Muscular Strength and Rates of Death in Men 20-80

by Pamela Jones, MA

Cardiovascular fitness has been shown to be a powerful tool against many diseases including the number one killer in the US— heart disease. Strength training, while proven to have health benefits, is unproven in its effects to decrease death from all causes including heart disease and cancer. Researchers reviewed information that had been obtained during a study at the Cooper Clinic in Dallas. The study, published in the British Medical Journal, found that men with higher levels of strength had lower rates of death from all causes.

About the Study

The study was a prospective cohort study that followed 10,265 men for an average of 18.9 years. The men, 20-80 years of age, received comprehensive medical and fitness evaluations at the beginning of the study. Over the study time, they received periodic re-evaluations. Researchers tracked deaths from any causes, and carefully tracked deaths from heart disease.

After adjusting for known risk factors for cancer, heart disease, and death, the men with the lowest level of muscle strength had:

  • 1.46 times greater risk for death
  • 1.59 times greater risk of death from cardiovascular disease
  • 1.24 times greater risk of death from cancer

Cardiovascular fitness did appear to have a stronger beneficial effect than strength training. The benefits of strength training carried across all age groups. It also appeared to provide benefits even if a participant was overweight or obese.

This type of study can allow confounding factors to affect the outcomes. Given the outcome, it does suggest that more controlled studies should be done to fully understand the benefits of strength training.

How Does This Affect You?

More rigorous studies need to be done to confirm these findings. However, it is widely accepted that overall physical fitness has multiple health benefits for people of any age. Given the high rates of overweight and obese people, it is also important to know that strength training provided protective benefits for people who were overweight or obese.

Talk to your doctor about your risk factors for heart disease and cancer. Introduce well-rounded physical activities that include cardiovascular and strength elements.


American Academy of Family Physicians

American Council on Exercise


Ruiz JR, Sui X, Lobelo F, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ . 2008 July 12; 337(7661):92–95.

Below is the referenced study:
BMJ 2008; 337 doi: 10.1136/bmj.a439 (Published 1 July 2008)
Cite this as: BMJ 2008;337:a439
  1. Jonatan R Ruiz, research associate12,
  2. Xuemei Sui, research associate3,
  3. Felipe Lobelo, research associate3,
  4. James R Morrow Jr, professor4,
  5. Allen W Jackson, professor4,
  6. Michael Sjöström, associate professor1,
  7. Steven N Blair, professor34
Author Affiliations

1Department of Biosciences and Nutrition at NOVUM, Unit for Preventive Nutrition, Karolinska Institutet, Huddinge, Sweden
2Department of Physiology, School of Medicine, University of Granada, Spain
3Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
4Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA

Correspondence to: J R Ruiz
Accepted 16 June 2008


Objective To examine prospectively the association between muscular strength and mortality from all causes, cardiovascular disease, and cancer in men.

Design Prospective cohort study.

Setting Aerobics centre longitudinal study.

Participants 8762 men aged 20-80.

Main outcome measures All cause mortality up to 31 December 2003; muscular strength, quantified by combining one repetition maximal measures for leg and bench presses and further categorised as age specific thirds of the combined strength variable; and cardiorespiratory fitness assessed by a maximal exercise test on a treadmill.

Results During an average follow-up of 18.9 years, 503 deaths occurred (145 cardiovascular disease, 199 cancer). Age adjusted death rates per 10 000 person years across incremental thirds of muscular strength were 38.9, 25.9, and 26.6 for all causes; 12.1, 7.6, and 6.6 for cardiovascular disease; and 6.1, 4.9, and 4.2 for cancer (all P<0.01 for linear trend). After adjusting for age, physical activity, smoking, alcohol intake, body mass index, baseline medical conditions, and family history of cardiovascular disease, hazard ratios across incremental thirds of muscular strength for all cause mortality were 1.0 (referent), 0.72 (95% confidence interval 0.58 to 0.90), and 0.77 (0.62 to 0.96); for death from cardiovascular disease were 1.0 (referent), 0.74 (0.50 to 1.10), and 0.71 (0.47 to 1.07); and for death from cancer were 1.0 (referent), 0.72 (0.51 to 1.00), and 0.68 (0.48 to 0.97). The pattern of the association between muscular strength and death from all causes and cancer persisted after further adjustment for cardiorespiratory fitness; however, the association between muscular strength and death from cardiovascular disease was attenuated after further adjustment for cardiorespiratory fitness.

Conclusion Muscular strength is inversely and independently associated with death from all causes and cancer in men, even after adjusting for cardiorespiratory fitness and other potential confounders.


  • We thank the doctors and technicians at the Cooper Clinic who collected the baseline data and staff at the Cooper Institute for data entry and data management.

  • Contributors: All authors were involved in the concept and design of the study, the analysis and interpretation of data, drafting the manuscript, and critical revision of the manuscript for important intellectual content. They are guarantors. XS and SNB acquired the data. JRR, XS, FL, JRM, AWJJr, and SNB did the statistical analysis.

  • Funding: The aerobics centre longitudinal study was supported by the National Institutes of Health (grants AG06945, HL62508); the Spanish Ministry of Education (AP2003-2128, EX-2007-1124); the Margit and Folke Pehrzon Foundation; the European Union, in the framework of the public health programme (ALPHA project, 2006120); the American Heart Association predoctoral fellowship; and the American College of Sports Medicine Paffenbarger-Blair fund for epidemiological research on physical activity.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the Cooper Institute institutional review board.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 16 June 2008