---
title: "Muscle-strengthening and Aerobic Activity Linked to Lower Mortality in US Adults with Diabetes"
id: "pubmed-39913676"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-39913676"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/39913676/"
doi: "10.1093/eurjpc/zwaf061"
published_at: "2026-09-08T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Muscle-strengthening and Aerobic Activity Linked to Lower Mortality in US Adults with Diabetes
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-39913676
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/39913676/)
- **DOI:** [10.1093/eurjpc/zwaf061](https://doi.org/10.1093%2Feurjpc%2Fzwaf061)
- **Published At:** 2026-09-08T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This prospective cohort study analyzed 29,609 US adults with diabetes (free of baseline CVD and cancer) from the National Health Interview Survey 1997–2018, with mortality follow-up through 2019. - Physical activity exposures were self-reported: frequency of **muscle-strengthening activity (MSA)** and minutes/week of moderate-to-vigorous aerobic physical activity (**MVPA**). - Over 270,178 person-years, there were 6,716 all-cause deaths, 1,995 cardiovascular deaths, and 1,202 cancer deaths; mean age 55.7 years, 51.6% female. - The association between MSA and **all-cause mortality** was U-shaped: benefits were seen for up to 3 sessions/week. Compared with no MSA, adjusted hazard ratios (aHRs) for all-cause mortality were: 0.72 for <1 time/week, 0.58 for 1 time/week, 0.76 for 2 times/week, 0.80 for 3 times/week, 0.97 for 4–6 times/week, and 0.99 for ≥7 times/week. - Non-linear (not strictly dose-response) associations were also observed for **cardiovascular disease (CVD)** and cancer mortality. - The observed associations did not differ by age or sex. - Joint exposure analysis showed the lowest all-cause and CVD mortality among adults performing MSA ≤ 2 times/week combined with MVPA ≥ 150 min/week, compared with no MSA and MVPA < 150 min/week. - The authors conclude that MSA up to three times weekly may be associated with lower all-cause, CVD, and cancer mortality in adults with diabetes, independent of MVPA, and that combining modest MSA with guideline-level MVPA (≥150 min/week) may confer the greatest reduction in all-cause and CVD mortality. - Conflict of interest: none declared. Specific details on covariates, questionnaire items, and modeling choices were reported in the source but are not reproduced in full here.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China. * 2 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA. * 3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. * PMID: **39913676** * DOI: [ 10.1093/eurjpc/zwaf061 ](https://doi.org/10.1093/eurjpc/zwaf061) Free article Item in Clipboard # Association of muscle-strengthening and aerobic physical activity with all-cause, cardiovascular disease, and cancer mortality in US adults with diabetes Jin Dai et al. Eur J Prev Cardiol. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Eur J Prev Cardiol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+J+Prev+Cardiol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+J+Prev+Cardiol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/39913676/) . 2026 Sep 8;33(12):2179-2189. doi: 10.1093/eurjpc/zwaf061. ### Authors [Jin Dai](https://pubmed.ncbi.nlm.nih.gov/?term=Dai+J&cauthor_id=39913676)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/39913676/#short-view-affiliation-1 "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/39913676/#short-view-affiliation-2 "Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA."), [Wen Dai](https://pubmed.ncbi.nlm.nih.gov/?term=Dai+W&cauthor_id=39913676)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/39913676/#short-view-affiliation-3 "Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA."), [Wen-Qing Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+WQ&cauthor_id=39913676)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/39913676/#short-view-affiliation-1 "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China.") ### Affiliations * 1 State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China. * 2 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA. * 3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. * PMID: **39913676** * DOI: [ 10.1093/eurjpc/zwaf061 ](https://doi.org/10.1093/eurjpc/zwaf061) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** The aim of this study was to evaluate associations of muscle-strengthening activity (MSA) with all-cause, cardiovascular disease (CVD), and cancer mortality in adults with diabetes, independent of and jointly with moderate-to-vigorous aerobic physical activity (MVPA). **Methods and results:** This prospective cohort study included 29 609 adults with diabetes free of CVD and cancer from the US National Health Interview Survey 1997-2018 (baseline). Muscle-strengthening activity and MVPA were derived from standardized questionnaires. Mortality by 2019 was ascertained through linkage to the National Death Index. Cox models were utilized to estimate adjusted hazard ratios (aHRs). Over 270 178 person-years, 6716 all-cause, 1995 CVD, and 1202 cancer deaths were documented in the study population (mean age, 55.7 years, 51.6% female). There were U-shaped associations of MSA with all-cause mortality risk, with ≤ 3 times/week associated with mortality benefits. Compared with no MSA, aHRs of all-cause mortality were 0.72 (95% confidence interval, 0.47-1.10) for MSA < 1 time/week, 0.58 (0.44-0.77) for 1 time/week, 0.76 (0.61-0.96) for 2 times/week, 0.80 (0.67-0.96) for 3 times/week, 0.97 (0.65-1.47) for 4-6 times/week, and 0.99 (0.83-1.19) for ≥ 7 times/week. Non-linear associations with CVD and cancer mortality were also observed. These associations did not vary by age or sex. Jointly, compared with no MSA and MVPA < 150 min/week, adults performing MSA ≤ 2 times/week and MVPA ≥ 150 min/week had the lowest all-cause and CVD mortality risk. **Conclusion:** For adults with diabetes, performing MSA ≤ 3 times/week may be associated with lower all-cause, CVD, and cancer mortality risk, independent of MVPA. Jointly performing MSA ≤ 2 times/week and MVPA ≥ 150 min/week may confer the lowest all-cause and CVD mortality risk. **Keywords:** Anaerobic exercise; Resistance training; Secondary prevention. ## Plain language summary Adults with diabetes often experience accelerated depletion of muscle mass and strength, further elevating their already high mortality risk associated with diabetes. Muscle-strengthening activity (MSA) is an effective strategy for improving muscle mass and strength and has demonstrated various short-term cardiometabolic benefits. However, it remains unknown whether there is a protective association between MSA and mortality risk among adults with diabetes. In a nationally representative sample of 29 609 US adults with diabetes, we newly observed a U-shaped association between MSA and all-cause mortality risk and non-linear associations between MSA and cardiovascular disease and cancer mortality risk. These associations did not vary by age and sex. Compared with no MSA, up to three times a week of MSA was inversely associated with all-cause, cardiovascular disease, and cancer mortality risk, independent of aerobic moderate-to-vigorous physical activity. The findings provide scientific evidence to support the integration of MSA into treatment protocols for managing mortality risk among adults with diabetes. © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflict of interest: none declared. ## Similar articles * [ Prospective Associations of Different Combinations of Aerobic and Muscle-Strengthening Activity With All-Cause, Cardiovascular, and Cancer Mortality. ](https://pubmed.ncbi.nlm.nih.gov/37548973/) López-Bueno R, Ahmadi M, Stamatakis E, Yang L, Del Pozo Cruz B.López-Bueno R, et al.JAMA Intern Med. 2023 Sep 1;183(9):982-990. doi: 10.1001/jamainternmed.2023.3093.JAMA Intern Med. 2023.PMID: 37548973Free PMC article. * [ The epidemiology of aerobic physical activity and muscle-strengthening activity guideline adherence among 383,928 U.S. adults. ](https://pubmed.ncbi.nlm.nih.gov/30999896/) Bennie JA, De Cocker K, Teychenne MJ, Brown WJ, Biddle SJH.Bennie JA, et al.Int J Behav Nutr Phys Act. 2019 Apr 18;16(1):34. doi: 10.1186/s12966-019-0797-2.Int J Behav Nutr Phys Act. 2019.PMID: 30999896Free PMC article. * [ Joint and dose-dependent associations between aerobic and muscle-strengthening activity with depression: A cross-sectional study of 1.48 million adults between 2011 and 2017. ](https://pubmed.ncbi.nlm.nih.gov/31876971/) Bennie JA, De Cocker K, Biddle SJH, Teychenne MJ.Bennie JA, et al.Depress Anxiety. 2020 Feb;37(2):166-178. doi: 10.1002/da.22986. Epub 2019 Dec 26.Depress Anxiety. 2020.PMID: 31876971 * [ Mortality and Morbidity Effects of Long-Term Exposure to Low-Level PM2.5, BC, NO2, and O3: An Analysis of European Cohorts in the ELAPSE Project. ](https://pubmed.ncbi.nlm.nih.gov/36106702/) Brunekreef B, Strak M, Chen J, Andersen ZJ, Atkinson R, Bauwelinck M, Bellander T, Boutron MC, Brandt J, Carey I, Cesaroni G, Forastiere F, Fecht D, Gulliver J, Hertel O, Hoffmann B, de Hoogh K, Houthuijs D, Hvidtfeldt U, Janssen N, Jorgensen J, Katsouyanni K, Ketzel M, Klompmaker J, Hjertager Krog N, Liu S, Ljungman P, Mehta A, Nagel G, Oftedal B, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rodopoulou S, Samoli E, Schwarze P, Sigsgaard T, Stafoggia M, Vienneau D, Weinmayr G, Wolf K, Hoek G.Brunekreef B, et al.Res Rep Health Eff Inst. 2021 Sep;2021(208):1-127.Res Rep Health Eff Inst. 2021.PMID: 36106702Free PMC article. * [ Muscle-strengthening activities and risk of cardiovascular disease, type 2 diabetes, cancer and mortality: A review of prospective cohort studies. ](https://pubmed.ncbi.nlm.nih.gov/34120373/) Giovannucci EL, Rezende LFM, Lee DH.Giovannucci EL, et al.J Intern Med. 2021 Oct;290(4):789-805. doi: 10.1111/joim.13344. Epub 2021 Jul 2.J Intern Med. 2021.PMID: 34120373Review. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=39913676) ## Cited by * [ Biomarkers of aging: from molecules and surrogates to physiology and function. ](https://pubmed.ncbi.nlm.nih.gov/40111763/) Furrer R, Handschin C.Furrer R, et al.Physiol Rev. 2025 Jul 1;105(3):1609-1694. doi: 10.1152/physrev.00045.2024. Epub 2025 Mar 20.Physiol Rev. 2025.PMID: 40111763Free PMC article.Review. ## MeSH terms * Adult Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Adult%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Adult) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/39913676/) * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/39913676/) * Cardiovascular Diseases* / diagnosis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cardiovascular+Diseases%2Fdiagnosis%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cardiovascular+Diseases) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/39913676/) * Cardiovascular Diseases* / mortality Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cardiovascular+Diseases%2Fmortality%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cardiovascular+Diseases) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/39913676/) * Cardiovascular Diseases* / physiopathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cardiovascular+Diseases%2Fphysiopathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cardiovascular+Diseases) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/39913676/) * Cardiovascular Diseases* / prevention & control Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cardiovascular+Diseases%2Fprevention+and+control%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?
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