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Aims Physical activity (PA) and systematic efforts, such as cardiac rehabilitation, are recommended by several national guidelines for those who have received heart valve surgery. However, only a few studies have demonstrated real-world situations, such as changes in the PA level after heart valve surgery, and their effects on long-term outcomes. We designed this study to investigate the changes in PA after heart valve surgery and their associations with mortality using nationwide representative data.Methods This study was performed using the Korean National Health Insurance Service database. We included patients who received heart valve surgery from 2009 to 2015 and underwent regular health checkups before and after surgery. Subjects were grouped according to their PA level before and after the surgery. Information on all-cause mortality was obtained until 31 December 2016, with a maximum follow-up period of 5 years.Results Of the 6587 subjects, 3258 (49.5%) were physically inactive after surgery. Among patients who were physically active (n= 3070), 1196 (39.0%) became inactive after surgery. The postoperative ‘inactive’ group showed higher mortality than the ‘active’ group (hazard ratio (HR): 1.41, 95% confidence interval (CI): 1.08–1.83). The ‘inactive/inactive’ group showed the highest risk of mortality (HR: 1.69, 95% CI: 1.19–2.40) compared with the ‘active/active’ group.Conclusions Insufficient PA level after heart valve surgery is associated with higher risk of mortality. However, maintaining sufficient PA after heart valve surgery may be challenging for many patients. Therefore, systematic efforts, such as cardiac rehabilitation, should be considered in those who received heart valve surgery.