities at sufficient levels, supporting integrated exercise prescriptions.

Potential Mechanisms

Several biological pathways may explain observed associations:

• Improved insulin sensitivity and glucose metabolism
• Increased lean muscle mass and reduced adiposity
• Enhanced vascular function and reduced arterial stiffness
• Anti-inflammatory effects
• Neuroprotective adaptations in long-term exercise patterns

The study also raises questions regarding elevated IGF-1 levels at higher resistance training volumes and potential implications for cancer risk, although evidence remains inconclusive.

Strengths and Limitations

Strengths

• Large sample size with long follow-up (up to 30 years)
• Repeated measures of physical activity
• Extensive adjustment for lifestyle confounders
• Detailed cause-specific mortality classification

Limitations

• Self-reported resistance training data
• Lack of detail on intensity, load, and training structure
• Limited generalizability beyond predominantly white health professionals
• Potential residual confounding despite adjustments
• Possible misclassification in neurological disease mortality

Practical Implications for Clinical Guidance

For clinicians advising patients:

• Encourage consistent resistance training approximately 1–2 hours per week
• Emphasize combined aerobic and resistance training for optimal outcomes
• Prioritize aerobic activity when time is limited, but include strength work where possible
• Recognize that more is not always better for mortality outcomes in resistance training volume

These findings align with current physical activity guidelines recommending both aerobic and muscle-strengthening activity for overall health maintenance.

Conclusion

This large cohort analysis suggests that moderate long-term resistance training is associated with lower risk of all-cause, cardiovascular, and neurological mortality, with benefits plateauing beyond approximately 120 minutes per week. Aerobic activity remains the stronger independent predictor of mortality reduction, but resistance training provides meaningful additional benefit across most activity levels.

For healthcare professionals, the key message is that balanced exercise prescriptions incorporating both aerobic and resistance training likely provide the most robust long-term survival benefits.

Source

Zhang Y, Lee DH, Rezende LFM, et alLong-term resistance training with all-cause and cause-specific mortality: assessing dose-response and joint associations with aerobic physical activityBritish Journal of Sports Medicine Published Online First: 02 June 2026. doi: 10.1136/bjsports-2025-110503

Disclaimer

This article is a rewritten educational summary intended for healthcare professionals and is based on a single observational cohort study. It does not constitute medical advice, clinical guidelines, or treatment recommendations. Findings reflect associations and do not establish causation. Clinical decisions should be based on a comprehensive evaluation of the current evidence base, official guidelines, and individual patient circumstances.