All-cause mortality is reduced by 20–30% in healthy individuals and in coronary heart disease (CHD) patients.

The objective of this study was to analyze the long-term impact of physical activity (PA) on all-cause mortality in stable CHD patients.

From May 2001 to March 2004, we included 834 consecutive male CHD patients (aged 45–74 years) in the Genetique et ENvironnement en Europe du Sud (GENES) study. Detailed baseline assessment of net energy expenditure in relation with work, commuting and leisure time PA in the preceding year, according to category of activity, was obtained by the MOSPA questionnaire. PA was expressed in weekly metabolic equivalent scores (MET) hours per week.

Final analysis was performed in 822 patients with complete data (60.1±8.1 years). Over an average of 12.5 (±4.3) years of follow-up (median 14.6), 324 patients died (39.4%). The distribution of mortality rates according to the MET tertiles (10, 40) was (from the lowest to the highest tertile) 46.1%, 23.4% and 17.6%, respectively (P<0.001). The unadjusted Cox proportional hazards analysis showed a greater reduction of all-cause mortality in patients with high levels of PA: for an increase of 10 MET per week, HR was 0.91 [95% CI: 0.88–0.94, (P<0.001)]. After adjustment for age, smoking status, treatment for diabetes, hypertension, dyslipidemia, total cholesterol, waist, weight or BMI, heart rate, LVEF, Gensini score, ankle-brachial index and length of disease, the HR was 0.95 [0.92–0.98, (P<0.002)] for an increase of 10 MET per week.

Our study shows an independent association of PA with mortality with a 5% total mortality decrease for an increase of 10 MET per week. Stable CHD should undergo vigorous aerobic PA in order to improve prognosis.