Do some people benefit from exercise more than others? A study published Oct. 27 in Nature Cardiovascular Research finds that women may have an edge over men when it comes to heart health.
Researchers in China analyzed data from 85,000 people without heart disease who were registered in the UK Biobank, a dataset that tracked participants’ physical activity levels using accelerometers and recorded heart events and deaths over an average of seven years.
Women who met exercise guidelines from the World Health Organization and the American Heart Association—175 minutes per week of moderate-to-vigorous activity, or 75 minutes per week of intense activity—had a 22% lower risk of heart events compared to those who didn’t meet the guidelines, while men had a 17% lower risk.
Further analysis showed that women were able to lower their heart risk with smaller amounts of exercise than men were. To lower their risk by 30%, men had to exercise for 530 minutes a week, while women had to be physically active for only 250 minutes a week: about half as long.
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“We are quite surprised that females achieved cardiovascular benefits comparable to those of males with only about half” of the physical activity, says Jiajin Chen, a researcher at the Institute of Cardiovascular Diseases at Xiamen University Cardiovascular Hospital, who led the study. What’s more, women who did the recommended amount of exercise “experienced a striking threefold reduction in mortality risk compared with males.”
Dr. Emily Lau, director of women’s heart health at Brigham and Women’s Hospital and Massachusetts General Heart and Vascular Institute, wrote a commentary on the findings and their implications. “Women appear to have a physical activity advantage,” she says. “Yet we see time and time again that women are less physically active and less likely to achieve the recommended physical activity targets. This highlights an opportunity for the medical community to think about how we can tailor our recommendations to women. Because what we are doing now is not quite working.”
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The results are a starting point for additional studies to better understand why women might be deriving more benefit from exercise than men, even at lower amounts. While the study did not explore potential explanations for the findings, Chen says that scientists have some theories. First, women have higher estrogen levels than men, and before menopause, estrogen may be protecting cardiovascular health—which in part may explain why women tend to develop heart events at later ages than men. Trials also show that men who take estrogen supplements can improve their coronary heart disease since it helps to break down lipids during exercise. There are also differences in muscle makeup among men and women and in muscle metabolism.
Chen did not analyze whether menopause, after which estrogen levels drop in women, led to any differences in the exercise benefit women achieved. However, the women in the study were generally older—likely past menopause—with a mean age of nearly 62. The number of pre-menopausal women was too small to provide a reliable comparison.
Based on the results, “our findings provide valuable evidence for sex-specific prevention of coronary heart disease by using wearable devices,” Chen says. “We believe that in the era of personalized medicine, future interventions will increasingly be tailored to individual characteristics to maximize cardiovascular benefits.”
Lau agrees, saying that “we have to stop treating men and women as the same,” Lau says. “It’s 2025, and we are still doing the same things where we take data from men and extrapolate them to women. We see studies telling us men and women are different, yet the guidelines for them are all the same.”
That could lead to more refined advice for improving heart health that may not look exactly the same for women and men—not just on exercise but for other heart health risk factors as well. “It’s time for us to really change the framework for how we think about sex-specific research and clinical recommendations,” Lau says.
