The “optimal exercise pattern” for cardiovascular health

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Systematic aerobic PA can exert a range of positive health effects on cardiovascular health by mitigating multiple pathogeneses associated with CVD. Primarily, it enhances metabolic health by improving insulin sensitivity and increasing energy expenditure, which are crucial for preventing and managing conditions like hypertension, hyperlipidemia, diabetes, and obesity. At the same time, it can also enhance the capacity and efficiency of the aerobic energy supply system, effectively improving CRF and the innate ability of muscles to extract and utilize oxygen from the blood. Evidence also suggests that regular aerobic PA can stimulate the development of coronary collateral blood vessels, increasing myocardial perfusion, and release exerkines that promote angiogenesis and vascularization, contributing to lowered BP and improved endothelial function, etc. It has also proven to play a major role in helping to promote cellular maintenance and repair processes. Collectively, these effects, in concert with other benefits including formulating a healthier metabolic milieu with attenuation of systemic chronic inflammation, adaptations at the vascular (antiatherogenic effects) and heart tissue (myocardial regeneration and cardioprotection) levels, as well as improvement in mitochondrial homeostasis, oxidative stress, autonomic balance and other risk factors, constitute the key biological basis for the role of aerobic PA in the prevention and treatment of CVD.

Physical activity is one of the most accessible and cost-effective strategies for improving cardiovascular health. Current guidelines recommend that healthy adults engage in at least 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic activity per week, or an equivalent combination, supplemented by muscle-strengthening activities on at least two days. However, systematic mechanistic elucidation and precise guidance regarding the specific associations of different exercise modalities and doses with cardiovascular health remain lacking. So, Fangchao Liu and colleagues set out to do so.

The review indicates a non-linear dose-response relationship between aerobic exercise duration and cardiovascular disease risk, with significant risk reduction observed across the entire range, and greater benefits for inactive populations. Objectively measured physical activity information suggests that performing aerobic exercise in the evening may yield greater health benefits; for individuals unable to maintain a daily routine, concentrating activity into one or two weekends (“weekend warrior” pattern) also significantly reduces cardiovascular risk.

Regarding muscle-strengthening exercise, evidence shows a “J-shaped” association with risk, peaking at 40–60 minutes per week, though more objective data are still needed to verify whether excessive muscle-strengthening activity poses potential risks.

Notably, this review emphasizes the significant advantage of combined (aerobic and muscle-strengthening) physical activity in improving cardiovascular outcomes, generating synergistic protection through hemodynamic improvement, metabolic regulation, and body composition optimization.

The review specifically notes that the cardiovascular benefits of physical activity are more pronounced in populations with pre-existing risk factors. However, while pursuing greater benefits, these individuals must pay more attention to safety limits to avoid exercise-related adverse events. The team says further studies are needed, leveraging objectively measured physical activity data to further deepen the understanding of mechanisms by which it improves health and identifying key biomarkers. Furthermore, with the integration of electronic health records and wearable technology, artificial intelligence and big data analytics are driving the development of intelligent personalized physical activity management systems.