Knowledge is lacking in MVPA and SB changes in individuals with coronary heart disease (CHD).

Remaining high levels of MVPA and low levels of SB are associated with the lowest risk of CVD.

A change in MVPA is associated with a lower risk of CVD than remain low.

A decrease in SB is associated with a lower risk of MACE than remain high.

Individuals with CHD should get support to remain high or improve levels of MVPA and low levels of SB.

Moderate-to-vigorous physical activity (MVPA) and limiting time in sedentary behaviour (SB) are recommended for the secondary prevention of coronary heart disease (CHD). Little is known about MVPA and SB changes and recurrent cardiovascular events. This study explores the associations between changes in MVPA and SB for recurrent cardiovascular events among individuals with CHD.

Prospective cohort study based on individuals with CHD. MVPA and SB were self-reported, and recurrent cardiovascular events were identified using health registers (2006–2022). Changes in MVPA and SB were categorized as remaining high, decreasing, increasing, and remaining low. Associations were explored using Cox proportional regression models.

There were 9430 Australians, 62 % males with a mean age of 70 (SD = 10) years. During the follow-up, with a median time of 4.9 (IQR = 6.1) years, 508 non-fatal cardiac events, 951 total cardiac events, and 2481 major adverse cardiovascular events (MACE) occurred. The risk of recurrent cardiovascular events was 32–39 % lower when MVPA remained high compared to remaining low. An increase in MVPA was associated with a 30 % lower risk of total cardiac events and a 26 % lower risk of MACE, while a decrease was associated with a 16 % lower risk of MACE. Keeping low SB was associated with a 25–29 % lower risk of total cardiac events and MACE than SB remained high. A decrease in SB was associated with a 25 % lower risk of MACE.

Supporting individuals with CHD to remain high or improve levels of MVPA and low levels of SB is important in secondary prevention.

Exercise

Sedentary time

Ischemic heart disease

© 2025 The Authors. Published by Elsevier B.V.