Return to Full Normal Activities Including Work at Two Weeks After Acute Myocardial Infarction

Published:February 14, 2006DOI:
      Patients are generally advised to return to full normal activities, including work, 6 to 8 weeks after acute myocardial infarction (AMI). We assessed the outcomes of early return to normal activities, including work at 2 weeks, after AMI in patients who were stratified to be at a low risk for future cardiac events. Patients were considered for randomization before discharge if they had no angina, had left ventricular ejection fraction >40%, a negative result from a symptom-limited exercise stress test for ischemia (<2 mm ST depression) at 1 week, and achieved >7 METs. Patients with left ventricular ejection fraction <40% were included only if they did not have inducible ventricular tachycardia at electrophysiologic studies. Seventy-two patients were randomized to return to normal activities at 2 weeks and 70 patients to undergo standard cardiac rehabilitation and return to normal activities at 6 weeks after AMI. There were no deaths or heart failure in either group. There was no significant difference in the incidence of reinfarction, revascularization, left ventricular function, lipids, body mass index, smoking, or exercise test results at 6 months. In conclusion, return to full normal activities, including work at 2 weeks, after AMI appears to be safe in patients who are stratified to a low-risk group. This should have significant medical and socioeconomic implications.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Topol E.
        • Burek K.
        • O’Neill W.
        • Kewman D.
        • Kander N.
        • Shea M.
        • Schork A.
        • Kirscht J.
        • Juni J.
        • Pitt B.
        A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion.
        N Engl J Med. 1988; 318: 1083-1088
        • Picard M.
        • Dennis C.
        • Schwartz R.
        • Ahn D.
        • Kraemer H.
        • Berger W.
        • Blumberg R.
        • Heller R.
        • Lew H.
        • DeBusk R.
        Cost-benefit analysis of early return to work after uncomplicated acute myocardial infarction.
        Am J Cardiol. 1989; 63: 1309-1314
        • Dennis C.
        • Houston-Miller N.
        • Schwartz R.
        • Ahn D.
        • Kraemer H.
        • Gossard D.
        • Juneau M.
        • Taylor B.
        • DeBusk R.
        Early return to work after uncomplicated myocardial infarction. Results of a randomized trial.
        JAMA. 1988; 260: 214-220
        • Mallory G.
        • White P.
        • Salcedo-Salgar J.
        The speed of healing of myocardial infarction. A study of the pathologic anatomy in seventy-two cases.
        Am Heart J. 1939; 18: 647-671
        • Hall J.
        • Wiseman V.
        • King M.
        • Ross D.
        • Kovoor P.
        • Zecchin R.
        • Moir F.
        • Denniss A.
        Economic evaluation of a randomized trial of early return to normal activities versus cardiac rehabilitation after acute myocardial infarction.
        Heart Lung Circ. 2002; 11: 10-18
        • Jain A.
        • Myers G.
        • Sapin P.
        • O’Rourke R.
        Comparison of symptom-limited and low level exercise tolerance tests early after myocardial infarction.
        J Am Coll Cardiol. 1993; 22: 1816-1820
        • Juneau M.
        • Colles P.
        • Theroux P.
        • de Guise P.
        • Pelletier G.
        • Lam J.
        • Waters D.
        Symptom-limited versus low level exercise testing before hospital discharge after myocardial infarction.
        J Am Coll Cardiol. 1992; 20: 927-933
        • Hamm L.
        • Crow R.
        • Stull G.
        • Hannan P.
        Safety and characteristics of exercise testing early after acute myocardial infarction.
        Am J Cardiol. 1989; 63: 1193-1197
        • Denniss A.
        • Baaijens H.
        • Cody D.
        • Richards D.
        • Russell P.
        • Young A.
        • Ross D.
        • Uther J.
        Value of programmed stimulation and exercise testing in predicting one-year mortality after acute myocardial infarction.
        Am J Cardiol. 1985; 56: 213-220
        • DeBusk R.
        • Blomqvist C.
        • Kouchoukos N.
        • Luepker R.
        • Miller H.
        • Moss A.
        • Pollock M.
        • Reeves T.
        • Selvester R.
        • Stason W.
        • et al.
        Identification and treatment of low-risk patients after acute myocardial infarction and coronary-artery bypass surgery.
        N Engl J Med. 1986; 314: 161-166
        • Stevenson R.
        • Umachandran V.
        • Ranjadayalan K.
        • Wilkinson P.
        • Marchant B.
        • Timmis A.
        Reassessment of treadmill stress testing for risk stratification in patients with acute myocardial infarction treated by thrombolysis.
        Br Heart J. 1993; 70: 415-420
        • Schlant R.
        • Blomqvist C.
        • Brandenburg R.
        • DeBusk R.
        • Ellestad M.
        • Fletcher G.
        • Froelicher V.
        • Hall R.
        • McCallister B.
        • McHenry P.
        • et al.
        Guidelines for exercise testing. A report of the Joint American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures (subcommittee on exercise testing).
        Circulation. 1986; 74: 653A-667A
        • Richards D.
        • Byth K.
        • Ross D.
        • Uther J.
        What is the best predictor of spontaneous ventricular tachycardia and sudden death after myocardial infarction?.
        Circulation. 1991; 83: 756-763
        • Mulcahy R.
        • Kennedy C.
        • Conroy R.
        The long-term work record of post-infarction patients subjected to an informal rehabilitation and secondary prevention programme.
        Eur Heart J. 1988; 9: 84-88
        • Senaratne M.
        • Smith G.
        • Gulamhusein S.
        Feasibility and safety of early exercise testing using the Bruce protocol after acute myocardial infarction.
        J Am Coll Cardiol. 2000; 35: 1212-1220
        • O’Connor G.
        • Buring J.
        • Yusuf S.
        • Goldhaber S.
        • Olmstead E.
        • Paffenbarger R.
        • Hennekens C.
        An overview of randomized trials of rehabilitation with exercise after myocardial infarction.
        Circulation. 1989; 80: 234-244
        • Rowe M.
        • Jelinek M.
        • Liddel N.
        • Hugens M.
        Effect of rapid mobilization on ejection fractions and ventricular volumes after acute myocardial infarction.
        Am J Cardiol. 1989; 63: 1037-1041
        • Giannuzzi P.
        • Temporelli P.
        • Corra U.
        • Gattone M.
        • Giordano A.
        • Tavazzi L.
        Attenuation of unfavorable remodeling by exercise training in postinfarction patients with left ventricular dysfunction.
        Circulation. 1997; 96: 1790-1797
        • Ehsani A.
        • Biello D.
        • Schultz J.
        • Sobel B.
        • Holloszy J.
        Improvement of left ventricular contractile function by exercise training in patients with coronary artery disease.
        Circulation. 1986; 74: 350-358
        • Froelicher V.
        • Jensen D.
        • Genter F.
        • Sullivan M.
        • McKirnan M.
        • Witztum K.
        • Scharf J.
        • Strong M.
        • Ashburn W.
        A randomized trial of exercise training in patients with coronary heart disease.
        JAMA. 1984; 252: 1291-1297
        • Cobb F.
        • Williams R.
        • McEwan P.
        • Jones R.
        • Coleman R.
        • Wallace A.
        Effects of exercise training on ventricular function in patients with recent myocardial infarction.
        Circulation. 1982; 66: 100-108
        • Hung J.
        • Gordon E.
        • Houston N.
        • Haskell W.
        • Goris M.
        • DeBusk R.
        Changes in rest and exercise myocardial perfusion and left ventricular function 3 to 26 weeks after clinically uncomplicated acute myocardial infarction.
        Am J Cardiol. 1984; 54: 943-950
        • Hung J.
        • Goris M.
        • Nash E.
        • Kraemer H.
        • DeBusk R.
        • Berger III, W.
        • Lew H.
        Comparative value of maximal treadmill testing, exercise thallium myocardial perfusion scintigraphy and exercise radionuclide ventriculography for distinguishing high- and low-risk patients soon after acute myocardial infarction.
        Am J Cardiol. 1984; 53: 1221-1227
        • Sullivan I.
        • Davies D.
        • Sowton E.
        Submaximal exercise testing early after myocardial infarction.
        Br Heart J. 1984; 52: 147-153