A set of physical exercises and therapeutic exercises for myocardial infarction

Exercise therapy for myocardial infarction is essentially a method of treatment prescribed to the patient after the disappearance of the main symptoms. Therapeutic physical culture helps to cope with the consequences of this serious illness. How this happens will be discussed further.

Physiotherapy exercises will ensure the physical recovery of the patient. The appointment is given by the attending physician, and the process is developed by a rehabilitation therapist together with an instructor of physiotherapy exercises. To achieve the result, each exercise is selected individually.

The need to select exercise therapy for myocardial infarction individually for each patient is due to the uniqueness of all cases. Each patient suffers differently this ailment and its consequences. Therefore, the correct selection of exercises is extremely important.

Correctly selected physical activity accelerates recovery, helps to restore lost skills, and also slows down the further development of the disease. But prescribing inappropriate as well as uncontrolled exercise after myocardial infarction can exacerbate the situation. They can bring the patient to a state where bed rest with medication is the only option.

To achieve great results, in addition to training, it is allowed to resort to moderate massage. The main thing is that it is not too intense, otherwise it can be harmful.

The patient's health is in his hands

Start of classes

Therapeutic exercises after myocardial infarction in a patient should begin at a strictly defined time. The onset of this time is determined by the attending physician. It relies on the following data:

• the severity of the patient's condition;
• the development of the disease;
• the age of the patient;
• the physical state.

When the set of indicators meets the standards, you can start classes. Contraindications to exercise therapy after myocardial infarction are temporary factors. If an exacerbation has occurred, then the first days cannot be dealt with. After 3 days, an examination is carried out, and if there are no complications, rehabilitation is resumed.

Patients first perform physical activity after a heart attack while in bed. They begin to perform them after about 3 weeks. But this is only if the suffered heart attack was the first.

In cases where it is a repeated or severe heart attack, a set of exercises begins to be done after at least 5 weeks.

A set of exercises

How to Exercise?

Charging should be done strictly according to the instructions. To do this, you should adhere to the following rules:

1. You cannot sharply raise the level of load, you cannot run with all your might, and so on. Even if the patient's condition is good and it seems to him that he will endure.
2. If in the process of training the patient develops weakness, malaise, shortness of breath, pain in the heart, or something similar, then you need to interrupt. In the case when the above symptoms do not go away in the patient, you need to take validol or nitroglycerin and call a doctor.
3. Physical education for myocardial infarction is performed several hours after eating.
4. Elderly people should avoid bending below the heart during exercise. Why? If they suffer from atherosclerosis or osteochondrosis, such inclinations can cause a sharp rush of blood to the head. It is also not recommended that they engage in strength exercises that require enhanced rotational movements of the head and trunk.

These exercises are the answer to the question: is it possible to play sports after a heart attack? A careful, correct approach to exercise allows you to restore health and play sports, provided that the load and severity are reasonable.

Nurse Supervised Activities

Rehabilitation

Rehabilitation after myocardial infarction and stenting takes place in two stages. The first stage is stationary, and the second at home:

Stationary stage

At this stage, it is important to achieve the following objectives:

• activate the patient's peripheral circulation;
• help the patient's psyche to adapt;
• reduce tension in segmental muscles;
• increase respiratory function;
• launch the systems responsible for counteracting the patient's blood clotting;
• prevention against disruptions in the gastrointestinal tract, muscle hypertrophy, pneumonia and arthrosis in the left shoulder joint;
• to increase the patient's resistance to the severity of loads in order to get used to everyday everyday affairs in the future;
• increase the collateral of the myocardium, the capillary bed and normalize trophic processes.

The patients involved in these tasks receive the result depending on the extent of the heart attack and its complications.

If there were no significant problems, then by the end of the inpatient stage, the patient will be able to independently climb the stairs to the 1st floor. He will be able to serve himself and take walks every day, 3 km, divided into 2-3 parts. In this case, the human body will not experience any inconvenience.

Home stage

Patients discharged from the hospital after a heart attack and stenting must undergo rehabilitation in a polyclinic or sanatorium. They pay attention to sports to achieve good results. For this, the patient is periodically engaged in a sports simulator. He has to run on a treadmill and use an exercise bike.

This approach has the following goals:

• the patient must learn to carry loads;
• he must adapt to his current state;
• secondary prevention is carried out;
• the number of drugs taken is reduced.

Correctly completed these 2 stages will reduce the negative consequences of the previous illness, adapt to your current state and return to normal life.

Gym

Exercises

To bring the body back to normal, there are a lot of different complexes. Among them, you can find the most suitable for a patient in any condition.

For example, there is such a complex:

1. Place your feet shoulder-width apart and place your arms perpendicular to your torso. Stretching your arms up, inhale. As you exhale, lower your arms, describe a circle with them and lower them. Actions need to be done 5 more times.
2. Place your socks apart on your feet and your hands on your waist. Turn to the left, spreading your arms out to the sides, and inhale. Return to the starting position and exhale. Then repeat the action to the right. And so about 5 times.
3. Sit on a chair with your elbows back and your legs extended. Grasp the seat firmly with your hands, bend over, inhaling and pulling your head back. Come back out exhaling. The steps must be repeated 5 more times.

Together with medications, these exercises will have a noticeable effect and speed up recovery.

For bedridden patients

The acute need for physical activity in bedridden patients has created several special complexes. These exercises are designed to bring patients who are unable to walk on their own back to normal.

This complex is performed as follows:

• breathing with the diaphragm is done at least 4 times;
• clench your fist quickly and also quickly unclench your fist at least 10 times;
• rotate your feet at least 5 times;
• bend each arm at the elbow at least 4 times;
• without lifting your feet from the bed, bend your legs 4 times;
• only under the guidance of an instructor, lift the pelvis 3 times;
• restore breathing;
• 5 times to spread and bring your knees, keeping your legs in a bent position and without lifting your feet from the bed;
• Straighten and take each hand to the side 4 times;
• only under the guidance of an instructor, turn 3 times on each side;
• Rotate each brush 5 times.

Any of the listed activities should be easy for the patient. If in the process he feels weak, then you need to interrupt. In no case should the patient's body be overstrained.

Breathing exercises

Respiratory gymnastics is a special movement that squeezes the chest, combined with inhalation and exhalation. The body's need for oxygen, raised by gymnastics, increases the ability to assimilate it and activate all metabolic processes.

This method has practically no contraindications, it is quite simple and very effective. It improves vitality and improves mood. Thus, it helps not only to improve the patient's condition, but also to overcome depression and other negative emotions..

Without active movements, a heart attack may occur again.

Correct recovery is essential. It will help the patient return to normal life. Therefore, it is worth listening to the opinion of specialists and, following their recommendations, undergo a full-fledged course of rehabilitation.

You can find even more information in the video:

More:

Exercise therapy techniques for various diseases of the cardiovascular system, the effectiveness and duration of therapy

19.10.2017

A heart attack is a dangerous condition in which the activity of the body's main "motor" is impaired. For people who have had a heart attack, a number of rehabilitation procedures and physiotherapy exercises, in other words, exercise therapy, are provided.

A complex of specialized exercises is selected and combined by a rehabilitation therapist in tandem with an instructor. Each of the exercises is selected individually, the course and consequences of a heart attack are different for each person.

The correct choice and implementation of remedial gymnastics will lead to the rapid restoration of lost skills, and stop the development of complications. If the load is poorly selected or not controlled, this threatens a deterioration in the condition, bed rest and the appointment of a course of medication.

When to start training after a heart attack

The time when it is time to master the set of exercises is in direct proportion to the severity of the course of the pathology, the causes of the disease, age and gender, physical form.

Contraindications to physical education are temporary - the prohibition applies to physical activity during the time from the acute period. Already at 3 weeks, you can consult with a rehabilitation therapist and, in the absence of complications, start exercising.

At first, physical exercises after myocardial infarction are performed in the supine position directly on the bed, where the patient is resting. When a heart attack occurs in a person for the first time, exercise therapy is prescribed after 3 weeks, and if repeated, after 5-6 weeks.

Rehabilitation rules for heart attack

Patients who are prescribed physiotherapy exercises must strictly follow the doctor's instructions - do not increase the load on their own, be sure to stop classes in case of discomfort and deterioration. If stopping the exercise does not bring relief, you need to take nitroglycerin and see a doctor.

Exercises are performed after 2 or more hours from a meal, not earlier. For those who have atherosclerosis / osteochondrosis, inclinations below the level of the heart are contraindicated so that the blood flow does not flow to the head. Strength exercises and rotation of the head, trunk are prohibited. The room where charging is carried out must be ventilated, the patient must wear comfortable clothing.

Rehabilitation of heart attackers takes place in two stages - inpatient and home, each stage is characterized by its peculiarities.

Inpatient rehabilitation is aimed at the following tasks:

• stimulate blood circulation in peripheral vessels;
• improve the psycho-emotional state of the patient;
• reduce muscle tension;
• increase respiratory function;
• activate systems that prevent blood from clotting;
• to establish the work of the digestive tract;
• prevent arthrosis, muscle atrophy, pneumonia and other complications;
• normalize trophic processes.

The exercise therapy complex for myocardial infarction is selected taking into account the severity of coronary insufficiency, the extent and depth of the infarction, and the presence of complications. By the end of the inpatient period of rehabilitation, the patient can go up to the 1st floor, walk 2 km a day in several stages. The body should not respond to physical activity.

After the inpatient, home rehabilitation follows, when the patient undergoes the prescribed procedures at a local clinic or in a sanatorium. Home remedial exercise is aimed at the tasks:

• increasing the body's endurance;
• secondary prevention of ischemia;
• restoration of the work of the heart and blood vessels;
• improving the quality of life;
• reducing the dosage of prescribed drugs.

You need to exercise at a certain time and exactly as the instructor showed - the number of repetitions and the intensity of the exercises should not be an overload, but a normalized exercise for a heart that has had a myocardial infarction.
Records are not set, the goal is different - to restore the body's working capacity, avoid disability, and prevent relapses. Presented are those exercises that are included in the complex of charging people after a heart attack. The complex is adjusted by the doctor for the patient.

Complex exercise therapy

Depending on the severity of the patient's condition, age and gender, the specified complex changes and is supplemented.

Standard exercises:

• stand up straight with your feet shoulder-width apart, and your arms at your sides. You need to concentrate on breathing, not strain. As you inhale, your hands are raised above your head, you need to reach for them. As you exhale, the arms fall smoothly into place along the circumference. Repeat 4-6 times;
• the starting position is the same as in the first exercise. On the exhale - a slow squat with a slight forward bend of the torso and the abduction of the arms behind you. Upon returning to the starting position, inhalation is performed. Repeat 4-6 times;
• stand straight, turn your feet to the sides, and place your hands on your belt. When turning to the right side, the arms are spread out to the sides and inhale. When returning to the starting position, exhale, repeat to the left. The exercise is performed 6 times;
• starting position - stand up straight, hands at the seams. Take a breath, squat, placing your hands on the belt. Exhale while squatting. Returning to the starting position, inhale. Repeat 4 times. Squats are useful, unload peripheral vessels, normalize venous blood flow, prevent blood stasis and vascular thrombosis;
• need a chair with a back. The starting position is to sit on a chair and lean on the back, grab the seat with your hands, straighten your legs, leaving your feet on the floor. On inhalation, bend your back, tilt your head back. On exhalation, return to the starting position, repeat 6 times.

Rehabilitation includes not only exercise therapy for myocardial infarction, but the doctor's medication and a therapeutic diet. Meals exclude fatty and spicy foods, alcohol and soda, sweets and other foods. The diet should be rich in fiber and vitamins. A detailed menu will be written by the doctor.

All therapeutic measures in the complex will have an effect. If the instructor permits, during the exercise you can use sports equipment - gymnastic sticks, balls, etc. The need for additional equipment arises as health improves, when it is time to increase the load.

Exercises for bedridden patients

Patients who are forced to comply with bed rest, a number of exercise therapy exercises for myocardial infarction will have to be carried out in a horizontal position.

Types of activity have been developed for them:

• breathing with the diaphragm - 4 times;
• unclenching the fingers into a fist for speed - 10 times;
• rotation of the feet clockwise and back - 5 times;
• pulling the legs towards you so that the knees are bent, the feet do not come off the bed - 4 times;
• flexion of the arms at the elbow joint - 4 times;
• raising the pelvis - 3 times. It is carried out under the supervision and with the help of an instructor.

After the exercises listed above, you need to rest a little so that breathing is restored, and the heart rate is normal.

When the condition returns to normal, charging continues:

• the legs are bent at the knees, the feet remain on the bed. Bring your knees and spread them to the sides - 5 times;
• straighten your arm and take it to the side - 4 times with each hand;
• side turns - 3 times in each side. It is carried out under the supervision and with the help of an instructor;
• rotation with brushes - 5 times.

Performing exercise therapy after myocardial infarction, they control their health and do not overstrain. Movements must be neat. If you feel severe fatigue, you do not need to overcome it, it is more correct to take a short rest and after that resume the gymnastics.

You can find out how to do the exercises correctly in the recommendations in the video. For those who have difficulty performing gymnastics from a prone position, it is recommended to use rollers and pillows, ensuring a comfortable position.

Any of the above exercises should be performed without much difficulty, with pleasure. If it is difficult to immediately complete the required number of repetitions, you can start with a smaller one, gradually bringing it to normal.

Breathing exercises

For therapeutic exercises after myocardial infarction to be beneficial, you need to breathe correctly. Calm breathing normalizes the heartbeat, blood flow improves, and helps to put pressure and other parameters in order.

One of the techniques is breathing according to Strelnikova. The author of the technique was a singer, and she developed this technique for singers. The uniqueness of gymnastics is that only this technique provides for a short and sharp breath against the background of exercises aimed at compressing the chest.

Physical education after a heart attack makes the blood move more actively throughout the body, and with the help of breathing exercises, the blood is saturated with oxygen and delivered to the organs in the best possible form. Strelnikova breathing increases the absorption of oxygen by tissues, irritates receptors on the nasal mucosa, which is interconnected with all organs.

The technique is suitable for patients of all ages, not only after a heart attack, but also during a cold. Correct breathing speeds up treatment, will prevent the development of complications.

Exercise is done twice a day - in the morning and before bed. In total, you need to take 1500 breaths. It is important to distinguish between food intake and exercise therapy after a heart attack, all exercises are done 2 hours before meals or 1 hour after. For the prevention of various pathologies, it is good to perform breathing exercises instead of morning exercises after waking up. You can practice correct breathing along Strelnikova in the evening in order to relieve accumulated fatigue, improve memory, and increase vitality.

Thanks to correct breathing, patients feel a surge of vivacity and increased efficiency. Correct implementation of breathing exercises relieves stoop, provides the body with flexibility, improves the functioning of the genitourinary system, accelerates recovery in case of gynecological diseases, varicocele.

Buteyko breathing is another popular technique that can accelerate the treatment of various ailments: chronic pneumonia, toxicosis, rhinitis, asthma attacks, epilepsy, angina pectoris. The author of the technique proposes to suppress deep breathing by willpower, eliminating hyperventilation of the lungs as needed.

Performing exercises, a person relaxes the muscles of the respiratory system, holding the breath until the moment, until he feels a lack of oxygen. This principle will make breathing not deep, you have to breathe less often, which expands the bronchi and blood vessels, relieves the excited state of the nervous system.

Respiratory gymnastics is allowed in the presence of a doctor. The help of a physician is especially important during attacks of suffocation. The doctor will teach you how to cope with critical conditions and conduct trainings. This will help to regulate the state of health with the help of breathing. Indications and contraindications for breathing exercises are necessarily evaluated, this applies to each of the exercises of physiotherapy exercises - they cannot be useful or harmful.

As for the choice of breathing exercises to relieve a painful attack, you need to keep a diary, where you enter information about medications, their dosage, recommendations regarding exercise therapy and their observance, about changes in well-being. By analyzing the information, you can start preventing relapse by controlling your breathing. When the condition returns to normal, the training schedule is adjusted.

An active lifestyle will help to restore a person's ability to work after a heart attack and improve the quality of life, including morning therapeutic exercises, dosed walks, climbing stairs and breathing exercises.

The rehabilitation process will not be quick, but you should not rush, the main thing is to achieve positive changes in well-being. The loads should be increased in a timely manner so that during exercise therapy there is no shortness of breath, feelings of fatigue and discomfort in the sternum. The attending physician will select the elements of gymnastics, will monitor the patient's condition.

For a patient who has had a myocardial infarction, for enhanced physical recovery, it is often recommended to undergo exercise therapy. This procedure is exclusively prescribed by the physician 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 in different ways.

When developing an exercise plan for myocardial infarction, the first thing to do is pay attention to their load. With the right approach, exercises contribute to a quick recovery, perfectly restore lost skills and slow down the development of the disease.

If the dosage of the load is prescribed incorrectly, or if it is not controlled at all, then this will lead to undesirable consequences: bed rest and drug treatment.

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

When to start classes

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

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

On the third day, a consultation is carried out with a doctor conducting rehabilitation. If the patient has no complications, then he is allowed to do the exercises.

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

With repeated MI or with its severe stage of development, exercise therapy can be done only after 5-6 weeks.

Basic rules for performing exercise therapy for myocardial infarction

If you are prescribed a therapeutic exercise, then you must follow all the doctor's prescriptions:

1. You should not increase the load very sharply, even if you are in good health.


2. If during or after exercise you feel discomfort and malaise, for example, shortness of breath, heart palpitations, heart discomfort, dizziness, rhythm disturbance, then the exercise should be stopped. And if after that the pain in the heart does not stop, it is recommended to take nitroglycerin or validol and immediately consult a doctor.
3. Exercise is performed only a few hours after eating.
4. People of age who, in addition, suffer from cervical osteochondrosis or atherosclerosis, should not bend "below the heart" so that blood does not suddenly rush to the head. In addition, strength exercises and rotational movements of the head or trunk are not recommended.

Rehabilitation stages

Physical rehabilitation of patients after suffering a myocardial infarction includes a stationary and home period:

Stationary

During the stationary period of rehabilitation, the following tasks are set: activation of peripheral circulation; beneficial effect on the mental state of the patient; reducing the tension of segmental muscles; increased respiratory function; activation of systems that prevent blood clotting; preventive measures to prevent malfunctions in the gastrointestinal tract, the occurrence of pneumonia, arthrosis in the left shoulder joint, muscle hypertrophy; increased resistance to physical stress and addiction to household; an increase in the capillary bed, collaterals of the amiocardium, normalization of trophic processes. Depending on the degree of FC the patient belongs to, the success and speed of accomplishment of the assigned tasks depends. At the same time, they look at the extent of the heart attack, at its depth, at how pronounced coronary insufficiency is, whether there are complications, and what are they of the nature. By the end of inpatient rehabilitation, the patient's physical condition should be such that he can climb the stairs to the level of the 1st floor, self-serve himself and take walks up to 2-3 km per day, having previously divided them into 2-4 stages. In this case, negative reactions of the body should not be observed.

Home

Patients who have had myocardial infarction and are discharged from the hospital undergo rehabilitation in a sanatorium or clinic. During this period, sports (namely exercise therapy) are very important for the patient. In home rehabilitation, the following tasks are set: increased exercise tolerance; rehabilitation of social, household and professional type; secondary prevention of coronary heart disease, restoration of the functioning of the cardiovascular system due to the work of the mechanism of extracardiac and cardiac compensation; improving life; reducing the doses of drugs taken. Before placing a patient in a rehabilitation center, the FC of the patient's condition is identified, taking into account the clinic of chronic coronary insufficiency, syndromes and complications that accompany myocardial infarction.

A set of physical exercises

To restore health after myocardial infarction, there are many complexes.

1. Stand in the starting position (IP): stand up, place your feet shoulder-width apart, and stretch your arms along your torso. First, raise your arms up and stretch while inhaling. As you exhale, lower your arms in a circle. The frequency is 4-6 times.
2. Take a standing position, put your feet toes apart, put your hands on your belt. First, turn to the left, while spreading your arms to the sides, and inhale. Return to the previous position by exhaling. The same exercise is done for the right side. The frequency is 4-6 times.
3. Take an upright position, stretch your arms along your torso, and put your feet shoulder-width apart. Take a breath. Then you squat, at the same time making a slight forward bend and taking your arms back - exhale. The frequency of execution is 4-6 times.
4. The starting position is the same as in exercise 3. Take a breath. Hands are placed on the hips and squatted, exhaling at the same time. When returning to the starting position, inhale. Exercise frequency 3-4 times.
5. You will need a chair for this quest. They sit on it, lean on the back, grab the seat with their hands, and stretch their legs. This is the starting position. Now you need to bend over and take your head back. At the same time, take a breath. Returning to the starting position, exhale. The frequency is 4-6 times.

With myocardial infarction, exercise, medication and rehabilitation will quickly have a positive effect. If your health allows, with the permission of the instructor, you can use gymnastic sticks, fitballs, balls when performing exercises.

For bedridden patients

Such patients perform exercise therapy while lying in bed. This does not require the use of fitballs, or a gymnastic stick.

The following sequence of exercises is performed:

1. Breathing with the diaphragm 4 times.
2. Rapidly clenching the fingers into a fist and quickly unclenching it. The sequence is performed 10 times.
3. They make rotational movements with their feet (5 times).
4. Bend the elbows 4 times for each arm.
5. Leg curl - 4 times. However, they should not come off the bed.
6. Raising the pelvis 3 times. This exercise should only be done with the help of an instructor.
7. Now they rest for some time until breathing is restored to a normal rhythm.
8. Bend your legs at the knees, leaving your feet on the bed. Now the knees are pulled apart and brought together (5 times).
9. The straightened arm is taken to the side and returned to its original position. Repeat 4 times for each hand.
10. With the help of the instructor, they make side turns. Three times for each side.
11. Rotating movements with brushes 5 times for each hand.

During exercise with myocardial infarction, it is important to be careful and not overexert the body. If you feel tired, you need to rest. For clarity, you can watch the video in order to perform the exercises correctly.

If it is difficult to do the exercises, you can use pillows that need to be conveniently positioned on the bed, thereby building a comfortable place for training. Remember, any recommended exercise should be done with ease.

serdce.hvatit-bolet.ru

Classes of severity of the condition of postinfarction patients

First grade. Under normal loads, there is no pain, they appear with the intensification of physical efforts.

Second class. Painful sensations appear during physical activity (walking), climbing several flights of stairs, getting into a cold room, immediately after waking up.

Third class. Painful sensations are caused by ordinary walking on level ground for a distance of up to 500 m, when climbing one flight of stairs.

Fourth grade. Painful sensations disturb at light load, the patient loses the ability to perform any type of work.

From the first to the third grades, these are patients with small focal and uncomplicated heart attacks. The fourth - with severe complications.

The restoration of the physical form of postinfarction patients (regardless of the severity class) includes three stages. Hospital stage - from the onset of the acute period until the appearance of clinical signs of recovery. Post-hospital stage - the period between discharge and resumption of work. At this stage, treatment is carried out on the basis of a polyclinic or in a sanatorium-resort way. Supporting stage - restoration of lost functions and return to work. At any stage of the rehabilitation process, physical education sets its own goals and solves certain problems.

Exercise therapy at the hospital stage: goals, objectives, contraindications

Therapeutic physical culture in the hospital is aimed at restoring the patient's motor functions to such an extent that would allow him to serve himself independently, climb the stairs for at least 1 flight, and walk up to 1 km in 1 reception (the number of receptions is brought to 3). After such activity, significant negative reactions should not be observed.

Further exercise therapy procedures are aimed at the patient's readaptation to the usual living conditions, the prevention of hypokinetic disorders, and the restoration of motor skills.

The main tasks of exercise therapy:

1. Psychological rehabilitation of postinfarction patients (improving mood and perception of the situation).
2. Physical recovery of heart attack patients. Reducing the tension of small muscle groups, restoring the functions of the muscular corset, improving trophism, expanding the system of collaterals (bypass paths) of the myocardium, etc. As well as adaptation to household loads, and the tolerance of physical exercises by patients.
3. Prevention of pneumonia (improvement of respiratory tract functions), gastrointestinal disorders (improvement of peristalsis, normalization of defecation processes), development of arthrosis in the joint of the left shoulder.

Despite the fact that remedial gymnastics solves such important problems, it has a number of serious contraindications. The approach to its appointment should be personal, taking into account the state of the myocardium, the vascular system and the presence of concomitant pathologies. Contraindications to the appointment of exercise therapy are the following conditions: arrhythmias, extrasystoles, acute heart failure, shock conditions, fluid accumulation in the lungs, repeated heart attacks, etc. At any stage of treatment, if the described phenomena occur, the transition to the next level of physical activity is prohibited.

Particular care must be taken when prescribing therapeutic and gymnastic measures for extensive myocardial infarction in combination with cardiosclerosis.

Exercise therapy load modes used for the rehabilitation of postinfarction patients

Isometric mode means that tension is generated in the muscle, but it does not shorten, for example, when trying to lift a large load. A kind of therapeutic isometric regimen for postinfarction patients is not so much in the strength of the load, but in its duration.

The wrist muscles are trained with an expander, the muscles of the lower extremities are developed using a special device that loads the leg extensors. The complex of exercises for the legs increases the static tolerance of patients. Isometric training is carried out until the end of the inpatient treatment. Electrocardiographic monitoring is required.

The mode, which combines static and dynamic loads, is carried out in a standard way, depending on the patient's motor activity regimen.

The interval mode consists in the fact that the patient makes several repetitions of the same type of movements (walking in a prone position, walking in a sitting position, standing up and sitting down), between which he observes fixed breaks. This mode allows the body to learn to bypass the lesion.

The interval mode is used to normalize the reactions of muscle, nervous and vascular elements, restore blood circulation through the selection of individual loads, reduce the subjective elements of the disease (negative mood, demoralization), and shorten the recovery time. This mode consists in the fact that after carrying out 4-6 exercises of exercise therapy, the complex includes some kind of the same type of repetitive exercise.

The basic rule is that there should be a pause of 120 seconds between repetitions, the exercise itself should be 45 seconds long. In case of an increase in the pulse (more than 35 beats), the occurrence of pain in the muscles and weakness, the exercise should be stopped.

When a complex of exercise therapy is introduced

It is introduced into the patient's regimen on the third day after pain relief.

Static exercises alternate with dynamic (breathing) exercises. There should be twice as many breathing exercises at the initial stage.

Depending on the mode of restriction of movement (bed strict extended, transitional, ward, general tonic), a complex of procedures for physical rehabilitation of the patient is being built.

The time spent by the patient on inpatient treatment is conventionally divided into 4 stages, which have subsections ("a", "b", "c"). The severity class of the patient's condition, the regimens used in therapeutic exercises, and the patient's transition from stage to stage are determined by the doctor, under the control of blood pressure, pulse rate and ECG. The severity class is determined after the removal of the pain syndrome. This is about 3 days. At each stage of medical gymnastics, there are contraindications for transferring the patient to the next stage. Contraindications are deterioration, wheezing in the lungs, tachycardia, arrhythmia, dizziness.

Despite all the usefulness of remedial gymnastics, any of its complex must be approached deliberately and carefully.

Physical activity does not need to be feared or avoided.

However, you should not overdo it with the load. If during the exercise you experience unpleasant or painful sensations, you should consult a doctor to avoid possible complications and a second heart attack.

kardiologdoma.ru

We offer a set of exercises, which is recommended to be performed in the first month after discharge from the hospital, of course, with the permission of the attending physician. If during the exercise there is pain in the heart, you must immediately take nitroglycerin and lie down until the pain disappears and the state of health becomes satisfactory. You should also lie down if you experience heart failure, weakness, shortness of breath. Immediately or the next day, you need to consult with your doctor if you need to make adjustments to the complex. In the first week after discharge from the hospital, at a slow pace, do morning exercises (exercises 1-10), and in the afternoon general strengthening (exercises 11-23). You need to do it in a well-ventilated room, in the warm season it is better in the yard, on the terrace, on the balcony.

Morning exercises

Sitting

1. Sit on a chair without touching the back, legs shoulder-width apart, hands on the belt. Inhale deeply through the nose and exhale slowly as fully as possible through the lips folded into a tube (photo 1). Repeat 3-4 times.

2. Hands on your knees, palms up. Bend (photo 2) and unbend the hands, straining the muscles of the forearm. Breathing is arbitrary, repeat 8-10 times.

3. Straighten your legs, lean on your heels. Extend and flex your feet. Breathing is arbitrary. Repeat 10-12 times.

4. Feet shoulder width apart. Turn your head to the right, to the left. Breathing is arbitrary. Repeat 4-5 times in each direction.

5. Hands along the body, palms forward. Clench your fingers into a fist, then bend your elbows (photo 3), straining the muscles of the forearm and shoulder. Breathing is arbitrary. Repeat 8-10 times.

6. Hands along the torso, relax. Breathe slowly, deeply for 15-20 seconds.

7. Legs together, hands stick to the seat of the chair. Alternately bend and unbend your knees, sliding your feet on the floor. Breathing is arbitrary. Repeat 5-6 times with each leg.

After 7-14 days, unbending your legs, you can alternately raise one of the feet 20-30 centimeters above the floor.

8. Legs shoulder-width apart - inhale, tilt the body to the right - exhale; return to starting position - inhale. The same to the left. Repeat 4-5 times in each direction.

9. Feet shoulder-width apart, hands on the knees - inhale; lean forward slightly - exhale (photo 4); stand up, resting your hands on your knees.

Standing

10. Breathe slowly deeply for 15-20 seconds, then walk slowly for 1-2 minutes (50-60 steps per minute). Relax for 2-3 minutes.

Approximately in the middle of the day, but not earlier than 1.5-2 hours after breakfast or 1.5-2 hours before lunch, at 12 o'clock, it is recommended to do a complex of general strengthening therapeutic gymnastics. It should be performed daily or intermittently for a day or two, if advised by the attending physician.

General strengthening gymnastics

11. Sit on a chair, feet shoulder-width apart. Breathe slowly, deeply for 15-20 seconds: inhale through the nose, exhale through the lips folded into a tube.

12. Do exercise 2 from the morning gymnastics complex, raising your arms slightly above your knees.

13. Do exercise 4.

14. Feet shoulder width apart, hands on knees. Raise your hands above your knees, rotate your hands 8-10 times inward (photo 5) and outward. Breathing is arbitrary.

15. Legs together, hold the seat of the chair with your hands, straighten your legs, rest your heels on the floor. Alternately take your legs to the sides and return to the starting position. Breathing is arbitrary. Repeat 5-6 times with each leg.

16. Relax for 15-20 seconds, relax. Shake hands (down), feet. Breathing is deep, calm.

17. Do exercise 5.

18. Do exercise 6.

19. Do exercise 8. Standing up, breathe deeply and calmly for 15-20 seconds.

20. Sit down, hands to shoulders; rotation of the elbows forward and backward; when the elbows move backwards - inhale, forward - exhale. Repeat 5-6 times in each direction.

21. Hands on the belt; turning the body to the right and left: turning the body - exhale, returning to the starting position - inhale. Repeat 5-6 times in each direction.

22. Walk slowly for a minute (50-60 steps) and then walk at an average pace for a minute (60-70 steps), raising your knees low.

23. Sit down, feet shoulder-width apart, relax, lower your arms along your torso, rest for 2-3 minutes. Breathe slowly and deeply for 15-20 seconds.

In the first week after discharge from the hospital, it is recommended to walk daily for 45 minutes at a slow pace, accompanied by a relative or acquaintance. Be sure to periodically make stops: wait, sit on the bench. After a walk at home, rest, sit, lie down. Continue your morning and restorative exercises for the second and third weeks. Perform morning exercises (exercises 1-10) in the same volume as in the first seven days. And add interval exercises 24 and 26 to general strengthening gymnastics. Those who are good at coping with this load, with the permission of the attending physician, can do exercises 11-16, 24-31 during the day. However, remember that you can include interval exercises in the complex no more than three times a week! Perform each of these exercises with rest (intervals) for 45-60 seconds, after which be sure to rest for 1.5-2 minutes, but not longer! Then repeat the exercise for the specified number of times.

Gymnastics with interval exercises(Do exercises 11-16.) 24. Stand, feet shoulder-width apart, arms lower along the body. At an average pace, bend and unbend your arms at the elbows for 45-60 seconds. Relax, while standing or sitting for 1.5-2 minutes. Repeat the exercise 3-5 times. 25. Sit on a chair. Breathe calmly deeply at 26. Stand up, stay in a standing position for 1-2 seconds. Sit down. Continue this exercise at a slow pace for 45-60 seconds. Then relax, sit for 1.5-2 minutes. Repeat 3-4 times. 26. Stand up, stay in a standing position for 1-2 seconds. Sit down. Continue this exercise at a slow pace for 45-60 seconds. Then relax, sit for 1.5-2 minutes. Repeat 3-4 times. If, when performing interval exercises 24 and 26, you feel fatigue, headache, pain in the muscles of the arms, and more than 30 strokes compared to the initial one, you should stop the exercise, rest while standing or sitting. 27. Stand, feet shoulder-width apart, arms along the body. Take your right hand to the side while turning your head to the right - inhale (photo 6); return to starting position - exhale. The same in the other direction. Repeat 5-6 times in each direction. 28. Walking for 1.5-2 minutes at an average pace, raising your knees low. Do not hold your breath! 29. Feet shoulder-width apart, arms down. Turn the torso to the left, while moving your arms to the sides - inhale; return to starting position - exhale. Repeat 4-5 times in each direction. 30. Sit down, do exercises 2, 3. 31. Breathe deeply, calmly for 15-20 seconds. In the second week, try climbing stairs, but only one floor. You can go out into the street and go to the nearest store, provided that it is no further than 250-300 meters from your house. And don't lift more than 3 kilograms. It is not forbidden to wash dishes, cook a simple dinner, make a bed, slowly type on a typewriter, draw, knit. In the third week after morning exercises, it is useful to start rubbing off with a damp towel (water temperature 36-37 degrees). After 7-8 days, the water temperature can be reduced to 30-25 degrees. If after morning exercises and wiping down you feel a surge of vivacity, then the classes are being conducted correctly. During the day, take a leisurely walk for one and a half to two hours, preferably after a day's rest, at 16-17. Take some rest half way and return home.

In the fourth week, physical activity can be increased. Repeat each of the morning exercises 3-4 times more. Perform the complex of general strengthening gymnastics with interval exercises in the same volume as in the second and third weeks, and exercise 24 is allowed to be done with dumbbells or any objects weighing no more than 0.5 kilograms each. During the third or fourth week of training, try cleaning the apartment without bending over! You can sew, iron, wash small things, go to a store or market at a distance of 2-3 kilometers, carry a load of 5-6 kilograms (put in two bags). It is better to carry the same load in a backpack or in a bag on wheels.

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The main task of the rehabilitation of patients who have undergone myocardial infarction, - restoration of the cardiovascular system, improving exercise tolerance, lowering blood cholesterol levels, lowering blood pressure, increasing psychological resistance to stress.

Part of the rehabilitation therapy system is physiotherapy exercises with a gradual and strictly controlled increase in the intensity of physical exercises.

All exercises should be performed smoothly, rhythmically, alternating with breathing exercises. The goal of physical training is to gradually increase the number of heartbeats to 100-120 per minute. During the rehabilitation period after myocardial infarction, each patient is assigned their own mode of physical activity, therefore, all additional physical activities must be approved by a doctor.

Complex 1:

Exercise 1
Raise your hands, palms out, and stretch - inhale. Bring your arms down in a circle - exhale. Return to starting position. Repeat the exercise 4-6 times.

Exercise 2
Starting position - standing, hands on the belt, legs apart.
Turn to the left, spread your arms to the sides - inhale. Return to the starting position - exhale. Do the same on the other side. Repeat 4-5 times.

Exercise # 3
Starting position - standing, arms along the body, feet shoulder-width apart.
Take a breath. Sit down without lifting your heels off the floor, leaning forward a little and taking your arms back - exhale. Return to starting position - inhale. Repeat 4-6 times.

Exercise 4
The starting position is the same.
Take a breath. Sit down with your hands on your hips - exhale. Return to starting position - inhale. Repeat 3-4 times.

Exercise # 5
Starting position - standing, hands on the belt, feet shoulder-width apart. Lean to the left, raising your right hand up - inhale. Return to the starting position - exhale. Do the same on the other side. Repeat 3-4 times.

Exercise 6
Starting position - sitting, leaning back relaxed on the back of a chair and grabbing the seat with your hands, legs are extended.
Bend over, pulling your head back - inhale. Return to the starting position - exhale. Repeat 4-6 times.

Exercise 7
The starting position is the same.
Raise your left leg to a horizontal position, lower it. Do the same with your right foot. Breathing is even. Repeat 3-4 times.

Exercise # 8
Starting position - sitting, leaning back in a chair and raising your arms up, legs are extended.
Take a breath. Bend your left leg and, clasping your shins with your hands, touch your chest with your knee, tilt your head forward - exhale. Return to starting position - inhale. Follow the same movements, bending your right leg. Repeat 3-4 times.

Exercise 9
Starting position - standing, arms along the body, feet shoulder-width apart.
Extend your left hand forward and swing your leg back and forth. Return to starting position. Repeat 3-4 times with each leg without holding your breath.

Exercise # 10
The starting position is the same.
Extend your left hand forward; step forward with your right leg and extend your right arm in the same direction. Place your hands on your shoulders (hands are clenched into fists). Return to starting position. Follow the same movements, starting with the right arm and taking a step with the left foot. Repeat 3-4 times.

Exercise 11
Walk in place for 15–20 seconds.

Exercise 1

Starting position - lying on your back in bed.
Raise your arms up, grasping the headboard. Pull up, pulling your head back (going deeper into the pillow), straighten your legs, pull your toes. Repeat 5-6 times.

Exercise 2

Starting position - sitting in bed.
Taking your arms back, raise your head, while trying to straighten your back as much as possible and bring your shoulder blades together. Repeat 5-6 times.

Exercise # 3

Starting position - standing, arms along the body, feet shoulder-width apart.
Raise your arms up (through the sides or linked in a "lock" in front of you), rise on your toes, pull yourself up. Return to starting position. Repeat 4-5 times.

Exercise 4

The starting position is standing, one hand up, the other down.
Change the position of your hands for each count. Repeat 8-10 times.

Exercise # 5

Starting position - standing, hands on the belt (you can hold on to the back of the chair with one hand), feet about the width of your feet. Swing your legs back and forth. Repeat 4-5 times with each leg.

Exercise 6

Starting position - standing, hands on the belt, feet shoulder-width apart. Bend forward - exhale, return to starting position - inhale. Repeat 8-10 times. Exercise 7

Starting position - standing, arms along the body, feet shoulder-width apart.
For a count of 1-2, raise your hands up. On a count of 3, lower them in arcs downward backward, legs slightly bent. On the count of 4-5, continuing to move your arms back, tilt your torso forward, straighten your legs. For a count of 6, move your arms forward, bend your legs slightly, straighten your torso (half-squat position). On the count of 7-8, lift your arms up in arcs, straighten your legs, pulling up, rise on your toes and return to the starting position. Repeat 5-6 times.

Exercise # 8

Starting position - standing, straight arms in front of the chest, feet about the width of the feet.
For each count, perform jerking movements with straight arms or arms bent at the elbows (it is possible with a simultaneous half-turn of the body). Repeat 8-10 times.

Exercise 9

Starting position - standing, hands behind the head, legs together.
On a count of 1, lean to the left while lunging with your left foot in the same direction (you can simultaneously stretch your arms up). On a count of 2, return to the starting position. For a count of 3, bend over to the left while lunging with your left foot in the same direction at the same time. On a count of 4, return to starting position. Repeat 4-5 times on each side. Exercise # 10

Starting position - standing, arms along the body, feet shoulder-width apart.
Do squats at an arbitrary pace. At the time of squatting, one hand is behind the head, the other is on the belt. Change the position of your arms the next time you squat. Repeat 8-10 times.

Exercise 11

Starting position - standing, hands on the belt, feet shoulder-width apart.
Perform circular rotations with the pelvis (left, forward, right, back). Do the same on the other side. Repeat 4-5 times on each side.

Exercise 12

Starting position - standing, hands on the belt, feet about the width of the feet.
On the count of 1-2, spread your arms to the sides, slightly turn the body to the right - inhale, on the count of 3-4, return to the starting position - exhale. Repeat 3-4 times on each side. Acute myocardial infarction emergency care

After myocardial infarction, physical therapy (exercise therapy) is necessary to restore health, which will prevent various complications, including the vulnerability of the heart and blood clotting disorders. Exercises are selected depending on the patient's condition and gradually become more complicated.

When to start physiotherapy exercises?

The start time of classes is determined by the attending physician based on the development of pathology, the patient's well-being, his age, gender and physical fitness. As a rule, they are allowed the next day after the attack. Charging is done in bed. You can start active physical activity already from the 3rd week if the suffered heart attack was the first. Otherwise, it will take at least 5 weeks.

If exacerbations occur after an attack, it is worth interrupting the exercise. As a rule, after 3 days after the examination, in the absence of complications, the exercise can be resumed, but the supervision of the attending physician is necessary.

Stages and tasks of gymnastics

Exercises can be performed both in bed and free mode, depending on the degree of disease activity. The following table will help to understand this:

Degree	Sick day	Mode	Permitted loads
1A	1st	Bed strict	The patient is in a supine position. Special exercises from exercise therapy are prohibited. He can only turn on his right side, take food on his own.
1B - 2A	2nd to 3rd	Bed extended	The patient can independently turn and sit in bed, initially with the help of the medical staff, and then independently. You can later sit down on a chair. Exercises in the supine position are allowed, which are performed for 8-10 minutes. Breathing should be static. Take a break after each exercise. The pulse should not exceed 20 beats per minute.
2B - 3A	4th to 14th	Ward strict	The patient can already walk along the ward and the corridor at a distance of 20 to 200 m. Exercises performed in a sitting position are already allowed. The pace is slow or medium.
3B	14th to 21st	Ward extended	The patient is already allowed to walk along the corridor without restrictions. Exercises are performed in standing and sitting positions, and they can be both individual and group.
4A and 4B (classes I, II, III and IV)	From the 21st	Free	Walking is already permissible, and the pace is average - from 70 to 100 steps per minute. A set of exercises is performed in a sitting and standing position.

So, conditionally, physiotherapy exercises can be divided into two stages, each of which has its own tasks:

1. Stationary... It is carried out immediately after the attack. It is required to stimulate blood in peripheral vessels, reduce muscle tension, increase respiratory function, and activate systems that prevent blood from clotting. Thanks to competent loads, it is possible to avoid arthrosis, muscle atrophy, pneumonia and other complications. In addition, they allow you to increase the psychoemotional state of a person. After the completion of the stage, it is already possible to independently climb to the 1st floor and walk 2 km a day.
2. Home... Required after stationary phase. Home rehabilitation is needed to increase the body's endurance, restore the functioning of the heart and blood vessels, improve the quality of life and reduce the dosage of drugs used. In addition, it is a secondary prevention of ischemia.

Only an instructor can determine the load, because physical overvoltage for a heart attack is unacceptable.

A set of exercises for the hospital

Exercise should be done 2 hours after eating. If the patient suffers from atherosclerosis or osteochondrosis, bending, strength exercises, head and trunk rotation are prohibited for him. All this negatively affects the work of the heart.

The complex consists of exercises that are performed in a horizontal position from 4 to 8 times as the condition improves:

1. Bend and unbend the fingers.
2. Rotate the feet in different directions or alternately bend and unbend them.
3. With an inhalation, bend your forearms and take your elbows to the sides, and with an exhale, open your arms along the body.
4. With a breath, lower your arms along the body and turn your palms up. With an exhalation, slowly raise them forward, turn your palms down and reach your knees, raising your head and straining the muscles of the trunk and legs. If the exercise is difficult, you can initially not raise your head.
5. Bend your left leg without lifting it from the bed, and then lower it. Do the same with your right foot. If possible, you can complicate the exercise - bend one leg and at the same time unbend the other.
6. Bend your legs at the knees. Initially lower to the right side, and then to the left.
7. Bend your legs at the knees, and keep your arms along the body. Stretch your left hand forward, and then pull it to your right knee. Repeat the same on the other side.
8. Straighten your legs, and keep your arms along the body. While inhaling, perform 3 actions at the same time - raise your left arm and right leg, and turn your head to the right side. With an exhalation, take the starting position. Repeat the same on the other side, but turn your head to the left.
9. Bend your arms at the elbows, and clench your fingers into a fist. Simultaneously perform circular rotations with hands and feet.
10. Straighten your legs and spread a little, and keep your arms along the body. With an inhalation, put your left hand to the head, and with an exhale, touch the right edge of the bed. Do the same on the other side.
11. Arms are placed along the body. With an exhalation, tighten the muscles of the buttocks, lower extremities and pelvic floor for 2-2.5 seconds. Relax with a breath.
12. Arms are placed along the body. With an exhalation, raise them forward, and with an exhalation, lower them.

In an extended gradual mode, you can practice exercises that are performed from a semi-bed position 3-4 times:

1. As you exhale, press a little on the chest and abdomen with your hands.
2. Bend your elbows. Bend the hands and feet at the same time, and then straighten.
3. With an inhalation, raise your hands up behind your head, and with an exhale, lower it.
4. Imitate walking - bend the right leg at the knee and the right arm at the elbow, and with their extension, do the same for the right leg and arm.
5. Lean on your elbows, with an inhalation, raise the chest and press on the chest and abdomen with your hands. Go down with the exit.
6. With an inhalation through the sides, raise your hands behind your head, and with an exit, lower them along the body.
7. Lower your arms along the body. With an inhalation, raise the pelvis, leaning on legs bent at the knees and straight arms. With a breath, lower yourself onto the bed.
8. Raise the body to a sitting position. If the exercise is difficult, you can tie a rope or long cloth to the headboard, which you can grasp with your hands when lifting the body.
9. With an inhalation, raise the body, already resting your hands on the bed, and with an exhalation, slowly lie down.
10. Lift the body up. From a sitting position, lower your legs down to hang from the bed. Breathe calmly.

All 10 exercises are clearly demonstrated in the picture:

A set of exercises for home rehabilitation

Here are examples of effective exercises that are performed in a standing position and are repeated 4-6 times:

1. Stand up straight, lower your arms, and spread your legs shoulder-width apart. Slowly raise your hands up and down, and then they describe a small circle around you.
2. Feet shoulder width apart, and hands on the waist. Turn your body to the left, spread your arms to the sides and inhale. Return to starting position and exhale. Repeat the same, but on the other side.
3. Feet shoulder width apart, and lower your arms. Take a deep breath, sit down and lean forward slightly. Take your hands back a little and exhale. Slowly return to a standing position.
4. Without changing the starting position, take a deep breath, put your hands on your hips and sit down with an exhalation. With an inhalation, return to the starting position.

The training continues with exercises that are performed on a chair and are repeated 4-5 times:

1. Lean on the back of a chair. Grab the seat with your hands and stretch your legs. Bend your torso and take your head back with a smooth inhalation. Return to starting position and exhale smoothly.
2. Sit on the edge of a chair. With an inhalation, take the left arm and right leg to the sides, and with an exhale, return to the starting position. Repeat the same for the right arm and left leg.
3. Lean on the back of a chair, and lower your arms along the body. Raise your right shoulder and simultaneously lower your left. Then lower your right shoulder, and raise your left. Breathing should be free.
4. With an inhalation, take your hands to the sides, and then, with an exhalation, use your hands to raise your right knee to your chest. Do the same for the left knee.
5. Hands on the belt. Put your left hand on your right knee and exhale, and then return to the starting position and inhale. Repeat the same on the other side.
6. Breathe calmly for 20-30 seconds and finish the workout.

Walking for rehabilitation

Within the framework of the ward and free regime, one of the effective methods of complete recovery is active walking. It activates all links of the central nervous system and normalizes the disturbed vegetative functions of the body, causing functional and trophic changes in all tissues and organs, including the cardiovascular system.

It is worth mastering walking according to the following scheme:

1. In the extended ward mode, if the patient has no complications of myocardial infarction, a 3-6 minute walk is allowed. The pace is 30-40 steps per minute. In this case, it is necessary to control the frequency of the console, blood pressure indicators and subjective sensations.
2. If the body responds adequately to previous loads, increase the pace of walking - 40-60 steps per minute. In this case, the pulse should not increase by more than 12 beats per minute, the systolic pressure indicators increase by no more than 20-40 mm Hg. Art., and diastolic - by 5-10 mm Hg.

If loads cause angina pectoris, severe shortness of breath, a drop in pressure, severe weakness and pallor, it is worth interrupting walking and returning to the initial stage.

1. In free mode, the initial walking pace is 70-80 steps per minute. Start by doing a 6 minute workout. If at such loads there is a stable adequate response from the cardiovascular system, you can increase the distance from 500 m to 1000 m, and then up to 1500 m. In this case, you do not need to change the pace. It is recommended to walk 2-3 km in several steps.
2. If the previous loads are already given with ease, increase the walking pace to 80-100 steps per minute. The walking distance should also be gradually increased from 500 m to 1000 and 1500 m.

Video: exercise therapy after myocardial infarction

What kind of physiotherapy exercises is carried out a few weeks after the attack, the expert will tell and show in the 2nd part of the video:

After suffering a myocardial infarction, in order to restore well-being, it is extremely important to master the correct physiotherapy exercises. It is necessary to stimulate blood flow, which is required to train the contractile function of the myocardium. In addition, correct physical activity during the rehabilitation period is needed to return the patient to a full life.

Myocardial infarction is a necrosis of a part of the heart muscle that develops as a result of a violation of blood supply due to narrowing of the coronary arteries or closure of the lumen by a thrombus or atherosclerotic plaque.

Stationary stage

Features of exercise therapy in a hospital:

1. early activation and possibly early discharge from the hospital;
2. application of individualized rehabilitation programs.

The entire period of this stage of treatment is divided into four stages, which are subdivided into steps (a, b, c) for a more detailed definition of physical activity. The transfer of a patient from one stage to another is carried out by the attending physician. On the second or third day of the illness, after the elimination of the pain syndrome and severe complications (arrhythmias, cardiogenic shock, pulmonary edema), the class according to the severity of the disease, the rehabilitation program, and physiotherapy exercises are prescribed for the patient.

Stationary stage

Step	Mode	Exercises	Exercise therapy tasks
Sick day
1st day	Strict bedding... Position - lying on your back. Turn to the right side, eating, using the bedpan with the help of honey. staff
Ib-IIa 2-3rd day	Extended bedding... The patient is allowed to independently turn in bed, then sit down, first with help, and then on his own (2-3 times a day for 5-20 minutes), later transplanted into a chair. Massage the legs, back	Therapeutic gymnastics complex No. 1 (8-10 min.), Which includes movements in the distal parts of the limbs and trunk, static breathing. After each exercise, there is a break for rest. An increase in heart rate by 20 beats per minute is permissible. Exercises are carried out smoothly, with incomplete amplitude, at a slow pace, repeated 2-3 times. As the condition improves, the range of motion is gradually increased, repeated 4-5 times. The pace of movement is slow for large muscle groups, and for medium and small muscle groups, it is adjusted to medium. Rest pauses are shortened, and in the afternoon the complex is repeated independently	Improve peripheral circulation (exercises in the distal extremities), increase venous blood flow (movements in the large joints of the limbs, mainly the lower ones, alternating with breathing exercises and rest pauses), strengthening the muscles of the legs and trunk to prepare for standing up, increasing adaptation of the cardiovascular systems to physical activity
IIb-IIIa, 4-14th day	Ward... Walking in the ward, along the corridor at a distance of 50-200 m in 2-3 steps	Therapeutic gymnastics (set of exercises No. 2) for 10-15 minutes. sitting on a chair at a slow to medium pace	Warning: hypodynamia, gentle cardio-respiratory system training, preparation for walking in the hallway and climbing stairs
IIIb 11-21st day	Walking along the corridor without restrictions, master one flight of stairs, then one floor and full self-service (shower)	A set of exercises number 3 sitting and standing, individually or in a group method for 20 minutes. slowly with a gradual acceleration. The mastery of the staircase is carried out as follows: at rest, inhalation is made, and on exhalation, the patient rises 2-3 steps	Gentle training of the cardiovascular system, preparing the patient for a walk, for dosed training walking
IVa, b, on the 16-20th day for I class and later for II, III and IV classes	Free... Going out for a walk at a distance of 500 m to 3 km at a speed of 70-100 steps per minute.	The complex of remedial gymnastics No. 4 in the PI while sitting and standing at a slow and medium pace. Duration of classes is up to 30 minutes. Rest breaks are required	A gradual increase in physical activity to the level at which the patient can be transferred to follow-up care in a cardiological sanatorium or home under the dispensary supervision of a local doctor

Sanatorium stage

Exercise therapy tasks: to restore the physical performance of patients, psychological rehabilitation and preparation for independence and production activities. Within three to four days, the patient performs the IV stage activity regimen, and subsequently he is transferred to the V, VI and VII stages. Classes are carried out in a group method, include the work of all muscle groups and auto-training. Dosed walking is the best way to adapt the cardiovascular system to moderate exercise.

Dispensary and polyclinic stage

At this stage, patients are persons suffering from chronic ischemic heart disease with postinfarction cardiosclerosis. The main tasks of exercise therapy: prevention of further development of atherosclerosis, secondary prevention of coronary artery disease, the possibility of complete or partial withdrawal of medications, return to work. Exercise therapy is carried out in the form of long-term physical training (DFT). DFT is indicated when myocardial infarction is at least four months old in the gym using a group method or at home according to an individual program. Functionality is determined using bicycle ergometry. They use remedial gymnastics, dosed walking, skiing, cycling, etc. throughout the patient's life.

Massage for myocardial infarction

The timing of the start of the massage is strictly individual. With a generally satisfactory condition, normal temperature and positive dynamics of clinical indicators, suction massage of the legs, light massage of the back (on the right side), hands are used for 3 to 10 minutes daily. In a satisfactory condition, the absence of negative dynamics on the ECG and severe complications (edema and pulmonary infarction, gastrointestinal bleeding) V.I.Dubrovsky recommends massage from the first days of the disease in combination with oxygen therapy... Massage the back (in the PI, lying on the right side), using stroking, rubbing, shallow kneading, abdomen, lower and upper limbs; stroking the chest. The duration of the massage is 5-20 minutes, after which the patient breathes oxygen for 10-15 minutes. After discharge from the hospital, a general massage is performed in a sitting position with a head support or lying down. Massage is started from the back and neck area. When massaging the anterior chest wall, the emphasis is on the left pectoral muscle and sternum. The duration of the procedure is 10-20 minutes (under the supervision of a doctor).

Approximate sets of exercises for medical gymnastics for patients with myocardial infarction

Complex number 1

1. Flexion and extension of the fingers of the hands 6-8 times. Breathing is arbitrary.
2. Flexion and extension of the feet 6-8 times. Breathing is arbitrary.
3. Flexion of the forearms, elbows to the sides - inhale, straighten your arms and lower them along the body - exhale (2-3 times).
4. Hands along the body, turn palms up - inhale. Raising your arms forward upward, palms down, stretch them to your knees, raising your head, straining the muscles of the torso and legs - exhale. (2-3 times). In the first lesson, you can not raise your head.
5. Calm breathing for 20-15 seconds. Relax.
6. Alternate bending of the legs without lifting them from the bed - 4-6 times. Breathing is arbitrary, from the second or third lesson to bend and extend the legs simultaneously - one leg bends, the other unbends.
7. The arms are along the body, the legs are straightened and somewhat divorced. At the same time, the rotation of the arms and legs outwards - inhale, inward - exhale. Return to IP - inhale. The same with the left hand to the right knee (4-5 times).
8. Legs bent at the knee joints, lower on the bed to the right, and then to the left. Breathing is arbitrary (4-6 times).
9. The legs are bent at the knee joints. Raise your right hand up - inhale, stretch it to your left knee - exhale. Return to IP - inhale. The same with the left hand to the right knee. (4-5 times).
10. The legs are straightened. Take your right arm and left leg away from the bed at the same time, turn your head to the right - inhale. Return to IP - exhale. The same with the left hand and. with the right leg, turn the head to the left (3-5 times).
11. Calm breathing for 30-40 seconds. Relax.
12. Bend your arms at the elbow joints, clench your hands into a fist, legs straightened. Simultaneous rotation of the hands and feet 8-10 times. Breathing is arbitrary.
13. The legs are bent at the knees. Straighten your right leg up, return to the IP. The same with the left leg (4-6 times). Breathing is arbitrary. This exercise is included from the third to fourth lesson.
14. Legs are straightened and slightly apart, arms are along the body. Put your right hand on your head - inhale, touch the opposite edge of the bed with your right foot - exhale. The same with the left hand (3-4 times).
15. Hands along the body. Alternate moderate static tension and relaxation of the gluteal muscles, muscles of the lower extremities and pelvic floor for 2-2.5 seconds. When relaxing, inhale, when stressed, exhale. Repeat 4-5 times. This exercise should be included from the second or third lesson.
16. Hands along the body. Raise your arms up - inhale, return to the IP - exhale. Repeat 2-3 times.

Complex number 2

SP sitting on a chair.

1. Lean against the back of the chair, hands on your knees, do not strain. Hands to shoulders, elbows apart - inhale. Return to PI - exhale (4-5 times).
2. IP is the same. Roll from heels to toes with legs apart, at the same time clench and unclench the hands into fists. Breathing is arbitrary (10-15 times).
3. Hands forward upward - inhale. Return to PI - exhale (2-3 times).
4. Sliding feet on the floor forward - backward. Breathing is arbitrary (6-8 times).
5. Spread your arms to the sides - inhale. Return to PI - exhale (3-5 times).
6. Sitting on the edge of a chair, take your right arm and left leg aside - inhale. Return to IP - exhale. The same with the left hand and right leg (6-8 times).
7. Sitting on the entire seat of the chair, lower your arms along your body, raising your right shoulder up, at the same time lower your left shoulder, then change the position of your shoulders. Breathing is arbitrary (3-5 times).
8. Spread your arms to the sides - inhale. With your hands, pull your right knee to your chest - exhale. The same with the left knee (4-6 times).
9. Hands on the belt. Circular rotations of the head first to the right, then to the left 3-5 times in each direction. Breathing is arbitrary.
10. IP is the same. Put the right leg on the knee of the left leg - exhale, return to the PI - inhale. The same with the left leg (3-5 times).
11. Calm breathing for 20-30 seconds.