Cardiologists say the old goal of 10,000 steps a day isn’t needed for heart benefits, according to a new scientific statement from the American College of Cardiology (ACC). The guidance, published in a leading cardiology journal, offers detailed exercise prescriptions for both prevention and treatment of cardiovascular disease.
ACC’s Updated Exercise Targets
The ACC recommends that healthy adults and patients with stable chronic heart disease aim for at least 150 minutes of moderate-intensity aerobic activity or an equivalent amount of vigorous exercise each week. Benefits continue to rise up to roughly 300 minutes of moderate or 150 minutes of vigorous activity, which can also be expressed as 500–1,000 MET-minutes per week.
A meta-analysis cited in the guidance linked an average of about 7,000 steps per day with a 47% lower risk of all-cause and cardiovascular mortality compared with only 2,000 steps. This suggests that moving from a sedentary baseline to modest activity yields the greatest risk reduction, rather than chasing a specific step count.
Resistance training is also emphasized. The committee advises at least two weekly sessions of strength work to preserve muscle mass, improve insulin sensitivity, and lower blood pressure. While data on resistance training alone preventing events are limited, combined aerobic and strength programs are supported by the evidence.
Tailored Plans for Specific Conditions
For patients recovering from coronary artery disease, the statement reaffirms cardiac rehabilitation as first-line care. A prior meta-analysis of 47 trials showed a 26% reduction in cardiac mortality and an 18% drop in hospital admissions among participants, though overall mortality did not change significantly.
Individuals with peripheral artery disease and intermittent claudication should engage in supervised walking bouts that bring discomfort to a moderate or near-maximal level, followed by rest and gradual progression. This approach improves walking distance and relieves symptoms.
In heart failure with reduced ejection fraction, the HF-ACTION trial demonstrated an 11% lower combined risk of death or hospitalization for those following a structured exercise regimen, after adjusting for baseline characteristics. For heart failure with preserved ejection fraction, exercise enhances functional capacity, though its impact on major events remains uncertain.
Patients with hypertrophic cardiomyopathy or adult congenital heart disease may benefit from cardiopulmonary exercise testing to gauge safe intensity, but routine maximal testing is unnecessary for most asymptomatic or stable individuals. Over-testing can generate false-positive results that discourage activity.
Wearable devices can provide real-time feedback and support home-based or hybrid rehabilitation, especially when clinicians guide their use. However, the guidance warns that device costs and digital literacy gaps could widen health disparities.
Historically, public health campaigns highlighted the “10,000 steps” target as a simple benchmark. Compared with that era, the new ACC guidance shifts focus toward individualized dose, intensity, and type of activity, recognizing that even modest increases from inactivity deliver substantial heart protection.
For older adults with frailty, the initial focus should be on strength, balance, mobility, and flexibility before progressing to endurance work. This staged approach aligns with the FITT principle—frequency, intensity, time, and type—used throughout the recommendations.
Integrating Exercise Into Clinical Practice
Clinicians often lack formal education in prescribing physical activity, leading to limited use of structured counseling during routine visits.
Guidelines organize recommendations around frequency, intensity, time, and type, encouraging gradual progression from low-to-moderate workloads.
Evidence highlights cardiorespiratory fitness as a powerful predictor of survival, matching or surpassing traditional risk factors such as hypertension and diabetes.
Patients with raised blood pressure or excess body weight receive specific advice to combine aerobic movement with strength work, aiming to improve vascular tone and metabolic health.
When patients present with complex cardiac histories, referral to exercise specialists or rehabilitation programs ensures safe implementation of the plan.
Patients experiencing unstable cardiac symptoms or specific cardiomyopathies may require temporary activity restrictions until specialist assessment confirms safety.