Heart disease remains the leading cause of death in Australia, claiming one life approximately every 12 minutes. Yet decades of research — and a growing body of landmark clinical trials — confirm that exercise is one of the most powerful tools we have to prevent it, manage it, and recover from it.

PART ONE: EXERCISE AS PREVENTION — STOPPING HEART DISEASE BEFORE IT STARTS

The relationship between physical activity and cardiovascular disease (CVD) risk reduction is one of the most robustly established findings in all of medical science. Physical activity can improve insulin sensitivity, alleviate plasma dyslipidemia, normalise elevated blood pressure, decrease blood viscosity, promote endothelial nitric oxide production, and improve leptin sensitivity to protect the heart and blood vessels.

A comprehensive 2024 systematic review and meta-analysis published in Cureus examined the impact of aerobic, resistance, and combined exercise training on cardiovascular risk factors across randomised controlled trials, cohort studies, and observational studies conducted over a decade. The findings confirmed that structured exercise programmes consistently and significantly reduce the major modifiable risk factors for CVD — including blood pressure, LDL cholesterol, fasting glucose, and body fat percentage.

One of the most clinically significant recent trials is the CardioRACE trial, published in the European Heart Journal (2024). This randomised controlled trial enrolled 406 adults aged 35–70 years with overweight or obesity and elevated blood pressure, assigning participants to resistance training, aerobic training, combined resistance plus aerobic exercise, or a no-exercise control group, exercising three times per week for one year.

Aerobic exercise alone, or combined aerobic plus resistance exercise, but not resistance exercise alone, improved the composite cardiovascular risk profile compared with the no-exercise control group. Importantly, the combined group achieved meaningful improvements across all four major CVD risk markers — systolic blood pressure, LDL cholesterol, fasting glucose, and body fat — whilst investing only 25 minutes of aerobic and 25 minutes of resistance training per session. This has significant practical implications: it confirms that time-efficient, combined training programmes deliver comparable cardiovascular protection to longer aerobic-only sessions.

How does exercise protect the heart at a biological level?

Physical activity has crucial roles at all three levels of prevention: primary prevention (preventing disease from occurring), secondary prevention (early detection and limiting disability), and tertiary prevention (recovery and rehabilitation after disease has developed). The mechanisms are numerous and interconnected:

• Blood pressure regulation: Aerobic exercise reduces resting heart rate and improves vascular compliance, directly lowering blood pressure

• Lipid profile improvement: Regular exercise raises HDL ("good") cholesterol and lowers LDL ("bad") cholesterol and triglycerides

• Blood glucose management: Exercise increases insulin sensitivity, reducing fasting glucose and the risk of type 2 diabetes — a major independent CVD risk factor

• Inflammation reduction: Modest improvements in weight loss, physical fitness, and physical activity levels may reduce cardiovascular risk through modulation of factors involved in coagulation and inflammation, including plasminogen activator inhibitor-1 and platelet-derived growth factor — markers associated with clot formation and arterial damage

• Endothelial health: Exercise promotes the production of nitric oxide in the blood vessel lining, improving arterial flexibility and reducing the risk of atherosclerosis

  
  

How much exercise is needed for cardiovascular protection?

Current Australian guidelines recommend at least 150–300 minutes of moderate-intensity aerobic activity per week, or 75–150 minutes of vigorous-intensity activity, combined with muscle-strengthening activities on at least two days per week. The CardioRACE trial demonstrates that three structured sessions per week of approximately one hour — combining both aerobic and resistance elements — is sufficient to meaningfully shift cardiovascular risk profiles even in individuals who are overweight with elevated blood pressure.

PART TWO: EXERCISE FOR PEOPLE LIVING WITH HEART DISEASE — CARDIAC REHABILITATION

For people already diagnosed with coronary heart disease, exercise is not a luxury — it is a clinically proven, cost-effective treatment. The evidence base for exercise-based cardiac rehabilitation (CR) is among the strongest in all of cardiovascular medicine.

A landmark 2023 meta-analysis published in the European Heart Journal — the world's leading cardiology journal — synthesised data from 85 randomised controlled trials involving 23,430 participants. Exercise-based cardiac rehabilitation was associated with significant risk reductions in cardiovascular mortality (26% lower risk), hospitalisations (23% lower risk), and myocardial infarction (18% lower risk) compared with no-exercise control groups. Evidence also demonstrated significantly improved health-related quality of life with cardiac rehabilitation participation, and cardiac rehabilitation is cost-effective.

These findings apply across a range of cardiac conditions — from those recovering from heart attack or coronary bypass surgery, to those managing chronic heart failure.

Heart failure and exercise

Heart failure — a condition in which the heart cannot pump efficiently enough to meet the body's demands — was long thought to be a contraindication to vigorous exercise. Research has completely reversed this thinking. A 2025 systematic review and meta-analysis examining high-intensity interval training (HIIT) versus moderate-intensity continuous training in heart failure patients found that both exercise modalities produced meaningful improvements in peak oxygen uptake (VO₂ peak), six-minute walk test distance, and quality of life measures. Both modes were well-tolerated and safe when appropriately supervised.

A separate 2025 systematic review examining exercise-based rehabilitation in heart failure with preserved ejection fraction (HFpEF) — a condition affecting up to half of all heart failure patients — found that structured exercise programmes, including aerobic training, resistance training, and inspiratory muscle training, consistently demonstrated significant improvements in functional capacity, with notable increases in peak oxygen uptake and six-minute walk test distance, as well as meaningful enhancements in quality of life measures.

The role of the Accredited Exercise Physiologist in cardiac care

Exercise prescription for people with heart disease requires specialist knowledge. Heart rate targets, exercise intensity, contraindications, medication interactions, and symptom monitoring all require careful individual assessment. Accredited Exercise Physiologists (AEPs) are university-trained health professionals with the clinical skills to design, deliver, and progress exercise programmes safely for people with cardiovascular disease — and are recognised providers under Medicare chronic disease management plans.

PART THREE: EXERCISE, CANCER TREATMENT, AND THE HEART — THE EMERGING FIELD OF CARDIO-ONCOLOGY

One of the fastest-growing areas of cardiovascular and exercise science is cardio-oncology — the study of how cancer treatments affect the heart, and how exercise can protect it. This is directly relevant to cancer survivors, whose long-term health is increasingly threatened not by cancer recurrence, but by the cardiac side effects of the very treatments that saved their lives.

How cancer treatment damages the heart

Chemotherapy agents — particularly anthracyclines (used widely in breast, bowel, and blood cancers) — and chest-directed radiotherapy can cause a spectrum of cardiovascular complications, collectively known as cardiotoxicity. More than 40% of cancer deaths are now attributed to cardiovascular diseases, and cardiotoxicity is the most concerning cardiovascular complication caused by anti-cancer drugs, with harmful mechanisms including DNA damage, endothelial dysfunction, and oxidative stress.

A 2023 state-of-the-art review published in JACC: CardioOncology — the leading journal in this field — examined the role of exercise in preventing and managing cancer treatment-induced cardiotoxicities. Despite exercise's established benefits on the cardiovascular system, it has not been widely adopted as a non-pharmacological cardioprotective strategy within cardio-oncology care. This represents both a significant gap in current practice and a major opportunity for exercise physiology.

A 2025 whitepaper from the ICOS-CORE working group — an international consortium of cardio-oncology rehabilitation experts — published in the European Heart Journal established a research roadmap for Cardio-Oncology Rehabilitation and Exercise (CORE) programmes.

There is an urgent need to reinforce and extend the evidence informing the cardiovascular care of cancer survivors. CORE is an attractive model that is potentially scalable to improve the cardiovascular health of cancer survivors, leveraging many of the existing frameworks developed through decades of cardiac rehabilitation delivery.

What the evidence says about exercise protecting the heart during cancer treatment

Research on exercise during and after chemotherapy demonstrates several cardioprotective mechanisms:

• Preservation of cardiac function: Aerobic exercise helps maintain left ventricular ejection fraction (LVEF) — a key measure of how effectively the heart pumps — during and after anthracycline chemotherapy

• Reduction of oxidative stress: Exercise upregulates antioxidant defence pathways that counteract the oxidative damage caused by chemotherapy

• Vascular protection: Exercise maintains endothelial function and reduces arterial stiffness, both of which are compromised by cancer treatment

• Cardiorespiratory fitness: Maintaining or improving VO₂ max through exercise is one of the strongest independent predictors of long-term survival in cancer patients

  
  

Exercise recommendations for cancer survivors

Based on current international consensus guidelines, cancer survivors are recommended to undertake:

• At least 150 minutes of moderate-intensity aerobic exercise per week

• Resistance training at least twice per week

• Exercise started as early as safely possible — ideally during, not just after, cancer treatment

  
  

Critically, exercise programmes for cancer survivors with cardiac risk should be individually designed and supervised by an Accredited Exercise Physiologist working within a multidisciplinary care team.

CONCLUSION: EXERCISE IS HEART MEDICINE

Whether your goal is to prevent heart disease, manage an existing condition, or protect your heart during and after cancer treatment, the evidence is unambiguous: regular, appropriately prescribed exercise is one of the most powerful interventions available. It is safe, it is accessible, and — when guided by a specialist — it is transformative.

At Canfit Exercise Physiology, every programme we design is grounded in exactly this evidence. If you are ready to take the first step, we are here to help.

📞 0422 972 663 | 🌐 www.canfitexercisephysiology.com.au

Sources:

• Lee DC et al. Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial. European Heart Journal. 45(13):1127–1142 (2024). doi: 10.1093/eurheartj/ehad827

• Dibben GO et al. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. European Heart Journal. ehac747 (2023). doi: 10.1093/eurheartj/ehac747

• Masmoum MD et al. The Effectiveness of Exercise in Reducing Cardiovascular Risk Factors Among Adults: A Systematic Review and Meta-Analysis. Cureus. e68928 (2024). doi: 10.7759/cureus.68928

• Tian D, Meng J. Exercise for Prevention and Relief of Cardiovascular Disease: Prognoses, Mechanisms, and Approaches. BioMed Research International. 3756750 (2019). doi: 10.1155/2019/3756750

• Campana N et al. Exercise Prescription in Cardio-Oncology. Journal of Clinical Medicine. 14(11):3724 (2025). doi: 10.3390/jcm14113724

• ICOS-CORE Working Group. Cardio-oncology rehabilitation and exercise: evidence, priorities, and research standards. European Heart Journal. 46(29):2847 (2025). doi: 10.1093/eurheartj/ehad827

Keywords:

exercise physiology, heart health, cardiovascular disease, cardiac rehabilitation, cardio-oncology, exercise prescription, heart week Australia, Central Coast NSW