Association between muscle-strengthening activity participation and estimated arterial stiffness in adults: Evidence from NHANES 1999 – 2006

Estimated pulse wave velocity has been proposed as a surrogate indicator of arterial stiffness and may serve as a prognostic marker for cardiovascular events and all-cause mortality. Regular physical activity is known to improve cardiovascular health, yet most evidence focuses on moderate-to-vigorous aerobic activities. The impact of muscle-strengthening activities on estimated pulse wave velocity, however, remains uncertain. This study aimed to investigate the relationship between estimated pulse wave velocity and meeting the muscle-strengthening activity guidelines. Using data from the 1999–2006 cycles of the National Health and Nutrition Examination Survey, sequential regression models were constructed. Model 1 included muscle-strengthening activities only. Models 2 and 3 additionally adjusted for modifiable risk factors. Models 4 and 5 further accounted for non-modifiable factors. Participants were categorized according to whether they met the muscle-strengthening activity guidelines or not (≥ 2 sessions/week vs. < 2 sessions/week). Data from 18 438 adults (49% female; mean age 47.2 ± 20.3 years) were analyzed. Meeting the guidelines was significantly associated with lower estimated pulse wave velocity (β [95% CI]: -0.899 [-0.981; -0.817]; p < 0.001; adjusted R² = 0.020). After sequential adjustment for modifiable and non-modifiable risk factors, the association remained significant (-0.267 [-0.328; -0.206], p < 0.001; adjusted R² = 0.545). Engaging in muscle-strengthening activities at least twice a week is associated with lower estimated arterial stiffness in adults. These findings suggest an independent contribution of muscle-strengthening activities to cardiovascular risk reduction and support their inclusion in disease prevention strategies.