- New research suggests that adults who completed 560 to 610 minutes of moderate-to-vigorous exercise per week had a more than 30% lower risk of cardiovascular disease than inactive individuals.
- Current guidelines of 150 minutes of weekly exercise were linked to a more modest 8 to 9% reduction in cardiovascular risk.
- The findings suggest that those with lower cardiorespiratory fitness appeared to need more weekly exercise than fitter individuals to achieve the same heart health benefits.
- Researchers suggest future exercise recommendations may need to become more personalized, with separate targets for minimum health benefits versus optimal cardiovascular protection.
Regular exercise plays a
Cardiorespiratory fitness describes the ability of the heart, lungs, and blood vessels to supply oxygen to the muscles during exercise. It can serve as a powerful, independent biomarker for heart health. It is improved through aerobic activities, such as walking, running, cycling, and swimming, which can help improve blood circulation and lower blood pressure and cholesterol levels.
Current guidelines from the
However, this one-size-fits-all approach to exercise may not provide sufficient activity levels for all people, with a new study suggesting that some may need roughly four times higher weekly exercise than the current guidelines to achieve significant protection against heart attacks and stroke.
The findings, published in the British Journal of Sports Medicine, also propose personalized targets, suggesting that a person’s fitness level may influence how much exercise they need to gain cardiovascular benefits.
The researchers analyzed health and activity data from more than 17,000 adults participating in the UK Biobank study. The average age of participants was 57 years, 56% were female, and 96% were white.
Individuals wore wrist-based activity trackers continuously for 7 days and completed exercise testing designed to estimate their VO2 max. This is a measure of cardiorespiratory fitness that reflects the maximum volume of oxygen the body can use during intense exercise.
The analysis also included data on smoking status, alcohol intake, self-rated health and diet, body mass index, resting heart rate, and blood pressure.
During nearly 8 years of follow-up, the researchers recorded more than 1,200 cardiovascular events, including atrial fibrillation, heart attacks, heart failure, and strokes.
Adults who met the current 150-minute recommendation saw an 8 to 9% reduction in cardiovascular risk, regardless of fitness level. However, researchers reported that substantially larger benefits appeared only at much higher exercise volumes.
Notably, adults who completed between 560 and 610 minutes of moderate-to-vigorous physical activity each week achieved substantial protection in cardiovascular risk, classed as a greater than 30% risk reduction.
However, the researchers add that only 12% of people in the study achieved this level of exercise.
Study author Ziheng Ning, PhD, Professor of Faculty of Health Sciences and Sports at Macao Polytechnic University emphasized to Medical News Today that these findings should not deter people from exercising.
“I think it is important that people interpret this finding carefully and not conclude that 150 minutes is ‘insufficient’ or ‘meaningless.’ The current WHO guideline remains extremely important because it is achievable, evidence-based, and clearly beneficial.”
— Ziheng Ning, PhD, study author
“What our study suggests is that 150 minutes per week may function more as a minimum effective threshold rather than the amount associated with maximal cardiovascular protection,” he said.
“To some extent, we were surprised that the estimated risk reduction at 150 minutes was relatively modest compared with the larger reductions observed at higher activity levels. However, modern lifestyles are also extremely sedentary. Many individuals spend most of the day sitting, so relatively short periods of exercise may not fully counterbalance prolonged inactivity physiology,” Ning explained.
“At the same time, cardiovascular adaptations are likely cumulative and nonlinear. Improvements in vascular function, autonomic regulation, metabolic health, and cardiorespiratory efficiency may continue developing with larger accumulated activity exposure over time,” he added.
The study also found that people with lower cardiorespiratory fitness may require roughly 30 to 50 additional minutes of weekly exercise to achieve the same level of protection as fitter individuals.
For example, participants with lower fitness required approximately 370 minutes of moderate-to-vigorous activity per week to lower cardiovascular risk by 20%, compared with around 340 minutes among those with higher fitness levels.
The researchers note that this may reflect a steeper challenge that people who are less physically conditioned may experience. This aligns with previous knowledge, as cardiorespiratory fitness is already known to be strongly linked with heart health, and lower fitness levels have consistently been associated with a higher risk of heart problems.
“The most important principle is consistency and gradual progression. Many people hear ‘500 to 600 minutes’ and imagine intense athletic training, but much of this activity can come from:
- brisk walking
- cycling
- commuting
- recreational sports
- hiking
- sustained daily movement
Improving cardiorespiratory fitness generally requires:
- regular movement
- moderate-to-vigorous intensity
- long-term adherence
For many adults, a realistic strategy may involve:
- reducing sedentary time
- increasing daily movement exposure
- incorporating some more vigorous aerobic activity when appropriate
Importantly, exercise should ideally become part of lifestyle rather than a short-term intervention.”
— Ziheng Ning, PhD
Based on their findings, the researchers suggest that exercise guidance may need to shift away from a one-size-fits-all approach. Instead, future recommendations could distinguish between the minimum amount of exercise necessary for basic cardiovascular protection and the higher levels required for optimal risk reduction.
However, the team highlights that the study was observational, meaning it cannot prove cause and effect. Additionally, the participant group was predominantly white and may have been healthier than the broader population, potentially limiting the generalizability of the findings.
Also, the study did not fully account for certain factors, such as sedentary behavior or lower-intensity physical activity.
“I believe that [personalized exercise recommendations based on fitness levels] may gradually become an important future direction,” Ning told MNT. “Traditional public health guidelines are designed to be simple, achievable, and broadly applicable across populations. That remains extremely valuable.”
“However, our findings suggest that individuals with different cardiorespiratory fitness levels may require different amounts of physical activity to achieve comparable cardiovascular protection. This raises the possibility that future exercise medicine could become more individualized, incorporating fitness status, baseline cardiovascular risk, age, metabolic Health, and lifestyle factors,” he continued.
“One important message from our study is that exercise should probably not be viewed as a simple pass/fail threshold. Cardiovascular protection appears to exist along a continuum. Some movement is better than none, more movement may provide additional benefit, and fitness itself plays an important independent role.”
— Ziheng Ning, PhD, study author
“Our findings ultimately support a broader shift toward more personalized and precision-based approaches to exercise and preventive medicine. In other words, we may gradually move from one-size-fits-all recommendations toward fitness-informed personalized exercise prescriptions,” Ning added.
While the suggestion of requiring 4 times the amount of recommended exercise may sound daunting, it should not discourage people who do not regularly meet current exercise goals.
Even modest increases in physical activity remain beneficial for heart health, and current guidelines are still considered an important baseline for reducing disease risk.
Instead, the study findings suggest that people seeking greater cardiovascular protection may benefit from gradually increasing activity levels over time. In particular, people can incorporate enjoyable activities that improve overall fitness, such as brisk walking, jogging, swimming, or cycling.
The findings also support future preventive heart care strategies implementing personalized exercise targets based on an individuals fitness levels rather than universal guidelines.
“I would strongly emphasize that even small increases in activity are meaningful. People should not think, ‘If I cannot reach the guideline, there is no point trying.’
In reality, moving from complete inactivity to modest activity often produces substantial health benefits. For many sedentary adults, the safest and most sustainable starting point may be:
- brisk walking
- walking after meals
- taking stairs
- cycling for transportation
- short movement breaks during work
- light recreational activities
The key is gradual progression and habit formation. In many cases, building movement into daily routines may be more sustainable than relying entirely on formal exercise sessions.”
— Ziheng Ning, PhD
