Exercise therapy, gymnastics and physical activity for myocardial infarction

When can you do exercise therapy after a heart attack?

A set of exercises after myocardial infarction (Exercise therapy - remedial physical culture) includes the consistent implementation of rehabilitation programs in a cardiological hospital, a rehabilitation department of a local sanatorium, a polyclinic at the place of residence.

In this regard, there are three stages:

1. Stationary.
2. Sanatorium and health resort.
3. Outpatient.

Patients with MI at the stationary stage are divided into 4 classes.

On the basis of this:

• course of the disease;
• the severity of myocardial infarction;
• complications;
• coronary insufficiency.

The time of prescribing physical activity in myocardial infarction is due to the severity class, which is determined after the elimination of pain and complications, approximately 1-3 days (a little later in patients who underwent coronary artery bypass grafting).

The timing of the appointment of medical physical culture to patients with myocardial infarction, depending on the severity class of the disease (days after the onset of the disease)

Indications and contraindications for exercise

Exercise therapy is indicated for all patients with myocardial infarction, whose condition has stabilized and does not pose a threat to life. In this case, physical activity will have a recovery effect and great benefits for the patient.

Absolute contraindications:

• left ventricular aneurysm;
• frequent attacks of angina pectoris;
• FP;
• polytopic, group, frequent ECS;
• PT;
• AH with diastolic AT> 110 mm Hg;
• tendency to thromboembolic complications.

What sport and how to do it?

The first degree of activity (strict bed rest, perform slowly, after the disappearance of pain and complications):

1. Light limb movements.
2. Tension of the muscles of the limbs and trunk.
3. Static breathing.

Adequacy measures:

1. Increase in Ps by no more than 20 beats / min.
2. Breathing is not> 6-9 r / min.
3. Systolic blood pressure by 20-40 mm. rt. Art., diastolic by 10-12 mm Hg.
4. Decrease in Ps by 10 beats / min., Decrease in blood pressure by no more than 10 mm Hg.

The second degree of activity (ward mode, 2A - lying on the back, 2B - near the bed, then in the ward):

1. Morning exercises.
2. Allowed to eat, sit at the table.
3. Breathing exercises.

The third degree of activity (first exit into the corridor before going outside):

1. 50 - 200 steps in 2-3 runs, slowly (70 per minute) along the corridor (3A), using a shared toilet).
2. Unlimited walks down the hallway.
3. Full self-service.

The fourth degree of activity (preparation for transfer to a sanatorium, adaptation to everyday life):

1. Movements in large joints, back muscles, trunk (30 - 35 minutes, slowly, with pauses, which take 25% of the class time).

Recommended sports

At the sanatorium stage, the patient should be recommended, first of all, health-improving therapeutic gymnastics. With her they use: gymnastic sticks, balls, dumbbells, a bench, hoops, elements of games, as well as some sports: swimming, skiing, rowing, dosed running, sports games, a bicycle ergometer. If the patient is a former athlete, training in the previous intensive regimen is now contraindicated for him.

Gymnastics at home

At the dispensary and polyclinic stage, long loads are suitable. They can be started in 3-4 months. after THEM. Before starting, it is imperative to determine the capabilities of a person, using: veloergometry, spirography, clinical data. With regard to their results, the patient can be attributed to a certain functional class: 1 - 2 strong group, 3 - weak.

Physiotherapy exercises after a heart attack at home:

Stage I (2-2.5 months):

• separate exercises 6-8 times;
• walking on the sides of the feet, heels, toes (15-20 s.);
• walking (120 steps / min., 4 min.);
• running 120-130 steps / min;
• ski step, walking with a high rise of the knees 1 min;
• elements of sports games.

A similar exercise therapy after myocardial infarction is performed at home 3 times a week, and lasts up to 10 minutes. If the patient feels discomfort, he must rest for a while or completely stop the load.

An increase in heart rate in a strong group is permissible by 65-70%, in a weak one by 55-60% of the boundary norm. The average rate is 135 beats / min. (120-155 beats / min.).

Stage II (5 months):

• running at a slow and medium pace (3 minutes), volleyball (8-12 minutes, with a rest of 1 minute, every 4 minutes) with a ban on jumps;
• Heart rate - 75% of the borderline in the weak and 85% in the strong group. Heart rate 130-140 beats / min.;

ІІІ stage (3 months):

• physical activity as in stage II, only their duration increases up to 15-20 minutes. The heart rate in the weak group is 135 beats / min., In the strong group - 145 beats / min.

You need to train 3 times a week. Do not forget that morning exercises after a heart attack are required at home at all stages, as it helps the body to adapt after sleep and slowly switch to daily work.

Morning exercise after a heart attack at home (description of the method):

• arms along the body, legs slightly apart → stretch your arms up while inhaling → lower, exhale (5 times);
• hands on the belt, socks in different directions → turn to the left → exhale; the same in the right;
• sit on a chair, stretch your legs → bend in the back, inhale, head back → exhale, initial position.

Elderly people are not recommended to do bends, as well as power loads. An example of optimal exercise is shown in the illustration:

Physical education after a heart attack against the background of arrhythmia

Physical education for arrhythmias is prescribed only following a thorough examination by a specialized cardiologist. In some cases, it is completely contraindicated:

• rhythm disturbances and an attack of anginal pain with small loads;
• СН ІІ-ІІІ degree;
• diabetes;
• heart defects;
• renal and hepatic impairment;
• pressure> 160/90 mm Hg;
• aneurysm of the heart and aorta.

Memo for patients with extrasystole (ECS)

A patient with a pacemaker should remember that it is desirable for him to have a heart rate monitor and monitor the pulse rate, as well as to stop any load in case of poor health and the appearance of extrasystoles. Ventricular pacemakers should be especially attentive, since they are more dangerous than sinus ones and can lead to the development of life-threatening arrhythmias. It is not recommended to go in for sports with extrasystole and fitness. However, there are permitted exercises after a heart attack at home:

• daily walks;
• morning warm-up (15 minutes);
• you can go swimming and cycling, while the loads are necessarily limited in time;
• breathing exercises.

Criteria for the effectiveness of exercise therapy

The rehabilitation period after myocardial infarction, a process that requires competent medical tactics, the desire and diligence of the patient, lasts for years, depending on the severity of the condition. Rehabilitation centers are able to teach the patient all the exercise therapy techniques he needs and choose the most suitable one for each patient. It is important to evaluate the performance criteria. The adequacy of the loads is evidenced by the ability to move to higher levels according to the time elapsed after the illness. Positive test results (bicycle ergometry, spirometry) are taken into account.

Conclusions

Every person who has had a heart attack should change his lifestyle and be extremely attentive to his health, undergo medical examinations on time. Physical activity should be adequate to the condition. Also, do not forget about constant drug therapy.