Smoking vs Not Lifting Weights: Which is Worse?
Updated: Apr 9
Modern medicine has long detailed the dramatic effects of smoking on human health. Today, everyone knows that smoking leads to cancer, heart attacks, strokes, and premature death. However, another fact that has been quietly gaining traction in scientific literature in recent years is that muscle strength and functional capacity are biomarkers as powerful as smoking in determining mortality risk.
In particular, the lack of resistance training is a risk factor that is still not taken seriously enough by society. New studies show that muscle strength is not only an indicator of fitness but also plays a central role in vital areas such as cardiovascular health , metabolic endurance , independent living capacity , and immune system function .
This article will examine the findings of large-scale research data on smoking, new research-based data on cognitive and muscular strength, how these two risk factors affect mortality (risk of death) , and the differences and similarities between them.
The Effect of Smoking on the Risk of Death
The Effects of Smoking
The effects of smoking on health are not limited to individual health; it also causes significant harm to public health. Individuals who smoke have a higher risk of death than non-smokers. Research shows that smoking leads to serious health problems such as heart disease and cancer.
WHAT IS THE HAZARD RATIO?
The hazard ratio is one of the most reliable relative risk measures used in epidemiological research. Its purpose is to compare the rate of events occurring over time between two groups . This event is usually " death ," but it could also be a heart attack, stroke, or cancer.
Simply:
HR = 1.0 → Risk remains the same.
HR = 1.5 → The risk is 50% higher in a group.
HR = 2.0 → Risk is twice as high.
HR = 3.0 → Risk is three times higher.
For example, if we compare a group of non-smokers with a group of daily smokers and find the Hazard Ratio (HR) to be 2, this indicates that the smoking group has twice the risk of death. The important point is that the Hazard Ratio does not give an absolute mortality rate , but rather captures the relative difference between the two groups.
The value of HR is important for the following reason:
Even when numerous variables (age, gender, income, BMI, diseases, medications, activity) are controlled for, it shows the independent effect of a single factor (smoking, muscle strength, obesity, hypertension, etc.).
HOW MUCH DOES SMOKING INCREASE THE RISK OF DEATH?
(Details of the NHANES analysis of 30,674 people)
NHANES (National Health and Nutrition Examination Survey), one of the largest population health screenings conducted in the US, is an excellent data source for examining the effect of smoking on mortality. In this study, 30,674 adults were followed for an average of 8.3 years.
Risk Distribution According to Smoking Levels
Non-drinkers = Reference group (* HR ≈ 1.0)*
This group forms the basis of all calculations.
Occasional smokers (nondaily smokers)
HR ≈ 1.50
Key finding: Even those who say, "I only smoke one a day, and only occasionally," have a 50% increased risk.
Those who smoke less than 20 cigarettes a day
HR ≈ 1.54
Even in the "light drinker" category, the risk increases by 54%.
People who smoke 20–40 cigarettes a day
HR ≈ 2.09
Smoking a typical pack increases the risk of death by 109%. That's more than double the risk.
People who smoke ≥40 cigarettes a day
HR ≈ 2.78
This group is at the highest risk of mortality. The risk of death is almost three times higher.
SPECIFIC TYPES OF DEATH CAUSED BY SMOKING
Smoking not only increases overall mortality; it dramatically increases the risk of death in two specific categories:
Cardiovascular deaths
Smoking damages the inner lining of blood vessels.
It increases inflammation,
It accelerates atherosclerosis,
Myocardial infarction can predispose to heart failure and stroke.
Cancer deaths
Carcinogens in cigarette smoke cause DNA mutations.
There is a strong association with 16 types of cancer, particularly lung cancer.
DOES QUITTING SMOKING REDUCE THE RISK?
The effect of quitting smoking is clearly shown in the table: each year spent quitting creates a measurable improvement in the risk of death. Using current smokers as a reference (HR = 1.0), the risk decreases as follows after quitting:
In the first 5 years: Although the risk of death does not yet fully normalize, it begins to decrease significantly (HR ≈ 0.74–0.79 ).
After 5–10 years: The risk decreases much more dramatically, falling to approximately 55% lower compared to non-drinkers (HR ≈ 0.45–0.51 ).
10–20 years later: Risk continues to decline steadily (HR ≈ 0.50–0.54 ).
In those who quit more than 20 years ago: The risk of death almost completely approaches that of non-smokers (HR ≈ 0.37–0.46 ).
This pattern is observed not only in all-cause mortality but also in cardiovascular and cancer deaths . In particular, in cardiovascular deaths, a decrease in HR to 0.35 after 5–10 years indicates that the risk of heart disease can be reduced by more than half.
HOW MUCH DOES NOT DOING WEIGHT TRAINING INCREASE THE RISK OF DEATH?
The 2024 Scientific Reports study is one of the most comprehensive analyses to evaluate the relationship between muscle strength and mortality.
Why Hand Grip Strength?
Grip strength is a simple, inexpensive, fast, and accurate measurement of overall muscle strength . Studies have shown that hand strength is linked to whole-body muscle strength, functional capacity, lifespan, metabolic health, immune function, frailty, and sarcopenia (muscle wasting).
Therefore, hand grip strength is one of the most powerful biomarkers for predicting aging and disease risk.
LOWER MUSCLE STRENGTH = HIGHER RISK OF DEATH
A study using NHANES data from 2011–2014, which followed 9,583 adults for approximately six years, clearly demonstrates how powerful a biomarker for longevity muscle strength is.
Participants were divided into four groups based on their strength level (Q4 = strongest, Q1 = weakest), with the strongest group serving as the reference. The common finding across all measurements is this:
Being in the weakest quartile means a 2–3 times higher risk of death compared to being in the strongest quartile.
The strongest group in the findings (Q4) has HR=1, meaning that when taken as the reference group, the data for the weakest group (Q1) is as follows:
The group with the weakest average cognitive ability (HCE) has a 3.00 times higher risk of death. (That is, even when adjusted for the same age, smoking habits, BMI, and diseases, the risk is three times higher.)
The group with the weakest maximum grip strength (MGS) carries a 3.16 times higher risk. This is one of the strongest associations in the study.
In the group with the weakest HGS/BMI (strength-to-body weight ratio): the risk is 2.88 times increased.
The HGS/HT² (power-to-height² ratio) is lowest in the group with the lowest risk: 2.39 times higher. This measurement is particularly significant as it shows the true power capacity independent of height.
In the group with the weakest MGS/weight (maximum power/weight ratio): the risk increases 3.09 times .
All these measurements consistently support each other: the greater the decrease in muscle strength, the greater the risk of death.
Normalized measurements show no change in the results. Even when muscle strength is adjusted for body weight or height, those with weaker muscles systematically have higher mortality. This suggests that grip strength reflects "overall physiological capacity."
IS SMOKING WORSE OR NOT EXERCISING?
When we put the data on the table, this is the picture that emerges:
Risk Factor | HR (Original Death from All Causes) |
This table tells us the following:
1) Heavy smoking → increases the risk of death by 2.5–3 times.
2) Being in the weakest 20% of muscle strength → increases the risk of death by approximately 3.0 times.
This does not mean that "a person with low muscle strength is worse off than a smoker." However, we can state very clearly that very low muscle strength is just as serious a warning sign in terms of mortality as heavy smoking.
CONCLUSIONS
1) Smoking — it is not safe at any level.
Even drinking small amounts is risky. Quitting always offers benefits.
2) Do weight training — muscle strength is critical for mortality.
Resistance training at least 2-3 days a week:
It prolongs lifespan.
Reduces the risk of chronic diseases.
It increases independent living duration.
It reduces inflammation.
Increases metabolic endurance.
CONCLUSION
Smoking kills — there's no debate about that. But physical weakness is a much stronger risk factor than most people are aware of.
References:
Zhu D, Zhao G, Wang X. Association of Smoking and Smoking Cessation With Overall and Cause-Specific Mortality. Am J Prev Med. 2021 Apr;60(4):504-512. doi: 10.1016/j.amepre.2020.11.003. PMID: 33745522.
Chai L, Zhang D, Fan J. Comparison of influenza strength measurements for predicting all-cause mortality among adults aged 20+ years from the NHANES 2011-2014. Sci Rep. 2024 Nov 25;14(1):29245. doi: 10.1038/s41598-024-80487-y. PMID: 39587152; PMCID: PMC11589676.
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