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Posted on Tuesday February 3, 2026 in Metabolic Health
An article written by Dr Edward Leatham, Consultant Cardiologist © 2025 E.Leatham
(Even If You Walk a Lot, Run, or Hit 10,000 Steps)
For decades, the dominant public health message around exercise has been simple: move more. Walk more. Run more. Increase your step count. Aerobic exercise undoubtedly improves cardiovascular fitness, mood, insulin sensitivity, and longevity.
Yet in everyday clinical practice, particularly in people over 50, a paradox is increasingly obvious. Many patients are already active. They walk 8,000–12,000 steps a day. Some cycle, swim, or jog regularly. And yet their waist circumference continues to rise, strength declines, glucose control deteriorates, and visceral fat accumulates.
The missing ingredient is rarely more movement.
It is strength.
This article explains why 10 minutes of resistance training per day, five days a week, when combined with adequate daily protein intake, has a disproportionate impact on metabolic health, visceral fat reduction, and long-term strength — even in people who already exercise aerobically.
If you have no time to read this (length) blog, I recommend patients tune in to the AI-produced podcast instead or just jump straight to our favorite 10 min strength training video.
Cardiometabolic disease is not driven by body weight alone. It is driven by a slow, often invisible combination of:
Body mass index (BMI) performs poorly at detecting this process. Many people with “acceptable” BMI have excess visceral fat and are metabolically unhealthy, while others lose weight without improving metabolic risk.
For this reason, we prioritise waist circumference in clinical assessment. Waist size is one of the simplest and most reliable surrogate markers for visceral fat — the fat depot most closely linked to type 2 diabetes, hypertension, dyslipidaemia, and cardiovascular disease¹.
If you want to understand metabolic risk, look at the waist, not just the scale. To measure yours accurately, see a seperate blog.
Skeletal muscle is often thought of purely as a movement system. In reality, it is the body’s largest insulin-sensitive organ and a central regulator of metabolic health.
It plays a key role in:
From midlife onwards, skeletal muscle mass and strength decline progressively — often unnoticed. Weight may remain stable, masking the fact that muscle is being replaced by fat, particularly visceral fat.
Crucially, aerobic exercise alone does not reliably prevent this process. While it improves cardiovascular fitness and mitochondrial efficiency, it provides insufficient mechanical stimulus to preserve muscle mass and strength in ageing adults².
This is why people can be highly active yet progressively weaker and more metabolically unwell.
Resistance training provides a stimulus that aerobic exercise does not: mechanical load.
When muscle is exposed to load:
These effects persist for up to 48 hours after a single session. When resistance exercise is performed regularly, the metabolic benefits accumulate³.
Importantly, these benefits do not require long sessions.
The focus on 10 minutes is not arbitrary, and it is not a compromise. It is a deliberate design choice grounded in long-term behaviour.
Restoring and maintaining metabolic health is not a short programme. It is not a 12-week challenge or a temporary reset. It is far closer to everyday habits such as:
These are not activities people negotiate with themselves about. They happen because they are embedded in daily life.
There is little value recommending an exercise intervention that looks impressive on paper but cannot realistically be sustained for years. If an approach cannot survive work stress, travel, illness, ageing, or loss of motivation, it cannot protect long-term metabolic health.
Ten minutes, five days a week, fits real lives.
It removes the psychological barrier to starting.
It does not require special facilities or equipment.
It is still doable when energy is low.
Most importantly, people keep doing it.
A common misconception is that effectiveness requires either:
In reality, strength gains can be driven by progressive load, not necessarily longer workouts.
By fixing the time commitment at 10 minutes, the variable that changes over time is not duration — it is weight lifted.
As strength improves:
The session stays short.
The stimulus increases.
This approach keeps strength training progressive, measurable, and motivating — without allowing it to expand into something unsustainable.
One of the most consistent clinical observations we see is this:
Waist circumference continues to fall even when body weight plateaus, once resistance training is added.
Resistance training:
Visceral fat is highly insulin-sensitive and metabolically active. When insulin levels fall and skeletal muscle demand rises, VAT is preferentially mobilised⁴.
This explains why waist measurement often tells a clearer metabolic story than body weight or bioimpedance-derived fat estimates.
The figure below overlays weight, waist circumference, and visceral adipose tissue (VAT) from a single individual followed longitudinally. During a prolonged period of fixed-dose GLP-1 mimetic therapy, body weight fluctuates and biometric scales suggested possible “lean mass loss”. In contrast, waist circumference and inferred VAT continue to fall steadily. The key behavioural change introduced during this phase was 10 minutes of daily resistance training, performed five days per week, alongside adequate protein intake and improved glucose control. No increase in total exercise time or aerobic activity was required.
By deliberately keeping the intervention short and sustainable, adherence was maintained and progression occurred through increasing resistance rather than extending session duration. The continued reduction in waist/VAT despite weight variability highlights why small, repeatable strength stimuli can drive meaningful metabolic change, and why waist measurement provides a more clinically relevant signal than weight or bioimpedance estimates alone.
Interpreting change: why we measure waist and strength, not weight or muscle mass
Weight, waist circumference, and paired low-dose CT–derived visceral adipose tissue (VAT) measurements from a representative patient using SCVC’s 8 month metabolic reset programme using strength training alongside low dose GLP-1 mimetics .
The CT VAT points track closely with changes in waist circumference, illustrating why waist measurement is a practical surrogate for VAT, and why paired low-dose VAT CT scans are offered as an optional tool within our GLP-1 clinic.
In contrast, weight alone is unhelpful as a marker of metabolic improvement. As resistance training is introduced and strength increases, gains in skeletal muscle and intracellular water can offset or exceed losses in visceral fat on the scales. A stable or modestly falling weight may therefore mask substantial improvement in metabolic risk.
Similarly, measuring limb or muscle circumference can be misleading. Circumference reflects not only muscle, but also subcutaneous fat, intramuscular fat, and fluid shifts, all of which may change independently of true muscle function. For this reason, limb measurements, skinfold callipers, and bioimpedance-derived muscle mass estimates often provide conflicting or confusing signals during weight loss or GLP-1 therapy.
Instead, we prioritise functional measures of strength, such as the sit-to-stand test and hand-grip dynamometry. Strength reflects the integrated performance of skeletal muscle and correlates more strongly with clinical outcomes — including metabolic health, independence, and longevity — than muscle mass alone. For patients, these tests are simple, repeatable, and meaningful (see app link to test your own strength).
Click image for higher resolution
Taken together, this figure illustrates a central principle of our approach: waist tracks visceral fat, strength tracks muscle health, and weight alone tells very little.
Walking, running, cycling, and swimming are excellent for cardiovascular fitness. They improve endurance and reduce cardiovascular risk. But they do not:
In some cases, high volumes of aerobic exercise combined with calorie restriction and inadequate protein intake can accelerate muscle loss.
This is why some very active people still develop:
They are active — but under-muscled.
Strength training corrects this imbalance.
Resistance training provides the signal.
Protein provides the raw materials.
Without adequate protein:
This becomes particularly important during:
Older adults require higher protein intakes than younger adults to preserve muscle mass, especially when physically active or losing weight⁵.
Rather than guessing, we track protein intake using food analysis apps. This allows us to confirm adequacy directly, rather than inferring muscle loss from indirect body composition estimates.
A short, home-based routine has another powerful advantage: it can be shared.
Men and women use different absolute weights, but they can perform:
A 10-minute routine can therefore become a shared daily habit for partners. Shared routines improve adherence, motivation, and long-term consistency.
Adherence determines outcomes.
Weight loss of any kind includes some loss of lean tissue. The clinical aim is not zero lean mass loss, but:
Short, regular resistance training sessions — combined with adequate protein intake — help achieve this balance.
In patients using GLP-1 mimetics, reduced appetite and calorie intake raise theoretical concerns about muscle loss. In practice, when strength training is maintained, we consistently observe:
The body adapts to the dominant stimulus it receives.
This approach reframes strength as a clinical endpoint, not an aesthetic goal.
Measures such as:
are strongly associated with morbidity, mortality, independence, and cardiovascular risk².
Strength is not optional.
Strength is medicine. You can read more on how muscle strength is a better mark than mass in a related blog.
The strength assessment accessed by click on the icon uses a simple sit to stand assessment in 30 seconds and grip meter to gather objective information on upper and lower body strength.
Think of skeletal muscle as your metabolic engine.
Aerobic exercise improves the efficiency of the engine.
Strength training increases the size and capacity of the engine.
Protein supplies the materials needed to maintain it.
If you only focus on efficiency while allowing the engine to shrink, performance eventually declines.
Ten minutes a day keeps the engine powerful enough to do the work.
If your goals include:
then 10 minutes of resistance training per day, five days a week, combined with adequate daily protein intake, is one of the highest-yield interventions available.
It is simple.
It is sustainable.
It works — even for people who already do plenty of cardio.
Ten minutes is not about doing the minimum.
It is about doing what you can still be doing five years from now.
For this reason, tracking strength during weight loss is often more meaningful than focusing on muscle size alone. At SCVC we use the VAT Trap strength assessment tool to gauge and track strength in our patients, click on the icon below to try out the free app, developed for the VAT-TRAP.
Examples of short session training at home sessions are shown in the Youtube links below or see the strength training playlist on VAT-TRAP channel
In cardiometabolic medicine, muscle is not a cosmetic tissue but a metabolic organ. Evidence consistently shows that strength, not muscle mass, predicts insulin resistance, cardiovascular risk, and survival. Many older adults are not losing muscle tissue — they are losing muscle function, and that is the pathology that matters.
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Is is increasingly obvious that not everyone with raised coronary inflammation and elevated risk of heart attack simply has a raised LDL Cholesterol- in fact there appears to be a mixed bag of risk factors associated with high coronary artery inflammation, including raised LDL, raised LP (a), raised Homocysteine, hypertension and dysregulated glucose. Our metabolic health assessment is therefore designed to offer a comprehensive dive into known contributory causes, the latest and most controversial of which is 'glucose dysregulation', the principle topic of this article.
If you have ever found yourself feeling breathless climbing stairs or walking uphill — even though your lung and heart tests are “normal” — you are not alone.Many people attribute it to age or fitness. But recent research has uncovered a powerful hidden cause of breathlessness: visceral fat — the fat stored deep inside your abdomen, around your organs. In this blog, we will explore what visceral fat is, how it affects your breathing, and — most importantly — what you can do about it.