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

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

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

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

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

The rehabilitation period is conventionally divided into three phases:

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

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

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

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

Exercise therapy rules

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

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

Stages of rehabilitation

Stationary (hospital)

The rehabilitation period in a hospital is carried out for:

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

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

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

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

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

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

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

Recovery stage

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

Home stage of rehabilitation

The tasks of this stage are:

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

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

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

Exercise therapy complexes for myocardial infarction

I complex.

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

II complex.

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

Therapeutic exercise for bedridden patients

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

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

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

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

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

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

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

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

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

Therapeutic gymnastics classes have great importance not only for restoring the physical capabilities of patients with myocardial infarction, but also important as a means psychological impact, increasing resistance to stress. The main task in the rehabilitation of patients who have suffered a myocardial infarction, is the restoration of the cardiovascular system, improving exercise tolerance, lowering blood pressure and lowering cholesterol levels in the blood.

Therefore, the sooner and taking into account individual characteristics diseases, the more therapeutic exercises will be started, the better the overall healing effect will be.

All exercises must be performed smoothly, rhythmically with a gradual and strictly controlled increase in intensity, alternating them with breathing exercises. The goal of physical training is to gradually increase the number of heartbeats to 100 - 120 per minute.

Physical rehabilitation of patients with myocardial infarction consists of three stages, each of which has its own tasks.

FIRST STAGE: Hospital (hospital) - exercise therapy, dosed walking, walking up the stairs, massage.

SECOND STAGE: Readaptation (sanatorium) - exercise therapy, dosed walking, walking up stairs, exercise equipment general action(exercise bike), massage, occupational therapy.

THIRD STAGE: Supportive - exercise therapy (physical education and health forms, gymnastic exercises, sports games. Occupational therapy, as restoration and development of lost skills.

A set of therapeutic gymnastics exercises

We start the lesson by walking in place for 15-20 seconds. At the same time, watch your breathing.

• Starting position: standing, feet shoulder-width apart, arms along the body. Raise your arms up, palms facing out, and stretch upward while inhaling; as you exhale, lower your arms down, making a circle with them. Repeat the exercise 4 - 6 times.

• Starting position: standing, hands on your belt, feet shoulder-width apart. Turn to the left, spread your arms to the sides and inhale. Return to the starting position and exhale. Repeat this exercise, turning to the right. Repeat the exercise 4 - 5 times.

• Starting position: standing, feet shoulder-width apart, arms along the body. Inhale and squat down, try not to lift your heels off the floor, exhale by bending forward a little and moving your arms back. Return to the starting position inhale. Repeat the exercise 4 - 6 times.

• Starting position: standing, feet shoulder-width apart, arms along the body. Take a breath. Squat down with your hands on your hips and exhale. Return to the starting position inhale. Repeat the exercise 3 - 4 times.

• Starting position: standing, feet shoulder-width apart, hands on your belt. Lean to the left while lifting right hand up, inhale. Return to the starting position and exhale. Repeat the exercise on the other side. Do the exercise 3 - 4 times.

• Starting position sitting on a chair, grab the seat with your hands and stretch your legs. Bend your chest forward while moving your head back and inhaling. Return to the starting position and exhale. Repeat the exercise 4 - 6 times.

• Starting position sitting on a chair. Raise your left leg bringing it to a horizontal position and lower it. Repeat the same with your right leg. Maintain even breathing. Repeat the exercise 3 - 4 times.

• The starting position is sitting, leaning back in a chair and raising your arms up, while your legs are extended. Inhale and bend your left leg, clasping your shin with your hands, touching your knee to your chest. Tilt your head forward and exhale. Return to the starting position inhale. Perform the same movements, bending your right leg. Repeat the exercise 3 - 4 times.

• Starting position: standing, feet shoulder-width apart, arms along the body. Pull left hand forward and swing your leg back and forth. Return to the starting position. Repeat the exercise 3-4 times with each leg, maintaining even breathing.

• Starting position: standing, feet shoulder-width apart, arms along the body. Extend your right arm forward, then step forward with your left foot and extend your left arm in the same direction. Place your hands on your shoulders, clench your hands into a fist. Return to the starting position. Perform the same movements, starting with your left hand and stepping with your right foot. Repeat the exercise 3 - 4 times.

You can finish the exercises by walking in place for 20 - 30 seconds.

Attention! During the rehabilitation period after myocardial infarction, each patient is assigned his own physical activity regimen, so all additional physical activity must be approved by your attending physician.

Rehabilitation after myocardial infarction: therapy, nutrition and exercises

Most often, myocardial infarction is caused by a blood clot in the coronary artery, and the longer the victim is left without assistance, the greater the likelihood of death. Back in Soviet times, domestic scientists proposed principles for the treatment and rehabilitation of patients who had suffered a myocardial infarction. Today, these rules are recognized almost throughout the world and have changed little (except in the names of medications). Therefore, we suggest that you familiarize yourself with them in more detail.

Drug therapy for myocardial infarction

Medicines are prescribed to patients exclusively by a doctor and are designed to improve his condition and prolong life by reducing pain or improving blood circulation, thereby minimizing the occurrence of recurrent blood clots.

• Disaggregants (Plavix, Aspirin). Use daily to reduce the risk of recurrent blood clots.
• Beta blockers (containing Concor and Egilok, for example, Propranolol, Timolol). Reduces possible stress on the heart, lowers blood pressure and reduces heart rate.
• ACE inhibitors (Enalapril, Monopril, Captopril). These drugs reduce blood pressure and are actively involved in slowing down the restructuring of the muscular layer of the heart. and this allows the myocardium to be more resistant to various internal and external factors.
• Diuretics (prescribed prophylactically) to remove excess fluid from the body.
• Statins help in the fight against atherosclerotic plaques, which can appear due to high cholesterol levels in the patient's blood. Prescribed along with a diet.
• Calcium antagonists (Nifeldipine, Nicardipine). Applicable for a year as therapy.
• Metabolites – improve the functioning of the metabolic system.
• Antioxidants – neutralize free radicals in the body, eliminate diseases and give youth. They can be prescribed both natural (in vegetables and fruits) and as vitamins. teas and other supplements.

You should consult your doctor about the advisability of using a particular drug. The correct dosage and use of all prescribed medications will allow patients to forget about the problem and enjoy life.

Nutrition after myocardial infarction

For patients who have had a heart attack, the diet is integral part rehabilitation program. Reduce role proper nutrition In no case should it be, since it is the presence of large amounts of salt, sugar and saturated fats in foods that leads to cardiovascular diseases and increased cholesterol. which is precisely the cause of the appearance of plaques and blood clots in the vessels.

Rehabilitation after myocardial infarction implies that the patient needs to adhere to a certain diet throughout his life, taking into account the fact that many foods will be prohibited.

What not to eat:

• offal
• boiled egg yolks
• lard, fatty meat
• sausages and salami
• smoked meats and pickles
• hot spices, seasonings and sauces
• alcohol. strong coffee and tea

If the patient is overweight, it will be necessary to limit the intake of flour, since excess weight negatively affects the functioning of the heart.

Products that should be in the diet:

• greens and vegetables (especially cabbage)
• a serving of lean meat per day
• soups and meat broths
• any types of dried fruits
• dairy
• cereals
• fruits and berries
• black bread
• durum wheat pasta
• seafood
• legumes and nuts
• vegetable and butter
• rosehip jam and decoctions
• fresh juices

Strictly following a diet will improve your quality of life and improve your health.

Physical activity after myocardial infarction

Restoring physical abilities occupies a major place in rehabilitation after myocardial infarction. Special gymnastics. carried out under the supervision of a specialist, will help to quickly return the patient to his former mobility.

In this case, gymnastics is done either independently (at home), or by visiting special centers, since ordinary clinics often do not provide such services.

At home, during gymnastics and exercises, you need to monitor your pulse and blood pressure; in no case should you overdo it, but no one has canceled the regularity of exercise.

The main sports recommended by cardiologists include swimming, running, walking or skiing. Classes should be carried out daily for 30 minutes or three times a week, but increasing the time to 60-90 minutes with the permission of the attending physician.

As general recommendations It is worth remembering that exercise should not occur immediately after eating; it is not recommended to exercise in the cold or in direct sunlight. All this increases the load on the heart, which is not recommended in the case of a previous myocardial infarction.

As for heavy physical activity, you should forget about it. Men cannot lift anything heavier than 20 kilograms; women should limit themselves to 3-5 kilograms.

Increasing the load, if required, is performed after the body has adapted to the previous weight. Rest during physical activity is recommended for at least 20 minutes.

In conclusion, it is worth recalling that a real assessment of your condition and a timely rest or stop will improve your health without harming it.

Psychological rehabilitation after myocardial infarction

After an attack, the patient most often begins to experience fear of a repeat heart attack, even if he does not show it, and internal problems can lead to panic attacks and stressful conditions that negatively affect the general well-being of the patient.

Psychological rehabilitation after myocardial infarction will allow patients to return to normal life without fear, to understand that there is life after the disease.

Basically, psychological rehabilitation is aimed at helping the patient adapt to new living conditions (diet and regimen, giving up bad habits, physical activity).

It is worth noting that specialists help to set the patient up positively, focusing him on the result and achieving positive dynamics in rehabilitation.

Active work is also carried out with the patient’s relatives who will live or live with him under the same roof. They must be aware of overprotection, as well as neglect and stress. can cause a second attack, which has a greater chance of death.

There is a high risk of recurrent myocardial infarction in the first days and first year after an attack.

Therefore, each patient must understand for himself how dear and valuable life is to him and that the duration and quality of further life depends on his behavior.

If all recommendations are followed and all prescriptions are followed, the patient will soon be able to return to his almost usual way of life. This, of course, will not be the same person, since the disease often changes views on things, lifestyle, personal opinion, but in general, it will be the same person with minor improvements in his life (sports, proper nutrition).

From the program with Elena Malysheva Live Healthy you will learn more information about such a disease as myocardial infarction.

The main thing is that you should not close yourself off from the whole world and consider yourself flawed or inferior; after a myocardial infarction, many people live happily for many years, without remembering heart problems. Modern medicine, qualified doctors and loving family and friends help them with this.

Rehabilitation after myocardial infarction

All treatment of a patient who has suffered a heart attack should be aimed at rehabilitation after a myocardial infarction - its prevention. Since, according to statistics, a relapse occurs in 7 cases out of 10. Dealing with repeated heart attacks is much more difficult, since in any case, the first relapse is not without consequences, reducing and compressing the coronary arteries (heart).

Rehabilitation after myocardial infarction should begin from the first days. The patient must take mumiyo and other medications, follow a diet, perform therapeutic exercises and kneading massage of large muscle groups.

It is very important to master the basics of psychocorrection; cultivating in oneself, friends, and loved ones such qualities as easy-going, goodwill, patience, and tolerance. To do this, be in nature more often, listen to the sounds of nature: rivers, forests.

Rehabilitation after myocardial infarction includes stress management. Stay away from people who might offend you or make you angry. If you do find yourself in such a company, respond to rudeness and rudeness with a smile.

To keep your heart in order, fight depression, hypochondria, and blues. Creativity and handicrafts will help here - embroidery, knitting, drawing, cooking, wood carving. It’s not for nothing that women who love to work live on average 20 years longer than their lazy friends and men who waste time in front of the TV.

Herbal medicine will also help to rehabilitate after a myocardial infarction. To prevent a second heart attack (if there are no scars on the heart after the first), dissolve 5 grams of mumiyo in 150 grams of aloe juice. Take the product for 2 weeks on an empty stomach 2 times a day - before breakfast and at night. Repeat the course after 2 months.

Rehabilitation after myocardial infarction - gymnastics

Be sure to do physical therapy (physical therapy) and gymnastics. Take the dumbbells in your hands and perform smooth swinging movements. Mowing exercise, for example: bend your knees slightly and swing your arms in front of you, as if mowing grass.

Or the “skier” exercise: squat down slightly and swing your arms back and forth along your body, as if you were pushing off with ski poles.

There is a wonderful exercise called “gutta-percha boy”: alternate smooth swings of your arms down and back, up and back. In this case, the joints of the hands actively work - the more joints are involved in the exercises, the higher the healing effect of therapeutic exercises. It trains and strengthens blood vessels, preventing heart attacks and angina.

Slow swimming in the pool also strengthens blood vessels and nerves. At the initial stage of hypertension, the best medicine is skiing. In calm weather in winter, arrange ski trips for half an hour or an hour. Even ordinary walking on foot will bring the blood vessels and heart back to normal. fresh air, with wide, sweeping steps, slowly.

In the period after a heart attack, patients should perform self-massage. Do it in the morning after waking up, repeat in the afternoon. Start by rubbing the fingers of one hand over the fingers of the other, starting with the little finger. Then rub your palms, wrists, forearms, elbow joints, shoulders and upper arms deeply. Try to reach your shoulder blades and massage them. Then rub the back of your head, neck, stroke your temples, forehead, face. During the massage, tell yourself: “No worries,” “I am calm,” “My heart beats calmly and evenly.”

Rehabilitation after myocardial infarction - folk remedies

Diet is also important in the prevention and rehabilitation after myocardial infarction. You need to eat at least 700 grams of vegetables per day. Be sure to have raw carrots from 150 grams, walnuts 8 pieces each, with raisins or dried apricots. Try replacing table salt seaweed, meat - poultry, fish.

• In May, be sure to prepare salads from medicinal wild plants: quinoa, squash, cuffs, plantain. For heart diseases, the berries and flowers of rowan and hawthorn are of particular value among medicinal plants; flowers and leaves of motherwort, sweet clover, oregano, lemon mint; jasmine flowers.
• They perfectly relieve vascular spasms and nervous tension, stress reactions and weather sensitivity.
• For heart diseases, it is also very useful to take a mixture of tinctures of motherwort, valerian, and hawthorn from folk remedies: add 15 drops of each tincture to jasmine, green or mint tea.
• An effective folk remedy that helps restore heart function. Grind the partitions in a coffee grinder walnut, pour vodka 1:5 (25 grams of partitions per 250 milliliters of vodka), let it brew for several days. Drink a teaspoon before meals (walnut tincture).
• It is also recommended to add 10 grams of licorice and wheatgrass roots to the tincture. Licorice will serve as a raw material for creating our own hormones that we lack. Wheatgrass will cleanse the blood of excess cholesterol and prothrombin (normalize hormonal balance).
• If you cook compote, add rowan and hawthorn berries to it. They will help save you from extra pounds, interfering with blood vessels, the heart and creating additional stress.

It should be emphasized that the process of rehabilitation after myocardial infarction does not end here. A person who has had a heart attack and has taken a considerable amount drugs of chemical origin, the body is greatly weakened. To strengthen the body, such a patient is recommended to drink more vitamins.

You have read the information

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 for discharge 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 carried out in a hospital, according to the patient’s physical condition, the following load should be available, 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 of internal organs. Gymnastics is carried out in a 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. Extend your left arm, palm down. With your right hand, take the fingers of the other hand and pull them 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 your breath (breathing exercises for holding your breath are carried out carefully, 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 the achieved results, try to lead a correct lifestyle to prevent the development of complications and to avoid situations that contribute to the occurrence of repeated attacks. You should continue regular morning exercises and take long walks in the fresh air.

The attending physician should select appropriate exercises. He will determine the required frequency and intensity of training. Exercise therapy is carried out only under the supervision of a specialist. Exercise is different for everyone, as all bodies cope with a heart attack differently.

A properly designed set of exercises allows you to restore lost skills and reduce risk. But excessive stress will require bed rest and the use of medications.

What exercises to perform depends on the patient’s condition, age and course of the disease.

It is important to remember that there are certain contraindications for performing exercises. Therefore, the doctor selects the complex based on the patient’s health condition.

During the period of exacerbation, you cannot engage in exercises. If you are absent, you can start training on the third day. Start with exercises performed in bed.

Execution Rules

If you are prescribed exercise therapy after a heart attack, then you need to follow some recommendations:

1. Even in good health, you should not sharply increase the intensity of your exercise.
2. If during the exercise there are difficulties with breathing, the heart beats strongly and discomfort is felt, then you should take a rest.
3. It is allowed to exercise a few hours after eating.
4. If you have a history of atherosclerosis, you should not bend low so that the blood does not rush sharply to the head.
5. It is necessary to abandon strength exercises that require significant effort and rotation.

Conducting training in the hospital. But you need to continue studying after discharge. In the hospital using exercises:

• activate blood flow through peripheral vessels;
• achieve improvement in the moral condition of the patient;
• normalize breathing;
• prevent excessive blood clotting;
• prevent pathologies of the digestive system, hypertrophic changes in muscles, pneumonia.

The rehabilitation period in the hospital ends when the patient can walk up to the first floor, walk several kilometers and take care of himself. In this case, there should be no unpleasant symptoms.

Therapeutic exercise is integral part general physical education and one of the most important methods complex treatment of patients with the cardiovascular system, as well as effective means preventing exacerbations with the correct structure of classes and the entire complex.

The heart ensures the movement of blood through the vessels. However, the force of contraction of the left ventricle alone is not enough for this, and in the process of blood circulation, a large role belongs to extracardiac (extracardiac) factors. There is negative pressure (below atmospheric pressure) in the jugular and iliac veins, and blood moves towards the heart due to the suction force of the chest cavity during inhalation.

The increase in the volume of the thoracic cavity during inhalation creates greater negative pressure inside the cavity than in the vena cava, and this promotes the movement of blood towards the heart. Blood flow in the veins of the abdominal cavity is provided by another important extracardiac factor - the pressor function of the diaphragm. When contracted during inhalation, it flattens and descends, enlarging the thoracic cavity and simultaneously reducing the abdominal cavity; at the same time, intra-abdominal pressure increases, which ensures the movement of blood to the heart. When you exhale, the diaphragm relaxes and rises, accordingly the volume of the abdominal cavity increases, the pressure in it drops and blood from the lower extremities moves into the inferior vena cava.

During passive and active exercises, the muscles compress the veins and the valves in the veins move blood towards the heart. This mechanism of blood flow in the veins is called the “muscle pump.”

The purpose of this work is to indicate the physiological basis for the use of exercise therapy for this disease, some guidelines, as well as an approximate structure of classes and basic exercises.

The complex of treatment for patients with the cardiovascular system necessarily includes physical therapy - exercise therapy.

1. Exercise therapy for myocardial infarction

1.1. Classification of the severity of the condition of patients with myocardial infarction

Myocardial infarction is focal or multiple necrosis of the heart muscle caused by acute coronary insufficiency. The necrotic tissue is subsequently replaced by a scar. During a heart attack, severe pain appears in the heart area, increased heart rate, decreased blood pressure, suffocation, and drowsiness. An electrocardiogram (ECG) determines the location of the infarction and its severity. In the first 3 days, body temperature rises, leukocytosis appears and ESR increases.

In accordance with the WHO classification and recommendations of the Cardiology Research Center of the Russian Academy of Medical Sciences, there are four functional classes of severity of the condition of patients who have suffered a myocardial infarction, as well as those suffering from coronary heart disease (without a history of a heart attack).

I functional class- ordinary physical activity (walking, climbing stairs) does not cause heart pain; pain may appear with heavy loads.

II functional class- pain occurs when walking, climbing stairs, cold weather, with emotional stress, after sleep (in the first hours). The motor activity of patients is somewhat limited.

III functional class- pain appears when walking normally on level ground for a distance of 200-400 m, or when climbing stairs to one floor. The possibility of physical activity is noticeably limited.

IV functional class- pain occurs with the slightest physical activity, i.e. the patient is not able to perform any physical work.

Patients with small-, large-focal and transmural uncomplicated infarction are classified as severity classes I-III. Class IV includes patients with severe complications: angina at rest, heart failure, rhythm and conduction disorders, thromboendocarditis.

1.2. Comprehensive rehabilitation program for patients with myocardial infarction

The Cardiological Research Center of the Russian Academy of Medical Sciences has developed a comprehensive program for the rehabilitation of patients with heart attacks at the stage of inpatient treatment and together with the Russian scientific center rehabilitation treatment and balneology ( Central Institute balneology and physiotherapy - until 1992) - at the stages of outpatient and sanatorium treatment.

Physical rehabilitation of patients with myocardial infarction is divided into three phases (stages):

First stage- treatment in hospital in the acute period of the disease until clinical recovery begins.

Second phase- post-hospital care (readaptation) in a rehabilitation center, sanatorium, clinic. The recovery period begins from the moment of discharge from the hospital and lasts until return to work.

Third stage- supportive - in a cardiology clinic, clinic, medical and physical education clinic. In this phase, rehabilitation continues and ability to work is restored.

The first stage is sick leave

Objectives of exercise therapy:

• warning possible complications, caused by weakening of heart function, a violation of the blood coagulation system, a significant limitation of motor activity due to bed rest (thromb-embolism, congestive pneumonia, intestinal atony, muscle weakness, etc.);
• improving the functional state of the cardiovascular system through physical exercise, mainly for training peripheral circulation and orthostatic stability;
• restoration of simple motor skills, adaptation to simple everyday stress, prevention of hypokinesia and kinesia (hypokinetic syndrome);
• creating positive emotions.

Forms of exercise therapy. The main form is therapeutic exercises at the end of this stage - dosed walking, walking up the stairs, massage.

In case of an uncomplicated heart attack, classes begin on the 2-3rd day, when the main signs of an acute heart attack subside.

The timing of the start of classes and the gradual increase in load are strictly individual and depend on the nature of the heart attack and the severity of post-infarction angina.

The physical rehabilitation program, taking into account the severity class and day of illness at the first stage of treatment in the hospital, is presented in Table. 1. The period of hospital stay is conventionally divided into four stages, which are divided into substages (a, b, c) for a more differentiated approach in choosing the load. The severity class and transfer of the patient from one stage to another is determined by the attending physician.

The physical rehabilitation program for patients with myocardial infarction during the hospital phase is built taking into account the patient’s belonging to one of 4 classes of severity of the condition. The severity class is determined on the 2-3rd day of illness after the elimination of pain and complications such as cardiogenic shock, pulmonary edema, severe arrhythmias. This program provides for the assignment to the patient of one or another nature and volume of physical activity of a domestic nature, a training regimen in the form of therapeutic exercises, and leisure activities at different times depending on his belonging to one or another severity class. The entire period of the stationary stage of rehabilitation is divided into four stages with a division of characterizing the daily level of loads and ensuring their gradual increase.

Stage I covers the period the patient is on bed rest. Physical activity to the extent of step “a” is allowed after the pain syndrome and severe complications of the acute period have been eliminated and is usually limited to one day.

Indications for transferring the patient to stage “b” (even while the patient is on bed rest):

• pain relief;
• elimination of severe complications on the 1st-2nd day of the disease with an uncomplicated course.

Contraindications to transferring the patient to stage “b”:

• persistence of angina attacks (up to 2-4 per day);
• pronounced signs of circulatory failure in the form of sinus tachycardia (up to 100 or more per minute);
• severe shortness of breath at rest or with the slightest movement;
• a large number of congestive wheezing in the lungs;
• attacks of cardiac asthma or pulmonary edema;
• complex severe rhythm disturbances provoked by physical activity or leading to hemodynamic disturbances (for example, frequent paroxysms of the tachysystolic form of atrial fibrillation)
• tendency to develop collapse.

Table 1

Physical rehabilitation program for patients with myocardial infarction during the hospital phase

Note. When transferring a patient to each subsequent level of activity, one should be guided by the criteria for expanding the regimen: in patients 60 years of age and older or who suffered from arterial hypertension or diabetes mellitus before the present myocardial infarction (regardless of age):

* the specified period is increased by 2 days;

** the specified period is increased by 3-4 days.

With the transfer of the patient to step “b”, he is prescribed Therapeutic gymnastics Complex No. 1. The main purpose of this complex is to combat hypokinesia in the conditions of bed rest prescribed to the patient and prepare him for the earliest possible dilation physical activity. The use of therapeutic exercises in the first days of myocardial infarction plays an important psychotherapeutic role. Classes are conducted by a physical therapy instructor with the patient lying down, individually with each person. The timing of the prescription of therapeutic exercises and its volume are determined collectively: by the cardiologist observing the patient, the exercise therapy doctor and the instructor. The beginning of therapeutic exercises precedes the patient’s first sitting down. Actually, step “b” involves joining the above activity by sitting down in bed, dangling your legs, with the help of a sister for 5-10 minutes 2-3 times a day. The first sitting down is carried out under the guidance of a physical therapy instructor, who must explain to the patient the need to observe a strict sequence of movements of the limbs and torso when moving from a horizontal position to a sitting position, physically help the patient at the stage of raising the upper body and lowering the limbs, and carry out dynamic clinical monitoring of the patient’s reaction to this load. Therapeutic gymnastics ensures a gradual expansion of the patient’s physical activity regime.

Therapeutic gymnastics complex No. 1 includes light exercises for the distal extremities, isometric tension of large muscle groups of the lower extremities and torso, relaxation and breathing exercises. The pace of the exercises is slow, subordinate to the patient’s breathing. The depth of breathing in the first days is not recorded, as this can cause pain in the heart, dizziness and fear during subsequent exercises. The instructor, if necessary, helps the patient in performing the exercises. Each movement ends with relaxation of the working muscles. After completing each exercise, a pause is provided for relaxation and passive rest. The total duration of rest breaks is 50-30% of the time spent on the entire lesson.

During exercise, you should monitor the patient's pulse. When the pulse rate increases by more than 15-20 beats, pause to rest. After 2-3 days of successful implementation of the complex and improvement of the patient’s condition, it can be recommended to repeat this complex in the afternoon in a shortened version. Duration of classes - 10-12 minutes.

1.3. Complexes of therapeutic exercises for patients with myocardial infarction

We present approximate complexes of therapeutic exercises for patients with myocardial infarction who are undergoing hospital treatment, which correspond to the rehabilitation program (see Table 1).

Therapeutic gymnastics complex No. 1 (IP - lying down)

1. Dorsal and plantar flexion of the feet. Breathing is arbitrary (6-8 times).

2. Flexion and extension of the fingers. Breathing is arbitrary (6-8 times).

3.Bend your arms to your shoulders, elbows to the side - inhale, lower your arms along your body - exhale (2-3 times).

4. Hands along the body, turn them palms up - inhale. Raising your arms forward - up, palms down, pull them to your knees, raising your head, tensing the muscles of your torso and legs - exhale. When doing therapeutic exercises for the first time, you should not raise your head in this exercise (2-3 times).

5.Take 2-3 calm breaths and relax.

6. Alternately bending the legs while sliding along the bed. Breathing is voluntary. From the second lesson, bend the legs as if riding a bicycle (one leg is bent), but without lifting the feet from the bed (4-6 times).

7.Arms along the body, legs straightened and slightly apart. Turn your hands with your palms up, move them a little, at the same time turn your feet outward - inhale. Turn your hands palms down, feet inward - exhale. At the 3-4th lesson, make movements with your hands so as to feel the tension in shoulder joints(4-6 times).

8. Lower your legs, bent at the knee joints, onto the bed to the right, then to the left (rocking the knees). Breathing is arbitrary (4-6 times).

9.Legs bent at the knees. Raise your right hand up - inhale; stretch your right hand to your left knee - exhale. Do the same with your left hand to your right knee (4-5 times).

10. Straighten your legs. Move your right arm to the side, turn your head in the same direction, at the same time take your left leg to the side on the bed - inhale, return them to their previous position - exhale. Do the same with your left hand and right foot. The exercise can be complicated by combining leg abduction with leg lifting (3-5 times).

11.Calm breathing. Relax.

12.Bend your arms at the elbow joints, clench your fingers into fists, rotate your hands in the wrist joints while rotating your feet. Breathing is arbitrary (8-10 times).

13.Legs bent at the knees. Raise your right leg up, bend it, return to IP. Do the same with the other leg. Breathing is voluntary. The exercise is included in the complex no earlier than after 2-3 sessions (4-6 times).

14. Legs straightened and slightly apart, arms along the body. Right hand on the head - inhale; touch the opposite edge of the bed with your right hand - exhale. The same with the left hand (3-4 times).

15.Arms along the body. Squeeze your buttocks together, simultaneously straining your leg muscles, relax them (4-5 times). Breathing is voluntary.

16. As you inhale, raise your arms up, and as you exhale, lower them (2-3 times).

Criteria for the adequacy of this complex of therapeutic exercises: increased heart rate at the height of the load and in the first 3 minutes after it - by no more than 20 beats, breathing - by no more than 6-9 per minute, increase in systolic pressure - by 20-40 mm Hg. Art., diastolic - by 10-12 mm Hg. Art. (compared to the baseline) or a decrease in heart rate by 10 beats/min, a decrease in blood pressure by no more than 10 mm Hg. Art.

The occurrence of an attack of angina pectoris, arrhythmia, sudden shortness of breath, tachycardia with a slow return to the initial heart rate, sudden changes in blood pressure (mainly its decrease), severe weakness and a feeling of discomfort, pallor of the skin, acrocyanosis indicate an unfavorable reaction to physical activity. In these cases, further loading should be temporarily suspended.

Stage II includes the amount of physical activity of the patient during the ward period - before he goes out into the corridor.

At this stage of activity, the patient performs therapeutic exercises in the same volume (therapeutic exercises complex No. 1), lying on his back, but the number of exercises increases.

If there is an adequate response to this amount of physical activity, the patient is transferred to step “b” and he is allowed to walk first around the bed, then around the ward, sit down at the table, and eat food while sitting at the table. The patient is prescribed complex of therapeutic exercises No. 2, which is also carried out individually under the guidance of an instructor. The main purpose of the complex is to prevent physical inactivity, gentle training of the cardiorespiratory system, and prepare the patient for free walking along the corridor and climbing stairs. The pace of the exercises is regulated by the instructor, especially in the first 2-3 lessons. Therapeutic gymnastics complex No. 2 is performed in the supine - sitting - lying position. The number of exercises performed while sitting gradually increases. Movements in the distal parts of the limbs are gradually replaced by movements in the proximal parts, which involves larger muscle groups. Additional effort is introduced into leg exercises. Each change in body position is followed by passive rest.

Therapeutic gymnastics complex No. 2 IP - sitting

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, lower your hands to your knees - exhale (4-5 times).

2. Roll from heels to toes with legs spread to the sides, simultaneously clench and unclench your fingers into fists (10-15 times). Breathing is voluntary.

3. Hands forward, up - inhale, lower your hands down through the sides - exhale (2-3 times).

4. Slide your legs forward and backward on the floor without lifting your feet from the floor (6-8 times). Breathing is voluntary.

5. Spread your arms to the sides - inhale, hands on your knees, tilt your torso forward - exhale (3-5 times).

6. Sitting on the edge of a chair, move your right arm and left leg to the side - inhale. Lower your arm and bend your leg - exhale. Do the same in the other direction (6-8 times).

7. Sitting on a chair, lower your arm along your body. Raising your right shoulder up, simultaneously lower your left shoulder down. Then change the position of the shoulders (3-5 times). Breathing is voluntary.

8.Spread your arms to the sides - inhale, with your hands pull your right knee to your chest and lower it - exhale. Do the same, pulling your left knee to your chest (4-6 times).

9. Sitting on the edge of a chair, place your hands on your belt. Relax your torso, bring your elbows and shoulders forward, lower your head to your chest. While inhaling, straighten up, spread your elbows and shoulders, bend your back, turn your head to the right. Relax, head on chest. Continuing to do the exercise, turn your head to the left - exhale (4-6 times).

10.Calm breathing (2-3 times).

Particular attention should be paid to the patient’s well-being and his reaction to the load. If there are complaints of discomfort (chest pain, shortness of breath, fatigue, etc.), it is necessary to stop or reduce the load, reduce the number of repetitions and additionally introduce breathing exercises.

In patients of classes I and II of severity, an increase in heart rate during exercise up to 120 beats per minute is permissible. Before discharge, the threshold power of work that the patient can perform should be determined.

The second stage is post-hospital

The recovery period begins from the moment of discharge from the hospital and for an uncomplicated heart attack lasts two months. In the first month of the recovery period, it is most effective to continue rehabilitation in a cardiological sanatorium, which has been tested since 1988. Patients with an uncomplicated heart attack are sent to the sanatorium if they are in satisfactory condition, capable of self-care, and have achieved the ability to walk up to 1 km and climb 1-2 flights of stairs without any discomfort.

Patients enter the sanatorium on the 12-17th day, in total - after 20-30 days, i.e. in the first month of the recovery period.

Based on the results of an exercise test, patients sent to a sanatorium are divided into three classes:

1st class— performance 700 kgm/min and more, 2nd class— performance 500-700 kgm/min, 3rd grade— performance 300-500 kgm/min.

Objectives of exercise therapy:

• restoration of physical performance, elimination of residual effects of hypokinesia, expansion of the functional capabilities of the cardiovascular system;
• increased physical activity; preparation for physical household and professional stress.

Contraindications to the use of exercise therapy:

• circulatory failure degree II and higher;
• chronic coronary insufficiency of functional class IV;
• severe disturbances of heart rhythm and conduction;
• recurrent course of myocardial infarction;
• aortic aneurysm, cardiac aneurysm with symptoms of heart failure.

Contraindications to exercises in the exercise therapy room of a polyclinic, medical and physical education clinic:

• frequent attacks of angina, angina at rest, unstable angina, severe arrhythmias;
• circulatory failure above stage II;
• persistent arterial hypertension over 170/100 mmHg;
• accompanying diabetes severe form. It is allowed to practice therapeutic gymnastics at home using a lightweight complex.

Forms of exercise therapy: therapeutic exercises, dosed walking, walking on stairs, walks, exercises on general exercise equipment (an exercise bike, treadmill, etc.), elements of applied sports exercises and games according to simplified rules, occupational therapy, massage.

With concomitant asthenic syndrome in the early post-hospital period, the general and special load in therapeutic exercises should be limited and at the same time, relaxation exercises should be used more widely.

The procedures are carried out in a group method, preferably without musical accompaniment. Lesson duration: 20-30 minutes.

The main means of training is walking up to 3500 m, at a pace of 100-110 steps per minute. During outdoor games, according to simplified rules, it is necessary to pause for rest every 7-15 minutes. The pulse rate should not exceed 110 beats/min, and for those taking beta blockers - 100-105 beats/min. Use natural factors of nature, air baths, moderate solar radiation, sleep in the air.

In the second month of recovery, patients are at home under observation in the clinic. They do exercise therapy at a medical and physical education clinic (VPD), a clinic 3-5 times a week, or independently at home. When doing therapeutic exercises, training on an exercise bike, or a treadmill for 10 to 20 minutes at the end of the month, it is considered optimal to increase heart rate by 20-25 beats/min, but not more than 120 beats/min. In addition to therapeutic exercises, walking 2 times a day for 3-5 km is recommended; by the end of the month, accelerated walking for 2-3 minutes is acceptable with an increase in heart rate to 135-145 beats/min.

The third stage is supportive

Starts at 3-4 months. from the onset of the disease and continues throughout life. Provided regular exercise at the previous stage, physical performance approaches that of healthy peers—700-900 kgm/min.

Objectives of exercise therapy:

• maintaining and increasing physical performance;
• secondary prevention of coronary artery disease and recurrent infarction.

Forms of exercise therapy: physical exercises are similar to those used in people with poor health and reduced physical performance. They use therapeutic exercises, walking, climbing the stairs to the 3rd-5th floor 2-3 times, training on general exercise equipment, sports games with simplified rules, massage.

The described physical therapy exercises for myocardial infarction can be used for other diseases of the cardiovascular system, but the transition time to higher loads is shorter.

2. Exercise therapy for coronary heart disease

Coronary heart disease is a common disease that manifests itself as angina pectoris - pain in the heart, behind the sternum, in the left arm, under the left shoulder blade. Pain occurs as a result of vasospasm and myocardial ischemia. Attacks of pain are provoked by negative emotions, smoking, alcohol abuse, physical and mental stress.

Objectives of exercise therapy:

• contribute to the regulation of the coordinated activity of all parts of the blood circulation and the development of reserve capabilities of the cardiovascular system;
• improve coronary and peripheral circulation, improve emotional condition, increase and maintain physical performance;
• secondary prevention of ischemic heart disease.

Contraindications:

Forms of exercise therapy: therapeutic exercises, dosed walking, physical exercises in water and swimming, massage; use of natural factors.

Exercise therapy is indicated in the period between attacks of angina:

• for mild attacks (on the 2-3rd day),
• during severe attacks (on the 6-8th day),
• in older people (after a moderate attack after 3-4 days).

The training methodology is similar to that used in survivors of myocardial infarction (Table 2).

table 2

Scheme of the therapeutic exercises procedure for patients with a mild form of chronic ischemic heart disease (for the middle of the course of treatment)

3. Exercise therapy for arterial hypertension

Arterial hypertension (AH) is a common disease characterized by increased blood pressure.

The US Joint National Committee on the Prevention, Detection, Evaluation and Treatment of Hypertension in Patients 18 Years of Age and Over offers the following classification of this disease (Table 6).

Table 3

Classification of blood pressure level (VI revision, 1999)*

* US Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of Hypertension for Persons 18 Years of Age and Over.

The World Health Organization has adopted the following classification of hypertension:

Stage I- increased blood pressure without involvement of target organs;

Stage II- increased blood pressure with involvement of target organs (heart, fundus, kidneys);

Stage III- increased blood pressure with damage to target organs (stroke, heart attack, renal failure, heart failure).

Objectives of exercise therapy: help reduce blood pressure and prevent crises, improve the general condition of the patient.

Contraindications to the use of exercise therapy:

Forms of exercise therapy: therapeutic exercises, dosed walking, general exercise equipment, physical exercises in the pool and therapeutic swimming, massage.

During a crisis, bed rest is prescribed and exercise therapy is not used. Therapeutic exercises are prescribed after the pressure has decreased and the complaints that occur during a crisis have disappeared.

In the first days, classes are conducted individually, and if improvement occurs, after 5-6 days in a group. They use general strengthening exercises, breathing exercises, balance exercises, coordination exercises, exercises with objects, on apparatus. Turns; tilting the head and body is done with caution.

During the non-crisis period, patients should exercise in the same way as patients with coronary heart disease, the load power is 55-85% of the maximum that the patient is able to perform.

4. Exercise therapy for chronic heart failure

Circulatory failure is not a specific disease, but a complex of symptoms that occurs with heart valve defects, myocardial damage, and arrhythmias.

In case of heart circulatory failure, the stroke and minute volumes of the heart decrease, the pulse quickens, arterial pressure decreases and venous pressure increases, blood flow slows down, swelling, cyanosis, and shortness of breath appear.

There are three stages of chronic heart failure.

At stage I at rest and during normal work and household loads there are no signs of circulatory disorders. With increased stress, shortness of breath occurs, the pulse quickens and a feeling of fatigue appears, sometimes swelling in the legs appears in the evening.

Exercise therapy in the first half of the course of treatment is aimed at stimulating extracardiac circulatory factors. In the second half, the loads gradually increase from 50% of the threshold power to 75-80% in order to train the heart muscle. The density of classes is increased from 40-50 to 60-70%. All starting positions, exercises with objects, apparatus, and on apparatus are used. Includes exercises to develop strength, sedentary games, walking.

Lesson duration: 25-30 minutes.

For Stage II signs of insufficiency at rest are characteristic.

At Stage IIa the liver enlarges, congestion in the lungs, moderate swelling in the legs are detected. In case of circulatory insufficiency at the Pa stage, therapeutic exercises increase the effect of medications. General strengthening exercises are used in alternation with static breathing exercises, at a slow pace, at the beginning of the course of treatment - in a lying position, later - sitting and standing, at an average pace, with a decrease in breathing exercises in the ward mode, walking is added. Lesson duration: 10-15 minutes.

Stage II b is characterized by a significant enlargement of the liver, pronounced edema, shortness of breath and rapid heartbeat occur with minor movements. Such patients in the hospital are on extended bed rest. mode. In case of circulatory failure stage II b, exercises are used for small and medium muscle groups, passive, active with help at a slow pace. Lesson duration: 10-12 minutes, 2-3 times a day.

At Stage III Chronic heart failure is characterized by significant congestion with accumulation of fluid (ascites) in the serous cavities and persistent changes in the heart, liver, kidneys and other organs. Therapeutic exercises are contraindicated.

Physical performance is reduced from 350-450 kgm/min in stage I to almost complete absence in stage III.

5. Exercise therapy for heart defects

Mitral disease is manifested by narrowing (stenosis) of the left atrium-ventricular orifice (mitral) and/or insufficiency of the left atrium of the ventricular valve.

Mitral orifice stenosis or a combination of stenosis and valve insufficiency - serious disease. Acquired heart defects form with rheumatism.

In the acute stage, patients are on bed rest. During the period of extended bed rest, therapeutic exercises begin to be used.

Use active exercises in combination with breathing, at a slow pace, without effort, for 10-15 days.

The next 2-3 weeks. patients on a ward basis are prescribed therapeutic exercises similar to those used for stage II circulatory failure.

After 6-8 months. after discharge from the hospital, classes are allowed in health groups, and for students - in a special or preparatory group.

Conclusion

When performing physical exercises, the pulse quickens, blood pressure rises, the amount of circulating blood and the number of functioning capillaries in the skeletal muscles and myocardium increase.

Therapeutic exercises for diseases of the cardiovascular system, maximally activating the effect of extracardiac circulatory factors, contribute to the normalization of impaired functions.

Exercise therapy is widely used for diseases of the circulatory system in the acute period during recovery and, in reality, as a factor in maintenance therapy.

Contraindications:

Exercise therapy is effective only if long-term, systematic classes are carried out with a gradual increase in load both in each of them and throughout the course. Both the coach and the student must know this in order to achieve appropriate results.

Strict consistency in increasing the load and its individualization are the main conditions for conducting all classes. In this case, the condition, reaction of the students, features of the clinical course, concomitant diseases and physical fitness of the students should be taken into account.

Another thing is also important: by doing physical exercises, the patient himself actively participates in the healing process, and this has a beneficial effect on his psycho-emotional sphere.

The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. Therefore, exercise therapy is a very important element in the treatment of the disease.

With regular exercise, as in the process of physical training, energy reserves gradually increase, the formation of buffer compounds increases, and the body is enriched with enzyme compounds, vitamins, potassium and calcium ions.

The effect of physical exercise is determined by its intensity and time of use.

There is a beneficial effect of exercise therapy on blood circulation and breathing, which also expands the functional capabilities of the body and increases its reactivity.

Classes also have an educational value: students get used to systematically performing physical exercises, this becomes their daily habit. Exercise therapy classes turn into general physical education classes and become a human need even after recovery.

Bibliography

1. Gishberg L.S. Clinical indications for the use of physical therapy for diseases of the cardiovascular system. M.: SMOLGIZ, 1998.

2.Grigoryan V.L. Therapeutic exercise for heart defects. M, 2000.

3. Dolin G.K. Exercise therapy, indications for use in heart diseases. M., 1999.

4. Ivlitsky A.V. Cardiovascular diseases, prevention and treatment. M., 2000.

5. Kozyreva O.V. Therapeutic exercise for diseases of the cardiovascular system M., 1993.

6. Krivorozhsky V.S. Heart disease and treatment Physical Culture. M., 2001.

7. Mayorov V.V. Diseases of the cardiovascular system and therapeutic physical culture. M., 2001.

Gishberg L.S. Clinical indications for the use of physical therapy for diseases of the cardiovascular system. M.: SMOLGIZ, 1998. P.68

Gishberg L.S. Clinical indications for the use of physical therapy for diseases of the cardiovascular system. M.: SMOLGIZ, 1998. P.79

Gishberg L.S. Clinical indications for the use of physical therapy for diseases of the cardiovascular system. M.: SMOLGIZ, 1998. P.94