Dr. Erik Ekker Solberg,
A reverse J-shaped association of leisure time physical activity with prognosis in patients with stable coronary heart disease: evidence from a large cohort with repeated measurements Ute Mons et al.Heart 2014; DOI: 10.1136/heartjnl-2013-305242.
This 10 years follow-up German study, based on a cohort of 1038 continuous patients with stable coronary heart disease from cardiac rehabilitation clinics, explores the association between physical activity level with prognosis measured as major cardiovascular events, cardiovascular mortality and all-cause mortality. Frequency of strenuous leisure time physical activity was assessed by repeated self-administered standardised questionnaires during the study period. A decline in engagement in physical activity was observed. For all outcomes, the highest hazards were consistently found in the least active patient group, with a roughly twofold risk for major cardiovascular events and about a fourfold risk for both cardiovascular and all-cause mortality in comparison to the reference group of moderately frequent active patients.The data indicated also a reverse J-shaped association of physical activity level with cardiovascular mortality, with the most frequently active patients also having increased hazards. The study substantiates previous findings of increased risks for adverse outcomes in physically inactive coronary patients. However, increased cardiovascular mortality also in patients with daily strenuous physical activity was observed.The lesson from this study, which represents a useful contribution to the debate on dose-response of physical activity in coronary patients, seems to be that too little, but also too much physical activity increased the risk. Challenging is that during a 10 years cardiac rehab period the patients’ physical activity level decreased.
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