Physical activity and the heart: how much is enough

WHO defines physical activity as any bodily movement produced by the muscles that uses energy. That includes leisure activity, getting from place to place, and movement at work or around the home. Walking, cycling, sport and active play all count.

Intensity matters when counting minutes. The NHS describes moderate activity as something that leaves you able to talk but not sing, such as brisk walking or dancing. Vigorous activity, such as running or swimming, leaves you able to say only a few words before pausing for breath. The American Heart Association (AHA) uses the same talk test.

The WHO fact sheet gives the global adult recommendation as at least 150 minutes of moderate-intensity activity per week. The NHS adult guidance for ages 19 to 64 offers the same 150 minutes, or 75 minutes of vigorous activity, each week, plus strength exercises for all major muscle groups on at least 2 days a week. The AHA agrees: 150 minutes of moderate or 75 minutes of vigorous activity, or a mix, with muscle strengthening on at least 2 days.

For older adults, the NHS also advises at least 150 minutes of moderate-intensity activity a week, along with activities that improve strength, balance and flexibility on at least 2 days a week. For young people, the AHA advises children aged 6 to 17 to get at least 60 minutes a day of moderate to vigorous activity, mostly aerobic. The WHO fact sheet says its guidelines cover children from age 5, adolescents, adults, older adults, and pregnant and postpartum women, and refers readers to the full guidelines for the detail on each group.

WHO reports that, in adults, regular activity is associated with a lower risk of death from cardiovascular disease, a lower risk of developing high blood pressure and type 2 diabetes, and better mental health and sleep. The AHA lists lower risk of heart disease, stroke and high blood pressure, less weight gain, better sleep, and fewer symptoms of depression and anxiety. The NHS notes that exercising even once or twice a week can lower the risk of heart disease or stroke.

On cholesterol, the NHS says you can lower it by eating healthily and getting more exercise; cholesterol and blood fats explains what those numbers mean. Blood pressure is covered in high blood pressure explained. WHO also notes that physical inactivity is one of the leading risk factors for deaths from noncommunicable diseases, and that insufficiently active people have a 20% to 30% higher risk of death than active ones.

The 150-minute figure is a target, not a pass mark. WHO's fact sheet says any amount of physical activity is better than none, and that all physical activity counts. The AHA says the same, and advises that sitting less is a good place to start, since even light activity can offset some of the risks of being sedentary.

This matters because WHO estimates that about 31% of adults, around 1.8 billion people, do not reach the 150-minute level. Falling short is common, not a personal failing. The NHS guidance for older adults makes a similar point: be active every day, even if it is only light activity such as cleaning or standing up.

The AHA calls walking the simplest way to begin: it is free, easy and can be done almost anywhere. Short bursts add up, and a brisk walk of five or ten minutes a few times a day counts. The AHA suggests setting a reachable goal for today and increasing time and intensity gradually as you get stronger.

For a picture of the organ doing the work, see how the heart works. For people also trying to reduce salt and look after their blood pressure, salt and heart health is a useful companion read.

A simple way to ramp up

• Begin with short walks at a pace where you can still talk.
• Add a few minutes at a time as it feels comfortable.
• Spread activity across the week rather than saving it for one day.
• Add strength work on two days a week once walking feels easy.

The NHS advises seeing a doctor first if you have not exercised for a while or have a medical condition or concerns, and the AHA says that people with a chronic condition should talk to their healthcare provider about the types and amounts of activity that suit them. That includes chest pain, breathlessness out of proportion to effort, a known heart condition, or any new symptom. Stop and seek help if activity brings on chest pain that feels tight or squeezing, pain spreading to the arms, neck or jaw, severe difficulty breathing, sweating with feeling sick, or pale, blue or grey skin; the NHS lists these among heart attack signs. See heart attack signs and what to do. Emergency numbers differ by country, so use your local emergency number and do not drive yourself.

WHO, the NHS and the AHA agree on roughly 150 minutes of moderate activity a week for adults, with muscle strengthening on two days, and on the idea that any movement counts. Activity is linked with lower risk of heart disease, high blood pressure and depression. Start where you are, build up gradually, and speak to a clinician first if you have a health condition or new symptoms.