Substantial heart health benefits may require 560-610 minutes of weekly exercise, with lower fitness individuals needing even more activity to achieve similar protection.
Adults may need far more exercise than current public health guidelines recommend to significantly lower their risk of heart attack and stroke, according to an observational study published online in the British Journal of Sports Medicine.
Researchers found that adults needed between 560 and 610 minutes of moderate to vigorous physical activity each week for a substantial reduction in cardiovascular risk. That is roughly 3 to 4 times higher than the current recommendation of at least 150 minutes weekly of activities such as brisk walking, running, or cycling.
The findings also suggest that people with lower fitness levels need slightly more exercise than highly fit individuals to achieve the same cardiovascular benefits.
Researchers said current exercise recommendations may need to move away from a one-size-fits-all approach and instead provide personalized goals based on a person’s fitness level.
VO2 Max and Cardiovascular Fitness Explained
Cardiorespiratory fitness differs widely between individuals and is considered a strong indicator of heart health. Researchers noted that low cardiorespiratory fitness is closely linked to a higher risk of heart attacks, strokes, and early death.
One common way to measure fitness is through VO2 max, which reflects the maximum amount of oxygen the body can use during intense exercise. The measurement shows how efficiently the heart, lungs, and muscles work together to deliver and use oxygen.
Researchers from Macao Polytechnic University in China investigated how physical activity levels and cardiorespiratory fitness, measured through VO2 max, influenced cardiovascular disease risk.
UK Biobank Study Tracks Exercise and Heart Events
The study analyzed data from 17,088 participants in the UK Biobank study collected between 2013 and 2015. Participants had an average age of 57, while 56% were women and 96% were white.
Participants wore wrist devices for seven consecutive days to track their normal exercise levels. They also completed a cycling test to estimate VO2 max.
The researchers included additional information such as smoking habits, alcohol use, self reported health and diet, body mass index, resting heart rate, and blood pressure.
Over an average follow-up period of 7.8 years, researchers recorded 1,233 cardiovascular events. These included 874 cases of atrial fibrillation, 156 heart attacks, 111 cases of heart failure, and 92 strokes.
560–610 Minutes Weekly Linked to Stronger Risk Reduction
Adults who met the current guideline of 150 minutes of exercise per week saw a modest 8% to 9% reduction in cardiovascular risk, regardless of fitness level.
However, achieving a more substantial reduction of greater than 30% required between 560 and 610 minutes of moderate to vigorous exercise weekly. Only 12% of participants reached that level of activity.
Lower Fitness Levels Require More Physical Activity
The analysis showed that participants with the lowest fitness levels needed about 30 to 50 additional minutes of exercise each week compared with highly fit individuals to gain similar benefits.
For example, a person with low fitness needed about 370 minutes of moderate to vigorous exercise each week to reduce cardiovascular risk by 20%, compared with 340 minutes for someone with high fitness.
The researchers say, “This finding highlights the steeper challenge faced by deconditioned populations.”
Researchers Call for Personalized Exercise Guidelines
Because the study was observational, the researchers said it cannot prove cause and effect. They also acknowledged that participants may have been healthier and fitter than the general population. Additional limitations included estimating cardiorespiratory fitness rather than directly measuring it and not tracking sedentary behavior or lighter physical activity.
The team said the findings support current exercise guidelines as an effective minimum target for cardiovascular protection. However, they added that more personalized recommendations could help motivated individuals further reduce their heart disease risk.
“Future guidelines may need to differentiate between the minimal moderate to vigorous exercise volume required for a basic safety margin and the substantially higher volumes necessary for optimal cardiovascular risk reduction,” they conclude.
Reference: “Joint non-linear dose–response associations of device-measured physical activity and cardiorespiratory fitness with cardiovascular disease: a cohort and Mendelian randomisation study” by Zhide Liang, Senyao Du, Shiao Zhao, Xianfei Wang, Qiang Yan, Baichao Xu, Sanfan Ng and Ziheng Ning, 19 May 2026, British Journal of Sports Medicine.
DOI: 10.1136/bjsports-2025-111351
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