Hypercholesterolaemia and Exercise: A Practical Guide for Personal Trainers

High cholesterol is one of the most significant contributors to cardiovascular disease in the UK. According to the NHS and the British Heart Foundation (BHF), raised cholesterol levels play a major role in the development of coronary heart disease, stroke, peripheral artery disease and vascular dementia. With cardiovascular disease remaining one of the UK’s leading causes of death, personal trainers have a crucial role to play in helping clients reduce their long-term risk.

This guide explains what hypercholesterolaemia is, how it develops, how exercise helps, and what personal trainers should consider when designing safe and effective programmes for clients with raised cholesterol. All guidance is based on credible UK sources such as the NHS, BHF, NICE and WHO.

Understanding Hypercholesterolaemia

Hypercholesterolaemia simply refers to high levels of cholesterol in the blood. Cholesterol itself is not inherently harmful. In fact, it is essential for hormone production, vitamin D synthesis and the structure of cell membranes. Problems arise when the balance of different cholesterol types moves in the wrong direction—particularly when LDL cholesterol becomes too high.

When excess LDL circulates in the bloodstream, it can be deposited inside artery walls, leading to the formation of fatty plaques. Over time, this process—known as atherosclerosis—narrows the arteries, reduces blood flow and increases the likelihood of cardiovascular events.

Types of cholesterol explained

A typical UK lipid profile includes:

LDL cholesterol
Often referred to as “bad” cholesterol because high levels contribute to plaque build-up.

HDL cholesterol
The “good” cholesterol. HDL helps remove LDL from the bloodstream and transport it back to the liver.

Non-HDL cholesterol
A measure of all harmful cholesterol particles. The NHS uses non-HDL cholesterol as a key marker.

Triglycerides
A form of fat used for energy. High levels significantly increase cardiovascular and metabolic risk.

UK Cholesterol Classifications

These are the current targets recommended by the NHS and BHF:

When levels become concerning

• Raised cholesterol: Total cholesterol between 5–6.4 mmol/L

• High cholesterol: 6.5 mmol/L or above, or significantly elevated LDL/non-HDL levels

• High triglycerides: Above 2.3 mmol/L

• Very high triglycerides: Above 10 mmol/L, which can increase risk of pancreatitis

• Familial Hypercholesterolaemia (FH): A genetic condition causing extremely high LDL levels from childhood. Clients with FH must be under medical supervision.

Why Clients Develop High Cholesterol

Hypercholesterolaemia can occur for several reasons, many of which are lifestyle-driven.

Common causes include:

• Diets high in saturated fats and trans fats

• Low levels of physical activity

• Increased body fat, particularly around the waist

• Smoking

• Excessive alcohol consumption

• Type 2 diabetes or insulin resistance

• Underactive thyroid

• Liver or kidney conditions

• Age-related vascular changes

• Family history and genetic factors

• Familial Hypercholesterolaemia (FH)

For personal trainers, it is important to recognise that many clients may not know they have high cholesterol until they have a blood test. Encouraging clients to discuss risk factors with their GP can be part of your role within scope of practice.

Why Exercise Is So Effective

Research consistently shows that regular physical activity is one of the most effective non-pharmacological interventions for lowering cholesterol.

The benefits include:

• Reducing non-HDL cholesterol (LDL and triglycerides)

• Increasing HDL cholesterol

• Improving body composition

• Increasing insulin sensitivity

• Reducing systemic inflammation

• Enhancing the effect of cholesterol-lowering medications

• Reducing long-term cardiovascular risk

The NHS and WHO highlight a dose–response relationship: the more consistently clients engage in physical activity, the greater the improvements in lipid profiles and cardiovascular health.

Exercise Recommendations for Clients With High Cholesterol

The goal of exercise programming is twofold:

1. Improve lipid levels

2. Reduce overall cardiovascular risk

Below are the evidence-based guidelines.

Aerobic Exercise

Aerobic training has the greatest impact on cholesterol levels.

Recommendation:

• Frequency: 4–6 sessions per week

• Duration: 30–60 minutes per session

• Intensity: Moderate (RPE 11–13 or 40–70% HRR)

• Modes: Walking, jogging, cycling, rowing, elliptical, swimming, circuit-based cardio

• Goal: At least 150 minutes per week, but 300 minutes per week is more effective for cholesterol reduction

Consistency is the key factor here. Many clients will need structured guidance to build up to this volume safely.

Resistance Training

Strength training supports metabolic health and helps improve triglycerides and HDL.

Recommendation:

• Frequency: 2–3 times per week

• Sets/reps: 1–3 sets of 10–15 reps

• Intensity: 40–70% 1RM

• Rest: 60–90 seconds between sets

• Structure: Whole-body training or upper/lower split

Resistance training also supports fat loss, which in itself improves cholesterol.

Combined Training

Clients get the best improvements when they perform:

• Aerobic training, and

• Resistance training

NHS-backed research shows this combination produces the greatest improvements in LDL, HDL, triglycerides and metabolic health.

Flexibility & Mobility

While flexibility has no direct impact on cholesterol, it:

• Reduces injury risk

• Improves movement quality

• Supports long-term adherence

Helping clients enjoy movement increases the likelihood that they will continue training beyond the initial programme.

Contraindications & Red Flags

Most clients with high cholesterol can exercise safely, but personal trainers must be cautious when cardiovascular risk is elevated.

Do not train and refer to a GP if a client:

• Has untreated Familial Hypercholesterolaemia

• Reports chest pain, jaw pain, arm pain or tightness

• Experiences unexplained shortness of breath

• Feels dizzy or faint

• Has extremely high triglycerides (above 10 mmol/L)

• Developing calf pain during walking (possible peripheral artery disease)

• Reports severe muscle pain after starting statins

Statin use considerations

Statins are widely used in the UK and are safe for exercise. However, some clients may experience:

• Muscle pain

• Weakness

• Fatigue

If symptoms are severe, the client should consult their GP. PTs must never recommend stopping medication.

Lifestyle Recommendations

Exercise is most effective when paired with supportive lifestyle changes.

Diet

Encourage:

• Reduced saturated fat

• Avoidance of trans fats

• Increased soluble fibre

• Increased fruit and vegetable intake

• More oily fish (salmon, sardines, trout, mackerel)

• More nuts, seeds and olive oil

• Moderate calorie intake to support weight management

The NHS strongly recommends a Mediterranean-style diet for improving cholesterol.

Weight Management

Losing 5–10 percent of body weight can significantly improve lipid profiles.

Alcohol Intake

• Keep alcohol intake low

• Avoid binge drinking

• Excess alcohol raises triglycerides and increases cardiovascular risk

Smoking

Smoking significantly lowers HDL cholesterol and damages arteries.
Direct clients to NHS Stop Smoking Services where appropriate.

Stress & Sleep

• Encourage daily walking

• Nature exposure

• Breathwork

• Consistent sleep patterns

• Reducing work-life stress where possible

These habits support hormonal regulation and cardiovascular health.

Programming Considerations for PTs

When working with clients with hypercholesterolaemia:

• Complete a full PAR-Q and lifestyle screening

• Understand all cardiovascular risk factors

• Prioritise moderate-intensity aerobic volume

• Introduce progressive resistance training

• Support long-term lifestyle change

• Monitor for exercise tolerance and medication-related side effects

• Liaise with healthcare professionals when appropriate

• Provide simple education clients can implement immediately

Your role is not just to deliver training sessions, but to support long-term cardiovascular health through structured, goal-driven coaching.

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Next Steps

If you want to build confidence working with clients who have medical conditions, check out our Level 3 Exercise Referral Course. If you also need your PT qualifications, we can put together a bespoke package that saves you some pennies.

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