Just 2 Hours of Strength Training May Lower Heart Disease Risk in Women

• A new study suggests that women who do at least 2 hours of strength training per week have a lower risk of cardiovascular disease. 
• The findings add that women who perform 150 minutes of weekly aerobic exercise and at least 2 hours of weekly strength training have a lower risk of heart attack. 
• Strength training is considered highly beneficial both during and after menopause.

There are many well-known benefits of strength training, including stronger bones and muscles, improved heart health, and decreased abdominal fat. 

A new study suggests that women who engage in more strength training during midlife and beyond have a lower risk of cardiovascular disease than those who do not.

The findings, published on June 17 in JACC, the flagship journal of the American College of Cardiology, show that heart health benefits increased when strength training was paired with aerobic exercise. 

Cardiovascular disease remains the leading cause of death worldwide. This makes accessible prevention strategies even more important. 

“Beyond heart disease, resistance training uniquely addresses osteoporosis by improving bone mineral density at the femoral neck and lumbar spine, frailty due to muscle loss, and fall risk, which are all conditions that disproportionately affect postmenopausal women,” said Mary Greene, MD, board certified cardiologist with Manhattan Cardiology in NYC. Greene wasn’t involved in the study. 

“This makes resistance training a particularly high-value intervention in this population, [as it addresses] multiple morbidities simultaneously.”

Strength training lowers heart disease risk by 20%

The study analyzed 117,025 females from the Nurses’ Health Study and Nurses’ Health Study II, with average baseline ages of 66.8 and 48.1 years, respectively. 

The researchers assessed strength training every 4 years, with arm and leg training reported separately. 

The primary measure of sedentary behavior was time spent watching TV. This was assessed by averaging hours per week spent sitting at home watching TV. 

The primary outcome was measured in incidents of major cardiovascular disease. This was defined as: 

• fatal or nonfatal myocardial infarction (heart attack) 
• stroke 
• coronary artery bypass grafting
• percutaneous coronary intervention (PCI)

In both groups of participants, higher levels of strength training were associated with a lower risk of major cardiovascular disease, especially heart attack. However, there was no significant association for stroke. 

“One possible explanation is that heart attacks and strokes do not arise through identical pathways,” said study co-authors Tianyue Zhang, MD, and Edward Giovannucci, MD.

“Resistance training is thought to improve factors such as cholesterol and other blood lipids, insulin sensitivity, and overall body composition, all of which are strongly linked to coronary artery disease and myocardial infarction,” they told Healthline.

“Stroke, however, is a more heterogeneous outcome that includes several subtypes, ischemic, hemorrhagic, and cardioembolic, which may not all respond in the same way to the physiological changes associated with resistance training. In addition, we cannot fully exclude the role of chance, so these subtype‑specific differences should be interpreted with some caution,” the study authors explained. 

Females who did 2 or more hours of strength training per week had a 20% lower risk of cardiovascular disease than those who did none. 

Each additional hour of strength training per week was associated with a 5% lower risk of major cardiovascular disease and 14% lower risk of heart attack. 

These associations weakened after adjustments for body mass index (BMI) and cardiometabolic conditions, such as diabetes, high blood pressure, and high cholesterol. However, the researchers say the associations remained clear. 

“[The findings] fit with what we know about the metabolic effects of maintaining muscle, including better insulin sensitivity, healthier body composition, and improved blood pressure control,” said Rigved Tadwalkar, MD, consultative cardiologist and director of Digital Transformation Pacific Heart Institute in Santa Monica, CA. Tadwalkar wasn’t involved in the study. 

“I would not tell a patient that lifting weights guarantees a 20% reduction in risk, since this was an observational study. However, I would tell her that strength training now has a stronger cardiovascular case than many people realize,” he told Healthline.

Strength training, aerobic exercise lower heart attack risk by 45%

The researchers found that strength training provided additional benefits when combined with regular aerobic exercise. 

Females who did 2 or more hours of weekly strength training along with 150 minutes of weekly aerobic exercise had a 45% lower risk of heart attack than those with no physical activity. 

Associations with major cardiovascular disease also changed slightly. 

In an analysis of movement patterns, which considered strength training, aerobic exercise, and TV viewing time together, females who met all three recommendations had the lowest risk of cardiovascular disease, heart attack, and stroke, compared with those who met some or none. 

“[The findings] support the current guidelines and make them feel more clinically meaningful. ‘2 days a week’ can sound vague to patients, whereas this study gives us a practical frame: roughly an hour or more per week, sustained over time, may matter,” said Tadwalkar.

“The women doing at least 2 hours had the lowest risk in the main analysis, although we should be careful about turning that into a rigid threshold. For most patients, 2 solid sessions per week remains a very reasonable starting prescription,” he said.

Exercise guidelines for females during and after menopause

Strength training and aerobic exercise during and after menopause may improve heart health and help reduce menopause and age-related muscle loss. 

Current guidelines recommend 150 minutes of moderate-intensity aerobic exercise and two days of strength training each week. The guidelines also emphasize limiting sedentary behavior, such as prolonged TV watching.

Aerobic exercise, such as brisk walking, jogging, cycling, or swimming, is well-established as a way to lower cardiovascular disease risk. However, strength training, or resistance training, is less established.

Strength training involves working your muscles against a force, like body weight, free weights, resistance bands, or weight machines. 

Clarinda Hougen, MD, a primary care sports medicine specialist at Cedars-Sinai Orthopedics in Los Angeles, CA, said that you don’t need a gym to get started with strength training. Hougen wasn’t involved in the study.

“Simple body weight exercises like squats, step-ups, modified pushups, and planks can be very effective. Aim for two to three sessions per week and focus on proper form to prevent injury. As you build strength, you can add resistance with dumbbells, kettlebells, or bands,” she told Healthline.

A yoga practice may also help build muscle strength, benefit heart health, and improve flexibility and balance. Older studies have shown that yoga can help manage menopausal symptoms.

The important thing is to find an exercise you can do consistently. 

“The biggest barrier is often that people do not know what to do, and they are afraid of hurting themselves. Joint pain, poor balance, cost, transportation, and discomfort in a gym can quickly derail a plan that looked good on paper,” said Tadwalkar.

“What helps is a very clear entry point, like a few exercises, a written schedule, and some instruction from a physical therapist, trainer, or exercise professional who understands older adults. Home-based routines can work extremely well when they are simple and easy to repeat,” he added. 

Tadwalkar noted that consistency becomes much more likely when the plan is tied to something you care about, such as staying independent, getting off the floor, carrying groceries, or keeping up with children and grandchildren.