Medically supervised programs (cardiac rehabilita- tion) and physician-directed, home-based programs are recommended for at-risk patients at first diag- nosis.602,609,610 (Level of Evidence: A) Class IIa 1. It is reasonable for the clinician to recommend complementary resistance training at least 2 days per week.611,612 (Level of Evidence: C) Physical activity counseling is an integral component of a comprehensive coronary risk factor modification strategy in patients with SIHD. Consistent with the American College of Sports Medicine and AHA recommendations for healthy adults,603 most patients with CAD should be encouraged to engage in 30 to 60 minutes of moderate-intensity aerobic activity, such as brisk walking, on most, and preferably all, days of the week. Similar recommendations (2 hours and 30 minutes of moderate-intensity aerobic activity and muscle- strengthening activities on $2 days a week) have been advanced by the Centers for Disease Control and Preven- tion.18,613 Many patients benefit from participation in a cardiac rehabilitation program that incorporates super- vised exercise into a comprehensive secondary prevention Multiple controlled clinical trials have examined the ben- efits of exercise training and cardiac rehabilitation in patients with IHD. Most of these studies have been relatively small, Fihn et al Stable Ischemic Heart Disease: Full Text e399 but in aggregate they demonstrate that regular exercise reduces mortality in patients with IHD. A systematic review and meta-analysis published in 2004 examined 48 RCTs of exercise interventions in a total of 8940 patients with IHD.602 The median intervention duration was 3 months (range, 0.25 to 30 months), and the median duration of follow-up was 15 months (range, 6 to 72 months). Exercise training resulted in a 20% reduction in all-cause mortality and a 26% reduction in total cardiac mortality; favorable but nonsignificant trends were noted in nonfatal MI, CABG, and percutaneous coro- nary revascularization procedures. 