Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Exercise and Mortality in Patients with CHD

J Am Coll Cardiol; 2017 Oct; Stewart, et al

Increased physical activity is associated with lower mortality in patients with stable coronary heart disease (CHD), with the greatest benefit occurring in sedentary patient groups and in those with the highest mortality risk. 15,486 patients from 39 countries with stable CHD from the STABILITY 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. Researchers found:

  • 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 HR, 0.82).
  • These associations were similar for CV mortality (unadjusted HR, 0.83), but myocardial infarction and stroke were not associated with exercise volume after adjusting for covariates.

Stewart RAH, Held C, Hadziosmanovic N, et al. Physical activity and mortality in patients with stable coronary heart disease. J Am Coll Cardiol. 2017;70(14):1689-1700. doi:10.1016/j.jacc.2017.08.017.


In the general population, increasing levels of exercise predicts for lower cardiovascular mortality. This study extends that observation to individuals with established CHD. It is important to note that the groups who benefited the most from exercise were those individuals at the highest cardiovascular risk and those who where doing the least physical activity at the beginning of the study. We should emphasize to patients, both with and without established CHD, that exercise is effective at decreasing the risk of death and at improving health, and, while rigorous exercise routines yield the greatest benefit, the greatest incremental improvement in risk occurs when people who are sedentary start engaging in low levels of physical activity. Many patients feel overwhelmed by the idea of starting an exercise program, but they should not be intimidated by feeling they need a rigorous exercise program; any program is better than none. —Neil Skolnik, MD

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