Advice for aging exercise enthusiasts
Keep up the good work! But dial down your activity level if needed, and don't neglect other heart-healthy habits.
- Reviewed by Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
Are you one of those people who not only meets but routinely exceeds the recommended amount of exercise on most days? The federal guidelines call for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise every week for all adults, including those ages 65 and older. But some people spend far more time exercising, clocking daily hourlong runs or gym workouts, often coupled with lots of physical activity on the weekends — playing tennis, cycling, hiking, or skiing, for example.
In general, exercise-related injuries to the joints, tendons, and muscles become more common with age, mostly due to natural declines in muscle mass and flexibility. The prevalence of heart disease also rises with age. How does exercise — especially higher-than-average amounts — affect that risk?
Without question, exercise is the best "medicine" for your heart. "Physical activity profoundly improves your cardiovascular health and longevity," says Dr. Meagan Wasfy, a cardiologist at Harvard-affiliated Massachusetts General Hospital. And, she notes, there are people who, by virtue of a combination of good lifestyle habits and good genes, can continue to exercise at high levels well into their 60s and beyond.
Is more always better?
Still, don't assume that the more exercise you do, the better, says Dr. Wasfy. The most impressive benefits occur when a person who has been inactive starts doing regular, moderate-intensity exercise. Doing more offers some added benefits, but only up to a point. One study tracked exercise and longevity in more than 660,000 people, with a follow-up that lasted an average of 14 years. Researchers found that even people who did less than the minimum amount of exercise recommended by the guidelines had a 20% lower risk of dying compared with inactive people. Those who did double the minimum amount lowered their risk by 31%, and those who did three to five times the minimum had a 39% lower risk. Beyond that, more exercise didn't earn any additional survival benefits. However, there was no evidence of any downside, even at levels 10 times more than the minimum.
Benefits beyond heart health
So if you're accustomed to doing lots of exercise, staying the course as you age seems to be safe from a cardiovascular perspective. "As a person who's highly active myself, I recognize that there are other reasons for exercising beyond improving heart health and longevity," says Dr. Wasfy. Exercise helps people maintain a healthy weight and also helps to tame stress, especially when you work out with other people.
But it's fine if you decide to dial back your routine to a more moderate level. A less intensive regimen may protect you from overuse injuries but still benefit your cardiovascular health.
Still, just because people are physically active doesn't mean they are immune to heart problems. Here's Dr. Wasfy's advice:
Get routine check-ups and keep tabs on your heart-related risk factors. "I sometimes worry that doctors may be biased to undertreat risk factors like high blood pressure or high cholesterol in people who appear very fit and healthy," says Dr. Wasfy. Another issue she's encountered: Avid exercisers are often reluctant to take medications because they feel they can control their risks with lifestyle changes alone. But you can't outrun dangerously elevated levels of LDL cholesterol, which should be treated with medication.
Don't assume you can eat whatever you want. People who exercise a great deal can certainly consume more than their sedentary counterparts because their workouts burn so many calories. That doesn't mean you can ignore the standard advice for a heart-healthy diet. You still need to limit foods that promote narrowing of the heart's arteries (atherosclerosis), says Dr. Wasfy. Too much saturated fat and highly processed carbohydrates (like crackers, chips, and cookies) and sugary treats in your diet can crowd out more healthful foods like fruits, vegetables, and whole grains.
Pay attention to heart-related symptoms. In general, highly active people tend to be good patients in this regard because they're tuned in to their bodies, says Dr. Wasfy. "When people are used to running at a certain pace, they notice if they are suddenly going slower than normal," she says. If there is no reasonable explanation — for example, they took time off or are recovering from an injury — that may be a reason to check in with a doctor, she says. Sometimes, the first symptom of atherosclerosis or a heart rhythm disturbance can be a subtle reduction in exercise capacity, Dr. Wasfy says.
Image: © Alistair Berg/Getty Images
About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter
About the Reviewer

Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
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