Deconditioning in coronary artery disease: an underrecognized problem with contemporary clinical relevance

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Beyond recurrent ischemic events, many patients experience a sustained and gradual reduction in physical activity and functional capacity after diagnosis, hospitalization, and treatment. Deconditioning is a complex process that encompasses physiological and behavioral decline driven by inactivity, symptoms, fear-avoidance behaviors, and treatment-related factors. It provides a unifying condition through which these deficits can be understood and targeted. Although exercise-based cardiac rehabilitation is a cornerstone of secondary prevention, deconditioning is rarely measured explicitly in clinical practice or treated as a reportable outcome in CAD studies and clinical pathways. In this narrative review, we aim to refine the contemporary definition of deconditioning as it applies to CAD, and we summarize drivers of deconditioning across the CAD continuum (stable angina, acute coronary syndromes, and postrevascularization care). Furthermore, we discuss clinical consequences, including impaired quality of life, hospital readmission risk, and reduced participation, in evidence-based therapies. Finally, this review proposes a pragmatic research and implementation agenda to incorporate objective activity/functional endpoints and early patient mobilization strategies into routine CAD care. Treating deconditioning as a modifiable, patient-oriented outcome may improve recovery after adverse coronary events and might offer a platform that aligns coronary revascularization and pharmacotherapy decisions with what matters to patients the most. This includes the absence of ischemic symptoms, recovery of functional capacity, and return to usual leisure and work activities.