Performing a successful primary angioplasty and prescribing preventive medication without advising on the importance of keeping up with or taking up physical activity is a waste of one of our many opportunities to improve the quality of life of our patients and reduce mortality among them.

If clinical cardiologists do not take over the patient, our job is not done, not even after a final angiography with TIMI flow 3. In consequence, we should be aware of all existing evidence for both pharmacological and non-pharmacological follow-up.

According to this recent Swedish study, taking up or maintaining a high level of physical activity after an acute myocardial infarction may help reduce mortality at 4 years after the event.

Compared with patients who remained sedentary or who abandoned physical activity after the event, those who maintained it experienced the lowest mortality risk.

Read also: Peri-Procedural Infarction: More Frequent than and Not as Innocent as We Thought.

This should be emphasized, since physicians generally do not provide as much advice on the importance of physical activity as they do regarding other lifestyle recommendations such as lowering alcohol consumption or stopping smoking.

Patient fear and ignorance combine to limit activity.

This work included three studies and 22,227 total patients, and it recorded physical activity reported at secondary prevention visits at 6 and 10 weeks, and then 1 year after the index event. If they reported no more than one physical activity session lasting at least 30 minutes in the past week, they were considered as sedentary. This information was used to form four groups: patients who were inactive at all secondary prevention visits (constantly inactive), patients active at first and then inactive (reduced activity), patients inactive at first who take up physical activity (increased activity), and, finally, patients who remained active (constantly active).

Read also: Complete Revascularization Is Beneficial in Acute MI with Cardiogenic Shock.

After a follow-up of 4.2 years, the mortality rates per 1000 patient-years were 28.2%, 12.7%, 11.4%, and 7.5% among patients who were “constantly inactive”, who had “reduced activity”, who had “increased activity”, and who were “constantly active”, respectively. After adjustment for multiple variables, the three groups of patients with some level of physical activity experienced lower mortality compared with patients who were consistently inactive.

Original title: Increased Physical Activity Post-Myocardial Infarction Reduces Mortality.

Reference: Ekblom O et al. EuroPrevent 2018. Ljubljana, Slovenia.

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