Exercise therapy for cardiovascular diseases

The therapeutic effect of regular physical exercise is manifested primarily in improving the activity of the cardiovascular system (hereinafter referred to as CVS). Exercise therapy activates all main and auxiliary hemodynamic factors: cardiac, extracardiac, vascular, etc. During exercise, the coronary vessels dilate, the volume of circulating blood increases, the number of functioning capillaries and collaterals in the skeletal muscles and myocardium increases, due to which redox processes and metabolism are enhanced in them. In turn, this is accompanied by an increase in myocardial contractility. Exercise training also has a positive effect on supporting factors blood circulation: the elasticity of the arteries increases, the capillaries expand, which leads to an increase in blood flow to organs and tissues, and the circulation of blood and lymph accelerates.

During physical activity, the functioning of such important extracardiac circulatory factors as the respiratory movements of the chest and diaphragm improves. Breathing exercises provoke an increased flow of venous blood to the heart muscle due to rhythmic cyclic changes in intra-abdominal and intrathoracic pressure. As a result of training the overall tone of the body increases, tolerance to physical activity increases, positive dynamics of lipid metabolism and blood coagulation parameters are observed.

Strength exercises increase the general adaptive capabilities of the body, its resistance to various stressful influences, thus providing mental relaxation and increasing emotional state sick.

All this predetermines the widespread use of exercise therapy for most cardiovascular diseases for the purpose of prevention, treatment, rehabilitation and secondary prevention.

Contraindications for exercise therapy for cardiovascular diseases are temporary. It is not used in the acute stage of rheumatic heart disease, endocarditis and myocarditis, in severe cardiac arrhythmias, the presence of aneurysms of the heart, aorta and other vessels, in high blood pressure (over 220/120 mm Hg), in moments of frequent and high-intensity attacks, as well as pain in the heart area, with increasing circulatory failure, body temperature above 38 “C, and severe complications in other organs.

1. Myocardial infarction (MI)
2. Arterial hypertension
3. Chronic heart failure

Myocardial infarction (MI)

Rehabilitation after myocardial infarction includes movement regimen, physical therapy and massage. Physical training of patients is based on the principle of constantly increasing loads. Physical exercise helps reduce or disappear angina attacks, improve exercise tolerance, reduce the number of exacerbations of coronary artery disease, prevent relapses of myocardial infarction, and improve the psychological state of patients. The mechanism of action of physical training in patients with myocardial infarction (and in general with ischemic heart disease) is associated with a positive effect on hemodynamics (decreasing heart rate, blood pressure, increasing stroke and minute volumes, myocardial contractility), lipid metabolism, as well as improving oxygen transport and oxygen supply to tissues , increasing myocardial tolerance to ischemia, economizing the work of the heart.

In the rehabilitation of patients with MI there are: three periods: inpatient, convalescent and supportive. After relief of the pain syndrome and in the absence of severe complications, on the 2-3rd day of the patient’s stay in the hospital, one of four functional classes is assigned to him and an appropriate physical rehabilitation program is prescribed, which at the inpatient stage is approximately divided into 4 stages of increasing physical activity. For each stage of motor activity, appropriate complexes of therapeutic exercises have been developed. The difficulty of the exercises, pace of execution, power expended and work increase in accordance with the patient's level of activity.

1. At the first stage (under bed rest), a complex of PH is performed lying on the back, which, as a rule, includes only static breathing exercises, as well as exercises for small and medium muscle groups, and training in vigorous turning on the right side. The duration of the LH procedure is 10-12 minutes; classes are conducted individually. It is recommended that the patient sit down with the help of a nurse 2-3 times a day for 5-10 minutes.
2. The second stage (the ward period) includes sitting on the bed with legs down for 1/3 of an hour several times a day, transferring to a chair, and walking around the ward. LH (including hygienic gymnastics) is carried out individually or in a small group method, in a sitting position, lasting 10-15 minutes.
3. The third stage of physical activity contains the period from the first independent exit into the corridor to the first walk on the street. Patients walk along the corridor from 50 to 200 m at a slow pace, first in 2-3 steps, and then without restrictions, climb one flight and later one floor of the stairs. A PH complex is prescribed, which includes small-group exercises in the initial sitting and standing position for up to 20 minutes.
4. The fourth stage (free mode) includes going for a walk, walking at a pace of 70-80 steps per 1 minute over a distance of 500-900 m in 1-2 steps, then the walking pace increases to 80-90 steps per 1 minute, and the distance to 1 - 1.5 km. Walk outside up to 2-3 km in 2-3 steps at a pace of 80 - 100 steps (or the optimal pace for the patient).

Y = 0.042 * X1+0.15 * X2+65.5,

where the desired Y is the required walking pace, X1 is the threshold load power (kg*m/min), X2 is the frequency of contractions of the heart muscle during a load of threshold power.

The threshold load power is determined using a bicycle ergometer, a treadmill, or climbing a step (step test).

LH classes are carried out in a group method in a sitting and standing position, the intensity and density of therapeutic exercises is expanded.

With proper activation of patients, the increase in heart rate at the peak of the load and in the first 3 minutes after it should not be more than 20 beats per 1 minute, breathing - by 10 respiratory movements per 1 minute. The rise in systolic blood pressure should not exceed 20-40 mmHg. Art., diastolic - 10 mm Hg. Art. If, with the expansion of the motor regime, any complications develop and the patient’s well-being worsens, a temporary reduction in the volume of physical activity and a decrease in the rate of activation is allowed. This program should prepare patients for transfer to a rehabilitation unit or for discharge to outpatient treatment.

On stationary During the rehabilitation stage, physical activity of patients with myocardial infarction includes morning hygienic exercises, physical therapy, training of small muscle groups, dosed walking, walking on stairs, cycling, physical exercise in water, games, etc. There are 4 stages of activity with a gradual increase in load. During the LH process, complex exercises are performed for all muscle groups in combination with proper breathing, special training for balance, attention span, coordination of movements and proper relaxation. It is rational to use exercises with equipment and objects. The duration of LH increases from 20 to 40 minutes. The duration of the training walk increases from 300 m at a pace of 70 steps and heart rate - 90-100 beats per minute to 2-3 km at a pace of 100-120 steps. Peak loads (heart rate - 100-120 beats per minute) are recommended 4-6 times a day for up to 3-6 minutes. The walking distance increases from 2-4 km to 7-10 km with a total duration of 1-1.5 hours to 2.5 hours. The pace of walking should be less intense than training walking by about 10-20 steps per minute. Training walking on the stairs is carried out 2 hours after eating from 1 to 3-4 times a day. The pace of climbing the stairs can be slow, average and fast. Upon returning home, patients should be able to climb the stairs without outside help to the 4th-5th floor. Training on a bicycle ergometer is carried out every other day, and with good tolerance and high tolerance to physical activity - daily. Outdoor and sports games without competitive elements are carried out under the supervision of a physical therapy instructor. They have a pronounced tonic effect and create a favorable psycho-emotional background.

Dispensary and polyclinic period rehabilitation for a significant number of patients who have suffered an MI is the longest. At this stage, the physical activity of patients includes exercise therapy, dosed walking, sports games, and intense physical training (as indicated).

The amount of physical activity is determined depending on the functional class. Based on the results of tests with dosed exercise, patients are divided into conditionally 4 functional classes (FC), the division into which is based on the limits of maximum oxygen consumption. In FC I, LH is performed in training mode for up to 30-40 minutes (heart rate - up to 140 beats per minute). Sports games (table tennis, badminton, volleyball, etc.), measured walking, jogging, skiing, and swimming are widely used. In FC II, LH is carried out in a gentle training mode for up to 30 minutes with a heart rate of up to 130 beats per minute. It is recommended to take short-term (up to 10 minutes) participation in non-competitive sports games, measured walking, jogging at a moderate pace, cycling, and swimming under the supervision of medical staff. In FC III, LH lasts up to 20 minutes with a heart rate of up to 110 beats per minute. It is recommended to walk at an average pace without acceleration. Running, sports games, swimming, and cycling are contraindicated for patients. For patients with FC IV, only individual LH classes are carried out in a gentle mode for 15-20 minutes with a heart rate of up to 90-100 beats per minute; walking at a pace of 60-70 steps per minute without elements of acceleration is recommended.

Patients who have had an MI for at least 4 months and have FC II-III are recommended to undergo long-term physical training for 12 months for half an hour to an hour 3 times a week using gymnastic exercises, running, training on a bicycle ergometer, and sports games. Loads should range from 50-60% of the threshold at the beginning and up to 80-90% by the end of the year. For patients with FC IV, training is carried out in the hospital for up to 8 weeks with a load of 50% of the individual peak (threshold) power (usually 50-100 kg * m/min) 5 times a week, starting from 3 minutes and up to 30 minutes.

Contraindications to long-term physical training: aneurysm of the heart and aorta, low-tension angina, rest and unstable angina, severe disturbances and disruptions of heart rhythm and conduction, circulatory failure of the 2nd degree and higher, increased diastolic pressure above 110 mm Hg. , dysfunction of the musculoskeletal system, concomitant diseases that interfere with training.

Arterial hypertension

The objectives of exercise therapy for arterial hypertension are: normalizing the balance of excitation and inhibition processes in the subcortex of the brain, increasing the reactivity of the vascular system, improving peripheral circulation and the functionality of external respiration, training the vestibular apparatus, reducing increased muscle tone, optimizing blood and lymph circulation in the abdominal and pelvic areas , stimulation of metabolism, reduction of psycho-emotional stress, adaptation and adaptation of the body to increasing physical activity.

It is recommended to include physical therapy in the complex of exercise therapy, cyclic exercises (metered walking, running, swimming, skiing and others), cycling, walking and cycling; short-range tourism, massage and self-massage are very useful.

Features of PH in arterial hypertension are combinations of general strengthening training for all muscle groups and special exercises (volitional muscle relaxation, special breathing exercises with lengthening of exhalation, exercises for the vestibular apparatus, etc.). Most favorable affect the body isotonic exercises light intensity, but medium to long duration. Isotonic exercises are performed with full amplitude, always without holding the breath or excessive straining, with cyclic alternation of muscle groups involved in the movement. Exercises containing bending, turning the torso and head are performed with caution. The LH technique for patients with arterial hypertension of the 1st and 2nd degrees is similar. For patients with arterial hypertension of the 2nd degree, a low load in the PH procedure corresponds to the beginning of the course, and a medium load corresponds to its second half; for patients with arterial hypertension of the 1st degree, an average load is applied at the beginning of the course, and a large load at the end. In the first days of the procedure, LH is performed in the initial position lying down, then sitting and standing. During bed or ward rest, PH is carried out individually or in a small group method, and as the condition improves in an outpatient setting - in a group method.

Contraindications to the use of exercise therapy for arterial hypertension: severe form of hypertension, a condition after a hypertensive crisis or a sharp decrease in blood pressure with a deterioration in the well-being and general condition of the patient, as well as a severe form of heart or cardiovascular failure; Aerobic exercise is contraindicated if blood pressure is above 180/110 mmHg. Art.

Absolute contraindications to cycling exercises in patients with arterial hypertension are: frequent attacks of angina pectoris, severe heart rhythm disturbances, aneurysms of the heart, aorta and other vessels, renal failure, severe retinopathy, glaucoma, diabetes mellitus, heart failure of the 2nd degree and higher, thrombophlebitis .

Chronic heart failure

The objectives of exercise therapy in the early stages are to maintain and increase functionality patients, in the later stages - prevention of complications associated with physical inactivity and severity of the condition.

In physical therapy classes for the initial stage of chronic heart failure, the main focus in the first half of the course is on stimulation of extracardiac circulatory factors with subsequent training of the heart muscle increasing physical activity. The load starts at 50% of the threshold power and is increased to 75-80% by the end of the course. The density of classes gradually increases from 40 to 70%. The duration of the procedures is 25-30 minutes. The exercise therapy complex includes short runs at a leisurely pace, measured walking, swimming, skiing, outdoor games, and hardening. Contraindicated running and sports games with elements of competition.

In the later stages of heart failure, the main form of exercise therapy is PH, while the starting position during exercise is determined by the motor mode of the patients. For grade IIA circulatory failure, exercises for all muscle groups are used in combination with static breathing exercises lasting 10-15 minutes. With IV degree circulatory failure, the load is reduced due to fewer repetitions of exercises and an incomplete range of movements. Procedures lasting 8-12 minutes are repeated several times a day. But in case of circulatory failure of the third degree, it is possible to use exercises for small and medium muscle groups in combination with static breathing exercises (with prolonged exhalation) for 7-10 minutes (only with the reverse development of clinical signs of the disease).