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Regular exercise in middle age may ward off heart failure

American Heart Association

Why It Matters:

  • The right amount of weekly exercise before age 65 can prevent or reduce heart stiffening, a factor in heart failure.
  • Little can be done to treat certain types of heart failure, so prevention is key.
  • Physical activity and other lifestyle choices can enhance cardiovascular health.

Paying attention to your health in middle age with a sufficient dose of exercise could be the medicine to prevent heart failure in later years.

The right type and amount of weekly physical activity begun by late middle age — by age 64 or earlier — can reduce heart stiffening, research indicates. Stiffness in part of the heart muscle is found in people with a condition known as heart failure with preserved ejection fraction. It causes fatigue, excess fluid in the lungs and legs and shortness of breath, and affects about half of the 6 million Americans with heart failure.1

“There’s little that can be done to treat the condition, so prevention is key,” explained Dr. Benjamin Levine, M.D., professor of internal medicine at UT Southwestern Medical Center and director of Texas Health Presbyterian’s Institute for Exercise and Environmental Medicine. Levine recommends making exercise a part of personal hygiene habits, like brushing your teeth.

“It’s a mindset that’s important,” he said, noting there is a “sweet spot” in middle age when physical activity can decrease heart damage. “We know that there will come a time when it’s too late.”

Impact on the heart

Exercise as medicine has been the subject of ongoing research. Levine and his colleagues recently studied the effect of a year of exercise training in people ages 45 to 64 who had early signs of heart failure. They were experiencing heart stiffening and had blood biomarkers associated with heart failure. At the end of the study, participants showed more heart elasticity.2

“So, we really did make a major impact on the structure of their heart,” Levine said. He compares an aging, stiffening heart with a rubber band left unused in a drawer a long time. The old rubber band doesn’t have the elasticity to snap back and perform the way a new one does.

Previously, his research team found heart stiffening begins in middle age and that stiffening increases in those who are living sedentary lives, even if there’s no evidence of cardiovascular disease. But heart stiffening may be prevented or reversed with physical activity if it’s initiated before age 65.2

Getting enough physical activity

“Exercising four to five days each week is the goal,” Levine explained. It should be predominantly aerobic activity.

One session should be a higher-intensity workout that boosts the heart rate with sustained aerobic activity totaling 30 minutes. Two or three moderate-intensity sessions should be incorporated each week, perhaps causing you to work up a sweat while still allowing a conversation with someone. Another hour each week can be devoted to some other physical activity you enjoy, like tennis or biking. A strength-based training session, such as Pilates or yoga, is also recommended.

The American Heart Association recommends adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity (or a combination of both), preferably spread throughout the week.3

Physical activity produces health benefits at any age by potentially lowering blood pressure, promoting better sleep and managing certain diseases such as Type 2 diabetes and arthritis.4 Getting physically active is one of the American Heart Association’s Life’s Simple 7, seven factors that have the biggest effect on cardiovascular health. The others are eating better, maintaining a healthy weight, not smoking, and controlling blood pressure, cholesterol, and blood sugar.5

“However, waiting until the senior years between ages 65 and 80 to begin a committed exercise plan doesn’t reverse heart stiffening as it does in middle age,” Levine noted. So don’t delay.

Ways to get moving

If you’re living a sedentary life in middle age, it may seem daunting to embark on an exercise routine. “Some people get busy with work and family and life gets in the way,” Levine said. “Exercise takes a low priority.”

There are many ways to get motivated. Finding a partner is helpful and makes it a social activity. Consider joining a friend, spouse, or a community or religious group to provide encouragement.

Try to make physical activity interesting and fun. Walking, team sports, and dancing can all boost the heart rate.

Get started slowly with low-intensity activities and build from there. Over-exercising immediately can cause injuries, which can lead to quitting. Be sure to warm up and cool down after each session. Drink water before, during, and after exercising to stay hydrated.6

Prevention improves lives, saves money

Combatting heart failure improves the quality of life of individuals and can reduce society’s total healthcare expenditures. Heart failure is an expensive chronic condition costing the nation more than $30 billion annually.7

“Using exercise to ward off heart failure and enhance overall health should be recognized as the medicine that it is,” Levine said. Instead of encouraging massive spending on prescription medicines to treat people who are already sick, he suggests that the healthcare community emphasize prevention — and exercise is a crucial part of that solution.

He hopes to focus future research on ways to help people better engage in physical activity. “Just losing weight makes it easier for you to do things,” he pointed out.

“While individual preferences vary, it’s most important to get in the habit of being physically active, especially by late middle age,” Levine added. “It positively impacts health and may change the structure of your heart for the better.”


Things to Consider:

  • Make exercise a part of routine health hygiene habits, like brushing your teeth.
  • Waiting too late in life to get physically active won’t prevent heart stiffening, so get going by middle age.
  • Find a partner or group in your community to help motivate you to exercise.


1 A Year Of Committed Exercise In Middle Age Reversed Worrisome Heart Stiffness,” American Heart Association, September 2021
2One-Year Committed Exercise Training Reverses Abnormal Left Ventricular Myocardial Stiffness in Patients With Stage B Heart Failure With Preserved Ejection Fraction,” Circulation, September 2021
3How Much Physical Activity Do You Need?” American Heart Association, 2021
4Real-Life Benefits of Exercise and Physical Activity,” National Institute on Aging, April 2020
5 2022 Heart Disease and Stroke Statistics Update Fact Sheet,” American Heart Association, 2022
6 How Older Adults Can Get Started with Exercise,“ National Institute on Aging, April 2020
7Heart Failure,” Centers for Disease Control and Prevention, September 2020


This article was prepared by the American Heart Association (AHA). Transamerica is not affiliated with the AHA and does not control, guarantee, or endorse the information. This information does not constitute the practice of medical advice, diagnosis, or treatment. Always talk to your healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified healthcare professional immediately. If you are in the United States and experiencing a medical emergency, call 911, or call for emergency medical help immediately.

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