Assessment of Long-Term Engagement to Aerobic Versus Resistance Exercise on 20-Year Cardiovascular Disease Incidence (2002-2024): the ATTICA Epidemiological Cohort Study

Background/Objectives: The aim of this study was to assess whether aerobic exercise, as opposed to resistance training or a combination of both, is associated with long-term cardiovascular out-comes. Methods: The ATTICA is a population-based cohort study with 20-year follow-up (2002-2022); it was conducted in the Attica region, Greece, and included 3042 adult participants (45±11 years, 1518 females). Physical activity engagement to aerobic, resistance or combined exercise, and 20-year tracking, together with information regarding cardiovascular disease (CVD) incidence were available from1,988 participants (45±12 years old, 987 males, 1,001 females). Physical activity levels were evaluated using the validated International Physical Activity Questionnaire, in all follow-up examinations (2001-2002, 2006, 2012, and 2022). Results: Participants engaged in combined (aerobic and resistance) physical activity group had 0.41-times [95%CI (0.20, 0.82)] lower atherosclerotic cardiovascular disease (ASCVD) risk as compared to inactive; participants in the healthy engaging aerobic physical activity (HEPA) group had 0.54-times [95%CI (0.36, 0.80)] lower ASCVD risk; no significant associations were observed regarding minimally active aerobic group [HR, 0.81, 95%CI(0.57, 1.17)], or resistance training only group [HR, 1.17, 95%CI(0.25, 1.52)]. Conclusions: These findings carry a strong public health message, underscoring the importance of incorporating aerobic or combined aerobic-resistance training into physical activity guidelines to enhance cardiovascular health and reduce the long-term risk of CVD.