Review

This paper summarizes the evidence on the relationship between physical activity (PA) and cardiovascular disease (CVD) that has been published mainly during the past 10 years. The primary focus is on aspects related to the primary prevention of the clinical events of coronary heart disease and stroke. The material was collected by conducting a search of the Medline, Embase and Cochrane electronic databases to identify systematic reviews and meta-analyses having been published on the relationship between PA and CVD since 2002. The terms used for the exposure were physical activity or exercise, and for the outcome the following terms: cardiovascular disease, coronary heart disease, coronary artery disease, coronary disease, myocardial infarction, stroke, peripheral vascular disease or peripheral arterial disease. In addition, committee reports on the topic were identified through scientific meetings and by personal communication. A large majority of the studies included in the reviews were prospective cohort studies of at-risk populations. The quantity and quality of scientific data on the cardiovascular and other health-related effects of physical activity has increased greatly during the past decade. The evidence now shows convincingly that insufficient physical activity is one of the key causal risk factors of CVD, particularly of the most prevalent of them, CHD and stroke. The effects of insufficient physical activity are mediated partly through the traditional major risk factors, and partly they are independent. This rather recently shown fact emphasizes the essential