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Why Excess Strenuous Exercise May Not Be Heart Healthy


Questions: How to Get Your Heart-Healthy Exercise Routine Right


woman exercising at gym

1. Can you explain why exercising is important for heart health?


Our heart beats over 84,000 times a day. Imagine doing a pushup, 84,000 times a day for 80+ years! That is what your heart is doing each day, moving 5 liters of blood throughout your body. Exercising the heart further can improve its strength so you can goal for a 100-year heart!


Exercise is critical to our heart health because the heart is the main pump for our circulation. Circulation of blood is what provides nutrients and oxygen to our body and removes cellular waste products. Think of a pond that is stagnant-it has moss growing on it, and the water is fouled. That is what happens to our blood and the ability to absorb nutrients when our circulation is stagnant.  Then, our lymphatic system (akin to our sewage system) gets blocked up too, unable to move toxins out, causing more inflammation and stagnation! Exercise promotes circulation, clearing the pond and helping to keep stagnation at bay while providing nourishment to the body.


2. Is there a specific age where heart health begins to decline and exercise should be ramped up?


As we approach mid-life, many changes happen to our bodies, especially regarding hormone shifts. In men, the risk for heart attack increases significantly after the age of 45. In women, heart attacks are more likely to occur a little later, after the age of 50, due to the cardio-protective nature of their female hormones. A heart attack strikes someone about every 34 seconds. Heart disease is the number 1 cause of death, over all cancers COMBINED, at number 2. Number 3 is medical error. Medical error is the third largest cause of death, so if anything, that is incentive alone to exercise, get your heart healthy, support your health and stay out of hospitals!


The question really is “When should we instill exercise habits of at least 20 minutes a day 5 days a week?” These habits should be established in childhood. Right now we have rampant obesity and increasing diabetes in the youth of our country, which will age out in the population in further illness and chronic disease processes. This is because of a sedentary lifestyle online as opposed to “playing outside until the streetlights come on!” 


3. What are the benefits of high-impact cardio on the heart?


I am not so much a fan of high impact cardio, unless you were an athlete and have been consistently athletic since youth. High-impact movements create a force equal to about 2.5 times your bodyweight, which can put a lot of stress on your joints, ligaments and tendons. This can increase the risk of injuries. High-impact exercise is not suitable for older people, whose bones and joints are naturally more susceptible to damage, as well as people with existing joint problems or arthritis. We see athletes with bandages and tape and splints due to injury. At some point we have to address the risk for injury over the proposed benefit.


Examples of high-impact cardio are:


  • Running 

  • Rugby 

  • Tennis 

  • Skiing


Instead, I like rebounding-it serves to elevate heart rate, is much easier on joints, really improves lymphatic circulation and the best part is you only need about 9 minutes total to get an effective workout.


4. How often should we engage in high-impact cardio? 


High impact or HIIT workouts can be 2-3 times a week, with recovery times 48 hours in between.


5. What examples of high-impact cardio do you recommend?


I recommend a formal HIIT training or a combination of movements like squats, mountain climbers, jumping rope and jumping jacks. A little easeful jumping such as rebounding is good for bone health.


6. Can you speak to the benefits of walking for the heart? How often should we be walking for ultimate heart health? Any walking tips you recommend (like walking uphill? jogging then slowing down repeatedly? etc.) 


Walking is the best exercise. I try to get in 45 minutes a day. Walking is a gentle cardiac workout, better if you can get on some hills, such as in hiking or on country roads. Walking backward (retro walking) is a great way to improve muscle strength in areas of the legs not normally used. Walking backward helps improve balance and coordination, increase flexibility and range of motion, and enhances quadriceps strength. Retro walking improved gait and muscle strength in people with knee osteoarthritis, juvenile rheumatoid arthritis, and ACL injuries.


Low-impact exercise like walking is an excellent way to maintain your fitness and get your body moving without putting too much stress on your joints. You could also consider low-impact exercise like the elliptical if you are new to working out or are managing joint issues. 


7. Can you speak to the benefits of yoga for heart health?


Yoga is excellent for heart health. It is not an aggressive cardiac workout, and it has been misaligned and dismissed as a non-strength workout. You are lifting your own weight, much like a ballet dancer. 


I am a cardiac nurse, certified in cardiac medical yoga and key important things to know about yoga and heart health for a cardiac patient are that one needs to take into consideration the cardiac diagnosis and medications. For example, if a patient who has congestive heart failure were to be put in a restorative pose like “legs up the wall” this position - though restful, could put the patient in respiratory distress, flooding fluids to the chest from the inverted legs, and causing fluid overload in the lungs. If the patient has had a beta blocker, which causes the blood pressure and heart rate to go down, were to do an inversion such as down dog, where the head is below the heart, could get dizzy and pass out. If they lean forward such as in a forward fold they could also get dizzy and pass out. Knowing your students as a yoga teacher is important.


8. Are walking/yoga/Pilates as beneficial for the heart as high-impact cardio? 


I would say they are. Walking is an excellent form of cardio that can boost your heart and lung health. Yoga is excellent for stretching muscles and fascia, the connective tissue, and Pilates is a form of resistance and core work that serves to strengthen.


I’d like to add that there are so many other factors that are equally important as exercise and nutrition in relation to heart health. 


We need to consider mindset and stress mitigation. Our cells listen to everything we think and respond with hormones and chemicals as if it really did happen! Having a positive outlook can benefit stress levels. 


Yoga and meditation, or any sport such as biking where you “get into the zone” as you are performing the activity is great. Watching stress is important. Stress increases inflammation, the root cause of most disease processes is inflammation. 


Here is an extrapolation from an article by Dr. Joe Mercola, who points to research AGAINST frequent high strength training high intensity workouts.


Other Studies Confirm Importance of Strength Training in Moderation


Land also reviews other studies that confirm the importance of strength training in moderation, keeping your weekly total to an hour or less. Among them is a systematic review and meta-analysis of 16 studies published in the British Journal of Sports Medicine in 2022.2


Muscle-strengthening activities were associated with a 10% to 17% lower risk of cardiovascular disease (CVD), total cancer incidence, Type 2 diabetes and all-cause mortality. As in O’Keefe’s study, this review found a J-shaped association, with a maximum risk reduction of all-cause mortality, CVD and cancer (10 % to 20%) being observed at a dose of 30 to 60 minutes per week.


After 60 minutes, the benefits of strength training started to diminish, and above 140 minutes per week, it was associated with an increased risk of all-cause mortality. Another 2022 systematic review published in the American Journal of Preventive Medicine (AJPM) found that:3


“Compared with undertaking no resistance training, undertaking any amount of resistance training reduced the risk of all-cause mortality by 15% ... cardiovascular disease mortality by 19% ... and cancer mortality by 14% ...


A dose-response meta-analysis of 4 studies suggested a nonlinear relationship between resistance training and the risk of all-cause mortality. A maximum risk reduction of 27% was observed at around 60 minutes per week of resistance training ... Mortality risk reductions diminished at higher volumes.”


fit man holding barbell

Why Does Too Much Strength Training Backfire?


None of the studies mentioned above provide an answer for why strength training backfires beyond a certain amount. A separate paper,4 published in November 2023 theorized it might be due to increased arterial stiffness and chronic inflammation, but noted a lack of confirmatory evidence.

Land suspects the association may have to do with excessive catabolism in older people. The studies didn’t separate people into age groups, so this potential explanation cannot be confirmed. But it makes sense that older individuals might accrue damage from excessive breakdown of muscle tissue. The question is, is that enough to account for the J-shaped curves seen when all age groups are included?


More Moderate Activity Outperforms More High-Intensity Exercise


Another fascinating conclusion of O’Keefe’s analysis5 is that moderate activity outperforms vigorous, high-intensity exercise once you get past 75 minutes a week. At around 75 minutes of high-intensity exercise, you’ve reduced your all-cause mortality risk by 17% and it doesn’t get any lower than that, no matter how much you work out.


If you’re over the age of 40, benefits may actually decrease a little, as the risk of atrial fibrillation skyrockets. The same is not true for moderate activity. Here, the reduction in all-cause mortality continues to accrue the greater the dosage, hitting a reduction of 35% around 850 minutes per week, or just over 14 hours.


An even more extreme benefit for moderate activity is seen when looking at the reduction in cardiovascular risk. Here, vigorous activity maxes out around 200 minutes with a risk reduction of 15%, whereas moderate activity continues reducing cardiovascular risk in a dose-dependent manner, hitting a 40% risk reduction at 850 minutes, but still not leveling off.


Limited Resistance Training Combined With Unlimited Moderate Activity Is Best


So, to wrap this up, when it comes to vigorous exercise and strength training, too much will backfire, resulting in higher mortality risk than had you trained less. But when it comes to moderate exercise, like walking, dancing and gardening, just to name a few, you cannot overdo it, and the more active you are, the greater your benefits.


Land also includes a systematic review and meta-analysis published in 2019, which found that, compared with no exercise, resistance training by itself was associated with 21% lower all-cause mortality, but when combined with aerobic exercise, it lowered all-cause mortality by 40%.

A combination of appropriately dosed strength training with unlimited moderate activity provides the greatest benefit.


Based on all of these findings, we can conclude that a combination of appropriately dosed strength training with unlimited moderate activity provides the greatest benefit.


My Updated Workout Recommendations


I’ve tweaked my own workout regimen considering these findings, reducing the amount of vigorous exercise and strength training I do, and instead making sure I walk more on a daily basis. Typically, I aim for 12,000 steps (about six miles).


Experimentation has also shown me that I really need to rest at least twice a week. Giving myself these rest periods has significantly boosted the quality of my sleep and ability to feel strong when I reengage my resistance training.


Overall, walking appears to be one of the best forms of exercise in terms of making you fitter and increasing your life span. So, focus on activities like daily walking, hiking, gardening, and leisurely bike rides first. Again, more IS better when it comes to moderate-intensity activities like walking. For most, I think it’s better to get your walking done before you start resistance training.


However, if you want to avoid frailty and sarcopenia (age-related muscle loss), it would be wise to consider doing both. So, if you’re already getting an hour of moderate activity per day, add in 20 to 30 minutes of strength training two to three times a week on non-consecutive days, or 40 to 60 minutes once a week.


To prevent injury, I recommend doing KAATSU (blood flow restriction training), which gives you the same or better results as conventional weightlifting with very light or no weights. Considering you’re not pushing your body to the max with heavy weights, you can also likely train longer than one hour a week without nullifying benefits. It’s closer to moderate movement exercise than conventional resistance training.


If you have the time, also add some flexibility and balance training sessions like yoga or tai chi. Finally, make sure you rest and recover for a day or two after strenuous exertion. The recovery phase is just as important as the exertion phase in terms of producing a high level of fitness.


I pick you up where the medical system dropped you off. I founded a holistic cardiac wellness program which encompasses protocols for stress mitigation, circulation enhancement, gut healing and immunity improvement, detoxification, tactical strategy for nourishment, Ayurvedic techniques and more holistic tools for not only heart health, but whole body wellness. 


mary yuter signature



Mary Yuter, RN

@hearthealthaccelerator



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