Heart Benefits of Exercise Vary by Race, Exercise, Sex

Disparities in participation may be preventing women and racial and ethnic minorities from deriving the full cardiovascular benefits of exercise, according to a new review. 

Women derive greater cardiovascular benefits from exercise and have reduced rates of sudden cardiac death than men, according to the review. Moreover, Black race or ethnicity and male sex are consistently linked to increased rates of sudden cardiac death. 

“Whilst the cardiovascular benefits of exercise are irrefutable, the magnitude of these benefits vary when the specific social determinants of health of interest — namely race, ethnicity, and sex — are taken into consideration,” first author Daniel T. Tardo, MBBS, a cardiologist completing a clinical fellowship in inherited cardiac conditions and sports cardiology at St George’s University Hospitals NHS Trust in London, United Kingdom, told Medscape Medical News.

The review was published on November 13 in the Canadian Journal of Cardiology.

Race and Mortality 

The current review was invited to be included in the journal’s focus issue on sports cardiology, which will be published in March 2025, said Tardo. “This topic is important to help us expand our understanding of how exercise and physical activity impact individuals from a cardiovascular perspective, depending on important social determinants of health.” 

Social determinants of health, as defined by the World Health Organization, include nonmedical factors related to a patient’s economic, social, environmental, and psychological status that affect wellness or disease. They include place of birth, area of residence, education, workplace, and religion. Race, ethnicity, and sex are often discussed in the literature as social determinants of health, especially regarding cardiovascular health. 

The authors presented various studies to show the influence of disparities in exercise participation on cardiovascular outcomes. A Canadian study evaluating approximately 371,000 participants showed that, after adjustment for sociodemographic characteristics, participants from the most apparent minorities had lower levels of physical activity and would benefit from screening for diabetes and hypertension.

The Multi-Ethnic Study of Atherosclerosis followed 6814 Black, White, Hispanic, and Chinese adults in the United States for about 15 years. It found that Hispanic participants had a lower mortality risk than White participants, and Black and Chinese participants had a similar mortality risk compared with White participants. But after adjustments for age and sex, Black participants had a 72% greater cardiovascular mortality risk than White participants.

Studies have also shown that women are less likely to participate in cardiac rehabilitation programs, although they are just as likely to benefit from them as their male counterparts. Women face greater barriers to cardiac rehabilitation. In a study of 822 patients (half of whom were non-White participants) consecutively referred to cardiac rehabilitation), non-White patients were 78% less likely to initiate cardiac rehabilitation than white participants. Yet reductions in mortality were demonstrated for participants who engaged in cardiac rehabilitation.

“We hope our review encourages the utilization of equitable, tailored exercise prescriptions by a wide range of clinicians to help encourage and bring about good cardiovascular outcomes. The review highlights the fact that the relationship between race, ethnicity, and sex and cardiovascular outcomes is complex and evolving. As researchers, we are looking forward to seeing what future research offers, in terms of shedding light on the interplay between social determinants of health and exercise,” Tardo said.

Genetic Influence 

“This review highlights how genetics influences how different racial groups respond to exercise, which explains the varying benefits of exercise,” said Christopher Tanayan, MD, director of sports cardiology at Northwell Lenox Hill Hospital in New York City.

“The difference in survival rates between men and women after exercise is what stands out, possibly due to hormones like estrogen protecting women’s hearts, especially before menopause. Access to safe exercise spaces also plays a significant role,” said Tanayan.

“As someone who prescribes exercise to a wide range of patient groups who vary by age, race, social status, gender, and sexual orientation, I am convinced that exercise recommendations should be individualized and tailored. The blanket recommendation of 150 minutes of vigorous exercise and 300 minutes of moderate-intensity exercise per week should be further broken down to realistic approaches that now can be further refined by the information detailed in this article,” he said.

The review was prepared without funding. Tardo is funded by a grant provided by the charitable organization Cardiac Risk in the Young. Tanayan reported no relevant financial relationships.