If you've been diagnosed with borderline or high cholesterol, you probably already know the importance of losing weight and eating a healthy diet. But there's another part of the lifestyle prescription that's just as important: exercise.
"When it comes to cholesterol, there are three things your doctor is looking at: your LDL ("bad" cholesterol), HDL ("good" cholesterol) and your triglycerides (a type of fat found in your blood)," explains Suzanne Steinbaum, DO, a cardiologist in New York City and spokesperson for the American Heart Association (AHA).
"Exercise seems to have the most impact on your cholesterol by raising your HDL levels and lowering your triglycerides."
"We now think that exercise's main effects are to elevate HDL cholesterol, which is important because this type of cholesterol acts as a sort of 'clean up' crew to remove LDL from your blood vessel walls and send it over to your liver, which gets rid of it."
How Exercise Lowers Cholesterol
For a long time, experts weren't exactly sure how exercise itself helped to improve cholesterol — because most studies looked at a variety of lifestyle changes together, such as losing weight, eating a healthy diet and staying active.
But now, new research offers some new clues. "We now think that exercise's main effects are to elevate HDL cholesterol, which is important because this type of cholesterol acts as a sort of 'clean up' crew to remove LDL from your blood vessel walls and send it over to your liver, which gets rid of it," Dr. Steinbaum says.
When people exercised for 40 minutes three to four times a week, their HDL cholesterol was observed to increase by two to three points in as little as eight weeks, according to a May 2007 review of 35 studies published in the Archives of Internal Medicine.
And like most other healthy habits in life, the more you can do, the better off you'll be: The review also found that each additional 10-minute increase in exercise was associated with an additional 1.4-point increase in HDL levels.
Do Cardio and HIIT
Exercise's results are felt across the board. When people took up aerobic exercise such as jogging, running and biking for 12 weeks, they saw their HDL increased by 4.6 percent, their triglyceride levels fall by 3.7 percent and their LDL drop by 5 percent, according to a February 2014 review published in the journal Sports Medicine.
"I tell my patients that exercise is even better [than medication] because it's the only thing that's proven to raise HDL cholesterol — no drug can do that."
These benefits are similar to what you'd see initially on a cholesterol-lowering medication such as statins. "I tell my patients that exercise is even better [than medication] because it's the only thing that's proven to raise HDL cholesterol — no drug can do that," Dr. Steinbaum stresses.
To get even better results, ramp it up. People who engaged in around 12 miles of walking or jogging per week were observed to have lower LDL levels, but the best results were seen in those who jogged about 20 miles a week, according to the Sports Medicine review.
If you're up for it, also consider increasing your intensity. Overweight women with type 2 diabetes who participated in high-intensity interval training (aka HIIT) — short bursts of intense exercise followed by rest periods — saw both their HDL levels rise and their triglyceride levels drop by about 20 percent, according to a June 2016 study published in the International Journal of Sports Medicine.
Don’t Forget Strength Training
The AHA recommends at least 150 minutes of moderate aerobic physical activity (think: walking, jogging, gardening or playing a sport) a week. But resistance training is also really important when it comes to improving cholesterol levels.
Men who weight-train several times a week have were observed to have higher HDLs than those who don't, even if they're overweight, according to an October 2013 study published in the Journal of Applied Physiology. The guys who had higher HDLs also had lower triglycerides than those who didn't pump iron.
"This seems to show that your weight matters less when it comes to your cholesterol than staying physically active, including doing resistance training," says Ragavendra Baliga, MBBS, professor of internal medicine at Ohio State University Wexner Medical Center. (Although you should aim for both, of course, he notes.)
The AHA recommends strength training twice a week. If you can get a third session in, do it: The Sports Medicine review found that lifting weights three times a week for 40 to 50 minutes showed the best results when it came to improvements in cholesterol and triglyceride levels (more exercise than that didn't show a greater effect).
You'll likely start seeing results anywhere between six to twelve weeks, Dr. Steinbaum says. Women between the ages of 30 and 60 who did two weekly one-hour weight-training sessions for three months showed a reduction in total cholesterol, triglycerides and a boost to HDL cholesterol compared to a control group, according to a February 2015 study published in Revista médica de Chile.
Which Exercise Is Best to Reduce Cholesterol?
Since a variety of exercises — from cardio to resistance training — are linked to improving your cholesterol profile, the best exercise is the one you enjoy doing. Here's how to find a workout you'll actually stick with.
The Stress-Cholesterol Connection
You probably already know that feeling wigged out can ramp up your blood pressure — but it can raise your cholesterol levels, as well.
This is because when you're anxious, your body churns out stress hormones cortisol and adrenaline, Ragavendra says. This, in turn, sets off a cascade of chemical reactions, including hiking up your triglycerides and causing your body to deposit more fatty plaques in your arteries.
In fact, research found a link between having a stressful job and unhealthy cholesterol levels, according to a March 2013 study published in the Scandinavian Journal of Public Health.
When you're anxious, your body churns out stress hormones cortisol and adrenaline. This, in turn, sets off a cascade of chemical reactions, including hiking up your triglycerides and causing your body to deposit more fatty plaques in your arteries.
And people who reported they were under higher psychological stress were about 15 times likelier to have high LDL levels or an LDL that was over 130. They were also 1.5 times more likely to have high triglycerides, and more than 15 times as likely to have a low HDL of under 45, according to the May 2017 study in the medical journal Medicine.
There are also indirect reasons why stress can mess up your cholesterol levels. When you're stressed, you're more likely to turn to comfort foods laden with fat and sugar — two things that can hurt cholesterol, Ragavendra says. If you're stressed, you may hit the booze, which has been shown to increase triglycerides, or smoke, which raises LDL levels and lowers HDL.
The good news is, exercise can help offset both your anxiety and your wonky cholesterol levels, Ragavendra says. You won't just get feel-good endorphins that make you feel better, but your cholesterol will improve in the bargain.
Also, consider throwing some downward facing dog into your daily routine. People who regularly practice yoga were observed to have lower LDL cholesterol and higher HDL cholesterol than those who don't, according to a December 2014 study published in the European Journal of Preventative Cardiology.
While you're at it, make sure you're getting enough shut-eye. Getting less than five hours of zzzs a night, or more than nine, is associated with high triglycerides and low HDL, according to an August 2016 study published in Sleep Medicine. Lack of sleep can raise cortisol levels, which, in turn, affects cholesterol, Dr. Steinbaum explains.
But even tweaking your sleep schedule can make a big difference: In teen girls, each extra hour of sleep was associated with a significantly lower risk of having high cholesterol in young adulthood, according to a July 2010 study published in Sleep.
Can't seem to catch enough zzzs? Try these simple steps to getting a good night's sleep.
Finally, consider keeping a gratitude journal, where you jot down three things you're grateful for each day. "Practicing gratitude has been associated with a lower risk of heart disease overall, including lower blood pressure, lower HDL and higher HDL levels," Ragavendra says.
"I regularly encourage my patients to jot down what they are thankful for. It forces them to take some deep breaths and slow down, which is good for them overall — not just for their cholesterol."
- Archives of Internal Medicine: "Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis"
- Sports Medicine: "Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations"
- International Journal of Sports Medicine: "Low-Volume High-Intensity Interval Training as a Therapy for Type 2 Diabetes"
- Journal of Applied Physiology: "Untrained young men have dysfunctional HDL compared with strength-trained men irrespective of body weight status"
- Revista Medica de Chile: "Resistance exercise improves serum lipids in adult women"
- Scandinavian Journal of Public Health: "The relationship between job stress and dyslipidemia"
- Medicine: "What are the effects of psychological stress and physical work on blood lipid profiles?"
- European Journal of Preventative Cardiology: "The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials"
- Sleep Medicine: "Associations between sleep duration and abnormal serum lipid levels: data from the Korean National Health and Nutrition Examination Survey (KNHANES)"
- Sleep: "Short sleep duration as a risk factor for hypercholesterolemia: analyses of the National Longitudinal Study of Adolescent Health"
- AHA: "American Heart Association Recommendations for Physical Activity in Adults and Kids"