On July 24, 2025, the American pro wrestling celebrity Hulk Hogan, whose real name was Terry Bollea, died at the age of 71. Hogan had chronic lymphocytic leukemia and a history of atrial fibrillation, or A-fib, a condition in which the upper chambers of the heart, or atria, beat irregularly and often rapidly. His cause of death has been confirmed as acute myocardial infarction, commonly known as a heart attack.
Hogan became a household name in the 1980s and has long been known for maintaining fitness and a highly active lifestyle, despite having had 25 surgeries in 10 years, including a neck surgery in May.
Hogan’s death has brought renewed attention to the importance of maintaining heart health through exercise. Many people think that bodybuilders are the “picture” of health. However, the truth is that too much muscle can increase strain on the heart and may actually be harmful. It may seem ironic, then, that people who exercise to extreme levels and appear healthy on the outside can, in fact, be quite unhealthy on the inside.
As the director of sports cardiology at the University of Colorado Anschutz Medical Campus, I see patients of all age groups and at varying levels of fitness who are interested in promoting health by incorporating exercise into their lifestyle, or by optimizing their current exercise program.
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Exercise is the foundation for good health
When people think of vital signs, they usually think about things such as heart rate, blood pressure, temperature, breathing rate and blood oxygen levels. However, the American Heart Association also includes “fitness” as an additional vital sign that should be considered when determining a patient’s overall health and risk of heart disease, cancer and death.
While fitness may be determined in various ways, the best way is by checking what is known as peak oxygen uptake, or VO2 max, through a specialized evaluation called a cardiopulmonary exercise test. These can be performed at many doctors’ offices and clinics, and they provide a wealth of information related to overall health, as well as heart, lung and skeletal muscle function.
Exercise is one of the most effective interventions to prolong life and reduce the risk of developing chronic diseases throughout life – in effect, prolonging lifespan and improving health span, meaning the number of years that people spend in good health.
In fact, a large study done by the Cleveland Clinic found that a low level of fitness poses a greater risk of death over time than other traditional risk factors that people commonly think of, such as smoking, diabetes, coronary artery disease and severe kidney disease.
When it comes to brain health, the American Stroke Association emphasizes the importance of routine exercise and avoiding sedentary behavior in their 2024 guidelines on primary prevention of stroke. The risk of stroke increases with the amount of sedentary time spent throughout the day and also with the amount of time spent watching television, particularly four hours or more per day.
Regarding cognitive decline, the Alzheimer’s Society states that regular exercise reduces the risk of dementia by almost 20%. Furthermore, the risk of Alzheimer’s disease is twice as high among individuals who exercise the least, when compared to individuals who exercise the most.
There is also strong evidence that regular exercise reduces the risk of certain types of cancer, especially, colon, breast and endometrial cancer. This reduction in cancer risk is achieved through several mechanisms.
For one, obesity is a risk factor for up to 13 forms of cancer, and excess body weight is responsible for about 7% of all cancer deaths. Regular exercise helps to maintain a healthy weight.
Second, exercise helps to keep certain hormones – such as insulin and sex hormones – within a normal range. When these hormone levels get too high, they may increase cancer cell growth. Exercise also helps to boost the immune system by improving the body’s ability to fight off pathogens and cancer cells. This in turn helps prevent cancer cell growth and also reduces chronic inflammation, which left unchecked damages tissue and increases cancer risk.
Finally, exercise improves the quality of life for all people, regardless of their health or their age. In 2023, Hulk Hogan famously quipped, “I’m 69 years old, but I feel like I’m 39.”
The optimal dose of exercise
Major health organizations, such as the American Heart Association, American Cancer Society and Department of Health and Human Services, all share similar recommendations when it comes to the amount of exercise people should aim for.
These organizations all recommend doing at least 150 minutes per week of moderate-intensity exercise, or at least 75 minutes per week of vigorous-intensity exercise. Moderate exercises include activities such as walking briskly (2.5 to 4 miles per hour), playing doubles tennis or raking the yard. Vigorous exercise includes activities such as jogging, running or shoveling snow.
A good rule of thumb for figuring out how hard a specific exercise is is to apply the “talk test”: During moderate-intensity exercise, you can talk, but not sing, during the activity. During vigorous intensity exercise, you can say only a few words before having to stop and take a breath.
There is a lot of solid data to support these recommendations. For example, in a very large analysis of about 48,000 people followed for 30 years, the risk of death from any cause was about 20% lower among those who followed the physical activity guidelines for Americans.
Life can be busy, and some people may find it challenging to squeeze in at least 150 minutes of exercise throughout the course of the week. However, “weekend warriors” – people who cram all their exercise into one to two days over the weekend – still receive the benefits of exercise. So, a busy lifestyle during the week should not prevent people from doing their best to meet the guidelines.
What about the number of steps per day? In a new analysis in The Lancet, when compared with walking only 2,000 steps per day, people who walked 7,000 steps per day had a 47% lower risk of death from any cause, a 25% lower risk of developing heart disease, about a 50% lower risk of death from heart disease, a 38% lower risk of developing dementia, a 37% lower risk of dying from cancer, a 22% lower risk of depression and a 28% lower risk of falls.
Historically, people have aimed for 10,000 steps per day, but this new data indicates that there are tremendous benefits gained simply from walking 7,000 steps daily.
It’s never too late to start
One question that many patients ask me – and other doctors – is: “Is it ever too late to start exercising?” There is great data to suggest that people can reap the benefits even if they don’t begin an exercise program into their 50s.
Being sedentary while aging will cause the heart and blood vessels to stiffen. When that happens, blood pressure can go up and people may be at risk of other things such as heart attacks, strokes or heart failure.
However, in a study of previously sedentary adults with an average age of 53, two years of regular exercise reversed the age-related stiffening of the heart that otherwise occurs in the absence of routine exercise.
And it is important to remember that you do not have to look like a body builder or fitness guru in order to reap the benefits of exercise.
Almost three-quarters of the total benefit to heart, brain and metabolic health that can be gained from exercise will be achieved just by following the guidelines.
