It’s never too late to get active

"These encouraging findings highlight how patients with coronary heart disease may benefit by preserving or adopting a physically active lifestyle," said study author Dr. Nathalia Gonzalez of the University of Bern, Switzerland.

Regular physical activity is advised for patients with heart disease, but recommendations are largely based on studies that used either a single assessment or an average of activity levels assessed over time. However, patients may modify the amount of exercise they do, and it remains unclear whether these changes are related to survival.

This study investigated activity levels over time and their relationship to the risk of death in patients with heart disease.

The meta-analysis included 33,576 patients with coronary heart disease from nine longitudinal cohorts. The average age was 62.5 years and 34% were women. The median follow-up was 7.2 years. Activity was assessed at baseline and follow-up using validated questionnaires and participants were classified as active or inactive at the two time points. Definitions of active and inactive varied across the studies but were in line with recommendations for healthy people: at least 150 minutes a week of moderate intensity, or 75 minutes a week of vigorous activity, or a combination.

Patients were divided into four groups according to their activity status at baseline and follow-up: inactive over time, active over time, increased activity over time, and decreased activity over time. All the studies defined "increased activity over time" as moving from the inactive to the active category and "decreased activity over time" as moving from the active to the inactive category.

The researchers examined the risks of all-cause death and death from cardiovascular disease according to the four groups. Compared to patients who were inactive over time, the risk of all-cause death was 50% lower in those who were active over time, 45% lower in those who were inactive but became active, and 20% lower in those who had been active but became inactive.

Similar results were observed for death due to cardiovascular disease. Compared to those who remained inactive, the risk for cardiovascular mortality was 51% lower among those who remained active and 27% lower for those whose activity increased. Cardiovascular mortality was not statistically different for those whose activity decreased over time, compared to those who remained inactive.

Dr. Gonzalez said: "The results show that continuing an active lifestyle over the years is associated with the greatest longevity. However, patients with heart disease can overcome prior years of inactivity and obtain survival benefits by taking up exercise later in life. On the other hand, the benefits of activity can be weakened or even lost if activity is not maintained. The findings illustrate the benefits to heart patients of being physically active, regardless of their previous habits."