How exercise can improve cholesterol

The usual recommendations for managing this are diet and statins. But exercise makes a difference too.

As we probably all know, standard cholesterol measures in a blood test are for:

• total cholesterol
• LDL-C
• HDL-C, and
• triglycerides.

Remember that cholesterol is cholesterol; the terms ‘good’ and ‘bad’ reflect which vehicle is ferrying it around our bodies.

If it’s being carried by an LDL particle, it’s being taken from our liver to our cells. This gets called bad cholesterol, but since all of our cells need cholesterol to function, the baddie tag really isn’t fair.

LDL-C (i.e. cholesterol travelling in an LDL particle) got this reputation because it’s found in arterial plaque, but that doesn’t mean it’s the cause of plaque.

Scientifically, this is called association vs causation.

I’ve seen it illustrated with a slide showing a big fence that had fallen over or been knocked over. A cat was perched on top of it. The caption read ‘The cat didn’t do this’. While the cat might be there, it didn’t push the fence over.

But since this piece is about exercise, let’s not go too far down that rabbit hole, other than to say that in spite of the emphasis on LDL-C, it’s been shown to be a poor predictor of heart disease risk.

If we’re interested in our cardiovascular health, there are two better ways to monitor it.

One is HDL-C which, of course, is the cholesterol carried by HDL particles. HDL is known as the good guy because it acts like a cleanup crew collecting excess cholesterol from our cells and arteries and taking it to the liver to be processed and removed from the body.

The liver converts that cholesterol into bile which is channeled into our intestines then out via our feces.

Low levels of HDL-C point to higher heart disease risk, regardless of LDL-C.

HDL-C also increases the availability of nitric acid, which helps regulate blood pressure and has antioxidant, anti-inflammatory, and anti-thrombotic (anticlotting) effects.

Finally, triglycerides are a type of fat made from excess calories, especially from diets high in carbohydrates such as sugar.

The other good indicator of metabolic and cardiovascular health is one I’ve mentioned in previous posts — the ratio between triglycerides and HDL-C. If it’s less than 1.5 we’re doing well.

So how does exercise help?

In two ways. First, it helps HDL with the removal process by boosting the enzymes that help scavenge cholesterol from our cells and arteries.

And second, it lowers triglycerides because active muscles use triglycerides for fuel, which leaves less circulating in our blood.

All four cholesterol measures should benefit from aerobic exercise (walking, swimming, dancing, cycling and so on).

HDL-C responds well to a bit more intensity, so for example, if your main exercise is walking, see if you can lift the tempo for sections of your route, or include some hills. If not, try to increase your distance some days, to increase the volume.

There’s been less research into the effects of resistance exercise, and it seems that HDL-C might be the only one that responds to resistance training alone.

But all four measures respond best to a combination of aerobic and resistance. So if you can manage both, that will make the biggest difference.

It’s fair to say that the impact of exercise on cholesterol will probably be moderate rather than dramatic. We also need to exercise regularly for at least a couple of months before we’ll see much change.

Finally though, the ideal recipe for healthy cholesterol is exercise plus diet. On the dietary side, this means cutting down on sugar, starches and processed foods, and creating meals around healthy proteins and fats with vegetables and fruit. This should both boost HDL-C and lower triglycerides.

Resource: Exercise training for the management of dyslipidaemia. A position statement from Exercise and Sport Science Australia (ESSA). In the Journal of Science and Medicine in Sport, December 2025.

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