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Systematic Review of Physical Activity Trajectories and Mortality in Patients With Coronary Artery Disease
Nathalia Gonzalez-Jaramillo1, Matthias Wilhelm2, Ana María Arango-Rivas3
1University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
Maintaining an active lifestyle significantly reduces mortality risk for coronary heart disease (CHD) patients. Preserving physical activity (PA) offers the greatest benefit, while adopting activity also improves outcomes.
Area of Science:
- Cardiology
- Public Health
- Exercise Science
Background:
- The impact of physical activity (PA) trajectories on mortality in coronary heart disease (CHD) patients is not well understood.
- Investigating how lifestyle changes in physical activity influence long-term health outcomes in CHD is crucial.
Purpose of the Study:
- To determine the association between longitudinal physical activity (PA) trajectories and all-cause and cardiovascular disease (CVD) mortality in patients with coronary heart disease (CHD).
Main Methods:
- A systematic review and meta-analysis of longitudinal cohorts was conducted, searching 5 databases.
- Included studies assessed PA via validated questionnaires and documented mortality outcomes.
- Random effects models were used to pool hazard ratios (HRs) and 95% confidence intervals (CIs).
Main Results:
- Analysis of 9 cohorts (33,576 patients) revealed significant mortality reductions for patients who remained active (HR: 0.50) or became active (HR: 0.55) compared to inactive individuals.
- Patients who were active but became inactive showed a modest increase in mortality risk (HR: 0.80).
- Similar trends were observed for cardiovascular disease (CVD) mortality, though not significant for the decreased activity group.
Conclusions:
- Preserving or adopting an active lifestyle is beneficial for patients with coronary heart disease (CHD).
- The mortality benefits of physical activity (PA) may diminish if activity levels are not maintained.
- Disease progression could potentially confound the observed associations between changes in PA and mortality.
Background:
The role of lifestyle physical activity (PA) trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear.
Objectives:
The purpose of this study was to determine the association of longitudinal PA trajectories with all-cause and cardiovascular disease (CVD) mortality in patients with CHD.
Methods:
Longitudinal cohorts reporting the association of PA trajectories with mortality in patients with CHD were identified in April 2021 by searching 5 databases without language restrictions. Published HRs and 95% CIs were pooled using random effects models and bias assessed by Egger regression.
Results:
A total of 9 prospective cohorts included 33,576 patients. The mean age was 62.5 years. The maximum follow-up was 15.7 years. All of the studies assessed PA through validated questionnaires, and mortality was well documented. Changes in PA defined 4 nominal PA trajectories. Compared with always-inactive patients, the risk of all-cause mortality was 50% lower in those who remained active (HR: 0.50; 95% CI: 0.39-0.63); 45% lower in those who were inactive but became active (HR: 0.55; 95% CI: 0.44-0.7); and 20% lower in those who were active but became inactive (HR: 0.80; 95% CI: 0.64-0.99). Similar results were observed for CVD mortality, except for the category of decreased activity (HR: 0.91; 95% CI: 0.67-1.24). The overall risk of bias was low. No evidence of publication bias was found. Multiple sensitivity analyses provided consistent results.
Conclusions:
This study illustrates how patients with CHD may benefit by preserving or adopting an active lifestyle. The observation that the benefits of past activity can be weakened or lost if PA is not maintained may be confounded by disease progression.
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