RU2379017C1 - Method of physical rehabilitation of patients with ischemic heart disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to therapeutic exercises. Respiratory trainings are carried out. For patients with ischemic heart disease - on training sports simulator "Samozdrav" 3 times per day respiratory trainings are carried out, after 6 hours, with 1 minute increase of respiration time daily during 10-14 days until respiration time equals 10 minutes. 3 hours after 2-d training bicycle training during 10 minutes is carried out daily, increase of respiration time on training simulator is carried out basing on control of heart beat rate, arterial pressure, time of air holding at inhale and exhale, respiratory rate, intensity performed during bicycle training.

EFFECT: method allows to increase efficiency of physical rehabilitation of patients of IHD, individualise rehabilitation programs.

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Description

The invention relates to restorative medicine, namely to physiotherapy exercises, and can be used in the rehabilitation of patients with coronary heart disease at the stage of aftercare in medical institutions, sanatoriums with medical rehabilitation departments. The invention is aimed at accelerating the processes of adaptation to the expansion of the motor mode.

Currently, the following forms of physical therapy are known that are used in the physical rehabilitation of patients with coronary heart disease.

Therapeutic gymnastics in sanatoriums is carried out by a group method. The exercises include exercises for all muscle groups and joints in combination with rhythmic breathing. The complexity and intensity of exercises increases from step to step. Physical activity can be increased through exercises with objects (gymnastic sticks, stuffed balls, dumbbells), the use of cyclic movements (various types of walking, jogging) and elements of outdoor sports. (one)

The number of repetitions, amplitude, pace of the exercises performed correspond to the average load. Saturation of breathing exercises 1: 2, deep breathing, breathing exercises are included with holding the breath (without straining) on inspiration. The ratio of exercises for large, medium and small joints is 1: 2: 1. The introductory and final part are held in a sitting position. (2)

The disadvantage of this method is that the pace of exercise for a given level of load is not always observed, there is no individual approach to the patient.

There is also a method of rehabilitation by determining an individual training load, using a heart rate as an indicator of myocardial oxygen consumption. Dosed training walking (terrenkur) is assigned at a pace that is calculated by the formula X = 0.042 M + 0.015 Ps + 65.5, where X is the desired walking pace, M is the threshold power of physical activity during bicycle ergometry, Ps is the heart rate at the height of the load during bicycle ergometry test. . (one)

The disadvantage of this method is that the development of shortness of breath when walking, causing the phenomenon of hyperventilation in the lungs, affects the hemodynamics during exercise, which leads to a decrease in the pace of walking. This affects the power of the load and reduces the possibility of rehabilitation in this way.

There is also known a method in which, starting from the third week from the moment of myocardial infarction, a four-month complex of early physical exertion is presented, which includes: first, a warm-up in the gym of physiotherapy exercises - a set of gymnastic exercises performed for 30-40 minutes; then training on a bicycle ergometer. The first two months, the training load on the bicycle ergometer is 50-60% of the individual threshold heart rate achieved with the bicycle ergometer test. (3)

However, the hypodynamic changes that occur in the patient’s body with the progression of angina pectoris, as a result of phobia of the pain syndrome, lead to a decrease in the reserve of the respiratory system and make it difficult to start training on exercise bikes.

The reserve of the respiratory system will be enhanced by the use of the Samozdrav fitness simulator. The basis of the application is a combination of treatment with normobaric hypoxytherapy with Buteyko breathing method. The simulator forms a breathing mixture of exhaled and atmospheric air, while due to the lengthening of the exhalation path, breathing becomes superficial and rapid. (four)

This helps to reduce the phenomena of hyperventilation syndrome that occur with an increase in physical activity in patients.

The disadvantage of this treatment method is that there is no differentiated approach to the treatment of various types of somatic conditions. For control, the determination of the concentration of carbon dioxide in the blood is used by measuring the minute volume of breathing using the attached capnometer. The reaction of the pulse, blood pressure, and respiratory tests to exercise is not determined, which must be done daily with the introduction of early physical exertion to patients with coronary heart disease.

The purpose of the invention is to increase the efficiency of physical rehabilitation of patients with coronary heart disease, individualization of rehabilitation programs.

This goal is achieved by the fact that patients with coronary heart disease use the simulator - Samozdrav physical education simulator 3 times a day for respiratory training, after 6 hours, with an increase in breathing time by 1 minute daily, for 10-14 days, until the breathing time reaches 10 minutes, 3 hours after the 2nd respiratory training, carry out daily cycling for 10 minutes, and the increase in breathing time on the simulator - physical training simulator "Samozdrav" is carried out on the basis of monitoring the heart rate, blood pressure niya, time delay of air on inhalation and exhalation, respiratory rate, power performed during cycling.

Clinical example: Patient S., born in 1961, was admitted to the Metallurg sanatorium for aftercare with a diagnosis of Coronary heart disease. Angina pectoris unstable with stabilization in 2 functional class. Heart failure of 1 degree. Hypertension 2 degrees. Risk 4.

The patient received medical and physiotherapeutic treatment, was engaged in medical gymnastics in a sparing, sparing and preparatory regimen.

The implementation of the method was as follows: to the patient on the simulator - physical education simulator "Samozdrav" was conducted 3 times a day breathing training, after 6 hours. The reaction of the pulse, blood pressure, and breathing tests was adequate, therefore, the respiration time, starting from one minute, increased by 1 minute daily for 10 days until the respiration time reached 10 minutes.

3 hours after the 2nd respiratory training, daily exercise for 10 minutes was carried out according to the cardioprogram at a controlled heart rate of 65% of the training heart rate.

As a result of the proposed treatment, from 3 days of training, the patient decreased shortness of breath with daily physical exertion. During the treatment in the sanatorium, the power of the performed load on a bicycle ergometer with a pulse of 93 beats per minute increased from 25 to 100 watts. Significantly improved results of breathing tests (41 s on inhalation and 30 s on exhalation). At discharge: shortness of breath does not bother, heart pain when climbing stairs to the 4th floor does not occur; daily volume of dosed walking increased to 3 km (with a total volume of walking during the day up to 5 km).

In total, in the Metallurg sanatorium, comprehensive trainings were conducted for 92 patients with coronary artery disease. The following results were obtained: an increase in the power of the performed load on the bicycle ergometer during 10-14 trainings was observed in 84% of patients; increased respiratory test results in 92% of patients; an improvement in the restoration of the pulse, respiration rate, blood pressure after physical exertion was observed in 100% of patients; 95% of patients noted an improvement in tolerance to normal exercise.

Thus, the use of the foregoing method of physical rehabilitation of patients with coronary heart disease on the simulator-gymnastics simulators “Samozdrav” and bicycle ergometers makes it possible to more effectively achieve increased exercise tolerance, increase levels of regulation, adaptation and improve the emotional state of patients.

Information sources

1. L.F. Nikolayeva, D.M. Aronov. Rehabilitation of patients with coronary heart disease. - M., 1988.

2. V.V. Arshin, L.V. Kartamysheva. Rehabilitation for diseases of the circulatory system. - Samara, 2002.

3. Patent RU 2154460, M. cl. A61B 5/00, 2000.

4. Set "Samozdrav" TU9619-001-42529619. - 2001.

Claims (1)

A method of rehabilitation of patients with coronary heart disease by conducting respiratory training, characterized in that patients with coronary heart disease use respiratory training 3 times a day for physical training simulator Samozdrav, after 6 hours, with an increase in breathing time of 1 minute daily, for 10-14 days before reaching a breathing time of 10 minutes; 3 hours after the 2nd training, daily cycling is carried out for 10 minutes, while increasing the breathing time on the simulator is based on control of the heart rate, blood pressure, time of air retention during inhalation and exhalation, respiratory rate, power performed during cycling.