Abstract
Background: Physical activity (PA) is central to the secondary prevention of coronary heart disease (CHD), yet real-world adherence is poor, and data from Central Asia are scarce. Methods: In this cross-sectional study (October 2024–May 2025), 402 patients were recruited 6–24 months after an index coronary event at two Kazakh centers. PA was measured by IPAQ-SF and dichotomized as low versus moderate/high IPAQ-SF category. Multivariable logistic regression identified independent associations with low PA. Results: A total of 152 patients (37.8%) had low PA. Activity was almost exclusively ambulatory: 86.3% reported walking but only 19.9% had any moderate and 11.7% any vigorous activity, and only 29 (7.2%) met WHO/ESC recommendations without counting walking. Low PA was independently associated with recruitment in Aktobe (aOR 3.76, 95% CI 1.98–7.34) and obesity (aOR 1.68, 1.04–2.69); professional exercise advice (aOR 0.45, 0.27–0.73) and the absence of depressive symptoms (aOR 0.42, 0.23–0.76) were associated with lower odds of low PA. Advice was often given but inconsistently followed, and the uptake of fitness clubs (5.6%) and walking groups (10.8%) was minimal. Conclusions: More than one in three patients had low PA, and fewer than one in ten met WHO/ESC recommendations when excluding walking. Depression, obesity, and regional disparity and not conventional risk factors characterized inactive patients.