Diagnosis of ischemic heart disease For what reasons most often does a person see a doctor? As a rule, to find out if his ailments are a sign of illness, and if so, how to get rid of the illness. No wonder they say that the correct diagnosis is half

Prognosis of the course of coronary heart disease If you are not ready to change your life, you cannot be helped. Hippocrates After the diagnosis of ischemic heart disease is established, the question of the prognosis of the disease inevitably arises. Moreover, this question is equally interested in

Prospects for the treatment of coronary heart disease As has been repeated on the pages of this book, coronary heart disease belongs to the category of incurable diseases. This means that at this stage in the development of medicine and civilization, completely get rid of it

Massage for Coronary Artery Disease Massage in combination with exercise is widely used in the program of rehabilitation treatment for patients with coronary artery disease (IHD). Massage has a direct neurohumoral effect on local and general

Physical activity is necessary for healthy and sick people at any age. Exercise therapy for ischemic heart disease is able to improve blood circulation, improve the condition no worse than drugs, but it does not have a negative effect on the liver and kidneys. Physical activity, special complexes after ischemic stroke at home give a comprehensive result for the whole body:

• excess weight is effectively lost. Even primitive leg swings, squats and "cycling" noticeably speed up metabolism. With ischemia, it is dangerous to have fatty deposits or atherosclerotic plaques in the lumen of the vessels;
• reducing the likelihood of developing diabetes mellitus and other autoimmune diseases;
• increasing the efficiency and endurance of the body. Simple walking or jogging for 30 minutes is an excellent exercise therapy option for ischemic heart disease. Moreover, the training results will be useful in any crisis situations;

An insufficient supply of oxygen to the heart due to narrowing of the arteries and their clogging with plaque leads to the development of coronary heart disease (CHD)

• lowering blood cholesterol. Regular physical exercise in patients normalizes triglyceride levels at the level of drugs;
• prevention of age-related degenerative changes in bone tissue in the elderly. The phenomenon is often observed in patients with circulatory pathologies. Instead of physical activity, they choose a passive lifestyle, for which they pay with fractures;
• exercise therapy for coronary heart disease prevents thrombosis, heart attacks and other common complications of the disease;
• normalization of sleep. With ischemia, patients often suffer from nervousness, irritability, and other problems. The complexes approved by the cardiologist solve this problem efficiently and quickly.

It is also worth recalling that exercise therapy for coronary heart disease gives such a result only with a complete cessation of smoking and alcohol.

Features and nuances

Why, in general, does insidious ischemia appear? To provoke a deficiency of oxygen in the heart muscle, a reduction in its volume and functional activity can be:

• alcohol and. Nicotine and ethyl alcohol negatively affect the state of blood vessels, blood density, increase the likelihood of thrombosis and other complications. Therefore, no matter how effective walking is with an illness, while the patient smokes and drinks, it is unrealistic to achieve positive dynamics;

There can be many reasons: alcohol abuse, improper diet, sedentary lifestyle

• unbalanced diet, and especially the passion for high-calorie foods high in animal fats.

Physical education for this disease is not indicated for all types. With oxygen deficiency, the patient suffers from pain and. In order to prevent such an attack, do not self-medicate and fully listen to the recommendations of cardiologists:

• excessive physical activity easily provokes exacerbations and ailments. Do not think that by doing more exercises faster, you will completely get rid of the disease. Exercise with pathology of the heart muscle requires a calm pace and ability to listen to your body;
• the optimal workout length is 40 minutes. With less quantity, you will not feel the result, and life in the gym will completely exhaust your body. Therefore, take care of yourself.

Medical statistics claim that patients who have suffered a heart attack during ischemic stroke and who regularly exercise are 7 times less likely to face a relapse. And mortality in this category of patients is reduced by 6 times.

Disturbance in lipid metabolism (accumulation of LDL, decrease in HDL), leading to atherosclerosis of the coronary arteries - the main risk in the development of cardiac ischemia

But in practice, most often patients completely refuse to walk and run. Therefore, they re-enter the bed in cardiology. Of course, the degree of activity in ischemia and heart attack should be different, and in advanced cases, restoration is required only in a sanatorium of a special profile.

Groups of patients with ischemia

The development of exercise therapy after ischemic stroke is carried out by groups of cardiologists. The most modern domestic theory of rehabilitation of patients with this circulatory pathology is the theory of D.M. Aronov. The professor divided all patients into 4 categories depending on the severity of their condition:

• first. Angina attacks are very rare. Patients positively tolerate physical activity of moderate severity;
• average. Discomfort in patients with ischemia occurs after eating a dense meal, climbing stairs to the upper floors;
• heavy. Chest pain occurs after exercise. Therefore, a set of exercises is developed only by a cardiologist. If there is a threat of stroke or ischemic heart attack, then the exercises are chosen sparing;
• dangerous. Attacks of angina pectoris occur absolutely regardless of physical activity;

A sedentary lifestyle is also considered a risk factor

What exercises to choose

Patients with pathology are strictly prohibited deadlift, bench press and other types of work with iron. Also popular is step aerobics, which increases the load on the atria. Therefore, this type of training should be abandoned.

For rehabilitation after seizures, restoration of functional activity, patients with ischemia are shown:

• "bicycle". Everyone remembers this habitual exercise from kindergarten. But it not only amuses, but also perfectly strengthens the cardiovascular system. With daily execution, a person gets rid of not only angina attacks, but also varicose veins;
• swing your legs. Lean against the wall. Lift your left and right legs 10 times in turn. You can alternate movements forward, backward, sideways;
• squats. Perform movements at a low speed, try to keep your back straight;
• run. On the spot, jogging, fast or at your own pace. Speed ​​is not as important as regularity and a positive attitude.

Daily physical activity can prevent the development of many diseases

Optimal types of loads

Gymnastics after an accurate diagnosis is carried out on a par with taking medications. A set of exercises for an ailment sets clear goals for itself:

• increase endurance. To do this, cardiologists recommend hiking and horseback riding, try tennis or table tennis. Even simple and familiar gardening is useful;
• increased flexibility. For this, physiotherapy exercises include various dances, water aerobics, a visit to the pool, Pilates;
• strength exercises for cerebral ischemia are necessary in a metered amount and only on the recommendation of a doctor. If it is not possible to buy an expensive subscription or visit a gym, dig the ground at your summer cottage.

Gymnastics in case of ischemic disease after suffering a heart attack or other complications requires agreement on the duration and intensity of classes.

In order for gymnastics for patients with circulatory pathologies to bring only benefit and pleasure, heed the recommendations of trainers and cardiologists:

• do a set of exercises in a good mood. Turn on your favorite music and have fun;
• improving blood circulation is not only a set of exercises. It is a whole mindset and a way of life. For example, walk 2-3 public transport stops. In the evening, take a walk before going to bed, and do not lie on the sides on the couch;
• gymnastics after exacerbation of ischemia or its consequences is necessary daily. And if you skip a day, there will be no result;
• if you live in a multi-storey building, skip the elevator. Gradually, slowly go up to your home. This is the best workout for the heart and legs;
• gymnastics for coronary artery disease also includes walking with a pet. An hour or two in the fresh air will benefit not only the animal.

The provocateur of the disease can be vascular spasm against the background of intense emotional and psychological stress.

Methods for the prevention of ischemic heart disease

An effective way to prevent coronary artery disease (apart from following the daily regimen and proper nutrition) is weakened physical exercise, since it has long been known that physical therapy for ischemic heart disease, no matter in an active or inactive form, helps to stabilize the activity of the vascular-cardiac, respiratory and other systems ...

Physical exercises accelerate the patient's adaptation to climatic factors, increase the body's resistance to diseases, emotional trauma.

Properly selected physical exercise inhibits the progression of many diseases and helps restore disturbed functions. Gymnastic exercises, sports, hardening are especially effective.

It should not be forgotten that significant physical activity contributes to significant changes in the body, disruptions of metabolic processes, tissue hypoxia. The conclusion suggests itself - any physical education must be strictly dosed, it must be done exclusively under the supervision or according to the doctor's instructions.

Do not abuse weight lifting in the morning, refuse long (over 60 minutes) jogging that causes fatigue.

Complex therapy of ischemic heart disease

Complex therapy of ischemic heart disease must necessarily contain therapeutic gymnastic and physical exercises. Before recommending any complex of classes to a patient, a cardiologist needs to establish the functional class of the patient, in other words, to determine what kind of load he can withstand. This is done through special stress tests on a moving walk and stationary bike.

The entire period of the tests, the patient is monitored: the pulse rate is recorded, the ECG is recorded, and the blood pressure is monitored.

In addition to monitoring within the framework of stress testing, additional daily monitoring of the ECG, as well as the pressure in the cardiac arteries, is necessarily carried out, this allows you to notice abnormal heart activity in time, for example, during exercises that involve significant household loads.

Echocardiography is performed separately both during exercise and in a state of inactivity.

Functionality classes

Depending on the results of stress testing, the patient is assigned one of the following classes of functionality:

1. with no restrictions. Everyday physical work is carried out by the sick without any difficulty. Shortness of breath and fatigue does not occur, the heart works in a normal rhythm.
2. moderate limitation. Performing daily work causes shortness of breath, and the pain also develops a feeling of fatigue. The heartbeat is out of order. At rest, none of this is observed.
3. strong limitation. At rest, no symptoms are observed, however, they appear even from minimal exertion (less daily).
4. full limitation. All symptoms are noted at rest, from the slightest physical activity they are noticeably intensified.

There are also contraindications for therapeutic physical exercises, in particular: periodic attacks of angina pectoris, especially at rest; severe violation of the rhythm of the heartbeat (extrasystole, arrhythmia, etc.); persistent arterial hypertension (more than 170/110 mm Hg); diabetes mellitus in acute form.

Exercise therapy complex for ischemic heart disease

For patients of the last 2 classes of functionality, therapeutic exercises are almost completely contraindicated, for the second class it is permissible, but with great care. For patients of functionality class I, the following exercise therapy complex has been developed - for ischemic heart disease, consisting of 20 exercises:

1. steps are taken in place within seconds.
2. for 60 seconds, running movements are performed on the spot.
3. the stand is straight, hands at the seams; slowly, while inhaling, the arms are spread apart until their position is parallel to the floor; slowly on exhalation, the arms return to their original position; repeat several times.
4. the stand is straight, hands at the seams; on inhalation, the arms bend at the elbows, as if trying to touch the shoulders; on exhalation, the arms are spread apart; again on inhalation, the hands are transferred to the shoulders; on exhalation, the arms return to their starting position; you need to repeat 5 times.
5. the initial stance is straight, while the hands should be on the belt; tilts of the body are performed first to the left, then to the right; the pace of the exercise is kept average; repeat 7 times.
6. the starting position is the same; first raise the right leg, bend at the knee, straighten and return to its original position; do the same with the left; repeat 8 times; you need to be careful with this exercise and in case of dizziness and osteochondrosis, you should refuse it.
7. the starting position is the same; head tilts are made - back, forward, left, right; the pace of the exercise is slow; repeat 3 times.
8. starting stance straight, hands at the seams; hands are spread apart, then they are thrown over the head, then they are again divorced and again behind the head; the pace of the exercise is average; repeat 7 times; little by little, the exercise can be complicated, at the same time as raising the arms, turn the body to the right and left.
9. quick steps in place lasting 60 seconds.
10. starting stance straight, hands at the seams; immediately with both hands, make circular movements in opposite directions, one forward, the other back; change hands; do it 9 times.
11. the starting position is the same; hands are located on the belt, then 3 springy tilts to the left are made; repeat, first raising your hands to your shoulders, then lifting them up; takes up the starting position; everything is done the same, only to the right; repeat 5 times in both directions.
12. the stand is straight, the lower limbs are widely spaced, the arms are raised forward and apart on the sides; the exercise begins with the right leg, alternately swinging it, first towards the right hand, then the left; the pace of the exercise is average; you cannot put your foot on the floor during the swings; takes up the starting position; the exercise is repeated 3 times with each leg.
13. the stand is straight, hands at the seams; while inhaling, the arms are spread to the sides; on exhalation, arms are crossed behind the back, right below, left above, fingers locked; do the same by changing the position of the hands; the pace of the exercise is slow; repeat 6 times.
14. the stand is straight, the legs are crossed, the upper limbs are on the belt; the body bends alternately, now to the left, then to the right; the pace of the exercise is average; repeat 9 times.
15. the stand is straight, hands at the seams; the right leg is set back a little, the body leans forward, while you need to try, as it were, to reach the floor with your hands; return to the starting position; repeat 7 times in both directions.
16. the stand is straight, hands on the belt; swings are made with each leg in turn - to the right, to the left, to the right; return to the original position; do the same with each leg 5 times.
17. stand straight, upper limbs at the seams; bend back, then move forward 2 smooth tilts, trying to touch the floor, as it were; at the same time, the knees should remain straight; return to the original position.
18. the initial position is the same as the previous one; 3 springy tilts back, the position of the hands for each tilt should be respectively: up, to the sides, up; return to the original position; do it 7 times.
19. the stand is classic, the lower limbs are wide apart, the hands are on the belt; on inhalation, the left leg bends at the knee, at the same time, the maximum possible squatting is done on the second leg; exhalation; return to the starting position; do this 7 times, changing your leg each time.
20. stand straight, arms parallel to the floor; the arms are bent at the elbows so that the hands with the forearms look up; return to the original position; repeat, only the hands with the forearms should look down this time; return to the starting position; do the same thing 10 times; breathing is arbitrary.

Recall that all of the above gymnastics for coronary heart disease is allowed to be done mainly for patients of class I functionality, that is, for those who have not had myocardial infarction. Such patients need not be afraid to do these exercises, loading all muscles for a minute.

Patients after myocardial infarction (second class of functionality) should approach these exercises with caution, loading only certain muscle groups. Respiratory gymnastics must be accompanied by rest. Also, constant monitoring of the pulse is required, its deviation from the norm should not exceed 10%. The maximum exercise duration is 20 minutes.

For patients of III and IV functional class, physical education should be severely limited due to the likelihood of thromboembolism. Exercises must be done with partial amplitude, using only certain muscle groups. After every 3 exercises, the patient must have a rest, the duration of the exercise itself should not exceed 10 minutes. If the state of health worsens (tachycardia, hepatic-renal failure, shortness of breath, heart pain), it is necessary to immediately stop exercise therapy.

Useful exercise therapy exercises for ischemic heart disease

Exercise therapy in ischemic heart disease affects the modifiable factors of coronary heart disease: arterial hypertension, hypodynamia, overweight.In addition, the patient's overall quality of life improves, and the prognosis for the future becomes more stable.

Ischemic (coronary) heart disease is the most common cause of death in most industrialized countries of the world. It accounts for approximately one third of the total mortality of the population. Thousands of people suffer from cardiac ischemia. People with low physical activity, the risk of getting sick is doubled compared to those who are active in life.

Where to begin?

Physiotherapy for ischemic heart disease is the basis for the rehabilitation of patients who have had this serious disease. The effect of exercise is significant and multifaceted, the effectiveness is undeniable. Dynamic training is coronary artery bypass grafting. Standard therapy works best if supported by physical therapy. Here, the help is needed not only from a cardiologist, but also from a specialist who helps rehabilitation - a physical therapy doctor. He determines the individual program, observes the dynamics of the patient, corrects the load. He also prescribes control studies and optimizes rehabilitation depending on the individual condition of the patient. Such an integrated approach helps to improve the recovery of the victim's body.

The first exercises are prescribed by the doctor at the very beginning of the postinfarction period. These are the simplest exercises for restoring breathing and removing the patient from a serious condition. They can only be carried out under the supervision of a cardiologist.

1. Resting ECG.
2. Bicycle ergometric test (carried out on an exercise bike to determine exercise tolerance).
3. Echocardiography (allows you to diagnose complications of heart disease).
4. Urine and blood tests.
5. Determination of total cholesterol, etc.

In the presence of complications, as well as with increased or decreased pressure, the maximum power of the training load at the preparatory or initial stage of rehabilitation is 50 percent of the identified threshold value. Another important condition for success is the elimination of exercises with elements of static tension. Patients with coronary heart disease require increased attention from medical personnel during classes. After the first week of training, a resting ECG is recommended.

As a rule, controlled training in a polyclinic is carried out 3 times a week, or 2 times in a polyclinic and 1 time at home in a safe mode and subject to all the doctor's recommendations. During exercise, you may continue to take medications prescribed by your doctor. Of course, all appointments are made by the cardiologist, who also adjusts the medication regimen. An integrated approach should take into account the depth of myocardial damage, clinical data, the general condition of the heart at the moment, the real volumes of the patient's motor activity after the start of training.

Before each next workout, the patient's blood pressure is measured, the pulse is checked, the general state of health, complaints, if any, are monitored.

Patients are not allowed to engage in physiotherapy exercises in case of deterioration of health and in the presence of the following symptoms:

1. Changes in heart rate (the presence of tachycardia, arrhythmias, angina pectoris may indicate a possible progression of ischemia).
2. The appearance, increased shortness of breath or other similar signs of circulatory failure.
3. Increased blood pressure.
4. An increase in body temperature, indicating an exacerbation of the patient's chronic diseases or the presence of a cold.
5. Muscle pain or any violation of the musculoskeletal system.

In addition to temporary suspension from classes, the patient is shown an urgent consultation with a cardiologist in order to diagnose and correct supportive therapy.

How are the lessons going?

After a thorough medical examination, physical therapy classes begin. Factors of both objective and subjective nature influence the individual tolerance of physical activity. Therefore, the adequacy of muscle tension must be strictly controlled during the course of the session by the doctor. When training on a stationary bike, the load is dosed according to the heart rate. The load tolerance is considered satisfactory if the patient does not have complaints during the exercise, the general state of health remains normal, and the blood pressure and heart rate do not exceed the permissible values.

The normal type of reaction to exercise is characterized by the following indicators:

• moderate fatigue, passing quickly enough (within 5-7 minutes or earlier);
• no pain in the heart area;
• lack of shortness of breath;
• change in the patient's pressure and pulse within the limits recommended during training;
• lack of heart rhythm disturbances.

Approximate set of exercises

Workouts usually take approximately one minute. The patient must breathe with an open mouth and breathing must be full - this is monitored not only by the patient, but also by his doctor.

All exercises are performed in a sitting position, at a calm pace.

Physical training includes the following series of exercises:

1. Head tilts back and forth.
2. Turning the head left and right.
3. Raise your shoulders up, then sharply lower them down
4. Pulling in the abdomen.
5. Stretching the arms forward (hands are locked in a "lock").
6. Bringing forward and spreading back the arms, bent at the elbows.
7. Tilts of the body forward with straightening to the starting position.
8. Turns of the body alternately to the left and right with abduction to the side of the arms.
9. Hands touch the shoulders. Alternate establishment of arms bent at the elbow behind the head.
10. Bend your knee and raise it, then lower it down. Exercise with the other leg.
11. Raise your hands up, lower, clasping your knees.

Of course, the set of exercises is given approximate, it can be corrected by the attending physician. During training, he monitors the patient's breathing and gives instructions on how to breathe. There are also a number of exercises recommended by doctors to be performed by the patient in the supine position (naturally, if there are no contraindications). Currently, specialists have also developed breathing exercises for ischemic heart disease.

When performing the exercises, simple sports equipment (gymnastic stick, ball) can be used. Exercise should be alternated with a little rest.

What can you do yourself

There are simple exercises that will help the heart recover, facilitate its work, and fill it with oxygen. This will keep the heart safe for as long as possible. They can be done at home during the day.

Physiotherapy exercises not only contribute to the restoration of body functions, but also increase the body's resistance to stress and disease.

In the future, if the state of affairs is favorable, you can practice walking for minutes, but only with the permission of the attending physician. Do not engage in heavy or power sports.

Complex of therapeutic exercises for coronary heart disease

Active physical education not only normalizes the reactions of the cardiovascular, respiratory and other systems, but also restores the convalescent's adaptability to climatic factors, increases a person's resistance to diseases and stress. In many diseases, properly dosed physical activity slows down the development of the disease process and contributes to the fastest recovery of impaired functions. Regular gymnastics, sports games, hardening help to achieve such good results.

However, it must be remembered that heavy physical activity contributes to significant changes in the body, metabolic disorders, tissue hypoxia. Hence we can conclude: any physical activity should be strictly dosed, performed under supervision or on the recommendation of a doctor.

Ischemic heart disease (IHD) is an acute or chronic disease associated with a decrease or cessation of blood delivery to the myocardium due to a pathological process in the cardiac artery system. The cause of the disease can also be vasospasm caused by strong psycho-emotional stress.

Moderate exercise - walking, jogging, skiing, hiking, cycling, swimming - is an effective method of preventing coronary artery disease (in addition to rational nutrition, adherence to the daily regimen). Do not get carried away with lifting weights (weights, large dumbbells) in the morning, it is better not to make long (more than an hour) jogging, which cause overwork. Hardening is required.

Exercises to treat coronary artery disease

Legend: IP - initial position; TM - slow pace; TS - average pace.

1. IP - standing over the seat of the chair, hands on the belt. Take your hands to the sides - inhale; hands on the belt - exhale. The exercise is performed 4-6 times. Breathing is even.

2. SP - the same. Hands up - inhale; forward bend - exhale. So 5-7 times. TS.

3. IP - standing, hands in front of the chest. Take your hands to the sides - inhale; return to IP - exhale. 4-6 times. TM.

4. IP - standing at the chair. Sit down - exhale, get up - inhale. 5-7 times. TM.

5. IP - sitting. Bend the right leg - cotton; return to the IP. The same with the other leg. 3-5 times. TS.

6. IP - sitting on a chair. Sit in front of the chair; return to the IP. Do not hold your breath. 5-7 times. TM.

7. SP - the same legs are straightened, arms in front. Bend your knees, hands - on the belt; return to the IP. 4-6 times. TS.

8. IP - standing. Take your right leg back, arms up - inhale; return to IP - exhale. The same with the left leg. 4-6 times. TM.

9. IP - standing, hands on the belt. Tilts left and right 3-5 times. TM.

10. IP - standing, hands in front of the chest. Take your hands to the sides - inhale; return to IP - exhale. 4-6 times. TS.

11. IP - standing. Take your right leg and arm forward. The same with the left leg. 3-5 times. TS.

12. IP - standing, hands up. Sit down; return to the IP. 5-7 times. TS. Breathing is even.

13. SP - the same hands up, hands in the "lock". Torso rotation. 3-5 times. TM. Do not hold your breath.

14. IP - standing. Step from the left foot forward - arms up; return to the IP. The same with the right leg. 5-7 times. TS.

15. IP - standing, hands above the chest. Turns left-right with arms spread. 4-5 times. TM.

16. IP - standing, hands to shoulders. Straighten your arms one at a time. 6-7 times. TS.

17. Walking in place or around the room - 30 sec. Breathing is even.

Physical activity for coronary artery disease

According to modern medical data, a large number of factors can contribute to the development of coronary artery disease (ischemic heart disease). Among the most common and "aggressive" are bad heredity, alcohol abuse, smoking, chronic stress, metabolic disorders due to malnutrition, chronic fatigue, and physical inactivity. Of course, it is almost impossible to get rid of a hereditary predisposition to ischemic heart disease, and you cannot completely save yourself from stress. But you can adjust your lifestyle so as to avoid the rest of the above factors. First of all, it is worth quitting smoking, optimizing nutrition and ensuring proper physical activity on the body.

Why physical activity is beneficial:

• Regular physical activity allows you to stay in good shape and stay in good shape.
• With regular physical activity, the amount of "useful" lipids in the blood increases, which helps to reduce the risk of developing atherosclerosis.
• The likelihood of blood clots is reduced.
• Blood pressure is normalized, which helps to reduce the risk of cerebral hemorrhage (stroke).
• Exercise promotes weight loss and prevents diabetes.
• Regular exercise can improve mood, sleep and help you cope with stressful situations.
• Regular physical activity reduces the risk of osteoporosis, the most common cause of bone fractures in old age.

Regular physical activity is beneficial for everyone, as it helps to protect yourself from the development of many unpleasant diseases. But, unfortunately, the disease itself often pushes us to change the way of life and regular exercise.

For people with coronary artery disease, only certain types of physical activity are suitable.

IHD develops as a result of acid starvation, which leads to the formation of an atherosclerotic plaque. The plaque narrows the artery that supplies the heart with blood, so less oxygen-rich blood reaches the heart muscle. In this case, the intensive work of the heart is hampered and, under heavy loads, angina pectoris develops - a painful attack of the heart muscle.

Naturally, angina attacks require restriction of physical activity. Often, in order to get rid of angina pectoris, it is necessary to resort to medication, and even surgical treatment. In the case of a severe heart attack - a heart attack, patients begin to be afraid of physical exertion at all and, trying to "save" the heart, often restrict movement to the point of refusing to walk.

For patients with angina pectoris and those who have suffered a heart attack, physical activity can have a twofold meaning:

• On the one hand, excessive physical activity and intense physical activity can provoke angina attacks and lead to a second heart attack - such excessive activity should be avoided.
• On the other hand, moderate physical activity and periodic exercise (no more than 40 minutes 5 times a week), on the contrary, are very useful.

Moderate physical activity increases the level of good cholesterol, which prevents the further development of atherosclerosis, reduces the rate of development of heart failure, strengthening the cardiovascular system. Regular aerobic exercise helps to normalize the functioning of collateral blood flow, an inter-arterial connection that redistributes blood flow, which helps to increase the amount of oxygen-rich blood that reaches the heart muscle.

As medical studies show, physical activity in patients who have had a heart attack helps to reduce the risk of re-infarction by 7 times, and reduce mortality by 6 times, compared with patients who prefer to reduce physical activity as much as possible.

Therefore, for patients who have suffered a heart attack, the implementation of normal household loads (light daily housework) is mandatory. After an inpatient course of treatment, it is preferable for such patients to undergo a course of physical rehabilitation under the supervision of specialists in a cardiological sanatorium. If rehabilitation in a sanatorium is impossible for one reason or another, it is necessary to undergo a course of physical rehabilitation on an outpatient basis under the supervision of a cardiologist.

The simplest option for physical activity in this case is daily walking. In this case, you should not reboot yourself: the walk should take place at a slow or moderate (depending on how you feel) pace, for half an hour - an hour, but at least 5 days a week. If during a walk you feel weak or tired, you need to take a break - sit down on a bench or slowly return home. Do not be upset - in the process of rehabilitation you will be able to go through more and more. However, the increase in motor loads, exactly like the beginning of physical exercise, after the hospital must be coordinated with an exercise therapy specialist or an attending cardiologist.

Physical activity should in no way lead to another attack of angina pectoris. During exercise, severe shortness of breath or heart palpitations are unacceptable. During physical exertion, you need to monitor the pulse - its frequency should increase in accordance with the increase in load. At the same time, the optimal increase in heart rate should be determined by the attending physician individually, according to the severity of coronary artery disease and associated pathologies.

At the first stages of physical rehabilitation, the heart rate can increase by no more than 20 - 30%, about 15 - 20 beats per minute. If loads are tolerated without complications, an increase in heart rate of more than 30% can be allowed, however, no more than the value calculated by the following formula: 200 is the patient's age. For example, for a patient with coronary artery disease at the age of 60 years, the maximum allowable heart rate should not exceed 140 beats per minute.

Leading specialist of Russia in the field of rehabilitation of patients with heart diseases, professor D.M. Aronov, developed recommendations for physical activity, depending on the functional class (severity of manifestation) of the disease. According to the tables below, developed by Professor D.M. Aronov, it is possible to determine the permissible load in each specific case.

Remember that depending on the severity of the manifestation, angina pectoris is divided into four functional classes, where I is mild angina, in which attacks occur only with very intense physical exertion, and IV is the most severe angina, in which an attack occurs with the slightest physical activity and even at rest. Prohibited loads are marked with "-", permitted loads - with "+". The number of “+” signs indicates the permissible intensity and volume of loads.

Daily physical activity

Fast (130 steps / min)

Medium (100/120 steps / min)

Slow (<=шагов/мин)

Types of homework

Work on a personal plot

large watering can (10 kg)

small watering can (3 kg)

Note: it is necessary to avoid work in the open sun, heat, in the "upside down" position. The load should be performed in several approaches, with short breaks. In case of pain in the chest area, feeling of weakness or fatigue, it is worth stopping work and resting.

What physical activity is optimal for heart attack patients?

The priority is the types of loads aimed at developing endurance. However, it is best to combine these exercises with loads aimed at developing flexibility and strength.

Endurance activities include walking, cycling, swimming, dancing, playing tennis and doing housework.

Power types of activity include: walking up an inclined plane, including climbing stairs; lifting and carrying weights, such as shopping; digging up land, some types of housework.

The following types of work are aimed at developing flexibility: dancing, swimming, gymnastics, work in a personal plot or in a garden.

Do not forget that the load should be gradual, especially at the beginning of physical rehabilitation. Extension of the motor regimen without prior consultation with a cardiologist, especially after coronary complications such as myocardial infarction, unstable angina pectoris, progressive heart or coronary insufficiency, can only worsen your condition and provoke complications.

For full rehabilitation after undergoing coronary complications, it should be comprehensive and include drug therapy, an individual physical rehabilitation program, and, if necessary, surgical correction. All restorative procedures should be carried out under the supervision of a physician.

• Give preference to those exercises and loads that bring you pleasure. Exercise with family or friends. Positive emotions are the key to a speedy recovery.
• Try to walk at least one floor a day. Gradually, without sudden jerks, increase the number of floors that you overcome without the help of an elevator.
• In order to gradually increase physical activity, you can leave the bus stop earlier and cover the remaining distance on foot.
• If solo walks make you sad, take a small dog as a companion. Firstly, it will be more fun for you together, secondly, the pet is always positive emotions, and thirdly, the dog in the house is a guarantee that you will go out for a walk regularly.

© "Profimedica", 2016. Multidisciplinary clinic

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Complex exercises, especially outdoors, will be of great benefit. They improve blood circulation, the work of various muscle groups ensures their more harmonious development, and all this contributes to an increase in bone mass.

And in the treatment of diseases in order to prevent them in medical practice, along with medications, means of physiotherapy exercises are used. The famous French physician (who lived in the 18th century) Tissot, who widely practiced physical exercises and high physical activity in the medical field.

Walking is a common and natural way to move. It activates metabolic processes and trains the thermoregulation system. You need to walk energetically, straighten your shoulders, lightly and freely, feeling movement, calmly and deeply breathing.

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Exercise for ischemic heart disease

Physical activity is necessary for healthy and sick people at any age. Exercise therapy for ischemic heart disease is able to improve blood circulation, improve the condition no worse than drugs, but it does not have a negative effect on the liver and kidneys. Physical activity, special complexes after ischemic stroke at home give a comprehensive result for the whole body:

• excess weight is effectively lost. Even primitive leg swings, squats and "cycling" noticeably speed up metabolism. With ischemia, it is dangerous to have fatty deposits or atherosclerotic plaques in the lumen of the vessels;
• reducing the likelihood of developing diabetes mellitus and other autoimmune diseases;
• increasing the efficiency and endurance of the body. Simple walking or jogging for 30 minutes is an excellent exercise therapy option for ischemic heart disease. Moreover, the training results will be useful in any crisis situations;

An insufficient supply of oxygen to the heart due to narrowing of the arteries and their clogging with plaque leads to the development of coronary heart disease (CHD)

• lowering blood cholesterol. Regular physical exercise in patients normalizes triglyceride levels at the level of drugs;
• prevention of age-related degenerative changes in bone tissue in the elderly. The phenomenon is often observed in patients with circulatory pathologies. Instead of physical activity, they choose a passive lifestyle, for which they pay with fractures;
• exercise therapy for coronary heart disease prevents thrombosis, heart attacks and other common complications of the disease;
• normalization of sleep. With ischemia, patients often suffer from nervousness, irritability, and other problems. The complexes approved by the cardiologist solve this problem efficiently and quickly.

It is also worth recalling that exercise therapy for coronary heart disease gives such a result only with a complete cessation of smoking and alcohol.

Features and nuances

Why, in general, does insidious ischemia appear? To provoke a deficiency of oxygen in the heart muscle, a reduction in its volume and functional activity can be:

• alcohol and smoking. Nicotine and ethyl alcohol negatively affect the state of blood vessels, blood density, increase the likelihood of thrombosis and other complications. Therefore, no matter how effective walking is with an illness, while the patient smokes and drinks, it is unrealistic to achieve positive dynamics;

There can be many reasons: alcohol abuse, improper diet, sedentary lifestyle

• unbalanced diet, and especially the passion for high-calorie foods high in animal fats.

Physical education for this disease is not indicated for all types. With oxygen deficiency, the patient suffers from pain and angina pectoris. In order to prevent such an attack, do not self-medicate and fully listen to the recommendations of cardiologists:

• excessive physical activity easily provokes exacerbations and ailments. Do not think that by doing more exercises faster, you will completely get rid of the disease. Exercise with pathology of the heart muscle requires a calm pace and ability to listen to your body;
• the optimal workout length is 40 minutes. With less quantity, you will not feel the result, and life in the gym will completely exhaust your body. Therefore, take care of yourself.

Medical statistics claim that patients who have suffered a heart attack during ischemic stroke and who regularly exercise are 7 times less likely to face a relapse. And mortality in this category of patients is reduced by 6 times.

Disturbance in lipid metabolism (accumulation of LDL, decrease in HDL), leading to atherosclerosis of the coronary arteries - the main risk in the development of cardiac ischemia

But in practice, most often patients completely refuse to walk and run. Therefore, they re-enter the bed in cardiology. Of course, the degree of activity in ischemia and heart attack should be different, and in advanced cases, restoration is required only in a sanatorium of a special profile.

Groups of patients with ischemia

The development of exercise therapy after ischemic stroke is carried out by groups of cardiologists. The most modern domestic theory of rehabilitation of patients with this circulatory pathology is the theory of D.M. Aronov. The professor divided all patients into 4 categories depending on the severity of their condition:

• first. Angina attacks are very rare. Patients positively tolerate physical activity of moderate severity;
• average. Discomfort in patients with ischemia occurs after eating a dense meal, climbing stairs to the upper floors;
• heavy. Chest pain occurs after exercise. Therefore, a set of exercises is developed only by a cardiologist. If there is a threat of stroke or ischemic heart attack, then the exercises are chosen sparing;
• dangerous. Attacks of angina pectoris occur absolutely regardless of physical activity;

A sedentary lifestyle is also considered a risk factor

What exercises to choose

Patients with pathology are strictly prohibited deadlift, bench press and other types of work with iron. Also popular is step aerobics, which increases the load on the atria. Therefore, this type of training should be abandoned.

For rehabilitation after seizures, restoration of functional activity, patients with ischemia are shown:

• "bicycle". Everyone remembers this habitual exercise from kindergarten. But it not only amuses, but also perfectly strengthens the cardiovascular system. With daily execution, a person gets rid of not only angina attacks, but also varicose veins;
• swing your legs. Lean against the wall. Lift your left and right legs 10 times in turn. You can alternate movements forward, backward, sideways;
• squats. Perform movements at a low speed, try to keep your back straight;
• run. On the spot, jogging, fast or at your own pace. Speed ​​is not as important as regularity and a positive attitude.

Daily physical activity can prevent the development of many diseases

Optimal types of loads

Gymnastics after an accurate diagnosis is carried out on a par with taking medications. A set of exercises for an ailment sets clear goals for itself:

• increase endurance. To do this, cardiologists recommend hiking and horseback riding, try tennis or table tennis. Even simple and familiar gardening is useful;
• increased flexibility. For this, physiotherapy exercises include various dances, water aerobics, a visit to the pool, Pilates;
• strength exercises for cerebral ischemia are necessary in a metered amount and only on the recommendation of a doctor. If it is not possible to buy an expensive subscription or visit a gym, dig the ground at your summer cottage.

Gymnastics in case of ischemic disease after suffering a heart attack or other complications requires agreement on the duration and intensity of classes.

In order for gymnastics for patients with circulatory pathologies to bring only benefit and pleasure, heed the recommendations of trainers and cardiologists:

• do a set of exercises in a good mood. Turn on your favorite music and have fun;
• improving blood circulation is not only a set of exercises. It is a whole mindset and a way of life. For example, walk 2-3 public transport stops. In the evening, take a walk before going to bed, and do not lie on the sides on the couch;
• gymnastics after exacerbation of ischemia or its consequences is necessary daily. And if you skip a day, there will be no result;
• if you live in a multi-storey building, skip the elevator. Gradually, slowly go up to your home. This is the best workout for the heart and legs;
• gymnastics for coronary artery disease also includes walking with a pet. An hour or two in the fresh air will benefit not only the animal.

IHD presents the greatest difficulties for intense physical training due to sclerotic narrowing of the coronary vessels and decreased myocardial blood flow. Because ischemia is myocardial hypoxia, a decrease in the oxygen content in the heart muscle, without which it cannot work effectively (contract). The difficulties of its treatment are associated with the general problems of atherosclerosis, sclerotic vascular lesions. The final stage of ischemic heart disease is, alas, well-known to our contemporaries myocardial infarction, necrosis (necrosis) of the area of ​​the heart muscle corresponding to the affected vessel. And these difficulties depend on the fact that to perform any cyclic work, a corresponding increase in blood flow in the heart muscle is required, providing additional oxygen delivery, and the sclerosed arteries are not able to expand and increase blood flow. Therefore, at a certain stage of the development of coronary artery disease, any physical activity causes pain - a sign of a lack of oxygen, myocardial ischemia - exertional angina. And at the next stage of the disease, the coronary blood flow is so reduced that pain in the heart appears without any load, at rest - angina pectoris at rest. Here it is already close to a heart attack. And therefore, any physical and emotional stress that requires additional oxygen delivery to the heart muscle can provoke a heart attack. These are the extraordinary conditions for a wellness workout. And therefore, not a single experienced doctor will dare to give permission to a patient with coronary artery disease to jog, for example. Nevertheless, aerobic training, including brisk walking and even slow jogging, is increasingly used as a physical rehabilitation for coronary patients in many countries around the world.

The first mention of the treatment of angina pectoris through exercise we find in the 18th century, when the French physician Geberden in 1772 described a case of getting rid of pain in the heart with the help of a daily sawing of wood. This is also a cyclical work, only not with your feet, but with your hands! And the English physician T. Morris (1970) was one of the first to point out that one should not be afraid of physical activity, but of a sedentary lifestyle, the notorious physical inactivity, which, along with overeating, is the main cause of the growth of cardiovascular diseases. Since the mid-70s of the last century, physical (aerobic) training has been increasingly used for the purpose of primary and even secondary prevention of heart attack in coronary patients (prevention of recurrent heart attack) (O. (Laizzep, 1970; O. Gagwep, 1973; M. Magop 1976; Maggan a, 1973, etc.) The scientific basis of which was the experiments on animals (dogs and monkeys), in which the positive effect of aerobic training on endurance, on the state of the heart and coronary vessels after a heart attack was convincingly shown. So, in dogs with experimental infarction (after ligation of the left descending coronary artery), after 6 weeks of daily forced training on a treadmill for 30 minutes at a speed of 6.5 km / h (note, this is the speed of our recreational walking!), A 100% increase was noted the density of the capillary bed of the myocardium, its capillarization, which cannot be achieved with any drugs. a control group of animals that did not participate in the training. In addition, it was also found in experiments on animals with experimental atherosclerosis that long-term endurance training of moderate intensity reduces the prevalence of the sclerotic process. So, by means of an atherogenic diet containing a large amount of cholesterol, they caused extensive aortic atherosclerosis in monkeys, after which half of the animals trained on a treadmill three times a week for an hour. After 6 months of "health-improving walking", the trained monkeys showed an almost complete disappearance of the phenomena of atherosclerosis, while in the control group they continued to increase. As they say, comments are superfluous. Based on long-term observations of patients with coronary artery disease, many scientists believe that in humans it is also possible to stop the development of sclerosis by performing cyclic endurance exercises. The possibility of the reverse development of atherosclerosis in coronary patients under the influence of aerobic training is associated with the activation of fat metabolism, a decrease in the content of atherogenic fraction of cholesterol (LDL) in the blood, and an increase in "good" cholesterol (HDL), which can destroy sclerotic plaques on the walls of blood vessels. For example, in a group of 100 patients with coronary artery disease who were undergoing rehabilitation at the Toronto Heart Center (USA) under the guidance of Professor Cowan, after 6 months of accelerated walking, the content of "bad" cholesterol (LDL) decreased by an average of 20%, triglycerides - by 24%, and the HDL content increased by 12%. N. D. Gogokhia also notes the normalization of cholesterol metabolism in coronary patients with increased HDL cholesterol after a six-month rehabilitation program, including brisk walking and work on a bicycle ergometer. Attention is drawn to a particularly sharp drop in the level of atherogenic blood triglycerides (Fig. 30).

Rice. 30. Dynamics of lipid metabolism in patients with coronary artery disease under the influence of 6-month aerobic training

Under the influence of endurance training, the fibrinolytic activity of the plasma also increases and the viscosity of the blood decreases, which facilitates the work of the heart, reduces the risk of thrombus formation and blockage of the coronary arteries (heart attack). According to A. Nalivaiko, in the study of the state of coronary blood flow by the method of radioactive isotopes (thallium 201), also in a number of patients with coronary artery disease (but not in all) after a 12-month course of training in health-improving walking, an improvement in the supply of blood to the myocardium was noted. Consequently, if not for all, then at least part of patients with coronary artery disease, cyclic exercise can bring real benefits. In addition to directly affecting the course of the sclerotic process and the blood supply to the heart muscle, aerobic training significantly improves the general condition of coronary patients. With regular health-improving walking, most of them have a decrease in pain and an increase in the functionality of the cardiovascular system. Thus, many domestic and foreign experts observed an improvement in functional status under the influence of endurance training, which was expressed in the normalization of high blood pressure, a decrease in heart rate and an increase in physical performance. Thus, in a group of 96 people who performed a 4-week training program for recreational walking, blood pressure decreased on average from 160/92 to 146/88 mm Hg. Art., and the maximum power of the work performed on the bicycle ergometer increased by 20% compared to the initial level. The positive effect of aerobic training on patients with coronary artery disease is confirmed by the data of the cardiological center of the Academy of Sciences of the Russian Federation (Nikolaeva L.F., Aronov D.M.

Interesting data are given by S.P. Zhukovsky, who for three years observed a group of men in the Riga club "Daugava". During an in-depth medical examination at the beginning of classes, most of them were found to have coronary cardiosclerosis with rare attacks of angina pectoris, three suffered myocardial infarction.

According to the data of radio telemetry ECG recording, during the sessions, 20 out of 30 participants examined in dynamics were found to have various electrocardiogram abnormalities. When re-examining after 6 months of aerobic training, pathological changes directly during walking and running were found in only three people, in other cases the ECG was completely normalized. The author gives an interesting example of the striking effect of brisk walking on an elderly person. In a 72-year-old patient D., the following diagnosis was established during clinical examination: coronary cardiosclerosis, ischemic heart disease, exertional angina, hypertension stage II. He was repeatedly treated in a hospital, periodically took nitroglycerin to relieve chest pain. He began to engage in recreational walking on his own and gradually increased the distance to 6 km, which he covered in 55 minutes. For three years of regular exercise, blood pressure completely normalized, pains in the heart area stopped, signs of coronary insufficiency on the ECG disappeared. The case, of course, is not an ordinary one, since it is far from safe to engage in brisk walking in the presence of angina pectoris - physical activity can provoke an attack. And in this case, it is necessary to observe the special training conditions, which will be discussed below.

Under our supervision, 22 patients with coronary artery disease of varying severity were engaged in recreational walking for a number of years. Most of them were periodically bothered by aching pains in the region of the heart, which did not require emergency medical attention. On the ECG, all patients had changes typical for myocardial ischemia: displacement of the ST segment, depression (decrease) of the T wave, etc. In two people, myocardial changes were of a diffuse nature. In the process of training, everyone noted an improvement in well-being and a decrease in discomfort in the region of the heart. However, positive changes on the ECG developed much more slowly than the general condition of the trainees improved. We considered the presence of unstable angina pectoris (frequent bouts of pain requiring emergency medical care) and severe coronary insufficiency, according to ECG data, at rest or with minimal exercise on a bicycle ergometer as a contraindication to practicing brisk walking (but not walking!). And before starting the classes, they definitely carried out testing on a bicycle ergometer - a limit test. It consists in a stepwise increase in the load by 25 W (150 kgm) every 4 minutes to the level of tolerance - the power of work at which pathological ECG changes or clinical symptoms develop ("jump" of pressure, pain in the heart, severe shortness of breath, etc. .). The power of work, at which these phenomena occur, is critical for patients with coronary artery disease, or threshold, since it corresponds to the level of TANM. Usually it is below 75% of the maximum age-related heart rate, the level of healthy trained people. The results of the limit test (a test that limits the magnitude of the load, its intensity) are fundamental for determining the permissible walking speed: it should be 15–20 pulse beats less than the critical heart rate - the heart rate value corresponding to the last threshold level of the load. For example, pathological changes on the ECG appeared at a pulse rate of 130 beats / min, which means that the maximum heart rate during exercise should not exceed 110 beats / min. And this walking speed will be safe in terms of complications. With this in mind, our classes with patients with coronary artery disease were built. This technique has fully justified itself.

Here are some examples. B.C. And-in, 50 years old, started his studies three months after an attack of angina pectoris. Complaints of discomfort and occasional aching pain in the heart area, unstable blood pressure, poor sleep and rapid fatigue. Clinical diagnosis: coronary cardiosclerosis, coronary artery disease, hypertension stage I – II. On the ECG, not sharply expressed signs of myocardial hypoxia are determined: high pointed T waves in the chest leads. The reaction to the functional load is unsatisfactory. Classes began with walking at a normal pace at a distance of 1600 m with a heart rate of 16-18 beats. in 10 sec. (100-110 bpm). For 6 months, the walking distance increased to 3200 m (and not in 6 weeks, as in Cooper's aerobics tables), after a year - up to 5000 m, the speed increased to 6.0 km / h with the same heart rate - 110 bpm ... An increase in speed at the same heart rate is a favorable indicator in relation to the tolerance of the training load, since it speaks of an economization of cardiac activity and a lower oxygen demand for the same work. At the same speed, the power of oxygen is now required less, which means that an attack of angina pectoris can now develop only at higher heart rate values, that is, the range of a person's motor capabilities has expanded, and work capacity has increased. Q.E.D. By this time, the general condition had improved significantly, the pain in the heart did not bother, the blood pressure dropped, and physical performance increased sharply. However, the complete normalization of the ECG came only after three years of regular exercise, the speed increased to 7 km / h with a pulse rate of 120 beats / min.

T.A. Cherkas, 60 years old, atherosclerosis of the aorta and coronary arteries, atherosclerotic cardiosclerosis, ischemic heart disease, hypertension stage II. The indications for classes are questionable. However, during a trial workout, which we usually do before admission to the club, it became clear that the functional capabilities of the cardiovascular system are still quite high: at a fairly high walking speed (800 m in 8 min 30 s, which is faster than 5 km / h) the pulse did not exceed 110 beats / min. And we were right. Within three years, the pressure dropped from 180/10 to 145/85 mm Hg. Art., pain in the heart does not bother, taking numerous medications is discontinued. During a workout, one walks up to 5 km in 45 minutes - an excellent result for an elderly woman with a whole bunch of diseases in the recent past. But just get me wrong: I do not want to say that she got rid of atherosclerosis and got a new young heart, no, just the functional state of the circulatory system has increased so much that the pathological symptoms receded. But even such a result suits us completely, and no more modern medicine is able to do more.

A.S. Savchenko, 60 years old, periodically worried about pain in the heart, on the ECG there are signs of myocardial ischemia (decrease in the R-T segment by 2 mm), but physical performance according to the FRS test is quite high - 700 kgm. Classes began with a long course of walking with a pulse of only 90 bpm at a distance of 1600 m. Six months after the start of classes, the walking distance increased to 4000 m in 39 minutes. (faster than 6 km / h) with a heart rate of 110 bpm. During this time, there were two attacks of angina pectoris, requiring an ambulance call. For the next three years, such excesses were not observed, the pain in the heart disappeared. Alexander Stefanovich successfully completed the Gibbs walk test - he calmly walked 5 km in 45 minutes, the FRS test indicators increased to 850 kgm. In the future, he began to alternate walking with short runs. And a year later, running turned into continuous, though not much faster than walking. He covered his Sunday distance of 7 km in exactly 60 minutes. He even tried to leave with a group of our runners to Moscow for a race in honor of the academician

S.P. Korolyov in Kaliningrad near Moscow, but he was stopped in time in our medical and physical dispensary - of course, he was not allowed to compete. The dream of becoming an athlete in his old age never came true, but otherwise he had no complaints about our club, just like we have towards him. And the most interesting thing is that all the signs of ischemia on the electrocardiogram, which I demonstrated at the All-Union Conference on the Physiology of Muscular Activity in the then Leningrad, completely disappeared, and no objections from the luminaries of Russian sports medicine followed: facts are stubborn things.

Even more striking results of rehabilitation of patients with coronary artery disease were obtained by my friend and colleague Dr. V.N. Sergeev from the “Istra” sanatorium near Moscow, where he ran the health walking and jogging club and carried out an enormous amount of work to survey the population and organize mass physical education. He showed us his 80-year-old patient suffering from coronary heart disease for a long time, who, as a result of five years of training in health-improving walking and running (!) On the ECG, completely eliminated the hypoxic displacement of the I-T segment, which before the start of training, five years ago, reached 5 mm!

And here is a case from my practice. About 10 years ago I received the following letter: “Your colleague, a surgeon from Novokuznetsk, Kemerovo region, is writing to you. I am 61 years old, of which 37 years I have been doing surgery, I went through the whole Great Patriotic War as a soldier. I operated on a lot in the clinic, slept 5 hours a day. Heart pains never bothered and - suddenly, like a bolt from the blue! Three months ago I developed a massive myocardial infarction. Now I am undergoing medical and physical rehabilitation and doing dosed walking. I would be very grateful if you would give me recommendations for further exercise. Head of the Department of Surgery Associate Professor Kupchik BM ". My first quite natural desire was to refuse a colleague - to deal with a patient who had suffered a heart attack, and even in absentia by correspondence! But, on reflection, I realized that to refuse a person who devoted his whole life to medicine and protected us from the Nazis is, to put it mildly, not ethical. Of course, we both took risks - both he and me. I perfectly understand doctors who, in such cases, do not give permission to engage in brisk walking - usually quiet walking is recommended. But we took a chance. And fortunately, it turned out not bad at all. The training began at a distance of 1600 m (only 4 laps along the track of the stadium, since he was nearby) with a pulse of 16-18 beats. in 10 s (96-108 bpm). In the next 6 months, the walking distance gradually increased to 3200 m, and after another six months - to 5000 m, the heart rate did not exceed 110–120 beats / min. By this time, his condition had improved significantly, pain in his heart almost did not bother him, and he was able to return to his favorite job as a surgeon. However, a radical improvement in the electrocardiogram indicators occurred only 3.5 years after the start of health-improving walking. He even tried to switch to running - there is such an intermediate stage of training - jogging-walking, when during walking, short jogging segments of 20-30 m are allowed, but I could not go for that. If he were here, in Smolensk, under our vigilant surveillance, then it would be another matter, but at a distance of, it seems, five thousand kilometers, this is already too much. And we made a compromise - consensus, as they say now: we decided to walk at a speed of 7 km / h, and this is actually already running, only without the flight phase. And if it happened now, then of course I would recommend him walking with a ski pole - my last hobby. Boris Mikhailovich regularly informs me about the results of the medical examination, and he has no complaints.

A preliminary limit test, in addition to ensuring the safety of training, also allows all patients with coronary artery disease to be divided into four functional classes, as well as patients with essential hypertension.

First functional class- indicators of physical performance (FRS) according to the limit test in men is not lower than 750 kgm / min, acute pain in the heart (angina attacks) is very rare or absent altogether.

Second functional class- FRS in the range of 500-600 kgm / min, angina attacks occur when walking fast or when climbing stairs or other physical activity (exertional angina).

Third functional class- FRS in the range of 300-450 kgm / min, frequent attacks of angina pectoris with minimal exertion or at rest (angina pectoris at rest).

Fourth functional class- FRS below 300 kgm / min, multiple heart attacks during the day.

Patients III-IV classes usually have already suffered myocardial infarction. Patients with IHD functional class I can walk independently with an intensity of 75% of the threshold heart rate shown in the limit test, according to the general rules of health training. Class II patients can study only under the guidance of an experienced methodologist. Classes begin with walking at the usual pace, the duration is only 20 minutes with mandatory heart rate control. However, training on a treadmill or a bicycle ergometer in a rehabilitation center is preferable, since it allows you to continuously record your heart rate using special sensors (or Japanese watches) and more accurately monitor the intensity of the load in order to prevent it from increasing beyond the limit test. Training on a treadmill or bicycle ergometer has an advantage only in coronary patients. In healthy people, it is not worth replacing fast walking with it in natural conditions, since when working on simulators there is no important effect of moving the body in space, vibration of blood vessels and internal organs when placing the foot on the ground and positive emotions, the joy that fast walking and running give ... And to control the pulse, instead of a Japanese toy, the nasal breathing test described above is quite suitable. It is both simpler and cheaper with one hundred percent quality assurance. But this is in healthy people! With the growth of fitness in the process of training and the transition to the 1st functional class, respectively, the loads can increase. Any physical activity is contraindicated in patients with III-IV functional classes, here only medical treatment or bypass surgery is possible, which is now quite widely used both abroad and in our country, suffice it to recall the first president of Russia.

Thus, aerobic training in the form of accelerated walking is also possible in patients with coronary artery disease who have had myocardial infarction, if they belong to the I – II class in terms of their functional capabilities (FRS is not lower than 600 kgm). Please note that aerobic training is in the form of walking, but not running, even the slowest one. Here is another indisputable advantage of walking - it can be used in cases where running is prohibited, and with no less healing effect. This category includes patients with coronary artery disease who have had myocardial infarction. And now we will come to grips with this issue.