By Steven Nissen, MD, the Chairman of the Department of Cardiovascular Medicine at Cleveland Clinic.

Patients often ask me: Is sex good for your heart?

The question seems simple. The answer is complicated, in part because of the limits of what research can tell us. But we do have a strong sense that sex fits in with a heart-healthy lifestyle.

1. Is sex exercise?

Yes — but it’s not much exercise. 

Assuming an average of five to 15 minutes for sex, you get about the same amount of activity as walking a mile in 20 minutes. The partner on top reaches a heart rate of around 120. The partner on the bottom reaches about 110.

In other words, you get a minimum of cardiovascular exercise from sex. Don’t count on it as your only workout.

2. Is sex good for your heart?

Probably. For example, one study found that men who had sex twice a week or more were less likely to develop cardiovascular disease than those who had sex once a month or less. Research like this typically focuses on men because more men have heart disease. But we generally apply the same reasoning to women, too.

Studies such as this do not prove that sex prevents heart disease. We tend to think of sex as a “marker” for your health. If you’re having more sex, there’s a good chance you are fitter and more active to begin with. 

3. Will anyone prove sex is good for your heart?

Probably not. For example, observational studies can’t prove a cause-effect relationship.

To prove cause and effect, you need a randomized clinical trial with a control group that abstains from sex for a long time period. This seems unlikely. 

4. If you have heart disease, is sex risky?

Not in the vast majority of cases. If you’re fit enough for sex, we encourage it.

There has been evidence that sex with an unfamiliar partner — like sex outside of a marriage — can be risky for men with heart disease. Men have even died during sex, but it is rare.

5. Does sex benefit your overall health?

Yes, it likely does. It can make you happier, more relaxed and less stressed.