A set of exercises after myocardial infarction. Exercise therapy and other special exercises for myocardial infarction

The fundamental issue is to determine the patient's functional capabilities and the appropriate motor mode.

Best results are achieved with early, extensive and comprehensive rehabilitation.

Generally accepted physical rehabilitation programs currently in effect provide for a gradual (step-by-step) expansion of physical activity in patients with myocardial infarction.

Hospital stage of rehabilitation

The severity class is determined on the 1st-3rd day of illness after the elimination of pain and complications such as cardiogenic shock, pulmonary edema, severe arrhythmias.

This program involves prescribing a volume of physical activity to the patient in the form of therapeutic exercises. The main task therapeutic physical culture (physical therapy) at the inpatient stage - activation of extracardiac circulatory factors, reduction of the negative impact of hospital physical inactivity, preparation of the patient for household physical activity.

Period of inpatient rehabilitation phase

1st stageactivity covers the period the patient is on bed rest. Classes therapeutic exercises (LH) carried out in IP lying in bed. Complex of therapeutic exercises No. 1 is used. During rest breaks, breathing exercises and relaxation exercises are performed. Lesson duration 10-12 minutes.

The load is considered adequate if the increase in heart rate at the height of the load and in the first 3 minutes after it does not exceed 20 beats per minute, the increase in breathing is no more than 6-9 per minute, the SBP increases no more than 20-40 mm Hg. Art., DBP - no more than 10-12 mm Hg. Art. (compared to the original).

Possible decrease in heart rate by 10 beats per minute, decrease blood pressure (BP) no more than 10 mm Hg. Art. If the body reacts adequately to the complex of therapeutic exercises, there are no attacks of angina pectoris and no new complications, or negative dynamics of the ECG, the patient is transferred to the 2nd stage.

At the 2nd stageactivity the patient is allowed to sit down at the table, eat at the table, walk around the bed and around the ward. The load is performed within the framework of LG complex No. 2. The main purpose of the complex is gentle training of the cardiorespiratory system, preparing the patient for free walking along the corridor and climbing stairs.

Therapeutic gymnastics complex No. 2 is performed in IP. lying down - sitting - lying down. The number of exercises performed while sitting gradually increases. Movements in the distal limbs are gradually replaced by exercises in the proximal limbs, involving large joints and muscle groups in movement.

Each change in body position is followed by passive rest. Exercises of the LH complex No. 2 are recommended for patients to practice independently in the form of morning hygienic exercises. Lesson duration 10-15 minutes.

Sets of exercises that cause ST segment depression, rhythm disturbances, or the development of tachycardia over 100 beats per minute are excluded from the program or a more gentle option is selected. Indications for transferring the patient to the 3rd stage of activity are an adequate response of pulse and blood pressure, orthostatic test, the approach of the ST segment to the isoline, the formation of a coronary T wave.

Contraindications to transfer to the 3rd stage of activity are frequent attacks of angina pectoris, signs of circulatory failure at the stage and above, frequent paroxysmal rhythm and conduction disturbances with pronounced hemodynamic changes.

3rd level of activity includes the period from the first time the patient enters the corridor until he goes outside. The patient is allowed to walk along the corridor from 50 to 200 m in 2-3 steps at a slow pace (up to 70 steps per minute), up the stairs within 1 flight.

The main objectives of therapeutic exercises at the 3rd stage of activity: preparing the patient for full self-care, going for a walk outside, and dosed walking in a training mode. LH is carried out in the initial position sitting and standing, gradually expanding the volume of loads within the framework of the complex of therapeutic exercises No. 3.

The pace of the exercises is slow with gradual acceleration, with a total duration of up to 20 minutes. Patients are recommended to independently perform LH complex No. 1 in the form morning hygienic gymnastics (UGG) or in the afternoon. The first exit into the corridor and the first climb up the stairs is recommended to be carried out under the control of telemonitoring.

If there is an adequate response to the load, walks along the corridor are allowed without restrictions on distance and time, free mode within the department. By this time, patients are fully caring for themselves and are allowed to shower.

4th stage(the latter for the inpatient stage) provides, within the framework of a free regime, an increase in physical activity to a level at which the patient can be transferred to a specialized department for patients with myocardial infarction of a cardiological sanatorium.

The patient is allowed to go outside and walk at a pace of 70-80 steps per minute over a distance of 500-900 m in 1-2 steps.

At the 4th stage, the patient is prescribed complex of therapeutic exercises No. 4.

The main tasks of stage 4 LH are to prepare the patient for transfer to a local sanatorium to undergo the 2nd stage of rehabilitation or for discharge home under the supervision of a local therapist.

The classes use movements in large joints of the limbs with a gradual increase in amplitude and force, as well as exercises for the muscles of the back and torso. Exercises for the arms and shoulder girdle should be performed with a low number of repetitions. The pace of the exercises is slow and medium.

Lesson duration is up to 30 minutes. Motor density of classes is 8085%. Rest breaks are required after intense effort or exercise that causes dizziness.

When performing exercises, an increase is permissible heart rate (HR) at a load height of up to 110 blows for 3-6 minutes, which corresponds to the level of training impact. The walking pace increases from 70-80 to 80-100 steps per minute, and the distance covered from 500-600 m to 23 km in 2-3 steps. Walks are allowed 2 times a day.

In the absence of contraindications, the patient undergoes bicycle ergometry to determine the threshold load power, on the basis of which the optimal walking pace for the patient is calculated (see below).

It should be noted that not all patients can overcome all stages of the recommended set of physical activities. In case of unfavorable course initial period myocardial infarction (appearance various forms arrhythmias), the frequency of subsequent complications and deaths increases.

Early walking around the ward of such patients may be accompanied by an increase in late complications and deaths compared to patients of similar severity who are activated at a later date.

Therapeutic exercise in patients with myocardial infarction complicated by heart failure

Contraindications to the use of the program are: heart failure of class III and higher according to Killip, aortic stenosis above moderate, acute systemic disease, uncontrolled ventricular or atrial arrhythmia, uncontrolled sinus tachycardia above 120 beats/min, 3rd degree AV block without a pacemaker, active pericarditis or myocarditis, embolism, acute thrombophlebitis, diabetes mellitus, defects of the musculoskeletal system that make it difficult to exercise.

In the classical scheme, changes in motor patterns are based on the disease calendar and the dynamics of clinical data and ECG parameters. Bicycle ergometry in the early stages (5-10 days) from the onset of the disease can be performed only in a small number of patients, with a small area of ​​damage to the heart muscle and without severe complications.

In patients with transmural myocardial infarction, which occurs with complications, bicycle ergometry is impossible at such an early stage. In order to individualize and more flexible control of the patient’s motor mode, as well as stimulate functional reserves, after determining the severity class of the patient’s condition, the program provides for simple functional tests.

In order to comply with the principle of adequacy and safety of the testing load, simple functional tests are performed in strict sequence. Only after receiving an adequate response to the previous, simpler test do they move on to the next one. Test order: apnea test, hyperventilation test, semi-orthostasis, 6-minute walking test (Table 9).

For example, as a result of the patient’s initial functional testing, data is obtained that allows him to determine his motor mode above the first stage. Then, in therapeutic exercises, on the 1st day a complex of motor mode 1a is used, on the 2nd day - a complex of motor mode 16, on the 3rd day - a complex of motor mode 2a, respectively, under the control of blood pressure and heart rate data.

Table 9. Parameters of physical activity and oxygen consumption in patients with different functional classes of chronic heart failure

In case of inadequate reactions of the cardiorespiratory system to the proposed load, the patient engages in a complex of therapeutic exercises at a lower functional level until an adequate response is achieved.

The selected mode guarantees the performance of any movement in the zone of aerobic exercise, which eliminates the risk of developing overexertion in a patient with MI and allows developing the endurance of the patient’s body.

A distinctive feature of the proposed LH complexes is that breathing exercises are in the nature of basic exercises. Regulating the depth and frequency of breathing has a powerful systemic effect on the body.

It is the breathing exercises that determine the amount of physical activity and allow you to regulate the sequence, pace and duration of movements in the peripheral joints in various starting positions.

A rational combination of dynamic and static exercises used sequentially for small, medium and large muscles of the arms and legs, synchronization of movement with a certain phase of breathing is an effective method of individual selection of physical activity in patients with acute myocardial infarction in the early stages of the hospital stage of rehabilitation, corresponding to all the basic principles of rehabilitation treatment.

Objectives of early rehabilitation treatmentmyocardial infarction are:

A) restoration of normal breathing patterns;

B) a rational combination of the respiratory stereotype with the stereotype of the body’s reaction to the initial position of the body;

C) rational combination of respiratory function with increasing the level of tolerance of the patient with MI.
The activating techniques of therapeutic exercises are based on the following breathing exercises:
a) exercises with “open” expiratory resistance improve bronchial clearance, increase tidal volumes and prevent bronchial collapse;

B) breath-holding exercises increase the tolerance to hypoxia by increasing the metabolic adaptation of the body and the myocardium (warm-up phenomenon), and increase resistance to subsequent ischemia;

C) exercises with changing the duration of breathing phases increase the efficiency of oxygen consumption from the same volume of inhaled air, the tolerance of hypoxia, and also stabilize reflex reactions from the respiratory center to the vasomotor center.

Walking in training mode

Active walking- a complex process in which all parts of the central nervous system participate; it helps to normalize impaired vegetative functions of the body, since it causes functional and trophic changes in all organs and tissues, especially in the cardiovascular system. The most effective use of a treadmill is when dosing training with walking.

In the ward motor mode, after carrying out appropriate tests in patients with uncomplicated MI, dosed 3-6 minute walking is used within the ward at a pace of 30-40 steps per minute under the control of pulse rate, blood pressure and subjective state. If the patient responds adequately to the proposed volume of load, the walking pace increases to 40-60 steps per minute.

With proper activation of the patient, the increase in heart rate at the height of the load does not exceed 12 beats per 1 minute, breathing - 6-9 per 1 minute, the level of systolic pressure increases no more than - 20-40 mm Hg. Art., diastolic - 5-10 mm Hg. Art.

The occurrence of an attack of angina pectoris, arrhythmia, severe shortness of breath, tachycardia with a slow return to the initial heart rate, a drop in blood pressure, severe weakness, pallor, acrocyanosis indicate an unfavorable reaction to physical activity.

In free motor mode, the walking pace is 70-80 steps per minute. When a stable adequate response of the cardiovascular system is achieved, the walking time increases and, accordingly, the distance covered at a given pace from 500 m to 1000 m, 1500 m. Then walks on the street for a distance of 23 km in 2-3 steps. At the next stage, the walking pace increases to 80-100 steps per minute.

For patients with myocardial infarction complicated by heart failure, measured walking is carried out at a freely chosen pace (usually the most comfortable walking pace is 40 steps per minute) for 6 minutes. In this case, the distance traveled is recorded in accordance with the above scheme.

Clinical data is supplemented by data from ECG monitoring or stress testing.

To dose training loads, the threshold heart rate is determined and the working heart rate is calculated in the range from 60 to 90% of its threshold value. Training begins the day after testing and is carried out daily until discharge from the hospital. Treadmill training is carried out on the principle of gradually increasing load without rest intervals, until a stable heart rate is achieved at each load level.

If the patient’s tolerance to the training load is noted, then the power of the next workout is reduced to the previous level. The goal of the training is to achieve a stable response of the cardiovascular system to the applied load, and not to cover a certain distance.

At the end of the treadmill training course, a control test with physical activity on the treadmill is carried out.
The use of measured walking is also possible using specially prepared routes under mandatory monitoring of heart rate and blood pressure.

Sanatorium stage of rehabilitation

1) further increase in the physical performance of patients;
2) elimination or reduction of psychopathological syndromes;
3) preparing patients for professional activity;
4) secondary prevention of exacerbations of coronary heart disease.

Drawing up a rehabilitation program is based on data from a stage-by-stage examination of patients, including confirmation of the patient’s diagnosis upon discharge from the hospital, determination of the patient’s functional capabilities in terms of tolerance to physical activity.

The sanatorium stage of rehabilitation involves organizing the patient’s motor activity within the framework of a gentle, gentle-training, training regimen.

It is possible to optimize the use of physical activity at the sanatorium stage with individual dosing of physical activity, improving methods for monitoring tolerance and assessing the effectiveness of exercise, using biotelemetry, expanding the used forms of sports-applied exercises, including such as training on simulators, skiing, swimming and hydrokinesitherapy, rowing, running, sports games.

The main guidelines in choosing training loads and their dosage are the maximum permissible heart rate values ​​and the duration of “peak” loads. The duration of the peak heart rate should be 3-6 minutes. Peak loads are created during therapeutic exercises, when walking on level ground and stairs 4-5 times a day.

However, in some patients, heart rate cannot serve as a guide in determining tolerance to various physical activities. These are patients with severe bradycardia or tachycardia, circulatory failure, atrial fibrillation, AV block, artificial pacemaker, and, finally, persons taking beta-blockers, cordarone and cardiac glycosides.

In this group of patients, the adequacy of the response to stress is taken into account according to clinical data and the results of dynamic ECG recording.

LH in the sanatorium is performed both individually and in groups. The classes include exercises for all muscle groups and joints in combination with rhythmic breathing, exercises for balance, attention, coordination and relaxation. The complexity and intensity of the exercises used gradually increase. The time of therapeutic exercises increases to 30-40 minutes, while the heart rate can reach 110-120 beats/min, depending on the mode.

Physical activity can be increased by including exercises with objects (gymnastic sticks, clubs, rubber and medicine balls, hoops, dumbbells, etc.), exercises on equipment (gymnastic wall, bench), and the use of cyclic movements ( different kinds walking, jogging) and elements of outdoor games.

After the final section of the classes, elements of autogenic training are shown that promote proper rest, calmness and targeted self-hypnosis.

Training using dosed walking in sanatorium conditions can be carried out on specially prepared routes.

Outpatient stage

Objectives of exercise therapy at the outpatient stage:

1) restoration of the function of the cardiovascular system by including compensation mechanisms of a cardiac and extracardiac nature;
2) increasing tolerance to physical activity;
3) secondary prevention of coronary artery disease;
4) restoration of working capacity and return to professional work;
5) the possibility of partial or complete refusal drug treatment;
6) improving the patient’s quality of life.

At the outpatient stage, the following forms of therapeutic exercises are used: morning hygienic exercises, exercise therapy, training on exercise machines, dosed walking, health path, hydrokinesitherapy, swimming, sports games, short-range hiking, running, skiing.

When performing therapeutic exercises at home, the loads performed and the reaction to them are recorded in a diary. Before the lesson, the patient notes the date of the lesson in the diary and counts the pulse for 10 seconds. on the radial artery at rest. After this, the patient begins to practice LH. Every 3 minutes of exercise (training on a simulator), immediately after the end of therapeutic exercises, and every minute until complete recovery, the pulse is counted, and all data is entered into a diary. At the end of the classes, the patient dynamically notes all the sensations that appeared during the classes.

The best form of physical rehabilitation for patients who have suffered a myocardial infarction is long-term physical training. Long-term, regular physical activity in patients with coronary artery disease in conditions of limited coronary reserve affects the mechanisms of regulation of heart function, synchronization and optimization of the activity of the muscular, cardiovascular and respiratory systems.

Indications for long-term physical training: previous myocardial infarction for at least 4 months at the time of inclusion in the group. If the course of the disease is favorable, there is no coronary or heart failure, or cardiac arrhythmias, this period can be reduced to 3 months.

The duration of the training course is 10-12 months. Frequency of classes - 3 times a week; The duration of one lesson is determined individually depending on the patient’s condition at the time of the lesson. Classes are conducted in a room equipped for bicycle ergometry, which is important when training patients with coronary artery disease with a low threshold of exercise tolerance.

Long-term physical training is contraindicated if:

Aneurysm of the left ventricle of the heart, confirmed using clinical or instrumental research methods (electrocardiography, echocardiography, ventriculography, etc.);
- unstable angina and angina IV functional class (FC);
- violations heart rate(constant or paroxysmal form of atrial fibrillation and flutter, parasystole, pacemaker migration, frequent polytopic or group extrasystole, especially ventricular);
- violation of atrioventricular conduction of high degrees;
- circulatory failure stage II and higher;
- arterial hypertension with persistently elevated diastolic blood pressure above 110 mm Hg;
- a tendency to thromboembolic complications (history of thromboembolism, the presence of blood clots in the cavities of the heart, thrombophlebitis);
- pathologies of the musculoskeletal system.

A distinction is made between supervised training, carried out under the supervision of medical personnel (group and individual), and unsupervised or partially supervised, carried out at home. individual plan. Controlled group training for patients who have suffered a myocardial infarction is carried out in a group method 3 times a week for 30-60 minutes.

The optimal number of patients in a group is 12-15 people. The training course is divided into 2 periods: preparatory and basic. The latter, in turn, is divided into 3 stages, which allows for a smooth transition from light physical activity to more intense ones, preventing the possibility of overtraining.

Methodically, each lesson is divided into 3 sections: introductory, main and final.

Indicators of heart rate, blood pressure, color of the skin and mucous membranes, sweating are studied before the start of the lesson, at the end of the introductory section, at the peak of the load and at the end of the main section, at the end of the final section and until complete recovery to the state of initial rest.

The indication for switching to the main course of training is a stable adequate response of the patient to the loads used, the appearance of signs of economization of the function of the cardiovascular system under load: a decrease in blood pressure and resting heart rate, a decrease in heart rate, blood pressure and double product (DP) loads, quickly achieving training heart rate and blood pressure, reducing recovery time.

The main period of long-term training (9-10 months) is divided into 3 stages.

At the beginning of the first stage of the main period of the main part of the training session, the loads should correspond to 50-60% of the individual threshold power in patients with FC III (weak group) and 60-75% of the individual threshold power in patients with FC (strong group).

The introductory period should be at least 10% of the lesson time, the final period - no more than 25% of the lesson time. During the introductory period, a heart rate level of 75% of the maximum calculated for this activity should be achieved for this patient. In the final period, the heart rate should decrease to the HRin level by the end of the lesson. + 15% HRin.

For example:the resting heart rate of patient K., belonging to the weak group, was 75 beats/min. During functional testing, the threshold load level was reached at a heart rate of 135 beats/min. Heart rate max load 55% of the individual threshold power will be:

HRmax. 55% = resting heart rate + (threshold heart rate - resting heart rate) x 0.55

HRmax. 55% = 75 + (135 - 75) x 0.55 = 108 (bpm)

Accordingly, the maximum valueheart rate during the lesson is 108 beats/min.

In the water part of the lesson, the heart rate should be at least 75% of the maximum, i.e. 100 beats/min.

Heart rate of the introductory part = 75 + (135 - 75) x 0.55 x 0. 75 = 100 (bpm).

At the end of the final part of the lesson, the heart rate should be no more than 25% of the maximum, i.e. 83 beats/min.

Heart rate of the final part = 75 + (135 -75) x 0.55 x 0.25 = 83 (bpm).

The structure of the lesson should take place primarily using the interval-circular method, in which the physiological heart rate curve will have several peaks of heart rate max. for this lesson (2-3) lasting no more than 30-40 s.

The criteria for moving to the next stage of training are the same as for preparatory stage. Another criterion for moving to the next stage of training can be the stabilization of the patients’ condition: the absence or reduction of angina attacks; no signs of circulatory failure.

The second stage of the main period of long-term training is aimed at maximum stimulation of compensatory-adaptive reactions due to the intensification of training loads, stable stabilization of the clinical condition of patients, and complete or partial withdrawal of coronary drugs. The duration of this stage is about 5 months. At this stage, the training program gradually becomes more complicated, the intensity and duration of the loads increase.

Taking into account the individual threshold heart rate according to bicycle ergometry, the heart rate in the main part of the lesson reaches 75% of the threshold in the “weak” and 85% in the “strong” subgroups.

The criteria for moving to the next stage of training are: adequate response to physical activity according to the analysis of the physiological exercise curve and other auxiliary research methods.

By the end of the second stage of training, patients’ tolerance to dosed loads increases significantly, the body’s response to increasing loads improves as a result of economization of heart activity, and psychological condition and quality of life of patients, secondary prevention of IHD is carried out.

At the third stage of the main training period, the task is to consolidate the achieved effect, transfer the patient to a higher functional class, and increase working capacity.

At this stage of training (lasting up to 3 months), loads are intensified up to 90% (in the weak group) and 95-100% (in the strong group) in relation to the threshold heart rate determined in patients during repeated exercise testing. It is advisable to conduct an intermediate study of physical performance, necessary to assess the effectiveness of the rehabilitation program and identify a new threshold of tolerance to physical activity, 3-4 times a year.

After a one-year course of training, group classes are stopped; patients are advised to continue training on their own at home. In this case, the training loads should be lower than those prescribed to the patient under medical supervision. Once every 4-6 months, patients are referred for consultation to a cardiologist and exercise therapy doctor for regular checks and correction of the loads performed by the patient under self-control.

Individual, controlled, optimal training in terms of training effect and safety for patients who have suffered a myocardial infarction account for 25% of individual exercise tolerance. Precise load dosage is possible when using calibrated simulators.

During ergometric training (bicycle ergometer, treadmill, Harvard step), it is always possible to monitor the condition of the heart. For patients with FC III, walking training is carried out against the background of drug therapy. Walking pace is 3-3.5 km/h, training duration is from 20-60 to 120 minutes, depending on the time of year. It is recommended to perform a complex of therapeutic exercises 1-2 times a day.

The possibilities for physical rehabilitation of patients with FC IV are sharply limited. Walking at a pace of 60-70 steps per minute, individually selected therapeutic exercises in a gentle mode are recommended.

L.E. Smirnova, A.A. Kotlyarov, A.A. Alexandrovsky, A.N. Gribanov, L.V. Vankova

A patient who has suffered a myocardial infarction is often recommended to undergo exercise therapy to enhance physical recovery. This procedure is prescribed exclusively by the doctor performing the treatment.

The set of exercises and their intensity are developed by a rehabilitation specialist with the assistance of a physical therapy instructor.

All exercises are thought out and prescribed exclusively on an individual basis, since myocardial infarction affects patients differently.

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When developing an exercise plan for myocardial infarction, the first thing to pay attention to is their load. With the right approach, exercises promote rapid recovery, perfectly restore lost skills and inhibit the development of the disease.

If the dosage of the load is prescribed incorrectly or is not controlled at all, this will lead to undesirable consequences: bed rest, etc.

In addition to exercise therapy, it has a beneficial effect in the treatment of myocardial infarction. But here you also need to observe moderation: an intense massage will only lead to harm, and a moderate one will do good.

When to start classes

The plan of prescribed complex exercises completely depends on how severe the patient’s condition is, how the disease progressed, how old the patient is, what is the gender and how physically prepared the patient is.

As for contraindications to exercise therapy for myocardial infarction, they are relative and temporary. For example, during an exacerbation of the disease, exercises should not be performed for the first few days.

On the third day, a consultation is held with the doctor conducting the procedure. If the patient has no complications, then he is allowed to perform the exercises.

Initially, exercise therapy is performed while lying in bed. For the first myocardial infarction, physical education is prescribed after 3-4 weeks.

They can be very unpredictable and lead to death, so it is important to quickly call an ambulance in the early stages of a strike.

Read about the principles of the clinical picture of the subacute stage of myocardial infarction.

You can find out the code for myocardial infarction according to ICD-10.

Myocardial infarction is one of the most dangerous diseases of the cardiovascular system, ranking first in the world in terms of the number of deaths.

To return to normal life after a heart attack, adequate treatment and long-term rehabilitation are necessary. The patient must be under constant supervision of a cardiologist and follow all doctor’s instructions to avoid relapse of the disease.

To prevent recurrent attacks, you need to: give up bad habits, get proper rest, follow the prescribed diet, and avoid excessive physical and psycho-emotional stress.

During the recovery period it is necessary to exercise physical therapy(physical therapy) to strengthen muscles and improve general condition sick.

Physical exercises should begin with small loads, gradually increasing them as the patient strengthens and regains strength. Conduct exercise therapy sessions after a heart attack It is necessary under the supervision of a doctor; improper exercise can lead to a worsening of the condition. It is necessary to continue exercise therapy after discharge, while carefully monitoring your well-being and avoiding overwork. Remember the risk to your health and do not force an increase in stress on the heart.

The rehabilitation period is conventionally divided into three phases:

• hospital phase (treatment and recovery in hospital);
• recovery phase (return to work capacity);
• support phase (medication, observation by a cardiologist, prevention).

Selecting physical exercises after myocardial infarctionrehabilitator and exercise therapy instructor for each patient, taking into account his condition after the attack. The dosage of the load must be prescribed and its gradual increase must be steadily controlled. The same goes for massage. A light, moderate massage will benefit the patient, but an intense one can be harmful.

During the acute period of the disease, the patient is prescribed bed rest and complete rest. If the condition has improved and the patient has no complications, on the third day the doctor may allow you to perform simple exercises while lying in bed.

No earlier than 3-4 weeks later, if the heart attack was the first, exercise therapy is prescribed. In case of repeated attacktherapeutic exercises after myocardial infarction can be prescribed no earlier than 6 weeks later.

Exercise therapy rules

During classes During physical education during myocardial infarction, the following rules must be observed:

• even if you feel well, you cannot sharply increase the load;
• if during or after exercise your heartbeat quickens, shortness of breath, dizziness, or any discomfort appears, stop exercising and tell your doctor;
• you can’t exercise immediately after eating;
• Patients suffering from osteochondrosis and atherosclerosis should not do low bends. Strength exercises and forceful rotation of the torso and head are also not recommended.

Stages of rehabilitation

Stationary (hospital)

The rehabilitation period in a hospital is carried out for:

• improving peripheral blood circulation;
• increase in coronary collaterals (bypass paths of blood flow) and capillary bed;
• restoration of the patient’s mental state;
• improving respiratory function;
• normalization of the gastrointestinal tract;
• relieving tension in segmental muscles.

Inpatient rehabilitation is divided into 4 levels of activity; the level of permissible load is individually selected and adjusted daily.

Stage 1 – a patient who has suffered a myocardial infarction remains on bed rest. Therapeutic gymnastics (TG) is performed according to complex No. 1. Classes last 10-15 minutes. with relaxation and breathing exercises during pauses. Indicators (pulse rate, breathing rate and pressure readings) are checked before and after the lesson. If there are no attacks of angina, complications or negative ECG changes, the patient is transferred to the next step.

The 2nd stage involves the transition to eating at the table, walking around the ward and corridor with an accompanying person. PH according to complex No. 2, including exercises not only while lying down, but also while sitting on a chair. The patient is prepared to move independently along the corridor, and is allowed to climb several steps up the stairs. If pulse and blood pressure readings and the orthostatic test (reaction of the ss to standing up) are normal, then you can proceed to the 3rd stage of activity.

3rd stage. The patient is allowed to walk along the corridor 50-200 m at a slow pace, and climb one flight of stairs. They prepare the patient to fully care for himself, to go out for walks on the street. LH – complex No. 3 with sitting-standing exercises with a gradual increase in load. Duration of classes is 15-20 minutes, at a slow pace with slight acceleration. Telemonitoring is used to monitor performance.

4th stage. Allowed are walks of 500-900 m at an average pace, 2 times a day, 30-minute exercises on the LH complex No. 4 at a slow and medium pace with exercises for the limbs, shoulder girdle, and back muscles. The patient is prepared for discharge home under the supervision of a cardiologist or transfer to a sanatorium for further rehabilitation.

After inpatient rehabilitation, the patient must independently climb the stairs to one floor, take care of himself, walk 2-3 km per day with breaks for rest, if there is no deterioration in the condition.

Recovery stage

After discharge, the patient continues rehabilitation in a clinic or sanatorium to bring the cardiovascular system back to normal. Adaptation to various loads (domestic, professional) is carried out. Exercise therapy, walking, exercises on machines, using simple sports games. Doctors strive to achieve maximum activity of the recovering person, without exceeding the load beyond the permissible limit.

Home stage of rehabilitation

The tasks of this stage are:

• increasing permissible physical activity;
• everyday, social, professional adaptation;
• improvement of vital signs;
• secondary prevention of cardiac ischemia;
• reducing the amount and dose of medications taken.

There is a high probability of a recurrence of a heart attack, especially within a year after the attack, so you must constantly monitor your well-being and indicators of breathing, heartbeat, and your sensations. Physical exercise should be easy and without undue stress.

Many exercise therapy complexes have been developed to restore health after a heart attack.

Exercise therapy complexes for myocardial infarction

I complex.

1. IP: standing, feet shoulder-width apart, arms hanging freely. Hands up, stretch - inhale. Lower your arms, describing a circle - exhale. Repeat 4-6 times.
2. IP: standing, feet with toes apart, hands on the belt. Turn to the left, arms to the sides - inhale. To the starting position – exhale. The same in the other direction. Repeat 4-6 times.
3. IP: as in exercise 1. Inhale, squat, leaning forward, arms back - exhale. Perform 4-6 times.
4. IP: same. Inhale. hands on hips. Sit down, exhaling. 3-4 times.
5. IP: sit on a chair, lean on the back. Grab the seat with your hands, stretch your legs forward. Bend over, moving your head back - inhale, to the starting position - exhale.

II complex.

1. IP: sitting on a chair, arms along the body. Inhale - raise, exhale - lower your shoulders. (4 times).
2. Sit on the hand of one hand, tilt your head with the other hand, clasping it from above to the shoulder, relaxing the neck muscles.
3. Hands - on shoulders. Make circular movements with your arms at a slow pace with maximum amplitude (6-8 times in each direction).
4. Place your hands in a “lock” at the back just below the crown. Bend your head forward with your hands, stretching the neck muscles, elbows down. Do 10 spring elbow raises, stretching the neck muscles. Breathe rhythmically through your nose.
5. Arms bent at the elbows, forearms parallel to the floor, palms up. Bring the shoulder blades towards the spine with springing movements 20-30 times. Breathing is rhythmic, nasal.
6. Bend your elbows and try to clasp your hands behind your back. Reach towards the middle of your back: one hand from above, the other from below. Repeat 4-8 times, changing the position of the hands;
7. Sit on the edge of the chair seat, lean back. Hold the front edge of the seat with your right hand. Tilt your head to the left towards your shoulder, do not strain your neck muscles. Slowly turn your head up and right, then left and down. 4-6 times. The same in the other direction.
8. The left arm is extended forward, palm down. With your right hand, grabbing the fingers of your left, pull it towards you, stretching the muscles of the forearm and palm - 10-15 springing movements. Repeat for each finger.
9. Tighten the chin muscles and slowly lift your face up, trying to touch the back of your head with the back of your head, pause 3-4 times, return to IP. head and relax.

Therapeutic exercise for bedridden patients

When performing exercise therapy, do not overexert yourself, perform the exercises with caution, but minimal physical activity should be started as early as possible in order to recover faster and so that the muscles do not weaken from prolonged inactivity. You need to prepare yourself for further rehabilitation by lying in bed, doing simple physical exercises. developing fingers, arms, legs

In addition to exercise therapy exercises for myocardial infarction, breathing exercises according to Strelnikova or Buteyko are used during the recovery period. Breathing exercises relax the respiratory muscles, promote dilation of blood vessels, improve the absorption of oxygen by body tissues, and provide a calming effect. Breathing exercises must be selected very carefully and performed with extreme caution.

1. exercises with exhalation through a tube into a glass of water (“open” resistance);
2. breath holding exercises;
3. exercises with different durations of inhalations and exhalations.

Physical rehabilitation after a heart attack with the help of morning exercises, exercise therapy, training of different muscle groups, dosed walking and climbing stairs, training on paths with different angles of elevation accelerate the process of restoration of working capacity and return to normal life. This process can take a lot of time; you cannot force things. Increase the load gradually, avoid the appearance of shortness of breath, fatigue, increased heart rate, and discomfort in the heart area.

Patients with aneurysm, acute heart failure, arrhythmia fculture for myocardial infarction contraindicated.

Thanks to the achievements modern medicine More patients are now surviving heart attacks. And the rehabilitation process plays a big role in this progress. Therapeutic gymnastics exercises should be performed daily with a gradual increase in load.

You should feel stable without shortness of breath or chest pain:

• the pulse should not increase by more than 20 beats/min;
• pressure no more than 10-12 - upper (systolic) 20 mm Hg. – lower (diastolic);
• the respiratory rate should not increase by more than 6-9 r./min.

Otherwise, you need to reduce the load or stop exercising and consult a cardiologist.