Strength Training Associated With Reduced Mortality in Women

Jen Middleton, MD, MPH
Posted on March 25, 2024

International Women’s Day was celebrated earlier this month, just in time for the publication of a large prospective study comparing exercise habits and mortality outcomes between women and men.* This study found that women benefited more from equivalent exercise time and types than men, with the greatest gains for women coming from strength training; in general, though, women exercise less than men, and they engage in strength training even less often than men do. As heart disease is still the leading cause of death of women in the United States, this study’s findings should compel family physicians to prioritize counseling about exercise, especially strength training, in our female patients.

This large prospective study enrolled more than 410,000 U.S. adults; “54.7% were women, 14.4% identified as Black, and 18.4% identified as Hispanic.” The study reported that 32.5% of women engaged in regular exercise, compared with 43.1% of men. “Men reached their maximal survival benefit of HR 0.81 from 300 min/wk of moderate-to-vigorous physical activity, whereas women achieved similar benefit at 140 min/wk and then continued to reach a maximum survival benefit of HR 0.76 also at ∼300 min/wk.” Only 19.9% of women participated in regular strength training, compared with 27.8% of men, but “[f]or women compared with men engaging in 3 sessions/wk of muscle strengthening PA, there was ∼2-fold greater relative reduction in all-cause mortality [men 14%, women 28%].” Interestingly, women who did completed only one session per week of muscle strengthening had a similar all-cause mortality reduction as men who completed it three times a week.

Significant barriers stand between many women and strength training. Women can be intimidated by lifting weights and may fear the appearance of excessive muscle gain, which is unlikely to happen in those born female without years of significant commitment. Making time for exercise can be challenging for women, who typically bear a higher burden of caregiving in their households and communities. Finally, gyms are often not safe spaces for women and nonbinary people.

Family physicians are in an ideal position to help their patients recognize and overcome these barriers. For busy women, participating in one session a week may feel more achievable than three. Online resources for strength training abound. Gyms that cater to female and nonbinary people are in many cities. Working with patients, our collective effort could avert thousands of deaths annually in the United States.

You can read more in AFP By Topic for Coronary Artery Disease/Coronary Heart Disease and Health Maintenance and Counseling, as well as this 2017 AFP article, “Exercise Prescriptions in Older Adults.”

*—Participants in this study self-identified as women or men. No categorizations were reported for nonbinary people, and there was no mention of asking for gender assigned at birth. Please interpret this study’s findings within those limitations.