Exercise for a Healthy Heart: A Cardiologist’s Guide

If I could put the single most powerful thing you can do for your heart into a tablet, every cardiologist in the world would prescribe it. That tablet does not exist, but exercise comes remarkably close. It lowers blood pressure, improves cholesterol, helps control weight and blood sugar, keeps your blood vessels supple, and lifts your mood. No single medication does all of that at once.

In clinic I see patients chasing the perfect supplement or the latest scan while sitting still for most of the day. So in this guide I want to explain, in plain English, why exercise really is medicine for the heart, how much you actually need, what kind to do, how hard to push, and how to start safely if you have been sedentary or are getting older. The aim is to give you something you can use, not a counsel of perfection.

Why is exercise medicine for the heart?

Your heart is a muscle, and like any muscle it gets stronger and more efficient when you ask it to work. Regular activity helps the heart pump more blood with each beat, lowers resting blood pressure, nudges LDL (the harmful cholesterol) down and HDL (the protective kind) up, and keeps the lining of your arteries healthy and flexible. Over time that means less strain on the system and a lower chance of plaque building up.

The numbers behind this are striking. Large pooled studies tracking hundreds of thousands of people show a clear dose-response link between physical activity and living longer, with a sharply lower risk of dying from heart disease. Importantly, most of the benefit appears early. Moving from doing almost nothing to doing a moderate amount gives you the biggest single jump in protection. You do not need to become an athlete to gain most of the reward, which I think is the most encouraging fact in all of preventive cardiology.

Exercise also works on the things that quietly drive heart disease, including stress and poor sleep. I have written more about that in anxiety, heart health, and the power of exercise and men’s heart health and sleep.

How much exercise do I need?

The target most major bodies agree on is straightforward. The World Health Organization and the American Heart Association both recommend that adults aim for at least 150 to 300 minutes of moderate-intensity aerobic activity each week, or 75 to 150 minutes of vigorous activity, or a combination of the two. On top of that, they advise muscle-strengthening activity on two or more days a week.

That sounds like a lot until you break it down. 150 minutes is 30 minutes, five days a week, or even three brisk 50-minute sessions. It can be split into 10-minute chunks if that suits your day better, because the total across the week is what counts.

A few practical points I stress with patients:

• Some is always better than none. If 150 minutes feels out of reach right now, start with what you can manage. The early gains are the largest.
• More gives more, up to a point. Pushing toward 300 minutes a week adds further benefit. Beyond that the extra reward generally tapers off.
• Sitting still is its own risk. Long unbroken hours of sitting are bad for the heart even in people who exercise. Stand up and move briefly every hour.

Aerobic vs resistance: what is the right mix?

Both matter, and they do different jobs, so the honest answer is that you want some of each.

Aerobic (cardio) exercise is anything that raises your heart rate and keeps it up: brisk walking, cycling, swimming, jogging, dancing. This is the main driver of the cardiovascular benefits, the blood pressure and cholesterol improvements, and the gains in stamina. For most people it should make up the bulk of their weekly activity.

Resistance (strength) training means working your muscles against a load: free weights, resistance bands, machines, or bodyweight moves like squats and press-ups. It builds and preserves muscle, supports your metabolism and blood sugar control, strengthens bones, and indirectly helps the heart. It becomes more important, not less, as we age.

A sensible weekly pattern for most healthy adults is the bulk of your minutes spent on aerobic work, with two resistance sessions covering the major muscle groups (legs, hips, back, chest, shoulders, arms). You do not need a gym for the strength part. A pair of resistance bands and your own bodyweight at home will do the job.

What intensity should I aim for? A plain-English zones explainer

“Moderate” and “vigorous” are the words the guidelines use, and you do not need a heart-rate monitor to judge them. The simplest tool is the talk test:

• Light: you can sing comfortably. Useful for warming up, but it does not count toward your moderate minutes.
• Moderate: you can talk in full sentences but not sing. You are breathing harder and feeling a little warm. A brisk walk where you could still hold a conversation is the classic example. This is the zone most of your aerobic time should sit in.
• Vigorous: you can only say a few words before needing a breath. Jogging, fast cycling, or a tough class. Because it is harder, it counts roughly double, so 75 vigorous minutes are worth about 150 moderate ones.

If you prefer numbers, moderate activity is loosely around 50 to 70 percent of your maximum heart rate, and vigorous is above that. A rough maximum is 220 minus your age, though this is only an estimate and varies a lot between individuals. For most people, the talk test is more reliable and far less fiddly than chasing a number on a watch.

Exercise in your 50s, 60s and beyond

It is a myth that you become too old to benefit. If anything, exercise matters more with each passing decade. As we age we naturally lose muscle and bone (a process called sarcopenia when muscle loss becomes significant), our balance can decline, and the risk of falls rises. The good news is that regular activity counters all of this, and the heart benefits appear to be just as real in older adults as in the young.

For older patients I usually suggest a few additions to the standard advice:

• Keep up the strength work. Resistance training two to three times a week is one of the best defences against muscle loss and frailty, and it helps keep you independent.
• Add balance training. Simple practice such as standing on one leg, heel-to-toe walking, or tai chi meaningfully reduces the risk of falls. Programmes combining balance and strength work show the largest reductions.
• Build up gradually. If you are starting from a low base, begin gently and add a little each week. Walking is an excellent, low-risk entry point.

If you are over 65 and have been inactive, or you have heart or joint concerns, it is worth having a chat with your doctor first so the plan fits your starting point. A comprehensive heart check-up can be a sensible foundation before you ramp up.

How do I actually stick with it?

This is the part the guidelines skip, and it is the part that decides everything. The best exercise plan is the one you will still be doing in six months. A few things genuinely help:

• Pick something you do not dread. Enjoyment beats theoretical efficiency every time. A daily walk you look forward to beats a gym membership you avoid.
• Anchor it to your routine. Same time, same days, attached to something you already do. Consistency comes from habit, not willpower.
• Start smaller than feels necessary. Most people stop because they began too hard. Build the habit first, then build the intensity.

One of the most underrated tools is other people. Research consistently shows that social support helps people get started and keep going. There is interesting evidence on couples in particular: studies suggest that when partners exercise together, adherence improves, and one follow-up study of people aged 65 and over found that attending an exercise class with a spouse was linked to better long-term participation. The accountability of a regular partner, plus the simple fact that it is more enjoyable, seems to do real work. Whether it is a spouse, a friend, or a small group, having someone expecting you tends to get you out the door on the days you would otherwise skip. If you have a partner, exercising together is one of the easiest wins available.

Do I need a check-up before I start?

For most people who are generally well and planning light to moderate activity such as brisk walking, you can simply start. The risks of gentle exercise are very low, and the risk of staying sedentary is far higher.

That said, I would recommend speaking to a doctor first if any of the following apply to you:

• You have known heart disease, or have had a heart attack, stent, or bypass.
• You have diabetes, kidney disease, or several cardiovascular risk factors (high blood pressure, high cholesterol, smoking, strong family history).
• You have had symptoms such as chest pain, unusual breathlessness, palpitations, or blackouts.
• You have been very inactive and plan to take up vigorous or high-intensity exercise.

In these situations a check-up, and sometimes a cardiac stress test, can confirm it is safe to push harder and tailor the plan to you. The point is not to frighten anyone out of exercising. In most cases it simply lets us say “go ahead” with confidence.

Warning signs to stop and get assessed

Whatever your age or fitness level, learn the symptoms that mean you should stop and seek advice. Stop exercising and get assessed if you experience:

• Chest pain, pressure, or tightness, especially if it comes on with effort
• Unusual or severe breathlessness out of proportion to what you are doing
• Palpitations, a racing or irregular heartbeat
• Dizziness, light-headedness, or fainting
• Cold sweat or nausea with any of the above

If symptoms are severe, come on suddenly, or do not settle quickly with rest, treat it as an emergency and call 995 (Singapore’s ambulance line). These symptoms do not always mean something serious, but they should never be exercised through, and a new symptom on exertion deserves a proper assessment.

The bottom line

Exercise is the closest thing we have to a wonder drug for the heart, and the prescription is simple: aim for 150 to 300 minutes of moderate activity a week, add strength work twice a week, sit less, and find a way to keep it up, ideally with someone alongside you. You do not need to be perfect, and you are never too old to start. The biggest gains come from going from nothing to something, so the most important step is the first one. Pair it with a heart-healthy diet and you are doing most of what genuinely moves the needle.

If you have a heart condition or significant risk factors and want to exercise safely, I provide comprehensive cardiac assessment and exercise testing at the Harley Street Heart and Vascular Centre in Singapore. Call +65 6235 5300 to arrange an appointment.

---

Written by Dr Michael Ross MacDonald MB ChB, BSc (Hons), FRCP (UK), MD (Research), FESC (Europe) Senior Consultant Cardiologist at the Harley Street Heart and Vascular Centre, Singapore.

This article is general information, not a substitute for individual medical advice. Speak to your doctor before starting a new exercise programme if you have a heart condition or significant risk factors. In an emergency, call 995.

---

Frequently asked questions