Planning an exercise program for the sedentary patient: what a cardiologist needs to know - American College of Cardiology (2023)

Wisdom: past and present

The importance of lifestyle factors and health behaviors in maintaining good health has been known for centuries. In 1772, British physician Dr. William Heberden gives an example of how exercise was beneficial for cardiovascular disease without knowing the nature of the disease: “I knew someone who started sawing wood for half an hour every day and was almost cured. . "1

We further recognize that promoting health-promoting behaviors reduces cardiovascular risk.2Given the many challenges of modern society that limit the adoption of such behaviors, organized efforts are needed at the individual and infrastructural levels to reduce the cardiovascular risk of these non-pharmacological agents. The American Heart Association has identified seven optimal health metrics as part of its strategic goals for 2020 and beyond: no smoking, normal body mass index (BMI), physical activity, healthy diet, normal cholesterol level, normal blood pressure, and a normal fasting glucose.3In the landmark INTERHEART study (Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries), which covered 52 countries, nine risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, alcohol use , physical activity, and psychosocial factors) accounted for >90% of the risk of acute myocardial infarction in men and 94% of the risk in women.4These identified cardiometabolic metrics are highly correlated and generally modifiable. However, while getting patients to change their lifestyle behaviors is particularly difficult, this intervention is perhaps the most effective and underutilized prescription. Observational studies suggest that four out of five heart attacks can be prevented by low-risk health-related behaviors.5

exercise is important

Physical activity is one of the most important lifestyle risk factors that deserves attention. Lack of regular exercise and excessive physical inactivity are clearly associated with cardiovascular risk and mortality in men and women.6-10Reduced levels of physical fitness, as measured by exercise tests, were correlated with an increased risk of mortality.11Even a modest incremental increase in physical activity and exercise results in a measurable reduction in mortality.12,13The effect of exercise on health appears to be dose-dependent. Increased physical activity also has a beneficial effect on several cardiometabolic indices, including weight, blood pressure, glycemic parameters, blood lipids, inflammation, and psychosocial factors.14In addition to the health benefits, the tax advantages are obvious. In the United States, in the year 2000, the national cost associated with physical inactivity exceeded US$ 76 billion; An estimated $5.6 billion in savings would be achieved if 10% of adults started a regular walking program.152010 focused on health promotion with two unique national initiatives. The United States Congress established the National Council on Prevention, Health Promotion, and Public Health, chaired by the Surgeon General and tasked with developing a national prevention strategy. First Lady Michelle Obama took aim at the childhood obesity epidemicLet's go!Bell. In addition, the US Department of Health and Human Services' Health Promotion and Disease Prevention Initiative,healthy people 2020, made physical activity a public health priority. the goals ofhealthy people 2020This includes providing adults with 30 minutes of moderate physical activity most days of the week and ensuring that healthcare professionals assess patients' physical activity and opportunities to progress toward compliance with physical activity guidelines.sixteenThe doctor's encouragement is essential to encourage changes in lifestyle.17,18

the practical recipe

Positioning patients to successfully initiate and increase their physical activity and exercise begins by helping them identify their reasons for wanting to be active. Reinforce and affirm motivations while emphasizing the benefits of exercise. It is recommended to provide information and advice for a safe and enjoyable training session, including the following recommendations:

1. Considerations about the "E"

Energy:Exercise should be scheduled at a time of day when the patient feels rested and has the most energy. Adequate hydration and nutrition are important to fuel physical activity, but it is recommended that one wait at least 1 hour after eating before beginning an exercise session. This is especially important for diabetic patients and should include some tips on controlling and monitoring blood sugar levels before and after exercise.

Surroundings:If the patient plans to exercise outdoors, it is recommended to avoid extreme temperatures (>85°F or <32°F). Patients should dress appropriately for the weather and wear comfortable, supportive (preferably athletic) shoes. An indoor exercise contingency plan can help maintain consistency of physical activity during inclement weather.

Effort:The saying “no pain, no gain” should be avoided; Instead, encourage a pace that allows patients to comfortably continue a conversation.

2. Exercise regulation components: type, frequency, intensity, duration

Type:Aerobic exercise such as walking (outdoor or on a treadmill) and cycling (upright or recumbent bike with minimal resistance) are recommended for beginners. The session should begin with a "warm up" phase of slow walking or cycling with little or no resistance and end with a "cool down" phase of similar intensity. Below is an example of a walk schedule. At the end of the exercise, encourage the patient to exercise the major muscle groups involved during the exercise (eg, this can minimize injury and fatigue and increase flexibility). In addition to movement recommendations, the sedentary patient should be advised to increase general activity. , including sitting less, taking stairs, and parking some distance from your destination.19

Frequency:Encouraging daily exercise can help maintain consistency in beginners. Start with the amount of time that the patient believes is manageable (or that you believe is safe based on the individual's cardiovascular history); This can only take 5 minutes. Suggesting that a person exercise for short periods several times a day is also an option to consider (eg, 5 minutes each, 3 times a day). Since the patient can exercise continuously for 30 minutes, it makes sense to set the frequency to 5 days a week.

Table 1: Exercise program for beginners



Heating (RPE 6-10)

exercise time

Cooldown (RPE 6-10)



5 minutes easy walk/bike

5 min moderate walk/bikeEPR 11

5 minutes easy walk/bike



5 minutes easy walk/bike

8 min half walk/bikeEPR 11

5 minutes easy walk/bike



5-7 minutes easy walk/bike

11 min half walk/bikeEPR 11

5 minutes easy walk/bike



5-7 minutes easy walk/bike

15 min moderate walk/bikeEPR 11-13

5 minutes easy walk/bike



5-7 minutes easy walk/bike

20 min moderate walk/bikeEPR 11-13

5 minutes easy walk/bike


5x a week

10 minutes easy walk/bike

25 min moderate walk/bikeEPR 12-14

5 minutes easy walk/bike


5x a week

10 minutes easy walk/bike

30 min of moderate walking/bikingEPR 12-14

5 minutes easy walk/bike

Intensity:Using a subjective measure of exertion as the person begins to become more active and exercise is helpful for the beginner. The exercise should feel "rather easy" and the person should be able to carry on a conversation without feeling short of breath. One such useful measure of intensity is the Borg Perceived Exertion Scale (RPE).20Effort level is a number that can be used to estimate your heart rate when multiplied by 10. The intensity of the exercise or exertion should feel "fairly light" during the warm-up and cool-down and increase to "a little hard." ” during the more vigorous aspect of the session, as the patient's fitness level improves.

If a "target heart rate" is needed to control intensity, it is reasonable to suggest 20-30 beats per minute above resting heart rate as a training range for sedentary patients who begin to increase their activity (assuming that this rate range heart rate is safe and acceptable for the individual). As the patient's physical condition improves, a stronger intensity level can be individually determined and prescribed based on individual Exercise Tolerance Test (ETT) results, but this is not the focus of this article.

Duration:It is reasonable for the sedentary person to start slowly and maintain the exercise session for as long as they feel is manageable or as their physician deems safe and appropriate. This may take 3-5 minutes at first, but the most important thing is that the person enjoys the activity and feels comfortable. Success breeds success and this will (hopefully!) motivate you to keep going and progress. As mentioned above, several short bouts of exercise throughout the day are a useful approach to increasing exercise time and avoiding fatigue or overexertion in the sedentary individual. Physical activity guidelines for Americans21Include the following recommendation: 150 minutes of moderate aerobic exercise per week (30 minutes/day x 5 days) or 75 minutes of vigorous activity per week. For sedentary patients, this recommendation may seem a bit overwhelming and it is recommended that participants receive a more modest starting regimen.

3. Stay active

A number of resources and strategies to keep your patients motivated are worth discussing. Structured secondary prevention programs, such as cardiac rehabilitation programs, provide an excellent resource for you and your patients to get started and stay current with lifestyle changes, exercise, education and adjustment factors, risk, and social support. Additionally, participation in a cardiac rehabilitation program after a cardiac event has been shown to reduce mortality.22,23The American Association for Cardiovascular and Pulmonary Rehabilitation maintains a directory of programs on its website ( Fitness trackers and fitness apps are additional options you can recommend to your patients to practice their fitness activities. There are also interactive video games that can diversify patients' movement habits. Hiring a training partner adds an element of support and makes the activity enjoyable. Finally, suggest that when clients reach their physical activity and exercise goals, they reward this achievement with something appropriate that they enjoy. Prescribing exercises and moving your patients while sitting is necessary, necessary and effective.


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  3. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and Setting Goals for Promoting Cardiovascular Health and Reducing Disease: The American Heart Association's Strategic Impact Goal for 2020 and Beyond.Traffic2010;121:586-613.
  4. Yusuf S, Hawken S, Ounpuu S et al. Impact of potentially modifiable risk factors associated with myocardial infarction in 52 countries (INTERHEART study): case-control study.Lanzette2004;364:937-52.
  5. Akesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle choices in the primary prevention of myocardial infarction in men: a population-based prospective cohort study.J Am Coll Cardiol2014;64:1299-306.
  6. Kokkinos P, Myers J. Exercise and physical activity: clinical results and applications.Traffic2010;122:1637-48.
  7. Myers J, Kaykha A, George S, et al. Fitness versus physical activity patterns in predicting mortality in men.Bin J Med2004; 117: 912-8.
  8. Gulati M, Pandey DK, Arnsdorf MF, et al. Resilience and risk of death in women: The St. James Women Take Heart Project.Traffic2003;108:1554-9.
  9. Leon-Muñoz LM, Martinez-Gómez D, Balboa-Castillo T, Lopez-García E, Guallar-Castillón P, Rodríguez-Artalejo F. Persistent behavioral deficits, changes in sedentary lifestyle and star vision in older adults.Sport Exercise Med Sci2013;45:1501-7.
  10. Paffenbarger RS ​​Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality and longevity of college alumni.N incl. J Med1986;314:605-13.
  11. Blair S, Kohl HW 3rd, Paffenbarger RS ​​Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality: a prospective study in healthy men and women.JAMA, 1989; 262: 2395-401.
  12. Wen C, Wai JP, Tsai MK, et al. Minimum level of physical activity to reduce mortality and increase life expectancy: a prospective cohort.Lanzette2011;378:1244-53.
  13. Arem H, Moore SC. Patel A et al. Recreational activity and mortality: a detailed pooled dose-response analysis.JAMA Intern Med2015;175:959-67.
  14. Kokkinos P. Physical activity, health benefits, and mortality risk.ISRN Cardiol2012;2012:718789.
  15. United States Department of Health and Human Services. Chronic Disease Prevention: Investing Wisely in Your Health. Prevention of obesity and chronic disease through good nutrition and physical activity (CDC website). Available in: Accessed on 10/01/2015.
  16. Ministry of Disease Prevention and Health Promotion. Physical activity ( website). 2015. Available at: Accessed on 10/01/2015.
  17. Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, Patrick K. A controlled study of physician advice to encourage the introduction of physical activity.Back Med1996; 25:225-33.
  18. Shanks L, Moore SM, Zeller RA. Predictors of initiation of cardiac rehabilitation.rehabilitation nurses2007;32:152-7.
  19. Gennuso K. Sedentary behavior, physical activity and health markers in the elderly.Sport Exercise Med Sci2013;45:1493-500.
  20. Borg GA. psychophysical bases of perceived exertion.Sport Exercise Med Sci1982; 14:377-81.
  21. Ministry of Disease Prevention and Health Promotion. Physical activity guidelines for Americans ( website). 2008. Available at: Accessed on 10/01/2015.
  22. Suaya JA, Stason WB, Ades PA, Normand SL, Shepard DS. Cardiac rehabilitation and survival in elderly coronary patients.J Am Coll Cardiol2009;54:25-33.
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Key words: Achilles tendon,Drink alcohol,blood pressurebody mass index,Cholesterol,diabetes mellitus,dyspnoea,Test the stress,load tolerance,To hold,habits,health behaviorhealth workers,health priorities,health promotionheartbeat,Hypertension,Inflammation,Lifestyle,lipids,Motivation,myocardial infarction,obesity in children,physical effort,Risk factors,secondary prevention,sedentary behaviorfrom smoking,surgeons,E

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What is a good example of an exercise program for a sedentary person? ›

Type: Aerobic exercise, such as walking (outside or on a treadmil) and biking (upright or recumbant bike with minimal resistance), is recommended for someone just beginning.

What are the recommended exercise requirements of the American Heart Association? ›

The American Heart Association recommends adults get at least 150 minutes per week of moderate-intensity aerobic exercise, 75 minutes per week of vigorous aerobic exercise, or a combination of both.

How do you start exercising if you're sedentary? ›

If you have been inactive for a long time, start with short sessions (10 to 15 minutes). Add five minutes to each session, increasing every two to four weeks. Gradually build up to being active at least 30 minutes a day for most days of the week. Drink plenty of fluids before, during, and after exercise.

What is the introductory zone to start a program for sedentary people who want to improve their fitness? ›

If you've been sedentary for a while and are beginning a new exercise program, first check with your doctor, then start out in the moderate zone. As you become fitter, you can do some training in the vigorous zone.

What are 5 sedentary activities? ›

Examples of sedentary behaviour include:
  • sitting for long periods,
  • watching television,
  • riding in a bus or car,
  • playing passive video games,
  • playing on the computer, and.
  • sitting in a car seat or stroller.

What is the most common sedentary activity? ›

Sedentary activities most often understood are screen time activities such as watching TV, playing video games or sitting at a computer or smart phone.

What are the 4 guidelines from the American Heart Association? ›

minimally processed foods. minimized intake of added sugars. foods prepared with little or no salt. limited or preferably no alcohol intake.

What are three requirements of a good exercise program? ›

A complete fitness program must include three things: aerobic exercise, muscular strength and endurance conditioning, and flexibility exercise. Aerobic exercise does good things for your cardiovascular system and is an important part of weight management.

What are four 4 exercises you can do to improve heart health? ›

Examples: Brisk walking, running, swimming, cycling, playing tennis and jumping rope. Heart-pumping aerobic exercise is the kind that doctors have in mind when they recommend at least 150 minutes per week of moderate activity.

How many hours a day is considered sedentary? ›

Even if you are doing enough physical activity, sitting for more than 7 to 10 hours a day is bad for your health. There is evidence that spending a lot of time being sedentary is linked to an increase in health problems such as: being overweight or obese.

How many steps per day is considered sedentary? ›

Sedentary is less than 5,000 steps per day. Low active is 5,000 to 7,499 steps per day. Somewhat active is 7,500 to 9,999 steps per day. Active is more than 10,000 steps per day.

Can you reverse years of sedentary lifestyle? ›

Researchers have found that engaging in aerobic exercise four to five days a week for two years can be what it takes to start to reverse decades of sedentary living. The study, published in the journal Circulation looked at the hearts of adults aged 45-64 with no history of exercising regularly.

What are 5 key factors to consider before starting a fitness program? ›

As you design your fitness program, keep these points in mind:
  • Consider your fitness goals. ...
  • Create a balanced routine. ...
  • Start low and progress slowly. ...
  • Build activity into your daily routine. ...
  • Plan to include different activities. ...
  • Try high-interval intensity training. ...
  • Allow time for recovery. ...
  • Put it on paper.

What is an appropriate strategy to reduce sedentary time? ›

The solution to reducing sedentary behaviour is simple: Get up and move! And it doesn't have to be too intense – even light physical activity, such as going up and down the stairs, doing house chores, or walking around the block, can go a long way.

What are the 4 key components for an exercise program for older adults? ›

There are four components to an effective senior exercise programs: endurance, strength training, flexibility, and balance. When modified according to each individual's needs, these four elements can help you live a healthier, happier and a more independent life. Endurance: Every exercise plan needs to include cardio.

What are the six sedentary behaviors? ›

In general this means that any time a person is sitting or lying down, they are engaging in sedentary behaviour. Common sedentary behaviours include TV viewing, video game playing, computer use (collective termed “screen time”), driving automobiles, and reading.

What are the 5 major risk factors of sedentary lifestyle? ›

By not getting regular exercise, you raise your risk of:
  • Obesity.
  • Heart diseases, including coronary artery disease and heart attack.
  • High blood pressure.
  • High cholesterol.
  • Stroke.
  • Metabolic syndrome.
  • Type 2 diabetes.
  • Certain cancers, including colon, breast, and uterine cancers.
Jun 27, 2017

What are the 8 risk of sedentary lifestyle? ›

A sedentary lifestyle has an array of adverse health effects, including elevated all-cause mortality, CVD mortality, cancer risk, risks for metabolic diseases such as DM, HTN, dyslipidemia, and musculoskeletal diseases such as knee pain and osteoporosis.

What is the difference between sedentary lifestyle and inactivity? ›

There is a difference between a person who is sedentary and a person who is physically inactive. Being 'physically inactive' means not doing enough physical activity (in other words, not meeting the physical activity guidelines ). However, being 'sedentary' means sitting or lying down for long periods.

How much exercise does a sedentary person need daily? ›

An analysis of nine previous studies has concluded that 30 to 40 minutes per day of "moderate- to vigorous-intensity physical activity" is a good remedy for sitting for 10 hours or more daily. The studies involved a total of 44,370 people in four different countries who were wearing some form of a fitness tracker.

What common disease is associated with sedentary behavior and physical inactivity? ›

Unfortunately, physical inactivity, which has progressively increased over the past several decades, significantly increases the risk of numerous diseases/disorders, including several forms of cancer, diabetes, hypertension, coronary and cerebrovascular diseases, overweight/obesity, and all-cause mortality, among ...

Which fruit is good for heart blockage? ›

Berries. Berries include blueberries, strawberries, cranberries, raspberries, and blackberries. These fruits are associated with an impressive amount of health benefits, including their ability to reduce inflammation and improve heart health. Berries are packed with fiber, vitamins, minerals, and plant compounds.

What is the American College of Cardiology diet recommendations? ›

2021 AHA Dietary Guidance for Cardiovascular Health
  • Adjust energy intake and expenditure to achieve and maintain a healthy body weight. ...
  • Eat plenty of fruits and vegetables; choose a wide variety. ...
  • Choose foods made mostly with whole grains rather than refined grains. ...
  • Choose healthy sources of protein.
Nov 23, 2021

Are potatoes good for your heart? ›

Potatoes. As long as you don't deep fry them or load them with unhealthy toppings, a couple of servings of potatoes a week is great for your heart health. Potatoes are high in potassium, which helps lower blood pressure. They are also loaded with fiber, which has been shown to help lower the risk of heart disease.

What are the requirements for a good exercise program? ›

Aim to have aerobic fitness, strength training, core exercises, balance training, and flexibility and stretching in your exercise plan. You don't need to fit each of these elements into every fitness workout. But adding them to your regular routine can help you to have fitness for life.

What are the five keys to a successful exercise program? ›

The 5 key factors to consider in an exercise program
  • Range of movement.
  • Strength.
  • Fitness.
  • Osteoporosis.
  • Weight control.

What are 4 simple steps for a successful exercise program? ›

4 Steps to Your Perfect Exercise Plan
  1. Step 1: Talk with your doctor. This is the most important step to creating an exercise plan. ...
  2. Step 2: Choose your favorite aerobic activities. Aerobic activities work out your heart and lungs. ...
  3. Step 3: Choose your favorite strengthening activities. ...
  4. Step 4: Schedule it out.
Apr 11, 2018

How much exercise should a sedentary person do? ›

The research findings based on fitness trackers closely align with new World Health Organization guidelines, which recommend 150-300 minutes of moderate intensity, or 75-150 minutes of vigorous intensity physical activity, every week to counter sedentary behavior.

Which of the following is an example of sedentary activity *? ›

The correct option is A) playing video games at home

Playing video games is a sedentary activity that does not increase a person's positive mood than physical activities.

What would you recommend to those people who have sedentary lifestyles? ›

Plenty of research has borne out the health benefits of a daily 30-minute walk. It's easy to start walking more, even if you're at the office. Suggest walking meetings instead of sitting around a conference table. You can also try adding activity before or after work, such as walking your dog for longer stretches.

How many hours sitting is sedentary? ›

Even if you are doing enough physical activity, sitting for more than 7 to 10 hours a day is bad for your health. There is evidence that spending a lot of time being sedentary is linked to an increase in health problems such as: being overweight or obese.

How many steps a day is considered sedentary? ›

Sedentary is less than 5,000 steps per day. Low active is 5,000 to 7,499 steps per day. Somewhat active is 7,500 to 9,999 steps per day. Active is more than 10,000 steps per day.

How many hours is considered sedentary? ›

Unless you do at least 30 minutes per day of intentional exercise, you are considered sedentary. If you're Low Active, your daily activities include: Activities of daily living, such as shopping, cleaning, watering plants, taking out the trash, walking the dog, mowing the lawn, and gardening.


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