RU2684240C1 - Method for physical rehabilitation of patients with comorbid pathology - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to rehabilitation science, and can be used in physical rehabilitation of patients with combination of cardiovascular pathology and arthrosis. That is ensured by walking backwards at random pace on a flat surface or as a climbing ladder with or without support on rails. Length is gradually increased from 5 to 15 minutes a day for at least 4 weeks.EFFECT: method provides preservation of walking training potential with simultaneous reduction of load on knee joints in patients with comorbid pathology.1 cl, 2 ex

Description

The invention relates to medicine, namely to rehabilitology and can be used for physical training of patients with comorbid pathology, in particular with a combination of diseases of the cardiovascular system and musculoskeletal system.

The current structure of the incidence in the economically developed countries of the world is characterized by a predominance of cardiovascular pathology. Cardiovascular diseases remain the leading cause of population death in Russia (the contribution to total mortality is 57%) [5, C.7]. The pathology of the musculoskeletal system is extremely common in the population. Osteoarthrosis (osteoarthritis) is the leading frequency disease of the musculoskeletal system, it affects about 15% of the world's population and about 65% of people over 60 [7, p. 304].

The prevalence of diseases of the cardiovascular system and musculoskeletal system causes a high probability of their combination in one patient, especially in the elderly and senile. In particular, cardiovascular diseases are observed in more than half of patients with osteoarthrosis [7, P.306].

The combination of several diseases in one patient is called comorbidity. Comorbidity complicates the management of patients not only because of the effect of mutual burdening, but also because different diseases require different, sometimes conflicting, approaches to treatment. This fully applies to the process of physical rehabilitation of patients with a combination of pathology of the cardiovascular system and musculoskeletal system.

Physical rehabilitation is recognized as the most important stage in the management of patients, designed to ensure not only the restoration of organs and systems lost as a result of the disease, but also the mobilization of the body’s reserve forces. In particular, with cardiovascular diseases, regular physical activity improves myocardial contractility, strengthens central and peripheral blood circulation, increases adaptation to physical activity, and has a beneficial effect on lipid metabolism. Physical rehabilitation is equally important in the pathology of the musculoskeletal system; it prevents the progression of morphological changes in the joints, promotes the nutrition of the cartilage and the training of stabilizer muscles of the affected joint.

However, if the basis of physical rehabilitation for cardiovascular diseases is walking [3, C.153; 4, C.125], and quite intense [5, C.27], the complex of physical exercises for osteoarthritis involves minimizing the load on the supporting process walking and the most commonly affected knee and hip joints, and for this purpose, in particular, is carried out in sitting, lying on his back, on his stomach, standing on all fours, using canes as a support [3, S.535; 6, p. 152].

Thus, walking, recognized as the most optimal method of physical rehabilitation in cardiac patients and adopted by us as a prototype, cannot be fully used in the presence of concomitant pathology of the musculoskeletal system.

The present invention aims to eliminate this drawback. We propose a method for the physical rehabilitation of patients with comorbid pathology, which aims to maintain the training potential of walking while reducing the load on the knee joints in patients with a combination of diseases of the cardiovascular system and osteoarthritis.

This goal is achieved by replacing the usual walking with back-to-back walking. The theoretical prerequisites for the application of the proposed method of rehabilitation are the following facts regarding the kinetics and kinematics of walking backwards.

1. With the same parameters of physical activity, back-to-back walking leads to a greater load on the cardiovascular and respiratory systems and a more significant oxygen consumption [9, 11], which means its greater training effect.

2. Walking with your back forward is associated with less load on the joints of the lower limb due to the lack of contact of the heel with the ground at the beginning of the support phase [12]. She also acts as one of the few natural ways to strengthen the quadriceps of the thigh (providing knee extension), which is significant for patients with arthrosis of the knee joints [3, P.536].

3. Regular training in back-to-back walking is accompanied by an improvement in the ability to maintain balance [10], which is beneficial for patients with discirculatory encephalopathy on the background of cerebrovascular diseases.

In the existing recommendations on physical therapy, the technique of back-to-back walking does not appear [1-4, 6, 8]. This methodology is not applied for the rehabilitation of patients with comorbid pathology.

The proposed method is as follows. In a patient with a combination of diseases of the cardiovascular system and the musculoskeletal system as a physical training, back-to-back walking is performed at an arbitrary, comfortable for the patient pace in the form of daily sessions lasting 15 minutes with a course of at least 4 weeks. Walking backwards can be carried out on a flat or inclined (climbing stairs) surface, with or without support on the railing. The listed varieties of the technique allow you to adapt it to the individual characteristics of the patient and, as you master it, complicate it from walking on a flat surface with support on the railing to climbing stairs without resting on the railing. The indicated duration of a separate lesson and rehabilitation course as a whole is established by analogy with existing recommendations on the usual walking [2, 5, 6, 8].

Examples of specific implementation of the "Method ...":

Patient T., 52 years old, a smoker with a family history of heart disease (father died of myocardial infarction at the age of 45), suffering from arterial hypertension and overweight (body mass index 41.5 kg / m ² ), complained about pain and crunching in the knee joints when walking. The examination, along with stage II hypertension and grade III obesity, also made it possible to establish a diagnosis of stage II osteoarthritis of the knee joints (according to Kellgren). Due to the high cardiovascular risk (according to the SCORE scale, the 10-year risk of death was in the range of 10-14%), the patient was strongly recommended measures to modify his lifestyle: smoking cessation, dietary restrictions and physical activity in the form of regular walking at a fast pace . However, according to the patient, he repeatedly tried to walk and run with the goal of losing weight earlier, but each time they stopped because of increased pain in the joints. In this case, it was proposed to replace ordinary walking with walking backwards. Backstabbing on a flat surface (paved walkway of the park) for 15 minutes a day, as well as climbing backwards up the stairs to the 4th floor (initially holding onto the handrails and then without them) had a positive effect on the dynamics of the patient’s body weight and his general well-being. After a month of regular classes, he lost 4.5 kg and noted a decrease in shortness of breath during normal walking. The patient did not notice any amplification of pain in the joints that would force him to stop exercising.

Patient B., 72 years old, suffering from long-standing arterial hypertension and coronary heart disease in the form of angina pectoris of functional class II and myocardial infarction suffered 4 years ago, walking with his back forward was included in the complex of rehabilitation measures in the country sanatorium of cardiovascular profile. The combination of these cardiovascular diseases with deforming arthrosis of the knee joints, which impedes cardiorehabilitation, served as the basis for the purpose of walking back-to-back. Walking backwards was carried out on a treadmill with support on handrails with a gradual increase in the duration of daily classes from 5 to 15 minutes. The speed of the treadmill was selected in such a way that the workouts were well tolerated and did not cause angina pectoris. Subsequently, back-to-back walking classes were continued on an outpatient basis to a total course of 4 weeks. The positive effect of classes was expressed in increasing exercise tolerance, stabilizing blood pressure, reducing dizziness and instability when walking and was not accompanied by increased pain in the joints. On the contrary, the patient noted a decrease in the instability of the knee joints in the form of a decrease in the frequency of subluxations in them.

Information sources

1. Artamonova L. L., Panfilov O. P., Borisova V. V. Physiotherapy and adaptive-health culture: studies. manual for university students enrolled in the specialty "Physical Culture" .- M .: Publishing House VLADOS-PRESS, 2010.- 389 p.

2. Dubrovsky V.I. Physiotherapy exercises and medical supervision: Student for medical students. universities .- M .: MIA LLC, 2006.- 598 p.

3. Epifanov V.A. Reconstructive medicine: A guide. - M .: GEOTAR-Media, 2007 .-- 592 p.

4. Epifanov V.A. Therapeutic physical culture and massage: uch. - 2nd ed., Rer. and additional ..- M.: GEOTAR-Media, 2008 .-- 528 p.

5. Cardiovascular prophylaxis: National recommendations.- M., 2011.- 64 p.

6. Therapeutic physical education: Uch-for stud. higher textbook. institutions / Ed. S.N. Popova .- 7th ed., Ster .- M .: Publishing House. Center "Academy", 2009.- 416 p.

7. Mendel O. I., Naumov A. V., Vertkin A. L. et al. Osteoarthrosis and cardiovascular diseases in the elderly: clinical and pathogenetic relationships // Successes of gerontology. - 2010.- T. 23, No. 2.- S.304-313

8. Rehabilitation of cardiological patients / ed. K.V. Lyadova, V.N. Preobrazhensky .- M.: GEOTAR-Media, 2005 .-- 228 p.

9. Kachanathu S.J., Alenazi A.M., Algarni A.D. et al. Effect of forward and backward locomotion training on anaerobic performance and anthropometrical composition. Phys Phys Ther Sci. 2014; 26 (12): 1879-1882.

10 Kim C.S., Gong W., Kim S.G. The effects of lower extremity muscle strengthening exercise and treadmill walking exercise on the gait and balance of stroke patients. J Phys TherSci, 2011, 23: 405–408.

11 Terblanche E., Page C., Kroff J., Venter R. The effect of backward locomotion training on the body composition and cardiorespiratory fitness of young women. Int J Sports Med. 2005; 26 (3): 214-219.

12. Threlkeld A.J., Horn T. S., Wojtowicz G. et al. Kinematics, ground reaction force, and muscle balance produced by backward running. J Orthop Sports Phys Ther, 1989, 11: 56–63.

Claims (1)

A method of physical rehabilitation of patients with a combination of pathology of the cardiovascular system and arthrosis, including walking as a training factor, characterized in that daily walking backward forward at an arbitrary pace on a flat surface or in the form of climbing stairs, with or without support on the railing , with a gradual increase in duration from 5 to 15 minutes per day for at least 4 weeks.