A three-pronged approach to exercise

There's no question that getting regular exercise ranks as one of the leading strategies — if not the best one — for preventing heart disease. All forms of physical activity, even in small doses, can make a difference. But if you're looking to optimize your cardiovascular health, a regimen that includes three types of movement may be the way to go, according to a 2024 review article in Trends in Cardiovascular Medicine.

The foundation of this exercise triad is moderate-intensity aerobic (cardio) exercise like brisk walking, one of the go-to options for meeting the federal activity guidelines (see "Exercise recommendations and examples"). Moderate activity benefits your heart by burning calories and boosting metabolism, which helps control weight. But you can reap additional benefits by adding vigorous aerobic activity (the type that really gets your heart pumping) along with muscle-strengthening exercises.

How aerobic exercise helps

"People who run or do similar types of vigorous exercise may have experienced a 'runner's high' either during or after their workout," says Dr. Tim Churchill, a cardiologist at the Cardiovascular Performance Program at Harvard-affiliated Massachusetts General Hospital. That's because your body releases feel-good chemicals known as endorphins and endocannabinoids in response to intense exercise.

Any kind of aerobic exercise, whether moderate or vigorous, also helps dampen the body's "fight or flight" response, which plays a role in chronic stress and anxiety. Aerobic exercise also spurs the release of adrenalin and related hormones that stimulate receptors in the heart to beat more frequently and forcefully. Over time, the heart becomes more efficient, requiring less effort to send blood through the body. And as more blood circulates through the body, blood vessels expand slightly and become more flexible.

Why muscle-building matters

Including muscle-building exercises in your weekly routine has a synergistic effect with aerobic exercise that can further enhance your heart health. Strength training can make your body more efficient at burning fat for energy. It also helps improve how your body responds to insulin, the hormone responsible for regulating blood sugar levels, Dr. Churchill says. That can help prevent or improve diabetes, a potent risk factor for heart disease. Strength training also promotes the production of nitric oxide, a molecule that relaxes and widens blood vessels. "Your arteries are then better able to relax, which helps to maintain normal blood pressure," says Dr. Churchill.

As the review article notes, combining strength with moderate-intensity and some vigorous aerobic exercise leads to greater reductions in resting heart rate, blood pressure, body weight, and body fat percentage than doing single forms of exercise. "Exercise clearly improves a lot of specific markers related to cardiovascular disease. But when you add up all those individual effects, it still only accounts for about 50% of the overall health benefit related to doing regular physical activity," says Dr. Churchill. The elusive remaining 50% is why the decades-long quest to create "exercise in a pill" will probably never materialize, he adds.

Image: © Pyataeva Irina/Getty Images