Cardio plus strength training has been linked to a lower risk of diabetes, hypertension, heart disease, and cancer.

Middle-aged people who meet both aerobic and strength-based physical activity recommendations are less likely to develop a number of serious chronic diseases in later years than those who meet neither. This is the conclusion reached by researchers from the University of Queensland after analyzing data from 8,072 Brisbane residents aged 40-64 years, followed for nine years. The study was published in the Journal of Science and Medicine in Sport. [1]

The most significant association was observed for type 2 diabetes. Participants who met both the aerobic and strength training recommendations had a roughly 50% lower odds of developing diabetes in one of the study periods: the odds ratio was 0.50, with a 95% confidence interval of 0.28–0.89. For hypertension, the odds ratio was 0.76, representing a roughly 24% reduction in the odds of developing the disease. [2]

The study also found other signals. For heart disease, the odds ratio for those who met both recommendations was 0.63, or approximately 37% lower than for people who met neither the aerobic nor the strength training guidelines. For cancer, the odds ratio was 0.77, or approximately 23% lower, although the upper confidence interval reached 1.00, so the cancer result should be interpreted with caution. [3]

The study's primary significance is not that strength training can replace running, walking, or cycling. Instead, the authors demonstrate the potential benefits of combining the two types of exercise. Current Australian guidelines also recommend that adults engage in moderate to vigorous aerobic activity most days of the week and strength training at least two days a week. [4]

Main result	Compliance with both recommendations versus non-compliance with both
Type 2 diabetes mellitus	OR 0.50; 95% CI 0.28-0.89
Arterial hypertension	OR 0.76; 95% CI 0.60-0.98
Cancer	OR 0.77; 95% CI 0.59-1.00
Heart disease	OR 0.63; 95% CI 0.42-0.93
Participants	8072
Age at inclusion	40-64 years old
Observation	2007-2016

OR is the odds ratio. For example, an OR of 0.50 means approximately half the odds of an event occurring in the comparison group, rather than a guaranteed reduction in individual risk by exactly 50%. [5]

How the study was organized

The study is based on the Australian project HABITAT - How Areas in Brisbane Influence Health and Activity, a large longitudinal study of the health of Brisbane residents. The project was initially designed to examine how the environment, social conditions, and individual characteristics influence physical activity and health in middle-aged and older adults. [6]

The current analysis included 8,072 participants who were 40 to 64 years old at the time of the baseline survey in 2007. They completed questionnaires five times: in 2007, 2009, 2011, 2013, and 2016. By repeating the measurements, the researchers could assess not only activity at one point in time but also changes in habits and the emergence of diseases in subsequent years. [7]

Physical activity was assessed by self-reporting: participants reported the time spent on aerobic exercise and the frequency of muscle-strengthening sessions. The researchers then determined whether the individual met the aerobic recommendation, the strength training recommendation, both, or neither. Diseases were also assessed through repeated HABITAT questionnaires, making the study an observational longitudinal epidemiology study rather than a randomized trial. [8]

This design is significantly more informative than a typical cross-sectional survey: physical activity was assessed before or between subsequent disease registrations. However, it still doesn't allow for randomly assigning a person nine years of strength and aerobic exercise and comparing them to a control group. Therefore, the results speak to associations and probabilities rather than directly demonstrating a causal effect of exercise. [9]

Characteristic	Data
Study	HABITAT
Place	Brisbane, Australia
Participants in the analysis	8072
Age in 2007	40-64 years old
Survey waves	2007, 2009, 2011, 2013, 2016
General period	9 years
Physical activity	Self-report
Diseases	Repeated participant data
Design	Longitudinal observational study

[10]

What scientists considered sufficient physical activity

For aerobic activity, the study used the standard recommendation of approximately 150 minutes of moderate aerobic activity per week, 75 minutes of vigorous-intensity activity, or an equivalent combination of the two. Aerobic activity can include brisk walking, running, cycling, swimming, and other forms of exercise that significantly increase heart rate and breathing. [11]

The second part of the recommendations concerns muscles: adults are advised to perform strength training at least two days a week. This doesn't necessarily mean barbell training in a gym. Strength training includes exercises with body weight, dumbbells, machines, or elastic bands, as long as the load forces the muscles to work against resistance. [12]

The division of physical activity into these two components is key to the new article. In many studies and prevention campaigns, the phrase "physical activity" actually refers to walking, running, and other aerobic activities. However, international and Australian guidelines have long identified muscle strengthening as a separate, essential component. The World Health Organization also recommends that adults perform strength training for major muscle groups at least two days a week. [13]

However, compliance with the recommendations was far from universal. According to the research team, about half of the participants performed a sufficient amount of aerobic activity, but only 24% met both the aerobic and strength standards, and about 30% did not meet either recommendation. It was the latter group that served as an important comparison point. [14]

Component	Landmark
Moderate aerobic activity	≥150 min/week
Alternative	≥75 min of intense activity
Mixed mode is possible	Yes
Strength exercises	≥2 days/week
Examples of aerobic exercise	Brisk walking, running, cycling, swimming
Examples of strength training	Dumbbells, exercise machines, rubber bands, squats, push-ups
Both recommendations were followed	About 24%
Didn't do a single one	About 30%

[15]

The strongest result was obtained for type 2 diabetes.

The largest relative difference was found for type 2 diabetes. In the 2011–2013 analysis period, meeting both recommendations was associated with an odds ratio of 0.50 compared with not meeting both. The confidence interval was 0.28–0.89. [16]

In popular terms, this can be described as a roughly 50% reduction in the chances of developing diabetes. However, mathematically, the odds ratio cannot automatically translate into the same reduction in absolute risk in all situations. For example, a reduction in the probability of an event from 20% to 10% and from 2% to 1% appear similar in relative terms, although the number of cases actually prevented is completely different. Therefore, an individual prognosis cannot be calculated using these figures. [17]

Biologically, this result is entirely plausible. Muscle work increases glucose utilization, and regular strength training helps maintain or increase muscle mass—the largest tissue in the body capable of utilizing glucose in response to insulin. Aerobic activity, in turn, improves cardiorespiratory fitness, energy metabolism, and insulin sensitivity. The combination of the two types of exercise therefore potentially impacts multiple components of metabolic risk. The new study's findings are consistent with the World Health Organization's general recommendations, which consider both types of activity beneficial for adults. [18]

However, the study does not show that going to the gym is essential for diabetes prevention. Strength training can be achieved through bodyweight exercises such as squats, lunges, push-ups, sit-ups, and other resistance movements. From a practical standpoint, regular exercise of the major muscle groups is more important than specific equipment. [19]

Diabetes indicator	Result
Comparison	Both recommendations vs. neither
Odds ratio	0.50
95% confidence interval	0.28-0.89
Approximate relative difference in odds	-50%
Can this be interpreted as an absolute risk reduction of 50%?	No
Does the study prove causality?	No

[20]

Hypertension: Meeting both recommendations was associated with a roughly quarter-reduced odds

For hypertension, meeting both aerobic and strength training recommendations in the 2011–2013 analysis was associated with an odds ratio of 0.76. The confidence interval was 0.60–0.98, implying an approximately 24% reduction in the odds of being diagnosed with hypertension relative to the group that did not meet either recommendation.[21]

This result has clinical significance, as the two types of exercise impact the cardiovascular system somewhat differently. Aerobic exercise improves the ability of the heart and blood vessels to sustain prolonged work and is associated with improved vascular function. Resistance training improves muscle strength and functional capacity and may complement the effects of aerobic activity. Therefore, official guidelines do not recommend choosing only one of these options. [22]

It's worth emphasizing that strength training, when performed correctly, is not the same as extreme, maximal weight lifting. Population recommendations focus on routine muscle-strengthening activity. The 2026 Australian guidelines recommend that adults perform this activity at least two days a week, along with moderate-to-vigorous aerobic exercise. [23]

But even here, it's impossible to claim that adding two strength training sessions will reduce a specific person's blood pressure by exactly 24%. The study compares groups of people with different habits over the lifespan. People who regularly engage in both strength and aerobic activity may also differ in diet, body weight, smoking, medical behavior, and a host of other characteristics. Statistical models reduce, but do not completely eliminate, the problem of such differences. [24]

Hypertension	Result
Odds ratio	0.76
95% confidence interval	0.60-0.98
Approximate decrease in chances	24%
Result type	Observatory Association
Individual guaranteed effect	No

[25]

Heart disease and cancer: interesting results but require more careful interpretation

For heart disease, the researchers also found a favorable association. Compared with participants who did not follow either recommendation, those who followed both recommendations in the 2007-2011 analysis had an odds ratio of 0.63, with a 95 percent confidence interval of 0.42-0.93. This corresponds to an approximately 37% lower odds of developing the disease. [26]

It's important, however, that the associations presented in the article relate to individual observation periods, rather than representing a single, universal risk figure for the entire nine years. For heart disease, the most significant association was found in one time interval, while for cancer, hypertension, and type 2 diabetes, it was found in another. This makes the results interesting, but also cautions against the overly simple formula of "two types of sports reduce any disease by X percent." [27]

For cancer, the odds ratio was 0.77, or about 23% lower, but the 95% confidence interval was 0.59–1.00. The upper limit closely approximates the neutral value of 1, so statistical confidence here is weaker than, for example, for type 2 diabetes. The University of Queensland therefore cautiously concludes that a combination of aerobic and strength training may be associated with a lower risk of certain types of cancer. [28]

Furthermore, "cancer" is not a single disease. Physical activity can have different effects on the risk of colorectal, breast, endometrial, lung, and other cancers. The HABITAT sample size does not allow reliable conclusions to be drawn for each specific tumor type from this analysis alone, so the result is more accurately interpreted as a general epidemiological signal. [29]

Disease	OR	95% CI	A cautious interpretation
Heart disease	0.63	0.42-0.93	Strong inverse association
Cancer	0.77	0.59-1.00	Borderline result
Hypertension	0.76	0.60-0.98	Significant inverse association
Type 2 diabetes	0.50	0.28-0.89	Largest relative effect

[30]

Why strength training can provide benefits beyond cardio alone

Aerobic and strength training create different physiological stimuli. During prolonged aerobic exercise, the body's primary goal is to repeatedly supply the muscles with oxygen and energy. With regular exercise, the heart, blood vessels, mitochondria, and the system for utilizing energy substrates adapt. Aerobic activity has traditionally occupied a central place in cardiovascular disease prevention programs. The World Health Organization recommends adults 150-300 minutes of moderate or 75-150 minutes of vigorous aerobic activity per week. [31]

Strength training presents the body with a different challenge: overcoming resistance. It maintains muscle strength and functional capacity, and muscles are also a vital metabolic organ. This is why modern recommendations distinguish muscle strengthening as a separate category, rather than simply considering it another form of cardio. [32]

With age, the significance of this difference becomes especially noticeable. After middle age, muscle mass and strength gradually decline, and chronic diseases become more common. A combined program allows for the simultaneous maintenance of cardiorespiratory fitness and muscle reserve, so the potential benefits may extend beyond those of a single type of exercise. This is precisely the idea emphasized by the authors of HABITAT, who discuss the additional role of muscle-strengthening activity. [33]

The new study, however, does not elucidate the precise molecular mechanism behind the observed difference. This is an epidemiological analysis of behavior and disease, not a study of muscle biopsies, insulin sensitivity, or vascular function. Therefore, possible mechanisms help explain the plausibility of the result, but were not directly proven within the HABITAT framework. [34]

Aerobic exercise	Power load
Trains for long-term work	Trains work against resistance
Improves cardiorespiratory fitness	Maintains muscle strength
Running, walking, cycling, swimming	Dumbbells, rubber bands, exercise machines, body weight
The main guideline is minutes per week	The main reference point is the days of classes
Recommended separately	Also recommended separately
The most logical strategy	Combine both types

[35]

Why the figures 50%, 24% and 23% cannot be understood as a guaranteed risk reduction

The first fundamental limitation is related to the term "odds ratio." While the press release conveniently describes the results as "50% less diabetes" or "23% less cancer," the statistical model actually calculated the odds ratio. For common events, the odds ratio can differ significantly from the absolute risk ratio. Therefore, such percentages are best understood as a measure of comparative association rather than an individual's probability of avoiding the disease. [36]

A second limitation is that physical activity was assessed by self-report. People may misremember the number of minutes they walked or exercised, perceive an activity as more intense than it actually was, or report a socially desirable response. Studies of the HABITAT cohort itself also acknowledge the vulnerability of self-reported data to recall bias and social desirability. [37]

The third problem is called the "healthy user effect." A person who regularly follows two separate exercise recommendations is often also more likely to be more mindful of their diet, smoke less, have a higher socioeconomic status, receive more preventative health checkups, and may have better baseline health. Even good statistical adjustments cannot accurately measure all such differences. This is a common problem with observational studies, and it prevents the entire observed effect from being attributed solely to exercise. [38]

Finally, the study was conducted among residents of one Australian city who were 40-64 years old at the start of the study. Therefore, it cannot be automatically assumed that values of 0.50 or 0.76 will be accurately reproduced in 20-year-olds, 80-year-olds, professional athletes, or the population of countries with completely different social and medical conditions. [39]

Limitation	Possible influence
Observational design	Does not prove causality
Self-report of activity	Classification error possible
Self-report of health	There may be an inaccuracy in the diagnosis/time of illness
Healthy lifestyle in general	Residual confounding factors
One city in Australia	Limited tolerance
Age 40-64 at the start	You can't automatically transfer numbers to all ages
Different time intervals of effects	There is no single universal 9-year risk value

[40]

Why the result still matters

A strength of HABITAT is that physical activity was measured repeatedly. A single-point study might have found that healthy individuals simply exercise more frequently, as those already ill limit their activity. Five waves of observation from 2007 to 2016 allow for a better understanding of the temporal sequence of behavior and the emergence of chronic conditions, although reverse causality cannot be completely ruled out. [41]

A second strength is that the analysis focused not on an abstract level of "activity," but on compliance with two real-world components of official recommendations. This makes the results directly relevant to preventative medicine: it's not enough for people to hear "move more"; they can formulate two specific goals: regularly perform aerobic activity and don't forget about strengthening muscles. [42]

A third significance of the study is the low prevalence of a combined regimen. Although about half of the participants achieved the recommended aerobic level, only about a quarter met both parts of the recommendations. The authors believe that public campaigns are much more likely to emphasize walking, running, and general physical activity than regular strength training. [43]

This makes muscle-strengthening exercises a potentially underutilized preventative tool. The results don't require a complex exercise program: official recommendations allow for simple forms of resistance—bodyweight exercises, elastic bands, or weights. The practical implications of the study are therefore significantly simpler than its statistics: cardio shouldn't be replaced by strength training, but strength training shouldn't be excluded from a health program either. [44]

What does this mean in practice?

For healthy adults, the results align well with current recommendations: aerobic activity should remain regular, and muscle-strengthening activities should be included at least twice a week. The 2026 Australian guidelines recommend that adults engage in moderate-to-vigorous physical activity for 30 minutes or more on most days, and strength-training activities at least two days a week. [45]

According to international recommendations from the World Health Organization, the benchmark for aerobic exercise is 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity per week. Strength training consists of moderate or higher intensity exercise targeting major muscle groups at least two days per week. [46]

You don't necessarily need to be a bodybuilder to meet the strength recommendations. Squats, lunges, push-ups, exercises with rubber bands, dumbbells, or machines are all different ways to create muscular resistance. For people who are currently relatively sedentary, the World Health Organization's recommendations specifically emphasize that any physical activity is better than no activity, so there's no need to start with maximum volume right away. [47]

For people with existing chronic conditions, the volume and type of exercise may require adaptation. Australian guidelines for adults with chronic conditions still include moderate-intensity activity and strength training, but the specific program should take into account functional limitations and the medical situation. [48]

Practical purpose	Landmark
Moderate aerobic activity	150-300 min/week according to WHO
Intense aerobic activity	75-150 min/week
Strength training	≥2 days/week
Major muscle groups	It is advisable to turn it on regularly
If a person has not trained	Start with the available volume
The main principle of the article	Aerobic + strength activity

[49]

What the study showed—and what it didn't prove

The study showed	It didn't prove it
Following both recommendations is associated with a lower chance of diabetes.	That exercise is guaranteed to prevent diabetes
For diabetes, the OR was 0.50.	That the absolute risk is reduced by exactly 50%
For hypertension, the OR was 0.76.	That any person's blood pressure will decrease by 24%
For heart disease, the OR was 0.63.	That the strength itself gives the whole effect
For cancer, the OR was 0.77.	That all cancers are prevented equally
The combined activity looked most favorable	That cardio can be replaced with strength training
The observation lasted for 9 years.	That it was a randomized 9-year trial
The power component deserves more attention	What do you need: heavy weights or a gym?

[50]

Research funding

The HABITAT project was funded by the Australian National Health and Medical Research Council. The publication notes government funding for the HABITAT cohort itself. [51]

Other publications from the same cohort list key grants from the National Health and Medical Research Council of Australia: 339718, 497236 and 1047453. These grants supported successive stages of the long-running HABITAT project, from which the current work was prepared.[52]

The study was conducted by scientists from the University of Queensland in collaboration with Bond University and Griffith University. The authors of the new paper included Anh Tung Pham, Michalis Stylianou, Stephanie L. Duncombe, Wendy J. Brown, Nicola W. Burton, and Gregore I. Mielke. [53]

Therefore, the study is based on a longitudinal Australian population-based cohort, rather than data from a fitness company or sports equipment manufacturer. This does not eliminate the methodological limitations of an observational design, but it does alleviate concerns that the primary research question was directly shaped by commercial interests in selling strength training or sports products. [54]

Results

A new Australian study adds to the argument that thinking about physical activity as a two-component system is beneficial for chronic disease prevention. Aerobic exercise remains the foundation, but regular muscle strength training can add distinct metabolic and functional benefits. [55]

Among 8072 middle-aged adults, meeting both recommendations was associated with approximately 50% lower odds of type 2 diabetes, 24% lower odds of hypertension, and 23% lower odds of cancer in the corresponding analysis period. For heart disease, the odds ratio was 0.63.[56]

But these figures shouldn't be taken as a guarantee for any specific individual. These are odds ratios in a longitudinal observational cohort, where physical activity was measured by self-report, and the most significant associations with different diseases emerged at different time points. Particular caution should be exercised with the result for cancer, where the upper limit of the 95% confidence interval reached 1.00. [57]

The most consistent practical conclusion is much simpler: it's no coincidence that current recommendations include both cardio and strength training. New research suggests that focusing solely on aerobic exercise may mean missing a potentially important component of chronic disease prevention in midlife. [58]

News source

Pham AT, Stylianou M., Duncombe SL, Brown WJ, Burton NW, Mielke GI Adherence to aerobic and muscle-strengthening physical activity guidelines and development of chronic diseases: Findings from the HABITAT cohort. Journal of Science and Medicine in Sport. Published online July 24, 2026, ahead of print. [59]

DOI: 10.1016/j.jsams.2026.07.016.