Long-Term, Consistent Resistance Training Linked to Substantially Lower Type 2 Diabetes Risk

Sustained, consistent resistance training during approximately 19 years of follow-up may be associated with substantially lower risk of developing type 2 diabetes (T2D), according to a new analysis of 3 long-running US cohort studies published in JAMA Network Open.¹

These findings suggest that consistent resistance training, particularly when combined with adequate aerobic activity and limited sedentary behavior, may be an important component of recommendations for T2D prevention,” wrote the researchers of the study.

Closing a Research Gap

Current physical activity guidelines recommend resistance training at least twice weekly alongside aerobic exercise, but most prior evidence linking resistance training to T2D prevention has relied on a single baseline measurement—an approach vulnerable to underestimating long-term benefit because it cannot capture how behavior changes over time. To address this gap, researchers analyzed up to 14 repeated assessments of resistance training collected over nearly 2 decades among 143,715 participants in the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-up Study.

A Clear Dose-Response Pattern

Over a mean follow-up of 19.2 years, 10,038 incident T2D cases occurred. Compared with no resistance training, increasing weekly volume was associated with progressively lower risk: adjusted HRs ranged from 0.83 (95% CI, 0.79-0.88) for less than 30 minutes per week to 0.73 (95% CI, 0.66-0.81) for 2 or more hours per week (P < .001 for trend). The inverse association held even after additional adjustment for waist circumference, intentional changes in body weight, and time-updated body mass index (BMI) and was consistent across strata of age, BMI, diet quality, and family history of diabetes.

Consistency Over Time Matters Most

Trajectory analyses restricted to the Nurses’ Health Study II cohort—tracking patterns between ages 40 and 60—showed that participants who maintained consistently high resistance training (≥ 30 minutes weekly) had a 42% lower T2D risk than those with consistently low levels (HR, 0.58; 95% CI, 0.45-0.74). Notably, even a “low to high” trajectory, in which participants ramped up training later in midlife, was associated with a 21% risk reduction (HR, 0.79; 95% CI, 0.66-0.94), suggesting it is not too late to benefit from starting later. Consistency mattered: participants who reported at least 1 hour per week of resistance training on 75% or more of follow-up questionnaires had a lower risk (HR, 0.65; 95% CI, 0.60-0.72) than those with comparable average volume but inconsistent participation.

Combined Lifestyle Behaviors Offer the Greatest Protection

The strongest protection emerged when resistance training was combined with other healthy behaviors. Participants who met recommendations for both aerobic activity (≥ 15 MET-hours weekly) and resistance training (≥ 1 hour weekly) while limiting television viewing to under 2 hours daily had a 62% lower T2D risk than those meeting none of the 3 recommendations (HR, 0.38; 95% CI, 0.34-0.42).

Managed Care Implications

With T2D affecting roughly 38 million US adults and driving a disproportionate share of chronic disease spending, these findings carry direct relevance for payers and population health programs designing lifestyle-based benefit design.² The data suggests prevention-focused initiatives such as resistance training alongside aerobic activity, particularly given the observed independent association with lower T2D risk, rather than aerobic activity alone. The association was observed across BMI categories and persisted after adjustment for BMI and waist circumference.¹

“In this prospective cohort study, resistance training among US adult health care professionals was associated with substantially lower T2D risk, particularly when performed consistently over midlife and combined with adequate aerobic activity and limited sedentary television viewing,” wrote the researchers. “These findings support the inclusion of resistance training as a key component of lifestyle recommendations for diabetes prevention.”

References

1. Zhang T, Zhang Y, Lee DH, et al. Long-term resistance training and risk of type 2 diabetes. JAMA Netw Open. 2026;9(6):e2619420. doi:10.1001/jamanetworkopen.2026.19420
2. National Diabetes Statistics Report. CDC. January 21, 2026. Accessed June 22, 2026. https://www.cdc.gov/diabetes/php/data-research/index.html