May 22, 2024 — New research from The Cooper Institute and partners at University of Texas (UT) Southwestern Medical Center, The University of Texas at Tyler and University of Alabama at Birmingham, shows that exercising, even at very high levels, is not related to the progression of coronary artery calcium (CAC), a marker of atherosclerotic cardiovascular disease. Previous research on physical activity and CAC, which suggested that individuals who engage in high volume endurance training (such as marathoners and triathletes) have more sub-clinical atherosclerosis or CAC, has primarily relied on assessment at one point in time and was unable to track individual changes in CAC. This new study, published in the Journal of the American Medical Association Cardiology, shows that the progression of CAC over time is not associated with leisure-time aerobic physical activity measured at baseline and follow-up.
"These new insights suggest that being physically active, even at very high levels, does not appear to accelerate asymptomatic atherosclerosis progression, which might be good news for exercise enthusiasts,” said Kerem Shuval, PhD, Director of Epidemiology and Behavioral Science at The Cooper Institute and lead author of the study.
The study, which is part of the Cooper Center Longitudinal Study (CCLS), included 8,771 men and women who were 50 years old on average, at baseline (50.2 years for men and 51.1 for women). Their physical activity, CAC and other clinical measurements were determined during preventive medicine visits to Cooper Clinic in Dallas, Texas. Participants had at least two clinic visits between 1998 and 2019. Analysis of the data, which accounted for potential confounding factors, revealed that aerobic physical activity does not appear to elevate the rate of CAC progression.
“This study will assist health care providers who care for elite athletes, such as marathon runners, in managing and counseling their patients with subclinical atherosclerosis. They can feel safe in continuing to exercise as long as there are no symptoms or underlying issues," said Laura DeFina, MD, FACP, FAHA, President, CEO and Chief Science Officer of The Cooper Institute.
“This study provides important new knowledge which will greatly assist in the care of Masters athletes and highly active people who have high coronary calcium scores. Although previous work from our research team showed that there was a greater risk of having clinically significant coronary calcium in highly active people, the present analysis is reassuring that sustaining high levels of physical activity do not accelerate the progression of atherosclerosis," said co-author Benjamin Levine, MD, FACC, FAHA, FACSM, Professor of Internal Medicine at UT Southwestern Medical Center and director of the Institute for Exercise and Environmental Medicine, a collaboration between UT Southwestern and Texas Health Presbyterian Hospital Dallas.
For more information: cooperinstitute.org
June 25, 2025 
