Reviewed by Dietitian Alyssa Pike, RDN

Key Points

• A new study focuses on former emergency room (ER) patients with symptoms like chest pain.

• After leaving the ER, sedentary behavior was linked with a higher risk of cardiac events.

• But replacing sedentary behavior with sleep or exercise reduced the risk.

Mounting research supports the notion that the more sedentary time you rack up, the higher your risk of disease, including dementia. Too much sitting may even shorten your lifespan. Sedentary behavior has also been linked to a higher risk of heart disease, the number one cause of death in the U.S.

Each year, more than 11 million people visit emergency rooms across the country with chest pain, and around 65% of them are admitted to the hospital. That makes up a quarter of all hospital admissions from the ER. But even though heart disease is the top cause of death in America, it’s also highly preventable. Diet, physical activity, stress and sleep all play important roles in heart health—whether you’ve been diagnosed with heart disease or not.

Researchers from Columbia University took a closer look at sedentary behavior following an ER or hospital admission for chest pain and other symptoms of acute coronary syndrome (ACS), including shortness of breath, sweating and dizziness. They wanted to know if there was a connection between the amount of sedentary behavior and the risk of having a cardiac event, like a heart attack, or death from a cardiac event during the year following the hospital visit. They recently published their findings in Circulation: Cardiovascular Quality and Outcomes. Let’s break them down.

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How Was This Study Conducted?

For this study, researchers recruited patients who visited the ER at Columbia University Medical Center with symptoms suggestive of acute coronary syndrome between September 2016 and March 2020. They accepted a total of 609 participants who met their criteria. Participants’ average age was 62, and just over half were male.

Participants each received a wrist accelerometer to wear, which records time and intensity of movement, sleep and sedentary behavior. Accelerometers were provided to patients while in the hospital. They were instructed to wear it on their non-dominant wrist continuously for 24 hours while in the hospital and for at least 30 days post-discharge.

Besides accelerometer data, researchers also gathered data on age, sex, race/ethnicity, education and whether or not they had a partner, health insurance and an actual diagnosis of acute coronary syndrome.

Ultimately, researchers were looking for participants who had a cardiac event or died of any cause during the 12 months following entry into the study. Researchers received this information from electronic medical records and by calling participants at the end of the study period. Cardiac events included a heart attack, urgent coronary revascularization (like cardiac bypass surgery) or hospitalization for unstable angina (chest pain caused by reduced blood flow to the heart).

What Did This Study Show?

Several findings surfaced following statistical analysis.

• Replacing 30 minutes of sedentary time with low-intensity physical activity was associated with a 51% lower risk of cardiac events and dying from anything.

• Replacing 30 minutes of sedentary time with moderate-vigorous physical activity was associated with a 61% lower risk of cardiac events and dying from anything.

• Replacing 30 minutes of sedentary time with 30 minutes of sleep was associated with a 14% lower risk of cardiac events and dying from anything.

Ultimately, these results suggest that swapping sitting with just about anything else, including sleep, may reduce the risk of cardiac events and death.

An important note that researchers highlight is that there is evidence suggesting that patients who are hospitalized with symptoms suggestive of acute coronary syndrome, but who ultimately have acute coronary syndrome ruled out, are still at increased risk of adverse outcomes, including cardiovascular events. In other words, if you are hospitalized for signs of a heart attack but they rule it out, you are likely still at high risk for having one. So if you have symptoms but are not formally diagnosed, you should still take those symptoms seriously.

There are a few limitations to this study. First, participants wore accelerometers during the first 30 days following discharge. Some patients might have been less active during this time, as people are often cautious about movement following cardiac events. Also, while certain demographics were adjusted for, it’s impossible to catch all factors that can skew results. Lastly, the results lose some statistical power due to the small number of events (cardiac or death) that took place during the 12 months. Therefore, the researchers state that these results should be interpreted with caution and considered preliminary evidence.

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How Does This Apply to Real Life?

These results show that it doesn’t take a huge shift to potentially see big changes—in this case, a reduction in cardiac events and death. While moderate-vigorous physical activity showed the greatest risk reduction, low-intensity physical activity had some pretty amazing results, too.

While it might come as no surprise that physical activity reduces heart disease risk, you might be wondering why sleep would.

“Unlike sitting, sleep promotes healthful, restorative processes that help regulate blood pressure, reduce inflammation and support heart function,” explains Keith Diaz, Ph.D., one of the study’s lead authors and associate professor of behavioral medicine at Columbia University. “Sitting for hours at a time does the opposite. It increases blood pressure, can trigger chronic inflammation and contributes to poor heart health. For example, blood pressure typically drops by more than 10% during sleep. This gives your heart, blood vessels and other organs a reprieve from higher pressures that can be damaging to them.”

Current physical activity guidelines recommend getting at least 150 minutes a week of moderate-intensity or 75 minutes of vigorous-intensity physical activity a week. Strength training is also recommended at least twice a week. Plus you want to try to fit in some stretching throughout your week.

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The good news is that any amount of physical activity is better than none—and it doesn’t have to be done every day. We previously reported on a study that found that “weekend warriors” get just about as many health benefits as those who exercise over several days.

But physical activity and sleep are just a part of the heart disease puzzle. The American Heart Association promotes its Life’s Essential 8 wheel for heart disease prevention and overall good health. The wheel consists of four health behaviors and four health factors. The health behaviors include eating healthy, moving your body, quitting tobacco and getting healthy sleep. The health factors include things you can measure that are influenced by the health behaviors: weight, cholesterol, blood pressure and blood sugar.

If you need help with what to eat, the Mediterranean diet is a great place to start. Loaded with heart-healthy foods like fruit, vegetables, whole grains, legumes, nuts, seeds, seafood and healthy oils like olive oil, the Mediterranean diet ranks as one of the top eating patterns for heart health, along with the DASH diet, a spin-off of the Mediterranean diet that limits sodium. If you want more guidance, check out our 30-Day DASH Diet Meal Plan for Beginners or our 7-Day Mediterranean Diet Meal Plan for Heart Health.

Related: 5 Things to Do When You Wake Up to Help Lower Cholesterol, According to Experts

The Bottom Line

This study suggests that by replacing 30 minutes of sedentary time with exercise of any kind or with sleep, you may reduce your risk of having a cardiac event or dying following a visit to the hospital for chest pain. If you’re currently inactive, start looking for ways to be intentional with your activity. Take the stairs, park at the far end of the parking lot and take movement breaks throughout the day. If you’ve got sleep issues, assess your bedtime routine and sleep environment and make appropriate changes. If you snore or are getting the proper amount of sleep but are still exhausted, consult with your healthcare practitioner, who can assess your situation and refer you to the appropriate specialists.

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