Physical Activity and Cardiovascular Disease: How Much Is Enough?
Open accessAbstract
Physical inactivity is an established risk factor for cardiovascular diseases. However, although physical activity is recommended as a component of healthy lifestyle, the amount (intensity, duration, and frequency) of physical activity required to protect against coronary heart disease (CHD) and cerebrovascular disease (ie, stroke) is unclear. In general, there is a graded inverse association of physical activity with CHD and total cardiovascular disease (the combination of CHD and stroke). The patterns of association between physical activity dose and stroke are less clear; individual studies suggest a threshold effect for benefits, whereas meta-analytic studies report a graded inverse association. Despite known differences in physical activity behaviors between men and women, the patterns of association between dose of activity and cardiovascular diseases are similar by gender. Observational studies of walking behaviors and one recent clinical trial suggest that lower “doses” of physical activity are associated with a lower risk of cardiovascular disease. Thus, with very few specific cautions, there is enough evidence to recommend to healthy adults that any activity is beneficial and that more activity is even better.
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In the Swedish National Diabetes Register, most cardiovascular disease risk factors were more adverse among patients with HbA1c between 8.0% and 11.9% than among those with HbA1c between 5.0% and 7.9%.
“Observational data from the Swedish National Diabetes Register showed that most CVD risk factors were more adverse among patients with HbA1c between 8.0% and 11.9% than among those with HbA1c between 5.0% and 7.9%.”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [72]
In the Swedish National Diabetes Register, per 1% unit increase in HbA1c, the hazard ratio of fatal and nonfatal cardiovascular disease was 1.27.
“and 1.27 for fatal and nonfatal CVD.”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [72]
In the Swedish National Diabetes Register, per 1% unit increase in HbA1c, the hazard ratio of fatal and nonfatal coronary heart disease was 1.30 in multivariable adjusted models.
“Per 1% unit increase in HbA1c, the HR of fatal and nonfatal CHD was 1.30 in multivariable adjusted models”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [72]
In the Swedish National Diabetes Register, among patients with HbA1c 8.0% to 11.9% compared with those with HbA1c 5.0% to 7.9%, the hazard ratio of fatal/nonfatal coronary heart disease was 1.71.
“Among patients with HbA1c 8.0% to 11.9% compared with those with HbA1c 5.0% to 7.9%, the HR of fatal/nonfatal CHD was 1.71”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [72]
In the Swedish National Diabetes Register, among patients with HbA1c 8.0% to 11.9% compared with those with HbA1c 5.0% to 7.9%, the risk of fatal/nonfatal cardiovascular disease was 1.59.
“and the risk of fatal/nonfatal CVD was 1.59.72”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [72]
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Rogers, E. M., Banks, N. F., & Jenkins, N. D. M. (2023) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00052.2023 · Cited by 5 · see citing works
Huy, C., Steindorf, K., Litaker, D. G., Thiel, A., & Diehm, C. (2011) · European Journal of Sport Science · doi:10.1080/17461391.2010.521581 · Cited by 6 · see citing works
SMART System in the Assessment of Exercise Tolerance in Adults
Nierwińska, K., Myśliwiec, A. P., Konarska-Rawluk, A., Lipowicz, A. M., Małecki, A., & Knapik, A. (2023) · Sensors · doi:10.3390/s23249624 · Cited by 6 · see citing works
Park, W., Park, H., Lim, K., & Park, J. (2017) · Physical Activity and Nutrition · doi:10.20463/jenb.2017.16 · Cited by 5 · see citing works
Jia, A., Kuramoto, L., Warner, F. M., Liu, L., Williams, A. M., Conklin, A., West, C. R., & Cragg, J. J. (2023) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2022.2147891 · Cited by 5 · see citing works
Jung, W., Park, H., Kim, S.-W., Kim, J., Hwang, H., & Lim, K. (2021) · Physical Activity and Nutrition · doi:10.20463/pan.2021.0004 · Cited by 5 · see citing works
Interrogating the Age-Old Wisdom of Exercise
Cheng, S. C. (2012) · Circulation · doi:10.1161/circulationaha.112.155879 · Cited by 5 · see citing works
Cardiovascular Risk Profile in Health Cadres in Jatinangor, West Java
Tiksnadi, B. B., Afrianti, R., Sofiatin, Y., Ridha, A., Fihaya, F. Y., Roesli, R. M. A., & Akbar, M. R. (2019) · Althea Medical Journal · doi:10.15850/amj.v6n2.1529 · Cited by 4 · see citing works
Diet Quality and Biological Risk in a National Sample of Older Americans
Choi, Y. J., Ailshire, J., Kim, J. K., & Crimmins, E. M. (2021) · Journal of Aging and Health · doi:10.1177/08982643211046818 · Cited by 4 · see citing works
Hanafi, N. I., Saidan, N. H., Mohamed, M., Sirajudeen, K. N. S., Gan, S. H., Zaman, K. A. K. P., & Pasupuleti, V. R. (2022) · Jurnal Teknologi · doi:10.11113/jurnalteknologi.v84.17542 · Cited by 4 · see citing works
Khan, M. A. M., Siddiqui, T. W., Siddiqui, R. W., Nishat, S. M. H., Alzaabi, A. A., Alzaabi, F. M., Tarawneh, D. J. A., Tarawneh, Y. J. A., Khan, A., & Siddiqui, S. W. (2025) · Cureus · doi:10.7759/cureus.86284 · Cited by 4 · see citing works
Multiple Approaches to Reducing the Burden of Cardiovascular Disease: Summary and Conclusion
Ainsworth, B. E., & Gabriel, K. K. P. (2009) · American Journal of Lifestyle Medicine · doi:10.1177/1559827609337586 · Cited by 4 · see citing works
Larsen, R. T., Korfitsen, C. B., Juhl, C. B., Andersen, H. B., Langberg, H., & Christensen, J. (2020) · Journal of Aging and Physical Activity · doi:10.1123/japa.2020-0214 · Cited by 4 · see citing works
Krawczyk‐Ożóg, A., Płotek, A., Holda, M. K., Dudek, D., & Rajtar-Salwa, R. (2021) · Kardiologia Polska · doi:10.33963/kp.15856 · Cited by 4 · see citing works
The Sick Adipocyte Theory: The Forces of Clustering at Glance
Bermúdez, V., Rojas, J., Aguirre, M., Cano, C., Arráiz, N., Silva, C., Lima, M. A. M., Cano, R., Fonseca, E., & Velasco, M. (2011) · InTech eBooks · doi:10.5772/20963 · Cited by 4 · see citing works
Animal-assisted therapy for cardiac conditions
Abate, S. V. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-98815-5.00010-0 · Cited by 3 · see citing works
Menotti, A., Lanti, M., Mancini, M., Zanchetti, A., Laurenzi, M. W., Terradura-Vagnarelli, O., & Puddu, P. E. (2014) · Cited by 3 · see citing works
Physical Inactivity and Clinical Cardiovascular Impact -Updating Narrative Review
(2019) · Worldwide Medicine · doi:10.5455/ww.302644346 · Cited by 2 · see citing works
Narasimman, A., & Choudhari, S. G. (2022) · Cureus · doi:10.7759/cureus.30829 · Cited by 3 · see citing works
Effects of Three Different Modes of Exercise Training on Plasma Lipoprotein Profile in Healthy Men
Mohammadi, S., Ahmadi, S., Yektayar, M., & Dehrashid, K. A. (2015) · Journal of Advances in Medicine and Medical Research · doi:10.9734/bjmmr/2015/14898 · Cited by 3 · see citing works
Leisure time physical activity participation among Latino visitors to outdoor recreation areas
Burk, B. N., Shinew, K. J., & Stodolska, M. (2011) · Leisure/Loisir · doi:10.1080/14927713.2011.615642 · Cited by 3 · see citing works
Genome‐wide assessment reveals a significant association between ACSS3 and physical activity
Jo, J., Song, Y., Yoon, D., Lee, C. G., & Won, S. (2022) · Genes Brain & Behavior · doi:10.1111/gbb.12834 · Cited by 2 · see citing works
Chan, P. Y., Yuan, S., & Hunter, D. J. (2026) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2026.2649611 · Cited by 2 · see citing works
Ramadan, A., Aboeldahab, H. A., Bashir, M. N., Belal, M. M., Wageeh, A., Atia, A., Elbanna, M., Alhejazi, T. J., Abouzid, M., Atef, H., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-18553-3 · Cited by 2 · see citing works
Improving Cardiovascular Health Through Physical Activity
Ryckeley, J. B., & Randolph, S. A. (2012) · Workplace Health & Safety · doi:10.1177/216507991206000708 · Cited by 2 · see citing works
Lifestyle Factors and the Impact on Lifetime Incidence and Mortality of Coronary Heart Disease
Puddu, P. E., & Menotti, A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811279-3.00005-7 · Cited by 2 · see citing works
Muratsu, J., Kamide, K., Fujimoto, T., Takeya, Y., Sugimoto, K., Taniyama, Y., Morishima, A., Sakaguchi, K., & Rakugi, H. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.916374 · Cited by 2 · see citing works
Coronary Artery Disease Awareness: Levels of Socioeconomic Status and Dietary Restriction
Prasad, S., Mishra, M. K., & Yadav, T. (2021) · Nepal Journal of Health Sciences · doi:10.3126/njhs.v1i1.38726 · Cited by 2 · see citing works
Körperliche Aktivität und kardiovaskuläre Erkrankungen
Hansel, J., Burgstahler, C., & Niess, A. M. (2011) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-011-1390-2 · Cited by 2 · see citing works
Edafetanure-Ibeh, F. T. (2024) · doi:10.31219/osf.io/mz9xe · Cited by 2 · see citing works
Exercise, Sleep Quality, and Physical Health during the COVID-19 Pandemic
Wolf, J. K., & Cossman, J. S. (2024) · Southern Medical Journal · doi:10.14423/smj.0000000000001659 · Cited by 1 · see citing works
Survey on Physical Activity Among Adolescents in Pune City
Boro, N., Autade, D. S. S., & Vidhate, S. S. (2024) · International Research Journal on Advanced Engineering and Management (IRJAEM) · doi:10.47392/irjaem.2024.0007 · Cited by 1 · see citing works
Increasing Access to Physical Activity Opportunities for Patients: A Review
Nguyen, C., Abbott-Frey, A., Gallegos, A. D. A., Kaufman, M. W., Noordsy, D. L., Oppezzo, M., & Fredericson, M. (2025) · American Journal of Lifestyle Medicine · doi:10.1177/15598276251348174 · Cited by 1 · see citing works
Holcomb, L. A., Killen, E. C., Ryan, K. R., McRae‐Clark, A. L., Seipel, S. L., Aidoo, R., & Guille, C. (2025) · Biology of Sex Differences · doi:10.1186/s13293-025-00738-z · Cited by 1 · see citing works
Physical Activity on Coronary Heart Disease Patients
Merbawani, R. (2022) · Journal of Scientific Research Education and Technology (JSRET) · doi:10.29082/jsret.v1i1.5 · Cited by 1 · see citing works
Indoor Air Quality in Fitness Centers with/without the Restrictions of COVID-19
Peixoto, C., Slezáková, K., Pereira, M. D. C., & Morais, S. (2023) · Studies in systems, decision and control · doi:10.1007/978-3-031-38277-2_27 · Cited by 1 · see citing works
Cha, J., Kim, J., & Hong, K. (2024) · SAGE Open · doi:10.1177/21582440241297817 · Cited by 1 · see citing works
Sedentary Behavior and Health-Related Quality of Life across Meeting Physical Activity Guidelines
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Slezáková, K., Peixoto, C., Pereira, M. D. C., & Morais, S. (2021) · Studies in systems, decision and control · doi:10.1007/978-3-030-89617-1_31 · Cited by 1 · see citing works
Impact of physical activity in the prevention of colorectal cancer
Barnes, S. A. (2013) · ProQuest Demo Repository
Calvo, G., Limón, S., & Técnico (2012)
Childhood inactivity, a public health priority
Kovacic, S., & Sukreški, M. (2016) · International Archives of Medicine · doi:10.3823/1938
Nickels, E. M. (2019) · Cardinal Scholar (Ball State University)
- Authors
- Carnethon, M. R.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Carnethon, Mercedes R.
- Venue
- American Journal of Lifestyle Medicine
- Publisher
- SAGE Publications
- Published
- 2009-04-07
- Volume
- 3
- Issue
- 1_suppl
- Pages
- 44S-49S
- ISSN
- 1559-8276 (ISSN-L)
- 1559-8284
- PMC
- PMC2857374
- OpenAlex
- W2112321505
- Cited by
- 115
- References
- 32
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 11 · 2023: 9 · 2022: 12 · 2021: 14 · 2020: 8 · 2019: 11 · 2018: 4 · 2017: 6 · 2016: 1 · 2015: 4 · 2014: 3 · 2013: 4 · 2012: 8
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Lifestyle Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Arizona State University
- National Institutes of Health
- Centers for Disease Control and Prevention
- National Heart, Lung, and Blood Institute (R13HL091657)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- physical activity, cardiovascular disease, coronary artery disease, stroke, cerebrovascular disease, dose-response relationship, physical inactivity, threshold effects, walking, sex differences, health advice
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