HEART ATTACK: EARLY MOBILIZATION
Ten or twenty years ago, heart attack patients suffered not only from the intense pain, the threat to life, and forced early retirement, but also from rigid confinement to bed because it was believed that the heart muscle scar tissue would require at least six weeks to heal. Often patients who were intent on moving around a little could do so only at night when they felt that they were not being observed. However, later studies revealed that prolonged confinement to bed causes not only psychological, but physical problems, as for example the increased tendency to coagulation and thrombo-embolism, impaired circulation and a
tendency to develop pneumonia. Cardiologists in the 1960's became less strict about bed rest and began to encourage early mobilization when they saw that this caused no complications. In 1968 the World Health Organization reviewed these studies and recommended early mobilization as standard practice.
Since then most hospitals practice early mobilization if no contra-indications are present. The patient usually rests in bed or a chair for several days and then gradually increases activities. Already in the intensive care unit a nurse or a physical therapist begins working with the patient twice each day if this is feasible. The therapist begins with breathing and relaxation exercises and then, while carefully observing the pulse and respiration rate, proceeds to active and passive exercise of muscles in the arms and legs.
The immediate goals of washing oneself (while sitting in bed) and the use of a commode should be attained within a few days. After exercising larger sets of muscles while lying down and sitting on the bed for several days, the patient may stand up and walk around the room, eat at the table with his legs wrapped up and go to the bathroom by himself. Eventually the patient will be able to walk a little further, perform more exercises while sitting, and mount stairs slowly. He should be observed by means of a Holter monitor which he straps to himself. Before climbing stairs, the patient's ability to endure physical exertion may be tested by a bicycle ergometer examination. Then the gymnastic exercises, climbing of stairs and walking can be increased gradually so that the younger patients may participate in a coronary gymnastic group before leaving the hospital. Older patients or those who have sustained a more severe or complicated heart attack may not be able to increase their exercises so quickly, and may have to stay in the hospital for a longer period.
Cooperation between the attending physician, the nurse, or the physical therapist and the patient plays an important role in the early mobilization, as does the close observation and discussion of complications, irregularities in the cardiac rhythm, and changes in the pulse rate.
The advantages of early mobilization lie in the prevention of impaired coagulation with thromboses and embolisms, as well as of pneumonia. Improved blood circulation and heart muscle function also appear. The patient recovers more quickly in the psychological aspect when able to move about freely without direct supervision. The patient may also develop a better relationship with the physician when not confined to bed for six weeks as previous practice had dictated. In those hospitals where a physical therapist is not readily available, the patient should request a list of exercises to perform alone during the day.
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