Being physically active has been linked to a longer, healthier life, but what type of exercise is best? Should you focus on aerobic exercises, like walking or running? Or strength training with weights or bodyweight exercises like pilates? And how many minutes of each should you get during the week?
A new study recently published in the British Journal of Sports Medicine helps to provide some guidance and answers to these questions.
Researchers found that a combination of both high aerobic activity and between 60 to 119 minutes a week of strength training may be best for lowering a person’s mortality risk from any cause.
Scientists also found that between 90 to 120 minutes a week of resistance training may also possibly lower a person’s risk of dying from cardiovascular or neurological diseases.
For this study, researchers analyzed about 30 years of data from more than 147,000 participants with an average age of 54 of three large previously-conducted studies — Health Professionals Follow-up Study, 1992–2022; the Nurses’ Health Study, 2002–2021; and the Nurses’ Health Study II, 2003–2021.
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Study participants were asked questions about their weekly aerobic exercise and strength training regimen every two years, for up to 30 years total.
“The benefits of aerobic activity for longevity are already well established,” Edward Giovannucci, MD, ScD, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health, and corresponding author of this study, told Medical News Today. “What has been less clear is how resistance training relates to long-term mortality risk, especially at different volumes and in combination with aerobic activity.”
“Physical activity is not one single behavior,” added Yiwen Zhang, PhD, postdoctoral research fellow at the Harvard T.H. Chan School of Public Health, and the first author of this study. “Aerobic activity and resistance training may benefit health through different pathways, so it is important to study them separately and together.”
At the study’s conclusion, researchers found that participating in 90 to 120 minutes a week of strength training was correlated with a 13% lower risk of dying from any cause. And, scientists note, no further benefit was observed above 120 minutes a week.
Additionally, that amount of weekly strength training was also associated with a 19% lower risk of dying from a cardiovascular disease, and a 27% lower risk of dying from a neurological disease.
“For cardiovascular disease mortality, this finding is generally consistent with previous studies showing that resistance training is associated with lower cardiovascular disease risk, particularly for myocardial infarction,” Giovannucci explained. “For neurological disease mortality, there has been growing evidence suggesting that strength training may help preserve cognitive function.”
“However, this finding should be interpreted cautiously,” he added. “Neurodegenerative diseases such as Alzheimer’s can begin many years before diagnosis, and early symptoms may reduce a person’s ability or motivation to exercise. Also, neurological causes of death, especially dementia, can be difficult to classify accurately. More research is needed before drawing firm conclusions.”
Researchers also found that the lowest mortality risks were found among study participants who combined both high aerobic activity and between 60 to 119 minutes a week of resistance training every week.
“Aerobic exercise is generally linked to improved hemodynamics, lipid profiles, and cardio-respiratory fitness, whereas resistance training may improve glucose metabolism, body composition, and muscular strength,” Zhang explained to MNT.
“Some randomized trials in patients with coronary artery disease also found that, compared with aerobic activity alone, combining aerobic and resistance training yields greater improvements in cardiorespiratory fitness and body composition,” she said.
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Giovannucci said for the next steps in this research, they will be looking for opportunities to examine resistance training in a more diverse population and in relation to outcomes beyond mortality, such as physical function, independence, and quality of life.
“It will also be important to study resistance training more precisely, including exercise type, intensity, load, and using more objective measures if possible,” he added.
MNT spoke with Swapnil Patel, MD, MHCM, FACP, vice chair of the Department of Medicine at Hackensack Meridian Jersey Shore University Medical Center, and assistant professor at Hackensack Meridian School of Medicine in New Jersey, who was not involved in this study, about these research findings.
Patel commented that these findings reinforce something we have been emphasizing in preventive medicine for years: exercise should not be viewed as an “either-or” choice between cardio and strength training.
“Many patients focus heavily on walking, running, cycling, or other aerobic activities because they are often associated with heart health and weight loss. This study provides compelling long-term evidence that resistance training offers independent benefits and appears to further reduce mortality risk when combined with aerobic exercise.”
— Swapnil Patel, MD, MHCM, FACP
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“Different forms of exercise affect the body through different biological pathways,” Patel continued. “Aerobic exercise improves cardiovascular fitness, blood pressure, insulin sensitivity, and metabolic health, while resistance training helps preserve muscle mass, improve functional strength, enhance glucose metabolism, and reduce frailty,” he explained.
“Understanding how these exercise modalities influence specific disease outcomes allows clinicians to provide more targeted recommendations to patients,” he said.
“This study is especially important because it highlights a potential association between resistance training and reduced neurological disease mortality, an area that has received far less attention than cardiovascular disease,” Patel added.
“As our population ages and conditions such as dementia and neurodegenerative diseases become increasingly prevalent, identifying lifestyle interventions that may help preserve neurological health is a major public health priority. The findings suggest that strength training may play a meaningful role in healthy aging beyond simply maintaining muscle mass and mobility.”
— Swapnil Patel, MD, MHCM, FACP
MNTalso spoke with David Cutler, MD, a board certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, who was also not involved in this study, who said that for patients who only focus on aerobic exercise, it’s an eye opening study for them.
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“This is something that’s been known for a long time of the benefits of strength training, but this certainly brought it home how profound that benefit can be,” Cutler continued.
“A lot of people just focus on one form of exercise, whether it be strength training exercise as in this study, or on aerobic exercise. A lot of people focus on core exercise because they’re bothered by back pain — they know that core exercises can be helpful for that. And a lot of people focus a lot on stretching exercise, which can also be very helpful in terms of maintaining mobility. And this program, nor others, have focused on how important a comprehensive exercise program is, which incorporates strength training, aerobics, core, and stretching.”
— David Cutler, MD
For readers who may want to start strength training but aren’t sure where to start, Cutler advised getting guidance from a physical fitness trainer.
“There are some dangers in strength training exercise regarding injury, and I think getting some guidance from a trainer is actually a very good idea and money that’s very well spent to avoid injury and avoid incurring extra costs,” he said.
