Cardiovascular disease remains a leading health concern, and the American College of Cardiology asked clinicians to make exercise a routine part of care. The statement notes that even modest increases in activity can yield measurable benefits. Short, pragmatic targets may matter more for many patients than the familiar 10,000-step benchmark. Data referenced in the guidance link approximately 5,000 to 7,000 daily steps with clinically important improvements and substantial mortality reductions for many adults. Some patients will need higher doses; many others will gain benefit from incremental change. The writing committee emphasized that step counts are not a universal prescription and that activity type and amount must be matched to an individual’s health status, symptoms, and goals. Clinicians, the authors argued, should offer achievable goals that encourage adherence rather than imposing intimidating targets that patients are unlikely to sustain.
The statement provides practical considerations for clinicians crafting exercise plans. Exercise prescriptions should account for a person’s diagnosis, functional capacity, symptoms, treatment goals, and preferences. That means specifying frequency, intensity, and progression whenever possible, rather than offering vague advice to “get more active.” For most adults, the guidance recommends combining aerobic activity — for example, walking or cycling — with resistance training to maintain or build muscular strength. The committee identified wearable devices, home-based programs, and virtual rehabilitation as potential supports for monitoring activity and maintaining engagement; however, the statement noted that long-term adherence remains a challenge. The source did not provide detailed, universally prescriptive dosing schedules beyond general recommendations and step-count ranges; clinicians are expected to tailor plans to individual patients.
Authors described cardiac rehabilitation as a first-line treatment for many patients with established cardiovascular disease. Traditional programs blend structured exercise with education and risk-factor management, aiming to improve physical capacity and quality of life. The statement called for broader access to cardiac rehabilitation, highlighting center-based, home-based, and virtual approaches as ways to expand reach. Insurance reimbursement and program availability remain obstacles to participation, the authors observed. For patients unable to attend formal rehabilitation, the committee recommended providing individualized exercise prescriptions as an alternative, with the same attention to safety, progression, and patient preferences.
The statement’s authors identified several reasons clinicians often underprescribe exercise. Formal training in exercise prescription is limited in many medical education pathways; clinicians typically receive far more instruction about medications and procedures than about structured physical-activity counseling. Clinical encounters are often short and crowded with competing priorities, which can push exercise counseling to the margins. Practical barriers include limited reimbursement for counseling or structured programs and obstacles to patient access. The authors also noted uncertainty among clinicians about how to safely prescribe activity for patients with cardiovascular disease, especially when symptoms or complex comorbidities are present.
The committee advised that routine exercise testing is not required for most asymptomatic or clinically stable individuals before beginning physical activity. Testing, however, may be useful when clinicians need objective information to tailor exercise intensity or to assess exercise capacity in symptomatic patients or those with known cardiovascular disease. The statement also delineated situations in which activity should be limited: active myocarditis, unstable cardiac symptoms, and some cardiomyopathies may require exercise restriction and specialized assessment. The authors stressed that having cardiovascular disease is not an automatic contraindication to exercise; rather, many patients with CVD benefit from tailored programs that consider medications, symptoms, and potential exercise-related risks.
The writing committee proposed concrete changes but also acknowledged persistent, practical gaps. The statement recommends routine assessment of physical activity and fitness in clinical visits, plus involvement of exercise professionals such as exercise physiologists in care teams — yet the source did not provide a timeline for workforce changes or policy shifts to enable this. Reimbursement for cardiac rehabilitation and exercise counseling remains limited in many settings; the statement called for broader coverage but did not specify legislative or payer actions. Likewise, while virtual and home-based programs are promising for access, the authors noted long-term adherence and program quality as unresolved issues. Finally, the guidance did not present new randomized trial data or universal dosing protocols, leaving clinicians to interpret and individualize recommendations based on patient circumstances.
Limitations and next steps outlined by the authors include the need to improve clinician training in exercise prescription, expand access and reimbursement for cardiac rehabilitation and structured programs, and develop strategies to sustain long-term adherence to prescribed activity. These implementation questions remain central to whether exercise prescribing will become as routine as pharmacologic therapies in cardiovascular care.