Association Between Home Exercise Patterns and Cardiovascular Events in Patients with Coronary Heart Disease: A Retrospective Cohort Study

Home-based exercise is increasingly recognized as an alternative to center-based cardiac rehabilitation for patients with coronary heart disease (CHD), yet the association between different levels of home exercise regularity and cardiovascular outcomes remains unclear. This retrospective cohort study included 486 patients with angiographically confirmed CHD discharged between January 2018 and December 2021. Patients were classified into 4 EAR groups (inactive, low, moderate, and high regularity). The primary endpoint was major adverse cardiovascular events (MACE), comprising cardiovascular death, nonfatal myocardial infarction, or unplanned coronary revascularization. Cox proportional hazards models estimated hazard ratios (HRs); sensitivity analyses used cohort quartiles and continuous exercise adherence rate (EAR). Over a median follow-up of 71.2 months, 78 patients (16.0%) experienced MACE. Crude MACE incidence ranged from 22.58% in the inactive group to 9.82% in the high-regularity group. In the adjusted 4-group analysis, P for trend was 0.039, and the high-regularity group had an HR of 0.49 (95% CI, 0.24-1.03) versus the inactive group. Quartile-based analysis also showed a trend ( P for trend = 0.048), and each 10-percentage-point increase in EAR was associated with an adjusted HR of 0.91 (95% CI, 0.84-0.99). Among 423 patients with follow-up echocardiography, LVEF change differed across groups ( P < 0.001), ranging from + 0.77 ± 3.62 to + 5.89 ± 4.08 percentage points. Higher home exercise regularity was associated with a graded decrease in observed MACE risk among CHD patients. Given the observational design, these findings do not establish a causal protective effect or a clinical EAR threshold.