Resistance training linked to fewer heart attacks
Long-term resistance training was associated with lower major cardiovascular risk in women.
*Prospective cohort study; Level 2b (OCEBM).

Citation

Zhang T, Zhang Y, Lee DH, et al. Resistance Training, Aerobic Activity, Television Viewing, and Risk of Major Cardiovascular Events in U.S. Women. JACC. 2026;88:1946-1960.

Background

Aerobic exercise is well established for heart disease prevention, but less is known about long-term resistance training in women. This study examined whether strength training adds benefit beyond aerobic activity and less television viewing.

Patients

117,025 U.S. female nurses. Women with prior heart attack, bypass surgery, angina, stroke, cancer, death before baseline, or missing activity data were excluded.

Intervention

Repeated self-reported resistance training, analyzed as long-term average weekly time.

Control

No resistance training; for combined behavior analyses, meeting none of the activity and television-viewing recommendations.

Outcome

New major cardiovascular event: nonfatal or fatal heart attack, stroke, bypass surgery, or catheter-based heart artery procedure.

Follow-up Period

Mean 14.5 years.

Results

Finding Result
Major cardiovascular event, ≥2 hours/week resistance training vs none (primary) Hazard ratio 0.80 (95% confidence interval 0.69 to 0.92)
Major cardiovascular event, each additional 1 hour/week Hazard ratio 0.95 (95% confidence interval 0.92 to 0.99)
Heart attack, ≥2 hours/week resistance training vs none Hazard ratio 0.56 (95% confidence interval 0.41 to 0.76)
Met aerobic activity, resistance training, and low television viewing goals vs none Hazard ratio 0.60 (95% confidence interval 0.53 to 0.69)

Stroke was not significantly associated with resistance training. Results used repeated exposure assessments with a 2-year lag and adjusted for aerobic activity and other health factors.

Limitations

Observational design cannot prove causation. Resistance training was self-reported, without detail on intensity or supervision. Participants were mostly White health professionals, limiting generalizability. Healthier lifestyle patterns may partly explain the associations.

Funding

Public research grants; authors reported no relevant conflicts.

Clinical Application

Encourage women to add regular whole-body resistance training to aerobic exercise and reduce prolonged television time; evidence supports counseling, not mandates.