Sustained Physical Activity, Not Weight Loss, Associated With Improved Survival in Coronary Heart Disease

Trine Moholdt, Carl J. Lavie, Javaid Nauman

Research output: Contribution to journalArticlepeer-review

126 Citations (Scopus)


Background: Individuals with coronary heart disease (CHD) are recommended to be physically active and to maintain a healthy weight. There is a lack of data on how long-term changes in body mass index (BMI) and physical activity (PA) relate to mortality in this population. Objectives: This study sought to determine the associations among changes in BMI, PA, and mortality in individuals with CHD. Methods: The authors studied 3,307 individuals (1,038 women) with CHD from the HUNT (Nord-Trøndelag Health Study) with examinations in 1985, 1996, and 2007, followed until the end of 2014. They calculated the hazard ratio (HR) for all-cause and cardiovascular disease (CVD) mortality according to changes in BMI and PA, and estimated using Cox proportional hazards regression models adjusted for age, smoking, blood pressure, diabetes, alcohol, and self-reported health. Results: There were 1,493 deaths during 30 years of follow-up (55% from CVD, median 15.7 years). Weight loss, classified as change in BMI <–0.10 kg/m2/year, associated with increased all-cause mortality (adjusted HR: 1.30; 95% confidence interval [CI]: 1.12 to 1.50). Weight gain, classified as change in BMI ≥0.10 kg/m2/year, was not associated with increased mortality (adjusted HR: 0.97; 95% CI: 0.87 to 1.09). Weight loss only associated with increased risk in those who were normal weight at baseline (adjusted HR: 1.38; 95% CI: 1.11 to 1.72). There was a lower risk for all-cause mortality in participants who maintained low PA (adjusted HR: 0.81; 95% CI: 0.67 to 0.97) or high PA (adjusted HR: 0.64; 95% CI: 0.50 to 0.83), compared with participants who were inactive over time. CVD mortality associations were similar as for all-cause mortality. Conclusions: The study observed no mortality risk reductions associated with weight loss in individuals with CHD, and reduced mortality risk associated with weight gain in individuals who were normal weight at baseline. Sustained PA, however, was associated with substantial risk reduction.

Original languageEnglish
Pages (from-to)1094-1101
Number of pages8
JournalJournal of the American College of Cardiology
Issue number10
Publication statusPublished - Mar 13 2018


  • HUNT
  • body mass index
  • exercise
  • mortality
  • myocardial infarction
  • obesity paradox

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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