RU2147208C1 - Technique for estimating public health and working capacity - Google Patents

Abstract

FIELD: medicine; physical culture; monitoring physical health of children and adults. SUBSTANCE: technique consists of passive, active, and recovery phases of diagnostics. Passive diagnostics include metering weight-to-height ratio, tranquil pulse, arterial pressure, life index, oxygen consumption. Estimated during active diagnostics are flexibility of spinal column, motor and pupillary reaction by testing for gripping dropping ruler, muscular endurance of arms and shoulder girdle by counting how many times can patient get loose of floor, muscular endurance of prelum abdominale. Recovery phase includes assessing ability of pulse to recover and, in addition, hypoxia stability by arbitrary and maximal breath holding, coordination of movements, general working capacity, stroke blood volume. Numeric expression of each separately metered characteristic is converted to weight coefficients. All weight coefficients are summed up and weight coefficients characterizing motor activity, intensity of smoking, intensity of drinking alcohol obtained by patient's self-appraisal are added to them. Index of physical state obtained is used to estimate physical state and health reserves by comparing it with readings of human health estimate scale. EFFECT: improved accuracy of public health and working capacity estimation. 15 dwg, 21 tbl

Description

 The invention relates to medicine, physical education and can be used to monitor the reserves of physical health and health of children, adolescents, youth and adults.

 The method can be used for mass examination of the psychophysical state of people's health, it will allow you to objectively assess the potential of labor collectives, evaluate and monitor the level of public health, teach methods of self-monitoring and assessment of the physical health of each person, identify and timely eliminate physical imperfections and risk factors of the human body, issuing timely recommendations for individual motor mode. In the field of sports medicine, the method allows testing functional readiness, physical performance, and other characteristics of the state of the human body in order to select means of exposure that are adequate to the tasks of physical training, their quality and objective assessment of the test results. (Karpman V.L. et al. Testing in sports medicine. - M.: Physical education and sport, 1988).

 Traditional methods of functional diagnostics include three stages: first, at rest, the initial indicators are determined that are supposed to be studied, then the dosed load is given and the nature of the reaction of these indicators is determined, after which the recovery period is studied, i.e., the time they return to their original value. At the same time, both the indicators measured in an emphasis lying down, while running, jumping exercises, etc., and the measured indicators of the nature of the reaction to them - pulse, blood pressure, respiratory rate, pulmonary ventilation, ECG, etc., are very diverse and contradictory . (A.G. Dembo. On functional diagnostics in sports medicine. - M.: Soyuzexportobespechenie, 1974, Belov V.I. Determining the level of health and optimal physical activity of those engaged in health-improving training. - M.: Theory and practice of physical culture, 1989 , N 3).

 There is also a method of assessing a person’s physical condition, taking into account his age, gender, lifestyle, etc., in which the cardiovascular, neuromuscular, respiratory and other body systems are tested during cyclic exposure to physical loads (Kulik I.V. The definition of physical performance in the clinic and sports. - M .: Medicine, 1979). However, the above methods, firstly, do not allow to identify the optimal combination of test effects and physical indicators measured in this case for the comprehensive diagnosis of a physical condition, and secondly, the criteria for its assessment proposed in them are largely subjective due to the lack of justification for choosing type of test effects, and assessment (point, power, etc.), measured with this indicators.

 The closest analogue of the proposed method for assessing the reserves of physical health and working capacity of the population is the method consisting in the passive, active and restorative phases of diagnosis, while the passive diagnosis phase determines the weight coefficient, resting pulse, blood pressure, vital indicator of breathing using a spirometer, the maximum oxygen consumption reflecting aerobic performance; in the phase of active diagnostics, the flexibility of the spine is assessed in the test with a forward inclination from the bend position on the gymnastics bench with the fingers fixing for a possible lower point on the measuring line for two seconds, the visual-motor reaction in the test with the falling rule taken, the strength endurance of the muscles of the hands and the shoulder girdle by measuring the number of push-ups from the floor, performed in 30 s, the strength endurance of the abdominal muscles, determined by the number of movements performed in 30 s from the supine position Pina with outstretched hands behind his head in a sitting position in the group with girth knee feet with both hands; in the recovery phase of the diagnosis, the recoverability of the pulse is determined (in the Ruffier test), and the assessment is carried out by obtaining a generalized indicator in the form of an index of the physical condition. (Dushanin S.A. et al. Self-control of a physical condition. - M.: Health, 1980).

 In this case, the measurement of flexibility is carried out by registering the point of touch with the fingers of the hand mark below or above the zero point (it is at the stop level) when performing a forward bend from a standing position on a step with legs straightened at the knees and fixing the touch for two seconds. The speed of the compression reaction is evaluated by the "relay" test by the compression speed with the strongest hand of the falling ruler, for which the distance from the lower edge of the palm (previously extended forward with the fingers open, palm edge down) is measured at the time the ruler is compressed to the zero mark of the ruler, which before lowering it parallel to the palm of the subject at a distance of 1-2 cm.

 The dynamic force is estimated by measuring the maximum height of the upward jump from a place.

Speed endurance is estimated by calculating the maximum frequency of lifting straight legs to an angle of 90 ^o from a supine position for 30 s.

 Speed-strength endurance is estimated by calculating the maximum frequency of flexion and extension of the arms while lying down ("push-up") for 30 s.

 Total endurance is determined in an indirect way by registering the fixed state of a physical indicator (for example, heart rate) during a certain time of exposure to a variety of physical activities (running, swimming, cycling, rowing, skiing or ice skating).

 Measuring operations of the recovery phase are reduced to measuring the pulse before and after the perception of physical activity (for example, before and after 20 deep squats for 40 s or before and after a 10-minute run with a 10-minute pause after it).

 The assessment of the physical condition of a person is carried out in this case by simply summing up the number of points assigned according to the measurement results of the corresponding physical indicators.

 This method allows you to give a comprehensive assessment of the physical condition of the subject and evaluate the individual aspects of his body, however, he has the following main disadvantages.

 Both the complex of measured indicators of the active phase of diagnosis and the implemented nature of the test effects (their type, intensity and dynamics of implementation) do not allow to reliably determine the physical condition and reserve capabilities of the body and do not provide the required information content of the diagnosis.

 This is because, firstly, the active phase of the diagnosis in the known method does not imply and does not prescribe the implementation of its inherent test effects, which follow in the form of a single complex and in a certain sequence with or without fixed pauses, and the lack of taking into account the state of the organism causes and the unreliability of the results of the subsequent testing impact, because ignores the dynamics of relaxation processes during the phase of active diagnosis itself and, therefore, does not reveal the adaptive capabilities of the body. Secondly, the practice of carrying out functional diagnostics of the physical condition and comparing the results obtained with subsequent observations of the state of the test person indicates that the information obtained as a result of the listed testing effects inherent in the known method does not allow a reliable assessment of a number of indicators that really characterizing the physical state of the human body, namely, to assess the state of its cardiovascular system and aerobic Moznosti, which also reduces the information content and accuracy of diagnosis.

 In addition, the test effects and the measured parameters of the recovery phase suggest the determination of the body's response to physical effects, the nature of which is different from the nature of the test effects carried out in the active phase of diagnosis. This circumstance also reduces the reliability of assessing the physical condition and reserve capabilities of a person, since this ignores (does not take into account) the characteristics of the cumulative reaction of the body to the combined effect carried out in the active phase of diagnosis, which in fact is the desired result, given the fact that it is the complex the active phase should ensure the manifestation and registration of such indicators, the totality of which adequately reflects the physical condition and reserve capabilities of the body.

 And, finally, the classification of diagnostic results also seems to be quite subjective, both due to the fact that the assigned number of points is made without taking into account the characteristics of the factors noted above in the analysis of the active and recovery phases of diagnosis, and due to the lack of proper physiological justification of the number of points for most physical indicators, measured at diagnosis.

Known methods also do not allow:
- provide an assessment of the individual index of physical condition;
- issue normative indicators of the ideal psychophysical state, taking into account age, gender, weight and height, developed by experts of the World Health Organization and ensure their comparison with individual ones;
- give out indicators of the vital physiological systems of your body, namely: the state of the cardiovascular and respiratory systems, overall performance, aerobic capabilities of the body, the ratio of weight and height, the level of development of the muscular system and a number of motor qualities;
- Get recommendations on individual motor mode.

 Known methods do not allow to obtain an integral numerical indicator of physical health and the presence (or absence) of reserve capabilities of the human body - an individual index of physical condition, estimated using a computer program on a 6-point scale (from 0.5 to 6.0), which allows to evaluate a single scale as a specific person, and to compare among themselves individual people, groups, regions.

The objectives of the proposed method are:
- assessment of the reserves of physical health and health of each person;
- a real assessment and monitoring of the level of health of the population, especially children and adolescents;
- training in methods of self-control and assessment of the physical health of each person;
- identification and timely elimination of physical defects and risk factors of the human body;
- issuing timely recommendations on an individual motor regime;
- determining the individual path to health.

 These problems are solved in the proposed method for assessing the reserves of physical health and working capacity of the population, which consists in a passive, active recovery phase of diagnosis, while the passive diagnosis phase determines the weight coefficient, pulse at rest, blood pressure, vital indicator of breathing using a spirometer, maximum oxygen consumption showing aerobic performance, the phase of active diagnostics assesses the flexibility of the spine in the test with an incline forward from a standing position on a gymnastic bench with a fixation of the fingers for two seconds of a possible lower point on the measuring ruler, the visual-motor reaction in the test with the capture of the falling ruler, strength endurance of the muscles of the hands and shoulder girdle by measuring the number of push-ups from the floor, performed in 30 s, strength endurance of the muscles of the abdominal belt, determined by the number of movements performed in 30 s from the supine position with the arms extended behind the head, to the sitting position in a group with the girth of the knees of the legs with both hands, in the recovery phase of the diagnosis is determined by the recovery rate of the pulse (in the Ruffier test), and the assessment is carried out by obtaining a generalized indicator in the form of an index of the physical condition, the active phase additionally assesses resistance to hypoxia by arbitrarily maximizing respiratory arrest, coordination of movements, determined together with the throwing into the wall in a marked circle with a diameter of 50 cm and catching balls bouncing off the wall at a distance of 3 m, the overall performance determined in the step test with a consistent taken for 3 min for each of the three steps of different heights, the stroke volume of blood in a three-step step test, while the numerical expression of each separately applied indicator is translated into weight coefficients relative to the normative indicators for subjects of different age and gender, evaluating the state of a particular physiological system, summation of weight coefficients, weight coefficients characterizing motor activity, smoking intensity, intensity are added to the resulting amount alcohol consumption, obtained by self-assessment by the examinees, on the basis of the obtained index of physical condition, assess the physical condition and health reserves by comparing it with the indicators of the scale for assessing the index of the state of human health, while assessing the state of physical health and working capacity as excellent when finding the obtained index of physical condition in points in the range of 5.0-6.0; good in the range of 4.0-4.9; satisfactory in the range of 3.0-3.9; bad - 2.0-2.9; very poor 1.4-1.9; critical 0.1-1.3.

According to the proposed method, testing is carried out in three main areas:
1. Physical development and functional and somatic indicators (height, weight, blood pressure, lung capacity (VC), respiratory arrest, resting pulse and relaxation).

 2. The functionality of the cardiorespiratory system and the main parameters of its performance (Ruffier, PWC 150, 170).

 3. Indicators of motor qualities (coordination, strength endurance, visual-motor reaction, flexibility).

 Along with testing, a questionnaire is conducted in order to identify a lifestyle (physical activity, ecology, heredity, bad habits, etc.).

 Of the variety of indicators of the state of the body of the subject according to the proposed method include only those that are the most informative and widely used in the practice of mass screening of the population and cover the most important properties of human health.

Among these indicators according to the present method include the following:
weight coefficient;
pulse at rest (heart rate - heart rate);
blood pressure (blood pressure, systolic, diastolic pressure);
vital indicator (vital capacity of the lungs - VC);
resistance to hypoxia (hypoxic test Stange);
visual-motor reaction (ZDR);
adaptability of the cardiovascular system;
spinal flexibility;
strength endurance of the muscles of the hands and shoulder girdle;
strength endurance of the abdominal muscles;
coordination of movements;
overall performance;
oxygen consumption;
stroke volume of blood;
minute volume of blood circulation;
maximum pulmonary ventilation;
pulse recovery;
ability to relax.

 Based on some of these indicators, well-known integral characteristics are calculated, in particular, the individual index of the physical condition (IFS) of the human body is calculated (Fudin N.A. Comprehensive program for assessing the state of health and functional capabilities of the human body. - M .: ARiNA, 1996).

 In the proposed method, additional indicators are used, including those characterizing motor activity, smoking intensity, and alcohol consumption.

 The individual index of the physical condition of the organism of the subject according to the present method is determined using the developed evaluation scale, which is also used to evaluate individual physiological parameters that reflect the potential of the functional systems of the body. The normative and evaluation table for each measured or calculated indicator is focused on the physical characteristics of the age and gender of the subjects, expressing each indicator of a person by the value of points on a six-level scale. This approach allows you to compare all categories of the population in a single relative measurement system to assess the level of physical condition and reserve capabilities of the human body.

 The method of calculating an individual index of physical condition (IFS) is based on the use of a system of weighting coefficients for each of the measured psychophysical parameters.

 Numerical weighting coefficients - analogues of psychophysical parameters are determined on the basis of factor analysis and expert assessment for age categories of the population.

 Consider the implementation of the proposed method and the procedure for obtaining the indicators used in the method in the passive, active and recovery phases of diagnosis.

Determination of weight coefficient
The method of calculating the coefficient and normative and evaluation tables are based on determining the number of grams of body weight per 1 cm of its growth. The accuracy of the assessment will be higher if we take into account the type of addition of the human body - normosthenic, asthenic or hypersthenic. With these features in mind, normative body weight tables have been developed for people of different height, gender and age.

 This program uses weight-gain coefficients proposed in (Orlov V.A. et al. A comprehensive program for assessing the state of health and functional capabilities of the human body. - M .: ARiNA, M., 1996). These coefficients are presented in table. 1.

 The algorithm for determining the qualitative assessment of the weight-bearing index (Fig. 1) for a particular person in a computer program consists in a direct enumeration of the table coefficients depending on gender and type of body composition. The coefficient of the table is calculated by dividing the weight of a person in grams by his height in centimeters.

Pulse at rest (heart rate - heart rate)
This indicator is important in assessing the state of the heart and vascular system. The heart rate (HR) at rest is calculated by palpation for 1 min on the radial or temporal artery in a sitting position after a 5-minute rest. The rarer the pulse, the more effective the work of the heart. At a heart rate of 75 beats / min, the duration of one heart cycle is on average 0.8 s, of which 0.3 s are for ventricular contraction and 0.5 s for their relaxation and rest. A well-trained heart at rest is reduced 40-50 times in 1 min, providing optimal blood circulation and lengthening the pause of rest and recovery for the heart muscle itself. A detrained heart with a weakened heart muscle is usually characterized by an increased frequency of contractions at rest. A simple assessment of the functional state of the heart is based on this feature. In the proposed method, the entire range of possible heart rate values at rest is divided into 6 zones, each of which has a qualitative assessment (table. 2).

 The algorithm for determining a qualitative assessment of heart rate at rest (Fig. 2) consists in sequentially sorting the boundary values of heart rate for a specific qualitative assessment, depending on the measured value of the heart rate and the dependence on gender and age of the person being examined.

Arterial pressure
Arterial pressure (BP) at rest is measured by the standard method on the brachial artery in a sitting position after 5 minutes of rest. Blood pressure indicators characterize the state of the circulatory system and, in particular, the general peripheral resistance to blood flow. Direct measurements of blood pressure in different vessels show that in large and medium arteries the blood pressure drops by only 10%, and in arterioles and capillaries by 85%. This means that 10% of the energy expended by the ventricles of the heart to expel blood is spent on its movement in large vessels, and 85% - on the movement of blood in arterioles and capillaries.

 A well-developed capillary network (the sum of the diameters of all capillaries is approximately 500 - 600 times larger than the diameter of the aorta) provides optimal blood circulation, while blocking a certain part of the capillary network leads to excessive peripheral resistance for blood flow, increased blood pressure and excessive mechanical stress on the heart.

 In healthy adults, the maximum blood pressure at rest is 105 - 120 mm Hg. With age, the maximum blood pressure rises by 5 - 10%. The minimum blood pressure in adults is on average 60 - 80 mm Hg. The pulse pressure or pulse difference is 35-50 mm. There are no differences in blood pressure standards between men and women, but the majority of authors distinguish age-related blood pressure standards.

To determine the proper individual norm of blood pressure in this work, the following form is used (V. Dubrovsky. Sports medicine. - M.: VLADOS, 1999):
men:
HELL _max = 109 + 0.5 • age + 0.1 • body weight;
BP _min = 74 + 0.1 • age + 0.15 • body weight;
women:
HELL _max = 102 + 0.7 • age + 0.15 • body weight;
HELL _min = 78 + 0.17 • age + 0.15 • body weight.

 As can be seen from the formulas, the algorithm for determining the individual norm of blood pressure is quite simple, to calculate it, you need to know the age and body weight of the subject. In this method, a qualitative assessment of resting blood pressure is performed on a six-point scale (table. 3).

 The algorithm for determining a qualitative assessment of the blood pressure indicator (Fig. 3) is also based on direct enumeration and comparison of the normative and measured values of the indicator taking into account the age of the subject, however the enumeration here is somewhat more complicated and will require more time, since the standards are a structure of two indicators (upper and lower blood pressure).

Vital indicator
The vital indicator is determined after measuring the vital capacity of the lungs (VC) using a spirometer (water or mechanical). Calculations are made by dividing the value of VC in milliliters by body weight in kilograms. An underdeveloped pulmonary apparatus with a small respiratory volume can serve as one of the reasons for the poor oxygen supply of the body even with little physical activity. With a prolonged absence of physical exertion, intercostal and other muscles that provide respiratory movements reduce their performance and do not reveal the alveolar area in full. Under these conditions, part of the unused alveoli of the pulmonary parenchyma cease to fulfill their function. In the absence of physical exertion, lung volume and vital indicator gradually decrease, which leads to a decrease in gas exchange efficiency and a lack of oxygen even with light physical exertion.

 In the table. 4 shows a six-level scale for assessing vital indicators for people of different ages and sexes. In FIG. 4 presents an algorithm for determining a qualitative assessment of the indicator VC.

Hypoxia resistance
A hypoxic test (Stange test) consists in an arbitrarily-maximum breath holding, which is performed in a sitting position without previous hyperventilation. The examinee takes a deep breath, exhales slightly and at this stops breathing for the maximum possible time. The interpretation of the separately considered indicator of breath holding is difficult, because it depends on such subjective factors as the volitional qualities of the person and the sensitivity of the chemoreceptors to changes in the voltage of carbon dioxide in the blood. However, in conjunction with blood pressure, heart rate, vital indicator and weight index, the hypoxic test carries a fairly objective information load in assessing human health. When constructing an algorithm for obtaining a qualitative assessment, in this paper we use a normative-estimated six-point scale (Table 5). An algorithm for determining a qualitative assessment of an indicator is shown in FIG. 5.

Visual-motor reaction
The visual-motor reaction is evaluated in the test with the capture of the falling line. Subject stands with arm extended forward at shoulder level. The researcher sets a ruler 40-50 cm long with a zero mark at the level of the index and thumb of the subject. When both are ready for the test, the line suddenly drops and begins to fall vertically down. The test subject, seeing the fall of the ruler, must react and catch it with the movement of only one brush. The distance that the falling line will cover will show the magnitude of the visual-motor reaction. The test is repeated three times. The best result is recorded. In the table. Figure 6 shows the six-point rating scale for this test, which is based on the static processing of the results of our own mass examinations of the adult population.

Flexibility of the lumbosacral spine
The flexibility of the lumbosacral spine is measured in the test with an incline forward from a standing position on the gymnastics bench with the fingers fixing for two seconds a possible lower point on the measuring ruler. During bending, bending the knees is not allowed. The zero mark of the ruler is set at the bench level. If the subject does not reach the zero mark, his flexibility is assessed by the number of centimeters with a minus sign (-). With good mobility in the lumbosacral spine, the result is expressed in centimeters with a plus sign (+). The flexibility in this test reflects the physical condition of the lumbosacral spine, as well as the extension of the ligaments and muscle apparatus of the posterior back and lower extremities. People who work under conditions of physical inactivity and are not involved in physical exercises often have a marked limitation on the flexibility of this spine, which increases the risk of osteochondrosis, lumbosacral radiculitis, and other chronic diseases. In the table. 7 presents the results of mass examinations of adults aged 30 to 55 years, employed in various fields of production and management, the activity of which proceeds under conditions of hypodynamics. The six-point scale allows you to perform a qualitative assessment of the flexibility of the spine, sprains of the ligaments and muscle system. In FIG. 6 shows an algorithm for determining a qualitative assessment of the index of flexibility of the spine.

Strength of the muscles of the arms and shoulder girdle
The strength endurance of the muscles of the hands and shoulder girdle is measured by the number of push-ups from the floor, performed in 30 s. Men do push-ups with strictly straight bodies, touching the floor with only their toes and palms of their hands. Women push up, leaning on the floor with their knees. In the table. 8 shows the rating scale used in the method for men and women. In FIG. 7 presents an algorithm for determining a qualitative assessment of the strength endurance of the muscles of the hands and shoulder girdle.

Abdominal Strength
The strength endurance of the abdominal muscles is determined by the number of movements performed in 30 s from the supine position with the arms extended behind the head to the sitting position in a group with the girth of the knees of the legs with both hands. In the table. 9 shows the rating scale used in this method. In FIG. Figure 8 shows an algorithm for determining a qualitative assessment of the strength endurance of the abdominal muscles.

Coordination of movements
Coordination of movements (dexterity) is determined in the test with throwing into the wall in a designated circle with a diameter of 50 cm and catching balls bouncing off the wall at a distance of 3 m. The test subject successively throws 6 balls into the wall at a level of 2-3 m from the floor and catches bouncing balls, three times with your left and three with your right hand. The scale of a qualitative assessment of the results of testing of coordination of movements used in this method is given in table. 10 in FIG. Figure 9 presents an algorithm for determining the qualitative assessment of the index of coordination of movements.

Heart rate recovery (in Ruffier test)
The testing procedure begins with a measurement of heart rate at rest, sitting, after a 5-minute rest (P ₁ ). Then 30 deep squats are performed in 45 s (under the metronome) with arms straightened in front of you. During the rise, the arms fall along the torso.

 The physical work performed by a person for 30 squats depends on his height and the amplitude of the vertical movement of part of his body (about 80%) and per 1 kg of weight is from 13 to 18 kgm / kg in 45 s. For example, a person with a body weight of 75 kg, when doing 30 squats in 45 s, will do physical work in the range of 975 - 1350 kgm.

Immediately after the end of 30 squats, the pulse (P ₂ ) is measured in a standing position, and after a minute rest - in a sitting position (P ₃ ).

и классифицируется по табл. 11.Assessment of the rate of pulse recovery (Ruffier index) is performed according to the formula:

and is classified according to the table. eleven.

 A high level of reserve capabilities of the cardiovascular system ensures the fulfillment of this test load mainly due to an increase in stroke volume of the blood with a slight increase in the pulse rate, while a depleted heart and blood vessels will lead to an increase in heart rate and delayed recovery of the pulse after exercise, which will be accompanied by a high index Ruffier. Figure 10 presents the algorithm for determining a qualitative assessment of the rate of recovery of the pulse (in the Ruffier test).

Overall performance
This is one of the most important components of human health. In world practice, a large number of different test programs have been developed for the integrated assessment of these parameters. The most accurate and advanced programs are implemented in the laboratory using bicycle ergometers and treadmills with automatic control of load power and measuring the response of the functional systems of the body. Evaluation of indicators of a person’s physical working capacity at a pulse of 130, 150 or 170 beats / min, as well as determining the maximum aerobic power through measuring the maximum level of oxygen consumption, can accurately assess the state of physiological systems of the body, the availability of reserve capabilities (or lack thereof), first of all cardiovascular, respiratory and neuromuscular systems.

 For mass surveys of the population, the Harvard step test is often used with a step on the step, as well as its various modifications. The proposed method uses a nine-minute step test with successive lifting for 3 minutes for each of the three steps with a height of 20, 30 and 40 cm. For women, the steps are 10, 20 and 30 cm respectively.

 The testing procedure consists in the fact that the researched performs a climb to the 1st step, the lowest, within 3 minutes. Immediately after the end, heart rate is calculated for 10 s. Then, without a pause, our progress continues for 3 minutes to the 2nd step. The pulse is again counted for 10 s, after which the climb to the 3rd step is performed without a pause. After the end, the heart rate is calculated. Heart rates are converted to beats / min. The pace of stepping on the step is constant - 30 lifts in 1 min. A metronome is used to maintain the pace of the exercise.

Calculation of the power of the load when striding on the steps is carried out according to the formula proposed by P.M. Amosov
N = M • H • T • 1.33,
where N is the load power when treading a step in kgm / min;
M - body weight in kg;
H - step height in meters;
T is the number of lifts per step in 1 min;
1.33 - correction factor, taking into account the work performed during the descent from the stairs.

 The general characteristics of the 9-minute step test for men on steps 20, 30 and 40 cm at a pace of 30 times in 1 minute (3 minutes on each step) are given in Table. 12. The calculations in this table are made for a person weighing 70 kg. As can be seen from the table, the power of the test load was: at the step of 20 cm - 578 kgm / min, 30 cm - 838 kgm / min and 40 cm - 1157 kgm / min. The total amount of work for 9 minutes of stripping (all three steps) is 7719 kgm. The maximum heart rate during sequential stepping on each of the three steps is 137, 162 and 175 beats / min, respectively. The oxygen consumption on the 20 cm step was 1.64 l / min; 30 cm - 2.10 l / min; on a step of 40 cm - 2.5 l / min.

 The calculations were performed for a body weight of 70 kg.

N - power output (kgm / min);
Heart rate - heart rate (bpm);
PO ₂ - oxygen consumption (l / min);
IOC - minute volume of blood flow (l / min);
LV - pulmonary ventilation (l / min).

 To deliver the necessary amount of oxygen to the working muscles and organs, the subjects had to carry out quite intensive ventilation of the lungs, which averaged 75-80 l / min on a 30 cm step and 90-95 l / min on a 40 cm step. Using the formulas of the dependence of the load power, heart rate, oxygen consumption and minute volume of blood flow presented in the literature, the average values of cardiac output and stroke volume of blood were determined at each of the three steps of the test.

 In the table. 13 shows similar characteristics of a six-minute step test on steps for women.

 In untrained adults, performing a step test on the steps may be accompanied by an increased heart rate already at the first or second step. In this case, it is proposed to focus on the recommendations of academician A.N. Amosov and stop the further test load when reaching 80% of the proposed age-related maximum heart rate. The estimated age-related maximum heart rate and the level of 80%, acceptable with a three-step test step, are given in table. fourteen.

The physiological information obtained by carrying out the proposed test presents wide opportunities for researchers. Given that in a stepwise increasing load between the power of the work performed, oxygen consumption and heart rate (up to a heart rate of 75 - 80% of the individual maximum), there is a close correlation, the following individual parameters can be calculated with the accuracy acceptable for mass examinations:
PWC ₁₃₀ , PWC ₁₅₀ , PWC ₁₇₀ - indicators of physical performance at the corresponding heart rate (kgm / min);
MPC - maximum oxygen consumption: absolute (l / min) and relative (ml / kg / min);
IOC - minute volume of blood flow (l / min);
UOK - stroke volume of blood (ml / beats);
O ₂ pulse - oxygen pulse (ml / bpm).

 To determine the value of PWC - 130, 150 or 170, a graph is constructed (Andersen and Smith-Siversten method - 1966), on the vertical axis of which there is a heart rate scale, and on the horizontal axis - the power scale of mechanical work on each of the three steps (Fig. 11) .

Heart rate indicators recorded after 3 minutes of climbing on each of the steps are plotted on the coordinates of the graph. In the case when the subject successfully completed the steps on all three steps, the calculations of PWC and IPC will achieve maximum accuracy. The connection on the graph of the measured values of the tested person’s heart rate and extrapolation of this line to the heart rate level = 170 (if this test did not achieve the heart rate value) followed by lowering the perpendicular to the power scale will determine the individual relative physical performance indicator PWC kgm / (kg / min). In FIG. 11 for test subject “A” PWC ₁₇₀ was 15.8 kgm / (kg / min), and for test subject “B” PWC ₁₇₀ was 13.2 kgm / (kg / min). To calculate the absolute value of PWC _170, you need to multiply the relative indicator by the subject's body weight.

где N₁ - мощность первой нагрузки; N₂ - мощность последней нагрузки; P₁ - ЧСС в конце первой нагрузки; P₂ - ЧСС в конце последней нагрузки.If the subject cannot fully perform the step test, then it is limited to only two steps. In this case, the accuracy of the PWC graphical definitions is reduced. In such a situation, it is better to use the formula proposed for calculations (Karpman V.P. et al. Testing in sports medicine. - M.: Physical education and sports, 1988):

where N ₁ is the power of the first load; N ₂ - power of the last load; P ₁ - heart rate at the end of the first load; P ₂ - heart rate at the end of the last load.

The assessment of the individual relative indicator PWC ₁₇₀ , identified in the 6-minute three-step step test, is performed according to the normative table. 15. For older people or those with limitations on testing with a high heart rate, PWC ₁₅₀ is calculated and evaluated according to the normative table. 16. The algorithm for determining a qualitative assessment of the overall performance indicator is presented in FIG. 12.

Oxygen consumption
The maximum oxygen consumption (IPC) as an integral value reflecting aerobic performance was recommended by the World Health Organization as the most reliable method for assessing a person's physical performance. The individual value of BMD very reliably reflects the functional state of the cardiovascular and respiratory systems. Satisfactory and good development of the body's oxygen-transport system is an indispensable condition for intense physical performance, which provides a sufficiently high individual level of PWC ₁₇₀ . Persons who have deviations in the functional circulatory system, impaired hypodynamic parameters of the cardiovascular system (heart disease, atherosclerotic vascular lesions, etc.) have a low level of BMD. In clinical medicine, direct measurements of BMD are used to clarify the diagnosis of diseases, prognosis and evaluate the effectiveness of treatment and preventive measures.

Many authors point to a high correlation between PWC ₁₇₀ and IPC. To calculate the value of the IPC in this development, the formula of V.L. Karpman is used
IPC = 1.7 PWC ₁₇₀ + 1240,
where PWC ₁₇₀ is expressed in absolute value (kgm / min).

 After calculating the individual absolute value of the IPC (in l / min), it is necessary to determine its relative value by dividing this value by the weight of the subject (in kg) and express the IPC in ml (kg / min), after which the obtained value is estimated according to the normative table. 17. In FIG. 13 presents an algorithm for determining a qualitative assessment of an indicator of oxygen consumption.

Stroke volume of blood
PWC ₁₇₀ and heart volume have a strong enough connection. The correlation coefficient between them approximately reaches r = +0.62, and for highly trained athletes, the relationship between the PWC ₁₇₀ values and the maximum stroke volume of blood (Q ax 0) reaches the value r = +0.851. The maximum stroke volume of blood is calculated by the formula
Q _max (in ml) = 0.08 PWC ₁₇₀ (in kgm / min) + 25
The standard error of this formula is ± 25 ml at a 90% probability level.

With a certain degree of conditionality, this dependence can be extended to the category of untrained practically healthy adults and the stroke volume of blood can be calculated based on the PWC ₁₇₀ measured in the step test. The maximum shock (systolic) volume of blood is well illustrated by the capacity of the left ventricle and the power of the heart muscle, which by its contraction ejects this volume of blood into the aorta. This indicator is quite clear and convincing for all categories of subjects. Assessment of the maximum stroke volume of blood, calculated according to the above formula, is performed using the normative table. 18. In FIG. 14 is an algorithm for determining a qualitative assessment of stroke volume of blood.

The minute volume of blood circulation is associated with stroke through the heart rate and is measured by the formula
Q _min = Q ax 0 • P ₁
Heart rate recovery
The three-step step test represents a load of submaximal power and presents increased requirements for all functional systems of the body. In this case, the heart rate and blood pressure may increase to 80 - 100% of the individual maximum values.

 As is known, the rate of restoration of physiological functions after performing submaximal loads reflects well the physical condition and effectiveness of the compensatory mechanisms of the human body. Therefore, monitoring the dynamics of heart rate and blood pressure within 1-3 minutes of the recovery period can significantly expand and specify the physiological state of the human body.

 After performing a step test at three steps and measuring at the finish of the heart rate for 10 s, the subject should continue walking easily for several minutes and after 1, 2 and 3 minutes of recovery, his heart rate is measured.

 An estimate of the rate of heart rate recovery after 1 minute of rest after a six-minute step test (provided that at the finish of the test the heart rate level corresponds to the age maximum) is presented in Table. 19. The algorithm for determining a qualitative assessment of the heart rate recovery rate is shown in FIG. fifteen.

Calculation of an individual index of a physical condition (IFS) of a human body
A comprehensive methodology for assessing the psychophysical state of health and the reserve capabilities of the human body is based on a six-level assessment scale, which is also used for the qualitative assessment of individual physiological parameters that reflect the physical qualities and potential of the functional systems of the body. Regulatory and evaluation tables for each measured or calculated indicator take into account the specific features of the age and gender of the subjects, expressing each indicator by the numerical value of the points on a six-level scale. This approach allows you to compare all categories of the population in a single measurement system and use the integrated scale to assess the physical condition index (IPF) and the reserve capabilities of the human body.

 The method of calculating an individual health status index is based on the use of a system of weight coefficients for each of the 18 measured parameters. In the table. Figure 20 shows the structure and normative value of the weight coefficients of each indicator included in a comprehensive program for assessing human health.

Three subjective parameters are included in the IFS counting system, which are evaluated independently by the person being examined. These are three factors that actively affect the health and physical condition of a person:
physical activity;
smoking intensity;
the intensity of alcohol consumption.

 Calculation of individual IFS is carried out after a full-exchange examination of a person according to the program described above according to the following algorithm: at the first stage, the numerical expression of each individually measured indicator is translated into a point-based evaluation system that allows you to interpret the state of a specific physiological system of the human body. The second step in the algorithm for calculating the IFS is to find the table. 20 values of weights of each of 18 parameters. For example, according to the self-assessment of the subject, motor activity corresponded to 3 points; smoking intensity is equal to 1 point; the intensity of alcohol consumption is 6 points. According to the table 20 determine the values of weights for these parameters. They are equal to: 0.15; 0.01; 0.20. Summing this part out of all 18 weighting factors (0.15 + 0.01 + 0.20 = 0.36) will determine the value of the subjectively determined value in the total integral of the IFS.

An objective examination of the same person, for example, revealed the following weights:
Heart rate at rest - 0.16
HELL - 0.20
vital indicator - 0.10
Quetelet index - 0.20
breath holding - 0.08
Ruffier index - 0.25
ZDR - 0.12
spinal flexibility - 0.15
movement coordination - 0.08
muscle strength of the shoulder girdle - 0.10
abdominals - 0.20
PWC - 0.50
IPC - 0.50
stroke volume of blood - 0.08
pulse recovery rate - 0.04
The summation of this part of the weight coefficients of this subject will be equal to 2.76 points, and the combination of subjective (0.36) and objective (2.76) will determine the individual human IFS equal to 3.12.

 Thus, examination according to this comprehensive program and determining the state of health of the human body can be estimated by the value of IF in the range from 0.1 to 6.0 points. The rating scale for assessing IFS is presented in table. 21.

 Persons with a high degree of fitness of the body and not having “weak” links in the functional systems of the body should fall into the category of people with excellent physical condition and an IPF value of 5.0 - 6.0.

 The category of people with good physical condition (IPF is 4.0 - 4.9) will have smoothed manifestations of individual weak links in functional systems and very high reserve capacity with very effective interaction of almost all functional systems of the body.

 A group of people with a satisfactory physical condition (IPF is 3.0 - 3.9) may have some high and low levels of reserve capacity of the body. Experience shows that this category of people often has separate risk factors for coronary heart disease (noticeable overweight, high blood pressure, decreased lung capacity, etc.).

 The group of people with poor physical condition (IPF is 2.0 - 2.9) will include people who have a significant number of individual weak links in the functional systems of the body. As a rule, this is overweight, increased blood pressure, decreased performance, limited capabilities of the cardiovascular and respiratory systems.

 The category of persons with a very poor physical condition (IFS is 1.4 - 1.9) for most of the measured physiological parameters will be assigned to the pre-pathological condition, i.e. to be on the verge of norm and pathology. As a rule, these are people who are unable to fully implement the entire test load program. A comparative analysis of the proposed solution with an analogue shows that the claimed method differs from the prototype in that at the stage of the active phase of diagnosis, physical effects are carried out in the form of a single, fixed in time, sequentially with certain pauses, the complex of testing effects, and the testing effects themselves include forced breath holding, performing squats with a given fixed frequency, performing exercises for grouping in dix lying and performing a predetermined test mode, and the load on the stepper ups Uneven ground. The stage of the recovery phase of diagnosis is carried out in a passive mode with the registration of the total body reaction to the complex effect, perceived at the stage of the active phase of diagnosis. Thus, the claimed method meets the criteria of the invention of "novelty." From the above sources of information, methods of complex functional diagnostics of the physical state of the human body are known, in which the stage of the active phase of diagnostics includes the implementation of a number of physical effects and the measurement of the corresponding physical indicators, including tests with forced holding of breath, tests for attachment and grouping. However, these tests, known per se, were not used as a single complex and in the volume of their declared combination, which, along with the identified sequence and dynamics of their implementation, made it possible to reliably determine, with a minimum number of representative indicators, the level of the basic systems characterizing a person’s physical condition — cardio -vascular, respiratory and neuromuscular, taking into account the morphology and physical performance of the body. This became possible due to the fact that the set of essential features characterizing the claimed method allows to identify and comprehensively evaluate the mutual influence of such indicators of the physical condition of the body as its adaptive abilities, aerobic capabilities, the state of the heart muscle and the synchronization of the functioning of the cardiorespiratory system. In addition, the phase of the active diagnostic phase contains a test for the pace of stepping up to uneven grounds, which was not generally known in the practice of functional diagnostics and, therefore, its relationship and interdependence with traditional testing influences was not known.

 The proposed method for a comprehensive functional diagnosis of the physical state of the human body is implemented as follows.

 The subject at rest (stage of the passive phase of diagnosis) measures the values of the following indicators: heart rate (bpm); HELL (mmHg); vital indicator (ml / kg); weight-bearing indicator (rel. units). After that, by connecting the discharge electrodes to record the electrocardiogram, the patient in a sitting position is subjected to a breath hold test, during which the time of synchronous functioning of the cardiorespiratory system is recorded. Immediately at the end of the test, the subject with the frequency specified by the metronome performs thirty deep squats for 45 s and the index of heart performance is recorded, after which the subject is restored sitting for 3 minutes. After recovery, the speed of the compression reaction is measured. This test is carried out three times in a row and the best of the results obtained is offset. Immediately after this, a test for spinal flexibility is performed. To do this, the subject, standing on a step with his legs straightened at the knees, performs a forward bend with the touch of the mark relative to the zero point, which is at the level of the feet, and maintaining the pose for at least 2 s. Further, without a break in recovery, the examinee performs push-ups from the floor from the supine position for 30 s, trying to perform them the maximum number of times (the number of squeezes is recorded), after which the subject is restored to the sitting position during a two-minute pause. After recovery, the subject occupies a supine position and within 30 s performs groupings in a sitting position with the arms around the knees and then assuming a supine position, while trying to complete the maximum number of groups in the allotted time (the number of groups is recorded). Then the subject is restored in a sitting position for three minutes. After recovery, the subject performs step ascents at a pace of 30 cycles in 1 min to unequal bases, for which, initially, during the first three minutes, he performs step ascents and descents to a step 10 (or 15, or 20 cm) high. And the final three minutes (the whole test lasts 9 minutes), stepping ups at the same pace are carried out on a step 30 or 40 cm high. Moreover, all three stages of this test are carried out without rest - continuously. At the end of the step test, the subject takes a sitting position and measures the rate of recovery of the heart rate to a value corresponding to the resting state recorded at the passive phase of the diagnosis. The duration of the entire phase of the active and recovery phases is 40-42 minutes. Then calculate the value of PWC 170 (150). IPC and CLC and the tables determine the individual physical state indices corresponding to them and all changed physical indicators. In addition, subjective factors, such as motor activity (hour / week), are also taken into account; smoking (whitefish / day); alcohol consumption (l / wk). Using the values of the individual indices of the physical state, a profile of the physical state is constructed and the integral index of the physical state (IFS) is determined. The results of the examination are processed using a computer; typical examples of the survey are given in Appendix 1, 2.

 Using the proposed method for diagnosing the physical state of the human body allows you to quickly determine the physical condition of the body and its reserve capabilities with sufficient reliability and responsibility for mass examinations, which in turn allows timely correction of its physical activity, lifestyle, etc. , as well as recommend appropriate rehabilitation and recovery regimes.

Claims (1)

 A method for assessing the reserves of physical health and working capacity of the population, which consists in the passive, active and recovery phases of diagnosis, while the passive diagnosis phase determines the weight coefficient, pulse at rest, blood pressure, vital indicator using a spirometer, oxygen consumption, which displays aerobic performance, the phase of active diagnostics assess the flexibility of the spine in the test with an inclination forward from a standing position on the gymnastic bench with fixation by fingers over e 2 with a possible lower point on the measuring ruler, assess the visual-motor reaction in the test with the capture of the falling ruler, the strength endurance of the muscles of the hands and shoulder girdle by measuring the number of push-ups from the floor, performed in 30 s, the strength endurance of the abdominal muscles, determined by the number of performed 30 s of movements from a supine position with arms outstretched behind the head, to a sitting position with a girth of the knees of the legs with both hands, in the recovery phase of diagnosis, the recoverability of the b) (in the Ruffier test), and the assessment is carried out by obtaining a generalized indicator in the form of an index of the physical condition, characterized in that in the active phase they additionally evaluate resistance to hypoxia by arbitrarily maximizing respiratory retention, coordination of movements, determined in the test with throwing at the wall in the designated a circle with a diameter of 50 cm and catching balls bouncing off the wall at a distance of 3 m, the overall performance determined in the six-minute step test with a consecutive rise for 2 minutes for each of three steps of different heights, the stroke volume of blood in a three-step step test, and the numerical expression of each separately measured indicator is translated into weight coefficients relative to the normative indicators for the examined patient of different age and gender, assessing the state of a particular physiological system, summing the weight coefficients, add to the resulting amount weight coefficients characterizing locomotor activity, smoking intensity, intensity of alcohol consumption, obtained e by scoring self-esteem by the examinees, according to the obtained index of the physical state, the physical state and health reserves are estimated by comparing it with the indicators of the scale for assessing the index of the state of health of the human body, while assessing the state of physical health and working capacity as excellent when the obtained physical state index is in scores in the range 5.0-6.0; good in the range of 4.0 - 4.9; satisfactory in the range of 3.0 - 3.9; poor 2.0 - 2.9; very poor 1.4 - 1.9; critical 0.1 - 1.3.

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