Br J Sports Med
Heart protection may require 3–4x current exercise guidelines
Clinical Takeaway: The 150-minute weekly target is a starting point, not a finish line. Motivated patients seeking meaningful heart protection should be counseled toward much higher volumes, and less-fit patients need slightly more minutes than fitter peers to reach the same benefit.
Current guidelines recommend 150 minutes of moderate-to-vigorous activity per week, a one-size-fits-all threshold built largely on self-reported data. This analysis used wrist accelerometers and estimated VO2 max to evaluate whether that target actually captures the dose needed for substantial heart protection.
Meeting the 150-minute guideline cut composite cardiovascular risk by only 8% to 9%, consistent across fitness levels. Reaching a 30% reduction required 560 to 610 minutes per week, which is three to four times the current minimum. Just 12% of the cohort hit that volume.
The least fit individuals needed roughly 30 to 50 additional minutes weekly to match the benefit fitter peers got. For a 20% risk reduction, that meant 370 minutes versus 340. A residual analysis showed fitness itself carried a small independent protective effect beyond activity volume, reinforcing cardiorespiratory fitness as a marker worth tracking separately from minutes logged.
The cohort included 17,088 UK Biobank participants who wore accelerometers for seven days between 2013 and 2015 and completed a submaximal cycle test. Over a median 7.8 years, there were 1,233 cardiovascular events.
The authors argue future guidelines may need to separate a minimum safety margin from the substantially higher dose needed for optimal protection. The 150-minute floor stands as a public health anchor, but clinicians can now offer fitness-calibrated targets to patients ready to push past it.
"This finding highlights the steeper challenge faced by deconditioned populations," the authors note, patients who carry both higher baseline risk and a steeper climb to equivalent benefit.
Source: Liang Z. Br J Sports Med. 2026 May 19. Joint non-linear dose-response associations of device-measured physical activity and cardiorespiratory fitness with cardiovascular disease