Dose-dependent association between muscle-strengthening activities and all-cause mortality: Prospective cohort study among a national sample of adults in the USA

Arch Cardiovasc Dis. 2016 Nov;109(11):626-633. doi: 10.1016/j.acvd.2016.04.005. Epub 2016 Aug 31.


Background: We have a limited understanding of the association between behavioural participation in muscle-strengthening activities (MSA) and all-cause mortality.

Aim: To determine the effect of MSA on all-cause mortality, and examine a potential dose-response relationship between the frequency with which MSA are performed and the incidence of all-cause mortality.

Methods: Individuals (8772 adults aged≥20years) from the 2003-2006 National Health and Nutritional Examination Survey were evaluated for baseline characteristics, then followed for an average of 6.7years. MSA were assessed at baseline as the number of self-reported sessions completed within the past 30days. Analyses were performed in 2015.

Results: Only 18.6% of individuals met MSA guidelines (2-3 MSA sessions/week) at baseline, while those performing any form of MSA had a 23% reduced risk of all-cause mortality (hazard ratio [HR]: 0.77; 95% confidence interval: 0.60-0.98; P=0.04). Additionally, we created a five-category variable to determine whether a dose-response relationship existed between MSA and premature mortality; only individuals performing 8-14 sessions over a 30-day period (current MSA guidelines) had a reduced risk of all-cause mortality (HR: 0.70; P=0.02). Results were similar for CVD-specific mortality.

Conclusion: The national recommendations that 2-3 MSA sessions be performed per week appear to be most effective at reducing the risk of premature all-cause mortality; however, despite these recommendations, the majority of the adult population in the USA still fails to perform any MSA. Future studies should determine strategies for increasing adherence to these established guidelines.

Keywords: Epidemiology; Exercice physique; Exercice physique en résistance et en force; Health promotion; Institut de la santé; NHANES; Promotion de la santé; Resistance training; Strength; Épidémiologie.

MeSH terms

  • Adult
  • Aged
  • Cause of Death / trends
  • Exercise / physiology*
  • Exercise Therapy / methods*
  • Female
  • Follow-Up Studies
  • Health Promotion*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Motor Activity / physiology*
  • Muscle Strength / physiology*
  • Nutrition Surveys*
  • Prospective Studies
  • Risk Factors
  • Survival Rate / trends
  • United States / epidemiology
  • Young Adult