The health benefits of exercise are greater than the sum of the parts. The overall mortality benefit from physical activity is even greater than would be expected from its efficacy in improving all cardiac risk factors, preventing cancer, chronic disease and disability.1 It is valuable to dissect the mechanisms by which exercise promotes better health outcomes, and in this edition of Heart, Wilson et al2 elegantly detail the ways in which basic science investigations have advanced our understanding of exercise-dependent cardiovascular modifications. Study of the molecular pathways offers promise of new targets for therapies that may elicit exercise-like benefits for cardiovascular health. Furthermore, in the growing epidemic of chronic disease related to a sedentary lifestyle, it is hoped that increasing the evidence base linking exercise to health may motivate societal change. As enthusiastic pro-exercise scientific clinicians/researchers, we share the optimism of our colleagues and seek to extol the virtues of exercise but we also take the opportunity here to critically appraise some of the limitations in the exercise science translational model.

1. Where are the outcomes? This is perhaps our greatest failing. While our rodents are getting fitter, our community is getting fatter and there is a clear need to improve the translation of our scientific discoveries into more effective public health interventions. Perhaps there is a need to extend our focus to study the psychosocial impediments to exercise or the individual variation explaining why exercise is a joy for some and a chore for others.

2. Exercise is not a binary intervention: The public may be confused by the mixed messages coming from our laboratories. On the one hand, exercise is reported to promote healthy physiological heart growth in adult rodents2 while other investigators have used a slightly …