Exercise should be prescribed as a foundational component of cardiovascular disease (CVD) prevention and treatment, according to a new American College of Cardiology Scientific Statement published today in JACC, its flagship journal. The statement emphasizes that the greatest reduction in cardiovascular risk occurs when sedentary individuals become even modestly more active, and the best exercise prescription is one that is safe, individualized, achievable and sustainable over time.
Low cardiorespiratory fitness is a predictor of future CVD that is on par with traditional cardiovascular risk factors such as smoking, hypertension, high cholesterol and diabetes; however, exercise prescription is inconsistently integrated into routine cardiovascular care. The scientific statement highlights extensive evidence showing that regular physical activity, structured exercise and cardiorespiratory fitness improve exercise capacity, reduce hospitalization and enhance quality of life.
The most important message is that some activity is better than none. Patients do not need to become athletes to improve their cardiovascular health. Small increases in physical activity can produce meaningful benefits, particularly for those who are currently inactive."
Jonathan N. Myers, PhD, a health research scientist, Palo Alto VA Healthcare system and chair of the statement's writing committee
For example, the statement highlights growing evidence that meaningful cardiovascular benefits can be achieved with fewer than 10,000 daily steps. Data suggest that approximately 5,000 to 7,000 steps/day are associated with clinically important improvements and substantial reductions in cardiovascular and all-cause mortality for many adults.
Key recommendations and considerations in the statement include:
- Exercise prescriptions should be individualized based on a patient's cardiovascular condition, functional capacity, symptoms, treatment goals and preferences.
- Resistance training should complement aerobic exercise for most adults.
- Wearable devices and virtual or home-based rehabilitation programs may help support exercise participation and long-term adherence, particularly when combined with structured programs such as cardiac rehabilitation.
- Routine exercise testing is not required before starting exercise for most asymptomatic or clinically stable individuals but can provide valuable information for individualized exercise prescription when clinically appropriate.
- Cardiac rehabilitation remains first-line treatment for many patients with CVD and access should be expanded. While insurance reimbursement remains a barrier to entry for many, individualized exercise prescriptions should be provided to those with known CVD who are unable to participate in formal cardiac rehabilitation.
The authors also call for greater integration of exercise counseling into routine cardiovascular care, expanded access to cardiac rehabilitation and additional research on strategies that improve long-term adherence to physical activity.
"Exercise is one of the most effective therapies available for preventing and managing CVD, yet it remains underutilized in routine care," Myers said. "This statement provides clinicians with practical tools to help patients safely incorporate exercise into their treatment plans and improve long-term cardiovascular health."
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