Abstract Aims The role of physical activity in the BMI-survival relationship in coronary heart disease is unclear. Our aim was to examine isolated and combined associations between BMI and physical activity, and mortality in subjects with coronary heart disease.. Methods and Results 6 493 participants (34.4% women) with coronary heart disease from the Nord-Trøndelag Health Study, with examinations in 1986, 1996, and 2007, were followed until the end of 2014. We calculated hazard ratios (HR) for all-cause and cardiovascular disease mortality, estimated using Cox proportionate hazard regression adjusted for age, smoking, diabetes, hypertension, self-reported health status, and alcohol. 3 818 died (62.1 % of cardiovascular disease) during 30 (median 12.5) years of follow-up. Compared to BMI (in kg/m2 ) 18.5-22.4, BMI categories 25.0- 27.4, 27.5-29.9, and 30.0-34.9 had reduced all-cause mortality risk (HR, 0.80 95% CI 0.72-0.90; 0.80 95% CI, 0.71-0.90; 0.83 0.74-0.95), respectively. BMI categories 25.0-27.4 and 27.5-29.9 had reduced cardiovascular disease mortality risk (HR, 0.81 95% CI, 0.70-0.94; 0.83 95% CI, 0.71-0.96), respectively. Compared to physically inactive, all levels of physical activity were associated with reduced all-cause and cardiovascular disease mortality risk. In inactive, all BMI categories above 25.0 had reduced all-cause mortality risk (HRs across BMI categories: 0.77, 0.79, 0.79, 0.74), whereas in subjects who were following or exceeding the recommended level of physical activity, BMI did not associate with survival. Conclusions Overweight and obese subjects with coronary heart disease had reduced all-cause and cardiovascular disease mortality, but such an obesity paradox was only seen in participants who did not adhere to current recommendations of physical activity.