Acute myocardial infarction rehabilitation is used to guide the clinical treatment of patients, facilitate their return to normal life, reduce the occurrence of cardiac events, decrease morbidity and mortality, and improve the quality of survival through the development of reasonable exercise and psychological prescriptions and a safe range of activities of daily living capabilities, including exercise rehabilitation and psychological rehabilitation mainly. This article mainly discusses exercise rehabilitation.
I. Exercise rehabilitation.
1. Principles of exercise rehabilitation.
(1) Individualization principle.
Selection of individualized exercise prescriptions according to the patient’s physical condition, medical condition and assessment results.
(2) Type of exercise.
Aerobic exercise training is recommended. The intensity can be gradually increased to moderate intensity, i.e. 40%-60% of the maximum oxygen uptake (4-6 METs); form since walking, brisk walking, jogging, tai chi, etc., gradually escalated. Competitive sports should be avoided in the early stage, as they can cause sympathetic excitation, which may lead to an increased incidence of sudden death.
(3) Exercise intensity, duration and frequency of setting.
Exercise intensity has a direct impact on the effectiveness and safety of exercise, the simplest method is to use the exercise target heart rate to control the intensity of exercise. Exercise appropriate heart rate = 170 (180) – age (years), more than 60 years old or poor physical fitness of middle-aged and elderly people with 170 an age; there is another calculation method: the highest heart rate × (40% – 85%) as the target heart rate, where the highest heart rate = 220 – age (years). Exercise duration required 45-60 min each time, including 15 min warm-up, 20-30 min aerobic exercise, l0 min cool-down period, and 5-10 min relaxation period. The frequency of exercise should be 3-5 times per week.
2.Stage method rehabilitation.
(1) Acute phase rehabilitation treatment program:
Acute rehabilitation is often carried out in supervised recovery wards and general wards with good recovery and early PCI. its main components include early activity and early bed departure (3-7 days after myocardial infarction) and control of activity intensity at a low level, i.e., about 1 to 2 metabolic equivalents. These activities include personal living, eating, bedside urination and defecation, simple passive and active exercises of the upper and lower extremities, and bedside chair sitting. The activities should not cause hemodynamic changes, the heart rate should not be lower than 50 beats/min or higher than 120 beats/min, no discomfort and no ischemic changes in the ECG are appropriate. Our patients with comorbid AMI are treated with a 2-week rehabilitation program. This stage of rehabilitation can promote the recovery of cardiac function and reduce the incidence of deep vein thrombosis
(2) Early recovery phase rehabilitation program:
The rehabilitation is mainly aimed at patients in the early stage of discharge, usually within 3 months after the disease. At 11-12 weeks of myocardial infarction, patients are mostly able to complete the secondary ladder double load, equivalent to 6-7
METs, they can enter the community rehabilitation program. During this phase, the tasks of medical personnel are mainly to help patients formulate exercise programs, arrange for patients to perform rehabilitation exercises regularly, record the specific implementation, and evaluate the effectiveness of improving rehabilitation, etc.
(3) Rehabilitation program in the recovery phase:
The recovery phase rehabilitation should last until 6 to 9 months after the second phase. The main task is: to assist patients to gradually return their changed lifestyle to normal life and work. The content includes training the ability to perform activities of daily living, carrying out pre-vocational training, and improving the quality of life.
(4) Conditions that should reduce the progress of rehabilitation
Patients with multiple coronary artery lesions that have not been completely reconstructed, heart failure, malignant arrhythmias, intraventricular thrombosis, and large myocardial infarction should be cautious and proceed gradually with exercise rehabilitation. Remember that “individualized and gradual”, premature and overly aggressive exercise may lead to heart damage. Rehabilitation should be carried out under the guidance of a doctor.
3. Specific implementation plan:
Exercise rehabilitation program should not be rigid, emphasizing individualization and, above all, safety. If the duration of exercise exceeds 3 to 5
min, then a lower intensity (40%-50% of peak oxygen intake) is required. Small muscle group resistance training can be used, but with an emphasis on small loads, short duration, and small exercise volumes. Resistance inspiratory muscle training at 25%-35% of maximal respiratory pressure (20-30
min/d) to increase respiratory muscle endurance. The safety of high-intensity aerobic training, intermittent training and resistance training has been demonstrated to result in significant physiological and psychological improvements, increased exercise tolerance, improved cardiac and skeletal muscle function, improved endothelial function and peripheral blood flow, improved neurological control and improved quality of life. Cardiac exercise rehabilitation emphasizes individualization, gradual progression, adherence to systemic and long-term approaches.
Pre-exercise assessment:
Palpitations, shortness of breath, chest pain, arrhythmias, and electrocardiograms showing dynamic changes in myocardial ischemia in the resting state should not be rushed into cardiac exercise rehabilitation. Note that the ECG will recover dynamically over time after myocardial infarction and should be analyzed dynamically in conjunction with several ECG changes to determine if ischemia is still present or if it is only a sign of cardiac recovery. Plate exercise testing can indicate the state of cardiac recovery and the intensity and duration of exercise that can be safely tolerated by the patient, and is non-invasive, inexpensive, and easily accepted by the patient, and is currently the preferred method of assessment.
Stable forms of exercise training:
Such as walking, brisk walking, jogging, tai chi, etc. Frequency of training: Patients with more severe damage are recommended to have a short, multiple daily training of 5-10 min; patients with good function are recommended to have a longer training (20-30 min), 3-5 times/week. Intensity of training: mainly based on self-perception, exercise and slight sweating after exercise but no significant discomfort; or based on heart rate not exceeding 100 to 110 beats/min after exercise and able to return to pre-exercise level within 5 min. Improvement in aerobic capacity and symptoms generally occurred in the fourth week after training; physical and cardiopulmonary parameters peaked at 16 and 26 weeks, respectively, and then reached a plateau.
Pay attention to regular and feasible dynamic electrocardiogram to exclude the existence of possible asymptomatic myocardial ischemia or arrhythmia to ensure the safety of exercise rehabilitation.
4. Combine exercise and psychological rehabilitation:
The patient’s condition, cooperative attitude, social status and environmental situation can be combined to develop a reasonable program that the patient is willing to accept and is compatible with his or her wishes and living habits, to obtain the cooperation of the patient’s family, and to combine rehabilitation medical, vocational and social rehabilitation to help the patient return to society.