Benjamin Levine

MD · Professor of Internal Medicine/Cardiology and Distinguished Professor of Exercise Sciences, UT Southwestern Medical Center · founding director, Institute for Exercise and Environmental Medicine, Dallas

Go-to expert for: exercise and the ageing heart

Who and why

Benjamin Levine is a cardiologist in Dallas who has spent decades studying how the heart responds to exercise, inactivity, ageing, altitude and spaceflight. In 1992 he founded the Institute for Exercise and Environmental Medicine. His team showed that a sedentary, stiffening heart in late middle age can be made more flexible again with two years of structured training.

Why it matters after 50: With age and inactivity the heart muscle tends to stiffen, which is linked to a common type of heart failure in older adults. Levine's work suggests regular, fairly vigorous exercise can slow or partly reverse this, especially if started by late middle age.

What Levine recommends

Aim for about 4 to 5 exercise sessions a week, roughly 30 minutes or more each. In his studies, 2 to 3 sessions a week was not enough to keep the heart from stiffening with age.Strong evidence
Include one or two interval sessions a week, such as the Norwegian 4×4: four 4-minute hard efforts, each followed by 3 minutes of easy recovery.Strong evidence
Add one longer, easier session (such as a long walk, ride or swim) and some moderate aerobic work on other days.Some evidence
Do strength training about twice a week alongside the aerobic work.Some evidence
Late middle age (roughly 45 to 64) seems to be the best window. In a one-year programme in nine previously sedentary people around 70, fitness improved but heart stiffness barely changed, so starting earlier matters.Note
If you are inactive or have heart disease, see a doctor before starting vigorous training, and build up gradually over several months.Doctor only

Signature: The 2-year heart-rejuvenation programme

A supervised plan for sedentary 45- to 64-year-olds that started with three 30-minute sessions a week and built up over months to about 5 to 6 hours a week, mixing 4×4 intervals, a long easy session, moderate exercise and twice-weekly strength training. After two years, fitness rose and the heart muscle was measurably less stiff.

In your plan

Choose him for cardio: his mix of easy sessions, a longer session and one 4 × 4 interval session, scaled to your time.

Build my mix

Research and honest caveats

Reversing the heart effects of sedentary ageing

In 61 sedentary adults (average age 53), two years of high-intensity training 4 to 5 times a week raised VO2max by 18% and reduced left-ventricle stiffness, while a yoga, balance and strength control group did not change.

Howden, Sarma, Lawley et al. (senior author Levine), Circulation, 2018

How much lifelong exercise keeps the heart supple

Among 102 adults over 64, those who had exercised 4 to 5 times a week for decades had more flexible hearts than casual exercisers (2 to 3 times a week), who looked similar to sedentary people.

Bhella, Hastings, Fujimoto et al., Journal of the American College of Cardiology, 2014

The 2018 trial was small (53 people finished), included only healthy adults aged 45 to 64, and measured heart stiffness and fitness rather than heart attacks, heart failure or lifespan. The lifelong-exercise findings come from comparing groups, not a trial, so they show association rather than proof.

Career highlights

1992Founded the Institute for Exercise and Environmental Medicine in Dallas
2007Became team leader of the cardiovascular section of the NASA-funded National Space Biomedical Research Institute (to 2017)
2014Published the lifelong exercise dose study showing 4 to 5 sessions a week preserves heart flexibility
2018Senior author of the Circulation trial showing two years of training reduced heart stiffness in middle age