For decades, we have told our patients, students, and colleagues that aerobic exercise is the cornerstone of cardiovascular health. Walking, running, cycling, and other endurance-based activities have long been viewed as the primary exercise strategies for protecting the aging heart. Resistance training, meanwhile, has largely been prescribed for different reasons—to increase muscle mass, improve strength, maintain independence, and reduce the risk of falls.
Our recent findings suggest it may be time to broaden that perspective. In a two-year randomized controlled trial involving older women, we found that progressive resistance training not only improved muscle strength, skeletal muscle mass, and functional capacity, but also induced meaningful improvements in cardiac structure and function. At the same time, women who did not participate in structured exercise experienced a progressive deterioration in many of these same cardiac parameters.
These findings are important because cardiovascular aging is not a benign process. As women age, the heart undergoes structural remodeling characterized by increased ventricular wall thickness, greater left ventricular mass, impaired ventricular relaxation, and elevated filling pressures. Collectively, these changes contribute to the development of heart failure with preserved ejection fraction (HFpEF), a condition that disproportionately affects older women and remains one of the greatest unresolved challenges in contemporary cardiovascular medicine.
Unlike many cardiovascular diseases, HFpEF has proven remarkably resistant to pharmacological treatment. Prevention, therefore, may represent our most effective strategy. This is where resistance training may play a far greater role than previously appreciated. Over the course of two years, women in our training group demonstrated favorable changes in multiple echocardiographic markers associated with cardiac remodeling and diastolic function. Measures of ventricular wall thickness, left ventricular mass, atrial volume, and ventricular filling pressures all moved in a direction consistent with healthier cardiac aging. Importantly, these adaptations occurred alongside improvements in glucose regulation, cholesterol levels, skeletal muscle mass, strength, and physical function—factors that are themselves closely linked to cardiovascular risk.
What makes these findings particularly noteworthy is the duration of the intervention. Most exercise studies examining cardiac outcomes last only a few weeks or months. Yet cardiovascular aging unfolds over years and decades. To our knowledge, this is among the very few randomized controlled trials to examine the isolated effects of resistance training on cardiac structure and function over a two-year period in older women. This longer-term perspective may help explain why we observed adaptations that shorter interventions have often failed to detect.
The broader public health implications are substantial. Resistance training is relatively inexpensive, highly scalable, and can be implemented in a wide variety of settings, including community centers, health clubs, clinical exercise programs, and public health initiatives. As populations continue to age worldwide, interventions that simultaneously improve cardiovascular health, preserve muscle mass, enhance physical function, and support independent living are urgently needed.
Our findings do not diminish the importance of aerobic exercise. Rather, they suggest that resistance training deserves greater recognition as a cardiovascular intervention in its own right.
For years, resistance training has been viewed primarily as a strategy for strengthening muscles. Increasingly, the evidence suggests that it may also help preserve the heart. If confirmed by future investigations, particularly in other populations and clinical settings, resistance training may become an important component of strategies aimed at preventing the progression of age-related cardiac dysfunction and reducing the burden of HFpEF. That possibility represents far more than a training recommendation—it represents a potential shift in how we think about cardiovascular prevention in an aging society.
Edilson S. Cyrino, PhD, FACSMis a professor in the Department of Physical Education at the State University of Londrina, Brazil, and director of the Metabolism, Nutrition, and Exercise Laboratory. His research focuses on exercise training, aging, body composition, cardiovascular health, and healthy longevity. Dr. Cyrino has authored more than 350 peer-reviewed scientific publications and has led the Active Aging Longitudinal Study for more than a decade. He is a member of ACSM and serves as a mentor to graduate students and early-career researchers.
Ricardo J. Rodrigues, MD, PhDis a cardiologist at the Heart Center, Londrina, Brazil, and professor in the Department of Internal Medicine at the State University of Londrina, and clinical coordinator of the Active Aging Longitudinal Study. His research focuses on cardiovascular aging, cardiac remodeling, heart failure prevention, and the effects of long-term resistance training on cardiac structure and function in older adults. Through the integration of clinical cardiology and exercise science, Dr. Rodrigues investigates how non-pharmacological interventions can improve cardiovascular health, preserve functional capacity, and promote healthy longevity. His work has contributed to advancing the understanding of resistance training as a strategy for cardiovascular disease prevention and healthy aging.
