A study published in the British Journal of Sports Medicine found that adults may need significantly more weekly physical activity than current guidelines recommend in order to substantially reduce the risk of heart attack and stroke.

Main Findings of the Study

An analysis of observational data revealed that strong cardiovascular protection was associated with 560–610 minutes of moderate and vigorous physical activity per week. This is three to four times higher than the current public health recommendation of at least 150 minutes per week. Activities considered moderate or vigorous include brisk walking, running, and cycling.

The Role of Physical Fitness

The required amount of exercise may depend on an individual's fitness level. The study showed that people with lower physical endurance needed somewhat more activity to achieve similar cardiovascular benefits compared to those in better shape. Based on these findings, the authors suggest that a one-size-fits-all approach to physical activity recommendations may need to be reconsidered. In the future, guidelines could take into account individual activity goals based on fitness levels.

Cardiorespiratory Endurance and Heart Health

Cardiorespiratory endurance varies greatly among individuals and is considered an important indicator of heart health. Low endurance is closely linked to a higher risk of heart attack, stroke, and premature death. One common way to measure endurance is the VO2 max, which reflects the maximum rate at which the body can consume oxygen during intense exercise. This metric demonstrates how efficiently the heart, lungs, and muscles work together to deliver and use oxygen.

Study Design

The study included 17,088 participants from the UK Biobank database (2013–2015), with an average age of 57 years; 56% were women and 96% were white. Each participant wore a wrist device to track physical activity for seven consecutive days and completed a cycling test to assess VO2 max. The analysis accounted for factors such as smoking, alcohol consumption, self-rated health, diet, body mass index, resting heart rate, and blood pressure.

Over an average follow-up period of 7.8 years, there were 1,233 cardiovascular events recorded, including 874 cases of atrial fibrillation, 156 heart attacks, 111 cases of heart failure, and 92 strokes.

Link Between Activity and Disease Risk

Adults who met the recommended 150 minutes of exercise per week had an 8–9% lower risk of cardiovascular disease. This association was observed across all fitness levels. However, to achieve substantial protection (a risk reduction of more than 30%), 560–610 minutes of moderate and vigorous activity per week were required. Only 12% of participants reached this level of physical activity.

Those with the lowest fitness levels needed about 30–50 minutes more exercise per week than the fittest individuals to gain similar benefits. For example, a 20% reduction in cardiovascular risk was linked to 370 minutes of weekly activity for people with low endurance, compared to about 340 minutes for those with high endurance.

Study Limitations

The study was observational, so it cannot prove that increased physical activity directly reduces the risk of cardiovascular disease. Other limitations include the possibility that participants were healthier and fitter than the general population; cardiorespiratory endurance was assessed indirectly; and sedentary time and low-intensity activities were not considered.

Conclusions

Current physical activity guidelines are considered a reliable minimum for heart protection. At the same time, more detailed recommendations could help motivated individuals increase their activity and gain greater heart health benefits. In the future, guidelines may distinguish between the minimum amount of moderate and vigorous activity needed for basic protection and the much higher volumes required for optimal cardiovascular risk reduction.