Exercise is medicine: ACC says most heart patients need a prescription, not just advice

Clinical takeaway: Exercise should be treated as a core therapy for cardiovascular prevention and disease management, not simply a lifestyle recommendation. For most adults, clinicians should actively prescribe and monitor physical activity, aiming for at least 150 minutes per week of moderate-intensity exercise.

The American College of Cardiology's new scientific statement positions exercise as a foundational treatment across the spectrum of cardiovascular health, from primary prevention to established coronary disease, heart failure, hypertension, obesity, and peripheral artery disease. The document emphasizes that the greatest cardiovascular benefits occur when sedentary patients become even modestly active, while additional gains accrue with higher volumes of exercise.

“Exercise should be prescribed as a core component of cardiovascular prevention and disease management,” the writing committee concludes.

The statement recommends that most adults accumulate at least 150 minutes weekly of moderate-intensity aerobic activity or 75 minutes of vigorous activity, plus regular resistance training. However, the authors stress that exercise prescriptions should be individualized using the FITT framework (frequency, intensity, time, and type) and tailored to a patient’s cardiovascular condition, medications, symptoms, goals, comorbidities, functional capacity, and preferences.

Notably, the statement discourages routine exercise testing before initiating physical activity in most asymptomatic or clinically stable adults. The authors argue that unnecessary testing creates barriers to exercise, citing the low absolute risk of exercise-related cardiac events and the limited value of screening tests in predicting future events. Exercise testing remains appropriate when symptoms, recent clinical deterioration, or planned vigorous activity warrant risk stratification.

Among disease-specific recommendations, cardiac rehabilitation remains first-line therapy after myocardial infarction, PCI, CABG, stable angina, and spontaneous coronary artery dissection. Patients with symptomatic peripheral artery disease should be referred to supervised or structured exercise therapy before other interventions when feasible. For hypertension, exercise is recommended alongside antihypertensive drug therapy, while patients with stable HFrEF may benefit from cardiac rehabilitation to improve exercise capacity and clinical outcomes.

The statement also highlights emerging roles for telehealth, home-based cardiac rehabilitation, hybrid programs, and wearable devices. Evidence suggests activity trackers can increase daily activity and improve adherence, particularly when paired with clinician guidance. The authors caution, however, that cost, digital literacy, smartphone access, and other barriers must be considered to avoid widening health disparities.

What’s changed

• Routine exercise testing is no longer recommended before exercise prescription for most asymptomatic or stable patients.
• Greater emphasis on individualized exercise prescriptions using the FITT framework rather than generic activity advice.
• Expanded support for home-based, virtual, and hybrid cardiac rehabilitation models.
• New focus on wearable devices as adjuncts for self-monitoring, goal setting, and rehabilitation extension.
• Recognition that modest activity increases, including achievable step-count targets around 4,000-8,000 daily steps, can provide meaningful cardiovascular benefits.
• Updated guidance supports mild-to-moderate recreational exercise for many patients with hypertrophic cardiomyopathy, while continuing to urge caution in arrhythmogenic cardiomyopathy and active myocarditis.

Source: Myers J, et al. (2026 Oct 15) J Am Coll Cardiol. Exercise Prescriptions for Cardiovascular Health in Adults: 2026 ACC Scientific Statement