Best Exercises for Heart Health

Michelle Routhenstein, MS, RD, CDE


June 15, 2023

Exercise is one of the best things you can do for your heart. Even if you’ve had a cardiac event like a heart attack or stroke, there are exercises you can do to strengthen your heart. 

In fact, exercise is so powerful that simply moving more, or getting at least 8,000 steps per day, one or 2 days per week reduces your risk of heart attack over a 10-year period by 14.3%. Increasing the 8,000 step frequency to 3 to 7 days per week further reduces overall risk by 16.5%, suggesting a dose-response to increased daily activity.  

In this article, we’ll discuss the best exercises for heart health including exercises after a heart attack. One of my clients is a living testament to the restorative power of exercise. He was successfully able to run a 5K within a year after an unexpected coronary bypass surgery. My client’s story can be your story too, let’s discover how to use exercise to enhance your heart health. 

Best Exercise for Heart Health

When it comes to heart health, even the smallest amount of movement is better than none. Please note that if you have a current heart condition such as atrial fibrillation, aortic root dilation, congestive heart failure, or a history of heart attack, stroke, or bypass surgery, get medical clearance first. 

Medical clearance is important because though exercise is beneficial, it is also a form of stress, called a hormetic stressor. A hormetic stressor is a type of stress that can be damaging at high doses, but offers a beneficial effect at lower doses. Simply put, too much exercise can be potentially harmful to your heart health. 

Over-exercising physically taxes the body and causes an increase in inflammation, which negatively influences heart health. However, a low dose of a hormetic stress, such as one might receive from regular exercise can create positive adaptations in the cells making them more resilient against future stress. 

The best exercises for the heart include a combination of the three main categories of exercise: aerobic exercise, strength training and flexibility training. Let’s explore how each of these exercise modalities offers unique benefits and how collectively, they create a balanced fitness routine. 

Aerobic Exercise

Aerobic exercise is an umbrella term for exercise that benefits the heart and lungs, also known as cardiorespiratory and cardiovascular fitness, hence the term “cardio.” Aerobic activities can include walking, cycling, running, swimming, dancing, and more. 

Aerobic Exercise Benefits

The unique thing about aerobic exercise is that you immediately experience the heart health benefits of exercise. 

The short-term benefits of aerobic exercise begin within the first few minutes once your heart rate and breathing rate increase. As your heart beats faster, it moves more oxygen and vital nutrients to your muscles. Blood vessels work together with the heart to dilate, allowing greater blood flow. 

Over time, as you exercise regularly, there is a lasting positive effect on heart health. Regular aerobic exercise is associated with significant reductions in risk factors for heart disease such as blood cholesterol, blood pressure, and body composition.

Don’t forget that the heart is a muscular organ. Not only does exercise strengthen the body, but it also strengthens the heart. Exercise increases the heart muscles’ ability to expand, hold more blood with each contraction, and pump blood more efficiently. 

Cardiac output is a measure of how efficient your heart is. It is the product of your heart rate and how much blood you can pump with each heartbeat. A physician can measure your ejection fraction, or the amount of blood pumped by the heart per minute as a measure of your heart health. 

My client had an ejection fraction of 15%, which is consistent with heart failure. A normal ejection fraction is 50%. The good news is that you can improve your ejection fraction through exercise, along with other lifestyle modifications including quality nutrition. 

It is worthy of mention also that inflammation plays a supporting role in the development of heart disease. Regular aerobic exercise improves insulin sensitivity, markers for inflammation, and supports immune function which helps promote good heart health. 

Aerobic Exercise Recommendations

The Physical Activity Guidelines for Americans along with the American Heart Association recommend at least 150 to 300 minutes of moderate aerobic exercise per week. These recommendations can also include at least 75 minutes of vigorous-intensity aerobic exercise. 

There is an ongoing discussion in the exercise community about the appropriate dose of exercise, especially among athletes. 

It is well known that aerobic exercise is cardio-protective, but athletes who are training at a very high volume (> 10 hours per week) at high intensity activities (>9 METs) have statistically higher coronary calcium scores, which is an indicator of plaque buildup in the arteries that can lead to heart disease. 

To optimize your aerobic fitness for heart health, then zone 2 training should be a foundation of your aerobic workouts. Zone 2 aerobic training is performed at 60 to 70% of your maximum heart rate. Current research suggests that 2.5 to 5 hours per week of zone 2 training offers maximum heart health benefits. 

Strength Training

Some people may think of only aerobic training for heart health, but there is robust evidence to show that strength training also offers a host of heart health benefits. Together, aerobic and strength training are complementary types of exercise that have a tremendous impact on your health.

Strength Training Benefits

Strength training is associated with a lower risk of heart attack and stroke. One study of 12,000 participants examined exercise habits over a 10-year period. The study demonstrated that people who did strength training at least 1 to 3 times per week (or up to 60 minutes per week) had a 40 to 70% reduction in all cardiovascular disease events including heart attack

Studies have also linked strength training to a reduction in heart disease risk factors, such as improvements in HDL cholesterol and blood glucose control. 

Strength Training Recommendations

For overall health, the Physical Activity Guidelines for Americans recommend at least two strength training sessions per week. Look for exercises that target major muscle groups in the upper and lower body. 

If your goal is to build muscle and improve overall strength, perform 8 to 10 repetitions of each exercise in 1 to 3 sets. Choose a weight that allows you to feel resistance and by the final few repetitions should feel challenging.

If your focus is on building muscular endurance, increase the number of repetitions in each set to 15 to 20. Muscular endurance exercise may require a lighter weight, but should still feel challenging.

Proper breathing and body positioning are also important during strength training. As you are straining to lift weights and are holding your breath, this causes a sharp and sudden increase in blood pressure. To prevent blood pressure spikes, be sure to exhale during the contraction and  inhale during the ‘lowering” phase.

Combination exercises like squats, pushups, pullups, and deadlift target multiple muscle groups into a single movement and can be worked into a regular routine. If you are looking for inspiration, explore the ACE Exercise Library for step-by-step instructions on almost every common strength training exercise. 

Flexibility Training 

Flexibility training includes stretching, stability, and balance work to support a strong heart and body. 

Flexibility Training Benefits

Flexibility training benefits heart health in several ways, the first of which is an increase in blood circulation while doing passive stretching

Additionally, taking deep breaths as you are stretching helps to lower heart rate and blood pressure, which directly benefits heart health. There is also evidence that regular stretching helps the arteries to be more pliable which is a sign of good heart health. 

Flexibility Training Recommendations

There aren’t specific guidelines for flexibility training like aerobic or strength training. However, the American College of Sports Medicine recommends that after your heart rate has returned to a resting level following a workout, perform at least 60 seconds of stretching for each main muscle group. 

This 60-second stretch can be broken down into 10 to 30-second segments. The important thing to remember while stretching is that it should be done to the point of discomfort, but not pain. 

Personalize Your Heart Healthy Exercise Plan 

Regular exercise has meaningful heart health benefits. Though, recall that exercise is a stressor and creates small amounts of oxidative damage to the cells. Nourishing foods must be an important partner in a fitness plan for heart health. 

Learning how to include quality nutrition both before and after each workout can help to offset any damaging effects of stress and can help ensure that exercise helps, not harms, heart health.  

My client’s success story shows how exercise, when partnered with a nutrition plan, can dramatically alter the course of your heart health. We worked closely together for about 6 months. At that time, we optimized all of his risk factors, reduced underlying inflammation and insulin resistance, and improved his bowel health and cardiovascular function. 

After 4 months, his labs were optimized and his ejection fraction improved from 15% to 60% (normal is 50-75%), which is a dramatic improvement and allowed him to reach his goal of running a 5K.

Discover today how to use exercise along with nutrition to transform your heart health with my Heart Optimization Group Program

If you’re looking for a more targeted and personalized approach, schedule a 15 minute complimentary discovery call for 1:1 counseling today. 


1. Inoue K, Tsugawa Y, Mayeda ER, Ritz B. Association of Daily Step Patterns With Mortality in US Adults. JAMA Netw Open. 2023;6(3):e235174. doi:10.1001/jamanetworkopen.2023.5174.

2. Hormetic stressor Mattson MP. Hormesis defined. Ageing Res Rev. 2008;7(1):1-7. doi:10.1016/j.arr.2007.08.007.

3. Farrell C, Turgeon DR. Normal Versus Chronic Adaptations To Aerobic Exercise. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

4. Peake J, Markworth, J, et al. Modulating exercise induced hormesis: Does Less Equal More? Journal of Applied Physiology. 2015. doi: 10.1152/japplphysiol.01055.2014.

4. Aengevaeren V, Mosterd A, et al. Exercise and Coronary Atherosclerosis Observations, Explanations, Relevance, and Clinical Management. Circulation. 2020;141:1338-1350.doi:10.1161/CIRCULATIONAHA.119.044467. 

5. King J, Lowery DR. Physiology, Cardiac Output. [Updated 2022 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: 

6. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, George SM, Olson RD. The Physical Activity Guidelines for Americans. JAMA. 2018 Nov 20;320(19):2020-2028. doi: 10.1001/jama.2018.14854.

7. Neufeld EV, Wadowski J, Boland DM, Dolezal BA, Cooper CB. Heart Rate Acquisition and Threshold-Based Training Increases Oxygen Uptake at Metabolic Threshold in Triathletes: A Pilot Study. Int J Exerc Sci. 2019;12(2):144-154.PMCID: PMC6355121. PMID: 30761193.

8. O’Keefe EL, Torres-Acosta N, O’Keefe JH, Lavie CJ. Training for Longevity: The Reverse J-Curve for Exercise. Mo Med. 2020;117(4):355-361.PMCID: PMC7431070. PMID: 32848273.

9. Schroeder EC, Franke WD, Sharp RL, Lee DC. Comparative effectiveness of aerobic, resistance, and combined training on cardiovascular disease risk factors: A randomized controlled trial. PLoS One. 2019;14(1):e0210292. doi:10.1371/journal.pone.0210292.

10. Liu, Yang, et al.  Associations of Resistance Exercise with Cardiovascular Disease Morbidity and Mortality. Medicine & Science in Sports & Exercise. 2019;51(3):499-508. doi:10.1249/MSS.0000000000001822.

11. Pinckard K, Baskin KK, Stanford KI. Effects of Exercise to Improve Cardiovascular Health. Front Cardiovasc Med. 2019;6:69. Published 2019 Jun 4. doi:10.3389/fcvm.2019.00069.

12. Bisconti A, Cè E, Longo S, et al. Evidence for improved systemic and local vascular function after long-term passive static stretching training of the musculoskeletal system. The Journal of Physiology. 2020;598(17):3645-3666.doi:10.1113/JP280278.

13. Kato M, Nihei Green F, Hotta K, et al. The Efficacy of Stretching Exercises on Arterial Stiffness in Middle-Aged and Older Adults: A Meta-Analysis of Randomized and Non-Randomized Controlled Trials. Int J Environ Res Public Health. 2020;17(16):5643. doi:10.3390/ijerph17165643.

14. Lavie, C, O’Keefe, J; Sallis, R. Exercise and the Heart — the Harm of Too Little and Too Much. Current Sports Medicine Reports.2015; 14(2): 104-109. doi: 10.1249/JSR.0000000000000134.

© Copyright 2023 Entirely Nourished, LLC. All Rights Reserved. Terms. Privacy Policy. Disclaimer.

Brand and Web Design by