I’m a sports cardiologist. This is how to exercise to keep your heart strong after 50

Prof Dan Augustine is a consultant cardiologist and medical director of Sports Cardiology UK – Jay WilliamsOur series The Expert View brings you specialist health advice from professionals. In this article, we hear from Prof Dan Augustine, a consultant cardiologist and medical director of Sports Cardiology UK, about the cardiovascular benefits of strength training.

Aerobic exercise has long been considered the cornerstone of a healthy heart. Regular running, walking or cycling can help the heart pump blood efficiently while also lowering blood pressure, and helping to maintain a healthy weight.

But the cardiovascular benefits of strength training are often overlooked. A recent Harvard-led study in the British Journal of Sports Medicine followed nearly 147,000 adults for up to 30 years. It showed that combining strength training with regular aerobic exercise was associated with a reduction in the risk of death from any cause of up to 45 per cent.

As a cardiologist who works with elite athletes, professional rugby and football teams, plus NHS and private patients, I talk to them daily about the importance of maintaining skeletal muscle – the muscles that connect to your bones and that you have control over – as we age.

This is particularly important after 50. Without regular resistance exercise, we gradually lose muscle mass and strength as we age. Good-quality muscle helps you move more easily, remain active and process glucose effectively, all of which are important for long-term health.

It is important to note that strengthening any one muscle in isolation – whether your calf or glute – isn't going to directly improve your heart health. Rather, maintaining and improving your overall skeletal muscle is what matters.

That said, these are three key muscle groups I recommend focusing on.

A recent study found an impressive link between strong, high-quality chest muscles and a significantly lower risk of heart attacks and early death. Rather than the chest muscles themselves being uniquely protective against heart attacks, the researchers found that people with higher-quality pectoral muscles (also known as pecs) tended to have better overall skeletal muscle.

Prof Augustine works with elite athletes and professional sports teams – Jay Williams

This makes sense because muscles are metabolically active and absorb large amounts of glucose (sugar) from the blood. Building and using muscle makes your body more sensitive to insulin, helping to control blood sugar and potentially lowering the risk of developing type 2 diabetes – a major driver of heart disease.

At the same time, strength training improves the health and function of your blood vessels, allowing blood to flow more easily and helping to reduce blood pressure.

Simply put, people with good-quality chest muscles aren't just benefiting from stronger pecs. They are likely to be spending time strengthening their muscles more generally, improving their metabolic health and supporting their cardiovascular health as a result.

If you want to strengthen your chest, simple body-weight movements such as half press-ups – where you keep your knees on the floor – or wall press-ups are a good place to start. These activate your pec muscles while allowing you to build strength gradually.

Over time, you could consider buying resistance bands to practise different exercises at home. There are lots of good exercise plans online – I often recommend this one by the British Heart Foundation to my patients.

I often hear people refer to calves as "the second heart". Every time you walk, climb stairs or flex your ankles, your calf muscles contract and squeeze the deep veins in your lower legs. Inside these veins, tiny valves help pump blood upwards, efficiently returning it to the heart. This calf-muscle pump is particularly important when you are standing or moving around.

In 2024, researchers at the Mayo Clinic looked at what happens when this function doesn't work so well. In a study of nearly 6,000 patients, they found an association between those with the lowest pump function having more than twice the risk of death compared with those whose calf-pump function was normal.

The good news is that you don't need to go crazy in the gym every day to improve your calf strength. Walking up the stairs instead of using the lift is one simple way you can work your calves.

At home, you can work the muscles by doing simple standing calf raises – hold on to the back of a chair or worktop for balance, slowly rise onto your toes, pause and then lower yourself back down again. This is a simple way to maintain calf strength and function.

A standing calf raise is a simple and effective exercise to help maintain calf strength and function – iStockphoto/Zheka Boss

As one of the largest muscle groups in the body, strong glutes power everyday movements such as walking, cycling and climbing stairs with less physical strain and fatigue. They are also crucial for getting up from a chair, stepping over obstacles and maintaining your balance. As we get older, preserving this strength can make a real difference to how easily we can move around and remain independent.

Maintaining and strengthening your glutes makes aerobic exercise easier, helping you to stay consistently active and, over time, supporting your cardiovascular health.

There are metabolic benefits, too. Skeletal muscle is one of the body's major sites of glucose disposal, meaning that maintaining muscle mass and function plays an important role in blood sugar control and metabolic health.

Everyday movements such as repeatedly sitting down and standing up from a chair without holding on to anything can help strengthen your glutes. Compound movements such as squats and lunges are great too – they target the glutes while placing a healthy demand on your heart and circulation during exercise.

If you've never tried strength training, starting with body-weight exercises is a good way to build confidence. You can be creative and make your own routine, incorporating upper- and lower-body movements such as half press-ups, lunges, squats and calf raises.

Watching tutorials online can be useful for improving your form and learning new movements.

If you enjoy working out at home, I would recommend buying a variety of resistance bands. These open the door to lots more exercises, such as chest presses, bicep curls and hip abductions.

Two strength-training sessions a week are a good place to start. For each session, pick five or six movements you like and aim for a manageable number of repetitions with good technique.

As you get stronger, you can gradually increase the resistance or number of repetitions. You may also find that you enjoy resistance training and are ready to do more, or to break your workouts into routines that target different parts of the body.

Alongside strength training, don't forget the importance of aerobic exercise. A combined approach is the key to building and maintaining skeletal muscle while keeping your cardiovascular system healthy.

Set realistic goals – even if that's going for a brisk 10-minute walk every evening. You don't need to do everything at once. Start somewhere and build from there.

Professor Dan Augustine is a consultant cardiologist and medical director of Sports Cardiology UK.

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