What is arrhythmia? Cardiologist explains
29 September 2026
No Comments
Cardiovascular disease (CVD) remains the leading cause of mortality globally, accounting for millions of deaths annually. While advances in medical treatments have improved outcomes, lifestyle modifications—particularly regular exercise—are fundamental in preventing and managing heart disease.
The question many people ask is: How much exercise is enough to protect the heart? Is there a specific type or intensity of physical activity that offers the most cardiovascular benefit?
This article explores the science behind exercise for heart health, identifies the best cardio exercise, discusses the relationship between exercise and heart disease, and offers evidence-based guidelines on how much exercise is necessary for optimal cardiovascular health.
Physical activity exerts profound effects on the cardiovascular system. Regular exercise promotes numerous physiological adaptations that improve both heart function and vascular health.
Exercise strengthens the myocardium (heart muscle), increasing cardiac output (the volume of blood the heart pumps per minute). Individuals who engage in regular physical activity have higher stroke volumes (the amount of blood ejected with each heartbeat) and lower resting heart rates, indicating a more efficient heart beats. Regular exercise also helps to maintain normal heart beat. According to the ACTIVE-AF trial presented at European Society of Cardiology Congress in August 2021, a six-month exercise programme, tailored to individual needs and designed by clinical exercise physiologist, improves freedom from Atrial Fibrillation and decreases Atrial Fibrillation symptoms severity.
-120 participants with symptomatic Atrial fibrillation were randomised to either exercise programme or standard care for six months with further six months of follow up.
– Patients included had paroxysmal Atrial Fibrillation (only short runs) or persistent Atrial Fibrillation (a treatment was required to restore normal heart beat-sinus rhythm). Permanent Atrial Fibrillation, patients who are in Atrial Fibrillation all the time and sinus rhytm cannot be maintained were excluded from this study.
– The programme consisted of supervised sessions (once a week for first 3 months and then once in two weeks) to achieve up to 3.5 hrs of aerobic exercise per week. Standard care included an exercise but no individualised programme. Both groups received standard medical care otherwise. 43% of patients were women and an average age of participants was 65.
– At the end of follow up (12 months) recurrence of Atrial Fibrillation was significantly reduced in the intervention group (60%) as compared to the standard management cohort (80%) – HR 0.50, p=0.002. Participants assigned to the exercise programme also had a significant reduction in the severity of symptoms experienced during the study duration. ( https://www.jacc.org/doi/10.1016/j.jacep.2022.12.002 )
Hypertension is a major risk factor for CVD. Regular exercise can reduce both systolic and diastolic blood pressure, often to a similar extent as some antihypertensive medications.
This meta-analysis published in 2016 which included 1408 participants with a mean age of 36.1 concluded that: ACUTE EXERCISE session reduces SYSTOLIC BLOOD PRESSURE by 4.8 mmHg and DIASTOLIC BLOOD PRESSURE by 3.2 mmHg. ( https://pubmed.ncbi.nlm.nih.gov/27168471/ )
– The reduction observed was more considerable in individuals not on any antihypertensive medications when it was used as preventative measure.
-Epidemiological studies show that decline in systolic blood pressure by 2mmHg leads to decreased risk of mortality from coronary artery disease by 4% and from stroke by 6%. However if you achieve reduction in systolic blood pressure of 5mmHg that transmits to reduction of death from coronary artery disease by 9% and stroke by 14%.
Nordic walking, 6km walks and playing 18 holes golf leads to significant decrease in Systolic Blood Pressure (p<0.001), according to this study (https://bmjopensem.bmj.com/content/9/1/e001474). Interestingly, Nordic walking and walking showed also reduction in Diastolic Blood Pressure (p<0.05).
Exercise for heart health positively impacts lipid metabolism by increasing high-density lipoprotein (HDL) cholesterol and reducing low-density lipoprotein (LDL) cholesterol and triglycerides. Additionally, it improves insulin sensitivity, reducing the risk of type 2 diabetes—a significant risk factor for heart disease.
There are several ways to reduce Your blood Cholesterol and one of them is JOGGING, according a study published in 2021. ( https://jissn.biomedcentral.com/articles/10.1186/s12970-021-00436-2 ) Jogging was associated with a reduction of:
– Tryglicerides (95% CI = 5.9-14.5 mg/dL)
– Tryglicerides/High-density lipoprotein cholesterol ratio (95% CI = 0.22-0.49) and
– Increased level of High-density lipoprotein cholesterol (95% CI = 2.1-3.3 mg/dL)
It was an observational study, which enrolled 27735 participants and was published in the Journal of the International Society of Sports Nutrition in May 2021. Regular jogging was defined as 30 mins of ‘exercise’ three times a week. The author concluded: ‘Regular jogging was not only associated with an increased level of HDL-C, but also the only one exercise associated with decreased level of TG and TG/HDL-C ratio. Nonetheless, jogging may be difficult to engage in for subjects with limited exercise capacity. We here found that swimming, dancing, and cycling are also significantly associated with an increased level of HDL-C. People who are seeking exercise to improve their lipoprotein-lipid profiles can have other choices now’.
https://jissn.biomedcentral.com/articles/10.1186/s12970-021-00436-2
According to this study published in 2023, regular exercise, probably unsurprisingly, reduces risk of death from any cause and a chance of another vascular event. (https://academic.oup.com/ehjopen/article/3/3/oead057/7194785?login=false)
Not all forms of exercise provide the same cardiovascular benefits. Aerobic activities, in particular, have been shown to be the best cardio exercises for improving heart health. It`s difficult to choose the best cardio exercise, as they provide cardiovascular benefit and protection. Individual preference, ability and age are the important determining factors.
Walking is a low-impact, accessible form of aerobic exercise. However the question is `How many steps per day is enough to make you live longer?` According to this study, published in JAMA Network Open last year, the answer is 7000 steps a day.
– The researchers recruited 2110 adult participants, mean age of 45.2 with 51.7% females.
– The follow-up lasted 10.8 years and individuals taking more than 7000 steps were compared to those taking < 7000 steps.
– During the study period 72 (3.4%) research participants died. After using statistical adjustment models the researchers found that there was significantly lower risk of death in moderate amount of steps (>7k) and high number of steps (>10) as compared to group with <7k steps per day.
– According to this study, there was also no link between the step intensity and risk of dying.
Cycling, whether stationary or on the road, is another effective cardiovascular exercise. The question answered by this study published in the British Medical Journal in 2017 was if CYCLING to work can reduce Your risk of Heart Disease and Dying? And the answer was yes. – It was a large prospective study, which included over 250 000 participants, of whom 52% were female and the mean age was just over 52 years.
– Cycling and walking as a mode of commuting were associated with a lower risk of heart disease and risk of dying from heart related causes.
Interestingly commuting by cycling was also linked to lower risk of cancer, dying from cancer and also dying from any cause.
– The authors concluded: ‘Cycle commuting was associated with a lower risk of cardiovascular disease, cancer and all cause mortality. Walking commuting was associated with a lower risk of cardiovascular disease independent of major measured confounding factors. Initiatives to encourage and support active commuting could reduce risk of death and the burden of important chronic conditions.’ ( https://www.bmj.com/content/357/bmj.j1456)
Is playing GOLF good for Your Heart ? According to a study published in December last year in BMJ Open Sport & Exercise Medicine, the answer is ‘YES’. Researchers enrolled 25 golfers (mean age 68+/-4 years, 9 females) and compared 3 different types of activities: Nordic walk, 6km walk and 18 holes GOLF. Playing GOLF resulted in:
– reduction in blood glucose compared with walking (0.01+/-1.0 mmol/L, walk 1.3+/-0.9 mmol/L, p<0.001), difference in cholesterol (reduction in tryglicerides p=0.012 ) and increase in high-density lipoproteins p=0.002) as compared with walking and Nordic walking.
– The authors concluded: ‘Acute bouts of aerobic exercise improved cardiovascular profile in healthy older adults. Despite the lower exercise intensity of golf, the longer duration and higher energy expenditure appeared to have a more positive effect on lipid profile and glucose metabolism compared with Nordic walking and walking.’ ( https://bmjopensem.bmj.com/content/9/1/e001474 )
HIIT involves short bursts of intense exercise followed by periods of rest or low-intensity activity. In patients, who underwent Percutaneous Coronary Intervention (STENTS), High Intensity Interval Training (HIIT) prevents progression of Coronary Plaques and decreases already existing residual Atheroma. Claims this study, published in December 2022 in European Journal of Preventive Cardiology. (https://pubmed.ncbi.nlm.nih.gov/36562212)
.
Regular exercise reduces the risk of developing heart disease by addressing modifiable risk factors such as hypertension, obesity, and dyslipidemia. However, for individuals with established heart disease, exercise plays a critical role in secondary prevention. Cardiac rehabilitation programs, which include supervised exercise are beneficial for patients with heart problems. These programs typically combine aerobic and resistance training to optimize cardiovascular and muscular health and are a great example of Heart benefits of exercise.
For instance in this study, published in 2020 in British Journal of Sports Medicine the authors asked a question: `Does physical activity has an impact on mortality in patients with Hypertrophic cardiomyopathy?` ( https://pubmed.ncbi.nlm.nih.gov/32967852/ )
– 7666 study patients with mean age of 59.5 and 70.1% men were enrolled into this study.
– They were recognised from a national database between 2009 to 2016 and followed up for a mean of 5.3+/2 years.
– Patients who reported no physical activity were excluded.
– The incidence of death from all causes as well as from cardiovascular cause reduced from the lowest to the highest physical activity intensity: 9.1%(4.7%), 8.9%(3.8%) and 6.4%(2.7%).
– The authors concluded:
‘Moderate-to-vigorous-intensity PA, in a middle-aged population of patients with HCM, was associated with progressive reduction of all-cause and cardiovascular mortality’
In addition to this, a study was published in 2017 in European Journal of Cardiovascular Nursing in 2017 asked a question: `Does rehabilitation based only on exercise reduce depression and state of anxiety after a heart attack?` (https://pubmed.ncbi.nlm.nih.gov/27899438/ )
-The researchers enrolled 32 male patients (56.3+/-7.6 yo) and 30 female patients (59.2+/-8.1 yo) who suffered a heart attack.
– All participants underwent an exercise programme using cycloergometer, which lasted 8 week, 3 times a week.
– Patients were assessed before and after the intervention with: depression intensity assessment wirh the Beck depression inventory; levels of anxiety were tested with the state-trait anxiety inventory and symptom limited exercise test.
– Female participants experienced higher initial depression intensity than men, which decreased after the above intervention, reaching statistical significance of p<0.01.
– Anxiety levels were also higher in women in comparison to men and also statistically significant reduction was observed after the planned exercise programme.
– Neither depression intensity nor levels of anxiety changed in men.
– Both female and male participants experienced significantly improved physical capacity after study intervention.
Regular aerobic exercise, such as walking, cycling, swimming, or running, strengthens the heart and improves circulation. The NHS website answers the question `how much exercise heart` and adults between 19 and 64 years old should perform at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week with a spread of exercise evenly over 4 to 5 days a week, or every day. (https://www.nhs.uk/live-well/exercise)
While more exercise generally confers greater heart benefits, research suggests a plateau effect beyond a certain threshold. So the question is `What is the minimum time that you have to exercise vigorously to decrease your chances of dying from cancer or cardiovascular disease?` (https://academic.oup.com/eurheartj/article/43/46/4801/6771381?login=false)
A study published in October 2022 in European Heart Journal showed that:
– 15 MINUTES per week of VPA was associated with 16-18% lower all cause and cancer deaths.
– 20 MINUTES per week of VPA was linked with 40% lower incidence of cardiovascular deaths.
– VPA – Vigorous Physical Activity is defined as 6 or more metabolic equivalents (METs) i.e. running or swimming.
– In addition to this, the enhanced benefit on mortality was observed up to 50-57 MINUTES per week.
– It was a large study, which included 71893 adult participants (median age 62.5 years, 55.9% females)
– The individuals enrolled in the study wore wrist accelometers for 24hrs/day for 7 days to measure their physical activity.
– The recruitment took place between 2013-2015 and the follow up lasted 5.9 years.
Despite the well-documented benefits of exercise, many individuals struggle to maintain regular physical activity.
Lack of time is a common barrier. Incorporating short bouts of high-intensity exercise or integrating physical activity into daily routines (e.g., walking during lunch breaks) can help overcome this challenge.
Individuals with physical disabilities or chronic conditions may find traditional forms of exercise challenging. In such cases, tailored exercise programs, such as chair-based exercises or aquatic therapy, can provide cardiovascular benefits without exacerbating physical limitations.
Behavioural strategies, such as goal setting, self-monitoring, and social support, can enhance motivation and adherence to exercise routines. Additionally, technology-based interventions, including fitness trackers and mobile apps, can provide real-time feedback and encourage sustained engagement in physical activity.
– The answer is YES, according to a study published in November 2022 in the European Journal of Preventive Cardiology. (https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwac239/6814439)
– Study participants who were physically active in late morning had 16% lower risk of coronary artery disease (HR: 0.84, 95%CI: 0.77, 0.92) and 17% lower risk of stroke (HR: 0.83, 95%CI: 0.70, 0.98) in comparison to individuals who were physically active at midday.
– Interestingly these effects were more pronounced in female participants.
– It was a large trial, which included 86657 individuals with mean age of 61.6, mean BMI of 26.6 and 58% females.
– The follow up lasted for 6 years and 3707 cardiovascular events were noted.
– The researchers concluded:
‘Irrespective of total physical activity, morning physical activity was associated with lower risks of incident cardiovascular diseases, highlighting the potential importance of chronoactivity in CVD prevention.’
The answer, is 4.77 cases per million-year, according to a study, published in EuroPace (ESC) journal in October 2022. ( https://doi.org/10.1093/europace/euac172 )
– Use of AUTOMATED EXTERNAL DEFIBRILLATOR occurred only in 7.5% of cases, but was the strongest predictor of SURVIVAL at discharge.
– CPR by the bystanders was initiated in 82.6% of patients.
– Among individuals that benefited from both immediate DEFIBRILATION and bystander CPR, survival reached 90.9%.
– Ischaemic heart disease was the most commonly found cause of the arrest, 25.8%, with 86.9% of those suffering a heart attack.
– It was a German/French study, which included 147 individuals (mean age 28.1 +/- 4.8 years, 95.2% men) and was conducted between 2012 and 2019. 12 patients were competitive athletes.
– The authors concluded: ‘Sports-related sudden cardiac arrest in the young occurs mainly in recreational male sports participants. Public Automated External Defibrillators use remains disappointingly low, although survival may reach 90% among those who benefit from both bystander CPR and early defibrillation. Coronary artery disease is the most prevalent cause of Sports-Related Sudden Cardiac Arrest in young adults.’
Starting and continuing heightened cardiorespiratory fitness at an early adult age may decrease risk of dying and developing cardiovascular disease, according to a study published in the JAMA Network Open journal in February 2023. ( https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2801789/pettee_gabriel_2023_oi_230054_1676492675.88908.pdf )
– 4804 participants age 18 to 30 (mean age 24.8, 56% females) were recruited in 1985 and 1986. They were assessed at baseline and followed up ever since.
– At baseline, even 1 minute of increased fitness was associated with a lower risk of all-cause death.
– Similarly, retained fitness through year 20 was linked to reduced risk of dying from any cause.
– In addition to this, similar association was observed in terms of fatal and nonfatal Cardiovascular Events.
– The authors concluded: ‘This cohort study found that higher early-adulthood respiratory fitness and greater retention of early-adulthood cardiorespiratory fitness throughout midlife were associated with a lower risk of premature death and CVD events. Additional research is needed to clarify the association of cardiorespiratory fitness timing across the life course with risk of clinical outcomes.’
Exercise is a powerful tool for promoting cardiovascular health. Regular physical activity improves heart function, enhances vascular health, and reduces the risk of heart disease.
Ultimately, the question of how much exercise is enough for heart health depends on individual factors, including age, fitness level, and health status. Following established guidelines of at least 150 minutes of moderate-intensity exercise per week is a good starting point. However, individuals should aim for a balanced approach that prioritizes consistency, appropriate intensity, and adequate recovery.
By integrating regular exercise into daily life, individuals can significantly reduce their risk of cardiovascular disease and enhance overall well-being.
Consultant Interventional Cardiologist in Hampshire, UK.
Dr Bart Olechowski is an experienced Consultant Interventional Cardiologist based in Hampshire, UK. As a specialist in his field, Dr Olechowski leads with expertise, offering premier cardiovascular care.
Copyright © 2026 Dr Bart.Co.UK, All rights reserved. | Designed by KodeFlow