Background <p>Against the backdrop of comprehensive health benefits associated with 24-hour movement behaviors for cardiac rehabilitation in patients with coronary heart disease, and utilizing objective accelerometer data, this study aims to identify the potential classes of 24-hour movement behaviors (encompassing moderate-to-vigorous physical activity, light physical activity, sedentary behavior, and sleep) among patients with coronary heart diseas. Furthermore, it seeks to preliminarily clarify which factors are associated with different classes of activity behavior patterns, in order to inform the development of personalized daily activity management strategies.</p> Design <p>A cross-sectional study design.</p> Methods <p>From March to September 2025, patients with coronary artery disease who had been discharged for more than one month were recruited from the cardiology outpatient department of a tertiary hospital in Nanchang, China, using convenience sampling. A total of 308 participants were enrolled, all of whom provided written informed consent. Data collection involved questionnaire surveys using a general information form, the Pittsburgh Sleep Quality Index, and the Tampa Scale for Kinesiophobia for Heart Disease. Objective movement behavior data, including time spent in moderate-to-vigorous physical activity, light physical activity, sedentary behavior, and sleep, were continuously collected over 7 days using a triaxial accelerometer (ActiGraph GT3X-BT, Pensacola, Florida, USA). Latent class analysis was employed to identify subtypes of movement behavior patterns, and multivariable logistic regression models were used to analyze the associated influencing factors.</p> Results <p>This study identified three latent subtypes of 24-hour movement behaviors in patients with coronary artery disease: a Sedentary-Low Activity subtype (49.35%), a Low-Intensity Active subtype (28.25%), and an Active subtype (22.40%). The Sedentary-Low Activity subtype was characterized by the longest sedentary time and the shortest durations of physical activity among the groups. In contrast, the Active subtype exhibited the highest level of moderate-to-vigorous physical activity. The Low-Intensity Active subtype was distinguished by the highest amount of light-intensity physical activity, presenting a relatively balanced profile across all behavioral dimensions.Using the Sedentary-Low Activity subtype as the reference, patients with better cardiac function (OR = 13.007, <i>P</i> &lt; 0.001) and lower levels of kinesiophobia (OR = 0.902, <i>P</i> = 0.001) were more likely to be classified into the Active subtype. Gender and smoking history were not significant predictors for this subtype (<i>P</i> &gt; 0.05). Female patients were most likely to be classified into the Low-Intensity Active subtype (OR = 2.375, <i>P</i> = 0.020). Compared to patients with NYHA class III, those with NYHA class 0 also had a higher probability of belonging to the Low-Intensity Active subtype (OR = 3.756, <i>P</i> = 0.034). The kinesiophobia score and smoking history did not show independent predictive effects for this subtype (<i>P</i> &gt; 0.05).</p> Conclusion <p>The 24-hour movement behaviors of coronary heart disease patients exhibit heterogeneity. Healthcare providers should conduct comprehensive 24-hour movement behavior assessments for coronary heart disease patients, identify their activity patterns, and develop personalized management and intervention strategies based on these patterns. This approach may improve patients’ daily activity behavior and reduce the risk of readmission.</p>