Non-Occupational Physical Activity and All-Cause Mortality in Patients with Coronary Heart Disease: A Dose–Response Meta-Analysis

AIM: Higher physical activity (PA) has been associated with lower all-cause mortality in patients with coronary heart disease (CHD), but the dose-response relationship remains uncertain. We conducted a systematic review and dose-response meta-analysis to quantify the association between non-occupational PA and all-cause mortality in CHD patients. METHODS: We systematically searched six databases in November 2025 for prospective cohort studies reporting non-occupational PA and all-cause mortality in CHD patients. PA data were harmonised to marginal metabolic equivalent of task hours/week (mMET-h/week). We performed two-stage random-effects dose-response meta-analysis using restricted cubic splines. Risk of bias was assessed using the JBI checklist. RESULTS: Seventeen studies included 176,862 patients; 16 reported 31,783 study-level deaths. The primary dose-response curve was modelled over 0-40 mMET-h/week, and showed a non-linear inverse association (P for non-linearity <0.001; I2 = 84.7%). Relative to 0 mMET-h/week, estimated mortality risk was 38% lower at 8.75 mMET-h/week (RR = 0.62, 95% CI: 0.54-0.73) and 39% lower at 17.5 mMET-h/week (RR = 0.61, 95% CI: 0.47-0.79). At 30 mMET-h/week, the estimate was imprecise (RR = 0.92, 95% CI: 0.51-1.67), only 8 of 17 studies had data extending to this knot, and alternative harmonisation assumptions produced a different high-dose shape. CONCLUSION: Higher non-occupational PA was associated with lower all-cause mortality in CHD, particularly at low-to-moderate levels. These activity levels were consistent with the range recommended in current ESC guidelines.