Exercise and Cholesterol: Why Movement Matters

Cholesterol itself is essential for normal body function, but an unhealthy blood lipid profile—particularly elevated LDL cholesterol—can contribute to the development of atherosclerosis and cardiovascular disease.

Understanding your cholesterol

A standard lipid profile commonly includes:

• LDL cholesterol — often referred to as “bad” cholesterol because higher levels are associated with an increased risk of atherosclerotic cardiovascular disease.
• HDL cholesterol — often referred to as “good” cholesterol because it helps transport cholesterol from the bloodstream back to the liver.
• Triglycerides — a type of fat found in the blood; elevated levels can also be associated with increased cardiovascular risk.

How does exercise affect cholesterol?

A systematic review and meta-analysis of 148 randomised controlled trials involving 8,673 participants found that exercise training can (1):

• Increase HDL cholesterol - regular exercise can modestly increase HDL cholesterol.
• Reduce triglycerides - exercise increases the use of fats for energy and can help lower triglyceride levels in the bloodstream.
• Modestly reduce LDL cholesterol - exercise can lower LDL cholesterol, although changes are generally modest and can vary between individuals.

Importantly, the benefits of exercise for heart health extend beyond your cholesterol numbers. Regular exercise can also improve blood pressure, blood sugar regulation, cardiorespiratory fitness and body composition, contributing to an overall reduction in cardiovascular risk (2).

What type of exercise is best?

Both aerobic exercise and strength training can contribute to better cardiovascular and metabolic health.

Aerobic activities such as brisk walking, jogging, cycling and swimming can help improve blood lipid levels. Aim for at least 150 minutes of moderate-intensity aerobic activity each week, spread across the week where possible (3).

Strength training is also important. Regular resistance exercise can improve body composition and metabolic health while contributing to improvements in your overall cardiovascular health. Aim to strengthen the major muscle groups on at least two days per week (3).

A combination of aerobic and strength training provides benefits not only for cholesterol, but for overall cardiovascular health.

Does exercise replace cholesterol medication?

Cholesterol levels are influenced by many factors, including genetics, age, diet and underlying health conditions. For some people, lifestyle changes alone may not be enough to achieve recommended cholesterol levels.

If cholesterol-lowering medication has been prescribed, exercise should generally be viewed as an important complement to treatment rather than a replacement for it.

Don't forget nutrition

Exercise is only one part of cholesterol management.

A heart-healthy dietary pattern should prioritise vegetables, fruit, wholegrains, legumes, nuts, seeds and unsaturated fats, while limiting foods high in saturated and trans fats.

For people with significantly elevated cholesterol or a high cardiovascular risk, lifestyle changes may need to be combined with medication as recommended by their doctor.

Take-home message

Regular exercise is an important part of managing cholesterol and protecting your long-term cardiovascular health.

While exercise may only produce modest reductions in LDL cholesterol, it can improve triglycerides, HDL cholesterol and many other cardiovascular risk factors.

Aim for a combination of regular aerobic exercise and strength training, alongside a heart-healthy diet and any treatment recommended by your healthcare team.

When it comes to heart health, the benefits of exercise extend well beyond your cholesterol numbers.