Heart, blood pressure and cholesterol

How does regular activity help your heart?

Regular activity is linked with a lower risk of heart disease and of dying early, and the biggest gains come at the low end of the activity range, so small amounts count^1,2. People who were active at half the basic guideline level had a lower risk of coronary heart disease than people who did none². Benefits begin at very modest amounts, and the WHO guidelines say some activity is better than none^1,3. Reaching 150 minutes a week of moderate-to-vigorous activity captures most of the benefit for living longer¹.

Regular activity improves your fitness and lowers inflammation in the body, which lowers the risk of developing high blood pressure and heart disease⁴. Higher fitness is also linked with a lower risk of high blood pressure and of dying^4,6. The biggest gain comes from moving from the least fit group to a moderately fit one, and after that the gains taper off⁷. If you are starting from very little, modest improvements matter most.

Much of this evidence is observational, so it shows a link rather than proof.

Start with an amount that feels easy, such as a short walk, and build up gradually. Aim to do a bit more than you do now, rather than jumping straight to a big target.

Can exercise lower blood pressure?

Yes. Activity lowers blood pressure, most clearly in people who already have high blood pressure^3,4. Even modest-intensity activity such as walking has a blood-pressure-lowering effect⁴.

The size of the drop depends on where you start. Endurance training, such as walking, cycling or swimming, lowered blood pressure most in people with high blood pressure, less in people with slightly raised pressure, and least in people with normal pressure⁸. Very gentle activity gave smaller drops than moderate or vigorous activity, so build towards moderate effort over time⁸.

Aerobic exercise, strength training and a mix of the two all help, and no one type has been shown to be best⁹. In adults with metabolic syndrome, high-intensity interval training (short, hard bursts of effort) gave the largest drop¹⁰. That kind of training was prescribed and supervised, so it is not a place for beginners to start on their own⁴.

For an amount to aim for, the International Society of Hypertension advises 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous exercise a week, or an equivalent mix. It says to suit the activity to the individual and to build up gradually, starting slow⁴. Expect changes over weeks of regular activity, not days; bigger effects tended to appear in programmes lasting 16 weeks or more¹⁰.

Can activity improve cholesterol?

Probably, but the benefit is modest and uneven. Exercise has been linked with higher HDL (the "good" cholesterol) and lower LDL and triglycerides, but the size of any benefit is uncertain¹¹.

Results vary a lot between programmes and between groups of people. Many programmes made little difference to total cholesterol or HDL⁵. In people with coronary artery disease, exercise raised HDL but did not change LDL or triglycerides¹². In older adults with high blood pressure, combined aerobic and strength training lowered LDL, and strength training lowered triglycerides¹³. No single result applies to every inactive adult.

Mixing aerobic activity with some strength work is a sensible approach, since combined training tended to do best, including for lowering triglycerides^9,5. More sessions a week and longer programmes were linked with bigger drops in total cholesterol⁵.

Regular activity is still worthwhile for your heart and blood pressure even if your cholesterol changes little. If you have a blood test, ask your doctor how often to recheck your cholesterol.

When to check with a health professional

If you're starting exercise after a long break, it's always a good idea to see your doctor first. If you have heart disease, high blood pressure or another long-term condition, or take blood pressure or cholesterol treatment, ask your doctor or a heart organisation what type and amount of activity suits you.

Exercise doesn't replace blood pressure or cholesterol medicines. Keep taking any medicines as prescribed and talk to your doctor before any change.

For an injury or a health condition, see a health professional, such as your doctor or a physio.

Call your local emergency number for chest pain or pressure (or pain spreading to the arm, neck, jaw or back, especially with sweating or feeling sick), severe breathlessness, fainting or collapse, signs of a stroke, a serious injury, or someone who isn't safe.

If you feel unwell, sick, sweaty or dizzy, or get unexplained discomfort or breathlessness that doesn't settle, stop and get it checked. If it has settled, see a doctor soon. Ease off only for a sore muscle or joint, or soreness a day or two later. If that persists or gets worse, see a doctor or other health professional.

Unusual tiredness isn't something to push through or ease off for. Get it checked by a doctor.