After Heart Attack, Not Enough Survivors Getting Recommended Exercise

Clinical guidelines suggest that adequate physical activity after an acute coronary syndrome (ACS) event is a key component of preventing reoccurrence, but a recent study found disappointingly low levels of compliance with these recommendations.

Updated in 2011, the guidelines issued by the American College of Cardiology Foundation and the American Heart Association included a section of recommendations to prevent secondary incidence of myocardial infarction or unstable angina after a patient is discharged. They instructed healthcare teams to work with patients and their families to help the patients achieve specified targets for blood pressure, body mass index, cholesterol levels, and physical activity.

According to the guidelines, patients should be encouraged to get 30 to 60 minutes per day of moderate aerobic activity, like walking briskly, along with making more active lifestyle choices, such as taking walking breaks at work or doing more gardening or household tasks.

However, the actual level of adherence to these guidelines was unknown, as most previous studies relied on patient self-reports, which can be inaccurate. As part of a study recently published in the Journal of the American College of Cardiology, researchers instead distributed accelerometers to patients who had been discharged post-ACS.

After 35 days, the 620 patients returned the accelerometers to the investigators. Slightly more than half had sufficient data on the devices to be classified by physical activity level in relation to the guidelines. They were considered to meet the guidelines if they achieved at least 30 minutes of moderate-to-vigorous physical activity on at least two-thirds of the study days, while they were labeled “insufficient” if they had exercised on 1% to 65% of the study days and “none” if they had not exercised at all.

The amount of patients who met the guidelines increased throughout the study period, but by the fifth week after discharge only 16% had met the guideline recommendations, compared to 4.7% in the first week. Over 68% of participants did not have any exercise during the first week, but this proportion declined to 56.5% by week 5. The proportion of patients getting insufficient amounts of activity remained relatively stable from 26.5% in the first week to 27.5% in the fifth week. There was no association between activity level achievement and covariates like age, sex, race, comorbidity status, or ACS type.

According to the authors, these findings “suggest that remarkably few patients are achieving targets for physical activity after ACS.” This could be explained by patient misconceptions about the safety of exercising after a cardiovascular event, which could be combated through interventions that encourage physical activity as part of a cardiac rehabilitation program.

“Objectively monitoring physical activity and providing real-time feedback to patients and clinicians may be a disseminable approach for increasing physical activity in ACS survivors,” the study authors concluded.