Introduction
cardiovascular exercise regimes for middle aged sedentary people
research

exercise for health

Introduction

regular exercise is critical to maintain cardiovascular health, reduce chronic disease risks including cancer and improve mental health
care must be taken though to avoid injury from exercise which can then make exercise levels difficult to achieve

a 2025 systematic review of 31 studies (many not well powered) involving 160,000 adults suggests that walking 7000 steps a day has substantial health improvements:¹⁾
- 47% reduction in all cause mortality
- 28% reduction in falls
- 25% reduction in cardiovascular disease (this reduction further improved with more steps walked)
- 22% reduction in depression
- 14% reduction in type II diabetes
- may reduce dementia and cancer
even modest step counts (around 4,000 steps per day) are linked to better health compared to very low activity (around 2,000 steps per day)
other than for cardiovascular benefits, walking more than 7000 steps had less significant additional benefits for most conditions than just 7000 steps making this a more realistic goal than 10,000 steps
another 2025 study showed that walking fast for 15 minutes a day reduced mortality of those aged 40-79yrs by 20%²⁾

too much exercise may be bad for you
- sudden cardiac arrest (presumably in those with unrecognised predispositions) may occur during or after a long run
- rates of sudden cardiac arrest are 20x higher in professional female body builders compared with amateurs and they also had a rate of suicide or homicide 4x higher than in male bodybuilders ³⁾
- while moderate exercise reduces AF risk, high volumes of endurance training over years may be associated with heart arrhythmias like atrial fibrillation
  - a 2025 study showed elite male rowers were seven times more likely to develop AF ⁴⁾
- over-training syndrome causes chronic fatigue, immune system impairment, mood disturbances, and performance decline
- psychological strain and burnout with emotional exhaustion, reduced motivation, and mental health disorders are common in elite athletes
- overuse injuries
- excessive or poorly managed training may induce neuromuscular fatigue and mild chronic inflammation and chronic inflammation is a risk for atherosclerosis
- prolonged outdoor exposures to UV cause premature skin aging, solar dermatitis and skin cancer risk
- fortunately, other than skin cancers, there does not appear to be increased risk of other cancers due to consistence high level exercise
- many sports have characteristic long term musculoskeletal chronic effects such as:
  - hockey players: premature hip OA often requiring THR by age 50yrs
  - rugby, AFL: high prevalence of arthritis, dementia/Alzheimer’s disease, early onset osteoarthritis, and neurodegenerative conditions such as CTE due to repeated traumatic brain injuries
  - soccer: significant risk of traumatic knee and ankle injuries leading to early onset osteoarthritis and joint degeneration; heading the ball is now thought to cause repeated brain insults.
  - combat sports: shorter lifespan, likely from traumatic injuries.
  - volleyball and handball: shorter lifespan hypothesized due to severe musculoskeletal stress and physical trauma associated with the sport
  - long distance cycling: osteoporosis risk especially in women with amenorrhoea; tight hips and hamstrings; chronic pain commonly occurs in the neck, knees, and back due to repetitive strain and posture during cycling; high risk of road trauma; patellofemoral pain syndrome; numbness of hands or overuse tendonitis caused by weight-bearing on the handlebars; iliotibial band syndrome; rotator cuff tendonitis impacting shoulders; solar dermatitis and thickening on neck in particular;
  - mountain biking: high incidence of fractures, head injuries
  - swimming: chronic shoulder problems such as rotator cuff tendinopathy and impingement syndromes related to training volume and intensity;

cardiovascular exercise regimes for middle aged sedentary people

it seems that one can reverse years of adverse cardiac effects from long standing sedentary lifestyles in the middle age by adopting an exercise program with the following minimal levels:
- it has to be something they have access to
- it has to be something they enjoy
- it has to be alternating impact and low impact, and each week:
  - at least one or two long sessions (1hr) of brisk walking, dancing or sport such as tennis
  - at least one or two high intensity aerobic sessions (20-30min) of cycling, jogging, swimming, walking up hills, etc.
  - at least two or three moderate exercise sessions which raise a sweat but not shortness of breath such as moderate walking
- yoga or weight lifting do not improve cardiovascular fitness, but each have their own benefits and risks if not performed with care

research

dimethylguanidino valeric acid (DMVG), exercise and health
- increasing exercise can lower levels of dimethylguanidino valeric acid (DMVG), a molecule in the blood linked to poor health outcomes BUT those with “more room to improve” – actually saw less benefit from exercise than people with lower baseline levels of DMVG – those in better health to begin with. DMGV was associated with adverse metabolic risk even in very young individuals free of overt disease. DMGV levels may identify individuals who are less responsive to the metabolic health benefits of endurance exercise training and may require additional therapies beyond guideline-directed exercise to improve their metabolic health. ⁵⁾

¹⁾

Lancet 2025: Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis

²⁾

2025: Daily walking and mortality in racially and socioeconomically diverse US adults

³⁾

2025: Mortality in female bodybuilding athletes

⁴⁾

https://www.abc.net.au/news/2025-08-09/elite-male-rowers-exercise-atrial-fibrillation/105619180

⁵⁾

JAMA Cardiology 2019

Table of Contents

exercise for health

Introduction

cardiovascular exercise regimes for middle aged sedentary people

research