I had a reminder this weekend that recovery matters more as we get older.
On Saturday I played golf with my son and realised afterwards that I’d done something I almost never do: I’d barely drunk anything all day, and certainly hadn’t had any electrolytes.
After finishing the round, I put the clubs in the boot and lifted my left leg up to take my shoe off. Instantly my calf went into the most severe cramp I can remember. Most cramps last ten or fifteen seconds. This one seemed to go on for well over a minute and was genuinely excruciating. Today the muscle is still sore, which was frustrating because Sunday was meant to be leg day in the gym. When I was in my twenties I skipped leg day all the time. Now I do the opposite. Each week I’ll typically do hundreds of squats, lunges, deadlifts and balance exercises. As we get older, leg strength and stability become incredibly important for long-term health.
I was asked to write an article recently which was published last week for The i Paper about the role of strength training in heart health. If you subscribe to the ‘i’ you can read the article here It was nice to be asked for my expertise in a national paper, but as you many not have a subscription, I wanted to outline my advice on strength training here.
Something I see all the time in clinic is that most people think about exercise and the heart in only one way. They think about cardio. Cardio is important — but it’s only half the story Ask someone what exercise is best for heart health and you’ll usually hear the same answers: walking, running, cycling or swimming.
All excellent. All beneficial. But they’re only part of the picture.
As a cardiologist, I meet many patients who are very aware they “should do cardio”. Far fewer realise that resistance or strength training is just as important for cardiovascular health. Somewhere along the way we started to associate a “healthy heart” almost exclusively with aerobic exercise. But the body doesn’t work in neat compartments like that. Muscle, metabolism, blood pressure regulation and cardiovascular health are deeply interconnected.
Why strength training matters for the heart
One of the common concerns people have about lifting weights is that blood pressure rises during the exercise itself. That’s true — but it’s also completely normal. Blood pressure is supposed to rise when the body is under demand. What matters more is what happens the rest of the day. People who regularly perform resistance training often have lower resting blood pressure overall. In other words, allowing the cardiovascular system to work harder for short periods can lead to better control during the other twenty-three hours of the day.
Strength training also has powerful metabolic effects. Large muscle groups — particularly in the legs, hips and chest — act as major sinks for glucose. Training them regularly improves insulin sensitivity, helping the body manage blood sugar more effectively and reducing the risk of developing type 2 diabetes.
It also improves aspects of cholesterol metabolism, often lowering triglycerides and increasing HDL cholesterol.
When you combine improvements in blood pressure, metabolic health, body composition and inflammation, the overall result is a meaningful reduction in cardiovascular risk. Put simply: strength training doesn’t just make you stronger. It lowers the chances of heart attack and stroke.
The best results come from combining cardio and strength
None of this means cardio isn’t important. Aerobic exercise remains vital for endurance, cardiovascular fitness and overall wellbeing, but the evidence increasingly suggests that a combination of aerobic exercise and resistance training produces the best long-term outcomes. Cardio trains the heart and lungs to sustain effort. Strength training helps regulate metabolism, maintain muscle mass and preserve physical function. This last point becomes especially important as we age.
The problem of muscle loss: One of the most significant physiological changes of ageing is sarcopenia, the gradual loss of muscle mass and strength. We cannot stop it entirely, but we can slow it dramatically Maintaining muscle strength is about far more than appearance or athletic performance. It is a major determinant of independence later in life. The ability to catch yourself if you trip, step up onto a pavement, or regain balance after slipping depends on strength and power in the legs and hips. Jogging alone won’t give you that. Strength training will.
You don’t need a gym to start – One of the biggest misconceptions about resistance training is that it requires a gym membership or specialised equipment. It doesn’t. I have patients in their eighties who began with simple movements at home and saw remarkable improvements in strength and confidence. Two sessions per week is an excellent starting point. The key is to focus on movements that recruit large muscle groups. Some of the most effective include:
Squats (or sit-to-stands)
These work the largest muscles in the body and have powerful effects on blood sugar regulation and blood pressure control.
Hip hinges or deadlift movements
These strengthen the glutes, hamstrings and back, which are critical for posture and power.
Push-ups
A simple way to train the chest, shoulders and arms while engaging the core.
Step-ups
Great for balance, coordination and functional strength.
Loaded carries
Simply carrying weights — or even heavy shopping bags — while walking challenges the cardiovascular system and improves grip strength, which itself is a surprisingly strong predictor of overall health.
Consistency matters more than perfection
In my own training I often follow structured programmes for several weeks — perhaps focusing on strength, mobility or power — before changing things up again. The exact programme matters far less than consistency. I say this all the time in clinic, but the best exercise routine is the one you can keep doing. The combination of cardio and strength training remains one of the most powerful tools we have for maintaining heart health as we age.
In this week’s video, I thought it might be useful to talk about what exactly is insulin sensitivity, why it matters, and where does strength training fit in.