Cardiovascular disease remains the leading cause of death in the United States. The benefits of physical activity in reducing the risk for cardiovascular disease have led to recommendations that patients with heart disease increase their levels of physical activity. This study was conducted to investigate the degree of compliance with national and/or American Heart Association and American College of Cardiology guidelines for physical activity in United States adults with coronary heart disease (CHD) in comparison with subjects without CHD using data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS). Information on CHD or physical activity was self-reported. A total of 297,145 participants aged > or =18 years were included in the analyses. The age-standardized prevalence and the odds ratios for meeting total, moderate, or vigorous physical activity recommendations were calculated. Patients with CHD participated less in physical activity at recommended levels than those without CHD (40%, 32%, and 22% vs 49%, 37%, and 29%, respectively, for meeting total, moderate, and vigorous physical activity recommendations, p <0.01 for all). The unadjusted odds ratios for adults with CHD who met total, moderate, and vigorous physical activity were 0.61 (95% confidence interval 0.58 to 0.65), 0.76 (95% confidence interval 0.72 to 0.80), and 0.45 (95% confidence interval 0.42 to 0.49), respectively. These odds ratios were attenuated slightly but remained significant even after multivariate adjustment. In conclusion, the findings of this study demonstrate that patients with CHD are less likely to comply with physical activity recommendations than subjects without CHD. Intensive physical activity counseling is needed for patients with CHD to increase their physical activity levels if no contraindications to increased physical activity exist.