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Physical activity and exercise as part of cardiac rehabilitation after an acute coronary event improves exercise capacity and quality of life in most patients. The aim of the present study was to evaluate physical activity level, health-related quality of life (HRQL) and perceived health three to six years after an acute myocardial infarction or an episode of unstable angina pectoris in elderly patients and compare this to earlier follow-up examination data.Study design: three to six years (mean 4.4 years) after randomization a questionnaire about physical activity level, HRQL and perceived health was mailed to all subjects alive (n = 93) (response rate 96%). The original study population consisted of 101 patients aged ≥ 65 years admitted to the Coronary Care Unit at the Karolinska Hospital because of an acute coronary event between 1994 and 1997. The patients were randomized to either a three-month period of aerobic group training three times a week (n = 50; acute myocardial infarction 29, unstable angina pectoris 21) or served as control subjects (n = 51; acute myocardial infarction 31, unstable angina pectoris 20).Since the one-year follow-up examination eight subjects had died: five in the intervention group and three in the control group. At randomization, the level of physical activity level was similar in the two groups. Those in the intervention group improved their level of physical activity significantly over time (p = 0.05) in contrast to the control group. Measurements of HRQL showed no statistical difference between the groups by use of the EuroQol instrument. However, a small advantage for the intervention group measured over time was noted.It is important to include elderly patients in cardiac rehabilitation programmes after an acute coronary event, since even a short period of supervised exercise training has the potential to positively influence physical activity level for as long as three to six years.