Engaging in physical activity early after a heart attack is common and appears safe.Post-discharge physical activity (PA) during the first week after a myocardial infarction (MI) is not associated with a short-term risk of major adverse cardiovascular events* (MACE), but higher pre-admission PA appears to confer a MACE-free survival benefit, according to a recent study.
There were no significant differences in MACE between the high and low post-discharge PA groups at 6 months (8.5 percent vs 8.4 percent; log-rank p=0.98) and over 5 years after adjusting for multiple covariates (adjusted hazard ratio [aHR], 1.85; log-rank p=0.33).
“Sensitivity analyses for vigorous PA (VPA) and in patients who did not undergo coronary artery bypass graft (CABG) did not change the results,” said Rik Dijkman, a PhD candidate at Radboud University Medical Center, Nijmegen, Netherlands, who presented the findings at ESC Preventive Cardiology 2026.
Conversely, patients with high pre-admission PA levels had fewer events and significantly longer MACE-free survival over 5 years than those with low pre-admission PA levels (aHR, 0.47; log-rank p=0.03).
Safety is an issue
Exercise-based cardiac rehabilitation typically begins weeks to months after a heart attack, leaving the immediate post-discharge period poorly defined regarding PA and its safety. [Am J Prev Cardiol 2026:27:101641]
“Early mobilization after MI is increasingly common as hospital stays shorten, leading to an increase in PA as patients return to their home environment, and yet data on the safety of early PA are scarce,” Dijkman noted in the press release.
Dijkman and colleagues evaluated 165 patients (mean age 65 years, 66 percent men) who were consecutively admitted for MI (STEMI** or non-STEMI) at the Radboud University Medical Center. The patients were stratified into high and low post-discharge PA groups based on the median value.
The participants were given a thigh-worn accelerometer to measure their PA levels 24 hours/day for the first 7 days post-discharge. For pre-admission PA, the investigators used the SQUASH*** questionnaire and calculated MET scores.
A majority of the participants were treated with percutaneous coronary intervention (78 percent), while 9 percent underwent CABG.
The high post-discharge PA group generally had longer total activity (4.7 vs 2.4 hrs/day), total moderate-to-vigorous PA (51 vs 21 mins/day), and total VPA (6.6 vs 2.5 mins/day; p<0.001 for all) than the low post-discharge PA group.
After a median follow-up of 4.9 years, 50 patients experienced MACE (74 total events), with revascularization being the most common (n=28), followed by reinfarction (n=18) and mortality (n=16).
A core component of post-MI care
Dijkman said that there was no association between post-discharge and pre-admission PA. “Reassuringly, our findings suggest that being physically active after discharge was not associated with an increased risk of CV events. The period after an MI can act as a ‘teachable moment’ as patients may be more receptive to reconsidering lifestyle behaviour and it seems that encouraging early activity at this time is safe.”
“The longer MACE-free survival in those who were physically active pre-admission highlights long-term protective effects and further supports promoting an active lifestyle,” he added.
“[The findings support] advancing towards early mobilization as a core component of post-MI care,” Dijkman concluded.