Small changes for a healthy heart

February 18, 2021

Taking small steps to move more, eat more fruits and veggies, and sleep well supports cardiovascular health

You’ve heard it before: when you move more, eat well, and get good sleep, not only do you build a stronger body and healthier heart, you reduce the risk for cardiovascular disease, a leading cause of death in the United States.

But how can you form lasting heart-healthy habits to achieve those outcomes? Tackling all of those goals at once can seem daunting. Researchers at the National Heart, Lung, and Blood Institute (NHLBI) find making small changes is a way to start that can add up to meaningful change. During American Heart Month, they are sharing tips to help you get there, based on the latest science.

Move more

“Any activity is better than none,” said Jerome Fleg, M.D., a cardiologist and medical officer in NHLBI’s Division of Cardiovascular Sciences. “And any age and place is a great place to start.”

Exercise can lower “bad” LDL cholesterol levels, increase “good” HDL cholesterol levels, reduce blood pressure, and help you sleep better. Plus, those are just a few of the cardiovascular benefits.

To begin, Fleg recommends following the national guidelinesexternal link for physical activity. For adults, that’s at least 75 minutes of vigorous exercise each week, such as fast-paced cycling, running, jumping rope, or playing basketball; or 150 minutes (2.5 hours) each week of moderate exercise that gets your heart pumping and leaves you a little breathless. This might include brisk walking or aerobics that you can break up into smaller chunks at a time. He mentions, you should try to integrate vigorous and moderate exercise into your routine.

Don’t get discouraged, Fleg said, if you’re just starting out. Or if you miss a workout. The key, he noted, is to select activities you enjoy and can perform regularly. Then, set small, realistic, and quantifiable goals. Mark them on a calendar and share them with family members or friends. This builds accountability. For example, you could set a goal to walk, bike, or swim for 30 minutes, five days a week.

Even relatively short bouts of exercise provide cardiovascular benefits. A study in Circulationexternal link found 12 minutes of cycling activated hundreds of heart-healthy compounds in 411 middle-aged adults. When this, or other types of type of aerobic (oxygen-using) exercise, becomes a habit, the results can translate into lower blood pressure, improved cholesterol and insulin function, and reduced levels of inflammation and stress, which lowers the risk not just for heart disease, but obesity, type 2 diabetes, and premature death.

Furthermore, Fleg noted, “just getting out and doing some type of physical activity, even if it’s not a high-intensity activity is beneficial.”

For example, a Women’s Health Initiative study assessed how light physical activity among 5,861 women, ages 72-85, appeared to reduce cardiac events. In that study, daily movement which included household chores, light walking, or running errands – spanned from 30 minutes to 10 hours. Women who spent more than 5.6 hours each day in such activities were 42% less likely to have a heart attack or die from heart disease and 22% less likely to experience a stroke.

But even if you move little throughout the day – for example, if you sit at a desk or in a car for extended periods – you can benefit from exercise. A reviewexternal link of 44,000 middle-aged adults found that those who were inactive 10 hours a day but fit in 30-40 minutes of moderate-to-vigorous exercise were less likely to die early, compared to more sedentary peers.

For cardiovascular benefits, all movement matters, Fleg recapped.

Eat colorful foods

When it comes to selecting foods to support a healthy heart, “change starts at the grocery store,” said Alison Brown, Ph.D., a program director in NHLBI’s Division of Cardiovascular Sciences. “It depends on what you put in your cart.”

To make heart-healthy choices, Brown suggests shopping the perimeter of the store, starting in the produce aisle. “Focus on the fruits and vegetables that you enjoy and that align with your cultural background.” Familiar favorites may be collard greens, or apples and bananas.

The frozen food section is another place to stock up on fruits and vegetables, and allows for flexibility with a family’s taste preferences, budget, and time for meal planning. But whether fresh or frozen, Brown recommends regularly eating antioxidant-rich foods, such as berries, and cruciferous vegetables. Think broccoli, Brussels sprouts, kale, cabbage, and asparagus.

An observational review of thousands of adults found those who created meals around these types of colorful foods – which are packed with vitamins, minerals, antioxidants, and fiber – had lower levels of inflammation in their body. In this study, diets rich in leafy green vegetables, dark yellow vegetables, whole grains, fruit, among other nutrient-rich staples, correlated with lower levels of inflammatory markers that have been associated with cardiovascular disease. These eating patterns correlated with fewer incidents of heart attack and stroke years later.

To help people put this type of science into practice, the 2020-2025 Dietary Guidelines for Americansexternal link recommend adults and children fill half their plate with fruits and vegetables. The other half should be grains, preferably whole grains, and protein. Over time, studies show, heart-healthy meals can improve blood pressure, blood sugar, and cholesterol, which helps reduce long-term risks for heart disease, obesity, type 2 diabetes, and certain forms of cancer.

One way to make heart-healthy food choices become automatic, Brown notes, is to borrow lessons from behavioral economics. “When you display a bowl of fruit and vegetables at home, particularly with fruit, one filled with apples, bananas, and oranges, it’s right there,” Brown said.

“When your family members need snacks, they can easily pick them.” Another strategy, which works well with children, is to blend fruits and vegetables, such as berries or spinach into meals, like a breakfast smoothie.

Replacing sodium with spices, salt-free seasonings, and herbs is another example of a heart-healthy food swap, according to eating plans developed by NHLBI.

In a month-long study of adults with high blood pressure, those who reduced their daily sodium intake to the recommended 2,300 mg or lower, while making other dietary changes, saw benefits. The most significant changes came from participants who cut their daily sodium intake by about half, to 1,150 mg, while following heart-healthy eating principles. In this Dietary Approaches to Stop Hypertension (DASH) subgroup, adults with systolic blood pressure between 140-149 mm Hg saw their blood pressure fall by about 10 mm Hg. Participants with systolic blood pressure levels above 149 mm Hg saw average reductions of 20 mm Hg.

A normal level of systolic blood pressure, which measures the force of blood flow against artery walls, is below 120 mm Hg. “Dietary changes, similar to exercise, can improve how easily blood flows through the main arteries and tiny vessels surrounding the heart and other organs,” said Brown. “Over time, these changes can help prevent a heart attack, the need for heart surgery, or stroke.”

Sleep well

In addition to moving more and eating more colorful foods, getting a good night’s rest – 7-8 hoursexternal link of sleep for most adults – supports a healthy heart.

Marishka Brown, Ph.D., director of NHLBI’s National Center on Sleep Disorder Research, likes to envision the body as a symphony. “You have the woodwind, the brass, the percussion sections, and they all work together to give you this beautiful music,” Brown said. “But, if any one person is out of tune, then it’s no longer a symphony – it’s a cacophony of sound.”

Sleep, she explained, helps keep every system in the body, including the heart and blood vessels, in harmony. “Sleep health means not only are you getting enough sleep, but the quality of sleep that you’re getting is consolidated and refreshing,” Brown added.

An observational study of 400,000 adults, ages 37-73, underscored the benefits of sleep. Participants shared information about how much they slept each night, if they were a “morning” person, how alert they felt during the day, if they experienced insomnia, and if they snored. Adults who scored well across all five sleep metrics were less likely to experience heart failure a decade later. Although, sleep quality ranked first for risk reduction. Participants who did not experience excessive daytime sleepiness were 34% less likely to experience heart failure.

Other research has found similar connections between disrupted sleep and heart disease.

In a study of 1,600 adults, fragmented sleep patterns overlapped with inflammation that increased risk for atherosclerosis, a hardening of the arteries, which narrows blood flow and can lead to a heart attack or stroke. The severity of sleep disruption also correlated with a higher risk of cardiovascular disease.

To get enough high-quality sleep, Brown recommends going to bed and waking up at around the same time each day. Get outside each morning and expose yourself to daylight to remind your biological clock what time it is. Turn off artificial light from screens an hour before bed and instead opt for relaxing activities, like yoga or reading, to prepare your body for slumber.

If you can improve sleep patterns, your entire body will benefit, Brown explained. Sleep improvements can prevent increases in blood pressure and lower stroke risk. Regular sleep schedules, particularly in children and teens, help improve diet and physical activity. Sleep supports behavior, cognition, and more.

Sleep quality, timing, and duration, noted Brown, like exercise and diet, supports the health of every organ and system in the body, including the heart.

“When we make small, healthy changes in one area, we often see benefits in others,” concluded Brown.

To learn more about heart and vascular health, visit

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