Strength training plus cardio cuts type 2 diabetes risk the most

by · News-Medical

Adults who maintained resistance training through midlife had a lower long-term risk of type 2 diabetes, especially when they paired strength exercise with aerobic activity and less sedentary time.

Study: Long-Term Resistance Training and Risk of Type 2 Diabetes. Image Credit: Dragana Gordic / Shutterstock

Researchers drew on data from three large United States (US) studies following 143,715 adults for nearly two decades. They found that participants who performed aerobic activities such as brisk walking in addition to resistance training and curtailed television (TV) viewing time showed the greatest risk reduction. These findings highlight the importance of regular and consistent physical activity for long-term diabetes prevention.

T2D remains a health challenge worldwide. HCPs recommend regular physical activity for its prevention and management. In the US, health officials advise engaging in resistance training at least twice weekly in addition to aerobic exercise. Researchers are trying to develop strategies to optimize resistance training for preventing T2D. However, few studies have evaluated the benefits of combining different exercise modalities, such as resistance training and aerobic activity, while also reducing sedentary behavior. The influence of behavioral changes and exercise consistency on long-term health outcomes also remains unclear.

About the Study

In the present study, researchers investigated whether long-term resistance training was associated with a lower risk of T2D. They also explored the joint association of resistance training with aerobic exercise and limiting TV watching time on T2D risk.

The team analyzed data from three large-scale US studies. They obtained information on HCPs participating in the Health Professionals Follow-up Study (HPFS, between June 1992 and June 2021), Nurses’ Health Study (NHS, between June 2002 and June 2021), and NHS II (between June 2003 and June 2021). The participants were followed through June 2021 using biennial questionnaires.

The full analytic sample included HCPs without baseline diabetes, major cardiovascular disease, or cancer. For trajectory analyses, the researchers restricted the NHS II sample to participants who had at least 3 resistance training assessments between the ages of 40 and 60 years.

The researchers analyzed the study datasets between April and September 2025. They assessed the duration of resistance training sessions every two to four years. Long-term resistance training was characterized using cumulative means across follow-up, while trajectory patterns between ages 40 and 60 years were evaluated in NHS II. The researchers included up to 14 repeated assessments, which, along with trajectory analysis, enabled them to examine dynamic changes in resistance training patterns across middle age.

The team used TV viewing time to assess sedentary behavior. They used Cox regression models to estimate hazard ratios (HRs) for the analysis. The primary models adjusted for demographic, lifestyle, dietary, reproductive, and aerobic-activity factors, while additional models separately adjusted for body mass index (BMI), waist circumference, and intentional weight loss.

The team also used the inverse probability weighting method to address potential confounding. In sensitivity analyses, they excluded HCPs who engaged in very high levels of aerobic activity or had arthritis or chronic obstructive pulmonary disease (COPD).

Results

The mean age of the study participants was 56 years; over 78% were female, and nearly 97% were White. During 19 years of follow-up, 10,038 participants developed T2D. The team found that consistently high levels of resistance training were associated with the greatest T2D risk reduction. Increased aerobic activity, along with limited TV viewing, further reduced the risk.

In particular, compared with individuals who did not engage in resistance training, those performing resistance training for at least 2 hours weekly had a lower risk of T2D (HR, 0.73). The health benefits were also proportional to the consistency of training.

Middle-aged adults who consistently performed high-level resistance training for at least 30 minutes per week had a 42% lower risk of T2D (HR, 0.58). Trajectory analysis showed that individuals who expanded their resistance training over time experienced a lower incidence of T2D than those whose training levels remained consistently low, corresponding to an approximately 21% risk reduction (HR, 0.79). By contrast, a fluctuating resistance-training pattern was not significantly associated with a lower risk of T2D.

Individuals meeting recommendations for resistance training and aerobic activity, with limited sedentary time, had the lowest risk of T2D. People performing resistance training for at least 1 hour weekly, engaging in aerobic exercise for at least 15 metabolic equivalent (MET) hours weekly, and limiting TV viewing to less than 2 hours daily had the lowest risk of developing T2D (HR, 0.38).

The team obtained similar results after adjusting for variables such as age, family history of diabetes, smoking, alcohol intake, diet quality, menopausal status, and aerobic activity. Supplementary adjustment for baseline waist circumference, intentional weight loss, or time-updated BMI only modestly attenuated the associations. Sensitivity analyses also yielded similar results, indicating robustness of the findings.

Conclusion

Based on the findings, consistent resistance training, especially when performed alongside aerobic exercise and limited TV viewing, was associated with a considerably lower T2D risk among adult HCPs.

The findings support current recommendations that encourage resistance training and aerobic activity as part of T2D prevention strategies. However, residual confounding cannot be excluded, because participants who trained more consistently also tended to have healthier lifestyle profiles.

In future studies, researchers should include more diverse populations and objective measures of resistance training, including details on modality, intensity, and supervision, to improve the validity and generalizability of the study findings.

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