My Client's Cholesterol Results Sent Me Down a Research Rabbit Hole

A client of mine approached me recently after having some blood tests done. His cholesterol had come back higher than he'd hoped, and he was wondering whether strength training could help reduce his cholesterol levels.

We had a bit of a chat but, afterwards, I couldn't stop thinking about it. So I started digging into the research to see what the evidence actually says and came across some really interesting studies.

I thought I'd save you from spending your Friday evening reading about cholesterol like I did.

So in this blog, we'll go through what cholesterol is, what happens when it gets out of balance, and why strength training might deserve more of a mention in the conversation. And if you're the type of person who enjoys looking at the evidence yourself, I've included the research too.

When people think about improving cholesterol, strength training rarely makes the cut. Walking more, cycling, changing your diet — those are the usual suspects. Resistance training tends to get overlooked. But the research makes a strong case for including it, and if you look at the more recent evidence, it's a more compelling case than most health articles give it credit for.

What Is Cholesterol, and Why Does It Matter?

Have you ever looked at your blood test results and thought, "What am I even looking at?"

Well... you're not the only one.

The terms sound more like part of a secret code than something related to your health, so let's crack that code before we jump into the research.

Cholesterol is a fat-like substance that your body needs to build cells and produce hormones. In fact, your body couldn't function properly without it.

The problem isn't cholesterol itself — it's when the different markers become unbalanced.

The main ones you'll hear about are:

•               LDL cholesterol (Low-Density Lipoprotein) — often called "bad" cholesterol because high levels are associated with plaque build-up in the arteries (and I thought plaque was just for the teeth!)

•               HDL cholesterol (High-Density Lipoprotein) — often called "good" cholesterol because it helps remove excess cholesterol from the bloodstream.

•               Triglycerides — another blood fat that rises with poor diet, inactivity, and excess weight.

To make this easier for you, the goal is generally to keep LDL and triglycerides within a healthy range while maintaining healthy HDL levels.

What Does the Research Actually Show?

The evidence here is stronger than many people realise — and stronger than older summaries of it suggest.

A 2023 meta-analysis by Damirchi et al., published in the European Journal of Obstetrics and Gynecology and Reproductive Biology, pooled data from 19 randomised controlled trials in postmenopausal women and found that resistance training significantly reduced total cholesterol by around 11.5 mg/dL, LDL by 8.5 mg/dL, and triglycerides by 6.6 mg/dL. These aren't trivial numbers — and the postmenopausal focus matters, given how significantly lipid profiles can shift after menopause.

On the question of HDL specifically, a large observational study by Hsu et al. (2022), drawing on data from over 75,000 adults in the Taiwan Biobank, found that among all exercise types examined — aerobic exercise, weight training, and mixed exercise — resistance training showed the strongest positive association with HDL cholesterol levels. That's the opposite of what most people assume.

Of course, this isn't a one-size-fits-all situation, the effects do vary depending on the person, the training programme, and what else is changing in their lifestyle — but the overall picture from recent research is more encouraging than many people expect.

How Does Aerobic Exercise Compare?

Aerobic exercise — walking, cycling, swimming, jogging — has a well-established effect on blood lipids, and head-to-head comparisons tend to show it outperforming resistance training on most cholesterol markers, particularly total cholesterol, LDL reduction, and triglycerides.

This is all great, but what if we combined both?

Studies consistently show that combined aerobic and resistance training outperforms either modality on its own for improving total cholesterol, LDL, and triglycerides. The question isn't really which one to choose — it's how to include both .

Why Might Strength Training Help?

Muscle is metabolically active tissue. The more lean mass you maintain, the better your body tends to handle glucose, insulin and fat metabolism — all of which play an important role in overall metabolic health and can influence cholesterol levels indirectly.

Turns out muscle does more than help us carry the shopping and open stubborn jars.

Resistance training supports this through several overlapping mechanisms: it helps preserve or increase lean mass, improves insulin sensitivity, contributes to fat loss and weight maintenance, and reduces chronic low-grade inflammation.

None of these effects work on their own, they like to be part of a team, which is also why resistance training tends to show stronger results as part of a broader programme rather than as a standalone intervention.

Does Age Change the Equation?

Yes, significantly.

From our mid-30s onwards, we begin to lose muscle mass unless we actively work to maintain it — a process called sarcopenia — which affects strength, mobility, metabolic rate, and cardiovascular health. For women, menopause compounds this through shifts in body fat distribution and lipid metabolism that can raise LDL and lower HDL independent of lifestyle - what a bless to be a woman, I know, but not everything’s lost!

Resistance training can become valuable because it’s one of the few tools available that directly addresses muscle loss while also supporting the metabolic health that cholesterol management depends on.

The Bigger Picture

Resistance training works best alongside regular movement throughout the day, a diet rich in fibre and healthy fats, adequate sleep, weight management, aerobic exercise, and medical care where it's indicated. A GP or lipid specialist should always be part of the conversation if cholesterol is a clinical concern.

The reality is that cardiovascular health is influenced by many different factors, not just one thing. No single approach carries the whole load, and resistance training doesn't claim to. What it does offer is a practical, sustainable way to build muscle, protect metabolic function, and improve the physiological foundation that your heart health depends on.

Start Simple

If you're new to resistance training, you don't need an elaborate programme. Two to three well-

structured sessions per week — covering the major muscle groups with progressively increasing load — is enough to drive meaningful adaptations. Consistency over time matters far more than complexity.

If your cholesterol is something you're actively managing, this is worth taking seriously. The evidence is there. The barrier to entry is lower than most people think.

And perhaps that's the biggest takeaway from all of this. Strength training isn't just about building muscle or lifting heavier weights. It can be a valuable tool for supporting your long-term health too. You don't need to turn into Schwarzenegger and spend hours in the gym — a couple of well-planned sessions each week can go a long way.

References

Damirchi A et al. Resistance training and lipid profiles in postmenopausal women: a systematic review and meta-analysis of randomised controlled trials. Maturitas. 2023.

Li S et al. Effects of physical exercise on the lipid profile of perimenopausal and postmenopausal women: a systematic review and meta-analysis. 2025.

Hsu YL et al. Effects of regular aerobic exercise and resistance training on high-density lipoprotein cholesterol levels in Taiwanese adults. 2022.

Batacan RB et al. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile.

Smart NA et al. The effect of exercise training on blood lipids: a systematic review and meta-analysis. Sports Medicine. 2024.

Tan X et al. Effect of different exercise modalities on nonalcoholic fatty liver disease: a systematic review and network meta-analysis. 2024.