The Power of Resistance Training in Cardiovascular Health: Latest Research and Clinical Applications

Beyond Aerobics: Resistance Training's Role in Modern Heart Care

In the evolving landscape of cardiovascular care and rehabilitation, resistance training has emerged as a powerful complementary approach to traditional aerobic exercise. Once viewed with caution for heart patients, the latest research now positions strength training as an essential component of cardiovascular health programs. This comprehensive review examines groundbreaking studies from the 2025 American College of Cardiology Scientific Session and recent scientific statements that are reshaping how we approach exercise for heart health.

Resistance Training: A Paradigm Shift in Cardiovascular Care

The traditional focus of cardiovascular rehabilitation has long centered on aerobic exercise. However, an impressive body of evidence now demonstrates that resistance training provides unique cardiovascular benefits that aerobic exercise alone cannot deliver. The 2024-2025 guidelines represent a significant shift in how cardiologists approach exercise recommendations for both healthy individuals and those with existing cardiovascular conditions.

New Evidence Supporting Resistance Training

According to the recent American Heart Association scientific statement, adults who participate in resistance training have approximately 15% lower risk of all-cause mortality and 17% lower risk of cardiovascular disease compared to those who report no resistance training. The optimal "dose" appears to be approximately 30 to 60 minutes per week of resistance training, which is associated with maximum risk reduction for all-cause mortality and incident cardiovascular disease.

The benefits extend beyond mortality statistics. Studies now demonstrate that resistance training:

• Reduces resting blood pressure in healthy adults and those with hypertension

• Improves glycemia and insulin resistance across varied populations

• Has favorable effects on lipid profiles, particularly HDL cholesterol and triglycerides

• Positively impacts body composition by reducing fat mass and increasing lean body mass

• Improves non-traditional risk factors such as endothelial function and sleep quality

• Reduces symptoms of depression and anxiety

Breaking Down the Latest Research

2025 ACC Scientific Session Highlights in Sports Cardiology

The 2025 American College of Cardiology (ACC) Scientific Session in Chicago marked a milestone year for sports cardiology, with two major guideline releases:

1. The 2025 AHA/ACC scientific statement on sports participation for athletes with cardiovascular abnormalities

2. The 2024 Heart Rhythm Society expert consensus statement on arrhythmias in athletes

These guidelines reflect a paradigm shift from rigid restrictions toward an individualized, shared decision-making (SDM) model. Recent data suggests athletes with certain cardiomyopathies may not be at higher arrhythmic risk than non-athletes, allowing for more personalized return-to-play decisions.

The AHA Scientific Statement on Resistance Training

The updated American Heart Association scientific statement provides compelling evidence that resistance training delivers significant cardiovascular benefits:

• In healthy young adults (≤40 years), resistance training can elicit small but significant reductions in diastolic blood pressure (~1 mm Hg)

• For middle-aged and older adults (>40 years), resistance training results in larger reductions in systolic BP (~4 mm Hg) and diastolic BP (~2 mm Hg)

• The effects are more pronounced in those with prehypertension (−3 mm Hg systolic; −3 mm Hg diastolic) and hypertension (−6 mm Hg systolic; −5 mm Hg diastolic)

• Notably, these decreases in resting systolic BP are comparable to those achieved with antihypertensive medications

BJSM Study: Combined Training for Coronary Artery Disease

A systematic review published in the British Journal of Sports Medicine examined how combining resistance training with aerobic exercise affects patients with coronary artery disease. The researchers reviewed 23 randomized controlled trials involving 916 participants and found:

• Combined training improved cardiorespiratory fitness (CRF) more than aerobic training alone

• Lean body mass increased significantly with combined training

• Percent body fat decreased more with combined training than aerobic exercise alone

• The CRF improvements were only significant when resistance training was added without reducing aerobic training volume

This study emphasizes that for patients with coronary artery disease, the optimal approach is to add resistance training without compromising aerobic exercise volume. Even when time constraints make this difficult, replacing some aerobic exercise with resistance training still maintains cardiorespiratory fitness benefits.

Traditional Cardiovascular Risk Factors and Resistance Training

Blood Pressure Benefits

Recent meta-analyses have documented the significant impact of resistance training on blood pressure management. While the effects vary by population, even modest reductions in blood pressure can translate to substantial cardiovascular risk reduction. Proposed mechanisms include:

• Improvements in endothelial function

• Enhanced vasodilatory capacity

• Increased vascular conductance

The magnitude of blood pressure reduction appears to be dose-dependent and most pronounced in individuals with existing hypertension.

Glycemic Control and Diabetes Prevention

Regular participation in resistance training is associated with a 17% lower incidence of diabetes compared to no participation. The dose-response relationship appears nonlinear, with:

• Progressive lower risk of diabetes with up to 60 minutes per week of resistance training

• Continued but more gradual decrease beyond this threshold

Intervention studies demonstrate that resistance training may reduce fasting glucose by 2-5 mg/dL among older adults and those with prediabetes or type 2 diabetes. Among patients with type 2 diabetes, resistance training was associated with a 0.34% decline in hemoglobin A1c, with greater benefits observed in those with:

• More recently diagnosed diabetes (<6 years)

• Higher baseline hemoglobin A1c levels (≥7.5%)

Lipid Profile Improvements

Resistance training interventions have demonstrated favorable effects on blood lipids:

• HDL cholesterol increases of +2 to +12 mg/dL

• Total cholesterol reductions of approximately −8 mg/dL

• Triglyceride reductions of −7 to −13 mg/dL

The evidence for LDL cholesterol is less consistent, with some studies showing significant reductions (particularly in older adults with elevated cardiometabolic risk) and others showing minimal effects.

Body Composition Changes

While resistance training alone may not produce dramatic weight loss, it delivers meaningful changes in body composition:

• Increased lean body mass (average +0.8 kg)

• Decreased body fat percentage (−1.6%)

• Reduced whole-body fat mass (−1.0 kg)

These changes can have significant long-term implications for metabolic health and disease prevention.

Beyond Traditional Risk Factors: Additional Cardiovascular Benefits

Cardiorespiratory Fitness

Though traditionally associated with aerobic exercise, resistance training appears to confer small to moderate beneficial increases in cardiorespiratory fitness through mechanisms such as:

• Increased leg strength

• Improvements in oxidative enzymes

• Increased type II muscle fibers

Even modest improvements in cardiorespiratory fitness can be clinically meaningful, given the well-established relationship between fitness and reduced cardiovascular events and mortality.

Vascular Function

Research indicates that resistance training can favorably influence endothelial function, a critical marker of vascular health. However, the effects on arterial stiffness and inflammatory markers have shown mixed results, ranging from neutral to beneficial associations.

Psychological Well-being

The AHA's Life's Essential 8 framework now emphasizes psychological health as a foundational factor for cardiovascular health. Recent evidence suggests resistance training is associated with:

• Enhanced sleep quality

• Reduced symptoms of depression and anxiety

• Improved quality of life

These psychological benefits may provide additional cardiovascular protection beyond the physiological adaptations.

Implications for Clinical Practice

Resistance Training Prescription

Despite the documented benefits, only 28% of US adults report participating in the recommended two days per week of resistance training. The evidence suggests:

• Moderate to high-intensity resistance training (40%-80% of maximum effort) on 2-3 days per week appears optimal

• Programs should be individualized based on health status, fitness level, and goals

• For patients with coronary artery disease, adding resistance training without reducing aerobic training volume produces the best outcomes

High-Intensity vs. Low-Intensity Resistance Training

An emerging debate centers on the appropriate intensity for resistance training in cardiovascular patients. Evidence suggests that high-intensity strength training (≥70% of one-repetition maximum):

• Is more effective for increasing myofibrillar protein synthesis

• Causes neural adaptations that enhance strength gains

• Contrary to conventional wisdom, may cause fewer increases in arterial blood pressure and cardiac output compared to low-intensity resistance training with high repetitions

This challenges current clinical practice and suggests that properly prescribed high-intensity resistance training may be both safe and more effective for cardiovascular patients.

Special Populations

Athletes with Cardiovascular Conditions

The 2025 ACC guidelines reflect a major shift toward shared decision-making for athletes with cardiovascular conditions:

• A study of Division 1/professional athletes with sudden cardiac death-associated diagnoses found that while 75% were initially disqualified, 96% returned to play safely after shared decision-making and further evaluation

• Cardiac magnetic resonance imaging to evaluate myocardial scar burden may play a role in risk stratification

• Site-specific emergency action plans and automated external defibrillators remain critical life-saving tools

Children and Adolescents

For pediatric athletes at increased arrhythmia risk, the data support that blanket sports restrictions can be harmful, contributing to obesity and mental health conditions. Instead, an approach grounded in shared decision-making that supports safe return-to-play with disease-specific therapies and ongoing monitoring is recommended.

Practical Implementation

Overcoming Barriers to Resistance Training

Despite the compelling evidence, resistance training remains underutilized in both primary prevention and cardiac rehabilitation settings. Common barriers include:

• Limited equipment access

• Lack of knowledge about proper form and technique

• Misconceptions about safety for cardiac patients

• Time constraints

Healthcare providers can help patients overcome these barriers by:

• Providing education about bodyweight exercises that require minimal equipment

• Referring patients to qualified exercise professionals

• Emphasizing that even small amounts of resistance training (30-60 minutes weekly) provide significant benefits

• Addressing misconceptions about safety with evidence-based information

Integration into Cardiac Rehabilitation Programs

The BJSM study provides strong evidence for integrating resistance training into cardiac rehabilitation programs:

• For optimal cardiorespiratory fitness improvement, resistance training should be added to existing aerobic training

• When time constraints exist, replacing some aerobic exercise with resistance training maintains benefits

• The inclusion of resistance training improves both cardiorespiratory fitness and body composition in patients with coronary artery disease

Frequently Asked Questions

Is resistance training safe for people with cardiovascular disease?

Yes, when properly prescribed and supervised. Current evidence indicates that resistance training is safe for most individuals with stable cardiovascular disease. The 2025 guidelines emphasize individualized assessment and shared decision-making rather than blanket restrictions.

How often should I do resistance training for heart health benefits?

The evidence suggests that just 2-3 sessions per week for a total of 30-60 minutes weekly is associated with maximum risk reduction for cardiovascular disease and all-cause mortality.

What intensity of resistance training is recommended?

Most studies have implemented moderate to high-intensity resistance training (40%-80% of maximum effort). Emerging evidence suggests that properly prescribed high-intensity resistance training (≥70% of one-repetition maximum) may be both safe and effective for cardiovascular patients, though this should be implemented under proper supervision.

Can resistance training replace aerobic exercise?

No, resistance training complements but does not replace aerobic exercise. The BJSM study shows that the optimal approach for patients with coronary artery disease is to add resistance training without reducing aerobic training volume.

Will resistance training help lower my blood pressure?

Yes, resistance training can reduce both systolic and diastolic blood pressure, with effects comparable to some antihypertensive medications. The benefits are most pronounced in individuals with existing hypertension.

I'm taking statins for high cholesterol. Will resistance training help?

Resistance training has favorable effects on lipid profiles, including increases in HDL cholesterol and reductions in triglycerides. When combined with appropriate medication, resistance training may provide additional benefits for lipid management.

Key Takeaways

• Resistance training reduces mortality risk: Adults who participate in resistance training have approximately 15% lower risk of all-cause mortality and 17% lower risk of cardiovascular disease.

• Optimal "dose" identified: Just 30-60 minutes per week of resistance training is associated with maximum risk reduction for cardiovascular disease.

• Blood pressure benefits: Resistance training can reduce blood pressure by 4-6 mm Hg systolic in those with hypertension, comparable to some medications.

• Diabetes prevention: Regular resistance training is associated with a 17% lower incidence of diabetes.

• Combined training superiority: For patients with coronary artery disease, adding resistance training to aerobic exercise improves cardiorespiratory fitness more than aerobic training alone.

• Shared decision-making: The 2025 guidelines emphasize individualized assessment and shared decision-making rather than rigid restrictions for athletes with cardiovascular conditions.

• Beyond physical benefits: Resistance training improves sleep quality and reduces symptoms of depression and anxiety, contributing to overall cardiovascular health.

Call to Action

The evidence is clear: resistance training is a powerful tool for cardiovascular health. Whether you're a healthcare provider or someone concerned about heart health, it's time to embrace strength training as an essential component of cardiovascular wellness.

For healthcare providers:

• Update your exercise prescriptions to include specific resistance training recommendations

• Advocate for the inclusion of resistance training in cardiac rehabilitation programs

• Educate patients about the cardiovascular benefits of strength training

For individuals:

• Aim for 2-3 resistance training sessions weekly, totaling 30-60 minutes

• Start with lighter weights and proper form, gradually increasing intensity

• If you have existing cardiovascular disease, consult with your healthcare provider about incorporating resistance training into your exercise routine

By integrating resistance training into our approach to cardiovascular health, we can build stronger hearts, bodies, and communities. The science is clear—it's time for our practices to follow.

Note: Always consult with a healthcare provider before beginning any new exercise program, especially if you have existing cardiovascular disease or risk factors.

Related Article

The Psychology of Strength Training: Building Mental Toughness Beyond the Gym | Healthnewstrend

Citations

Hansen, D., Abreu, A., Doherty, P., & Völler, H. (2019). Dynamic strength training intensity in cardiovascular rehabilitation: Is it time to reconsider clinical practice? A systematic review. European Journal of Preventive Cardiology, 26(14), 1483-1492. https://doi.org/10.1177/2047487319847003

Paluch, A. E., Boyer, W. R., Franklin, B. A., Laddu, D., Lobelo, F., Lee, D., McDermott, M. M., Swift, D. L., Webel, A. R., & Lane, A. (2023b). Resistance exercise training in individuals with and without cardiovascular disease: 2023 Update: A scientific statement from the American Heart Association. Circulation, 149(3). https://doi.org/10.1161/cir.0000000000001189

Terada, T., Pap, R., Thomas, A., Wei, R., Noda, T., Visintini, S., & Reed, J. L. (2024). Effects of muscle strength training combined with aerobic training versus aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease: a systematic review and meta-analysis of randomised clinical trials. British journal of sports medicine, 58(20), 1225–1234. https://doi.org/10.1136/bjsports-2024-108530

Sports and Exercise Cardiology: Highlights from the 2025 American College of Cardiology Scientific Session and Expo - American College of Cardiology. (2025, May 20). American College of Cardiology. https://www.acc.org/Latest-in-Cardiology/Articles/2025/05/20/15/11/Sports-and-Exercise-Cardiology-Highlights-From-ACC-2025

Disclaimer

The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.This article is based on peer-reviewed research and is intended for educational purposes. Consult your healthcare provider before making significant changes to your activity levels.

About the Author:

Dr.T.S. Didwal, MD, is an experienced Internal Medicine Physician with over 30 years of practice. Specializing in internal medicine, he is dedicated to promoting wellness, preventive health, and fitness as core components of patient care. Dr. Didwal’s approach emphasizes the importance of proactive health management, encouraging patients to adopt healthy lifestyles, focus on fitness, and prioritize preventive measures. His expertise includes early detection and treatment of diseases, with a particular focus on preventing chronic conditions before they develop. Through personalized care, he helps patients understand the importance of regular health screenings, proper nutrition, exercise, and stress management in maintaining overall well-being.