A groundbreaking new study published in the American Journal of Cardiology reveals that only vigorous, not moderate, physical activity effectively reduces cardiovascular disease (CVD) risk in young adults—a discovery that could shape public health priorities in Thailand, where heart disease remains the country’s top killer. The findings underscore the need for Thais to do more than simply “move more” and highlight the unique health benefits of higher-intensity exercise for preventing serious heart problems.
Globally and in Thailand, cardiovascular disease takes more lives than any other cause, representing a growing public health burden (WHO). In recent years, Thailand has invested heavily in promoting physical activity as a shield against heart disease and other noncommunicable diseases (NCDs), with government-led campaigns urging citizens of all ages to move more, walk or cycle to work, and take part in community exercise events (WHO Thailand Physical Activity Drive). Previous national strategies, such as the Thailand Physical Activity Strategy 2018-2030, have focused on encouraging general increases in activity. However, many campaigns have not differentiated between moderate and vigorous intensity—an increasingly important distinction in light of emerging evidence.
The newly published research involved 196 Hispanic men, aged 18 to 40, whose physical activity was objectively measured using accelerometers over a seven-day period (Physician’s Weekly Summary). Their cardiovascular risk was assessed using the Framingham Risk Score (FRS), a widely recognized tool for estimating a person’s 10- or 30-year risk of developing cardiovascular disease (Wikipedia: Framingham Risk Score). Although both the “low-risk” and “high-risk” groups managed to meet minimum recommended exercise guidelines—at least 150 minutes of moderate-to-vigorous physical activity per week—the crucial difference was that the low-risk group engaged in nearly double the amount of vigorous activity: 25 minutes per day versus just 12 in the high-risk group.
Statistical analysis revealed a striking outcome: for every additional minute of vigorous physical activity performed each day, a participant’s odds of being in the high-risk CVD category fell by 4.4%, even after controlling for factors like age, body mass index (BMI), diet quality, and smoking status. In contrast, time spent on moderate physical activity showed no significant link to CVD risk reduction. This challenges longstanding assumptions that moderate activity, such as brisk walking, is sufficient for robust heart protection, at least in young adults (PubMed). Study authors concluded, “Vigorous, but not moderate, physical activity differentiated low from high cardiovascular disease risk, emphasizing the importance of higher-intensity exercise for risk reduction.”
Thai health experts have long emphasized the dangers of physical inactivity, which, along with poor diet, tobacco use, and harmful drinking, drives soaring rates of CVD and other NCDs in the country (WHO NCD Fact Sheet Thailand). The Ministry of Public Health and Thai Health Promotion Foundation, supported by global partners such as WHO, have adopted ambitious targets and community programs to increase physical activity and reduce NCD deaths. Recent WHO recommendations, adopted by Thailand, stipulate adults should accumulate at least 75 minutes of vigorous-intensity or 150 minutes of moderate-intensity aerobic activity weekly (WHO Physical Activity Recommendations). Yet, alarming numbers of Thais remain insufficiently active: only 26% of children and youth meet recommended levels, with adulthood faring only slightly better (PMC7732870).
Thailand faces unique challenges in promoting effective physical activity. Urbanization, reliance on motorized transport, and increasingly sedentary jobs have fundamentally reduced daily energy expenditure (WHO Regional Feature). Bangkok, in particular, struggles with consistently high predicted CVD risk among adults, exacerbated by dietary patterns, high BMI, and insufficient exercise, as demonstrated in a 2023 nationwide study of over 80,000 Thais with type 2 diabetes managed in hospitals (BMC Cardiovascular Disorders). The study revealed that mean predicted 10-year risk for CVD, as measured with the Framingham Risk Score, rose over recent years, especially among women and older adults. It also highlighted that increasing BMI and systolic blood pressure—risk factors highly modifiable by exercise—were on the rise.
The clear message from the new research is that simply “meeting guidelines” is not enough; how vigorously people move matters. This has significant cultural implications for Thailand, where leisurely group walking, yoga in parks, and traditional dance are common forms of exercise. While these activities certainly have social and mental health benefits, the latest science signals a need to integrate higher-intensity options—such as fast cycling, running, intense aerobics, or interval training—into public health messaging and facilities. Healthcare professionals with the Department of Health and the Thai Health Promotion Foundation have started to acknowledge this, with recent campaigns highlighting running events and gym-based workouts, especially among younger Thais.
Expert voices echo the urgency for adaptation. A senior official from the Thai Health Promotion Foundation explained, “To halt the rise in heart disease, we must diversify and intensify our public health approach. Vigorous activity should not be viewed as only for athletes—communities can encourage brisk jogging, cycling, or high-energy dance routines accessible to all ages.” International experts with WHO also caution that behavioral change is not instantaneous; governments and the private sector must work together to prioritize accessible, safe spaces for vigorous exercise, especially in overcrowded cities.
The importance of tailoring interventions for Thai society is made especially clear in the rural-urban divide. National data shows urban residents are more likely to be sedentary due to office-based work and limited green space. Conversely, villagers may already engage in moderate-intensity work but rarely reach the threshold for vigorous exercise, especially as agricultural labor becomes increasingly mechanized. Cultural traditions such as Muay Thai, or the rising popularity of community cycling clubs, provide promising models for integrating heart-healthy, vigorous activities rooted in Thai identity (WHO Thailand Physical Activity).
Looking forward, public health planners should consider revising exercise guidelines and educational materials to clearly distinguish between moderate and vigorous intensity. This could mean updating school curricula, community center programs, and media campaigns to showcase a range of heart-pumping activities suitable for all fitness levels. Technology, such as fitness trackers and mobile apps, could also help individuals monitor intensity, supporting self-motivation and feedback—a practice growing among urban youth.
Given the high burden of heart disease in Thailand, and the persistently high risk observed in high-BMI, older, and urban Thai groups despite rising awareness, this new evidence has clear implications: targeting increases in vigorous physical activity, alongside addressing tobacco use, healthy diet, and blood pressure control, could bring substantial benefits across the population. For Thai individuals, this might mean replacing some leisurely park walks with interval sprints, participating in group aerobics classes, experimenting with faster cycling, or taking up cardiovascular aspects of traditional martial arts.
In conclusion, Thai policymakers, community leaders, and individuals have a powerful opportunity to realign national health promotion strategies with the latest science. For readers looking to lower their own heart risk, here are actionable steps:
- Aim for at least 75 minutes of vigorous exercise per week or boost the intensity of regular activities.
- Incorporate several sessions per week of higher-intensity movement: running, cycling fast, Muay Thai, or intense group aerobics.
- Use a simple “talk test”: if you can speak only a few words without pausing for breath, the exercise is vigorous.
- Encourage local schools, workplaces, and community organizations to offer programs that mix both moderate and vigorous movement.
- For those with health conditions or new to exercise, consult with healthcare providers about safe ways to start high-intensity training.
- Embrace and adapt traditional cultural activities to elevate the heart rate—for example, faster dance, sport, or martial arts.
For the nation, integrating the unique Thai context—urban and rural lifestyles, climate, and cultural identity—with modern exercise science can help curb the rising tide of cardiovascular disease. The latest research reminds us: it’s not just about moving more, but also moving harder. Thai society, with its rich legacy of communal activity and adaptation, is well-placed to lead this vigorous new chapter in public health.
Sources:
- Physician’s Weekly: Exercise Intensity Affects Cardiovascular Risk
- [American Journal of Cardiology, May 2025, Gattoni et al.]
- WHO Thailand Physical Activity Drive
- BMC Cardiovascular Disorders: Trends in predicted 10-year risk for CVD among Thai patients with T2D
- Wikipedia: Framingham Risk Score
- PMC7732870: Physical activity level of Thai children and youth