Article Impact Level: HIGH Data Quality: STRONG Summary of British Journal of Sports Medicine https://doi.org/10.1136/bjsports-2025-111351 Dr. Zhide Liang et al.
Points
- An observational cohort study of over seventeen thousand individuals indicates that the standard recommendation of one hundred fifty weekly minutes of exercise provides only modest cardiovascular protection.
- Researchers determined that optimizing heart health and achieving a thirty percent reduction in cardiovascular risk requires between five hundred sixty and six hundred ten minutes of weekly exercise.
- The clinical data recorded over one thousand two hundred specific cardiovascular events including major instances of atrial fibrillation, myocardial infarction, heart failure, and acute strokes.
- Analysis shows that individuals with the lowest baseline fitness levels face steeper challenges and require thirty to fifty more minutes of weekly exercise than highly fit populations.
- Investigators utilized Mendelian randomization to verify that cardiorespiratory fitness is an independent causal predictor of early death and critical long-term cardiovascular health outcomes.
Summary
This study evaluated the non-linear joint dose-response relationship of accelerometer-measured moderate-to-vigorous physical activity (MVPA) and estimated cardiorespiratory fitness (CRF) with incident cardiovascular disease (CVD). Utilizing data from 17,088 UK Biobank participants (mean age 57 years; 56% female; 96% white) followed over an average of 7.8 years, researchers examined how both exercise volume and maximum oxygen consumption ($VO_2\text{ max}$) modulate risk. While current public health guidelines recommending at least 150 min/week of MVPA provided a modest safety margin with an 8–9% reduction in cardiovascular risk across all fitness cohorts, the study sought to define the higher activity thresholds necessary to achieve optimal, substantial cardioprotection.
During the follow-up period, 1,233 incident CVD events were recorded, comprising 874 cases of atrial fibrillation, 156 myocardial infarctions, 111 instances of heart failure, and 92 strokes. To achieve substantial clinical protection, defined as a greater than 30% reduction in relative risk, individuals required between 560 and 610 min/week of MVPA, an exercise volume achieved by only 12% of the study cohort. Furthermore, the analysis revealed a stratified requirement based on baseline physiology, showing that deconditioned individuals with the lowest CRF required an additional 30–50 min/week of MVPA compared to highly fit individuals to achieve equivalent risk reductions, such as requiring 370 min/week versus 340 min/week to secure a 20% risk reduction.
While Mendelian randomization reinforced the independent causal importance of CRF in cardiovascular risk reduction, the observational nature of the cohort limits definitive cause-and-effect conclusions. The researchers concluded that universal physical activity targets are insufficient for optimal outcomes and advocate for personalized, fitness-stratified behavioral prescriptions. Future guidelines must differentiate between minimal MVPA thresholds for basic safety margins and the substantially higher, stratified volumes required to optimize cardiovascular risk reduction in specific patient populations.
Link to the article: https://bjsm.bmj.com/content/early/2026/05/03/bjsports-2025-111351
References
Liang, Z., Du, S., Zhao, S., Wang, X., Yan, Q., Xu, B., Ng, S., & Ning, Z. (2026). Joint non-linear dose–response associations of device-measured physical activity and cardiorespiratory fitness with cardiovascular disease: A cohort and Mendelian randomisation study. British Journal of Sports Medicine, bjsports-2025-111351. https://doi.org/10.1136/bjsports-2025-111351
