Как тренироваться людям с сердечно-сосудистыми заболеваниями

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Зожник рассматривает, почему «сердечникам» нужно заниматься физическими нагрузками и как именно. Однако помните: если вы страдаете от высокого кровяного давления или сердечно-сосудистого заболевания, проконсультируйтесь с врачом и пройдите все необходимые обследования перед тем, как приступить к какому-либо виду тренировок – особенно такому, которым вы ранее не занимались. 

Физическая нагрузка для здоровья сердца

Примерно 1 из 5 случаев заболевания ишемической болезнью сердца (ИБС) в развитых странах связан с низкой физической активностью (гиподинамией). Регулярная физическая активность умеренной интенсивности снижает риск возникновения ИБС и может снизить вероятность умереть от болезней сердца.

Ученые из Национального фонда сердца Австралии говорят:

«Недостаток физической активности связывают с менее благоприятным прогнозом выживаемости у лиц, перенесших инфаркт миокарда по сравнению с пациентами, которые поддерживают двигательную активность».

Люди с сердечно-сосудистыми заболеваниями могут извлечь следующие выгоды от регулярных тренировок:

Улучшение физиологических функций

Физическая реабилитация неизменно улучшает объективные показатели функциональных способностей (трудоспособности) у пациентов с заболеваниями сердца. Тренировки на выносливость улучшают подвижность среди перенесших инсульт людей и увеличивают дистанцию, которую способны преодолеть пешком люди с заболеваниями периферических сосудов, а также лица, страдающие хромотой.

Снижение симптомов

Регулярные тренировки снижают рецидивирующие симптомы стенокардии, уменьшают связанную с сердечной недостаточностью и инсультом одышку, а также снижают выраженность хромоты при ходьбе у пациентов с заболеваниями периферических сосудов.

Улучшение профиля коронарного риска

Регулярная физическая активность умеренной интенсивности снижает повышенное кровяное давление и концентрацию триглицеридов, а также повышает липопротеины высокой плотности (защищающий сердце холестерин) у людей с ишемической болезнью сердца. Кроме того, регулярные тренировки снижают резистентность к инсулину и повышают восприимчивость к глюкозе у предрасположенных к развитию диабета лиц.

Снижение показателей смертности

Регулярно двигающиеся люди до 25% снижают шансы умереть после инфаркта по сравнению с пациентами, которые вели до инфаркта сидячий образ жизни.

Улучшение физической формы

Тренировки с отягощениями увеличивают физическую силу и уверенность в себе у людей с сердечно-сосудистыми заболеваниями, а также повышают способности выполнять связанные с физической силой повседневные заботы.

Важно отметить, что влияние регулярной физической активности на здоровье сердечно-сосудистой системы и трудоспособность человека является очень кратковременным явлением. Как только человек перестает тренироваться, его функциональные способности стремительно снижаются. Кроме того, сочетание регулярных тренировок с сопутствующей медикаментозной поддержкой позволяет еще больше укрепить здоровье сердца.

Повышение качества жизни

Физическую реабилитацию связывают с небольшими, но стабильными изменениями в оценке качества жизни среди перенесших инфаркт миокарда, а также людей с сердечной недостаточностью и заболеваниями периферических сосудов.

Регулярно тренирующиеся люди с заболеваниями сердца часто отмечают повышение уверенности в своих силах; у них появляется ощущение благополучия, а также отмечается снижение депрессии и чувства тревоги. Что немаловажно, у этих людей снижается ощущение социальной изоляции.

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Как именно тренировки помогают лицам с заболеваниями сердца

В позиции Американского колледжа спортивной медицины (ACSM) отмечается, что регулярные аэробные тренировки снижают частоту сердечного ритма и кровяное давление как в состоянии покоя, так и во время тренировок. Впоследствии нагрузка на сердце снижается, и неприятные симптомы стенокардии могут проявляться более мягко.

Регулярные тренировки укрепляют мышцы, усиливают транспорт и доставку кислорода к тканям, в результате чего пациент чувствует себя более энергичным и меньше устает. Это является важным моментом для лиц с заболеваниями сердца, чьи аэробные показатели уступают их здоровым ровесникам. При этом отмечается, что самые значительные улучшения наблюдаются у лиц с самой слабой физической подготовкой.

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Противопоказания «сердечников» к тренировкам

В Руководстве ACSM для предтренировочной оценки и разработки тренировочной программы указаны противопоказания к тренировкам для лиц с сердечно-сосудистыми заболеваниями.

Противопоказания к тренировкам для страдающих сердечно-сосудистыми заболеваниями:

o   Нестабильная стенокардия,

o   Неконтролируемая гипертензия с систолическим давлением >180 мм рт. ст и/или диастолическим >110 мм рт.ст. в состоянии покоя,

o   Ортостатическое падение давления (>20 мм рт. ст. систолического и/или >10 мм рт. ст. диастолического) с проявляющимися симптомами (головокружение, тошнота, слабость, туман в глазах, потеря сознания)

o   Тяжелый аортальный стеноз,

o   Неконтролируемая предсердная или желудочковая аритмия,

o   Синусовая тахикардия (пульс > 120 уд/мин.),

o   Неконтролируемая сердечная недостаточность,

o   Атриовентрикулярная блокада III степени у пациентов без кардиостимулятора,

o   Активный перикардит и миокардит,

o   Недавно перенесенная эмболия,

o   Острый тромбофлебит,

o   Обострившееся хроническое заболевание или высокая температура,

o   Неконтролируемый сахарный диабет,

o   Тиреоидит, гипо- и гиперкалиемия, гиповолемия,

o   Тяжелые ортопедические заболевания, которые препятствуют двигательной активности.

Если у вас есть одно из указанных выше противопоказаний, вам необходимо повременить с тренировками.

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Как и сколько тренироваться людям с заболеваниями сердца

Если у человека с заболеванием сердца нет противопоказаний к тренировкам, он может постепенно повышать свою двигательную активность под присмотром врача. Именно врач должен одобрить вид, частоту, длительность и уровень интенсивности тренировок, которые будут соответствовать физическим способностям и не нанесут вреда лицам с сердечно-сосудистыми заболеваниями.

Аэробные тренировки

По мнению ученых из ACSM, ходьба, занятия на эллиптическом и велотренажере, ходьба по лестнице – это лучшие виды аэробных тренировок для людей с заболеваниями сердца.

Значительные улучшения наблюдаются тогда, когда люди с заболеваниями сердца тренируются в аэробном стиле 3 раза в неделю на протяжении минимум 12 недель. Причем если люди тренируются чаще 3 раз в неделю, улучшения становятся еще более заметными.

Австралийские специалисты рекомендуют пациентам со стабильным состоянием сердечно-сосудистых заболеваний со временем уделять тренировкам по 30 и более минут в день, занимаясь в большинство дней недели, и даже ежедневно.

Длительность аэробных тренировок для людей без противопоказаний должна составлять 30 минут. Причем на выбор у человека есть 2 варианта: либо проводить одну получасовую тренировку за 1 раз, либо разбивать эти 30 минут на 3 тренировки по 10 минут.

Исходя из полученных на предтренировочном тесте данных (который должен проводить врач или компетентный специалист), ACSM рекомендует тренироваться с интенсивностью на уровне 40-80%, которая рассчитывается на основании сердечного резерва (HRR).

Сердечный резерв – это разница между максимальным пульсом и пульсом в состоянии покоя.

Как рассчитать интенсивность тренировки:

  1. Определите максимальную частоту пульса, отняв от числа 220 свой возраст.
  2. Определите свою частоту пульса за 1 минуту в состоянии покоя.
  3. Рассчитайте разницу между максимальной частотой и пульсом в состоянии покоя.
  4. Рассчитайте необходимую интенсивность по методу Карвонена:

Для примера рассчитаем интенсивность на уровне 50% для человека возрастом 60 лет и пульсом 65 уд/мин. в состоянии покоя.

Целевая зона пульса = % интенс. х сердеч. резерв + пульс в покое

Максимальная частота пульса: 220 – 60 лет = 160 уд/мин.

Сердечный резерв: 160 – 65 (пульс в покое) = 95 уд/мин.

Итоговый расчёт: 65 (пусль в покое) + 50% интенс. х 95 уд/мин. = 112 уд/мин.

112 уд/мин. – ориентировочная частота пульса, с которой нужно тренироваться.

Как подобрать интенсивность без проведения расчётов

Ученые из Британского фонда сердца считают, что тренировки должны проходить с таким уровнем интенсивности, при котором сердечный ритм заметно ускоряется и человеку становится тяжелее дышать. При этом человек должен быть в состоянии поддерживать беседу. Если же он не может разговаривать в процессе аэробной тренировки, значит ее интенсивность слишком высокая.

Некоторые «сердечники» не способны придерживаться вышеупомянутых рекомендаций относительно продолжительности и интенсивности тренировок. Однако на начальных этапах приветствуется хоть какая-нибудь активность. Начинайте с коротеньких 5-10 минутных прогулок в медленном темпе, ведь это значительно лучше, чем совсем ничего.

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Тренировки «сердечников» с отягощениями

Тренировки с отягощениями могут эффективно и безопасно увеличивать силу и выносливость мышц у пациентов с клинически стабильной ишемической болезнью. Силовые тренировки на верхнюю часть тела приводят к улучшению работы сердечно-сосудистой системы за счет снижения кровяного давления и частоты сердечных сокращений. Следовательно, такие тренировки помогают снизить нагрузку на сердце в процессе трудовой и повседневной активности.

Кроме того, как отмечается специалистами из Департамента кардиологической реабилитации и сердечно-сосудистых исследований, силовые тренировки особенно важны для самых хрупких пациентов, которые из-за слабости в ногах испытывают трудности в процессе аэробных тренировок.

Используемое тренировочное оборудование:

В процессе силовых тренировок можно использовать резиновые эспандеры, тренажеры и даже свободные веса – штанги и гантели.

Рекомендации к выполнению упражнений:

o   Поднимайте и опускайте вес с полным контролем,

o   Избегайте задержек дыхания,

o   Избегайте сильного напряжения и натуживания,

o   Не сжимайте гриф штанги (гантели) или рукоять тренажера слишком сильно, так как это может вызвать чрезмерный скачок давления.

Интенсивность и объём тренировок:

Интенсивность должна подбираться таким образом, чтобы человек мог без значительного натуживания выполнить 10-15 повторений — на уровне приблизительно 30-40% от 1 разового максимума для мышц верхней части тела и приблизительно 50-60% от максимума для мышц нижней части тела (свой максимум в случае с «сердечниками» выявлять противопоказано! Его можно посчитать на «калькуляторе силы» вот тут, однако делать упражнения до отказа сердечникам в любом случае противопоказано). Повышайте рабочий вес не более чем на 1-2 кг для верхней части тела и 1-4,5 кг для нижней части, но лишь тогда, когда способны выполнить все 15 повторений без значительного натуживания.

На начальных этапах в упражнениях для основных мышечных групп (руки, плечи, грудь, спина, ягодицы, мышцы живота и ноги) необходимо выполнять лишь по 1 подходу. Всего за тренировку рекомендуется выполнять от 8 до 10 упражнений для вышеупомянутых мышц.

Частота тренировок:

Силовые тренировки рекомендуется проводить 2-3 раза в неделю, при этом между тренировками одной мышечной группы должно проходить не менее 48 часов.

Другие важные моменты:

o   Силовая тренировка должна начинаться только после того, как человек провел тщательную аэробную разминку. (В целом рекомендуем также прочесть: «Почему нужно делать разминку и заминку» ).

o   Тренируйте большие мышечные группы перед маленькими.

o   Включайте в тренировку многосуставные упражнения, которые задействуют более 1 группы мышц.

o   После тренировки человек должен чувствовать умеренную, но не сильную усталость.

Важно отметить, что так как большинство связанных с физической активностью преимуществ по большей части наблюдается вследствие аэробных тренировок, работа с отягощениями должна дополнять, а не заменять аэробику.

В позиции Американской ассоциации сердца указано, что тренировки должны дополняться повседневной активностью – пешими прогулками в перерывах на работе, использованием ступенек вместо лифта, работой по дому или в саду. При этом отмечается, что при 5-6 часах общей физической активности в неделю (включая повседневную активность) пациенты могут извлечь максимальную пользу для здоровья.

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Лучший вид активности для начала тренировок – ходьба

Для людей с заболеваниями сердца ходьба имеет несколько преимуществ перед другими видами физической активности на начальных этапах тренировок. Такой вид тренировок может значительно улучшить физическую форму и показатели состояния здоровья, о которых говорилось в начале статьи.

Кроме того, ходьба – это достаточно легкий по интенсивности вид аэробной тренировки, который, как правило, без проблем переносится пациентами с заболеваниями сердца. К тому же ходьба не требует покупки абонемента в спортзал или тренировочного оборудования – достаточно одной пары спортивной обуви.

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Риски и предостережения

По словам ученых из Национального фонда сердца Австралии, преимущества, которые наблюдаются вследствие физической активности, значительно перевешивают связанные с нею риски. Специалисты из ACSM сообщают, что развитие сердечно-сосудистых осложнений во время тренировок наблюдается 1 раз на каждые 100 000-300 000 тренировочных часов. При этом их коллеги из Австралии отмечают, что смерть пациентов с заболеваниями сердца во время тренировок наступает лишь 1 раз на 750 000 тренировочных часов. Стоит отметить, что риски при отсутствии тренировок для сердечников — выше.

В целом специалисты сходятся на том, что риск рецидивов и развития осложнений возрастает во время физической активности у людей, которые ранее вели сидячий образ жизни и превышают рекомендуемую интенсивность на тренировках. Для того чтобы снизить риски, пациенту необходимо начинать с тренировок самой низкой интенсивности и повышать ее очень постепенно.

Таким образом, как отмечают ученые из ACSM, физическая активность с целью реабилитации является безопасной для пациентов со стабилизировавшимися заболеваниями сердца. Серьёзные осложнения встречаются очень редко; более того, у пациентов, которые тренируются регулярно, риски возникновения осложнений сердечных заболеваний во время тренировок снижаются.

В каких случаях тренировку необходимо прекратить немедленно

В позиции ACSM отмечается, что независимо от того, каким видом тренировок занимается человек с заболеванием сердца, он должен быть осведомлен о 4 основных предупреждающих симптомах, которые свидетельствуют о возможном ухудшении состояния здоровья:

  1. Появление постоянной или периодически возникающей стенокардической боли (боль или сдавливание в груди, боль в челюсти или шее, ощущение дискомфорта в нижней части рук, боль в плечах и спине).
  2. Непривычное затруднение дыхания, одышка,
  3. Головокружение,
  4. Нарушение сердечного ритма.

К симптомам, которые могут стать поводом для прекращения тренировок, австралийские специалисты также относят тошноту, нехарактерную потливость, слишком быструю утомляемость, боль в ногах и появление физической слабости.

При появлении хотя бы одного из вышеупомянутых симптомов необходимо прекратить тренировку (плавно снизив ее интенсивность) и обратиться к врачу.

Как нельзя тренироваться людям с заболеваниями сердца

Чрезвычайно усердные физические нагрузки или активность, при которой интенсивные периоды чередуются с резкими остановками, достаточно сильно нагружают сердце, особенно у людей, которые ведут малоподвижный образ жизни. К примеру, разгребание тяжелого мокрого снега лопатой вызывает существенное повышение сердечного ритма и кровяного давления. По этой причине сердечные приступы часто случаются у людей среднего и пожилого возраста, которые расчищают заснеженную дорогу.

Лицам с заболеваниями сердца британские ученые рекомендуют избегать такой напряженной повседневной деятельности, как переноска очень тяжелых предметов или тяжелая работа в саду, к примеру, – перекапывание земли. Также не рекомендуется участвовать в соревновательных мероприятиях высокой интенсивности – не стоит играть в баскетбол, футбол, волейбол, сквош и так далее.

В целом людям с заболеваниями сердца или высоким кровяным давлением необходимо избегать напряженных видов физической активности, которые вызывают тяжесть дыхания или его задержку, а также сильное натуживание.

«Сердечники» также должны избегать упражнений на статику, которые требуют прикладывания усилия против фиксированного объекта или удерживать тело в напряженном положении (к примеру, толкание стены или упражнение планка). Кроме того, лицам с высоким кровяным давлением рекомендуется избегать чрезмерного количества силовой работы, при которой руки поднимают вес над головой.

Важно!

Если вы принимаете лекарства для снижения кровяного давления, вам необходимо избегать резких изменений положения тела – к примеру, «быстрого» вставания со стула, подскакивания из положения лежа в положение стоя, так как это может вызывать головокружение. Вы также должны продлевать время, выделяемое на заминку, так как прием медикаментов может снизить давление слишком сильно, если вы закончите тренировку внезапно.

Кроме того, когда доктор назначает вам какой-либо новый препарат, обязательно уточняйте, повлияет ли он на физическую активность, которой вы занимаетесь. Это особенно относится к бета-блокаторам, которые снижают частоту сердечных сокращений.

Тренировочная памятка для людей с сердечно-сосудистыми заболеваниями:

o   Не начинайте тренироваться до тех пор, пока не получите одобрения от врача.

o   Повышайте уровень двигательной активности плавно – постепенно увеличивайте как длительность, так и интенсивность тренировок.

o   Каждая ваша тренировка должна состоять из трех блоков: тщательной разминки, основной части и заминки.

o   Не тренируйтесь сразу после еды, подождите минимум полтора часа.

o   Убедитесь, что пьете достаточно жидкости до, во время и после тренировки.

o   Ваша тренировочная форма должна быть удобной, а обувь – идеально подходить по размеру.

o   Не тренируйтесь в условиях сильного холода, жары и высокогорья. Если вы тренируетесь на холоде и ветру, одевайтесь тепло, не забывая о шарфе и шапке.

o   Не тренируйтесь при вирусной инфекции или высокой температуре тела.

o   Остановите тренировку при появлении опасных симптомов и сообщите о них врачу.

o   Не принимайте горячий душ в первые 15 минут после окончания тренировки – это может спровоцировать повышение сердечного ритма и аритмию.

Выводы:

Как видим, заболевания сердца не должны становиться причиной отказа от физических нагрузок. Более того, если люди с сердечно-сосудистыми заболеваниями хотят улучшить свое здоровье, им просто необходимо двигаться. Однако критически важно не переусердствовать. Не гонитесь за рекордами, ведь все это не стоит вашего здоровья и жизни. Тренируйтесь с удовольствием, укрепляйте свое сердце и живите долго.

Научные источники:

o   Exercise for Persons with Cardiovascular Disease, ACSM Current Comment.

o   ACSM’s Guidelines for Exercise Testing and Prescription, 9th ed., Exercise Prescription for Patients with CVD.

o   ACSM’s Resources for the Personal Trainer, Chapt. 15, Cardiorespiratory Training Programs.

o   Physical activity and your heart, The British Heart Foundation (BHF).

o   Physical activity in patients with cardiovascular disease: management algorithm and information for general practice, The National Heart Foundation of Australia.

o   Being active when you have heart disease, U.S. National Library of Medicine.

o   T. Briffa, A. Maiorana, Physical activity for people with cardiovascular disease: recommendations of the National Heart Foundation of Australia, Med J Aust 2006; 184 (2): 71-75.

o   Heart Failure – Exercise, Cleveland Clinic.

o   Paul D. Thompson, Contemporary Reviews in Cardiovascular Medicine: Exercise Prescription and Proscription for Patients With Coronary Artery Disease, Circulation, 2005; 112.

o   Recommendations for Prescribing Exercise to Patients with Heart Disease, The Central Health Education Unit,Hong Kong.

o   Orthostatic Hypotension, MD.

o   Orthostatic Hypotension, Cleveland Clinic.

 

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Расскажите друзьям:

Как тренироваться людям с сердечно-сосудистыми заболеваниями: 141 комментарий

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    Вот бы вы еще рассказали, что делать людям с очень низким давоением=)

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