Cardiologists’ New Guidance Treats Exercise Like a Medication

CATEGORY: EXERCISE & MOVEMENT

A visit to the cardiologist usually ends at the pharmacy: a statin, a blood pressure pill, maybe a blood thinner. Almost nobody leaves with a written dose of movement. The American College of Cardiology wants that to change. In a scientific statement published October 15 in its flagship journal, the College says exercise should be prescribed as a foundational part of routine heart care, tailored and tracked the way a medication would be.¹ The benefit starts earlier than most people assume. Meaningful gains appear well below the famous 10,000 steps, with roughly 5,000 to 7,000 a day linked to a substantially lower risk of dying from heart disease or any other cause.¹

A Dose and a Schedule, Like Any Pill

This isn’t a new experiment. It’s a consensus document, the College’s reading of decades of trials and long-term studies, turned into instructions for clinicians. The prescription it describes is individualized: built around a patient’s heart condition, fitness, symptoms, goals and preferences. Strength work belongs in it too. The statement says resistance training, the lifting-and-pushing kind of exercise, should complement aerobic activity for most adults. Wearable devices and virtual or home-based rehabilitation programs can help people stick with a plan. And for most people who are stable and symptom-free, there’s no need for a treadmill test before starting.¹

Low Fitness Ranks Alongside Smoking

Why treat movement as medicine? The statement points to cardiorespiratory fitness, which is how well your heart and lungs can deliver oxygen when you’re working hard. Low fitness predicts future heart disease about as strongly as smoking, high blood pressure, high cholesterol or diabetes.¹ The steepest gains come first. Moving from no activity to some carries the largest improvement, with further benefit as volume and intensity rise where that’s clinically appropriate. “The most important message is that some activity is better than none,” said Jonathan Myers, the research scientist who chaired the writing committee, adding that patients don’t need to become athletes to improve their heart health.¹

Cardiac Rehab Keeps the Front Door

For people who already have heart disease, the statement keeps cardiac rehabilitation as first-line treatment. That’s the supervised program of exercise and education offered after a heart attack, heart surgery, or a heart failure diagnosis. The College seeks to expand access and identifies insurance reimbursement as a barrier for numerous patients. When a formal program is out of reach, the statement asks clinicians to write an individualized exercise prescription instead of letting the matter drop.¹ The evidence behind that stance runs deep. A Cochrane review updated this fall, covering 107 randomized trials and nearly 27,000 people, found 28% fewer heart attacks and about a third fewer hospital admissions among people in exercise-based rehab programs.²

Key Takeaways

• This is aimed at doctors: the College advises prescribing exercise as part of routine heart care, with individualized plans and strength training alongside aerobic activity.
• Around 5,000 to 7,000 steps a day was linked to lower risk of death in the evidence the College reviewed, so the benefit arrives well short of 10,000.
• This is guidance distilled from existing trials and long-term studies, not a new study, and it says most stable, symptom-free patients can start without an exercise test.

References

1. Myers J, Beckie T, Chastin S, et al. Exercise Prescriptions for Cardiovascular Health in Adults: 2026 ACC Scientific Statement: A Report of the American College of Cardiology. Journal of the American College of Cardiology. 2026;S0735-1097(26)07722-3. link
2. Dibben G, de Vries FBG, Faulkner J, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews. 2026;9:CD001800. link