From the Guidelines
Patients with acute coronary syndrome (ACS) should begin a structured cardiac rehabilitation program approximately 1-2 weeks after hospital discharge, following medical clearance from their cardiologist, with an initial emphasis on low-intensity exercise, such as walking for 5-10 minutes several times daily, gradually increasing to 30-60 minutes of moderate activity most days of the week, as recommended by the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation 1. The goal of this program is to increase total physical activity, establish habitual routines, and reduce the risk of future cardiac events.
- Assessment of physical activity can be obtained through self-report or objectively with physical activity monitors.
- Aerobic physical activity guidelines recommend ≥150 min/wk of moderate-intensity activity or 75 minutes of vigorous activity for substantial health benefits.
- Resistance exercise training should initially be performed on 2 nonconsecutive days per week and progressed to 3 days per week, with an initial perceived exertion of 11 to 14 (fairly light to somewhat hard) using the Borg scale, as suggested by the European Heart Journal 1. Key considerations for exercise therapy in patients with ACS include:
- Frequency: at least 3 days/week, preferably 6–7 days/week
- Intensity: moderate or moderate-to-high intensity
- Time: 30-60 minutes per session
- Type: aerobic and resistance training
- Progression: gradual increase in intensity and duration based on individual tolerance and response. It is essential to monitor for warning signs during exercise, including chest pain, unusual shortness of breath, dizziness, or irregular heartbeat, and stop activity if these occur, as recommended by the European Association of Preventive Cardiology 1. Before beginning any exercise program, patients should complete their medication regimen as prescribed, which often includes antiplatelet therapy, statins, beta-blockers, and ACE inhibitors. Early mobilization and progressive exercise are crucial for recovery, as they improve cardiovascular function, reduce the risk of future cardiac events, help manage weight, and enhance psychological well-being, as supported by the highest quality and most recent study 1.
From the Research
Timing of Exercise for Acute Coronary Syndrome Patients
- The optimal time for a patient with acute coronary syndrome to start exercising is not explicitly stated in the provided studies, but several studies suggest that physical activity can be beneficial for patients with stable coronary artery disease, recent acute coronary syndrome, or recent revascularization 2.
- A study published in 2019 found that physical activity improved significantly at 3 months post-event, but 45% of patients did not reach guideline recommendation levels at 3 months post-event 3.
- Another study published in 2021 found that exercise training and high physical activity are beneficial for patients with stable coronary artery disease, recent acute coronary syndrome, or recent revascularization, and that high sedentary behavior is associated with poor cardiopulmonary fitness and increased mortality in acute coronary syndrome patients 2.
Factors Influencing Exercise in Acute Coronary Syndrome Patients
- A 2011 study found that a socio-cognitive intervention associated with a pedometer-based program can increase physical activity in patients following an acute coronary syndrome event 4.
- A 2016 study found that physical inactivity is associated with an increased risk of cardiovascular events during hospitalization in patients with acute coronary syndrome 5.
- A 1979 study found that exercise training can be beneficial even for patients with impaired ventricular function, and that increase in physical work capacity was not correlated with improvement of ventricular function 6.
Recommendations for Exercise in Acute Coronary Syndrome Patients
- While the provided studies do not offer a specific timeline for when patients with acute coronary syndrome can start exercising, they suggest that physical activity can be beneficial for these patients and that healthcare providers should encourage and support patients in increasing their physical activity levels 3, 2, 4, 5, 6.