Adults should aim to get between 560 and 610 minutes of moderate-to-vigorous physical activity per week to significantly reduce their risk of heart attack and stroke, suggest results from an observational study published online. British Journal of Sports Medicine.
This is three to four times the current public health recommendation that adults do at least 150 minutes of moderate-to-vigorous exercise, such as brisk walking, running, or cycling, per week.
Research suggests that people in poor health need to exercise slightly more than those in very good health to achieve the same cardiovascular benefits.
Researchers say current one-size-fits-all advice on exercise may need to be changed and replaced with individualized goals depending on an individual’s fitness level.
Cardiorespiratory fitness varies widely and is a strong predictor of cardiovascular health. Poor cardiovascular fitness is strongly associated with an increased risk of heart attack, stroke, and premature death, researchers say.
A simple way to assess your cardiovascular fitness is to measure your VO2 max (the maximum rate of oxygen your body consumes and uses during intense exercise). This measures how efficiently your heart, lungs, and muscles supply and use oxygen.
Researchers from Macau University of Technology in China set out to investigate how both exercise level and cardiorespiratory fitness, as measured by VO2 max, influence the risk of cardiovascular disease.
The study included data from 17,088 people who took part in the UK Biobank study between 2013 and 2015. The mean age was 57 years, 56% were female, and 96% were Caucasian.
Study participants wore the device on their wrist for seven consecutive days to record their typical exercise level and completed a cycle test to measure their estimated VO2 max.
Data on smoking status, alcohol intake, self-related health and diet, BMI, resting heart rate, and blood pressure were also included in the analysis.
During a mean follow-up of 7.8 years, 1,233 cardiovascular events occurred, including 874 atrial fibrillation, 156 myocardial infarctions, 111 heart failure, and 92 stroke events.
The study found that adults who met the guidelines for 150 minutes of exercise per week had a modest 8 to 9 percent reduction in cardiovascular risk. This was consistent across all levels of fitness.
Achieving substantial protection classified as >30% risk reduction required 560 to 610 minutes of moderate-to-vigorous exercise per week. However, only 12% of the study participants were able to achieve this level of exercise.
The analysis found that those with the lowest fitness levels would need approximately 30 to 50 additional minutes per week to achieve the same benefits compared to those with the highest fitness levels.
For example, to reduce the risk of cardiovascular events by 20%, people at the lowest fitness levels needed 370 minutes of moderate-to-vigorous exercise, compared to 340 minutes for people at the highest fitness levels.
researchers say. ”This finding highlights the deeper challenges faced by people in degraded environments.”
Because this is an observational study, no clear conclusions can be drawn about cause and effect. The researchers acknowledge that the study group may have been healthier and more fit than the general population. Another limitation is that cardiorespiratory fitness was estimated and sedentary time and less vigorous exercise were not measured.
Researchers say their findings confirm that current guidelines provide a reliable universal minimum for cardiovascular protection. However, they added that tiered advice is needed to guide motivated patients to go the extra mile to protect their heart health.
”Future guidelines may need to distinguish between minimal moderate-to-vigorous exercise levels needed for a basic safety margin and substantially higher levels of exercise needed for optimal cardiovascular risk reduction.” they conclude.
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Reference magazines:
Liang, Z. Others. (2026) Collaborative study of nonlinear dose-response associations of device-measured physical activity and cardiorespiratory fitness with cardiovascular disease: a cohort and Mendelian randomized study. British Journal of Sports Medicine. DOI: 10.1136/bjsports-2025-111351. https://bjsm.bmj.com/content/early/2026/05/03/bjsports-2025-111351
