Sedentary Behaviors Significantly Impact Heart Health, Increase CVD Risk: Melvin Echols, MD

Evidence has shown that regular physical activity can protect against chronic diseases and improve quality of life across all age groups.1 Currently, 1 in 4 adults do not meet the recommended level of physical activity exemplified by the CDC, which entails at least 150 minutes of moderate-intensity physical activity and at least 75 minutes of vigorous-intensity physical activity a week.2 The COVID-19 pandemic has exacerbated the percentage of people meeting the minimum requirements of physical activity, putting people at an increased risk of experiencing an adverse CVD event—which disproportionately affects Black men and women who’ve been shown to have a high prevalence of hypertension leading to CVD.1, 2

Melvin Echols, MD, the chief DEI officer of the American College of Cardiology, associate professor of medicine in cardiovascular disease at Morehouse School of Medicine, and associate director of clinical research at the Cardiovascular Research Institute, spoke with the American Journal of Managed Care® to discuss the future of CVD risk amidst the increase in sedentary lifestyles.

“For African Americans, we tend to have way more hypertension,” Echols said. And “[Black men and women] actually get heart failure earlier than any other population, and the heart failure that [they] get is usually related to hypertension. So, [they’re] almost looking heart failure in the eye over the next 10 to 20 years in terms of [the] population.”

Echols suggested that for those who are not meeting the minimum requirements of physical activity, they should just start. He emphasized that it doesn’t have to be intense or structured, but intentional movement to get your heart rate up for even 20 minutes can have a significant impact on your heart health.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Given the CDC's 150-minute weekly activity guideline, how should recommendations evolve to reflect the risks of sedentary behaviors despite regular exercise?

Well, so 2 things. The first thing I would say is, the guidelines are there for, sort of, recommendations for us, you know, to sort of encourage people to follow. Now, when you actually look at the reality of the real world and how many people are actually following these guidelines, very, very few. Take, for instance, you know, just for an example, heart failure—you know, I treat a lot of heart failure. That's what I do. We have all these medicines that are called guidelines, you know, directed medical therapies that can help people live longer, stay out of the hospital, and all that. But guess how many people are actually on them, you know, in terms of all the people that are eligible that should be on them, on the optimal doses?

Less than 10% of all heart failure patients. Now you have 600,000 heart failure patients, new heart failure patients coming in every single year, and you have over 6 million heart failure patients in America, and 10% of them are on the most optimal therapies. So, the first thing I would say is if you're not exercising, exercising 30 minutes is more than you were doing, and I guarantee you that's going to be a benefit that you will accrue from that. So, you know, get there first. Once you’re exercising 30 minutes a day and/or whatever and you know, 150 minutes a week, once you're there, then let's talk.

Now, if you're there, there are certain things you can do. I do think that wearables are very helpful for people who are interested in trying to maintain some sort of sense of consistency or habit. We do know the steps, which actually also can be very beneficial, you know. I saw a study—I can't necessarily quote it to you right now—but, you know, there's always this kind of thought that 10,000 steps a day is, you know, the average and what people should strive for. In certain populations, particularly in older populations, people have seen that actually about 6000-7000 steps a day, for certain people, actually still gives a good benefit. So, what I would say is, before we kind of talk about unstructured exercise and unstructured recommendations. I would try to say I would encourage people to try to meet those recommendations first.

That's the other thing; people think that exercise is going to the gym and doing reps doesn't take much. You know, you can do things around your house; you can do things up the stairs. You can do things, you know; sometimes I just dance in my house by myself for 20 minutes, and you just do it. But you know, it’s something fun, and it gets your heart rate up for 20 minutes. It's vigorous exercise, and you're done. You know, it doesn't have to be that hard. People have to understand that.

How do you think pandemic-era shifts in technology and convenience have permanently impacted sedentary behavior—and what does that mean for future cardiovascular risk?

That's a great question, and I'm glad you're still talking about COVID because number one, COVID is still killing people in America. It's still something that we should be concerned about. One of the things that we noticed early in the COVID-19 epidemic was the early signal of increased cardiovascular disease in certain people. And that signal for some was very, very acute, meaning, you know, coming in with acute heart failure or heart attacks or acute what we call thrombosis, or clots in the heart, or clots in the body. And these were, you know, really, really sick people. What we're now seeing is that although you may not see that sort of devastating trend anymore, there's a trend of increasing hypertension in people who've had COVID, compared to others, and then you can actually see differences in hypertension based on what type of strain, or, you know, the strain you had.

So, what I say is this: we already have disparities in cardiovascular disease across the board before COVID. We add sedentary rates and just sort of a whole upset of our lifestyle, and now moving forward, everybody is more likely to be less active, which is a problem, but added on to that. You now have the compounded risk of increased potential hypertension. Which may be from a sort of post-inflammation sort of process that occurred from the COVID, or maybe from just your overall change in lifestyle and gaining weight and changing eating habits. So, what does that mean for people who have disparities who already have disparity rates of heart failure and hypertension?

Well, it's going to get worse. And for African Americans, we tend to have way more hypertension, you know, even though when you look at the numbers, because we're less in the population, we're not, you know, count-wise, we don't have as much hypertension, but we actually get heart failure earlier than any other population, and the heart failure that we get is usually related to hypertension. So, we are almost looking heart failure in the eye over the next 10 to 20 years in terms of our population.

References

1. Gerber Y, Pettee Gabriel K, Jacobs DR, et al. Trajectories of physical activity before and after cardiovascular disease events in CARDIA participants. JAMA Cardiol. Published online July 23, 2025. doi:10.1001/jamacardio.2025.2282

2. Bácsné Bába É, Lengyel A, Pfau C, er al. Physical activity: the key to life satisfaction—correlations between physical activity, sedentary lifestyle, and life satisfaction among young adults before and after the COVID-19 pandemic. Frontiers in Public Health. 13, (2025). doi:10.3389/fpubh.2025.1486785