More Exercise, Lower Heart Risk: New Study Challenges the 150-Minute Rule

Is 150 Minutes of Exercise Really Enough for Your Heart?

For years, 150 minutes of moderate-to-vigorous physical activity per week has been one of the most widely used benchmarks for maintaining cardiovascular health.

But new research suggests that there may be a significant difference between doing enough exercise to achieve a basic health benefit and doing enough to achieve a much greater reduction in cardiovascular risk.

A new study published in the British Journal of Sports Medicine examined how physical activity and cardiorespiratory fitness work together to influence cardiovascular disease risk. Rather than relying only on people's estimates of how much they exercise, the researchers used accelerometer measurements to objectively assess physical activity and combined this with estimated cardiorespiratory fitness.

The study looked at both activity and fitness

The researchers analysed data from 17,088 participants in the UK Biobank who had objective physical activity measurements and estimated VO₂max, a widely used indicator of cardiorespiratory fitness.

Participants were followed for a median of approximately 7.9 years, during which 1,233 cardiovascular disease events were recorded.

The cardiovascular outcomes included atrial fibrillation, heart attack, heart failure and stroke.

The researchers then examined physical activity and fitness together rather than treating them as completely separate factors.

That distinction is important.

Someone can exercise regularly but still have relatively low cardiorespiratory fitness. Another person may have a high level of fitness and therefore require a different amount of activity to reach a similar level of cardiovascular protection.

The results suggest that exercise volume and fitness level should not necessarily be viewed as one-size-fits-all variables.

150 minutes still matters

The findings do not mean that the current 150-minute recommendation is wrong.

Quite the opposite.

The study found that reaching approximately 150 minutes of moderate-to-vigorous activity per week was consistently associated with a modest reduction in cardiovascular disease risk across different fitness levels.

The estimated reduction was approximately 8% to 9% compared with being sedentary at the same fitness level.

So, if someone currently does very little physical activity, reaching 150 minutes per week remains a meaningful and realistic target.

The important question is what happens after that point.

The cardiovascular benefits appear to continue with more activity

The researchers developed a fitness-stratified model to estimate how much weekly activity was associated with progressively greater reductions in cardiovascular risk.

The estimated targets were striking.

Approximately:

150 minutes/week → ~8% to 9% risk reduction

340 to 370 minutes/week → ~20% risk reduction

560 to 610 minutes/week → >30% risk reduction

These figures should not be interpreted as universal prescriptions for everyone. They are model-based estimates from this particular observational cohort, rather than results from a clinical trial proving that everyone should exercise for 10 hours a week.

Still, they illustrate an important concept:

The minimum amount of exercise needed to obtain a health benefit is not necessarily the amount that produces the maximum benefit.

Fitness may be just as important as exercise volume

One of the most interesting findings was the role of cardiorespiratory fitness.

Higher fitness was associated with lower cardiovascular risk even after accounting for physical activity and other factors.

The researchers estimated that every additional 1 mL/kg/min of VO₂max was associated with approximately a 2% lower cardiovascular disease hazard in their residual fitness analysis.

In simpler terms, two people who report similar amounts of exercise may not necessarily have the same cardiovascular risk.

Their physiological capacity to use oxygen efficiently may also matter.

This is one reason why simply counting exercise minutes may not provide the complete picture of cardiovascular health.

The genetics add another interesting layer

The researchers also used Mendelian randomisation, a genetic approach that can help investigate whether observed associations are consistent with potential causal relationships.

The genetic analysis provided suggestive evidence that higher genetically predicted cardiorespiratory fitness was associated with a lower risk of heart failure.

For heart failure, genetically proxied higher fitness was associated with an odds ratio of 0.79, although the researchers appropriately described the evidence as suggestive rather than definitive.

The genetic evidence for physical activity itself was weaker and less consistent.

This distinction is important.

The observational findings strongly support the relationship between physical activity, fitness and cardiovascular health, but the genetic analyses do not establish that simply increasing activity will necessarily produce the exact risk reductions predicted by the observational model.

What does this mean in real life?

The biggest message is not that everyone needs to exercise for 600 minutes every week.

It is that exercise recommendations should ideally move beyond a single number.

For someone who is currently inactive, reaching 150 minutes per week can be an excellent first goal.

For someone who already has a reasonable level of fitness and wants to optimise cardiovascular health, gradually increasing activity may provide additional benefits.

And for someone with low cardiorespiratory fitness, improving fitness itself may be an important part of the equation.

In other words:

The right exercise target may depend on where you are starting from.

This is particularly relevant to precision health, where the objective is not simply to give everyone the same recommendation, but to understand how individual characteristics can influence the most appropriate intervention.

From population guidelines to personalised exercise prescriptions

Traditional public-health recommendations are designed for populations.

They need to be simple enough for millions of people to understand and follow.

But clinical precision health operates differently.

A personalised approach can consider factors such as:

• Current cardiorespiratory fitness
• Existing physical activity levels
• Age
• Body composition
• Cardiometabolic risk
• Lifestyle factors
• Genetic characteristics
• Individual goals and capacity

The new study provides an interesting framework for thinking about exercise in this way.

Instead of asking only:

"How many minutes should I exercise?"

we may increasingly ask:

"Given my current fitness and health profile, how much activity is likely to provide the greatest benefit?"

That is a much more personalised question.

Why This Matters for GeneFit Readers

At GeneFit, we believe that health recommendations should be personalised rather than generic.

This study reinforces that philosophy.

Two people can follow the same exercise routine and still have very different physiological responses. Their baseline fitness, body composition, metabolic profile and other individual characteristics can influence how they respond to exercise.

The study also highlights an important distinction between minimum effective activity and optimal activity.

For the general population, 150 minutes per week remains an important and achievable target. But for individuals pursuing higher levels of cardiovascular resilience, the optimal exercise dose may be substantially higher.

This is where personalised assessment becomes valuable.

Rather than simply telling someone to "exercise more", a precision-health approach can begin by understanding where that individual is today and then developing a strategy for where they want to go.

At GeneFit, combining genetic insights with metabolic, body-composition and fitness-related assessments can help move exercise and lifestyle recommendations toward a more individualised model.

The future of fitness may not be about finding one perfect exercise prescription for everyone.

It may be about finding the right prescription for you.

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Reference

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. Advance online publication. https://doi.org/10.1136/bjsports-2025-111351

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