Physical Activity Trajectories and Mortality in Coronary Disease Patients

Quick Takes

  • Long-term maintenance of physical activity is associated with a lower risk for all-cause and CVD-related mortality among adults with CHD.
  • The transition from inactivity to activity is associated with a lower risk for all-cause and CVD-related mortality among adults with CHD.
  • Reductions in physical activity (moving from being active to being sedentary) are associated with an increased risk for CVD mortality.

Study Questions:

What is the association of longitudinal physical activity (PA) trajectories with all-cause and cardiovascular disease (CVD) in adults with coronary heart disease (CHD)?

Methods:

Published studies, identified through April 2021, which were prospective or retrospective cohort studies, were included if they met eligibility. Inclusion criteria were as follows: longitudinal observational study design, the study population of adults ≥18 years with a history of CHD, and reported associations between PA trajectories (using two or more data points). Changes in PA were defined as four PA trajectories ([1] always inactive, [2] always active, [3] inactive then active, and [4] active then inactive). PA trajectories were examined in association with all-cause and CVD mortality. Prior systematic reviews and misanalysis were excluded.

Results:

A total of 12,250 citations were identified, of which 24 were selected for a full-text review. Nine citations met all inclusion criteria and were included in this systematic review. These nine prospective cohort studies included 33,576 adults (mean age 62.5 years). Maximum follow-up was 15.7 years. All studies assessed PA through validated questionnaires, and mortality was well documented. Compared with always-inactive patients, the risk of all-cause mortality was 50% lower in those who remained active (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.39-0.63) and 45% lower in those who were inactive but became active (HR, 0.55; 95% CI, 0.44-0.7) compared with always-inactive patients. The risk for all-cause mortality was 20% lower in those who were active but became inactive (HR, 0.80; 95% CI, 0.64-0.99). Compared with always-inactive patients, the risk of CVD mortality was lower in those who remained active (HR, 0.49; 95% CI, 0.39-0.62) and for those who were inactive but became active (HR, 0.63; 95% CI, 0.51-0.78). The risk for CVD mortality was not statistically different between those always-inactive and those who were active but became inactive over time (HR, 0.91; 95% CI, 0.67-1.24). The overall risk of bias was low. No evidence of publication bias was found. Sensitivity analyses provided consistent results.

Conclusions:

The investigators concluded that the present systematic review illustrates the benefits of PA for adults with CHD. Furthermore, these data suggest that the benefits of PA are reduced or eliminated when PA is not maintained over time.

Perspective:

These data support the benefits of PA among patients with CHD. Although meta-analysis has limitations, these data support the recommendations for continued PA among adults with CVD.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Atherosclerotic Disease (CAD/PAD), Exercise

Keywords: Cardiovascular Diseases, Cause of Death, Coronary Artery Disease, Coronary Disease, Exercise, Healthy Lifestyle, Primary Prevention, Risk Assessment, Risk Factors, Sedentary Behavior


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