Cardiovascular disease (CVD) remains a major health concern, and identifying modifiable risk factors is an important part of prevention and treatment.
A new scientific statement from the American College of Cardiology recommends making exercise a routine part of cardiovascular care, highlighting evidence that even modest increases in physical activity may improve heart health.
Published in the Journal of the American College of Cardiology (JACC), the statement notes that exercise should be prescribed alongside other cardiovascular treatments to help prevent and manage heart disease.
According to the ACC statement, low cardiorespiratory fitness, or the body’s ability to deliver oxygen to muscles during sustained physical activity, is a predictor of future CVD risk comparable to established risk factors such as smoking, high blood pressure, high cholesterol, and diabetes.
The statement highlights evidence that regular physical activity, structured exercise programs, and improved cardiorespiratory fitness can increase exercise capacity, reduce hospitalizations, and improve quality of life.
Notably, the statement emphasizes that people do not need to undertake intensive exercise to experience benefits. For people who are currently inactive, even small increases in daily physical activity may help reduce cardiovascular risk.
Despite the evidence supporting the benefits of cardiorespiratory fitness, exercise is not consistently incorporated into routine cardiovascular care. As such, the ACC statement argues that healthcare professionals should give exercise a more prominent role in treatment planning, alongside other appropriate interventions.
The statement highlights evidence suggesting that people may experience meaningful health benefits without reaching the often-cited goal of 10,000 steps per day. Data indicate that approximately 5,000 to 7,000 daily steps are associated with clinically important improvements and substantial reductions in cardiovascular and all-cause mortality for many adults.
These findings suggest that people who are currently sedentary may benefit from setting achievable activity goals rather than feeling that they must immediately meet demanding exercise targets.
However, step counts are not a universal prescription. The amount and type of appropriate physical activity can vary according to a person’s health, functional ability, symptoms, and treatment goals.
The authors therefore recommend tailoring exercise plans to individual circumstances, preferences, and capabilities.
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“The most important message is that exercise should be viewed as a fundamental part of cardiovascular health care, not simply as a lifestyle option,” Jonathan Myers, PhD, a health research scientist with the Palo Alto VA Healthcare system and chair of the statement’s writing committee, told Medical News Today.
“We have overwhelming evidence that regular physical activity improves cardiovascular health, reduces the risk of chronic disease, and helps people live longer.”
— Jonathan Myers, PhD
“Yet despite this evidence, exercise remains underutilized in clinical practice. We routinely prescribe medications to manage blood pressure, cholesterol, and diabetes, but we often fail to prescribe one of the most effective interventions available to us: physical activity,” Myers said.
Myers said the ACC statement provides healthcare professionals with practical exercise-prescribing guidelines to both prevent and manage heart disease.
“For the public, I think the most important message is this: you don’t have to run marathons or join a gym to benefit. Even modest increases in daily activity can produce meaningful improvements in health. The key is to find activities that are enjoyable, achievable, and sustainable,” he added.
The ACC statement outlines several considerations for healthcare professionals when recommending physical activity.
Exercise prescriptions should account for a person’s cardiovascular condition, functional capacity, symptoms, treatment goals, and preferences. This approach may help people identify activities they can perform safely and maintain over time.
The authors emphasize that an effective exercise plan should be achievable and sustainable, rather than based on a one-size-fits-all target.
For most adults, resistance training should complement aerobic exercise.
Aerobic activities, such as walking and cycling, can improve cardiorespiratory fitness, while resistance exercises help build and maintain muscular strength. Including both forms of exercise may help people address different aspects of physical fitness as part of their overall cardiovascular care.
Wearable devices and virtual or home-based rehabilitation programs may help people monitor their activity and remain engaged with exercise plans.
According to the statement, these approaches may be particularly useful when combined with structured programs, including cardiac rehabilitation. Technology may offer additional ways to support participation, although long-term adherence remains an important consideration.
The authors note that routine exercise testing is not necessary before starting physical activity for most people who are asymptomatic or clinically stable.
However, testing may provide useful information when healthcare professionals need to develop an individualized exercise prescription or assess a patient’s exercise capacity. People with known cardiovascular disease or symptoms should discuss appropriate activity levels with their healthcare team.
Jonathan Myers, PhD, said there were several reasons:
“First, many physicians and other health care professionals receive relatively little formal training in exercise prescription. Clinicians learn a great deal about medications and procedures, but comparatively little about how to develop an individualized exercise program.”
Myers also said that because clinical encounters and appointments are often brief and limited, physical activity counseling can be overshadowed by more urgent medical concerns.
“There are also practical barriers, including limited reimbursement, access to exercise programs, and uncertainty about how to prescribe exercise safely in patients with cardiovascular disease,” he added.
“It is important to change the way we incorporate physical activity into routine clinical care. We should be assessing physical activity and physical fitness as much as we assess other cardiovascular risk factors, and we should provide patients with specific, individualized recommendations.”
— Jonathan Myers, PhD
Myers said that telling people to ‘get more exercise’ is often unhelpful advice and that healthcare professionals should be able to recommend specific activities, including frequency, intensity, and progression over time. He said a dedicated exercise professional, such as an exercise physiologist, could be routinely incorporated into treatment plans.
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He also touched on cardiac rehabilitation programs, including at-home and virtual applications.
“We also need to expand access to cardiac rehabilitation and other structured exercise programs, including home-based and virtual approaches. Ultimately, exercise prescription should become as routine in cardiovascular care as prescribing medications or managing blood pressure,” he said.
The statement identifies cardiac rehabilitation as a first-line treatment for many people with CVD and calls for broader access to these programs.
Cardiac rehabilitation typically combines structured exercise with other elements of cardiovascular care and support. It can help people manage their condition and work toward improving their physical capacity and quality of life.
However, access remains a challenge, with insurance reimbursement identified as one barrier to participation.
The authors recommend providing individualized exercise prescriptions to people with established CVD who cannot participate in formal cardiac rehabilitation. They also call for exercise counseling to become more integrated into routine cardiovascular appointments.
Myers notes that exercise recommendations for those with and without established heart disease are actually quite similar:
“Both those with and without cardiovascular disease benefit from regular aerobic activity, resistance exercise, and reducing sedentary time. The main difference is that patients with established cardiovascular disease often require a more individualized approach that accounts for their symptoms, functional capacity, medications, and potential exercise-related risks,” he emphasized.
“One important message from the ACC statement is that having cardiovascular disease should not automatically be considered a reason to avoid exercise. In fact, for many patients, exercise is an essential component of treatment. The goal is to identify the safest and most effective approach for each individual.”
— Jonathan Myers, PhD
However, Myers underscored that people with certain conditions, such as active myocarditis, unstable cardiac symptoms, and some cardiomyopathies, may have to limit exercise for a period of time and require specialized assessment,
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Although the evidence supporting physical activity is extensive, encouraging people to start exercising and maintain the habit over time remains a challenge.
The ACC statement calls for additional research into strategies that improve long-term adherence, as well as efforts to expand access to cardiac rehabilitation and integrate exercise counseling into standard care.
The statement aims to provide clinicians with practical tools to help people incorporate physical activity safely into their treatment plans.
For those who are currently inactive, the central message is that improving cardiovascular health does not necessarily require a dramatic lifestyle change. Small, manageable increases in physical activity may be a useful starting point, with exercise goals adapted to individual health needs and abilities.
Myers said the first step was to start small, preferably with an activity people enjoy.
“One of the biggest mistakes people make is thinking they need to undertake a demanding exercise program to improve their health. That’s simply not true,” he said.
“For someone who is currently inactive, I might suggest beginning with a 10-minute walk each day, perhaps after a meal, and gradually increase the duration or pace as their fitness improves. Even shorter periods of activity can be beneficial,” he continued.
“I would also encourage people to look for opportunities to move more throughout the day. Take the stairs when practical, walk while talking on the phone, or interrupt prolonged sitting with a few minutes of movement,” he told us.
Myers also stressed that setting realistic goals was important and that monitoring progress, such as via a pedometer or smartwatch, can be helpful, especially for motivation. However, he said expensive equipment or a gym membership wasn’t necessary.
“Over time, people can work toward the recommended 150 minutes of moderate-intensity activity per week and incorporate some resistance exercise to maintain strength and physical function. I think that the most important advice is to focus on consistency rather than intensity. The best exercise program is one that you enjoy, can fit into your daily life, and will continue doing over the long term.”
— Jonathan Myers, PhD
