Impact Of Exercise Counseling On Mortality In Patients With Coronary Artery Disease And Severe Obesity

BACKGROUND: Patients with Coronary Artery Disease (CAD) and severe obesity face an elevated risk of mortality. While exercise is widely recognized for its benefits in improving clinical outcomes across diverse populations, the specific impact of basic exercise counseling by clinicians on mortality risk remains unclear, particularly among older adults with multiple comorbidities. PURPOSE: This study aims to investigate whether exercise counseling provided by clinicians, without the inclusion of structured exercise programs, can reduce all-cause mortality in older adults diagnosed with CAD and severe obesity. METHODS: A retrospective cohort analysis was conducted using the TriNetX database to examine patients over the age of 60 with CAD and severe obesity, identified using CPT codes. Two cohorts were propensity score-matched to control for confounding variables, resulting in patients who received exercise counseling (n = 2,712) and those who did not (n = 2,712). The primary outcome was all-cause mortality over a 5-year follow-up period. Kaplan-Meier survival analysis, log-rank tests, and hazard ratios were employed to evaluate the effect of exercise counseling on mortality. RESULTS: The group that received exercise counseling demonstrated a significantly lower incidence of mortality (8.997%) compared to the non-counseling group (10.619%), with a risk difference of -1.622% (95% CI: -3.205% to -0.04%, p = 0.0446). The risk ratio was 0.847 (95% CI: 0.72-0.996), and the odds ratio was 0.832 (95% CI: 0.695-0.996). Kaplan-Meier analysis indicated improved survival rates in the exercise counseling group (75.992% vs. 74.735% at 5 years; log-rank test, χ2 = 4.867, p = 0.0274). The hazard ratio for mortality was 0.826 (95% CI: 0.696-0.979), suggesting a significant protective effect of exercise counseling. CONCLUSION: This study demonstrates that clinicians who provide exercise counseling, even in the absence of structured exercise programs, can significantly reduce all-cause mortality in older adults with CAD and severe obesity. These findings emphasize the importance of integrating exercise counseling into routine clinical care for this high-risk population to improve long-term survival.