Abstract MP61: Independent, Joint-Aerobic, and Dose-Response Associations of Resistance Exercise With Cardiovascular Disease Mortality: A Living Meta-Analysis
Authors: McDonough Daniel J , Siegel Lianne K , Steffen Brian T , Gabriel Kelley P , Pereira Mark A 
Published: May 2024

Introduction:
Cardiovascular diseases (CVDs) account for ~33% of all deaths globally. Aerobic exercise (AE) is a well-established modifiable risk factor for lowering the risk of CVD mortality, but the global prevalence of meeting the World Health Organization’s (WHO’s) recommendation for weekly AE in adults is only ~25%. Given the rapidly growing body of evidence indicating resistance exercise (RE) confers numerous health benefits independent of AE, and may also lower the risk of CVD mortality, we conducted a living meta-analysis (PROSPERO ID: CRD42022356528) to determine: 1) if RE is associated with lower CVD mortality risk independent of, and jointly with, AE; and 2) whether there is a dose-response pattern of CVD mortality by amount of RE.

Methods:
We searched MEDLINE, Embase, SPORTDiscus, The Cochrane Library, and SCOPUS from inception to October 10, 2023. We included prospective cohort studies in which: 1) AE and RE were the exposures and CVD mortality the outcome; and 2) nonclinical adult populations (aged ≥18 years) were sampled. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD mortality were pooled using random effects meta-analysis models. The independent effect of RE from AE was based on models with AE as a covariate. A random effects dose-response meta-analysis characterized the association between the RE dose (sessions/week) and CVD mortality risk.

Results:
Ten cohort studies from 5 countries (Mean follow-up time = 10.1 years) were included (9, 8, and 5 examined independent, joint, and dose-response associations, respectively). Relative to no RE, meeting the WHO guideline for RE (1-2 sessions/week), independent of meeting the AE guideline (≥150 minutes/week at moderate to vigorous intensities), was associated with a lower risk of CVD mortality (HR: 0.90, 95% CI: 0.85-0.95). A sensitivity analysis removing a highly weighted study (53%) yielded consistent results. Compared to meeting neither guideline, meeting the joint AE-RE guideline was associated with a larger difference in CVD mortality risk (HR: 0.60, 95% CI: 0.45-0.81). The dose-response meta-analysis showed evidence of a non-linear, U-shaped relationship between the amount of RE (independent of AE) and risk of CVD mortality. In detail, relative to no RE, participating in 1-2 sessions/week of RE was associated with a lower risk of CVD mortality (HR: 0.81; 95% CI: 0.72, 0.91), but there was no difference in CVD mortality risk between those who exceeded the guideline and those who participated in no RE (HR: 1.00, 95% CI: 0.89, 1.12).

Conclusion:
With the increasing global prevalence of obesity and physical inactivity, RE—a more movement-varied, lower-impact exercise modality—should receive more attention in public health policy to help alleviate the global burden of CVD mortality. Public health surveillance instruments capturing RE volume (sets, repetitions) are needed to improve prescription.