The recommendation of 150 minutes of exercise per week should be higher for greater cardiovascular protection, according to a study

Is the research of good quality?

“Yes, it is methodologically sound.”

How does it fit with the existing evidence?

“General recommendations need to be simple and clear. This article says that personalization is better, but that is always more difficult to explain and not very helpful in getting the message across.”

What are the implications? Do the recommendations need to be changed?

“This article doesn't have enough evidence to support that, although the message could be that a higher level of exercise leads to greater improvement.”

This is a well-designed study, based on data from the UK Biobank, with nearly 18,000 participants who experienced more than 1,000 cardiovascular events during follow-up.

Although the authors found that meeting the standard recommendation of 150 minutes of physical activity per week resulted in a moderate risk reduction, four times as much time (around 600 minutes/week) was needed to achieve maximum protection against the risk of cardiovascular events. The study suggests that to achieve optimal cardiovascular protection, we need more frequent physical activity than previously thought—almost an hour and a half daily.

This study addresses a highly relevant question: how do objective physical activity measured by an accelerometer and cardiorespiratory fitness (estimated as VO₂max) jointly relate to the risk of cardiovascular disease?

The study is methodologically sound for its intended analysis. It uses data from the UK Biobank with objectively measured physical activity—a significant strength compared to standard questionnaires.

One of the most interesting findings is that meeting the current recommendation of 150 minutes per week of moderate-to-vigorous physical activity is associated with a relatively modest reduction in cardiovascular risk, around 8–9%, while reductions exceeding 30% would require considerably higher activity volumes, in the range of 560–610 minutes per week. Furthermore, the study suggests that cardiorespiratory fitness plays an independent role.

This aligns reasonably well with previous evidence, which already showed that cardiorespiratory fitness is one of the most powerful predictors of cardiovascular health and mortality. The novelty here is the attempt to quantify how physical activity and fitness interact using objective measures and joint models.

The results should not be interpreted to mean that current recommendations are insufficient or should be modified immediately. Physical activity guidelines remain based on a much larger body of evidence and continue to be appropriate as a public health goal. Probably, the most useful message is to consider the 150 minutes per week as an effective minimum threshold, not necessarily as the level of maximum cardiovascular protection.

The study also has certain limitations. VO₂max is estimated and not directly measured. Furthermore, activity measured by accelerometer is not directly equivalent to self-reported activity, on which many clinical recommendations are based; therefore, a direct translation cannot be made between the minutes found in the study and current guidelines. Additionally, this remains indirect and observational evidence (not a clinical trial).

Overall, the study reinforces an important idea: in cardiovascular prevention, perhaps we should not focus solely on “counting minutes of exercise,” but also on improving functional capacity and cardiorespiratory fitness.

The article is very interesting and of high quality, though this does not mean that its findings can be directly applied to the Spanish population of people in their fifties. The sample is a highly selected group that includes individuals who are undoubtedly fitter than most people of their age. Given that they are fitter, I would venture to say that they undoubtedly have healthier lifestyle habits as well.

In summary, and greatly simplifying the results, the conclusions I draw for my clinical practice would be as follows:

1. The recommendation of 150 minutes of vigorous exercise per week remains highly valid for the general population, and I wish we could all meet it. This would surely reduce cardiovascular problems by more than 10% (this study mentions a reduction of 8–9%, but given the bias we discussed earlier, it is very likely that they are underestimating the benefit).
2. Doing more exercise (and reaching 10 hours a week) is likely to be more beneficial in a population that is already physically fit.
3. Doing more exercise is likely to improve the elasticity (and positive remodelling) of both the heart and the major arteries. This would justify an even greater improvement in the prevention of cardiovascular problems and, above all, heart failure. Heart failure, despite apparently good ventricular contraction, is one of the main heart problems, and one of the proposed causes is the ‘stiffness’ of the heart due, amongst other things, to a lack of exercise. I believe this article supports the hypothesis that, by doing more exercise, you keep the heart more ‘elastic’ and reduce the likelihood of developing heart failure.”

The press release does not accurately reflect the science in the paper. The data in the paper very clearly support current World Health Organisation physical activity guidelines. i.e. Achieving 150 minutes of moderate to vigorous intensity physical activity, irrespective of your physical fitness level, is associated with ≈8-9% lower risk of future cardiovascular disease. People who are able to do more activity have even lower risk, so every move counts.

However, it is misleading to say that people need to achieve >560 minutes (1hr 20mins per day) for health benefit.

The underlying research is good, using world-leading datasets and well accepted methods. The authors’ conclusions in the scientific manuscript are fine (e.g. “Importantly, these findings simultaneously reinforce the public health value of the current 150 min/week guideline. The remarkably consistent relative risk reduction across all fitness strata (HR, 0.91–0.92) and the broadly overlapping CIs in figure 2A confirm that this threshold functions as a robust universal minimum that does not require fitness-­ based modification. Given that large proportions of the population do not yet meet even this benchmark77, the primary public health message remains straightforward: achieving 150 min/week of MVPA delivers meaningful cardiovascular protection regardless of fitness level.”) … the only problem is with the less careful wording in the abstract and press release text.

We can’t give much weight to the figure of 560-610 minutes of exercise a week. Clearly there will be cardiovascular benefit for people who are able to do >1hr 20mins of moderate-to-vigorous intensity physical activity per day but this is not a sensible public health message. The public should continue to aim for at least 150 minutes of moderate to vigorous intensity of physical activity per week; more is better; every move counts.

“Public health guidelines are in a current state of transition to in future reflect evidence from studies with device-measured (rather than self-reported) physical activity levels. This exact same dataset has already been used many times (e.g.https://www.sciencedirect.com/science/article/pii/S0140673625022196?via%3Dihub… https://journals.lww.com/acsm-essr/fulltext/2026/01000/daily_steps_as_a_public_health_metric_for_ph…).

“This work clearly contributes to the evidence base showing that it is important for people to be physically active. However, the suggested target is misguided. The public should continue to aim for at least 150 minutes of moderate to vigorous intensity of physical activity per week; more is better; every move counts.