For the roughly 805,000 people who have a heart attack every year in the United States, avoiding a second heart attack is a major goal.

And new research published in the American Heart Association’s journal, Circulation: Cardiovascular Quality and Outcomes, has a few tips to do just that.

The study, which was conducted by researchers at Columbia University’s Vagelos College of Physicians and Surgeons, found that avoiding a sedentary lifestyle is the best way to fight off a second heart attack or other cardiac event, including chest pain or heart-related surgery.

The study followed 609 people ages 21 to 96 who went to the emergency department with symptoms of a heart attack. After leaving the hospital, participants wore movement trackers on their wrists for 30 days. Researchers then followed up a year later to see if additional cardiac events or death occurred.

Researchers found that those who replaced 30 minutes of sedentary behaviour with 30 minutes of light movement of any kind, such as a slow walk or house chores, had a 50% lower chance of having a second heart attack or cardiac event. When folks replaced 30 minutes of sedentary behaviour with moderate or vigorous exercise, like a jog or bike ride, their chance of a second heart attack or cardiac event dropped by 61%.

One surprising find? Those who replaced sedentary behaviour with 30 minutes of sleep had a 14% lower chance of having a second heart attack or cardiac event.

“So, you have options here. Obviously, exercise is going to yield the most bang for your buck and the most benefit, but these other behaviours also matter,” said Dr. Keith Diaz, the lead study author and director of the exercise testing laboratory at the Centre for Behavioural Cardiovascular Health at Columbia University.

How does sleep benefit heart health?

“Beyond just this research, [there’s] just a whole slew of research emerging now about the heart health benefits of sleep,” said Diaz.

Previous research has found that people with irregular sleep patterns have higher amounts of plaque in their arteries, and those who reported poor sleep are also more likely to have high blood pressure (which is a heart attack risk factor).

When it comes to the benefits of sleep over being sedentary, “I think the question we often get as somebody who studies sitting or sedentary behaviour is, ‘Well, sleep is sedentary, isn’t it? Why is it good?” Diaz said.

“And it’s just considered to be a separate entity. It’s a healthful restorative behaviour,” Diaz said. “It’s really helpful for things like inflammation and just recovery of your body at the end of the day.”

Getting up and moving around is key for better heart health.

Compared to people who averaged fewer than 12 sedentary hours each day (not including sleep), folks who averaged more than 15 sedentary hours per day were 2.5 times more likely to have a cardiac event or die during the study’s one-year follow-up.

“I think the important and actionable take-home message is that sedentary behaviour is deleterious. It’s bad for your health after a cardiac event,” said Dr. Sandeep Nathan, the medical director of the cardiac intensive care unit and co-director of the cardiac catheterisation laboratory at the University of Chicago Medicine’s Heart and Vascular Centre. Nathan is not affiliated with the study.

But there are limitations to this study. “These were patients who presented with ... acute coronary syndrome symptoms, but only about 25% of these patients actually had a solid diagnosis of acute coronary syndrome,” said Nathan.

In other words, not everyone in this study actually had a heart attack; some just went to the emergency room for heart attack symptoms, like chest pain.

“But it doesn’t diminish the importance of the primary finding, which is that in anybody who comes in with a constellation of symptoms suggesting that they have heart disease, they do better with physical activity,” added Nathan.

The study also did not consider where study participants lived or their income, which are two factors that can also impact heart health.

Physical activity has a range of benefits for heart health.

This study underscored a well-established notion: Physical activity of any kind is good for your heart. Overall, it improves your physical and cardiovascular conditioning, Nathan said.

Moderate to vigorous exercise also helps control the factors that put you at risk of a heart attack or coronary event, said Nathan. It “decreases blood sugar levels, it decreases blood pressure. It perhaps helps you lose weight and improve your lipid profiles as well, and all of those are independent risk factors for a second cardiac event,” Nathan said.

“And then finally, what I always tell patients is that if you’re consistently maintaining a high level of physical activity, you have a warning system. You can tell me that, ‘Doc, I normally go 30 minutes on the treadmill, but for the past couple of weeks, I hit the 15-minute mark and I just don’t feel well,’” said Nathan. “That’s an early indicator that something’s amiss, right?”

If you live a sedentary life, you can’t test your heart health the same way. In other words, changes to what you’re able to do in your regular fitness regimen can help indicate if you’re developing blockages or issues that could cause a second heart attack, said Nathan.

Cardiac rehab is also a great tool for lowering your risk of a second heart attack.

There is no doubt that avoiding sedentary behaviour is good for your cardiovascular health and your overall health. Beyond that, though, Nathan said it’s important for those who do have a heart attack to go to (and complete) cardiac rehab as prescribed, as it can help you from having a second heart attack or other cardiac event.

“And so, when I counsel patients after a heart attack, I point that out to them,” Nathan said.

“You may think that you can do this on your own, in your home gym, or in your basement, or your local fitness facility, but there is a substantial benefit to actually going to cardiac rehab and being pushed to engage in escalating intensity of activity for a period of about 12 weeks, typically,” Nathan noted.

“I think that the benefit of graded, vigorous physical activity — perhaps pushing you a little bit outside of your comfort zone and doing it in a very graded fashion ... that offers independent health benefits, both in terms of morbidity as well as mortality,” he said.

While all of these behaviours are important for reducing your risk of a second heart attack or cardiac event, Diaz said that “if you’re going to pick one thing to do, exercise is still like the healthiest, most beneficial thing to do.”

“But, it’s not an all or nothing. If you can’t do that, you can get health benefits from just light-intensity movement. And if you can’t do that, you can get health benefits from just sleeping a little bit more,” Diaz said.