September 8, 2021

Wellness Read – Exercise as Medicine: Using Movement to Reduce Cholesterol

by Scott Schafer

Checking blood cholesterol levels is a routine part of most annual physicals. By analyzing a simple blood draw, medical professionals can determine if you are at risk for stroke and heart disease, among other medical conditions. Typical medical interventions for high cholesterol include dietary and pharmacological support. Other lifestyle factors, such as activity and exercise, can also have a positive effect on blood cholesterol levels, which is less commonly known. In this month’s Wellness Read, we explain the basics of cholesterol, risks associated with high cholesterol, and what the research says about the relationship between exercise and blood cholesterol levels.  

what is cholesterol and where does it come from?

Cholesterol found in your blood comes from two sources: the foods you eat and your liver (where it is produced naturally). Ingested cholesterol is absorbed in the small intestines and eventually transported to the liver. It then travels through the blood stream to peripheral tissues before returning to the liver where it is either eliminated in feces or reabsorbed. Although having too much cholesterol in your blood can lead to fatty deposits in your blood vessels, cholesterol plays a vital role in building cells, vitamins and even hormones.1,8

Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) are two categories of cholesterol (along with triglycerides and the total cholesterol) that make up the Lipid Profile. LDL is known as the “bad” cholesterol because in excess it forms plaque on artery walls, increasing risk for heart disease and stroke.2  On the other hand, HDL is known as the “good” cholesterol because it removes excess cholesterol from cells, shuttling it back to the liver where it is eliminated in feces or reabsorbed  (see table below from the CDC for generic cholesterol targets for an otherwise healthy individuals without additional personal or family risk factors.1)

Table 1: Desirable cholesterol Levels

Adapted from CDC, 2020 (2)

how does exercise affect the lipid profile?

Pharmacological intervention is often recommended to help reduce high cholesterol levels; however, research also shows that lifestyle interventions also have a positive effect on lipid profiles. Studies show:

  • Regular, consistent exercise increases HDL cholesterol amount.3,4,5,6,7
  • Aerobic exercise is effective in reducing total cholesterol by 2%, LDL by 3%, triglyceride levels by 5%. It also increases HDL by 3% in women over 18 years of age.5 The same study found that consistent low-intensity aerobic exercise positively alters the lipid profile in sedentary individuals. Results displayed a significant decrease in total cholesterol and increased HDL levels after 60 minutes of exercise.5
  • High-intensity exercise improves the lipid profile by affecting not only the amount of HDL in the blood (HDL-C), but also the function of HDL within the reverse cholesterol transport pathway. A recent 2020 review shows that prolonged high-intensity exercise may improve cholesterol efflux capacity (CEC) of HDL. CEC measures HDL’s ability to transport cholesterol from the blood back to the liver, a cardioprotective function of HDL.6,9
  • Resistance training on its own has a positive effect on the lipid profile when the volume rather than the intensity of movement is increased (more sets and/or reps vs. higher weight/low rep training).7
  • Meeting physical activity guidelines is key. One study of 37,000 participants specifically analyzed physical activity, low HDL levels and risk of mortality. Findings showed those that regularly met physical activity guidelines had lower risk of all-cause mortality and cardiovascular disease, regardless of HDL amounts (high or low).4

Main takeaways and recommendations

As shown in the research, exercise of various modes can positively affect the lipid profile. In some instances, such lifestyle interventions can even eliminate the need for pharmacological involvement in treatment. If you are looking to improve your cholesterol levels, we recommend:

1. Get moving.

The most dramatic results occurred when participants had >60 mins of low-intensity cardio week over week.5 Start slow and build week-by-week until 60 minutes isn’t so daunting.

2. pick a mode that works for you.

Not everyone loves exercise as much as our Head of Fitness but finding a mode that fits your lifestyle can be crucial to success. Enlist a friend to join you for added accountability and fun.

3. Integrate resistance training.

Strength training with low weight and high reps can stimulate a low/moderate-intensity cardiovascular response as well as promote increased strength and physical function. Supplement these workouts with cardio to make the biggest impact on your lipid profile.

4. Progress to high-intensity exercise.

Progressing appropriately to high-intensity workouts will not only lead to a better lipid profile but also improved cardiovascular health as well.

Most of us are aware of the medications used to help reduce cholesterol, but fewer are aware that physical activity and exercise can yield similar results.  At the same time, there are other factors that play a role in physiological adaptations, such as genetics, age, and even gender. Ultimately, lifestyle intervention has proven to be an excellent tool to help improve cholesterol for various populations. It’s just another important reason to get moving, regardless of your own cholesterol levels.  As ever, please consult with your physician if you plan to start a new exercise program or aim to increase your intensity or frequency or both.

In Real Health,

Scott Schafer

Head of Fitness

Reference List

  1. McArdle, W. D., Katch, F. I., & Katch, V. L. (2015). Exercise physiology: Nutrition, energy, and human performance. Wolters Kluwer Health.
  2. Centers for Disease Control and Prevention. (2020, September 8). Getting your cholesterol checked. Centers for Disease Control and Prevention.
  3. Sarzynski, M. A., Ruiz-Ramie, J. J., Barber, J. L., Slentz, C. A., Apolzan, J. W., McGarrah, R. W., Harris, M. N., Church, T. S., Borja, M. S., He, Y., Oda, M. N., Martin, C. K., Kraus, W. E., & Rohatgi, A. (2018). Effects of increasing exercise intensity and dose on multiple measures of hdl (high-density lipoprotein) function. Arteriosclerosis, Thrombosis, and Vascular Biology, 38(4), 943–952.
  4. O’Donovan, G., Stensel, D., Hamer, M., & Stamatakis, E. (2017). The Association BETWEEN leisure-time physical activity, LOW HDL-CHOLESTEROL and mortality in a pooled analysis of NINE population-based cohorts. European Journal of Epidemiology, 32(7), 559–566.
  5. Marques, L. R., Diniz, T. A., Antunes, B. M., Rossi, F. E., Caperuto, E. C., Lira, F. S., & Gonçalves, D. C. (2018). Reverse cholesterol transport: Molecular mechanisms and the non-medical approach to enhance hdl cholesterol. Frontiers in Physiology, 9.
  6. Ruiz-Ramie, J. J., Barber, J. L., & Sarzynski, M. A. (2019). Effects of exercise on hdl functionality. Current Opinion in Lipidology, 30(1), 16–23.
  7. Mann, S., Beedie, C., & Jimenez, A. (2013). Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: Review, synthesis and recommendations. Sports Medicine, 44(2), 211–221.
  8. What is cholesterol? (n.d.).
  9. NutriPATH – Functional Pathology testing & Wellness: NATUROPATH SOLUTIONS. NutriPATH Integrative and Functional Pathology Services. (2021, July 16).


cholesterol, exercise, fitness tips, habits, hdl cholesterol, heart health, ldl cholesterol, lipid panel

You may also like

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}