Women gain stronger heart protection from exercise than men, study reveals

By Tarun Sai LomteReviewed by Susha Cheriyedath, M.Sc.Oct 28 2025

New research reveals that women achieve equal or greater protection from coronary heart disease and death with far less exercise than men, pointing to the need for personalized, sex-specific activity guidelines.

Study: Sex differences in the association of wearable accelerometer-derived physical activity with coronary heart disease incidence and mortality. Image Credit: doomu / Shutterstock

In a recent study published in the journal Nature Cardiovascular Research, researchers investigated sex differences in the associations between physical activity (PA) and the incidence risk of coronary heart disease (CHD) and all-cause mortality.

Current guidelines from the World Health Organization (WHO), the American Heart Association (AHA), and the European Society of Cardiology (ESC) recommend at least 150 minutes of moderate-to-vigorous PA (MVPA) per week to prevent the development or progression of CHD. However, a substantial gender gap exists in exercise capacity and adherence to guidelines. For instance, the prevalence of insufficient PA was 5 percentage points higher among females than among males worldwide. Moreover, it remains unclear whether and to what extent sex differences impact CHD development and prognosis. Understanding sex disparities is essential for tailored CHD prevention and could help bridge this gender gap.

About the Study

In the present study, researchers investigated sex disparities in the relationship of PA with CHD incidence risk and all-cause mortality. The study sample was derived from the United Kingdom Biobank cohort. About 103,695 individuals provided weekly accelerometer data using a wearable device between 2013 and 2015.

Of these, individuals with insufficient wear time, implausible acceleration values, poor calibration, or missing covariate data, and those who developed CHD during the wearing period were excluded. As such, 80,243 participants without CHD were included to assess CHD incidence risk, and 5,169 individuals with established CHD were included to determine all-cause mortality.

MVPA duration was defined as the accumulation of 5-s epochs with an average acceleration of ≥100 milligravity (mg), analyzed in 5-minute bouts, with at least 80% of epochs meeting this threshold. The following measures were derived from MVPA duration: adherence to standard WHO, AHA, and ESC recommendations (150 minutes/week), the extended WHO recommendation (300 minutes/week), and the number of days meeting these recommendations.

The outcomes were incident CHD in the CHD-free population and death in the CHD population. Cox proportional-hazards models assessed sex-specific associations of PA measures with CHD incidence and all-cause mortality, and tested sex interactions (Pinteraction = 0.009 for CHD incidence and Pinteraction = 0.004 for mortality). Dose–response associations and non-linear relationships between MVPA duration and CHD outcomes were also evaluated. Models were adjusted for demographic, lifestyle, and clinical covariates, including polygenic risk scores for CHD, and were validated through multiple sensitivity analyses.

Findings

In the CHD incidence analysis, 3,764 CHD events were recorded over a median follow-up duration of 7.88 years. In the mortality analysis, 593 deaths were recorded during 7.77 years of median follow-up. In total, 48.46% of the CHD-free population and 30.51% of CHD patients met the recommended MVPA duration. Notably, females lagged behind males in both MVPA intensity and duration.

An increase in MVPA time by 30 minutes/week was associated with a lower risk of CHD, especially in females. Physically active males meeting standard recommendations had a lower CHD incidence rate (703.53 per 100,000 person-years) than physically inactive males (1,143.62 per 100,000 person-years). Similarly, physically active females showed a lower CHD incidence rate (249.16) than inactive females (519.28).

In particular, males and females meeting standard recommendations experienced a 17% and 22% relative reduction in CHD incidence risk, respectively, with a similar pattern for those meeting the extended WHO recommendation. For mortality, adherence to the extended WHO 300-min/week recommendation was not significantly associated with lower risk after multivariable adjustment. Males required 530 minutes/week of MVPA, while females required 250 minutes/week to achieve a 30% reduction in CHD risk. An increase in the number of days meeting the daily standard recommendations was associated with a lower risk of incident CHD.

An increment of adherence to standard recommendations by one day per week was associated with a reduced risk of CHD in both sexes. The mortality analysis showed protective effects of MVPA duration in both sexes. Among females with CHD, only 340 met the standard recommendations, with only six deaths recorded. However, 111 deaths occurred in female CHD patients who did not meet guidelines.

Similarly, male CHD patients showed attenuated benefits, with guideline-adherent subjects having a low mortality rate compared to non-adherent individuals. Male CHD patients required 85 minutes/week and female CHD patients required 51 minutes/week of MVPA to achieve a comparable reduction in mortality risk. A one-day increment in meeting the standard recommendations was associated with 15% and 8% relative reduction in mortality risk in females and males, respectively.

It is important to note the study's limitations, as emphasized by the authors. Because the study population was mostly White and had healthier lifestyles, the findings may not be generalizable to all populations. The mortality analysis involved a relatively small sample, and as an observational study, the results demonstrate association rather than causation.

Conclusions

In sum, the findings indicate substantial sex disparities in the clinical benefits of PA on CHD incidence and death. Females required less MVPA engagement compared to males to achieve a comparable reduction in CHD incidence risk and all-cause mortality. The results highlight the potential of sex-specific physical activity recommendations for CHD prevention and suggest that wearable accelerometry could help personalize exercise guidance. This underscores the need for sex-specific personalized management of CHD prevention. Further research is required to uncover the biological mechanisms underlying these sex differences.