The first 10 minutes of exercise pay off most, so start slower than you think

Key takeaways

• About 1 in 4 U.S. adults did no physical activity outside of work in the past month, according to CDC survey data from 2017 to 2020⁵.
• A National Cancer Institute model estimated that 10 more minutes a day of moderate-to-vigorous activity could prevent about 111,000 deaths a year among U.S. adults 40 and older¹².
• In a 1993 study of 1,228 heart attack patients, heavy exertion raised the next hour’s risk about 107 times in people who exercised less than once a week, but only 2.4 times in those who exercised five or more times a week³.
• Federal guidelines tell inactive people to “start low and go slow,” and say healthy adults who build up gradually don’t need to see a doctor first⁶⁷.
• A single session of moderate-to-vigorous activity can ease anxiety, lower blood pressure and improve that night’s sleep, a federal advisory committee reported⁹.

Researchers in the Determinants of Myocardial Infarction Onset Study asked 1,228 heart attack patients a pointed question, on average four days after the attack: what were you doing in the hour before it started³?

A small share, 4.4%, said they had been doing heavy physical exertion, which the study defined as burning at least six times the energy you use sitting still³. When the team compared that hour with each person’s usual routine, heavy effort raised the risk of a heart attack in the following hour about sixfold³.

The surprise was who carried that risk. For people who exercised less than once a week, a bout of heavy exertion raised the hour’s risk about 107 times. For people who exercised five or more times a week, it raised the risk only 2.4 times³. The study, led by Murray Mittleman, appeared in the New England Journal of Medicine in 1993³.

Here is the paradox. The habit that protects your heart over years can strain it in the moment, if your body isn’t used to it.

That’s not a reason to stay on the couch. Inactivity is the bigger danger, and the first small steps out of it bring the largest payoff. The lesson is to start, and to start gently. Here’s how.

Going from none to some is the biggest health jump

The federal Physical Activity Guidelines, built on a review by an expert committee, say a large benefit occurs when a person moves from inactive to even somewhat active⁶. The relative gain is greater for people who are insufficiently active⁶.

A 2022 analysis from the National Cancer Institute put numbers on that idea. Pedro Saint-Maurice and colleagues studied 4,840 adults aged 40 and older who wore activity monitors for a week in a national health survey from 2003 to 2006¹². The team then tracked deaths for about 10 years².

They then modeled how many deaths a year might be prevented if U.S. adults 40 and older added moderate-to-vigorous activity¹²:

Extra minutes a day	Estimated drop in yearly deaths	Deaths prevented per year
10	6.9%	111,174
20	13.0%	209,459
30	16.9%	272,297

Look at the steps. The first 10 minutes bring a 6.9% drop, the next 10 add about 6 points more, and the last 10 add about 4. The early minutes count most.

Read the numbers with care. They are model estimates, not counts of lives saved. They rest on one week of monitoring in an observational study, which can show a link but not prove cause and effect, as the authors noted¹². Healthier people may simply move more.

I-Min Lee of Brigham and Women’s Hospital and Harvard told TCTMD that 10 extra minutes is a more realistic target than 30 for people who are inactive². In her words, “anything counts”².

Plenty of people start from zero. In CDC survey data from 2017 to 2020, 25.3% of adults said they did no physical activity outside their job in the past month⁵. Rates ranged from 17.7% in Colorado to 49.4% in Puerto Rico, and were higher among Hispanic and Black adults than among white and Asian adults⁵.

Our coming article on how much exercise is enough covers the full weekly targets and the latest federal updates. The current guidelines date from 2018; in March 2025, federal scientists wrote that a third edition was planned for 2028¹⁰.

A sudden hard effort is riskiest for an unready heart

The 1993 finding has held up. In a study published in 2000, researchers in Stockholm County, Sweden, interviewed 699 heart attack patients⁴. They found that vigorous exertion raised the risk about six times, and that the risk was higher in sedentary people⁴.

The absolute risk is small. The Swedish team put the added risk at 1.5 heart attacks per million person-hours, a person-hour being one hour of one person’s time⁴. They estimated that vigorous exertion set off about 5.7% of the heart attacks they studied⁴.

Heart events during activity are rare, the federal guidelines say, but the risk climbs when someone abruptly does far more than they’re used to⁶.

Injuries follow the same pattern. Less-fit people get hurt more often doing the same activity, and the risk of muscle and joint injury grows with the total amount you do⁶.

Picture someone who hasn’t exercised in years and decides to run hard on a New Year’s morning. That jump is the riskiest kind of start. A walk that leaves them able to chat is far safer, and it still counts.

So the goal for your first month is to teach your body, step by step, that movement is normal.

Most people don’t need a doctor’s note, but some do

You may have heard that everyone should see a doctor before exercising. The guidelines say otherwise: healthy adults who build up gradually don’t have to check with a provider first⁶.

The American College of Sports Medicine (ACSM) updated its screening advice in 2015 to reduce unnecessary barriers to starting¹¹. Its approach looks at three things: how active you are now, whether you have heart, metabolic or kidney disease or warning symptoms, and how hard you plan to work¹¹.

If you’re inactive and have none of those conditions or symptoms, ACSM-based guidance says you don’t need medical clearance to begin light to moderate exercise¹². Our cardio and outdoor exercise guides walk through the full screening steps.

A four-week plan to start from zero

This plan is our own design. It follows the federal advice to begin with light activity, build gradually and spread activity across at least three days a week⁶. Bouts of any length count, so two 5-minute walks equal one 10-minute walk⁸.

Pick the track that fits your body today. You can switch tracks anytime.

• Track A, walking: for people who can walk comfortably for a few minutes.
• Track B, seated or low-impact: for people with joint pain, balance worries, a larger body that makes walking uncomfortable, or limited mobility. Use a sturdy chair, a stationary bike or a pool.

Judge effort by your breath, not a number. “Easy” means you could sing a song. “Comfortable” means you can talk in full sentences but couldn’t sing. Our cardio guide explains this talk test.

Week	Track A: walking	Track B: seated or low-impact	Effort	Strength (2 days)
1	5–10 minutes, 3–5 days	5–10 minutes of seated marching, arm raises and ankle circles, 3–5 days	Easy	None yet
2	10–15 minutes, 4–5 days	10–15 minutes, adding a stationary bike or pool walking if you have one	Easy	1 set of 5 chair stands (use your hands if needed) and 5 wall push-ups
3	15–20 minutes, 5 days	15–20 minutes, 5 days	Easy to comfortable	1 to 2 sets of 5 to 8 of each
4	20–25 minutes, 5 days	20–25 minutes, 5 days	Comfortable	2 sets of 8 of each

By week 4, you’ll be doing 100 to 125 minutes a week, most of the way to the federal minimum of 150 minutes of moderate activity⁸. The guidelines also call for muscle-strengthening work on two or more days a week⁷. Our strength-training guide shows how to build on these first moves.

Rules for the month:

1. Never jump two rows at once. If a week felt hard, repeat it.
2. Keep a day off between strength sessions.
3. Warm up and cool down with two or three minutes of slower movement.
4. Write it down. A check mark on a calendar is enough.

If you can’t reach these amounts because of a health condition, that’s fine. The guidelines say adults with chronic conditions or disabilities should move as their abilities allow and avoid inactivity⁷.

Soreness, plateaus and the motivation dip are normal

Soreness. Mild muscle aches a day or two after new activity are common, and they ease as your body adapts. Our article on recovery explains why. Sharp pain, joint pain, or pain that keeps getting worse is different, and it’s a reason to stop and get checked.

Plateaus. Early weeks often feel easier quickly. Later, progress can slow. That’s when to add a few minutes, a hill or a new activity, as our recovery article describes.

Motivation. Motivation often dips once the novelty wears off. Our articles on how habits form, habit stacking and recovering from setbacks cover the research. The short version: tie your walk to something you already do, plan a 5-minute version for bad days, and treat a missed week as a pause, not a verdict.

Want to run? The National Health Service in England offers a plan called Couch to 5K. It lasts nine weeks, with three runs a week and a rest day after each¹³.

Every week-1 session opens and closes with five minutes of walking. In between, you trade 1 minute of jogging for 90 seconds of walking, again and again¹³. In week 9, each run is a half hour with no walk breaks¹³. The NHS says it’s fine to repeat a run or a whole week, and it suggests a doctor’s check before you begin if your health concerns you¹³.

If you’re starting from zero, finish the four-week plan before Couch to 5K. Its first week already includes running.

Move for how it makes you feel, not only for the scale

If you start exercising only to lose weight, a slow-moving scale can make the effort feel pointless. It isn’t, because many of exercise’s benefits don’t depend on weight.

The 2018 federal advisory committee reported that a single session of moderate-to-vigorous activity can improve that night’s sleep⁹. It can also ease anxiety, sharpen thinking, lower blood pressure and help your body use insulin better, and those gains grow with regular activity⁹.

In a 2021 review in the journal iScience, Glenn Gaesser of Arizona State University and Siddhartha Angadi of the University of Virginia argued for a weight-neutral approach¹⁴¹⁵. They concluded that gains in fitness or activity are more consistently tied to lower death risk than intentional weight loss is, and that exercise improves heart and blood sugar markers even without weight loss¹⁴.

Much of the death-risk evidence in that review comes from observational studies, so treat it as a strong argument, not final proof. Still, its message matches what many natural-health readers already believe: a healthy body is something you build by using it, at any size.

Movement is not a punishment for eating. If you notice yourself exercising to “burn off” food, or feeling panic when you miss a day, reach out to the National Alliance for Eating Disorders helpline at 1-866-662-1235. If you’re in crisis, call or text 988.

A restart guide for when life interrupts

Breaks happen: a busy season, an illness, a move. Fitness fades with time off, as our recovery article explains, so don’t restart where you stopped. Use this rule of thumb, which is our own.

Time off	Where to restart	How fast to rebuild
Less than 1 week	Your usual routine, a little easier for the first session	Back to normal within a few days
1–2 weeks	One week back in the plan	Move up after one comfortable week
2–4 weeks	Two weeks back in the plan	One row per week
1–3 months	Week 1 or 2	One row per week; repeat any hard week
More than 3 months	Week 1	As if starting fresh
After surgery, a hospital stay or a serious illness	Ask your clinician first	Follow their plan

The same safety logic applies to a restart as to a first start: hard effort that your body has stopped expecting is the riskiest kind³⁶. Our coming article on recovering after illness covers that situation in more depth.

How strong is the evidence?

Claim	Evidence level	What it rests on
Moving from inactive to somewhat active lowers health risks	Strong evidence	Federal expert review of many studies6
Ten more minutes a day could prevent about 111,000 U.S. deaths a year	Promising but early	A model estimate built on one observational study12
Heavy exertion briefly raises heart attack risk, most in inactive people	Strong evidence	Two large patient studies agree, and federal guidelines concur346
Regular exercise lowers that short-term risk	Promising but early	The pattern in the same patient studies34
One session can ease anxiety and improve sleep that night	Promising but early	Reported by the federal advisory committee; its cover letter doesn’t give the strength of the evidence9
Fitness matters more than weight loss for a long life	Promising but early	A review of mostly observational studies14

Questions readers ask

The bottom line

The biggest health gain from exercise comes at the very start, when you go from nothing to something. The biggest short-term risk also comes at the start, if you jump straight to hard effort.

So start small and stay steady. Walk or move in a chair for 5 to 10 minutes, add a little each week, and judge effort by your breath. If you have heart, metabolic or kidney disease or warning symptoms, talk with a clinician first.

Related reading

• Low fitness rivals smoking as a health risk, and cardio can change it
• Fitness gains happen between workouts, so plan the rest
• A slip doesn’t erase your progress, but your reaction to it can
• Most adults skip strength training, though under an hour a week goes a long way
• A trainer coaches your squat while a physical therapist treats what hurts

Sources

1. National Cancer Institute, Division of Cancer Epidemiology and Genetics. “Deaths Prevented by Exercise” (on Saint-Maurice PF, Graubard BI, Troiano RP, et al., JAMA Internal Medicine, January 24, 2022). NCI, 2022. dceg.cancer.gov
2. TCTMD. “Small Amount of Extra Exercise Would Prevent Many US Deaths” (on Saint-Maurice PF, et al., JAMA Internal Medicine, 2022). Cardiovascular Research Foundation, 2022. tctmd.com
3. Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. “Triggering of Acute Myocardial Infarction by Heavy Physical Exertion: Protection Against Triggering by Regular Exertion.” New England Journal of Medicine, 1993;329(23):1677–1683 (UMass Chan Medical School repository). pubmed.ncbi.nlm.nih.gov
4. Hallqvist J, Möller J, Ahlbom A, Diderichsen F, Reuterwall C, de Faire U. “Does Heavy Physical Exertion Trigger Myocardial Infarction? A Case-Crossover Analysis Nested in a Population-Based Case-Referent Study.” American Journal of Epidemiology, 2000;151(5):459–467 (University of Copenhagen research portal). pubmed.ncbi.nlm.nih.gov
5. Centers for Disease Control and Prevention. “Adult Physical Inactivity Outside of Work.” CDC, January 31, 2025. cdc.gov
6. U.S. Department of Health and Human Services. “Physical Activity Guidelines for Americans, 2nd edition.” HHS, 2018. odphp.health.gov
7. U.S. Department of Health and Human Services. “Physical Activity Guidelines for Americans, 2nd edition: Executive Summary.” HHS, 2018. odphp.health.gov
8. Office of Disease Prevention and Health Promotion. “Top 10 Things to Know About the Second Edition of the Physical Activity Guidelines for Americans.” HHS, updated November 19, 2025. odphp.health.gov
9. King AC, Powell KE. Letter to the HHS Secretary transmitting the 2018 Physical Activity Guidelines Advisory Committee Scientific Report. HHS, 2018. odphp.health.gov
10. Piercy KL, Vaux-Bjerke A, Polster M, et al. “Call to Action: Contribute to the Development of the Third Edition of the Physical Activity Guidelines for Americans.” Translational Journal of the American College of Sports Medicine, March 21, 2025 (CDC Stacks). stacks.cdc.gov
11. Riebe D, Franklin BA, Thompson PD, et al. “Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening.” Medicine & Science in Sports & Exercise, 2015;47(11):2473–2479. digitalcommons.uri.edu
12. Tsakirides C, Stavropoulos-Kalinoglou A. “Physiology Group Screening Process” (adapted from ACSM’s Guidelines for Exercise Testing and Prescription, 10th edition). Leeds Beckett University, July 2020. Www.Leedsbeckett.Ac.Uk
13. National Health Service (England). “Couch to 5K Running Plan.” NHS Better Health, updated September 4, 2026. nhs.uk
14. Gaesser GA, Angadi SS. “Obesity Treatment: Weight Loss Versus Increasing Fitness and Physical Activity for Reducing Health Risks.” iScience, October 2021 (DOAJ record). pubmed.ncbi.nlm.nih.gov
15. The News Letter (Belfast). “‘Fat but Fit’: Exercise Rather Than Weight Loss ‘the Key to Longer Life.'” September 20, 2021. newsletter.co.uk