150 minutes a week linked to 38% lower death risk in heart disease

People with coronary heart disease are routinely told to stay active, and plenty of research links movement to living longer. What has been far less clear is the dose: how much activity is associated with the biggest drop in mortality, and whether the benefit keeps climbing the more you do. That question matters for anyone managing a heart condition who wonders whether a daily walk is enough or whether they should be pushing much harder. This review set out to map the full dose-response curve rather than simply confirm that active beats inactive.

The researchers searched six databases in November 2025 for prospective studies that followed people with coronary heart disease over time, recording their non-occupational physical activity and deaths from any cause. Seventeen studies covering 176,862 patients qualified, and 16 of them reported 31,783 deaths. Because the studies measured activity in different ways, the team converted everything to a common currency of weekly activity energy, then modelled the relationship between dose and mortality across a range from zero up to high activity levels, using flexible curves that allow the benefit to rise, flatten or reverse.

The association was clearly inverse but not a straight line. Compared with doing nothing, mortality risk was an estimated 38% lower at a modest weekly dose of 8.75 marginal MET hours, and 39% lower at double that, 17.5 hours. In plain terms, activity around 150 minutes a week of moderate intensity was associated with 38% lower risk of death. At the high end of 30 weekly MET hours the estimate became imprecise, only 8 of the 17 studies had data reaching that far, and the shape of the curve there changed under different analysis assumptions.

The finding sits comfortably with current European cardiology guidance, since the activity levels linked to the largest benefit match the range those guidelines already recommend. It extends earlier work by showing that most of the mortality association is captured at low to moderate doses, with little clear additional gain beyond that. The big open question is the high end: whether large amounts of exercise are neutral, still beneficial or less helpful for people with heart disease simply cannot be answered from these data. And because all 17 studies followed people rather than assigning exercise, cause and effect remain unproven.

For anyone managing coronary heart disease, this is a reason to see consistent, moderate activity as the zone where the evidence is strongest, rather than feeling that only heroic training volumes count. The steep part of the curve sits at amounts many people can realistically achieve, which is encouraging rather than daunting. It is equally a reason not to read anything alarming into the fuzzy high-dose estimates, since the data there were too thin to support any conclusion. As always with studies that observe rather than intervene, fitter people may differ in ways beyond their step counts.