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

Introduction 3

1. Rehabilitation system for myocardial infarction 4

2. Methodology of exercise therapy for the rehabilitation of patients with myocardial infarction 7

Conclusion 13

References 14

Appendix 15

Introduction

Therapeutic physical culture has now received universal recognition as a method of rehabilitation therapy for those recovering from myocardial infarction. Previously, patients with myocardial infarction were recommended strict bed rest, as it was believed that absolute rest helped better scarring of the affected area of ​​the heart. However, the body is not indifferent to prolonged inactivity. It leads to general weakness, mental depression and increases the tendency to heart failure.

Under the influence of dosed physical activity, the blood vessels of the heart dilate, additional capillaries open, which leads to improved blood circulation in all its parts. Dosed physical training of the heart activates metabolic processes in it and enhances the contractile function of the myocardium. In addition, physical activity leads to improved blood supply to all organs and systems, trains the body's coagulation and anti-coagulation system better than all drugs, thereby reducing the possibility of blockage of blood vessels with blood clots (thrombi).

The positive effect of physical culture on the central nervous system is important. Physical exercise helps relieve mental depression that occurs in a patient due to a heart attack, provides pleasure, and evokes positive emotions.

The purpose of the work is to consider the methodology for conducting therapeutic physical training for myocardial infarction.

1. Rehabilitation system for myocardial infarction

Myocardial infarction develops as a result of blockage of one of the branches of the coronary vessels by a thrombus or atherosclerotic plaque, followed by disruption of the blood supply to this area of ​​the heart muscle and the development of ischemic necrosis.

Myocardial infarction usually develops in individuals with atherosclerotic lesions of the coronary vessels and most often with chronic coronary insufficiency, which sometimes precedes myocardial infarction for a long time.

Increased blood clotting plays a certain role in the formation of a blood clot.

The most characteristic symptom is a sharp pain in the heart area, which is localized on the front surface of the chest and behind the sternum; pain is often felt in the heart area, in the epigastric region or between the shoulder blades. The pain is accompanied by a significant deterioration in the general condition. After the sharp pain stops, the patient is left with dull pain.

In accordance with the WHO classification, there are four functional classes of severity in patients who have suffered a myocardial infarction, as well as those suffering from coronary heart disease (without a history of heart attack).

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

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

III functional class - pain appears during normal walking 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 unable 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.

In the complex treatment of myocardial infarction, along with pharmacological agents, exercise therapy and massage are used. V.I. Dubrovsky developed a method of general massage in the early stages with oxygen therapy. Objectives of massage: elimination of pain, psycho-emotional stress, prevention of thromboembolism; acceleration of muscle blood flow; relieving spasm of coronary vessels, improving coronary circulation.

Under the influence of massage, venous congestion is eliminated, blood flow accelerates, tissue metabolism improves, and positive ECG dynamics are noted. At the same time, the well-being of patients improves, they become more active, and they can more easily endure the first days of bed rest.

Exercise therapy occupies an important place in the system of patient rehabilitation. In the rehabilitation of patients with myocardial infarction, three periods are distinguished: inpatient, recovery and maintenance.

Stationary period. Therapeutic gymnastics in IP lying down, then sitting and standing. The duration of the classes is 5-15 minutes, the pace is slow, at first with a small amplitude and breathing exercises. ECG monitoring is required.

The recovery period takes place in a cardiological sanatorium. They include dosed walking, therapeutic exercises, games, health path, etc. Classes are conducted in a group method. The duration of the period is 1-1.5 months in a sanatorium and 1 month at home (under the supervision of a cardiologist). Patients exercise either independently or in a clinic under the guidance of a physical therapy methodologist. ECG monitoring is required.

The maintenance period begins from the 3-4th month from the onset of the disease and lasts throughout the patient’s life. The following means of exercise therapy are used: therapeutic exercises, walks (metered walking), skiing, cycling, fishing, picking mushrooms and berries, etc.

The method of exercise therapy depends on the clinical course of the disease, age, gender, physical fitness and motor mode of the patient. When compiling the LH complex, the patient’s health status and age are taken into account; etc., dosage (repetition of exercises) and regularity of performing the complex also depend on the nature of the course of the disease, its stage.

During bed rest, exercises for the distal parts of the extremities, breathing exercises and relaxation exercises are included.

In the ward mode, exercises for medium and large muscle groups in IP are recommended. lying and sitting, and breathing exercises in i.p. standing, holding the back of a chair. They include walking around the ward and on the spot, and then going out into the corridor, walking along the corridor, up the stairs; in free mode - with access to the garden (hospital park) and exercise therapy classes in the physical therapy room of the hospital in the individual p. sitting and standing (initially behind the chair), including general developmental, breathing and relaxation exercises. The pace is slow and average.

2. Methodology of exercise therapy for the rehabilitation of patients with myocardial infarction

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

The first stage is treatment in a hospital in the acute period of the disease until clinical recovery begins.

Objectives of exercise therapy:

1. prevention of possible complications caused by weakening of heart function, disruption of the blood coagulation system, significant limitation of motor activity due to bed rest (thromb-embolism, congestive pneumonia, intestinal atony, muscle weakness, etc.);

2. improving the functional state of the cardiovascular system through physical exercise, mainly for training peripheral circulation and orthostatic stability;

3. restoration of simple motor skills, adaptation to simple everyday stress, prevention of hypokinesia (hypokinetic syndrome);

4. creating positive emotions.

1. acute heart failure - heart rate (HR) more than 104 beats/min; severe shortness of breath, pulmonary edema;

2. shock, arrhythmias;

3. severe pain, body temperature above 38°C;

4. negative dynamics of ECG indicators.

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

In case of 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 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 involves assigning the patient one or another nature and volume of physical activity of a domestic nature, a training regimen in the form of therapeutic exercises, and spending leisure time 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 in the volume of step “a” is allowed after the elimination of pain and severe complications of the acute period and is usually limited to one day.

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

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 expansion of 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 exercises, and breathing exercises. The pace of the exercises is slow, subject 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.

The occurrence of an attack of angina pectoris, arrhythmia, sudden shortness of breath, tachycardia with a slower return to the initial heart rate, sudden changes in blood pressure (mainly its decrease), severe weakness and 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 volume 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.

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.

The second stage is post-hospital (readaptation) in a rehabilitation center, sanatorium, or clinic. The recovery period begins from the moment of discharge from the hospital and for an uncomplicated heart attack lasts two months.

Objectives of exercise therapy:

1. restoration of physical performance, elimination of residual effects of hypokinesia, expansion of the functional capabilities of the cardiovascular system;

2. increase in physical activity; preparation for physical household and professional stress.

Contraindications to the use of exercise therapy:

1. circulatory failure of degree II and higher;

2. chronic coronary insufficiency of functional class IV;

3. severe disturbances of heart rhythm and conduction;

4. recurrent course of myocardial infarction;

5. aortic aneurysm, cardiac aneurysm with symptoms of heart failure.

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.

Therapeutic gymnastics classes are almost no different from those carried out in the hospital before discharge. Gradually increase the number of repetitions, speed up the pace; use exercises at the gymnastic wall, with objects (gymnastic sticks, dumbbells, inflatable balls). 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 third stage of rehabilitation - 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:

1. maintaining and increasing physical performance;

2. secondary prevention of coronary artery disease and recurrent infarction.

Forms of exercise therapy: physical exercises are similar to those used for 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.

Conclusion

The problem of rehabilitation of patients with myocardial infarction is social, since in recent years cases of this disease have increased significantly not only among the elderly, but also among young people; Disability and death are common.

The basis for the rehabilitation treatment of post-infarction patients is the principles of phasing, continuity, complexity and a strictly individual approach to each patient.

The leading place in rehabilitation is given to exercise therapy, moderate physical training (walking, skiing and other cyclic types of exercise), the purpose of which is to gradually increase the volume of training and household loads

References

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. Dubrovsky V.I. Therapeutic physical culture (kinesitherapy). - M.: Humanite. ed. VLADOS center, 2001.

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

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 your 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, move your arms so as to feel the tension in the 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 move 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. Hands along the body. Squeeze your buttocks together, simultaneously straining your leg muscles, relax them (4-5 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).

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

When to start physical therapy?

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

If exacerbations occur after an attack, you should interrupt the exercises. As a rule, 3 days after the examination, if there are no complications, training can be resumed, but supervision by the attending physician is necessary.

Stages and tasks of gymnastics

Exercises can be performed either in bed or freely, depending on the degree of disease activity. The following table will help you understand this:

Thus, physical therapy can be conditionally divided into two stages, each of which has its own tasks:

1. Stationary. It is carried out immediately after an attack. It is necessary to stimulate blood in peripheral vessels, reduce muscle tension, increase respiratory function and activate systems that prevent blood clotting. Thanks to proper exercise, it is possible to avoid arthrosis, muscle atrophy, pneumonia and other complications. In addition, they can improve a person’s psycho-emotional state. After completing the stage, you can already climb to the 1st floor on your own and walk 2 km a day.
2. Home. Required after the inpatient phase. Home rehabilitation is needed to increase the body's endurance, restore the functioning of the heart and blood vessels, improve the quality of life and reduce the dosage of medications used. In addition, it is a secondary prevention of ischemia.

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

A set of exercises for the hospital

The workout should be done 2 hours after eating. If a patient suffers from atherosclerosis or osteochondrosis, he is prohibited from bending, strength exercises, or rotating the head and torso. All this negatively affects the functioning of the heart.

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

1. Bend and straighten your fingers.
2. Rotate your feet in different directions or alternately bend and straighten them.
3. With an inhalation, bend your forearms and move your elbows to the sides, and with an exhalation, open your arms along your body.
4. With an inhalation, lower your arms along your body and turn your palms up. With an exhalation, slowly raise them forward, turn your palms down and reach for your knees, raising your head and tensing the muscles of your torso and legs. If the exercise is difficult, you can initially not raise your head.
5. Bend your left leg without lifting it from the bed, and then lower it. Do the same with your right foot. If possible, you can complicate the exercise - bend one leg and simultaneously straighten the other.
6. Bend your legs at the knees. Initially lower it to the right side, and then to the left.
7. Bend your legs at the knees and keep your arms along your body. Extend your left arm forward, and then pull it towards your right knee. Repeat the same on the other side.
8. Straighten your legs and keep your arms along your body. While inhaling, simultaneously perform 3 actions - raise your left arm and right leg, and turn your head to the right side. Exhale and return to the starting position. Repeat the same on the other side, but turn your head to the left.
9. Bend your arms at the elbows and clench your fingers into a fist. Simultaneously perform circular rotations with your hands and feet.
10. Straighten your legs and spread them slightly, and keep your arms along your body. With an inhalation, place your left hand to your head, and with an exhalation, touch the right edge of the bed. Do the same on the other side.
11. Place your arms along your body. Exhale for 2-2.5 seconds, tighten the muscles of the buttocks, lower limbs and pelvic floor. Inhale and relax.
12. Place your arms along your body. With an exhalation, lift them forward, and with an exhalation, lower them.

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

1. As you exhale, apply a little pressure on your chest and abdomen with your hands.
2. Bend your elbows. Simultaneously bend your hands and feet, and then straighten them.
3. Inhale, raise your arms up behind your head, and exhale, lower your arms.
4. Imitate walking - bend your right leg at the knee and right arm at the elbow, and with their extension, do the same for the right leg and arm.
5. Lean on your elbows, inhale, lift your chest and use your hands to press on your chest and stomach. With the exit go down.
6. Inhaling through the sides, raise your arms behind your head, and as you exit, lower them along your body.
7. Place your arms along your body. With an inhalation, raise your pelvis, leaning on your legs bent at the knees and straight arms. Inhale and lower yourself onto the bed.
8. Raise your body to a sitting position. If the exercise is difficult, you can tie a rope or long cloth to the headboard, which you can grab with your hands when lifting the body.
9. With an inhalation, lift your body, already leaning your hands on the bed, and with an exhalation, slowly lie down.
10. Lift your body up. From a sitting position, lower your legs down so that they hang off the bed. Breathe calmly.

All 10 exercises are clearly demonstrated in the picture:

A set of exercises for home rehabilitation

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

1. Stand up straight, lower your arms, and place your feet shoulder-width apart. Slowly raise your hands up and down, and then use them to describe a small circle around you.
2. Feet shoulder-width apart, and hands on the belt. Turn your body to the left, spread your arms to the sides and inhale. Return to the starting position and exhale. Repeat the same, but on the other side.
3. Feet shoulder-width apart and arms down. Take a deep breath, sit down and bend forward slightly. Move your arms back a little and exhale. Slowly return to a standing position.
4. Without changing the starting position, take a deep breath, place your hands on your hips and exhale and squat down. Inhale and return to the starting position.

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

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

Walking for rehabilitation

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

You should master walking according to this scheme:

1. In the extended ward mode, if the patient does not have complications of myocardial infarction, 3-6 minute walking is allowed. Tempo – 30-40 steps per minute. In this case, you need to control the frequency of the remote control, blood pressure readings and subjective sensations.
2. If the body responds adequately to previous loads, increase the walking pace - 40-60 steps per minute. In this case, the pulse should not increase by more than 12 beats per minute, systolic pressure indicators should increase by no more than 20-40 mmHg. Art., and diastolic - by 5-10 mm Hg.

If exercise causes angina pectoris, severe shortness of breath, a drop in pressure, severe weakness and pallor, you should stop walking and return to the initial stage.

1. In free mode, the initial walking pace is 70-80 steps per minute. Initially, conduct 6-minute workouts. If, under such loads, a stable adequate reaction from the cardiovascular system is observed, you can increase the distance from 500 m to 1000 m, and then to 1500. There is no need to change the pace. Walks of 2-3 km in several stages are recommended.
2. If the previous loads are already easy, increase the walking pace to 80-100 steps per minute. The walking distance should also be gradually increased from 500 m to 1000 and 1500 m.

Video: Exercise therapy after myocardial infarction

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

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

Recently, doctors announced that they had found a way to restore the heart after a heart attack. We will tell you how to behave for a person who has suffered such a serious illness and has been discharged from the hospital to recover “at home.”

Doctors say that recovery from a myocardial infarction begins in the hospital and continues for the rest of your life. You need to try to return to your previous life, overcoming difficulties, without retreating a single step. It is necessary to defeat the causes that led to the heart attack.

It is also necessary to restore weakened health because after a heart attack the body no longer works the same way as before: there may be complications, and a long stay in a hospital bed leads to even greater weakening of the body. So there is no need to be afraid to move - albeit carefully.

Doctors offer this set of exercises - it is successfully used by those who have been discharged from the hospital after a myocardial infarction. They need to be performed at an average pace.

1. Starting position (i.p.) - sitting on a chair, hands on your knees. Hands to the sides, palms down - inhale, and... p. - exhale. As you inhale, bend slightly. Repeat 4-5 times.

2. I. p. - sitting on the edge of a chair, hands supported behind. Alternately bend and straighten your legs at the knee. Do not lift your feet off the floor. Repeat 6-8 times.

3. I. p. - sitting, hands to shoulders. Make circular movements in the shoulder joints. Elbows up - inhale, down - exhale. Repeat in one direction and the other.

4. I. p. - sitting. While sitting, imitate walking, then swing your legs with relaxation. Breathing is voluntary. Repeat 6-8 times.

5. I. p. - sitting, cross your arms over your chest, clasping your shoulders. Hands to the sides - inhale, and. p. - exhale. When you sigh, head back slightly. Repeat 4 times

6. I. p. - sitting. Head back - inhale, forward - exhale. Repeat 2-3 times. Tilts to the right, left. Repeat 2 times. Circular movements of the head. Repeat 2 times. Perform exercises smoothly without sudden movements.

7. I. p. - sitting on the edge of a chair, hands at the back, legs extended forward. Left leg to the side - inhale, and. n. - exhale, the same in the other direction. Repeat 4-6 times.

8. I. p. - sitting on the edge of a chair, hands on knees. Hands to the sides - inhale, alternately grabbing the knee - as you exhale. Repeat 4 times.

9. I. p. - sitting, feet shoulder-width apart, hands resting on the knees. Rise up and sit down. Repeat 2-3 times. Breathing is voluntary.

10. I. p. - sitting, stick on knees. Turn right - inhale and in. p. - exhale, the same - to the left. When turning your hand at shoulder level, look at your palms. Repeat 4 times

11. I. p. - standing, hands on a support, feet shoulder-width apart. Alternating abduction of the arms with rotation of the torso - inhale into the i. p. - exhale. When turning, the hand is at shoulder level. Repeat 3 times in each direction.

12. I. p. - standing, hands on a support, feet parallel. Walking in place. Complete 12-14 steps. Breathing is voluntary.

13. I. p. - standing sideways to the support. Alternate flexion, extension and abduction of the legs. Repeat 4-6 times. Breathing is voluntary.

14. I. p. - standing, feet shoulder-width apart. When tilting to the left, the right arm bends at the elbow joint, sliding along the body - exhale into the i. p. - inhale. Perform 4 times in each direction. Breathing is voluntary.

15. I. p. - sitting, hands on knees. Stand up and sit down at intervals to rest. Repeat 3 times. Do not hold your breath.

16. I. p. - sitting on the edge of a chair, hands on a support. Make uniform circular movements with your legs, one at a time. Breathing is voluntary. Repeat 4-6 times.

17. I. p. - sitting, on my knees - a stick. Stick up - inhale, and. p. - exhale. Repeat 4 times. Breathing is voluntary.

18. I. p. - sitting, hands on knees, legs wider than shoulders. Arms to the sides, downwards - inhale, hands on the knees, thumbs outwards, bend the torso forward - exhale. When bending, look forward, elbows slightly back. Repeat 4 times.

19. I. p. - sitting, hands on the belt, then - to the shoulders and return to i. n. Repeat 3 times. This is a coordination exercise.

20. I. p. - sitting. Left hand forward and to the side - inhale, and. p. - exhale. The same with the right hand. When inhaling, your hand is at shoulder level, lower your hand with relaxation. Repeat 3 times.

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After myocardial infarction. Therapeutic exercise

A system of physical exercises at home was developed by V.V. Kabelsky.

Motor mode N3.

If you maintain this movement pattern, you can continue to exercise while climbing stairs. In the first week, do this at an average pace - 1 step in 2 seconds to the 2nd floor, then rest for 2-3 minutes and continue climbing at the same pace to the 3rd floor.

The next week, having climbed once at this pace to the 3rd floor, rest for 2-3 minutes and continue climbing to the 4th floor. From now on, you can train twice a day, resting after the 2nd and 4th floors for 2-3 minutes. You need to go down the stairs at the same speed with which you went up. It is recommended to do dosed walking 2 times a day, 2-3 times a week. In the evening it is advisable to walk half the distance. By the end of the 4th week, increase the distance to 4.5-5 km. After walking every 1.5 km, rest for 5-10 minutes.

During this period, you can help your family a little with minor repairs and cleaning the apartment, going to the store (the weight of the load is no more than 5 kg). Most people, having successfully completed this stage, return to work. The energy intensity of the N5 complex increases to 115 kcal. The main task when following regimen No. 3 is to ensure restoration of working capacity to the maximum extent possible. The duration of this set of exercises is 35-45 minutes.

After a heart attack. Set of exercises N5

1. Walking with a change of pace every 20 seconds. Breathing is voluntary.

2. I. p. - hands to shoulders. Walking with rotation of the arms in the shoulder joints in both directions. Breathing is voluntary.

3. I. p. - standing, legs together, arms along the body. On the count of 1-4, raise your hands up, alternately clenching your fingers into a fist and unclenching them - inhale; on the count of 5-8, lower your hands, alternately relax your hands, forearms, shoulders - exhale.

4. I. p. - standing, legs together, hands on the belt. On the count of 1-2, raise your straight left leg forward, trying to touch the toe with your right hand - exhale; on the count of 3-4, lower your leg and arm - inhale. Repeat the same using the other leg and arm (Fig. 1).

5. I. p. - standing, legs together, hands in front of the chest. On the count of 1, take a step forward with your left foot, spread your arms to the sides - inhale, on the count of 2, put your right foot in, return to i. p. - exhale. Repeat the same on the other side.

6. I. p. - standing, legs together, dumbbells (2-3 kg) in lowered hands. On the count of 1-2, raise your arms up through the sides - inhale, on the count of 3-4, return to i. p. - exhale.

7. I. p. - standing, legs together, arms along the body. On the count of 1-2, sit down on your toes, stretch your arms forward - exhale, on the count of 3-4, return to i. n. - inhale.

8. I. p. - standing, legs together, dumbbells (3-4 kg) in lowered hands. On the count of 1-2, make a turn to the right, raise your hands to your shoulders - wow, on the count of 3-4, return to i. n. - inhale. Repeat the same in the other direction.

9. I. p. - standing, legs together, arms along the body. On the count of 1-2, spread your arms to the sides - inhale; on the count of 3-5, bend your left leg, clasping it with your hands, and press it to your stomach - exhale (Fig. 2). Repeat the same using your right leg.

10. I. p. - standing, legs together, dumbbells in lowered hands. On the count of 1, spread your arms to the side - inhale, on the count of 2, bring your hands to your shoulders - exhale, on the count of 3, raise your arms up - inhale, on the count of 4, lower your arms down through your sides - exhale.

11. I.P. - standing with his left side to the chair, holding the back of it with his left hand. Make swing movements with your right arm and right leg forward, to the side, and back. Return to i. n. Repeat the same with your left arm and leg, standing on the other side of the chair. Breathing is voluntary.

12. Jogging. Gradually slowing down the pace, switch to walking at an average and slow pace.

13. The exercise is performed while walking. Stretch your arms forward, then raise them up - inhale, relax your arms down through your sides - exhale.

14. The exercise is performed while walking. For each count: left hand to the shoulder, right hand to the shoulder, left hand up, right hand down. Repeat the same, starting with raising your right hand. Breathing is voluntary.

15. i. p. - standing, feet shoulder-width apart, arms along the body. At the count of 1-4, shake your arms up and inhale; at the count of 5-8, bend forward, lower your arms down to the sides, swing your arms freely, crossing them, and exhale.

While following this regime, you can play volleyball, table tennis, badminton for 10-15 minutes.

Be sure to keep practicing while climbing stairs. In the first week, stick to an average rate of ascent (30 steps per minute), perform the exercises once a day. Then gradually increase the duration and pace, practice 2 times a day, taking three-minute breaks every 5 minutes.

The distance of measured walking during the period of observance of the motor regimen N3 starts from 5-5.5 km and gradually, increasing by an average of 500 m weekly, reaches 8-8.5 km in the 4th week. Walking speed is 4 km/h, after every 2 km rest for 5-10 minutes. If you tolerate all these loads well, you can start short jogging.

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

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

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

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

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

The rehabilitation period is conventionally divided into three phases:

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

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

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

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

Exercise therapy rules

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

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

Stages of rehabilitation

Stationary (hospital)

The rehabilitation period in a hospital is carried out for:

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

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

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

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

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

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

After inpatient rehabilitation, the patient must independently climb the stairs to one floor, take care of himself, walk 2-3 km per day with breaks for rest, if there is no deterioration of 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 belt. Turn to the left, arms to the sides - inhale. To the starting position – exhale. The same in the other direction. Repeat 4-6 times.
3. IP: as in exercise 1. Inhale, squat, leaning forward, arms back - exhale. Perform 4-6 times.
4. IP: same. Inhale. hands on hips. Sit down, exhaling. 3-4 times.
5. IP: sit on a chair, lean on the back. Grab the seat with your hands, stretch your legs forward. Bend over, moving your head back - inhale, to the starting position - exhale.

II complex.

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

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

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

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

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

Thanks to 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.

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

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

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

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

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

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

When to start classes

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

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

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

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

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

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

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