Pathophysiological and Socio-Behavioural Determinants of Physical Activity in Ischemic Heart Disease: A Cross-Sectional Clinical Study

Introduction. Ischemic heart disease (IHD) remains a primary driver of global mortality, with coronary atherosclerosis often manifesting as stable exertion angina pectoris. Despite the known benefits of physical activity (PA) in managing cardiovascular pathophysiology, there is a significant gap in understanding how residential environments—specifically urban versus rural settings—and subjective perceptions of activity correlate with objective functional capacity. The aim of the study. This study aimed to evaluate the intersection of structured and unstructured PA, residential living conditions, and objective exercise tolerance among patients diagnosed with IHD and stable exertion angina pectoris. Materials and methods. A cross-sectional study was conducted between 2022 and 2025 at the Multidisciplinary Clinic of Tashkent State Medical University, enrolling 183 patients (98 men, 85 women; mean age 64.2 ± 5.1 years) diagnosed with IHD and stable exertion angina pectoris (Functional Class II–III). Participants were categorized into urban (n=89) and rural (n=94) cohorts. Subjective PA was assessed using the ODA-23+ questionnaire and daily activity diaries. Objective exercise tolerance was evaluated via cycle ergometry. All units are expressed in the International System of Units (SI). Results. Arterial hypertension was highly prevalent, affecting 84.3% of urban and 80.8% of rural patients. Daily diaries revealed profound sedentarism across both cohorts; urban men averaged 11.4 ± 1.8 hours of sleep per day, while rural women averaged 5.7 ± 0.7 hours of sedentary television viewing. Subjective assessments demonstrated a massive overestimation of physical condition, with 64.7% of rural men self-rating their activity as medium to high. Conversely, objective cycle ergometry revealed that 80% of urban patients and 88.4% of rural women possessed low or very low exercise tolerance. Ultimately, 36.2% of men and 44.1% of rural women significantly overestimated their physical capabilities compared to their physiological performance. Conclusion. A severe disconnect exists between self-perceived health literacy and objective physiological tolerance among patients with IHD. These findings underscore a critical need to combat hypodynamia across both urban and rural demographics. Management should transition from passive medical advice to the implementation of objectively quantified, culturally tailored cardiac rehabilitation programs to bridge the gap between perceived and actual functional capacity.