Muscle-Strengthening Activity, Psychological Distress, and Self-Rated Health Among US Adults: A Nationally Representative Analysis of the Neglected Exercise Pillar of Lifestyle Medicine
DOI:
https://doi.org/10.22230/ijdrp.2026v8n2a666Keywords:
chronic disease prevention, cross-sectional studies, lifestyle medicine, mental health, muscle strengthAbstract
Objectives: To examine associations of muscle-strengthening activity with psychological distress and self-rated health among US adults, adjusting for aerobic activity and other lifestyle pillars.
Methods: We analyzed 7,278 adults in the Health Information National Trends Survey (HINTS 7, 2024). Participants self-reported muscle-strengthening (days/week) and moderate aerobic activity. Outcomes were psychological distress (Patient Health Questionnaire-4, 0–12) and self-rated health (1 = excellent to 5 = poor); complete-case analytic samples were 5,485 and 5,511, respectively. Weighted linear and logistic regression with jackknife variance estimation adjusted for demographics, socioeconomic status, aerobic activity, adiposity, smoking, diet, food insecurity, social isolation, sleep, and mobility limitation.
Results: 41.6% met the muscle-strengthening guideline (≥ 2 days/week); 47.5% reported none. Each standard-deviation increment (≈ 2 days/week) was associated with lower distress (β = −0.12; 95% confidence interval [CI], −0.22 to −0.02; p = .021) and better self-rated health (β = −0.13; 95% CI, −0.18 to −0.08; p < .001) after adjustment. The association held for depressive symptoms (p = .014) but not for anxiety symptoms (p = .21). Aerobic activity was not associated with either continuous outcome (distress, p = .29; health, p = .54), although meeting the aerobic guideline, but not the musclestrengthening guideline, was associated with lower odds of fair or poor health. Distress was lowest at 2–3 days/week.
Conclusion: Muscle-strengthening activity remained associated with lower psychological distress and better self-rated health after adjustment for measured demographic, socioeconomic, behavioral, and health covariates. These cross-sectional data cannot establish direction or indicate that resistance exercise is superior to aerobic exercise. With low population uptake and existing trial evidence, they support prospective randomized evaluation of resistance training within lifestyle medicine.
