The Role of Physical Activity Trajectories in Risk for Coronary Heart Disease

Researchers sought to determine the association between physical activity trajectories and all-cause and CVD mortality in patients with CHD.

In patients with coronary heart disease (CHD), increased or continued physical activity (PA) has demonstrated a potential protective effect, whereas decreased PA or an inactive lifestyle is possibly harmful. These findings were published in the Journal of the American College of Cardiology.

A systematic review was conducted to identify prospective and retrospective cohort studies that reported on the association of PA trajectories with all-cause and cardiovascular disease (CVD) mortality. The researchers sought to establish the association of PA trajectories in cohorts of patients with CHD that had been identified in April 2021 by searching 5 databases without any language restrictions. The selected studies had a longitudinal, observational design; were conducted in patients aged 18 years or older with CHD; reported on the associations of at least 2-point PA trajectories with all-cause or CVD mortality; and reported on the study results with the use of a measure of relative risk.

A total of 9 prospective cohorts (N=33,576) were included in the analysis. The sample size of the studies ranged from 406 to 22,227 participants. Patients were mean aged 62.5 years. The duration of follow-up among the studies ranged from 4.2 to 15.7 years. The percentage of women in the studies ranged from 18% to 56%. In 1 of the studies, only women were included, whereas 2 other studies were conducted exclusively among men. Overall, 5 of the 9 studies were performed in patients with CHD, whereas the remaining 4 studies recruited patients after they had experienced an acute coronary event.

In all of the 9 studies, PA was assessed via the use of validated questionnaires, and mortality was well documented. All of the studies measured PA trajectories according to a comparison of activity status at baseline and follow-up, reporting 4 longitudinal nominal categories: inactive over time; active over time; increased activity over time; and decreased activity over time. In all of the studies, increased activity over time was defined as “moving from the inactive to the activity category,” whereas decreased activity over time was defined as “moving from the active to the inactive category.”

The CVD morality rate was 8.6% (819 of 9422 patients) and the all-cause mortality rate was 14.3% (4813 of 33,576 patients). Compared with always-inactive patients, the risk for all-cause mortality was 50% lower among those participants who remained active (hazard ratio [HR], 0.50; 95% CI, 0.39-0.63); 45% lower among those who were inactive but became active (HR, 0.55; 95% CI, 0.44-0.70), and 20% lower among those who were active but became inactive (HR, 0.80; 95% CI, 0.64-0.99).

The results were similar with respect to CVD mortality, except for those in the decreased-activity category (HR, 0.91; 95% CI, 0.67-1.24). The overall risk for bias in the study was low; no evidence of publication bias was observed.

A limitation of the current analysis is the fact that all of the individual studies involved relied on self-reports of PA. Further, the role played by potential confounders, such as comorbidities, diet, frailty, and smoking, could not be isolated.

“This study illustrates how patients with CHD may benefit by preserving or adopting an active lifestyle,” the study authors wrote. “The observation that the benefits of past activity can be weakened or lost if PA is not maintained may be confounded by disease progression.”

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  


Gonzalez-Jaramillo N, Wilhelm M, Arango-Rivas AM, et al. Systematic review of physical activity trajectories and mortality in patients with coronary artery disease. J Am Coll Cardiol. Published online May 3, 2022. doi:10.1016/j.jacc.2022.02.036