The behavioral change required to exercise can be challenging for many patients and motivation is often mixed. Furthermore, access to gyms or exercise equipment is variable. However, promoting physical activity of lower intensity and duration might mitigate some of these resource and feasibility limitations, especially in lower socioeconomic patients, patients with disabilities, and the elderly with poor physical function. As this is a Reviewed, New-added recommendation, the Work Group systematically reviewed evidence related to this recommendation.[134-142] The Work Group s confidence in the quality of the evidence was very low. The body of evidence had significant methodologic limitations. The potential large benefit on mortality would appear to outweigh the risk of musculoskeletal injury. Although feasibility and resource requirements might be a concern with higher activity levels for some patients, this would not apply to lower intensity activities. Therefore, this recommendation broadens acceptability and feasibility to patients who are unable to achieve the traditional moderate to vigorous intensity physical activity recommendations. Thus, the Work Group decided upon a Weak for recommendation. Research utilizing randomization and more accurate methods of measuring physical activity levels are needed to improve confidence in the effect of physical activity on CV outcomes in both primary and secondary prevention populations. Recommendation 27. We recommend a structured, exercise-based cardiac rehabilitation program for patients with recent occurrence of coronary heart disease (i.e., myocardial infarction, diagnosis of coronary artery disease, coronary artery bypass grafting, or percutaneous coronary intervention) to reduce cardiovascular morbidity and mortality. (Strong for | Reviewed, New-added) Discussion Although the benefits of regular physical activity involve many health domains, its effects on CV risk reduction are commonly cited by providers when advocating for lifestyle change to patients. The biological plausibility that physical activity could improve CV outcomes by positively altering lipid profiles is well established. 