Why strength training deserves a place in the conversation about cardiovascular and metabolic health

When we think about exercise for heart health, most of us picture running shoes, bicycles, or someone walking very determinedly on a treadmill. We rarely picture a set of dumbbells. Or a resistance band. Or ourselves repeatedly standing up from a chair while wondering whether this really counts as exercise.

Spoiler… It does.

Walking, running, and other aerobic activities remain enormously valuable. But for World Heart Day, we would like to introduce your heart to one of its less-celebrated allies: your muscles.

Muscle is not just for moving furniture

Skeletal muscle is not simply decorative tissue reserved for athletes, bodybuilders and people who understand what all the machines at the gym are for. It is a metabolically active organ involved in glucose regulation, insulin sensitivity, energy use and healthy ageing.

After we eat, skeletal muscle is one of the major places where glucose is taken up and stored. When muscle contracts during exercise, it can also increase glucose uptake through mechanisms that do not rely entirely on insulin. Over time, resistance exercise can improve the muscle’s response to insulin, making it easier for the body to manage blood glucose.[1,2]

This matters to the heart because cardiovascular disease seldom exists in splendid isolation. Insulin resistance, type 2 diabetes, elevated blood pressure, excess abdominal fat, fatty liver disease and cardiovascular disease frequently travel together.

Your muscles are therefore not innocent bystanders in the metabolic-health story. They are active participants.

Strength and heart health are connected

Observational research consistently finds that people who participate in muscle-strengthening activity have a lower risk of cardiovascular disease, type 2 diabetes and premature death than those who do none. A systematic review and meta-analysis of cohort studies found that muscle-strengthening activities were associated with approximately a 10–17% lower risk of cardiovascular disease, cancer, diabetes, lung cancer and death from any cause.[3] The largest apparent benefit was associated with roughly 30–60 minutes of muscle-strengthening activity per week.

This does not mean that precisely 47 minutes with a kettlebell is the secret to immortality. Most of the evidence comes from observational studies, which cannot prove that strength training alone caused the reduction in risk. People who exercise may also differ in their diet, smoking habits, healthcare access and other behaviours. Nevertheless, the findings are consistent with clinical research showing that resistance exercise can improve several established cardiovascular risk factors, including blood pressure, blood glucose regulation, body composition and physical function.[1]

There is also evidence that strength training may be particularly valuable for women. In a large 2024 observational study involving more than 400,000 adults, regular physical activity was associated with a greater reduction in cardiovascular mortality among women than men. Women reporting regular muscle-strengthening activity also appeared to receive substantial survival benefits.[4]

Again, association is not proof of cause and effect. But it is a persuasive reminder that the weights section is not exclusively male territory.

Your grip could tell you something, but not everything

Grip strength is increasingly used in research as a simple marker of muscular strength. Lower grip strength has been associated with greater risks of cardiovascular events, disability and mortality. That does not mean a weak handshake diagnoses heart disease. Grip strength may reflect several things at once: muscle health, nutritional status, underlying illness, frailty, activity levels and general physical resilience. It is better understood as a useful clue than as a crystal ball.

The broader message is more important: maintaining strength as we age matters.

From our 30s onwards, muscle mass and strength can gradually decline, particularly if we are inactive. Illness, prolonged bed rest, inadequate nutrition and ageing can accelerate that loss. Eventually, this affects far more than our ability to lift a heavy object. It influences balance, mobility, glucose regulation, independence and our ability to recover from illness.

The goal is not to develop impressive biceps for the family WhatsApp group. The goal is to remain capable.

Consider cardio and strength training teammates

This is not a competition between walking and weightlifting.

Aerobic exercise helps improve cardiorespiratory fitness and is strongly associated with lower risks of cardiovascular disease and premature death. Resistance exercise builds and preserves muscle, improves strength and supports metabolic function. Combining the two appears to provide broader benefits than treating either as the only form of exercise that matters.[1]

The World Health Organization recommends that adults perform muscle-strengthening activities involving all major muscle groups on at least two days each week, alongside regular aerobic activity.[5]

Yet strength training often receives much less attention than step counts or running distances. Perhaps that is partly because “resistance training” sounds like something requiring Lycra, complicated machinery and a person shouting encouragement.

It need not involve any of those things.

What counts as picking up something heavy?

“Heavy” is relative. It means providing enough resistance to challenge your muscles while still allowing you to move safely and with control.

Depending on your current ability, that could include:

• Lifting dumbbells, kettlebells, or barbells
• Exercising with resistance bands
• Performing squats, wall push-ups or modified push-ups
• Repeatedly standing up from a chair
• Carrying shopping bags
• Climbing stairs
• Lifting bottles filled with water
• Gardening, digging or carrying household objects
• Doing physical work that genuinely challenges the major muscle groups

A simple starting point might be two short sessions per week covering the legs, hips, back, abdomen, chest, shoulders and arms. Beginners can start with light resistance and gradually increase it as movements become easier.

The exercise should feel challenging, but it should not cause sharp pain, dizziness, chest discomfort or unusual breathlessness. People with known cardiovascular disease, uncontrolled high blood pressure, significant joint problems, or other medical conditions should seek professional guidance before beginning vigorous or heavy resistance exercise.

And holding your breath while straining is not a badge of honour. Breathing normally and learning good technique matter.

Protein matters, but the exercise sends the invitation

Building and preserving muscle also requires adequate nutrition, including sufficient high-quality protein. However, eating more protein without using the muscles does not reproduce all the effects of resistance exercise.

Think of protein as providing the building materials. The exercise tells the builders where to work. This is especially important with ageing, when the muscle-building response to food and activity may become less efficient. Regular resistance exercise, adequate protein and sufficient recovery work together to help preserve muscle and function.

There is no need for everyone to chase extreme protein targets or purchase a cupboard full of powders. For most people, the starting point is much less glamorous: eat adequate nutrient-dense food, include a meaningful source of protein in meals and give the body a reason to maintain its muscle.

The heart is part of a bigger system

World Heart Day messaging often reduces cardiovascular health to a short list: do some cardio, lose weight and keep an eye on the usual numbers. 

Those things may matter, but the human body is not a collection of unrelated departments. The heart, blood vessels, muscles, liver, kidneys, and pancreas constantly communicate. A change in one part of the system can affect the others.

That is why a person may improve their health without seeing an enormous change on the bathroom scale. Resistance exercise may improve strength, glucose regulation, blood pressure, waist circumference, and body composition even when total body weight changes very little.

The scale cannot tell the difference between losing muscle and losing fat. Your metabolism certainly can.

So, this World Heart Day, take your heart for a walk, but consider introducing it to some resistance too.

Pick up a weight. Stretch a band. Carry the shopping. Practise getting out of a chair without using your hands. Start gently, progress gradually and choose something you can continue doing.

Your heart does not require you to become a bodybuilder.

It would simply prefer that you remain strong.

References

1. Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee DC, et al. Resistance exercise training in individuals with and without cardiovascular disease: 2023 update: a scientific statement from the American Heart Association. Circulation. 2024;149(3):e217–e231. doi:10.1161/CIR.0000000000001189.
2. Sylow L, Kleinert M, Richter EA, Jensen TE. Exercise-stimulated glucose uptake—regulation and implications for glycaemic control. Nat Rev Endocrinol. 2017;13(3):133–148. doi:10.1038/nrendo.2016.162.
3. Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022;56(13):755–763. doi:10.1136/bjsports-2021-105061.
4. Ji H, Gulati M, Huang TY, Kwan AC, Ouyang D, Ebinger JE, et al. Sex differences in association of physical activity with all-cause and cardiovascular mortality. J Am Coll Cardiol. 2024;83(8):783–793. doi:10.1016/j.jacc.2023.12.019.
5. World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020. Available from: WHO Guidelines on Physical Activity and Sedentary Behaviour.