Exercise therapy for myocardial infarction exercises. Therapeutic exercise in patients after myocardial infarction

Myocardial infarction is ischemic necrosis of the heart muscle caused by coronary insufficiency. In most cases, the main etiological cause of myocardial infarction is coronary atherosclerosis.

Along with the main factors of acute coronary circulatory failure (thrombosis, spasm, narrowing of the lumen, atherosclerotic changes in the coronary arteries), insufficiency of collateral circulation in the coronary arteries, prolonged hypoxia, excess catecholamines, lack of potassium ions and excess sodium ions play an important role in the development of myocardial infarction, causing prolonged cell ischemia.

Myocardial infarction is a polyetiological disease. Risk factors play an undoubted role in its occurrence: physical inactivity, unhealthy diet, excess weight, stress, etc. The size and location of myocardial infarction depend on the caliber and topography of the blocked or narrowed artery.

There are: extensive myocardial infarction - large-focal, affecting the wall, septum and apex of the heart; small-focal infarction - affecting part of the wall; microinfarction - foci of infarction are visible only under a microscope.

In intramural myocardial infarction, necrosis affects inner part muscle wall, with transmural - the entire thickness of the wall. Necrotic muscle mass dissolve and are replaced by granulation connective tissue, which gradually turns into scar tissue. Resorption of necrotic masses and formation of scar tissue lasts 1.5 - 3 months. The disease usually begins with the appearance of intense pain in the chest and in the heart area; the pain continues for hours, and sometimes for 1-3 days, subsides slowly and turns into a long-term dull pain. They are squeezing, pressing, tearing in nature and sometimes are so intense that they cause shock, accompanied by a drop in blood pressure, sudden pallor of the facial skin, cold sweat and even loss of consciousness. Following the pain, acute cardiovascular failure develops within half an hour (maximum 1-2 hours). On the 2nd-3rd day, an increase in temperature is noted, neutrophilic leukocytosis develops, and the erythrocyte sedimentation rate (ESR) increases. Already in the first hours of the development of myocardial infarction, characteristic changes in the electrocardiogram appear, which make it possible to clarify the diagnosis and localization of the infarction. Drug treatment during this period is aimed primarily at eliminating pain, cardiovascular failure, as well as preventing repeated coronary thrombosis (anticoagulants are used - drugs that reduce blood clotting).

Early motor activation of patients promotes the development of collateral circulation, has a beneficial effect on the physical and mental state, shortens the period of hospitalization and does not increase the risk of death. Treatment and rehabilitation of patients with myocardial infarction are divided into three stages: inpatient (hospital), sanatorium (or in a cardiac rehabilitation center) and outpatient.

Methodology of exercise therapy at the inpatient stage of rehabilitation. At this stage physical exercise are of great importance not only for restoring the physical capabilities of patients, but also in to a large extent For psychological impact, instilling in the patient faith in recovery and the possibility of returning to work and normal life in society. Therefore, the sooner (naturally, taking into account individual characteristics diseases) the more therapeutic exercises will be started, the greater the effect will be.

Physical rehabilitation at the inpatient stage is aimed at achieving this level physical activity patient, in which he could take care of himself, climb one floor of the stairs, take walks of up to 2 - 3 km (in 2 - 3 doses during the day) without significant negative reactions. Objectives of exercise therapy during bed rest: - prevention possible complications(thromboembolism, congestive pneumonia, intestinal atony, etc.); - improving the functional state of the cardiovascular system (primarily training the peripheral circulation while sparing the load on the myocardium); - creating positive emotions in the patient, a tonic effect on the body; - training of orthostatic stability and restoration of simple motor skills.

At the inpatient stage of rehabilitation, depending on the severity of the disease, patients are divided into four classes. This division is based on various combinations of the main indicators of the characteristics of the course of the disease: the extent and depth of myocardial infarction; the presence and nature of complications; severity of coronary insufficiency. Severity classes of patients with myocardial infarction Small-focal infarction without complications, class 1, Small-focal infarction with complications, 1st or 2nd class, large-focal intramural infarction without complications, Intramural large-focal infarction with complications, 3rd or 4th class, transmural infarction without complications, Extensive transmural infarction with aneurysm or other significant complications - class 4. The physical rehabilitation program for patients is built taking into account the patient’s belonging to one of four classes of severity of the condition.

The severity class is determined on the 2nd-3rd day of illness, after the elimination of pain and complications such as cardiogenic shock, pulmonary edema, severe arrhythmias. myocardial infarction treatment rehabilitation

This program involves assigning the patient household loads of a certain nature, doing therapeutic exercises according to a certain method and a form of leisure time that is acceptable for him.

Depending on the severity of the disease, the inpatient rehabilitation stage lasts from 3 (for small-focal uncomplicated infarction) to 6 (for extensive transmural infarction) weeks. Numerous studies have shown that treatment effectiveness is achieved if therapeutic exercises begin in early dates. Therapeutic exercises are prescribed after the cessation of a painful attack and the elimination of severe complications (heart failure, significant heart rhythm disturbances, etc.) on the 2-4th day of illness, when the patient is on bed rest.

During this period, in the first lesson, in and. n. lying on your back, active movements are performed in the small and medium joints of the limbs; static tension of the leg muscles; muscle relaxation exercises; exercises with the help of a physical therapy instructor for large joints of the limbs; breathing exercises without deepening your breathing; elements of massage (stroking) of the lower extremities and back while passively turning the patient onto the right side. In the second lesson, active movements in the large joints of the limbs are added. Leg movements are performed alternately (legs slide along the bed). The patient is taught to economically, without effort, turn on the right side and lift the pelvis; After this, he is allowed to independently turn onto his right side. All exercises are performed at a slow pace. Number of repetitions of exercises: for small muscle groups - 4--6 times, for large ones - 2--4 times. Between exercises, rest breaks are required. Duration of classes - 10 - 20 minutes. After 1--2 days in the LG classes, the patient is seated with his legs down for 5--10 minutes - with the help of a physical therapy instructor or a nurse. The exercise is repeated 1-2 times during the day.

LH classes are carried out in starting positions lying on your back, on your right side and sitting. The number of exercises for small, medium and large muscle groups increases. Alternate movements are performed with the legs, lifting them above the bed. The amplitude of movements gradually increases. Breathing exercises involve deepening and lengthening the exhalation. The pace of the exercises is slow and medium. Lesson duration - 15 - 17 minutes.

3-4 days after the heart attack (with 1-2 classes of severity) and after 5-6 or 7-8 days (with 3-4 classes of severity) the patient is transferred to the ward mode. Objectives of exercise therapy during the period of ward regime: - prevention of the consequences of physical inactivity; - gentle training of the cardiorespiratory system; - preparing the patient for walking along the corridor, climbing stairs and everyday activities.

The exercises are performed in the starting positions lying, sitting and standing. The number of exercises for the muscles of the torso and legs increases, and the amount for small muscle groups decreases. Breathing exercises and muscle relaxation exercises are used as a rest after difficult exercises. At the end of the main part of the lesson, walking is mastered. On the first day, the patient is lifted out of bed with a safety net, limited to his adaptation to the vertical position. From the 2nd day he is allowed to walk 5-10 m, increasing the distance by 5-10 m every day. In the first part of the lesson, i.e. is used. n. lying and sitting, in the second part - sitting and standing, in the third part - sitting. Lesson duration - 15 - 20 minutes.

When the patient masters walking 20 - 30 m, special classes begin with dosed walking for a short distance, increasing it daily by 5 -10 m and gradually increasing to 50 m. In addition, patients perform morning hygienic gymnastics (UGG), including her individual exercises from the complex therapeutic exercises(LG). In the ward mode, patients spend 30-50% of the time in sitting and standing positions. 6--10 days after a heart attack (with 1st class of severity), or after 8-13 days (with 2nd class), or after 9--15 days (with 3rd class), or individually ( at 4th grade) patients are transferred to a free regime.

The tasks of exercise therapy during the period of free exercise: - preparing the patient for full self-care; - preparation for going out for a walk, for dosed walking in a training mode. The following forms of exercise therapy are used: UGG, LH, dosed walking, training in climbing stairs. During LH and UGG classes, active physical exercises are used for all muscle groups. Exercises with light objects (gymnastic stick, clubs, ball) and more complex ones in terms of coordination of movements are included. Just like in the previous period, breathing exercises and muscle relaxation exercises are used. The number of exercises performed in a standing position increases. Lesson duration - 20 - 25 minutes.

Measured walking (first along the corridor) begins at a distance of 50 m; tempo -- 50--60 steps/min. The distance increases daily so that the patient can walk 150 - 200 m along the corridor. Then the patient goes outside for a walk. By the end of your stay in the hospital, it should take place in 2 days - 3 km (in 2 - 3 doses). The walking pace gradually increases: first to 70-80, then to 90-100 steps/min.

Stair climbing training is done very carefully. During the first lesson, you climb 5-6 steps (with a rest on each). During rest, you inhale, while you rise, exhale. In the second session, while exhaling, the patient walks 2 steps, and while inhaling, he rests. In subsequent classes, he switches to normal walking up the stairs (with rest after completing a flight of stairs). By the end of the period, the patient masters climbing one floor. The adequacy of physical activity to the patient’s capabilities is monitored by the heart rate reaction. During bed rest, the increase in heart rate should not exceed 10-12 beats/min from the initial level; in ward and free modes, heart rate should not exceed 100 beats/min.

Myocardial infarction is necrosis of a section of the heart muscle that develops as a result of impaired 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 steps, which are divided into sub-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 illness, after the elimination of pain and severe complications (arrhythmias, cardiogenic shock, pulmonary edema), a class according to the severity of the disease is determined for the patient, a rehabilitation program is prescribed, and physical therapy is prescribed.

Stationary stage

Sanatorium stage

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

Dispensary and polyclinic stage

At this stage, patients are individuals suffering from chronic ischemic heart disease with post-infarction cardiosclerosis. Main tasks of exercise therapy: prevention further development 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 (LPT). DFT is indicated when myocardial infarction is at least four months old gym group method or at home according to an individual program. Functional capabilities are determined using bicycle ergometry. They use therapeutic exercises, dosed walking, skiing, cycling, etc. throughout the patient’s life.

Massage for myocardial infarction

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

Complex No. 1

1. Flexion and extension of the fingers 6-8 times. Breathing is voluntary.
2. Flexion and extension of the feet 6-8 times. Breathing is voluntary.
3. Bending your forearms, elbows to the sides - inhale, straighten your arms and lower them along your body - exhale (2-3 times).
4. Hands along the body, turn your palms up - inhale. Raising your arms forward up, palms down, stretch them to your knees, raising your head, tensing the muscles of your torso and legs - exhale. (2-3 times). During the first lesson, you don’t have to raise your head.
5. Calm breathing for 20-15 seconds. Relax.
6. Alternately bending the legs without lifting them from the bed – 4-6 times. Breathing is voluntary, from the second or third lesson, bend and straighten your legs simultaneously - one leg bends, the other unbends.
7. Arms along the body, legs straightened and slightly apart. At the same time, rotate the arms and legs outward - inhale, inward - exhale. Return to IP – inhale. Do the same with your left hand to your right knee (4-5 times).
8. Lower your legs, bent at the knee joints, onto 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. Do the same with your left hand to your right knee. (4-5 times).
10. Legs 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 your right foot, turn your 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 fists, and straighten your legs. Simultaneous rotation of the hands and feet 8-10 times. Breathing is voluntary.
13. Legs are bent at the knees. Straighten your right leg up, return to IP. The same with the left leg (4-6 times). Breathing is voluntary. This exercise is included from the third or fourth lesson.
14. Legs are straightened and slightly spread, arms along the body. Place your right hand on your head - inhale, touch your right foot to the opposite edge of the bed - 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 tense, exhale. Repeat 4-5 times. This exercise should be started from the second or third lesson.
16. Hands along the body. Raise your hands up - inhale, return to IP - exhale. Repeat 2-3 times.

Complex No. 2

IP sitting on a chair.

1. Lean against the back of a chair, hands on your knees, do not strain. Hands to your shoulders, spread your elbows to the sides - inhale. Return to IP – exhale (4-5 times).
2. IP - the same. Roll from heels to toes with legs spread to the sides, simultaneously clench and unclench your hands into fists. Breathing is arbitrary (10-15 times).
3. Hands forward up - inhale. Return to IP – exhale (2-3 times).
4. Sliding the feet forward and backward on the floor. Breathing is arbitrary (6-8 times).
5. Spread your arms to the sides - inhale. Return to IP – exhale (3-5 times).
6. Sitting on the edge of a chair, move your right arm and left leg to the side - 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. Using 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 voluntary.
10. IP - the same. Place your right leg on the knee of your left leg - exhale, return to IP - inhale. The same with the left foot (3-5 times).
11. Calm breathing for 20-30 seconds.

Myocardial infarction is one of the most severe cardiac diseases. In terms of the number of deaths, this disease occupies a leading place in world medical practice. And the difficulty lies not only in treating the pathology, but also in the subsequent return of the patient to normal life.

In addition to proper nutrition and sleep patterns, complete refusal from bad habits, the patient needs to engage in physical therapy. The purpose of such exercises is to improve the general condition of the body, strengthen muscles and stabilize the functioning of the cardiovascular system. At first, even minimal loads are contraindicated for the patient, but over time they should be increased. The success of returning to a full life largely depends on the regularity and correctness of the exercises.

The rehabilitation period after a heart attack can be divided into three stages:

1. Hospital, which the patient spends in an inpatient setting. Here he is prescribed the necessary course of treatment and rehabilitation procedures.
2. Recovery phase. The patient gradually returns to his original form, becoming able to work.
3. Support stage. Having returned to normal life, the patient must regularly visit a cardiologist, take medications and carry out preventive measures.

At all the stages described above, the patient must perform exercise therapy for myocardial infarction. They are determined by the instructor and rehabilitator taking into account the patient’s health condition. The increase in loads must be planned in advance, and for successful recovery the person will need to strictly follow this schedule.

Properly chosen exercises pursue the following goals:

• restoration of skills lost during the development of the disease;
• slowing down the progression of pathology and excluding recurrence of an attack;
• acceleration of recovery.

Rules and features of exercises

For each stage of patient rehabilitation, its own exercise program is developed. They should be done gradually. Recommended at first slow pace and no more than three repetitions. General course The lesson involves the following stages:

1. The first trainings are carried out in a lying position. After some time, the physical activity increases, the joints and pelvis are involved in the work, and then the lower limbs.
2. Gradually the complexity of the exercises increases. The shoulders are involved, the patient is recommended to raise the hip part and turn to the side. The number of repetitions also increases. It should be about 10 times.
3. This is followed by exercises in a sitting position. Most of them help strengthen the lungs and promote the work of the trunk muscles. Such exercises are performed at least once a day for 15 minutes.
4. The next stage is preparation for independent movement. Since the patient is quite long time was in a supine position, he should prepare himself before getting to his feet. It's about about exercises simulating walking and standing up. Every day you need to increase the number of steps. The task is completed when the patient can walk about 50 meters.

Even after fully recovering and returning to a full life, the patient must perform exercises for some time. A systematic visit to a specialist will allow you to monitor the rehabilitation process and prevent relapse of the disease.

Exercise rules for patients on bed rest

This is the initial stage of rehabilitation, so maximum attention should be paid to it. IN in this case no additional sports equipment, such as sports sticks or fitballs, is required. A set of physical therapy exercises after myocardial infarction involves the following actions:

• Breathing with the diaphragm is performed 4 times;
• slow unclenching followed by active squeezing of the fingers – 10 times;
• rotation of the feet with raised legs – up to 5 times;
• elbow bends – 4 times;
• leg bending (the exercise is performed in such a way that the feet do not come off the surface of the bed) – 4 times;
• pelvic lifting should be performed only under the supervision of a physical therapy instructor - 3 times;
• This is followed by a short rest, the purpose of which is to normalize breathing;
• bend your knees, placing your feet on the bed, after which you need to bring your knees in and out 5 times;
• the hand straightens to the side and returns to its original position (after this, this action is performed with the other hand, and so on 4 times);
• starting position - lying on your back, turns on your side (in the presence of an instructor) - 3 times;
• rotate the brushes 5 times.

It is very important to carry out the above steps without visible overexertion. In case of fatigue, it is imperative to rest, since any overload of the heart muscle is fraught with complications.

If the patient finds it difficult to perform the exercises, then he should consider increasing the comfort of the exercises. For example, you can arrange the pillows more comfortably or change the mattress. Each of the above actions should not cause discomfort when performed.

What should you pay attention to?

In the video, charging after a heart attack at home is not particularly difficult. But to get a positive result, the patient will have to pay attention to some nuances. Regardless of the set of exercises, to perform them correctly, it is recommended to follow the following expert advice:

1. Physical activity after a heart attack should increase gradually. Even if the patient feels well, and it seems to him that he can skip several stages of exercise, he should increase the intensity of the exercises in accordance with the treatment plan.
2. It is recommended to start restorative exercises no earlier than a few hours after eating.
3. If discomfort occurs during or after training, exercise should be stopped. We are talking about dizziness, arrhythmias, shortness of breath. If the pain does not go away over time, it is recommended to use Nitroglycerin. After this, you need to visit a doctor as soon as possible.
4. For elderly patients suffering from osteochondrosis of the cervical spine, which has developed against the background of atherosclerosis, bending “below the heart” is prohibited. Otherwise, a sudden rush of blood to the brain may occur. Any rotational movements exercises performed with the head and torso, as well as strength-type exercises after a heart attack at home.

What's next?

As soon as the patient is lifted from strict bed rest, he can begin to gradually return to normal activities. The further stage of rehabilitation is conditionally divided into several periods:

1. Stationary (hospital) mode. It is characterized by the patient’s adaptation to the usual everyday loads, which do not require significant effort from him. The patient is recommended to perform simple activities, walking up the stairs and massage treatments will be useful. It is very important to monitor the increase in heart rate during this period, which should not increase by more than 20 beats per minute.
2. Post-hospital regimen. This is further rehabilitation carried out in sanatorium conditions or specialized cardiology centers. The main goal of this stage is to restore the cardiovascular system and increase its potential. The patient should be aimed at obtaining maximum activity levels, adapting to both domestic and professional stress. Exercise therapy, exercise equipment and some sport games are mandatory.
3. Supportive mode. Involves the patient's stay in specialized sanatorium-type institutions. During this period, omnidirectional physical development patient, relapse prevention is carried out. A person must actively perform a set of gymnastic exercises. We recommend games that do not involve heavy loads.

What does the rehabilitation program involve?

Gymnastics after a heart attack at home is one of the main techniques used in the post-heart attack period. However, for a complete cure it is not enough - an integrated approach is required. Therefore, it is very important to follow these recommendations:

1. Diet food. Each patient who has suffered a heart attack needs to carefully review their diet, reducing calorie intake and the content of animal fats. It is advisable to avoid smoked foods and sweet foods, with an emphasis on fruits and vegetables, which are recommended to be consumed daily. A good solution would be to include in the diet low-fat varieties fish.
2. Correct daily routine. Each patient should be provided with adequate sleep, which is necessary for the restoration of the body. You should also consider short walks in the fresh air.
3. Getting rid of bad habits. This is very important for those who want to forget about heart attacks once and for all. Smoking and alcohol significantly undermine the body. If the patient continues to smoke, then even the most modern treatment is unlikely to help him.

Physiotherapy after myocardial infarction at home occupies a very important place in the rehabilitation of patients. The training program is developed individually for each patient, but there are a number of general recommendations which were described above. A properly designed course of exercise therapy largely determines a positive prognosis for the recovery of the body and the absence of relapses of the disease in the future.

Focal or multiple necrosis of the heart muscle caused by acute coronary insufficiency. The size and location of the infarction depend on the size and location of the damaged artery. The exsanguinated tissue becomes necrotic within a few days and is subsequently replaced by a scar. Myocardial infarction manifests itself as prolonged severe pain in the heart area, increased heart rate, decreased blood pressure, arrhythmia, suffocation, and cyanosis. From the very first hours, characteristic changes appear on the electrocardiogram, which determine the severity and localization of myocardial infarction. On the 2-3rd day, body temperature rises, leukocytosis and increased ESR appear. Depending on the severity of the disease, bed rest is indicated in the first days and weeks.

In Cardiology scientific center The Academy of Medical Sciences has developed a comprehensive rehabilitation (recovery) for patients who have suffered a myocardial infarction and are in a hospital setting, as well as at the dispensary and polyclinic stage. It includes a complex of medical, psychological, physical and socio-economic measures that contribute to the most complete restoration of the health and ability to work of these patients. Physical rehabilitation includes measures to restore physical performance, which is ensured by the early prescription of therapeutic exercises, and then physical therapy, including dosed walking and other physical exercises. Depending on the presence and severity of complications and heart failure, patients are divided into 4 classes according to the severity of the disease. After the pain attack has been relieved and severe complications have been eliminated, on the 2-3rd day of the patient’s stay in the hospital, a class is determined for the severity of the disease and physical rehabilitation is prescribed. The physical rehabilitation program provides for a different nature and volume of everyday loads and loads in physical therapy classes, as well as during leisure time, depending on the patient’s belonging to a certain class in terms of severity of the disease and the day of illness. The period of a patient's stay in a hospital is conventionally divided into 4 stages, which in turn are divided into substages (a, b, c) in order to more accurately characterize permissible physical activity and gradually increase it. The determination of the class according to the severity of the disease and the transfer of the patient from one stage to another is carried out by the attending physician.

We present approximate complexes of therapeutic gymnastics No. 1 and 2. In patients of classes I and II, it is permissible to increase the heart rate during therapeutic exercises to 120 beats per minute; they need to determine the threshold power of work before being discharged from the hospital.

Approximate sets of physical therapy exercises for patients with myocardial infarction

Complex No. 1. At stages 1b and IIa (extended bed rest).

Classes are conducted individually in a private room while lying on your back. The pace of the exercises is slow, subject to the patient’s breathing. Do not force breathing. When the pulse increases by 15-20 beats per minute, a pause is made. After 2-3 sessions, if the exercises are successfully completed and the patient’s condition improves, it can be recommended to repeat this complex independently in the afternoon in a shortened version. Duration of classes is 10-12 minutes.

1. Flexion and extension of the fingers 6-8 times. Breathing is voluntary.

2. Flexion and extension of the feet 6-8 times. Breathing is voluntary.

3. Bending your forearms, elbows to the sides - inhale, straighten your arms and lower them along your body - exhale. Repeat 2-3 times.

4. Hands along the body, turn your palms up - inhale. Raising your arms forward up, palms down, stretch them to your knees, raising your head, straining the muscles of your torso and legs - exhale. Repeat 2-3 times. During the first lesson, you don’t have to raise your head.

5. Calm breathing 20-15 s. Relax.

6. Alternately bending the legs without lifting them from the bed - 4-6 times. Breathing is voluntary, from the 2-3rd lesson, flexion and extension of the legs should be done simultaneously - one leg bends, the other unbends.

7. Arms along the body, legs straightened and slightly apart. Simultaneous rotation of the arms and legs outward - inhale, inward - exhale. Repeat 4-6 times. From the 4th lesson, perform arm rotation with slight tension.

8. Lower your legs, bent at the knee joints, onto the bed to the right and then to the left. Breathing is voluntary. Repeat 4-6 times.

9. Legs bent at the knee joints. Raise your right hand up - inhale, stretch it to your left knee - exhale. Return to IP - inhale. Do the same with your left hand to your right knee. Repeat the exercise 4-5 times.

10. Legs straightened. Lift your right arm and left leg on the bed at the same time, turn your head to the right - inhale. Return to IP - exhale. Do the same with your left hand and right leg, turn your head to the left. Repeat 3-5 times.

11. Calm breathing 30-40 s. Relax.

12. Bend your arms at the elbow joints, clench your hands into a fist, and straighten your legs. Simultaneous rotation of the hands and feet 8-10 times. Breathing is voluntary.

13. Legs bent at the knees. Straighten your right leg up, return to IP. Do the same with your left foot. Repeat 4-6 times. Breathing is voluntary. This exercise is included in the complex from the 3-4th lesson.

14. Legs straightened and slightly apart, arms along the body. Place your right hand on your head - inhale, touch the opposite edge of the bed with your right hand - exhale. The same with the left hand. Repeat 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 s. When relaxing, inhale; when tense, exhale. Repeat 4-5 times. This exercise is included in the complex from the 2-3rd lesson.

16. Hands along the body. Raise your hands up - inhale, return to IP - exhale. Repeat 2-3 times.

Complex No. 2. At stages IIb and IIIa (ward mode). Classes are conducted individually for 10-15 minutes. The pace of the exercises is slow and medium. IP - sitting on a chair.

1. Lean against the back of a chair, hands on your knees, do not strain. Hands to your shoulders, spread your elbows to the sides - inhale. Return to IP - exhale. Repeat 4-5 times.

2. IP - the same. Roll from heels to toes with legs spread to the sides, simultaneously clench and unclench your hands into fists. Breathing is voluntary. Repeat 10-15 times.

3. Hands forward up - inhale. Return to IP - exhale. Repeat 2-3 times.

4. Sliding the feet forward and backward on the floor. Breathing is voluntary. Repeat 6-8 times.

5. Spread your arms to the sides - inhale. Return to IP - exhale. Repeat 3-5 times.

6. Sitting on the edge of a chair, move your right arm and left leg to the side - inhale. Return to IP - exhale. The same with the left hand and right foot. Repeat 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 voluntary. Repeat 3-5 times.

8. Spread your arms to the sides - inhale. Using your hands, pull your right knee to your chest - exhale. Same with the left knee. Repeat 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 - the same. Place your right leg on the knee of your left leg - exhale, return to IP - inhale. Same with the left foot. Repeat 3-5 times.

11. Calm breathing 20-30 s.

Dispensary and polyclinic stage of rehabilitation for most patients who have suffered a myocardial infarction, it is the longest and takes about 10-12 months. At this stage, based on the results of a functional test with dosed physical activity, patients are divided into 4 functional classes. The program of each class regulates the amount of physical activity associated with production activities and household activities, the volumes and methods of physical rehabilitation were determined. For example, at the end of the preparatory period, physical therapy exercises for class I patients are carried out for 30-40 minutes, and the pulse rate at the height of the load can increase to 140 beats per minute, respectively, for class II patients - up to 30 minutes and 130 beats per minute , in patients of class III - up to 20 minutes and 110 beats per minute and in patients of class IV up to 15-20 minutes and 90-100 beats per minute.

Long-term physical training (LPT) is carried out with the aim of: 1) restoring the function of a diseased heart through the maximum inclusion of cardiac and extra-cardiac compensation mechanisms in the blood circulation; 2) increasing tolerance to physical activity; 3) secondary prevention of IHD; 4) restoration of working capacity and return to professional work; 5) the possibility of partial or complete refusal of drug treatment.

The indication for DFT is a registered myocardial infarction at least 4 months old. All patients can be involved in the classes, regardless of gender and age. First of all, DFT groups should include mature people with risk factors such as hypokinesia; they are classified into functional classes II and III. Patients of class I do not actually need such training, and patients of class IV are contraindicated. Contraindications to DPT: cardiac aneurysm, frequent attacks of angina, severe rhythm disturbances and conduction system of the heart, circulatory failure above stage I, hypertension with a consistently elevated minimum blood pressure above 100 mmHg. Art., pronounced concomitant diseases.

Training is carried out in a gym 3 times a week for 30-60 minutes, the group should have 12-15 people. The training course is divided into 2 periods: a preparatory period lasting 2-3 months and a main one, which in turn is divided into 3 stages, which allows you to gradually increase physical activity during classes and prevent overtraining.

In rehabilitation centers DFT is under control medical personnel is best shape restoration of health and ability to work in patients who have suffered a myocardial infarction. However, a significant proportion of patients, for various reasons, cannot attend organized physical therapy classes. For this category of patients, an individual training program has also been developed using home exercise equipment, which is a folding step of variable height. This device makes it possible to prescribe dosed training loads to patients in the range from 100 to 800 kgm/m. The method of training at home according to an individual program differs from training in the gym in that, to prevent overexertion, a known safe load is recommended, which is 50% of the individual threshold power of a given patient, but also has a training effect, although less than a load of 75- 80% threshold power. Therapeutic gymnastics exercises are the same as in the gym. The described physical therapy exercises for myocardial infarction can serve as an example for their implementation in all other diseases of the cardiovascular system, only the timing of the transition from one mode of movement to subsequent ones can vary widely and, as a rule, the steps and stages in conducting physical training are significantly Briefly speaking. The basis for dosing physical activity in patients with cardiovascular pathology should be data on the threshold power of work of each such patient, obtained during dosed functional tests during bicycle ergometry or stepergometry. Remember that you can only engage in physical therapy after careful consultation with your doctor.

A heart attack is a disease of the cardiovascular system, it is recognized as one of the most dangerous. Fatalities, occurring due to myocardial infarction, are the number one cause of death in the world. You need to take care of yourself. It’s not difficult - diet, active lifestyle, no bad habits. If a heart attack has already occurred, you need to avoid its recurrence with proper nutrition and moderate but constant physical activity.

Features of rehabilitation

The disease develops as a result of a lack of blood supply to the heart muscle. The cause may be a decrease in blood flow due to narrowing or blocking of the arterial lumen that delivers oxygen to the heart muscle.

There are common cases when, during intensive therapy, there is a need for surgical intervention to restore blood flow to the heart muscles. Often this is done by stenting - the installation of a special frame that expands the narrowed area of ​​the vessel. The stenting procedure is the most effective, but it must be carried out no later than five hours from the time of the onset of a heart attack.

To return to a full life for people who have suffered from this disease, it is important to engage in proper rehabilitation during and after the treatment they receive. To do this, you need to strictly follow the doctor’s recommendations - both in the hospital and while already in familiar conditions, at home.

First stage of rehabilitation

Rehabilitation can be roughly divided into three stages.

The first stage includes inpatient treatment with gradually increasing physical activity. While in the hospital, lying down for quite a long time, detraining of the whole body occurs. As a result, it is necessary to very carefully introduce dosed walking, climbing stairs, gentle loads, and massage.

During inpatient treatment, the patient goes through four levels of activity in stages; the load at the stage is selected individually, depending on the patient’s condition.

In the first degree, strict bed rest is observed. Gymnastics after a heart attack is prescribed according to the first complex. The duration of classes is from 10 to 15 minutes, interspersed with pauses with relaxation and breathing exercises. Vital signs are monitored, blood pressure and heart rate are measured before and after classes.

In the absence of negative factors, they begin to master the second degree. Walks are allowed in the presence of an accompanying person, you can walk around the ward and along the corridor, you can eat at the table. Therapeutic exercises for myocardial infarction are also carried out in a sitting position. Movement on low stairs is allowed strictly under the supervision of an accompanying person, who must secure the patient.

After checking the pulse and pressure, conducting an orthostatic test (measuring pressure and pulse after transferring the patient from a horizontal to a vertical position), they gradually begin the third degree of recovery. The patient can walk along the corridor, should walk up to 200 meters, slowly, and is allowed to climb one flight of stairs. The third set of therapeutic exercises is carried out, including exercises performed while sitting and standing, gradually increasing activity, including breathing exercises. The duration of classes is up to 20 minutes, gradually increasing the pace. To monitor indicators, telemonitoring is used.

At the fourth degree, walks of up to one kilometer are allowed, twice a day at an average speed. Classes are conducted according to the fourth set of exercises, lasting half an hour, including loads for the back and limbs, classes are held at an average speed. Preparations are underway Before being discharged from the hospital, at home you need to be under the supervision of a cardiologist in the clinic; another option is also possible - transfer to a specialized sanatorium (if, of course, there is such a possibility).

After rehabilitation in a hospital, physical condition The following load should be available to the patient, without negative sensations: in the form of climbing stairs to one floor, self-care, walking up to 3 km per day, dividing them into several intervals.

During the second stage of rehabilitation, therapeutic exercises after myocardial infarction are very important for strengthening the heart muscle and improving blood circulation in general. After all, moderate physical activity improves metabolism, which has a positive effect on the condition internal organs. Gymnastics is carried out in the sanatorium, specialized centers or at home under the supervision of a cardiologist. For better adaptation and recovery, therapeutic exercises after a heart attack at home are widely used. In this case, the necessary set of exercises is recommended by the doctor individually, if there are the following indications:

• lack of shortness of breath when not under load;
• Frequent and severe pain in the heart does not bother you;
• absence of negative dynamics on the electrocardiogram.

When performing exercise therapy at home, you need to monitor your health; you should not get carried away with the exercises; you must strictly monitor your pulse and blood pressure.

An important condition for the effectiveness of exercise therapy is the regularity of classes. The most commonly recommended sports by cardiologists are skiing, walking, and swimming. You should exercise every day for half an hour, or three times a week, for an hour, an hour and a half, it is advisable to coordinate the time of exercise and the efforts made with your doctor, but you also need to take into account your feelings.

We should not forget that it is not advisable to conduct classes in frosty weather, in the sun, or immediately after eating. It is necessary to avoid actions that lead to excessive stress on the heart, especially for people who have had this disease.

Second stage of rehabilitation

The tasks of the second stage of recovery are:

• increase acceptable physical activity;
• adapt the patient in everyday, social and professional terms;
• improve vital signs;
• carry out secondary prevention of heart ischemia;
• reduce the amount and dose of prescribed medications.

Developed a large number of complexes of therapeutic exercises for people who have had a heart attack. These exercises can be done at home.

Exercises

The first approximate complex.

1. Feet shoulder-width apart, arms down, arms up, you need to stretch and inhale. Hands lower, describing a circle - exhale. Repeat algorithm up to 6 times.
2. Standing, place your feet with your toes apart, rest your hands on your belt. Turn to the left, spread your arms to the sides, inhale, returning to the starting position - exhale. Likewise in the opposite direction. Repeat up to 6 times.
3. Use the starting position of the first exercise. Inhale, squat, lean forward with your arms pulled back. Exhale. Execute up to 6 times.
4. Also the starting position. Inhale, lean on your hips, squat, exhale. Repeat up to 4 times.
5. While sitting and holding the seat of a chair, you need to stretch your legs. When performing a bend, tilt your head back, inhale, return to the starting position, and exhale. Repeat several times.

Second example complex.

1. While sitting, lower your arms along your body. When you inhale, you need to raise your shoulders, and when you exhale, lower them. Up to 4 times.
2. Grab your head from above and pull it towards your shoulder, repeat the exercise in the opposite direction.
3. Rest your hands on your shoulders, bend your elbows and make slow circular movements up to 8 times in both directions.
4. Place your closed hands on the back of your head and tilt your head, stretching the neck muscles, lowering your elbows. Spring lifts of bent elbows are performed with rhythmic nasal breathing up to 10 times.
5. The arms are bent, the forearms are kept parallel to the floor, the palms are turned up. It is necessary, springing, to bring the shoulder blades up to 30 times with nasal rhythmic breathing.
6. Try to bring your hands behind your back, alternating them, one from above, the other from below, up to 8 times.
7. Sitting on the edge of a chair, lean back, holding the seat with one hand, make movements with your head to the shoulder opposite to the involved hand in a smooth parabola from top to bottom up to six times. Repeat in the opposite direction.
8. Stretch your palm down left hand. Right hand take the fingers of the other hand and pull towards you, while stretching the muscles of the forearm, up to 15 times. The exercise is repeated individually for all fingers in turn.
9. Tighten the muscles of the chin and raise the face up, trying to reach the back of the head with the back of the head, then pause for up to 4 seconds, the head returns to its original position.

Breathing exercises are also added to the complex:

• holding my breath ( breathing exercises Holding your breath is done with caution, because this exercise increases blood pressure);
• combining the duration of inhalation and exhalation (this exercise should not cause discomfort; it is better that, due to physical activity, breathing naturally accelerates, and when resting, it becomes slower);
• blowing air through a tube into a container of water (probably the most effective and safe breathing exercise).

During recovery period It is necessary to pay special attention to physical therapy exercises.

During the second stage, you should strictly follow the recommendations of your doctor, under no circumstances stop drug treatment on your own, and follow a diet and rest regimen. Loads should be increased gradually; it is important to avoid factors that contribute to shortness of breath, rapid heartbeat, and discomfort in the heart.

During the third stage it is very important to maintain results achieved, try to lead a correct lifestyle to prevent the development of complications and in order to avoid situations that contribute to the occurrence of repeated attacks. Should be continued regular classes morning exercises, take long walks in the fresh air.