Physical therapy for myocardial infarction

In 2002 a rehabilitation program for patients with myocardial infarction complicated by heart failure was developed, tested and proposed for use in addition to the existing scheme.

Contraindications to the use of the program are: heart failure of class III and higher according to Killip, aortic stenosis of higher than average degree, acute systemic disease, uncontrolled arrhythmia of the ventricles or atria, uncontrolled sinus tachycardia above 120 beats / min, third-degree AV block without pacemaker, active pericarditis or myocarditis, embolism, acute thrombophlebitis, diabetes mellitus, defects of the musculoskeletal system, which impede physical exercises.

In the classical scheme, a change in motor mode is based on the calendar of the disease and the dynamics of clinical data and ECG parameters. Bicycle ergometry in the early stages (5-10th day) from the onset of the disease can be carried out only in a small number of patients, with a small area of ​​damage to the heart muscle and without serious complications.

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

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

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

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

Functional classes of heart failure6 minute distance (m)Oxygen consumption (ml / min / sq.m)
gt; 551gt; 22,1
1426 – 54918,1 – 22,0
2301 – 2514,1 – 18,0
3151 – 30010,1 – 14,0
4lt; 150lt; 10,0

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

The selected mode guarantees the performance of any movement in the area of ​​aerobic exercise, which eliminates the risk of developing overstrain in a patient with MI, allows you to develop the endurance of the patient’s body.

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

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

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

a) restoration of a normal breathing stereotype;

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

c) a rational combination of breathing function with an increase in the patient’s tolerance level IM. The following breathing exercises are the basis for activating therapeutic gymnastics techniques: a) exercises with “open” resistance to exhalation improve bronchial clearance, increase tidal volumes and prevent bronchial collapse;

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

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

Walking in a training mode is considered the safest physiological method of rehabilitation of patients with myocardial infarction within the free regime of the hospital phase. Walking – a form of physical activity (FN), accessible to almost everyone, is easily dosed by determining the distance, pace and time to overcome it.

Active walking is a complex process in which all parts of the central nervous system participate, it contributes to the normalization of impaired autonomic functions of the body, as it causes functional and trophic changes in all organs and tissues, especially in the cardiovascular system. The most effective use of treadmill when dosing workouts is walking.

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

With proper activation of the patient, the increased heart rate at the load height does not exceed 12 beats per 1 min, respiration – 6-9 in 1 min, the level of systolic pressure rises no more – 20-40 mm RT. Art., diastolic – 5-10 mm RT. Art.

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

In free motor mode, the walking pace is 70-80 steps in 1 min. Upon reaching a stable adequate reaction of the cardiovascular system, walking time increases and, accordingly, the distance traveled at a given pace from 500 m to 1000 m, 1500 m. Then walks on the street at a distance of 23 km in 2-3 doses. At the next stage, the pace of walking increases to 80-100 steps in 1 min.

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

Clinical data are supplemented by ECG monitoring or stress tests.

For dosing training loads, a threshold heart rate is determined and a working heart rate in the range from 60 to 90% of its threshold value is calculated. Training starts the day after testing and is carried out daily until discharge from the hospital. Treadmill training is carried out according to the principle of stepwise increasing load without rest intervals, until a stable heart rate is achieved at each load stage.

If tolerance of the training load to patients is noted, then the power of the next training session decreases to the previous stage. The purpose of the training is to achieve a stable reaction of the cardiovascular system to the load shown, and not to go a certain distance.

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

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

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

The period when you can start conducting classes depends on the degree of myocardial damage and on the well-being of the patient. With moderate severity of the disease, exercise therapy can begin already for 2-3 days. In more severe cases, you will need to wait about a week. The main principles when restoring physical activity are as follows:

  • In the early days, you should adhere to bed rest;
  • Take a sitting position, lowering the legs from the bed to the floor, the patient is allowed for 4-5 days;
  • 7 days after the attack, under a favorable set of circumstances, the patient may begin to take the first steps around the bed;
  • After 14 days, a person can safely move around the ward;
  • Starting from 21 days after the incident, it is advisable for the patient to walk more and you can carefully go down the stairs.

Important! An increase in the load when walking should occur gradually, under the supervision of a specialist. The doctor must certainly monitor the pulse and pressure indicators after increased activity. In the event of a deviation from the norm, mobility should be reduced.

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

General recommendations

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

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

  1. Hospital, which the patient spends in stationary conditions. Here he is assigned the necessary course of treatment and rehabilitation procedures.
  2. The phase of recovery. The patient gradually returns to its original form, becoming able-bodied.
  3. Stage of support. Returning to normal life, the patient should systematically visit a cardiologist, take medication and take preventative measures.

At all the above stages, the patient should perform exercise therapy for myocardial infarction. They are determined by the instructor and rehabilitologist, taking into account the patient’s health status. The increase in loads should be scheduled in advance, and for a successful recovery, a person will need to follow this schedule steadily.

Properly selected exercises pursue the following goals:

  • restoration of skills lost during the development of the disease;
  • slowing the progression of pathology and eliminating relapse of the attack;
  • acceleration of recovery.

Stages and tasks of gymnastics

PowerIllness dayModePermitted loads
1-thStrict bedThe patient is in a supine position. Special exercises from exercise therapy are prohibited. He can only turn on his right side, take food on his own.
1B – 2A2nd to 3rdBed extendedThe patient can independently turn and sit in bed, and initially with the help of medical staff, and then independently. Later you can transfer to a chair. Allowed exercises in a supine position, which are performed for 8-10 minutes. The breath should be static. After each exercise, you need to take a break. The pulse should not exceed 20 beats per minute.
2B – 3A4th to 14thWard strictThe patient can already walk along the ward and the corridor at a distance of 20 to 200 m. Already exercises that are performed in a sitting position are allowed. The pace is slow or medium.
3B14th to 21stWard ExtendedThe patient is already allowed walks along the corridor without restrictions. Exercises are performed in an upright and seated position, and can be both individual and group.
4A and 4B (classes I, II, III and IV)From 21FreeWalking is already permissible, and the step speed is average – from 70 to 100 steps per minute. A set of exercises is performed in a sitting and standing position.
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So, conditionally physiotherapy exercises can be divided into two stages, each of which has its own tasks:

  1. Stationary. It is carried out right after an attack. It is necessary to stimulate blood in peripheral vessels, reduce muscle tension, increase respiratory function and activate systems that prevent blood coagulation. Thanks to competent loads, it is possible to avoid arthrosis, muscle atrophy, pneumonia and other complications. In addition, they allow you to increase the psycho-emotional state of a person. After the completion of the stage, it is already possible to independently ascend to the 1st floor and walk 2 km per day.
  2. Homemade. It is required after a stationary stage. Home rehabilitation is needed to increase the stamina of the body, restore the work of the heart and blood vessels, improve the quality of life and reduce the dosage of the drugs used. In addition, it is a secondary prevention of ischemia.

1. The back 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 the body – exhale (2-3 times).

4. Hands along the body, turn palms up – inhale. Raising the arms forward – up, palms down, pulling them to the knees, raising the head, straining the muscles of the body, legs – exhale. During the first lesson in therapeutic exercises in this exercise, one should not raise one’s head (2-3 times).

5. Take 2-3 calm breaths and relax.

6. Alternate bending of the legs with sliding on the bed. The breath is arbitrary. From the second lesson, bend the legs as if riding a bicycle (one leg is bent), but without lifting the foot from the bed (4-6 times).

7. Hands along the body, legs straightened and slightly divorced. Turn your hands with your palms up, take them a little, at the same time turn your feet outward – inhale. Turn your hands with your palms down, feet inward – exhale. In the 3-4th lesson, hand movements should be done in such a way as to feel tension in the shoulder joints (4-6 times).

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

9. The legs are bent at the knees. Raise your right hand up – inhale; reach out with your right hand to your left knee – exhale. Do the same with your left hand to the right knee (4-5 times).

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

11.Small breathing. To relax.

12. Bend your arms at the elbow joints, fingers tighten into fists, rotation of the hands in the wrist joints with simultaneous rotation of the feet. Breathing is arbitrary (8-10 times).

13. The legs are bent at the knees. Lift the right leg up, bend it, return to the SP. Do the same with the other leg. The breath is arbitrary. Exercise is included in the complex not earlier than after 2-3 lessons (4-6 times).

14. Legs are straightened and slightly apart, arms along the body. The right hand on the head is a breath; 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. Flatten the buttocks, while straining the muscles of the legs, relax them (4-5 times). The breath is arbitrary.

16. To inhale raise your hands up, to 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 – no more than 20 beats, breathing – no more than 6-9 per minute, increased systolic pressure – 20-40 mm RT. Art., diastolic – 10-12 mm RT. Art. (compared with the original) or a decrease in heart rate by 10 beats / min, lowering Blood pressure – not more than 10 mm RT. Art.

The occurrence of an attack of angina pectoris, arrhythmia, severe shortness of breath, tachycardia with a slower return to the initial heart rate, sharp changes Blood pressure (mainly its decrease), severe weakness and discomfort, blanching of the skin, acrocyanosis indicate an adverse 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 regimen – until it enters the corridor.

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

With an adequate response to a given volume of physical activity, the patient is transferred to the “b” riser and he is allowed to walk around the bed first, then around the room, sit down to the table, eat food while sitting at the table. The patient is prescribed a therapeutic gymnastics complex 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, sparing training of the cardiorespiratory system, preparing 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 classes. Therapeutic gymnastics complex No. 2 is performed in a lying position – sitting – lying down.

The number of exercises performed while sitting is gradually increasing. Movements in the distal extremities are gradually replaced by movements in the proximal parts, which involves larger muscle groups. An extra effort is introduced into the leg exercises. After each change in body position, passive rest follows.

Therapeutic gymnastics complex No. 2 IP – sitting

1. Lean against the back of a chair, hands on your knees, do not strain. Hands to shoulders, elbows spread apart – inhale, lower your hands to your knees – exhale (4-5 times).

2. Roll from heels to socks with legs spread to the sides, at the same time compress and unclench your fingers into fists (10-15 times). The breath is arbitrary.

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

4. Slipping the legs on the floor forward and backward without taking your feet off the floor (6-8 times). The breath is arbitrary.

5. Dilute hands to the sides – inhale, hands to the knees, tilt the body forward — exhale (3-5 times).

6. Sitting on the edge of the chair, put aside the right arm and left leg – 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 the torso. Raising the right shoulder up, simultaneously lower the left shoulder down. Then change the position of the shoulders (3-5 times). The breath is arbitrary.

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

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

10.Small breathing (2-3 times).

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

In patients of grades I and II, a pulse rate in the classroom of up to 120 beats per minute is permissible. Before discharge, you should determine the threshold power of the work that the patient can perform.

The second stage is post-hospital

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

Patients arrive at the sanatorium on the 12-17th day, only after 20-30 days, that is, in the first month of the recovery period.

1 class
– working capacity of 700 kgm / min and more, 2nd class
– performance 500-700 kgm / min, 3rd class
– performance 300-500 kgm / min.

  • restoration of physical performance, elimination of residual effects of hypokinesia, expansion of the functional capabilities of the cardiovascular system;
  • increase in physical activity; preparation for physical domestic and professional activities.

Contraindications to the appointment of exercise therapy:

  • circulatory failure of the II degree and higher;
  • chronic coronary insufficiency IV functional class;
  • severe cardiac arrhythmias and conduction;
  • recurrent course of myocardial infarction;
  • aortic aneurysm, heart aneurysm with symptoms of heart failure.
PowerIllness dayModePermitted loads
1-thStrict bedThe patient is in a supine position. Special exercises from exercise therapy are prohibited. He can only turn on his right side, take food on his own.
1B – 2A2nd to 3rdBed extendedThe patient can independently turn and sit in bed, and initially with the help of medical staff, and then independently. Later you can transfer to a chair. Allowed exercises in a supine position, which are performed for 8-10 minutes. The breath should be static. After each exercise, you need to take a break. The pulse should not exceed 20 beats per minute.
2B – 3A4th to 14thWard strictThe patient can already walk along the ward and the corridor at a distance of 20 to 200 m. Already exercises that are performed in a sitting position are allowed. The pace is slow or medium.
3B14th to 21stWard ExtendedThe patient is already allowed walks along the corridor without restrictions. Exercises are performed in an upright and seated position, and can be both individual and group.
4A and 4B (classes I, II, III and IV)From 21FreeWalking is already permissible, and the step speed is average – from 70 to 100 steps per minute. A set of exercises is performed in a sitting and standing position.
  1. Stationary
    . It is carried out right after an attack. It is necessary to stimulate blood in peripheral vessels, reduce muscle tension, increase respiratory function and activate systems that prevent blood coagulation. Thanks to competent loads, it is possible to avoid arthrosis, muscle atrophy, pneumonia and other complications. In addition, they allow you to increase the psycho-emotional state of a person. After the completion of the stage, it is already possible to independently ascend to the 1st floor and walk 2 km per day.
  2. Home
    . It is required after a stationary stage. Home rehabilitation is needed to increase the stamina of the body, restore the work of the heart and blood vessels, improve the quality of life and reduce the dosage of the drugs used. In addition, it is a secondary prevention of ischemia.
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Features of exercise therapy

The main cause of a heart attack is insufficient blood supply to the heart muscle. The cause may be a decrease in blood flow due to blockage or narrowing of the arterial lumen, which delivers oxygen to the heart muscle.

In many cases, there is a need for surgical intervention. Stenting is performed – the installation of a special framework expanding the narrowed portion of the vessel. This procedure is most effective, but it should be carried out no later than five hours after the development of a heart attack.

To return to normal life, a person who has had a heart attack should be responsible for rehabilitation. It is important to adhere to all the recommendations of a specialist, both when in the hospital, and already at home.

For each of the stages of patient rehabilitation, a separate exercise program is developed. Perform them gradually. At first, a slow pace and no more than three repetitions are recommended. The general course of studies involves the following stages:

  1. The first trainings are held in a prone position. After some time, physical activity intensifies, joints and pelvis, and then lower limbs, are included in the work.
  2. Gradually, the complexity of the exercises increases. The shoulders are engaged, the patient is recommended raising the hip and turning on its side. The number of repetitions also increases. It should be about 10 times.
  3. The following are sitting exercises. Most of them allow you to strengthen the lungs and contribute to the work of the muscles of the body. Similar exercises are performed at least once a day for 15 minutes.
  4. The next stage is preparation for independent movement. Since the patient was in a supine position for a rather long time, he should prepare before standing on his feet. We are talking about exercises that simulate step and standing. Every day you need to increase the number of steps. The task is completed when the patient can walk about 50 meters.

This is the initial stage of rehabilitation, therefore it should be given maximum attention. In this case, no additional sports equipment, such as sports poles or fitballs, is required. A set of exercises LFK after myocardial infarction involves the following actions:

  • diaphragm breathing is performed 4 times;
  • slow expansion followed by active finger compression – 10 times;
  • foot rotation with raised legs – up to 5 times;
  • elbow flexion of the hands – 4 times;
  • bending the legs (the exercise is performed so that the feet do not come off the bed surface) – 4 times;
  • pelvic lifting should be performed only under the supervision of an instructor in exercise therapy – 3 times;
  • followed by a short rest, the purpose of which is to normalize breathing;
  • bend your knees, placing your feet on the bed, after which you need to reduce and raise the knees 5 times;
  • the hand straightens to the side and returns to its original position (after this this action is performed by the other hand, and so on 4 times);
  • starting position – lying on your back, turns are performed on the side (in the presence of an instructor) – 3 times;
  • rotate with brushes 5 times.

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

If the patient is difficult to carry out exercises, then he should think about increasing the comfort of training. For example, you can more conveniently arrange the pillows, change the mattress. Each of the above actions should not cause discomfort during execution.

If myocardial infarction touches the patient for the first time, then the recovery process will begin after 3-4 weeks, with repeated transfer after 5-6 weeks. At the same time, exercise therapy has some limitations. It is necessary to avoid the load during the period of exacerbation of the disease. However, after three days, if there has been no deterioration, you can again start training.

You need to perform exercises 3-4 hours after eating. In order to avoid complications, it is necessary to abandon a sharp increase in the load, even in conditions of good health. When implementing the exercise therapy complex, the patient must certainly control his health. If during exercise there are unpleasant symptoms such as shortness of breath, dizziness, tachycardia, chest pain, exercise should be discontinued.

Sharp bends to the floor should be avoided, since such actions provoke a rush of blood to the head. In addition, it is not necessary to carry out strength exercises and exercises involving the use of rotational movements of the head or body.

Physical therapy can be recommended to the patient after getting rid of the main symptoms of the disease. Exercise therapy with myocardium promotes early rehabilitation and combats the consequences of a heart attack. The appointment should be carried out by a specialist who will carry out the selection of tasks in accordance with the patient’s state of health.

A well-selected set of classes helps to restore lost skills and prevents the progression of the disease. A mistake in this case can significantly aggravate the situation and bring the patient to a situation where bed rest and taking medication will be the only way to solve the problem.

Attention! To achieve the maximum effect, exercise therapy classes can be combined with the use of moderate massage.

Today, physical therapy is recognized as a method of rehabilitation therapy for people who have had myocardial infarction.

Exercise exercises after myocardial infarction:

  • dilate coronary vessels;
  • reveal additional capillaries and arterioles;
  • improve blood supply to all parts of the heart;
  • activate metabolic processes in the heart muscle and throughout the body;
  • enhance myocardial contractile function;
  • improve the functioning of the blood coagulation and anticoagulation system, thereby reducing the risk of clogging of blood vessels by blood clots.

Of great importance is the beneficial effect of exercise for the central nervous system. Regular training removes psychological depression in patients, normalizes sleep, and causes positive emotions.

A set of exercises for home rehabilitation

In the Cardiology Scientific Center of the Russian Academy of Medical Sciences, a comprehensive rehabilitation program for patients with a heart attack was developed at the stage of inpatient treatment and, together with the Russian Scientific Center for Rehabilitation and Balneology (Central Institute of Balneology and Physiotherapy until 1992), at the stages of outpatient and spa treatment.

The first stage
– treatment in a hospital in the acute period of the disease before the onset of clinical recovery.

The second stage
– post-hospital (readaptation) in a rehabilitation center, sanatorium, clinic. The recovery period begins from the moment of discharge from the hospital and lasts until returning to work.

The third stage
– Supporting – in a cardiology dispensary, clinic, medical and physical dispensary. In this phase, rehabilitation continues and disability is restored.

The first stage is sick leave

  • prevention of possible complications due to weakening of the heart functions, impaired blood coagulation, a significant limitation of motor activity in connection with bed rest (thrombus embolism, congestive pneumonia, intestinal atony, muscle weakness, etc.);
  • improving the functional state of the cardiovascular system through the use of physical exercises, mainly for training peripheral circulation, training for orthostatic stability;
  • restoration of simple motor skills, adaptation to simple household loads, prevention of hypo and kinesia (hypokinetic syndrome);
  • creating positive emotions.

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

With an uncomplicated course of a heart attack, classes begin from the 2nd-3rd day, when the main signs of an acute heart attack subside.

The timing of the start of classes, the gradual increase in the 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 the day of the disease at the first stage of treatment in the hospital is presented in table. 1. The period of stay in the hospital is conditionally divided into four stages, which are divided into approaches (a, b, c) for a more differentiated approach in the choice of load. The severity class, the transfer of the patient from one step to another is determined by the attending physician.

The program of physical rehabilitation of patients with myocardial infarction in the hospital phase is built taking into account the patient’s belonging to one of the 4 classes of severity of the condition. The severity class is determined on the 2-3rd day of the disease after the elimination of the pain syndrome and complications such as cardiogenic shock, pulmonary edema, severe arrhythmias.

This program provides for the appointment of a patient of a particular nature and volume of physical activity of a domestic nature, a training regimen in the form of therapeutic exercises, leisure activities at different times depending on his belonging to one or another class of severity. The entire period of the stationary stage of rehabilitation is divided into four stages with a subdivision of the characteristics of the daily level of loads and ensuring their gradual build-up.

Stage I covers the period of stay of the patient on bed rest. Physical activity in the scope of approach “a” is allowed after the elimination of pain and severe complications of the acute period and is usually limited to one day.

Indications for the transfer of the patient to the riser “b” (even during the patient’s stay in bed):

  • relief of pain;
  • elimination of severe complications in the 1-2 day of the disease with uncomplicated course.

Contraindications to the transfer of the patient to the substage “b”:

  • preservation 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 at 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 exertion or leading to a violation of hemodynamics (for example, frequent paroxysms of the tachysystolic form of atrial fibrillation)
  • a tendency to develop collapse.

The program of physical rehabilitation of patients with myocardial infarction in the hospital phase

Rehabilitation start day depending on the severity class of the disease

Turn on the side, limb movements, use of a bed-side vessel with the help of personnel, washing lying on your side; stay in bed with a raised head 2-3 times a day for 10 minutes

The same sitting with the help of a sister on the bed, legs dangling, for 5-10 minutes (the first sitting under the supervision of an exercise instructor) 1-2 times a day; shaving, brushing, washing; bowel movements sitting on a bedside chair

Complex of therapeutic gymnastics №1

The same more motor (20 min) sitting on the edge of the bed, legs dangling (2-3 times a day). Eating while sitting. Transplanting on a chair and performing the same volume of household loads while sitting on a chair

Also close relatives if the patient is not in the intensive care unit

but not earlier than the coronary scar T begins to form on the ECG

The same walking around the room, eating while sitting at the table, washing feet with outside help

Therapeutic gymnastics complex No. 2 (sitting, individually)

Board games, embroidery, drawing at the table, etc.

The same household loads, staying sitting without restrictions, access to the corridor, using a shared toilet, walking along the corridor from 50 to 200 m in 2-3 receptions

Walking along the corridor without restrictions, mastering one flight, later – one floor of the stairs, full self-service, taking a shower

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Therapeutic gymnastics complex No. 3 (sitting and standing, group exercises in the “weak” group)

Board games, embroidery, drawing at the table, etc. group entertainment.

Using a shared telephone, receiving visitors

The same exit for a walk, walking at a pace of 70-80 steps per minute at a distance of 500-600m

Therapeutic gymnastics complex Nt 4 (sitting and standing, group exercises in the “strong” group)

The same walking along the street at a distance of 1-1,5 km at a pace of 80-90 steps per minute in 2 doses

The same walks on the street at a distance of 2-3 km in 2-3 doses at a pace of 80-100 steps per minute at the optimum pace for the patient. Bicycle ergometry

* The indicated period is increased by 2 days;

** The indicated period is increased by 3-4 days.

With the transfer of the patient to the stage “b”, he is assigned the Medical Gymnastics Complex No. 1. The main purpose of this complex is to combat hypokinesia in the conditions prescribed for the patient bed rest and prepare him for the early expansion of physical activity. The use of therapeutic exercises in the early days of myocardial infarction plays an important psychotherapeutic role.

Classes are held by the instructor of exercise therapy in the position of the patient lying individually with each. The timing of the appointment of therapeutic gymnastics and its volume are determined collectively: by a cardiologist, patient observer, exercise therapy doctor and instructor. The beginning of classes in therapeutic gymnastics precedes the first sitting of the patient. Actually, the “b” riser involves joining the above activity by sitting in bed, legs hanging down, with the help of a sister for 5-10 minutes 2-3 times a day.

The first sitting is carried out under the guidance of an exercise therapy instructor who should explain to the patient the need to observe a strict sequence of limb and trunk movements 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 provide dynamic clinical monitoring of the patient’s response to this load. Therapeutic gymnastics provides a gradual expansion of the patient’s physical activity regimen.

Therapeutic gymnastics complex No. 1 includes light exercises for distal extremities, isometric tension of large muscle groups of the lower extremities and trunk, relaxation exercises, and breathing. The pace of the exercises is slow, Subordinate to the patient’s breathing. The depth of breathing in the first days is not fixed, as this can cause pain in the heart, dizziness and fear during subsequent exercise.

The instructor, if necessary, helps the patient in the exercise. Each movement ends with the relaxation of working muscles. After 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 classes, you should monitor the pulse of the patient. With an increase in heart rate by more than 15-20 beats, pause for rest. After 2-3 days of successful completion of the complex and improvement of the patient’s condition, it is possible to recommend the repeated execution of this complex in the afternoon in an abridged version. Duration of classes – 10-12 minutes.

  • frequent angina attacks, rest angina pectoris, unstable angina pectoris, severe rhythm disturbances;
  • circulatory failure over stage II;
  • persistent arterial hypertension over 170/100 mm Hg;
  • concomitant diabetes mellitus severe. It is allowed to practice therapeutic exercises at home in a lightweight complex.

Forms of exercise therapy:
medical gymnastics, dosed walking, stairs, walks, classes on general-purpose simulators (exercise bike, treadmill, etc.), elements of sports and applied exercises and games according to lightened 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 by a group method, preferably not musical accompaniment. The duration of the lesson is 20-30min.

  1. Stand up straight, lower your arms, and spread your legs shoulder-width apart. Slowly raise your hands up and down, and after them describe a small circle around you.
  2. The legs are shoulder width apart and the hands are on the belt. Turn the body to the left side, spread your arms to the sides and inhale. Return to starting position and exhale. Repeat the same, but to the other side.
  3. Legs are shoulder-width apart, and arms down. Take a deep breath, sit down and make a slight forward bend. Hands back a little and exhale. Slowly return to an upright position.
  4. Without changing the starting position, take a deep breath, put your hands on your hips and sit down with an exhale. With a breath, return to the starting position.

What should I look for?

In the video, charging after a heart attack at home is not particularly difficult. But to obtain a positive result, the patient will have to pay attention to some nuances. Regardless of the complex of exercises, for their correct implementation, it is recommended to follow these expert tips:

  1. Exercise after a heart attack should increase gradually. Even if the patient feels well, and it seems to him that he can skip several stages of classes, then he should increase the intensity of the exercises in accordance with the treatment plan.
  2. Restorative gymnastics is recommended to start no earlier than a few hours after a meal.
  3. If you experience any discomfort during the training or after it, classes should be discontinued. We are talking about dizziness, arrhythmias, shortness of breath. If the pain persists over time, the use of Nitroglycerin is recommended. After that, you should visit a doctor soon.
  4. For elderly patients suffering from osteochondrosis of the cervical spine, developed against the background of atherosclerosis, the implementation of the slopes “below the heart” is prohibited. Otherwise, there may be a sharp rush of blood to the brain. Any rotational movements performed by the head and body, as well as exercises after a heart attack at home of a power type are undesirable.

Walking for rehabilitation

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

To master walking is according to this scheme:

  1. In the ward advanced mode, if the patient has no complications of myocardial infarction, a 3-6-minute walk is allowed. The pace is 30-40 steps per minute. In this case, you need to control the frequency of the console, blood pressure and subjective sensations.
  2. If the body responds adequately to previous loads, increase the pace of walking – 40-60 steps per minute. At the same time, the pulse should not increase by more than 12 beats per minute, the systolic pressure indicators increase by no more than 20-40 mm RT. Art., and diastolic – 5-10 mm RT.
  1. In free mode, the initial pace of walking is 70-80 steps per minute. Initially conduct a 6-minute workout. If, under such loads, a stable adequate reaction from the side of the cardiovascular system is observed, you can increase the distance from 500 m to 1000 m, and then to 1500. At the same time, you do not need to change the pace. Walking at a distance of 2-3 km in several stages is recommended.
  2. If the previous loads are already given with ease, increase the pace of walking to 80-100 steps per minute. Walking distance also gradually increase from 500 m to 1000 and 1500 m.

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

What’s next?

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

  1. Inpatient (hospital) mode. It is characterized by the adaptation of the patient to the usual household loads, which do not require significant effort from him. The patient is recommended to perform simple classes, walking on the stairs and massage procedures will be useful. It is very important to monitor during this period the increase in heart rate, which should not increase by more than 20 beats per minute.
  2. Post-hospital mode. This is further rehabilitation carried out in sanatorium conditions or specialized cardiological centers. The main goal of this stage is to restore the cardiovascular system and increase its potential. The patient should be aimed at obtaining maximum activity indicators, adapting to both domestic and professional loads. Exercise therapy, training on simulators and some sports are mandatory.
  3. Supporting mode. It involves the patient’s stay in specialized institutions of the sanatorium type. During this period, the omnidirectional physical development of the patient continues, relapse prevention is carried out. A person should actively perform gymnastic exercises. Recommended games that do not involve serious loads.

What does the rehabilitation program suggest?

Gymnastics after a heart attack at home is one of the main methods used in the post-infarction period. However, for a complete cure, it is not enough – an integrated approach is required here. Therefore, the following recommendations are very important:

  1. Dietary nutrition. Every heart attack patient needs to carefully review their diet, reducing calorie intake and animal fat. Refusal of smoked meats, sweet foods, with an emphasis on fruits and vegetables, which are recommended to eat daily, is desirable. A good solution would be to include low-fat fish in your diet.
  2. The correct mode of the day. Each patient should be provided with a full sleep necessary for the restoration of the body. You should also think about short walks in the fresh air.
  3. Getting rid of bad habits. This is very important for those who want to forget about heart attack attacks once and for all. Smoking and alcohol significantly undermine the body. If the patient continues to smoke, then even the most modern treatment is unlikely to help him.

Physical therapy after myocardial infarction at home takes a very important place in the rehabilitation of patients. The training program is developed for each patient individually, but there are a number of general recommendations that have been described above. A correctly formulated exercise therapy course largely determines a positive prognosis of the recovery of the body and the absence of relapse of the disease in the future.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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