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J Am Coll Cardiol. 2017 Oct 3;70(14):1689-1700. doi: 10.1016/j.jacc.2017.08.017.

Physical Activity and Mortality in Patients With Stable Coronary Heart Disease.

Author information

Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. Electronic address:
Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Canadian Vigour Centre, University of Alberta, Edmonton, Canada.
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina.
Department of Medicine, New York University Langone Medical Center, New York, New York.
Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum fur Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Département Hospitalo-Universitaire FIRE (Fibrosis Inflammation REmodeling), Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National Heart and Lung Institute, Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, United Kingdom; French Alliance for Cardiovascular Trials, French Clinical Research Infrastructure Network, Institut National de la Santé et de la Recherche Mèdicale U1148, Paris, France.
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.



Recommendations for physical activity in patients with stable coronary heart disease (CHD) are based on modest evidence.


The authors analyzed the association between self-reported exercise and mortality in patients with stable CHD.


A total of 15,486 patients from 39 countries with stable CHD who participated in the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) study completed questions at baseline on hours spent each week taking mild, moderate, and vigorous exercise. Associations between the volume of habitual exercise in metabolic equivalents of task hours/week and adverse outcomes during a median follow-up of 3.7 years were evaluated.


A graded decrease in mortality occurred with increased habitual exercise that was steeper at lower compared with higher exercise levels. Doubling exercise volume was associated with lower all-cause mortality (unadjusted hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.79 to 0.85; adjusting for covariates, HR: 0.90; 95% CI: 0.87 to 0.93). These associations were similar for cardiovascular mortality (unadjusted HR: 0.83; 95% CI: 0.80 to 0.87; adjusted HR: 0.92; 95% CI: 0.88 to 0.96), but myocardial infarction and stroke were not associated with exercise volume after adjusting for covariates. The association between decrease in mortality and greater physical activity was stronger in the subgroup of patients at higher risk estimated by the ABC-CHD (Age, Biomarkers, Clinical-Coronary Heart Disease) risk score (p for interaction = 0.0007).


In patients with stable CHD, more physical activity was associated with lower mortality. The largest benefits occurred between sedentary patient groups and between those with the highest mortality risk.


cardiac rehabilitation; coronary artery disease; exercise; physical activity

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