Editor’s Note (September 2026): This article originally reported on a 2021 study that found an association between higher physical activity and faster progression of coronary artery calcium (CAC). It has been updated to include later evidence published in 2024 that did not find an association between physical activity volume and CAC progression. The available studies therefore do not establish that exercise causes coronary calcification or increases cardiovascular risk.
Key Takeaways
- A 2021 study of 25,485 adults found that higher levels of physical activity were associated with faster progression of coronary artery calcium (CAC), but the observational study could not establish that exercise caused the increase.
- The clinical meaning of the finding remains uncertain. Greater coronary calcification does not necessarily mean exercise is making coronary disease more dangerous, and the study did not determine whether the observed CAC progression resulted in more heart attacks or strokes.
- A later 2024 study involving 8,771 adults found no association between physical activity volume—even at high levels—and CAC progression, showing that the evidence is not consistent.
- The cardiovascular benefits of regular physical activity remain well established. People with known cardiovascular disease, concerning symptoms, or other significant risk factors should discuss vigorous exercise with their healthcare provider rather than stopping exercise because of CAC findings alone.
Coronary Deposits
A 2021 observational study raised an intriguing question about exercise and coronary artery calcium (CAC): people reporting higher levels of physical activity showed faster increases in CAC scores over time.
CAC is an established marker of coronary atherosclerotic burden, but an increase in calcium does not necessarily mean that exercise is making coronary disease more dangerous. The study did not establish cause and effect or determine whether the higher CAC progression resulted in more heart attacks or strokes.
More recent research has also complicated the picture. A 2024 JAMA Cardiology study of 8,771 adults found that physical activity volume, including high levels of activity, was not associated with CAC progression.
Taken together, the findings suggest that the relationship between high levels of exercise and coronary calcification remains uncertain.
What Is a Coronary Artery Calcium Score?
A coronary artery calcium score measures calcified plaque in the coronary arteries using a specialized CT scan.
CAC scoring can help clinicians refine cardiovascular risk estimates in selected people and can sometimes influence decisions about preventive treatment, including cholesterol-lowering therapy.
In general, higher CAC scores indicate a greater burden of coronary atherosclerosis and are associated with greater cardiovascular risk.
However, calcium is only one characteristic of atherosclerotic plaque.
Plaque composition and stability also matter, which is one reason an increase in CAC should not automatically be interpreted as evidence that exercise is damaging the arteries.
Can Exercise Increase Coronary Artery Calcium?
The 2021 study found that people who reported greater physical activity had higher CAC scores at baseline and experienced greater CAC progression during follow-up.
That finding appears counterintuitive because regular exercise has well-established cardiovascular benefits, including improvements in blood pressure, cardiorespiratory fitness, glucose metabolism, body composition, and overall cardiovascular risk.
The researchers therefore cautioned against interpreting greater CAC progression as evidence that exercise itself is harmful.
One possibility is that some calcification could represent changes in plaque characteristics rather than simply progression toward more dangerous disease. But the study was not designed to determine whether that explanation was correct.
The Kangbuk Samsung Health Study
Researchers studied 25,485 adults—22,741 men and 2,744 women—aged 30 years or older who underwent comprehensive health examinations between March 2011 and December 2017.
Participants were free of overt cardiovascular disease at the beginning of the study and had undergone at least two CAC measurements.
Physical activity was assessed using the International Physical Activity Questionnaire Short Form and participants were classified into three groups:
- 46.8% (11,920) were inactive.
- 38.0% (9,683) were moderately active.
- 15.2% (3,882) were classified as health-enhancing physically active, representing the highest activity category.
Researchers also collected information about participants’ medical histories, family histories, lifestyles, body mass index, blood pressure, cholesterol, and other health characteristics.
The adjusted estimated average CAC scores at baseline were:
- 9.45 among inactive participants;
- 10.20 among moderately active participants;
- 12.04 among participants in the highest physical-activity category.
Higher physical activity was also associated with faster CAC progression during follow-up.
Compared with inactive participants, the estimated adjusted additional increase in CAC over five years was:
- 3.20 points among moderately active participants; and
- 8.16 points among participants in the highest activity category.
The association remained after researchers adjusted for several potential confounding factors and was observed both among participants who started with a CAC score of zero and among those who already had detectable coronary calcium.
These results demonstrated an association.
They did not demonstrate that exercise itself caused the additional calcification.
Why Might Exercise and CAC Be Associated?
The researchers discussed several possible explanations for their findings.
Repeated increases in blood pressure and mechanical stress during physical activity could theoretically affect vascular walls. Exercise can also produce physiological changes involving hormones and mineral metabolism.
Another possibility is that people who exercise extensively differ from less-active people in dietary intake, supplement use, or other characteristics that are difficult to measure completely in an observational study.
The authors also raised the possibility that greater calcification could reflect changes in plaque composition or stabilization rather than a straightforward increase in dangerous plaque.
These proposed mechanisms are hypotheses, however.
The study did not establish which, if any, explains the association.
A 2024 Study Found No Increase in CAC Progression With Higher Exercise Levels
Later research produced a different result.
A 2024 study published in JAMA Cardiology examined 8,771 apparently healthy adults aged 40 years or older who underwent at least two preventive medical examinations that included CAC measurements.
Researchers examined physical activity over an average follow-up of approximately 7.8 years.
Unlike the 2021 Korean study, this analysis found no association between physical activity volume and the rate of CAC progression in either men or women.
For every additional 500 metabolic equivalent of task minutes per week (MET-min/week) of physical activity, the difference in the annual rate of CAC progression was essentially zero.
The researchers also examined whether higher baseline physical activity was associated with progression to a clinically meaningful CAC threshold of 100 Agatston units or greater.
It was not.
Even participants reporting high volumes of physical activity did not show significantly greater progression to that threshold.
The authors concluded that physical activity volume—including high levels of activity—was not associated with CAC progression in their cohort.
Why Did the Studies Reach Different Conclusions?
The studies differed in important ways.
They involved different populations, methods of assessing physical activity, follow-up periods, and statistical approaches.
The 2021 study involved predominantly Korean men undergoing health screening, whereas the 2024 study included both men and women aged 40 years and older in a different population.
Both were observational studies.
That means neither can provide the same level of causal evidence as a randomized trial assigning people to different long-term exercise levels and repeatedly measuring coronary plaque.
The conflicting findings are therefore important.
Rather than proving that exercise accelerates coronary calcification, the available evidence suggests that the relationship between physical activity and CAC progression is more complicated and remains unsettled.
Does a Higher CAC Score in an Athlete Mean Greater Heart Attack Risk?
Not necessarily.
CAC remains an important marker of coronary atherosclerotic burden, and a high score should not simply be dismissed because someone exercises.
At the same time, a calcium score does not provide a complete description of coronary plaque.
Some research in highly active populations has raised the possibility that athletes may have differences in plaque composition, including a greater proportion of calcified plaque.
Calcified plaques are generally considered more stable than some noncalcified or mixed plaques, but this does not mean that coronary calcium is harmless.
The important clinical question is not simply whether an athlete has calcium in the coronary arteries, but what that finding means in the context of age, symptoms, cholesterol, blood pressure, smoking, diabetes, family history, fitness, and other cardiovascular risk factors.
Does This Mean Intense Exercise Is Bad for the Heart?
No.
Neither the 2021 study nor the newer research demonstrates that regular exercise increases cardiovascular events.
Decades of evidence show that physical activity is associated with substantial cardiovascular and overall health benefits.
The 2024 study is particularly reassuring because even high physical-activity volumes were not associated with faster CAC progression in that cohort.
The appropriate conclusion is therefore not that people should exercise less to avoid coronary calcium.
Instead, these studies show that CAC findings in highly active people may require thoughtful interpretation rather than assuming that a rising calcium score means exercise itself is damaging the heart.
Should You Stop Exercising If You Have a High CAC Score?
A high CAC score is a reason to evaluate cardiovascular risk—not automatically a reason to stop exercising.
A healthcare professional may consider factors such as:
- symptoms during exercise;
- LDL cholesterol and other lipid measurements;
- blood pressure;
- diabetes;
- smoking;
- family history;
- the CAC score and its distribution;
- age;
- exercise intensity and training history;
- and other evidence of cardiovascular disease.
Someone with chest pressure, unexplained shortness of breath, fainting, palpitations associated with exercise, or a significant decline in exercise tolerance should seek medical evaluation.
People with known cardiovascular disease or substantial cardiovascular risk should discuss very vigorous or competitive exercise with their healthcare professional.
For most people, however, the evidence continues to strongly favor regular physical activity.
Frequently Asked Questions
Does exercise cause coronary artery calcification?
That has not been established.
A 2021 observational study found that greater physical activity was associated with faster CAC progression, but observational research cannot prove causation.
A larger 2024 analysis using a different cohort found no association between physical activity volume and CAC progression.
Does a higher CAC score mean exercise is damaging my arteries?
Not necessarily.
CAC indicates calcified coronary plaque and is an important cardiovascular risk marker, but the score does not reveal everything about plaque composition or stability.
A CAC result should be interpreted together with a person’s overall cardiovascular risk profile.
Should I stop exercising if I have a high CAC score?
Not simply because of the score.
Regular exercise has substantial cardiovascular benefits. People with high CAC, cardiovascular disease, symptoms, or significant risk factors should discuss the type and intensity of exercise appropriate for them with their healthcare provider.
How much exercise is too much?
There is no universal threshold at which exercise suddenly becomes harmful.
Appropriate exercise volume and intensity depend on age, health, fitness, cardiovascular disease, symptoms, medications, and the type of activity being performed.
Very high-volume endurance athletes and people with known cardiovascular disease may benefit from individualized medical guidance.
Does exercise make coronary plaque more stable?
Some researchers have proposed that exercise-related differences in coronary plaque could include greater calcification or more stable plaque characteristics.
However, the 2021 study did not directly establish that its observed CAC increases represented plaque stabilization.
This remains an area of ongoing research.
Bottom Line
The 2021 Korean study produced a provocative finding: people reporting greater physical activity experienced faster progression of coronary artery calcium.
But association is not causation.
The study did not show that exercise produced harmful arterial blockages, nor did it establish that participants with faster CAC progression experienced more heart attacks or strokes.
And importantly, later evidence does not consistently reproduce the finding.
A 2024 JAMA Cardiology study involving 8,771 adults found that physical activity volume—even at high levels—was not associated with CAC progression or progression to a CAC score of 100 or greater.
That leaves an important scientific question open.
Exercise has well-established cardiovascular benefits, while CAC remains a meaningful marker of coronary atherosclerosis. Understanding exactly how long-term, high-volume exercise influences plaque development, composition, calcification, and cardiovascular events will require further research.
For now, the evidence does not support avoiding exercise because of concern that physical activity will calcify the coronary arteries.
The more useful approach is individualized cardiovascular risk assessment—especially for people with symptoms, known coronary disease, high CAC scores, or other significant risk factors—while continuing to recognize regular physical activity as a cornerstone of cardiovascular health.
References
Sung, K.-C., Hong, Y. S., Lee, J.-Y., Lee, S.-J., Chang, Y., Ryu, S., Zhao, D., Cho, J., Guallar, E., & Lima, J. A. C. (2021). Physical activity and the progression of coronary artery calcification. Heart, 107(21), 1710–1716. https://doi.org/10.1136/heartjnl-2021-319346
Shuval, K., Leonard, D., DeFina, L. F., Barlow, C. E., Berry, J. D., Turlington, W. M., Pavlovic, A., Radford, N. B., Gabriel, K. P., Khera, A., & Levine, B. D. (2024). Physical activity and progression of coronary artery calcification in men and women. JAMA Cardiology, 9(7), 659–666. https://doi.org/10.1001/jamacardio.2024.0759