A 2026 ACC scientific statement, published in JACC on 15 October, sets out how to prescribe exercise across cardiovascular disease: coronary and peripheral artery disease, heart failure, cardiomyopathies, hypertension, obesity, adult congenital heart disease and older age.
Its central points are that the largest absolute benefit comes when inactive people start moving, that more volume and intensity add further gain within clinical limits, and that routine exercise testing before starting is not needed for most asymptomatic people. It covers aerobic, resistance, balance and flexibility training, and supports home-based, hybrid and virtual cardiac rehabilitation alongside supervised programmes.
The practical shift is treating exercise as a written prescription with frequency, intensity, time and type, recorded like a drug. Testing is kept for when it changes the plan: symptoms, high-risk disease, or a need to set intensity.
For India, where centre-based cardiac rehabilitation is scarce, the endorsement of home-based and hybrid models is the most usable part.
- Write an exercise prescription with frequency, intensity, time and type at cardiovascular reviews.
- Start with the inactive: any regular movement gives the largest gain.
- Do not order routine stress testing before exercise in most asymptomatic adults.
- Use exercise testing when symptoms, high-risk disease or intensity targets require it.
- Offer home-based or hybrid cardiac rehabilitation where centre-based programmes are unavailable.
Why it matters
Exercise is underprescribed largely because it is never written down; the statement treats it as therapy.
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