You don’t need 10,000 steps a day to benefit your heart, cardiologists say

From daily step counts to exercise after a cardiac event, new guidance examines how doctors can tailor physical activity to individual needs and what patients should know about exercising safely.

Exercise Prescriptions for Cardiovascular Health in Adults: 2026 ACC Scientific Statement: A Report of the American College of Cardiology. Image Credit: 19 STUDIO / Shutterstock

In a recent scientific statement published in the Journal of the American College of Cardiology, researchers from the American College of Cardiology (ACC) synthesized existing clinical and observational evidence to guide individualized exercise prescriptions for cardiovascular health. The recommendations address both prevention and the management of established cardiovascular disease (CVD).

The authors reported that the greatest absolute reductions in cardiovascular risk are associated with previously inactive individuals becoming even modestly active. The study provides practical guidance for tailoring aerobic and resistance training across clinical populations, alongside balance and flexibility exercises, potentially improving population-wide cardiovascular health.

Background

Cardiovascular diseases remain a leading cause of illness and death worldwide. Decades of epidemiological research have established that cardiorespiratory fitness (CRF; the ability of the heart and lungs to supply oxygen to working muscles during exercise) is an exceptionally powerful predictor of long-term survival.

Research indicates that CRF’s long-term survival associations equal or exceed those of conventional clinical risk factors (e.g., hypertension, hyperlipidemia, and diabetes mellitus), but clinicians who routinely manage these conditions often receive limited formal training in exercise prescription, leaving structured counseling underused in cardiology care.

Uncertainty about exercise safety and testing requirements has complicated efforts to tailor activity recommendations to patients with different cardiovascular conditions.

About the scientific statement

The present ACC scientific statement aimed to address these implementation bottlenecks and to inform preventive cardiology by providing practical, evidence-based recommendations for clinicians, supported by published research and existing guidelines.

A multidisciplinary writing committee convened in April 2026 developed the statement and drew on findings from seminal randomized controlled trials (RCTs), prospective cohort investigations, systematic reviews, and clinical practice guidelines across diverse populations.

The committee organized its recommendations around the FITT principle (frequency, intensity, time, and type) and gradual progression across primary and secondary prevention settings. The guidance covers coronary artery disease (CAD), peripheral artery disease (PAD), and heart failure (HF; including HF with reduced ejection fraction [HFrEF] and preserved ejection fraction [HFpEF]). It addresses hypertrophic cardiomyopathy (HCM), adult congenital heart disease (ACHD), hypertension, overweight and obesity, and older adults with frailty.

The committee considered the utility of cardiopulmonary exercise testing (CPET) to evaluate functional capacity and guide exercise intensity, and of commercial wearable devices to monitor physical activity and support participation.

Key findings and recommendations

The ACC recommends that healthy adults and those with stable chronic CVD aim for at least 150 minutes of moderate-intensity aerobic physical activity or 75 minutes of vigorous activity weekly, with further benefits generally occurring at higher amounts, up to approximately 300 and 150 minutes, respectively. Activity volume can also be expressed as 500 to 1,000 metabolic equivalent of task (MET)-minutes per week.

A meta-analysis cited in the statement found that taking approximately 7,000 steps daily was associated with a 47% lower risk of all-cause and cardiovascular mortality (compared to 2,000 steps daily). The committee recommended resistance training at least twice weekly, along with aerobic exercise, to preserve lean muscle mass, improve insulin sensitivity, and lower blood pressure. Evidence linking resistance training alone to fewer cardiovascular events is less extensive. For older adults with frailty, initial training should focus on strength, balance, mobility, and flexibility before progressing to endurance exercise.

The committee reaffirmed cardiac rehabilitation (CR) as first-line care for eligible patients with CAD after certain cardiac events or procedures. A previous meta-analysis of 47 randomized trials found a 26% reduction in cardiac mortality and an 18% reduction in hospital admissions, without a significant reduction in overall mortality or recurrent heart attacks.

For patients with symptomatic PAD and intermittent claudication (exertional muscle pain from impaired arterial blood flow), supervised walking therapy was associated with improved walking performance and symptoms. The statement recommends repeated walking bouts to moderate or near-maximal claudication discomfort, followed by rest and gradual progression.

In HFrEF, the cited HF-ACTION trial found that structured exercise was associated with an 11% lower combined risk of death or hospitalization after adjustment for baseline clinical characteristics. Exercise improves functional capacity and quality of life in HFpEF, but its effect on major clinical events remains uncertain. The ACC committee clarified that routine maximal exercise testing is unnecessary for most asymptomatic or clinically stable individuals, since false-positive results can discourage exercise initiation.

Exercise testing, including CPET where appropriate, can still help assess capacity and risk in selected patients with ACHD and HCM. Patients with unstable heart conditions or certain cardiomyopathies may require specialist assessment or temporary exercise restrictions. The authors caution that weekly exercise does not fully offset cardiovascular risks associated with prolonged sitting.

Conclusions

The present ACC statement reinforces the need to prescribe exercise as a standard component of cardiovascular prevention and treatment, rather than as generic lifestyle advice. Consumer wearable devices may support physical activity through real-time biometric feedback and home-based, virtual, or hybrid rehabilitation, especially when paired with clinician guidance.

The authors caution that wearable effects vary and that device costs, along with limited digital literacy or access, can widen existing health inequalities. To incorporate exercise into routine cardiovascular care, improved clinician training, broader access to exercise specialists and rehabilitation, and longer-term trials in diverse populations are needed.