Muscular Strength
Both the American Heart Association and the American College of Sports Medicine have endorsed the inclusion of resistance training as an integral component of an exercise program for preventing cardiovascular disease[4, 41]. These recommendations, in large part, stem from randomized controlled trials on the BP lowering effects of resistance training (reviewed below). Prospective data supporting the role of resistance training or measures of muscular strength/endurance (attributes developed from resistance training), however, are still limited. The earliest prospective study was published in 2010 by Maslow and colleagues who examined the association between muscular strength and incident hypertension among healthy men enrolled in the ACLS study[42]. It was reported that men in the high-strength group had a 28% lower risk for incident hypertension compared to the low-strength group. This association was no longer statistically significant after adjustment for cardiorespiratory fitness, although multicollinearity may have confounded this finding. More recently, in their analysis of the National Runners’ Health Study II and the National Walkers’ Health Study, Williams and Thompson reported that the amount of MET hours/day spent doing strengthening exercises was not associated with a reduced risk of incident hypertension[27]. Thus, the present literature from prospective studies provides little convincing evidence for a role of resistance training in the prevention of hypertension.