The state of discomfort, as well as pain behind the breastbone, appearing immediately after physical. stress or stressful situations - all these are signs of angina pectoris. Often, there is also an instability of the pulse. Attacks tend to come on unexpectedly. Pain is felt in the cervical spine, chin, the area between the shoulder blades, as well as the left shoulder. They do not last too long (about a quarter of an hour), they are removed by means of the nitrate group.

For the purpose of prevention and to prevent the development of pain attacks, special exercises for angina pectoris are prescribed. The complex is also able to help relieve pain without pills. Initially, such exercises are performed by patients in a hospital under the guidance of a health worker. In the future, classes are held without the help of a doctor.

The relevance and benefits of breathing and exercise for heart attacks

Methods of therapy without medication for angina pectoris are aimed primarily at preventing the development of ischemia. In this case, the patient's usual lifestyle should be changed. First, it is worth giving up bad habits - the use of alcohol and tobacco products. This will help strengthen the heart muscle through the respiratory system.

It is worth following a diet for cardiovascular diseases. The diet should reduce the amount of table salt, as well as completely remove foods:

• fried;
• sharp;
• smoked.

In order to reduce discomfort, improve the patient's well-being, a variety of therapy methods are used.

For patients with angina pectoris, feasible physical activity is also provided. As a result, you can start cardiac and respiratory work. The combination of gymnastic and breathing exercises will help improve the functioning of the circulatory system and metabolic processes, as well as relieve pain attacks.

Are there any restrictions on physical education?

An important task in angina attacks is to contain pressure from its sudden changes, as well as prevent the development of hypertension. That is why you need to ensure that there are no overloads, both physically and emotionally. In addition, it is not worth drinking a lot of coffee, eating spicy and salty foods, as this can cause overexcitation of the body and increase blood pressure. It is harmful for angina pectoris and making sudden movements, since the vessels are exhausted. Sanatorium treatment is not prescribed in almost all cases of this ailment.

What should be physiotherapy exercises

To achieve good results, during the appointment of exercise therapy for angina pectoris, a set of exercises is selected taking into account the patient's condition. Gymnastics is allowed only in the first two stages of the disease. If the course of angina pectoris is severe, unhurried walks are needed, preferably in green areas.

Therapeutic physical culture is one of the most effective means in the fight against angina pectoris

Physiotherapy is prescribed in this way, for example:

• it is taken into account at what stage of development the ailment is, how long pain attacks last and how often they occur. In a mild form, the load may be more intense. In severe angina pectoris - minimal;
• the entire therapeutic complex of gymnastics consists of three components - warm-up, main part, cool-down. During the warm-up, the body is adjusted to accept the load. In the main part, exercises for angina pectoris are aimed at obtaining a reasonable load by all organs and systems of the patient's body. During the hitch, they make a smooth exit from the set of exercises without surges in blood pressure;
• the set of tasks should not contain exercises with sudden movements.

How to warm up

First of all, physical exercises for angina pectoris begin with a warm-up. So that the load is not excessive, it is carried out lying on the floor (they spread a gymnastic mat):

1. Take a deep breath and exhale 3 times. This will give the mood for the whole complex.
2. Sit on the carpet. Raise your left hand - bend to the right, do the same in the other direction. Repeat 10 tilts to each side. Rest for 1 minute, then do two more approaches.
3. Lie down. Bend and unbend your knees 10 times. Rest for 1 minute, then two approaches.

It is important to choose the right set of exercises

What the main complex consists of

The entire main complex of physiotherapy exercises for angina pectoris is performed from a standing position.

The exercises below are done with a 1-minute rest break:

1. Sit down, stretching out your arms in front of you (start with 10 squats, then increase the number to 30).
2. I. p. - legs slightly apart. The torso is parallel to the floor. Hands are spread apart. Perform turns left and right, stretching as far as possible. Initial amount 10 times, increase to 50.
3. I. p. - legs apart shoulder-width apart. Raise one hand, bend in the opposite direction, the same for the other hand. In each direction from 10 to 30 times.
4. A slow run on the spot, gradually accelerating, 10 minutes. If you have a treadmill, you can do it.

How to finish gymnastics with angina pectoris

The hitch is done while sitting on the floor. Legs are kept straight, do not bend at the knees. Hands are drawn to the tips of the toes. Try to reach your knees with your head. Take your time, do it slowly. Lie down, rest, and restore breathing.

It is important not to overdo it during exercise for angina pectoris. At the slightest discomfort in the area of ​​the heart, you need to stop. Also lie down and try to take deep breaths in and out to get your breathing back to normal.

If this method does not help, you should take drugs from the nitrate group "Nitroglycerin" or "Sidnopharm".

The duration of the workout should not be more than 10-15 minutes

How can gymnastics be supplemented with angina pectoris

Other exercises can be added to the therapeutic gymnastic complex. The main thing is not to forget about the prohibition to make sudden movements. In addition, the innovations should also be feasible for the patient and not cause him discomfort. It is better to do stretching exercises, and use strength exercises carefully.

Respiratory gymnastics technique for angina pectoris

Performing a complex of exercise therapy for angina pectoris, you should always monitor correct breathing. Breathing is important not only during gymnastics. It also plays an important role in everyday life. A well-adjusted respiratory system will help avoid painful attacks. There are many techniques for proper breathing.

Breathing according to Strelnikova

There is a wide variety of breathing exercises in this system. There are exercises that allow you to get rid of them in emergency situations with severe angina attacks.

An equally effective type of therapy is breathing exercises for angina pectoris

Here is some of them:

1. Sit on a chair or kneel on the floor, eyes closed.
2. Inhale sharply to contract the muscles of the chest.
3. Do not hold your breath, but immediately exhale slowly.
4. Do such inhalation and exhalation until the pain stops.

At the end of the attack, the patient needs rest. If the pain persists, you need to call an ambulance.

Bubnovsky breathing

This technique involves breathing in which the diaphragm is involved and breathing through the chest is minimized. You need to know that many medical specialists point out the harm of chest breathing.

An approximate set of breathing exercises:

1. Sit on your knees, close your eyes, feel the diaphragm - the area in the middle of the peritoneum and chest.
2. Inhale slowly for a count of five, gradually increasing the diaphragm, contracting the muscles. Freeze, count to three, fixing this state of the diaphragm. Exhale gradually for a count of 5. Pull the diaphragm in with the effort of the muscles. Perform - starting with 20 breaths, and bringing up to 50.
3. Get on all fours, relax your abdominal muscles. Make breathing movements with effort and quickly for one minute. Further increase the duration up to 10 minutes.

If severe dizziness is observed, breathing exercises should be interrupted. Start with small doses the next time.

There are several types of breathing exercises.

Buteyko breathing

The main principle in the Buteyko breathing technique is a decrease in the frequency of respiratory movements while improving the quality of the respiratory process.

The main positions when performing breaths are as follows:

• the number of breaths-exhalations cannot be more than 16;
• you need to breathe strictly with your nose. Breathing through the mouth is not only harmful, but also dangerous to humans;
• you need to breathe slowly and naturally;
• inhale in time should be twice as short as exhale;
• hold after inhalation.

Approximate set of Buteyko exercises:

1. Sit on a chair with your eyes closed, keep your back straight, and place your hands on your knees.
2. Inhale for 10 seconds, holding the breath for 20 seconds, then exhale for 20 seconds. Such a period of time from the first lessons cannot be completed. The main thing is to observe the proportions 1x2x2 and comfortable sensations.

Buteyko breathing technique is a gradual transition to light breathing according to the scheme: inhale - pause - deep exhale. At the same time, there should be no tension.

INTRODUCTION 3
CHAPTER 1. Basic clinical data on angina pectoris 5
1.1. Prevalence of angina pectoris 5
1.2. Etiology of angina pectoris 6
1.3. Pathogenesis of angina pectoris 7
1.4. Clinical manifestations in angina pectoris 9
1.5. Diagnosis of angina pectoris 12
1.6. Treatment and prevention of angina pectoris 13
CHAPTER 2. Physiotherapy for angina pectoris 16
2.1. The technique of physiotherapy exercises for angina pectoris at the stationary stage of rehabilitation 16
2.2. The technique of physiotherapy exercises for angina pectoris at the outpatient stage of rehabilitation 23
2.3. The technique of physiotherapy exercises for angina pectoris at the sanatorium stage of rehabilitation 24
CONCLUSION 28
LIST OF ABBREVIATIONS 29
REFERENCES 30

INTRODUCTION

The relevance of the work. The modern way of life is characterized by high neuropsychic stress, makes significant demands on the cardiovascular system with excessive loads. Despite the significant advances in modern medicine, diseases of the cardiovascular system are very common and are the most serious.
Most angina patients experience discomfort or pain in the chest area. The discomfort is usually of a pressing, constricting, burning character. Often, such patients, trying to describe the area of ​​discomfort, apply a clenched fist or open palm to the chest. Often the pain radiates ("gives") to the left shoulder and the inner surface of the left arm, neck; less often - in the jaw, teeth on the left side, right shoulder or arm, interscapular region of the back, as well as in the epigastric region, which may be accompanied by dyspeptic disorders (heartburn, nausea, colic). Very rarely, pain can be localized only in the epigastric region or even in the head region, which makes diagnosis very difficult.
Attacks of angina pectoris usually occur during physical exertion, strong emotional arousal, after eating an excessive amount of food, staying in low temperatures, or with an increase in blood pressure. In these situations, the heart muscle requires more oxygen than it can receive through the narrowed coronary arteries. In the absence of coronary artery stenosis, spasm or thrombosis, chest pain related to exercise or other circumstances leading to an increase in the oxygen demand of the heart muscle may occur in patients with severe left ventricular hypertrophy caused by aortic valve stenosis, hypertrophic cardiomyopathy; and aortic regurgitation or dilated cardiomyopathy.
The tasks of exercise therapy for angina pectoris:
- stimulation of neurohumoral regulatory mechanisms to restore normal vascular reactions during muscle work;
- improving the function of the cardiovascular system;
- activation of metabolism (fight against atherosclerotic processes);
- improvement of the patient's emotional and mental state;
- adaptation to physical activity.
The problem of remedial gymnastics for angina pectoris was reflected in the works of V.A. Epifanov, V.I. Dubrovsky, G.L. Apanasenko.
The purpose of the work is to study the specifics of physical therapy for angina pectoris.
Achieving the goal involves solving a number of tasks:
1. Review the basic clinical data on angina pectoris.
2. To study physiotherapy exercises for angina pectoris.

A characteristic feature of modern society is physical inactivity - a violation of the functioning of the body due to a lack of physical activity. The development of the transport network, the automation of production and the increase in the number of workers of "mental" labor led to the fact that people began to lead a sedentary lifestyle. Unfortunately, this factor negatively affected the health of the human cardiovascular system. Diseases such as angina pectoris, stroke, heart attack have become more common. Physiotherapy for ischemic heart disease is an important component of the rehabilitation of patients with heart disease.

The benefits of physical activity for cardiac ischemia

For physical rehabilitation, doctors prescribe light exercises at the very beginning of the postinfarction period. The purpose of such exercises is to restore breathing and take the patient out of a serious condition.

It must be remembered that therapeutic exercises for coronary artery disease are prescribed strictly by a specialist. Excessive physical activity and too intense exercise can adversely affect the state of health and lead to a relapse of the attack.

Regular physical activity is beneficial for everyone. For healthy people, it helps prevent the onset of diseases, and for those who have already had heart disease, physical education shortens the recovery period and prevents the development of relapse.

Physical activity with ischemic heart disease helps:

• keep muscles in good shape;
• reduce the level of atherogenic lipids in the blood (cholesterol, low density lipoprotein, etc.), thereby reducing the risk of atherosclerosis;
• normalize blood pressure;
• prevent the formation of blood clots;
• improve the quality of life, improve mood;
• normalize sleep;
• prevent obesity and reduce the risk of diabetes.

According to medical research, people who engage in physical therapy after a heart attack are 7 times less likely to suffer from recurrence of such a heart attack and reduce the likelihood of death by 6 times. Exercise therapy for coronary heart disease can improve the overall health of the patient. Regular exercise improves blood flow, minimizes the effects of heart failure, and strengthens the cardiovascular system.

Features of physical education with ischemic heart disease

Not all types of physical activity are suitable for patients with coronary artery disease. The type of load and its intensity are determined by the attending physician based on a specific clinical picture.

For patients who have had heart disease, the nature of the exercise therapy can be of decisive importance:

1. With moderate activity, the course of recovery is accelerated, the strength and endurance of the body increase.
2. With excessive exertion, angina pectoris can occur, which often leads to a second attack.

The priority areas of physical education are exercises aimed at developing endurance. These include relaxing walks, cycling, housework, and dancing. The loads should be gradually increased. In this case, the heart rate should increase by no more than 15-20 beats per minute.

Indications and contraindications

Ischemic heart disease is a pathological condition characterized by disruptions in the blood supply to the myocardium due to damage to the coronary vessels. The reason for this situation is a lack of oxygen entering the heart with blood. Indications for performing therapeutic exercises are an acute form of ischemic heart disease (with myocardial infarction) and chronic (with periodic attacks of angina pectoris).

Contraindications for exercise therapy for ischemic heart disease:

• frequent attacks of angina pectoris;
• acute disturbances in the coronary circulation;
• advanced stages of heart failure;
• persistent arrhythmia;
• aneurysm of the heart.

For patients with angina pectoris, doctors recommend conducting therapeutic training in between attacks. So, with a light attack, simple exercises can be done already on the second day, with an average - on the fourth, with a severe one - on the eighth.

Rules for performing physical exercises with coronary artery disease

Physical education for patients with coronary heart disease is carried out only after the condition has been stabilized.

At first, it is advisable to engage in breathing exercises and exercises aimed at the activity of individual muscle groups. Then, in a clinic, a submaximal test is carried out to identify the permissible intensity and volume of loads in the framework of postinfarction rehabilitation.

The test ends when the heart rate rises to 120 beats per minute or when there are obvious signs of intolerance. The heart rate recorded at the termination of testing becomes the threshold value and subsequent physical activity should not exceed 75% of the experimentally established value.

At first, the optimal loads will be: therapeutic exercises, walking, exercise bike, swimming, jogging.

Prohibited loads are marked with "-", permitted ones - with "+". The number of "+" signs indicates the permissible intensity and volume of loads.

Daily physical activity

Types of homework

Activity type	Functional class
	I	II	III	IV
Sawing	+	-	-	-
Hand drill: comfortable posture uncomfortable posture	++ ++	+ -	- -	- -
Vacuuming	++	+	-	-
Washing vertical surfaces (windows, walls, cars): comfortable posture uncomfortable posture	++ +	+ -	- -	- -
Dust wiping	+++	+++	++	+
Dishwashing	+++	+++	++	+
Washing: comfortable posture uncomfortable posture	++ +	+ -	- -	- -
Sewing, embroidery	+++	++	+	-

Work on a personal plot

Activity type	Functional class
	I	II	III	IV
Earthworks (loosening the soil, digging the ground, digging holes)	++	+	-	-
Carrying goods by hand (water, sand, cement, brick, fertilizers, etc., in kg)	up to 15	up to 8-10	until 3	-
Transportation of goods by wheelbarrow (kg)	up to 20-25	up to 15	up to 6-7	-
Watering: hose large watering can (10 kg) small watering can (3 kg)	+++ +++ +++	++ ++ ++	+ - +	- - -
Landing: trees seedling	++ +++	+ ++	- +	- -
Harvesting: from the trees from the bushes	+++ +++	++ +++	+ +	- -

A set of exercises for coronary heart disease

Exercises for the treatment of coronary artery disease include a combination of breathing exercises with physical activity. Physical education can be carried out in a clinic or at home on the basis of the recommendations of the attending physician. During classes, you need to monitor your breathing - it should be calm and even.

Here are some exercises that can speed up your recovery from heart disease:

1. The patient lies on a firm horizontal surface with arms and legs wide apart. Then slowly bend and unbend the fingers. The exercise is repeated 5-6 times.
2. In the supine position, the patient does breathing exercises - alternating deep, slow breaths with exhalations. The number of repetitions is 3-4 times.
3. Lying on his back and stretching his legs, the patient alternately pulls the sock towards himself and away from himself. The exercise is repeated 5-6 times.
4. Sitting on a chair, the patient drops his arms along the body. Then, inhaling deeply, raises his hands up, exhaling - down. The number of repetitions is 5 times.
5. In a sitting position, the patient fixes his hands on the belt. Then he alternately unbends his arms and returns them to their original position. The number of repetitions is 5-6 times.
6. The patient takes a standing position and makes 3 slow head rotations in one direction and 3 in the other.
7. In a standing position, the shoulders are alternately raised and lowered. The number of repetitions is 5-6 times.
8. The patient puts his hands on his belt and makes 3 circular rotations of the body in one direction, 3 in the other.
9. The patient stands next to the chair, resting his hands on its back. Then he slowly sits down on a chair when inhaling and rises to the starting position when exhaling. The number of repetitions is 4-5 times.

What physical activity is optimal for heart attack patients?

In post-infarction, they will help to achieve better recovery of endurance load, in combination with exercises for flexibility and strength. So, for example, walking and cycling is best alternated with walking uphill, while developing strength and endurance. Doing chores or gardening can be alternated with dancing or swimming.

It should be remembered that any loads are introduced gradually. An increase in physical activity must be coordinated with a specialist without fail. Otherwise, such physical education can only worsen the state of health and provoke a second attack.

Postinfarction rehabilitation should be comprehensive. This means that an increase in activity alone is not enough. For a complete recovery of the body, additional drug therapy is carried out, adjusting the diet and lifestyle of the patient. In difficult cases, rehabilitation may include surgical correction.

Publishing house "Medicine", Moscow, 1968
Abbreviated

It is known that angina pectoris is based on a disorder of the coronary circulation, which provides nutrition to the heart. The most pronounced manifestations of angina pectoris are present against the background of atherosclerosis of the coronary vessels, although atherosclerosis is not a prerequisite for the occurrence of angina attacks. The latter are based on spasm of coronary vessels of neurogenic origin; while sclerosed vessels are more prone to spasms.

Attacks of angina pectoris are considered as a special case of psychoneurosis with the involvement of the cardiovascular system (G.F. Lang, V.F. Zelenin, E.M. Gelstein, etc.). It has now been proven that the initial mechanism in the onset of angina attacks are cortical and subcortical impulses, leading to impaired coronary blood flow and the development of acute myocardial ischemia.

Predisposing moments of development should be considered psychoneurosis, overexcitation with negative emotions, coronary sclerosis, hypertension, smoking, mental and physical stress, etc.

Patients suffering from angina pectoris (angioedema due to coronary sclerosis, hypertension, etc.) are treated with great success in local cardiological sanatoriums, where, in comparison with the resort environment, the whole complex of climatic factors is milder and more familiar to the patient.

Considering that the basis of the disease is psychoneurosis with cardiovascular manifestations, it is very important to use the conditions of the patient's stay in the sanatorium as a factor contributing to the creation of situational reflexes that switch the patient's nervous system to other types of irritation than in the conditions of professional activity and in everyday life. The development of new complexes of conditioned reflexes (distracting, switching reflexotherapy) leads to the creation of a new "healthy" dynamic stereotype (VF Zelenin). The conditions of the sanatorium regime and the whole environment with beautiful nature are the most successful "switching" therapy.

In these conditions, therapeutic physical culture is of great importance as a factor that contributes not only to the switching of nervous perceptions to others, but also as a means that improves the neuro-humoral regulation of the heart and adapts the coronary circulation to the requirements of the moment.

The study of the use of medical physical culture in cases of chronic coronary insufficiency allows us to consider the therapeutic effect of this method in the context of its leveling effect on the clinical manifestations of cardiovascular psychoneurosis in connection with the establishment of cortico-visceral relationships. Here, one should also bear in mind the reflex influences on the part of the working skeletal muscles, aimed at expanding the coronary vessels. It is necessary to add to the nervous influences the effect of the products of muscle activity on the expansion of peripheral vessels, as well as the effect of adrenaline on the endings of the sympathetic nerve in the myocardium, which is also manifested in the vasodilatory effect of the coronary vessels.

Here it is necessary to take into account that the number of capillaries in the myocardium is twice the number in skeletal muscles (BV Ognev, VN Savin, LA Savelyeva); this should be seen as an expression of the morphological adaptation of the coronary blood flow to the conditions of metabolism and the energy needs of the myocardium (VV Panin and F.3. Meerson).

In addition, if at rest the coronary blood flow is 200-250 ml per minute, then with pronounced physical activity and an increase in the cardiac output volume, the coronary blood flow reaches 3-4.6 liters, while the mass of blood flowing through the coronary vessels per minute is 10 -15 times the weight of the heart (A.V. Lebedinsky and V.I. Medvedev). It should also be borne in mind that the amount of blood flow in the heart is 10-12 times greater than in other tissues of the body. Such a high adaptability of the coronary circulation to different levels of functional activity of the myocardium expresses its characteristic feature (VV Parin and F.3. Meerson), which must be taken into account in conditions of dosed physical training within the framework of physical therapy.

Clinical observations on the use of physical therapy in chronic coronary insufficiency (L.S. Girshberg, A.M. Markov and G.P. Kareva, V.N. Moshkov, A.V. Nechaev and K.G. Rozanov, L. S. Oganesyan and others) show that a positive effect, apparently due to the vasodilating effect of physical exercises on the coronary system, takes place only with strictly adequate load, which causes a significant improvement in the blood supply to the heart and an increase in myocardial contractions.

At the same time, it should be borne in mind that in a number of patients with severe coronary sclerosis, physical activity can cause an angiospastic reaction, accompanied by insufficient blood supply to the myocardium (N.A. Kurshakov).

Dupler advises the use of passive and active exercises, as well as massage for cardiovascular diseases, starting as early as possible. The observations of domestic authors confirm that the regular dosed use of therapeutic exercises and walks (mainly) promotes the expansion of the functional adaptation of the heart muscle to increasing loads and the attacks of angina pectoris in the vast majority of patients develop much less frequently, and are less intense in their course (they allow to do without the use of therapeutic measures ). The extreme variety of forms, the nature of the course and the depth of damage to the cardiovascular system as a whole in chronic coronary insufficiency necessitates a strictly individual use of dosed physical activity.

Any physical activity that causes pain or discomfort in the region of the heart, behind the sternum, etc., is inadequate for the patient and should be replaced by one that does not cause the above phenomena.

Apply physical therapy in the treatment of patients with angina pectoris should be in quiet intervals between attacks. The degree of physical activity in the procedures of physical therapy can be different depending on the frequency and severity of attacks and the general condition of the patient. So, in case of coronary insufficiency with the presence of angina pectoris on the basis of hypertension, the technique is determined by the entire feature of the clinical manifestations of hypertension.

Special care when carrying out physical therapy is necessary in patients with severe sclerotic changes in the coronary vessels of the heart. The use of dosed physical activity for angina pectoris is also advisable to carry out under the control of vasodilators, in particular nitroglycerin. The latter is advisable to take before physical activity, which allows you to increase its dosage.

From the means of physical therapy for angina pectoris, therapeutic exercises and walks alternating with passive rest of patients are of primary importance. Gymnastic exercises, depending on the patient's condition, are used in various starting positions (lying, sitting and standing). Therapeutic exercises can be prescribed approximately the same as for patients who have had myocarditis or heart attack. Exercises for procedures are selected simple, they should be performed rhythmically, freely, without tension, with a large range of motion. A prerequisite is strict gradualness in increasing and decreasing physical activity and alternating gymnastic exercises with breathing exercises. The load in the therapeutic gymnastics procedure should not be concentrated; between exercises, it is necessary to introduce short pauses for rest.

In the first days of training, the starting positions for the exercises are mainly used lying and sitting. At first, exercises are selected in which only the distal parts of the limbs are involved in movement. With a satisfactory state of health of the patient, the total load gradually increases due to the inclusion of exercises for larger muscle groups in the therapeutic gymnastics procedure, changes in starting positions and a more rare use of breathing exercises.

It should be remembered that exercises with power tension for patients with angina pectoris are categorically contraindicated. It should also be borne in mind that the acceleration of the pace of exercises in the procedures should be carried out in a strict sequence. Rhythmically and calmly conducted simple gymnastic exercises in the second half of the course of treatment of patients can be supplemented with exercises in throwing air balls, first performed at a calm pace, and then in a playful way.

The amount of physical activity in the procedures of medical gymnastics, depending on the patient's condition, can vary significantly. So, if a patient periodically has attacks of angina pectoris, therapeutic exercises are prescribed according to the technique for second-degree circulatory failure. During the exercise, special observation is necessary for patients who develop angina attacks due to physical exertion. In other cases, in the absence of pain in the region of the heart, when the diagnosis of coronary sclerosis is made on the basis of an electrocardiogram that detects coronary insufficiency (a decrease, and sometimes an increase in the S-T segment of the electrocardiogram taken after physical exertion), the method of therapeutic gymnastics is used the same as in case of insufficiency circulation of the first degree.

Dosed walks are used mainly on level ground. Their distance is determined individually, depending on the manifestations of angina pectoris and the patient's fitness for movement. The total load during walking increases by daily (or after 2-3 days) adding the path length by 200-300 m. With a good reaction to quiet walking, it is recommended to accelerate the pace of walking for 20-50 m, followed by deep breathing.

The expansion of the requirements for the myocardium can be carried out by reducing the stops along the walking route. Before each rest stop while sitting, be sure to do 5-6 deep breaths.

The dosage of physical activity should be such as not to cause pain in the region of the heart. So, with angina pectoris, it should be slightly less than that which can cause pain; in addition, breathing exercises are the means of dosage.

With angina pectoris at rest, which most often develops against the background of coronary sclerosis, the use of physical therapy should be carried out with even greater caution. Prescribing physical therapy for angina pectoris is necessary in calm intervals between attacks, taking into account the form and severity of the disease.

So, with a mild attack of angina pectoris, especially with an angioneurotic form, therapeutic exercises can be started the next day. With psychogenic angina pectoris, devoid of atherosclerotic soil, which is more common in young people and patients with hypertension, therapeutic exercises should be used from 3-5 days after the attack. With angina pectoris at rest, it is necessary to start therapeutic exercises much later, after 6-12 days, depending on the patient's condition, the disappearance of the pain syndrome and the exclusion of the presence of a fresh heart attack.

When determining the dosage of physical activity, it is very important to know the anamnesis data, allowing to take into account the patient's reactivity to various household loads, as well as the degree of his adaptation to physical activity due to preliminary training (physical education, physical labor). Anamnesis data must be compared with the clinical manifestation of the disease.

When using therapeutic exercises and dosed walks in sanatoriums for patients with angina pectoris, it is necessary to take into account the time of the onset of the attack. It is better to carry out therapeutic exercises in the period from 11 am to 2 pm. If seizures occur in the evening or at night, quiet walks before bedtime should be recommended.

It is also necessary to take into account the weather conditions in different periods of the year. So, in cold, windy and damp weather, it is necessary to dress accordingly, and exercise therapy in a ventilated area. If, in the process of doing therapeutic exercises or walking, pain occurs in the region of the heart, behind the sternum, it is necessary to turn on a pause for rest, use coronary dilators and reduce the amount of load.

Exercise for angina pectoris is necessary, since a sedentary lifestyle contributes to an even greater disruption of cholesterol metabolism and the deposition of atherosclerotic plaques in the coronary vessels. At the same time, physical activity for angina pectoris should be dosed.

Physical activity for angina pectoris

Angina pectoris is an attack of acute sudden pain that develops against the background of ischemia. (oxygen deficiency) of the myocardium. Myocardial ischemia develops due to narrowing of the blood vessels that bring arterial blood to it - the coronary arteries. The narrowing of the coronary arteries occurs due to the deposition of atherosclerotic plaques on their walls.

During physical exertion, myocardial oxygen demand increases, which leads to acute oxygen deficiency, accompanied by attacks of severe short-term pain. Angina that develops during exercise is called exertional angina ... This is why exercise with angina pectoris, a specialist should be selected for the patient - a physician in physiotherapy exercises.

Respiratory gymnastics for angina pectoris

Correct conduct of breathing exercises contributes to the saturation of blood with oxygen, which means that it completely or partially removes the oxygen demand of the myocardium. You can do the following breathing exercises according to the yoga system:

• sitting on a chair with a straight back, relax, think about something pleasant, inhale through the nose for a count of 1 - 2 - 3, hold your breath for a count of 1 - 2 and exhale through your mouth for a count of 1 - 2 - 3 - 4 - 5 ; along with exhalation, you need to lightly hit the chest with arms bent at the elbows, like wings; repeat the exercise 10-12 times from one to three times a day.

With angina pectoris, you should also take leisurely walks in the fresh air every day and imagine how oxygen-enriched air enters the lungs, and from there into the blood and into the heart muscle.

Therapeutic exercises for angina pectoris

Therapeutic exercises for ischemic heart disease (IHD) and angina pectoris are very important. But the patient should not do the selection of exercises on his own, remembering that high physical activity can lead to attacks of angina pectoris.

Depending on the degree of exercise tolerance, stable angina pectoris (in which there is a clear dependence on physical activity) is divided into four functional classes (FC). Exercise for angina pectoris should correspond to the FC of angina pectoris:

• FC I - the usual working capacity is not reduced, angina attacks occur with loads that significantly exceed the usual ones, for example, with a long run, lifting weights; such angina pectoris can be detected when carrying out stress tests in certain categories of professions; such patients can walk for a long time at any pace and run at a slow pace;
• II FC - the usual performance is not reduced, angina attacks occur with loads that slightly exceed the usual ones, for example, quickly climbing stairs, brisk walking or running; the degree of load in this case largely depends on the fitness of the person; these patients tolerate walking at a moderate pace well;
• III FC - a decrease in physical activity due to the fact that attacks of angina pectoris can develop during normal physical exertion, such as slowly climbing stairs one floor, walking, etc.; they can be advised to walk at a slow pace for 40-60 minutes;
• IV FC - attacks of angina pectoris occur at rest or with minor physical exertion, for example, when walking on foot at a slow pace for short distances; for such patients, long walks are suitable, but with mandatory rest periods.

For patients with stable angina FC I and II, the following set of exercises for angina pectoris can be recommended.