The American College of Cardiology (ACC) has issued new directions for prescribing exercise for patients with cardiovascular disease, including those with coronary artery disease (CAD), heart failure and various cardiomyopathies, and peripheral artery disease (PAD).
The scientific statement, chaired by Jonathan Myers, PhD (Stanford University School of Medicine, CA), and published recently in the Journal of the American College of Cardiology, highlights the benefits of physical activity in different populations and the importance of structured cardiac rehabilitation following an acute event, such as a recent MI, PCI, or CABG surgery.
Meaghan Murphy Wasfy, MD, MPH (Massachusetts General Hospital, Boston), one of the coauthors, said the statement is intended to bridge the gap between the current knowledge about exercise’s benefits and patients seen daily in clinical practice.
“Some of this was meant to be a ‘cheat sheet,'” Wasfy told Cardiology Now News, noting that clinicians are frequently time-crunched when it comes to advising patients about physical activity. “No one has an hour, no one has time to read all the literature, so if your patient asks you why exercise is important for their condition, what’s been studied, this is a resource.”
The scientific statement is a “call to action” for clinicians to “scaffold out time and space for routine exercise counseling for patients with cardiovascular disease,” she added.
Personalizing Exercise, but General Principles Apply
The ACC experts point out that while recommendations should be individualized, the core components of exercise plans are generally consistent across different patient populations, noting that few patients won’t stand to gain. For adults, including those with CVD, the recommendation is 150 minutes of moderate-intensity aerobic exercise, or 75 minutes of vigorous-intensity aerobic activity per week, which is line with direction from the World Health Organization and US Department of Health and Human Services.
Muscle strengthening with resistance training is also recommended at least 2 days per week.
When prescribing exercise to patients, clinicians needn’t worry about maximal exercise testing as it is not necessary for most, although it might be useful for risk stratification in select groups, say the experts.
For patients with chronic CAD, cardiac rehabilitation is strongly recommended. Exercise-based rehab is a class 1 recommendation for patients after MI, PCI, and cardiac surgery. Patients with stable angina should also be referred to cardiac rehabilitation and be encouraged to exercise at an intensity just below the point where chest discomfort occurs. A structured or supervised exercise program is strongly recommended for patients with symptomatic PAD to improve symptoms, walking performance, functional status, and quality of life.
Similarly, patients with chronic, stable heart failure with reduced ejection fraction should be referred to cardiac rehabilitation to improve exercise tolerance and reduce future risk. For patients with hypertension, standard physical activity recommendations apply, just as they do in those with obesity. In older adults, exercise should be personalized, taking general health and frailty into account, but the general goal should still include exercise 3 to 5 times per week for 20 to 30 minutes.
There are some groups where exercise is not recommended, such as those with an MI within the past 2 days, those with unstable angina, or patients with uncontrolled cardiac arrhythmias with hemodynamic compromise. Other groups, such as patients with left-main coronary disease, tachyarrhythmia, bradyarrhythmia, or severe arterial hypertension, should be advised to exercise cautiously.
Wearable Technology
In the era of Apple watches and Garmin activity trackers, the ACC experts devote attention to use of wearable devices to monitor physical activity. While the technology does bolster the amount of physical activity, the effect is modest, and these products should be used in a broader context, such as face-to-face consultations, they say.
When used to complement exercise counseling or in a rehab setting, wearable products can support self-monitoring, goal setting, feedback and exercise progression, according to the statement. The devices also can be helpful as part of virtual or hybrid programs where patients might have difficulties accessing rehab centers.
“This is an enormously growing space,” said Wasfy. Wearable technology can motivate people to be active by quantifying their movement in easy-to-digest ways, such as time or step counts, she said. Reimbursement around cardiac rehabilitation is very strict so wearable devices can help patients and physicians gradually increase their movement in a safe way.
Wasfy cautioned that these consumer products can inadvertently have a downside if patients are hypervigilant about monitoring their metrics, such as heart rate (HR).
“It can have a downside where it leads to more anxiety than empowerment when it comes to getting our patients active,” she said. Patients may be too strict about staying below an arbitrary HR limit, for example, and yet most of the research around HR guidance after an event is based on data from cardiac rehabilitation. “In general, if we’re using any heart rate-based counseling, it’s general counseling, [such as] here is what a moderate-intensity based heart rate looks like.”
Source
Myers J, Beckie TM, Chastin S, et al. Exercise prescriptions for cardiovascular health in adults: 2026 scientific statement. J Am Coll Cardiology 2026; published online October 15, 2026.
Conflicts of Interest
Myers and Wasfy report no conflicts of interest.