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Лфк при ишемической болезни сердца

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17 августа 2019

Ишемия миокарда – весомый фактор, ограничивающий физическую свободу пациента. Из-за недостаточной васкуляризации сердечной мышцы больной испытывает сдавливающую боль и одышку. Бороться с болезнью нужно с помощью коррекции образа жизни, медикаментозного лечения и ЛФК.

Роль ЛФК в реабилитации при ИБС

В лечении кардиологической патологии ключевая роль принадлежит медикаментозной терапии и хирургическим вмешательствам. Кроме того, нельзя недооценивать важность профилактических мер: рационального питания, исключения вредных привычек. И ни в коем случае не забывают о значении и целебных свойствах физической активности. Правильно подобранный комплекс упражнений оказывает хороший терапевтический эффект и помогает избежать возникновения осложнений. Осознание этого факта легло в основу метода лечебной физкультуры, который на сегодня широко применяют в борьбе с последствиями сердечных заболеваний.

С помощью кардиореабилитации:

  • нормализуется уровень артериального давления;
  • повышается эффективность работы сердца;
  • улучшается трофика миокарда;
  • укрепляется иммунитет;
  • увеличивается концентрация в мозге «гормонов счастья»;
  • снижается уровень холестерина, триглицеридов и глюкозы крови;
  • уменьшается частота приступов сердцебиения.

Недавно американские ученые доказали факт обратного развития атеросклеротических изменений при выполнении физических нагрузок. И хотя опыты проводили исключительно на животных и в будущем ценность этой теории в отношении человека могут опровергнуть, уже сегодня со 100% вероятностью утверждают, что регулярная физическая активность замедляет скорость атеросклеротического процесса.

ЛФК должна стать ежедневной нормой жизни у пациентов с сердечно-сосудистой патологией. Однако заниматься самостоятельно и бесконтрольно нельзя. В каждом случае нужна собственная программа тренировок и специально разработанный комплекс упражнений. Потому этот вид восстановления назначает кардиолог или реабилитолог.

Упражнения, гимнастика и особенности выполнения

Основная задача реабилитации при ИБС – восстановление нормальной работы сердечно-сосудистой системы. Кроме того, комплекс ЛФК повышает иммунитет, улучшает общее состояние организма и возвращает его к прежней деятельности. Выделяют такие этапы:

  • адаптация – оценивают состояние здоровья пациента;
  • основной – подбирают индивидуальную программу тренировок;
  • завершающий период – заключительный осмотр пациента и подбор упражнений для занятий в домашних условиях.

ЛФК при ИБС назначают в зависимости от функционального класса заболевания (для ИБС четыре градации).

У I группы зарядку подбирают для всех мышц с полной амплитудой выполнения. Занятия построены по типу тренировочного режима. Кроме стандартных упражнений, этой категории больных разрешают кратковременные нагрузки с большей интенсивностью. Для ходьбы сначала используют дистанцию в 5 км и постепенно повышают ее до 8-10. Особенность комплекса для этой группы – бег трусцой, что противопоказано для остальных. Еще включают плавание. Акватренировки постепенно увеличивают до 65 мин. Дополняют спортивными играми (баскетбол, пинг-понг и др.). Максимально допустимое ЧСС – 140 ударов за минуту.

Щадяще-тренирующий режим необходим для больных II группы. Зарядку проводят в умеренном темпе. Ходить начинают с дистанции в 3 км и постепенно увеличивают до 6-7 км. Разрешают плавание продолжительностью не более 50 минут. Уровень подъема ЧСС не должен превышать 10%.

Больным III группы показан щадящий режим занятий. Дозированную ходьбу начинают с дистанции 450 м, ежедневно увеличивая ее размер на 200-400 м. Этой категории пациентов доступны нагрузки с минимальной интенсивностью. Повышение ЧСС не должно превышать 110 уд./мин. При первых симптомах напряжения, ухудшении состояния, возникновении тахикардии или болей в сердце срочно прекращают занятие.

Недавно больным с четвертым функциональным классом ЛФК не разрешали из-за риска возникновения осложнений. На сегодня, благодаря развитию современной медицины, для этих пациентов составлена специальная форма лечения. Занятия у такой категории проходят исключительно в стационаре и только после стабилизации состояния.

Наблюдение за пациентом и контроль результатов

Упражнения и методы реабилитации прописывает лечащий доктор. Он несет ответственность за их целесообразность и необходимость.

Занятия назначают ниже уровня пороговых нагрузок для пациента, и в то же время они с максимально возможным эффектом напряжения и тренировки сердца. Важнейший критерий дозирования физических усилий – частота сердечных сокращений. Изменение ЧСС наиболее быстро и точно отображает работу сердца, адекватность выполняемой нагрузки. При превышении допустимых пределов упражнение выполняют с меньшей интенсивностью или заменяют на другое. Недопустимо ухудшение состояния больных. В таком случае занятия временно отменяют, а план меняют.

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Реабилитационная программа пациентов с ишемической болезнью сердца составляет приблизительно год. Если в этот период не возникает осложнений, назначают более сложные упражнения. Дополнительно некоторым больным рекомендуют велоспорт, занятия в тренажерном зале, катание на лыжах.

Обязательно помнят, что даже при правильно подобранном лечении и его эффективности, необходимо постоянное медицинское наблюдение за состоянием больных и профилактические осмотры раз в два-три месяца. Точную частоту устанавливает лечащий врач.

Выводы

ЛФК при ишемической болезни сердца – основа для реабилитации больных. Базовая задача методики – восстановление нормальной работы органа. Кроме того, регулярные занятия укрепляют состояние организма и повышают качество жизни. Комбинирование лечебной физкультуры с адекватной медикаментозной терапией, правильным режимом сна и отдыха, рациональным питанием, отказом от вредных привычек и частыми прогулками на свежем воздухе поможет если не навсегда, то временно забыть о физических ограничениях.

Для подготовки материала использовались следующие источники информации.

Ишемическая болезнь сердца – это острый или хронический патологический процесс, поражающий миокард, вследствие нарушения функционирования системы кровообращения. В момент такого недуга сердечная мышца получает недостаточное количество крови и кислорода, в результате ее клетки, при несвоевременном лечении, начинают подвергаться некрозу. Часто ишемии сердца подвергаются представители мужского пола в возрасте от 40 лет.

Также причинами, провоцирующими такое заболевание, могут стать следующие факторы:

  • генетическая предрасположенность (присутствие такой болезни у родственников);
  • частое курение табака (более 10 сигарет в день) и алкоголизм;
  • врожденные и приобретенные патологии сосудов кровоснабжения;
  • наличие у человека повышенного уровня сахара в крови;
  • переизбыток массы тела;
  • преклонный возраст;
  • присутствие атеросклероза;
  • неправильное и несбалансированное питание;
  • мочекаменная болезнь;
  • наличие гипертонии;
  • недостаточное количество в организме витаминных элементов группы А, Е и С.

Симптоматика

Очень важно своевременно обнаружить и немедленно устранить ишемическую болезнь сердца для того, чтобы предупредить развитие необратимых последствий. Для этого медицинскими работниками был разработан специальный список общих признаков, присутствие которых указывает на прогрессирование данного заболевания в человеческом организме:

  • присутствие интенсивных болевых ощущений, которые локализуются в области сердца;
  • возникновение аритмии;
  • появление панического чувства страха;
  • снижение физической активности;
  • пассивное восприятие всего происходящего;
  • появление дискомфортного ощущения в области сердца, ощущается чувство сжатости данной мышцы;
  • различные психо-эмоциональные расстройства (частая смена настроения, повышенная раздраженность и т.д.);
  • часты позывы рвоты и тошноты;
  • появление отдышки даже при незначительных физических нагрузках;
  • чрезмерное выделение холодного и липкого пота.

При появлении вышеперечисленных симптомов больному необходимо, как можно быстрее, обратится в ближайшее медицинское учреждение за квалифицированной помощью. На основе проявленной симптоматики, возраста пациента и проведенных диагностических исследований опытный специалист назначает наиболее эффективную терапевтическую методику, благодаря которой можно быстро купировать ишемическую патологию и заболевание, провоцирующее его развитие. Одним и наиболее действующих лечебных методов считается ЛФК при ИБС.

Общие сведения и показания при назначении терапевтической гимнастики

Лечебная физкультура при ишемической болезни сердца отлично сказывается на работоспособности сердечно-сосудистой системы, стабилизирует дыхательную систему и другие, не менее важные, процессы, а также помогает человеческому организму адаптироваться к неблагоприятному воздействию существующих внешних факторов (климату, стрессовым ситуациям и т.п.).

Назначение необходимых терапевтических упражнений полностью зависит от присутствующей группы патологии:

  • 1 группа – люди, у которых прогрессирует стенокардия без приступа инфарктного состояния миокарда;
  • 2 группа – объединяет в себе больных, которые подверглись инфаркту миокарда и, в результате этого, приобрели кардиосклероз;
  • 3 группа – пострадавшие, у которых обнаружена постинфарктная аневризма левой части сердечного желудочка.

Распределение физической нагрузки должно быть в соответствии с присутствующей стадией заболевания, чтобы не принести вред ослабленному организму. Степени тяжести болезни существуют следующие:

  • 1 стадия – гипоксия сердечной мышцы не сопровождается серьезной симптоматикой;
  • 2 стадия – ишемия сердца, при определенных физических нагрузках, имеет ряд незначительных признаков;
  • 3 стадия – болезнь миокарда сопровождается ярко-выраженными симптомами, которые проявляются даже в состоянии покоя.
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Определять наиболее эффективный и безопасный комплекс физических упражнений должен исключительно квалифицированный врач, отталкиваясь от результатов проведенного диагностического обследования и присутствующих индивидуальных особенностей человеческого организма.

Полезные рекомендации при выполнении

Для больных, которые относятся к 1 группе (перенесшие стенокардию без последующего инфарктного состояния) составляется ряд упражнений, которые положительно воздействуют на все существующие мышцы. В таких случаях зачастую применяются упражнения, направленные на стабилизацию дыхательной системы. Продолжительность терапевтического мероприятия должна составлять не менее 20-25 минут.

Пострадавшие, которых отнесли ко второй группе (инфаркт с развитием кардиосклероза), должны производить физические нагрузки в умеренном темпе и задействовать лишь мелкую и среднюю группу мышечных тканей. При проведении дыхательной гимнастики больному необходимо периодически отдыхать и измерять уровень артериального давления. В случае, если сердечный ритм участился более, чем на 10 допустимых процентов, то следует завершить занятие лечебной физкультурой. Длительность процедуры не должна превышать 15-20 минут.

В случае с пострадавшими, которые относятся к 3 группе, необходимо придерживаться строгой осторожности, чтобы не спровоцировать развитие тромбоэмболии. Амплитуда физических действий должна быть направлена лишь на мелкие и средние группы мышечных тканей. После каждого третьего выполненного упражнения пострадавшему необходимо отдохнуть, чтобы чрезмерно не переутомить свой организм. Продолжительность выполнения гимнастики не должно превышать 10-15 минут и в случае, если при произведении терапевтической зарядки наблюдается резкое изменение человеческого состояния, то необходимо немедленно завершить лечебное мероприятие. Как правило, симптомы, которые свидетельствуют о том, что необходимо, как можно быстрее, прекратить выполнение упражнений бывают следующие:

  • приступы тахикардии;
  • проявление почечно-печеночной недостаточности;
  • возникновение отдышки;
  • появление болевых ощущений в области сердца.

Если не соблюдать вышеуказанные рекомендации и вовремя не остановиться, то последствия могут быть очень серьезными, вплоть до летального исхода пострадавшего.

Определить, что человеку ничего не угрожает, помогут признаки, свидетельствующие о нормальной реакции организма на лфк:

  • незначительная усталость, которая проходит в течение 4-6 минут;
  • отсутствие болевого синдрома при выполнении физических нагрузок;
  • варьирование уровня артериального давления и сердечного ритма в пределах разрешенной нормы;
  • отсутствие интенсивного колебания сердцебиения;
  • отсутствие чувства отдышки.

Список наиболее распространенных физических упражнений

Подборка физической деятельности, как было написано ранее, должна назначаться квалифицированным медицинским работником, который специализируется в данной теме. Но существуют и наиболее безвредные гимнастические упражнения при ишемической болезни сердца, которые разрешается выполнять самостоятельно, без рекомендации опытного доктора:

  • больной принимает положение лежа, а его верхние и нижние конечности разводятся по сторонам. Пострадавший начинает поочередно сгибать-разгибать пальцы рук и ног. Чуть позже сгибание-разгибание конечностей должно производиться одновременно руками и ногами. Такие манипуляции совершаются в умеренном ритме, примерно 5-6 раз;
  • не меняя положение своего тела, пострадавший начинает выполнять дыхательную гимнастику посредством трехразового повторения полного вдоха-выдоха;

  • находясь в лежачем положении, заболевший человек разводит нижние конечности в разные стороны и начинает производить медленные круговые движения носками ноги, дыхание, в момент выполнения, остается ровным;
  • не изменяя положение своего туловища, больной производит манипуляции плечами, двигая ними вверх-вниз на протяжении 3-4 раз;
  • лежа на полу пострадавшему необходимо приподнять верхние конечности в области локтей, а нижние – в коленях, и произвести одновременные круговые движения нижней частью ног и рук. Выполнять подобную лечебную процедуру нужно 4-5 раз в среднем темпе;
  • как и ранее, в лежачем положении, больному необходимо согнуть нижние конечности в коленях и совершать подъем таза (при этом человек делает вдох), а затем опустить тазовую кость и одновременно с этим выдохнуть. Дыхание остается ровных, упражнение повторяется три-четыре раза;
  • человек остается в лежачем положении, колени согнуты в ногах. Медленно необходимо опустить обе ноги, изначально – в левую сторону, а затем – в правую. Каждый односторонний наклон производится два раза в более-менее ускоренном ритме;
  • положение тела остается такое же, как и во всех вышеописанных упражнениях. Нижние конечности, согнутые в области колен разводятся в разные стороны. При их смыкании – вдох, при разведении – выдох. Выполнение такой манипуляции повторяется два-три раза в среднем темпе.
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Совершение таких терапевтических и физических процедур производится примерно 3-4 раза в день, если общее состояние здоровья больного, при этом, не ухудшается. Продолжительность и частоту назначает лечащий врач, который учитывает всевозможные индивидуальные особенности человеческого организма, сопутствующие заболевания и степень тяжести прогрессирующей ишемической болезни сердца.

Со временем, при положительной реакции человеческого организма на лечебную физкультуру и достижении какого-либо результата, медицинский работник может усложнить лечебные упражнения, увеличить их число или продолжительность выполнения. Все подобные нововведения зависят от стабильности организма и полученных положительных результатов.

Противопоказания

Исключить физические нагрузки необходимо в том случае, если в человеческом организме происходят сбои или состояние здоровья больного значительно ухудшается при выполнении назначенных терапевтических упражнений. Также запрещается прибегать лечебной физкультуре при ишемической болезни сердца, если присутствует следующая неблагоприятная симптоматика:

  • сердцебиение подвергается значительному учащению;
  • появляется сильная отдышка или другие симптомы того, что процесс кровообращения является нестабильным;
  • уровень артериального давления значительно повышается;
  • повышенная температура тела, которая, как правило, свидетельствует о присутствии в организме некоторых заболеваний;
  • появление болевых ощущений в мышечных тканей или любых другие нарушения опорно-двигательной функции.

При наличие вышеперечисленных симптомов следует обратиться на консультацию к квалифицированному врачу, чтобы он подобрал другой способ терапии сердечной ишемии.

Ишемическая болезнь сердца

Ишемическая (коронарная) болезнь сердца (ИБС) — хронический патологический процесс, обусловленный недостаточностью кровообращения миокарда. В подавляющем большинстве случаев (97–98 %) является следствием атеросклероза коронарных артерий сердца. Основные клинические формы — стенокардия, инфаркт миокарда и коронарогенный (атеросклеротический) кардиосклероз. Эта патология встречается у больных как изолированно, так и в сочетаниях, в том числе и с различными осложнениями и последствиями (сердечная недостаточность, нарушения ритма и внутрисердечной проводимости, тромбоэмболии и др.).

Комплексное лечение и профилактика ИБС предусматривают массаж, лечебную гимнастику и циклические виды физических упражнений (ходьбу, плавание, медленный бег и др.), диету (проведение разгрузочных дней), витаминизацию, нормализацию сна (прогулки перед сном, сон в проветренном помещении и пр.), сауну (баню) и др.

Методика массажа. Вначале проводится массаж воротниковой области в ИП сидя, затем в ИП лежа выполняется массаж нижних конечностей и живота. Используются поглаживание, растирание и разминание (особенно при массаже ног). Грудную клетку только поглаживают. Исключаются рубление, поколачивание, похлопывание. Продолжительность массажа — 10–15 мин., курс — 15–20 процедур. В год проводят 3–4 курса.

ЛФК при ишемической болезни сердца. Ишемическая болезнь сердца — распространенное заболевание, которое проявляется стенокардией — болями в области сердца, за грудиной, в левой руке, под левой лопаткой. Боли возникают в результате спазма сосудов и ишемии миокарда. Провоцируют приступы болей отрицательные эмоции, курение, злоупотребление алкоголем, физическое и психическое перенапряжение.

• способствовать регулированию координированной деятельности всех звеньев кровообращения и развитию резервных возможностей сердечно-сосудистой системы;

• улучшить коронарное и периферическое кровообращение, улучшить эмоциональное состояние, повысить и поддержать физическую работоспособность;

• вторичная профилактика ИБС.

• частые приступы стенокардии;

• острые нарушения коронарного кровообращения;

• сердечная недостаточность выше I стадии;

• устойчивые нарушения ритма сердца.

Формы ЛФК: лечебная гимнастика, дозированная ходьба, физические упражнения в воде и плавание, массаж; использование естественных факторов природы.

ЛФК показана в период между приступами стенокардии:

• при легких приступах (на 2–3-й день),

• при тяжелых приступах (на 6–8-й день),

• у пожилых людей (после приступа средней тяжести через 3–4 дня).

Методика занятий аналогична применяемой у перенесших инфаркт миокарда.

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