Combining small changes to sleep, diet, and exercise could be key to reducing heart attack and stroke risk
EMBARGO: 24 March 2026 at 00:01 CET
Key takeaways
The study followed more than 53,000 adults from UK Biobank over an eight‑year period and found that making even modest improvements across three behaviours had clinically meaningful benefits.
Sleeping for 11 minutes more, doing an additional 4.5 minutes of moderate-to-vigorous physical activity, and eating additional quarter of a cup of vegetables were associated with a 10% reduction in major cardiovascular events. Moderate-to-vigorous activity can include everyday tasks such as taking the stairs, carrying shopping bags, or walking briskly.
The research found that the optimal combination of behaviours involved sleeping for eight to nine hours per night, completing more than 42 minutes of moderate-to-vigorous physical activity per day, and a modest diet quality score. This combination was associated with 57% lower risk of major cardiovascular events compared to people with the least optimal health profile.
The paper titled ‘Combined Variations in Sleep, Physical Activity, and Nutrition and the Risk of Major Adverse Cardiovascular Events’ was published today (24 March 2026) in the European Journal of Preventive Cardiology.
Dr. Nicholas Koemel, lead author and research fellow at the University of Sydney, explained the importance of the study, “We show that combining small changes in a few areas of our lives can have a surprisingly large positive impact on our cardiovascular health. This is very encouraging news because making a few small, combined changes is likely more achievable and sustainable for most people when compared with attempting major changes in a single behaviour.”
“Making even modest shifts in our daily routines is likely to have cardiovascular benefits as well as create opportunities for further changes in the long run. I would encourage people not to overlook the importance of making a small change or two to your daily routine, no matter how small they may seem.” Dr. Koemel continued.
The study is the first to investigate the minimum and optimal combinations of sleep, physical activity, and nutrition necessary for meaningful improvements in the risk of having a major cardiovascular event, including heart attack, heart failure, and stroke.
The researchers used data from a sub-study of UK Biobank, a cohort study of 502,629 adults aged 40-69 who were recruited from 2006 to 2010. Amount of sleep and physical activity were estimated using wearable devices. Diet was assessed using a single food frequency questionnaire which allowed the researchers to calculate a diet quality score. A better quality diet involved a higher intake of vegetables, fruits, fish, dairy, whole grains, and vegetable oils and a lower intake of refined grains, processed meats, unprocessed red meat, and sugar-sweetened beverages.
“We plan to build on these findings to develop new digital tools that support people in making positive lifestyle changes and establish sustained healthy habits. This will involve working closely with community members to make sure the tools are easy to use and can address the barriers we all face in making tweaks to our day-to-day routines,” concluded Prof. Emmanuel Stamatakis, senior author of the study and professor of physical activity and population health at the University of Sydney and Monash University.
The paper notes that, as an observational study, the research cannot establish a definitive causal relationship between the lifestyle behaviours and cardiovascular risk. The researchers suggest that intervention trials are now needed to fully confirm the findings.
Sleep, physical activity, and diet have previously been shown to have a major influence on cardiovascular disease risk, although their effects are often assessed in research studies in isolation or in pairs. In our daily lives, however, these different behaviours can influence each other, which means studying their impact together is more meaningful. For example, poor sleep disrupts the normal transmission of appetite hormones, influencing what people eat and making them more likely to overeat. Physical activity improves sleep quality, but lack of sleep may reduce physical activity due to tiredness. Diet quality affects sleep and also energy levels needed for physical activity.
ENDS
Funding: National Health and Medical Research Council (NHMRC) Investigator Grant (APP1194510) and the National Council for Scientific and Technological Development (311109/2023-3).
Disclosures: None
References:
‘Combined Variations in Sleep, Physical Activity, and Nutrition and the Risk of Major Adverse Cardiovascular Events’ by N.A. Koemel et al., European Journal of Preventive Cardiology. https://academic.oup.com/eurjpc/article-lookup/doi/10.1093/eurjpc/zwag141
Copies of the paper are available on request.
More information about UK Biobank can be found here: https://www.ukbiobank.ac.uk/
ESC Press Office
Tel: +33 6 61 40 18 84
Email: press@escardio.org
Follow European Society of Cardiology News on LinkedIn
The European Journal of Preventive Cardiology (EJPC) is an official, international, peer-reviewed journal of the European Association of Preventive Cardiology (EAPC), an association of the European Society of Cardiology (ESC). The Journal embraces all scientific, clinical and public health disciplines that address the causes and prevention of cardiovascular disease, as well as risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology.
About the European Society of Cardiology
The ESC brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.
END
Key takeaways
- Small, combined improvements to sleep, diet and physical activity can reduce the risk of major cardiovascular events such as heart attacks, stroke, and heart failure, new research shows.
- Sleeping for 11 minutes more, doing an extra 4.5 minutes of moderate-to-vigorous physical activity and eating an additional quarter of a cup of vegetables every day were associated with a 10% lower risk of major cardiovascular events.
- The optimal behaviour combination was eight to nine hours of sleep per night, 42 minutes or more of moderate-to-vigorous physical activity per day, and a modest diet-quality score. This combination was associated with 57% lower risk of major cardiovascular events compared to people with the least optimal health profile.
- Smaller combined behaviour changes are likely to be more achievable and sustainable than making a larger change to one behaviour to get the equivalent health benefit.
The study followed more than 53,000 adults from UK Biobank over an eight‑year period and found that making even modest improvements across three behaviours had clinically meaningful benefits.
Sleeping for 11 minutes more, doing an additional 4.5 minutes of moderate-to-vigorous physical activity, and eating additional quarter of a cup of vegetables were associated with a 10% reduction in major cardiovascular events. Moderate-to-vigorous activity can include everyday tasks such as taking the stairs, carrying shopping bags, or walking briskly.
The research found that the optimal combination of behaviours involved sleeping for eight to nine hours per night, completing more than 42 minutes of moderate-to-vigorous physical activity per day, and a modest diet quality score. This combination was associated with 57% lower risk of major cardiovascular events compared to people with the least optimal health profile.
The paper titled ‘Combined Variations in Sleep, Physical Activity, and Nutrition and the Risk of Major Adverse Cardiovascular Events’ was published today (24 March 2026) in the European Journal of Preventive Cardiology.
Dr. Nicholas Koemel, lead author and research fellow at the University of Sydney, explained the importance of the study, “We show that combining small changes in a few areas of our lives can have a surprisingly large positive impact on our cardiovascular health. This is very encouraging news because making a few small, combined changes is likely more achievable and sustainable for most people when compared with attempting major changes in a single behaviour.”
“Making even modest shifts in our daily routines is likely to have cardiovascular benefits as well as create opportunities for further changes in the long run. I would encourage people not to overlook the importance of making a small change or two to your daily routine, no matter how small they may seem.” Dr. Koemel continued.
The study is the first to investigate the minimum and optimal combinations of sleep, physical activity, and nutrition necessary for meaningful improvements in the risk of having a major cardiovascular event, including heart attack, heart failure, and stroke.
The researchers used data from a sub-study of UK Biobank, a cohort study of 502,629 adults aged 40-69 who were recruited from 2006 to 2010. Amount of sleep and physical activity were estimated using wearable devices. Diet was assessed using a single food frequency questionnaire which allowed the researchers to calculate a diet quality score. A better quality diet involved a higher intake of vegetables, fruits, fish, dairy, whole grains, and vegetable oils and a lower intake of refined grains, processed meats, unprocessed red meat, and sugar-sweetened beverages.
“We plan to build on these findings to develop new digital tools that support people in making positive lifestyle changes and establish sustained healthy habits. This will involve working closely with community members to make sure the tools are easy to use and can address the barriers we all face in making tweaks to our day-to-day routines,” concluded Prof. Emmanuel Stamatakis, senior author of the study and professor of physical activity and population health at the University of Sydney and Monash University.
The paper notes that, as an observational study, the research cannot establish a definitive causal relationship between the lifestyle behaviours and cardiovascular risk. The researchers suggest that intervention trials are now needed to fully confirm the findings.
Sleep, physical activity, and diet have previously been shown to have a major influence on cardiovascular disease risk, although their effects are often assessed in research studies in isolation or in pairs. In our daily lives, however, these different behaviours can influence each other, which means studying their impact together is more meaningful. For example, poor sleep disrupts the normal transmission of appetite hormones, influencing what people eat and making them more likely to overeat. Physical activity improves sleep quality, but lack of sleep may reduce physical activity due to tiredness. Diet quality affects sleep and also energy levels needed for physical activity.
ENDS
Funding: National Health and Medical Research Council (NHMRC) Investigator Grant (APP1194510) and the National Council for Scientific and Technological Development (311109/2023-3).
Disclosures: None
References:
‘Combined Variations in Sleep, Physical Activity, and Nutrition and the Risk of Major Adverse Cardiovascular Events’ by N.A. Koemel et al., European Journal of Preventive Cardiology. https://academic.oup.com/eurjpc/article-lookup/doi/10.1093/eurjpc/zwag141
Copies of the paper are available on request.
More information about UK Biobank can be found here: https://www.ukbiobank.ac.uk/
ESC Press Office
Tel: +33 6 61 40 18 84
Email: press@escardio.org
Follow European Society of Cardiology News on LinkedIn
The European Journal of Preventive Cardiology (EJPC) is an official, international, peer-reviewed journal of the European Association of Preventive Cardiology (EAPC), an association of the European Society of Cardiology (ESC). The Journal embraces all scientific, clinical and public health disciplines that address the causes and prevention of cardiovascular disease, as well as risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology.
About the European Society of Cardiology
The ESC brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.
END