RU2788293C1 - How to recover covid-19 survivors with a comprehensive physical rehabilitation program - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to the field of health improvement of the human body, in particular to the means of therapeutic physical culture. They are conducting a comprehensive physical rehabilitation program for patients who have had a coronavirus infection. The program includes two stages: the preparatory stage - 1 week, the main stage - 7 weeks and 6 sets of exercises.

EFFECT: method allows to improve the quality of life, reduce the duration of the recovery period, expand the possibilities of physical rehabilitation, comprehensively improve the functions of the respiratory, cardiovascular, musculoskeletal and nervous systems of patients.

1 cl, 3 tbl

Description

The invention relates to the field of health improvement of the human body, in particular to the means of therapeutic physical culture, the complex use of which will minimize post-COVID consequences.

Functional disorders of the vital systems of the body in patients with COVID-19 after the elimination of the acute infectious and recovery process can persist for a long time, and prolonged lack of physical activity can lead to a significant decrease in the quality of life of patients.

Despite the fact that COVID-19 is an acute respiratory disease with a primary lesion of the upper and lower respiratory tract of varying severity from asymptomatic carriage to a clinically severe form of viral pneumonia with the development of acute respiratory failure, acute respiratory distress syndrome; The virus attacks various organs of the human body, most often leading to the development of cardiovascular, motor, neurocognitive disorders, and multiple organ failure. Therefore, speaking of post-COVID physical rehabilitation, one should keep in mind the advantage of a comprehensive program that affects not only the respiratory system, but also the cardiovascular, musculoskeletal, and nervous systems, which will provide:

- restoration of the vital capacity of the lungs;

- ensuring the evacuation of sputum from their bronchi, the pulmonary system, if any;

- restoration of saturation of arterial blood with oxygen (saturation);

- restoration of tolerance to physical stress and to hypoxia;

- restoration of muscle strength, limbs and joint mobility;

- stabilization of the psycho-emotional state.

There are known approaches to the rehabilitation of patients who have undergone COVID-19, based on antiviral and anti-inflammatory therapy and including, for example: inhalations, barotherapy, massages [RU 2 769 214, RU 2 766 246, RU 2 748 452], however, they lack a component of physical activity of patients, allowing to expand the possibilities of rehabilitation within the framework of a comprehensive unified program.

A known method of express rehabilitation of medical workers who are under high stress during a pandemic [patent for the invention of the Russian Federation No. 2 766 285, IPC A61H 39/00, A61H 1/00, A61H 33/04, publ. 03/11/2022, Bull. No. 8], in which group rehabilitation is carried out for 2 days. At the same time, on the first day of rehabilitation, a psychotherapeutic effect is carried out by training medical workers in stress management techniques. On the second day of rehabilitation, the impact is carried out in the following sequence: physical therapy exercises, which include dynamic exercises for large and small joints, exercises to relax the muscles of the body, coordination exercises to improve blood supply to the brain, breathing exercises - diaphragmatic breathing and sound gymnastics; manual body massage; exposure in a relaxation capsule at a temperature of 35 degrees by aromatherapy with lavender essential oil, vibration massage, oxygen therapy, ophthalmic chromotherapy at a wavelength of 465-470 and 620-625. Then, reflexotherapy is performed by Tsubo-therapy, for which purpose metal balls for "Tsubo" are applied to the biological active points of the auricles: AP55 and AP82. Hardware vibration massage of paravertebral reflexogenic zones is carried out.

This method cannot be transferred to the contingent of patients who have had a coronavirus infection, since the restoration of functional disorders of various body systems takes a long time. In addition, the proposed methods of physical rehabilitation (breathing exercises, dynamic general developmental exercises, sound gymnastics with a change in the rhythm of performance) are not specified: there is no list of exercises, the number of repetitions and recommendations for independent use.

Known technology for remote medical rehabilitation of patients with coronavirus infection [patent for the invention of the Russian Federation 2 735 722, IPC G16H 10/00, A61B 5/00, G06Q 50/00, publ. 06.11.2020, Bull. No. 31] using a complex of respiratory gymnastics, consisting of 24 exercises, of which 18 exercises in the initial position "standing", and 6 exercises in the initial position "sitting". After mastering respiratory gymnastics, while maintaining small residual effects of respiratory dysfunction, this invention provides for a transition to paradoxical respiratory gymnastics according to the method of A.N. Strelnikova.

This invention limits the circle of people who can use these recommendations, since not all patients have the physical ability to perform physical exercises in the initial “standing” position at the post-stationary stage, despite the fact that respiratory gymnastics has a sparing exercise regimen. Further use of breathing exercises by A.N. Strelnikova, after mastering the respiratory, also cannot be of a mass nature. Breathing gymnastics A.N. Strelnikova was formed as a result of treatment and restoration of the singing voice. Its feature is the use of forced inspiration and the involvement of the most powerful respiratory muscle, the diaphragm, in the process of the respiratory act. The essence of the technique is an active intense short breath, which trains all the muscles of the respiratory system. Exhalation after an active emotional inhalation occurs as if by itself (exhalation is the result of inhalation). But the role of exhalation is no less important than the role of inhalation, especially with diaphragmatic breathing, which, in principle, is not included in the work without understanding the mechanism of the diaphragm.

All movements are performed in the tempo-rhythm of the drill step, i.e. 110-120 respiratory movements per minute, which does not allow taking into account the state of human health at a certain moment, even during individual lessons with an instructor.

Thus, breathing exercises by A.N. Strelnikova, with careful consideration and practical application, can be recommended for a limited circle of people, and without a preliminary separate study of diaphragmatic breathing (which is especially difficult for older patients to master), it will include only the upper part of the organs of the respiratory system, making breathing partial, and therefore inferior.

Further recommendations on the implementation of aerobic and strength exercises, as well as the use of art and occupational therapy for the correction of neurological and mental disorders are not specified. The use of the proposed program of physical rehabilitation for self-study is possible only with the direct participation of patients in this invention.

The closest analogue (prototype) are methods of physical rehabilitation of patients with a new coronavirus infection [Temporary guidelines. Medical rehabilitation for a new coronavirus infection (COVID-19), prepared by the Ministry of Health of the Russian Federation, version 2 (07/31/2020), https://xn-80ae8fpedagmfblc0a.xn--pai/ai/doc/461/attach/28052020_Preg_COVID-19_v1. pdf], which includes various complexes of therapeutic exercises for coronavirus infection in a hospital in the case of a predominant lesion of the lungs in sparing starting positions (“lying” and “sitting”). Exercise complexes include exercises for small and medium muscle groups (fingers, hands, feet, arms, legs) in combination with static and dynamic breathing exercises.

Upon discharge from the hospital, it is recommended to continue physical rehabilitation at the place of residence using both breathing techniques (respiratory gymnastics by A.N. Strelnikova, qigong therapy, full yoga breathing) and aerobic exercise combined with progressive muscle resistance. Training programs for the development of endurance and strength are presented: “Continuous and intermittent endurance training programs at the stages of medical rehabilitation”, “Optimal parameters of an active training program with overcoming resistance”.

The proposed breathing techniques are quite complicated for self-study, and in medical institutions at the place of residence there are not always specialists who know them.

The most effective type of breathing in oriental breathing practices (qigong, pranayama, etc.), which helps restore health and longevity, is breathing from the lower half of the abdomen. The advantage of qigong therapy is that it activates arterial and venous circulation. When breathing from the lower abdomen, the person is in an exceptional position to optimize diaphragmatic breathing. Breathing exercises can be performed in any of three postures: standing, sitting and lying down. At the same time, it is necessary to achieve the immersion itself, which forms the basis of autogenic training, which is impossible without certain skills and special training in immersion techniques. In Chinese philosophy, one of the main categories - "qi" - is defined as "air", "breath", "energy". In the healing practice of qigong, people breathe just at the expense of the diaphragm, such breathing is also called “abdominal breathing”. It is divided into two types: direct and reverse. When performed correctly, qigong breathing exercises are useful for the lungs, spine and joints, help to improve the flow of oxygen-rich blood, and eliminate stagnation in the articular tissues, as well as to lose weight. In the practice of Taoist monks, the main exercise is "direct Taoist breathing", the main purpose of this exercise is to change breathing habits and make abdominal breathing natural in everyday life, allowing you to evenly expand the alveoli, improve lymphatic drainage from the lungs, massage the stomach, liver, intestines and other organs located near the diaphragm.

As for full yogic breathing, as the most complete, it is a rather difficult type to learn, requiring a high level of coordination and fairly long workouts. Therefore, this type is not available to most patients who have had a coronavirus infection, not only due to the complexity of mastering the technique, but also due to the need to achieve the effect in real conditions, and not in a delayed time.

At the same time, Eastern practices suggest a rather in-depth, long-term, multicomponent approach to exercises, their types, methods and directions, including not only meditative practices, but also knowledge of one’s philosophy as a whole, and this can be negatively perceived by many people with already formed foundations, principles and beliefs. Consequently, the application of Eastern practices from this point of view will be very limited.

The use of recommendations for aerobic and power loads also has limitations, because. not all patients can take advantage of rehabilitation measures in polyclinics at the place of residence, in sanatoriums, in medical centers with halls equipped with special simulators. Home conditions also do not always allow you to have exercise equipment. In addition, for a number of reasons, older patients will not be able to use them even if there are simulators in the apartment.

The objective of the claimed invention is to develop a comprehensive physical rehabilitation program for patients who have had a coronavirus infection, which allows to improve the quality of life by reducing the duration of the recovery period through the availability of both the rehabilitation programs themselves and the technique for performing their components.

The technical result is aimed at expanding the possibilities of physical rehabilitation, at a comprehensive improvement in the functions of various systems of the human body within the same single program with a pronounced and persistent clinical effect.

The technical result is achieved through a comprehensive program of physical rehabilitation by simultaneously affecting the respiratory, cardiovascular, musculoskeletal and nervous systems of patients, performed in two stages: (preparatory stage - 1 week, main stage - 7 weeks), and includes 6 sets of exercises.

The first complex is aimed at the patient's respiratory system and is a rehabilitation gymnastics with elements of full breathing, performed in the initial position "sitting on a chair", and includes 20 consecutive exercises, each of which is repeated 4 to 6 times. For a better discharge of sputum from the bronchi on exhalation, it is recommended to open your mouth wide and exhale, as it were, from the depths of the pharynx.

The second and third of the complexes are aimed at the patient's cardiovascular system. At the same time, the second complex includes 12 consecutive exercises to restore general endurance on the step platform, each of which is performed 6 times, while after the 4th repetition, either pauses for rest are performed, or a transition to normal stepping is carried out, which will restore breathing and continue the execution of the complex.

The third complex includes 12 consecutive exercises on the step platform with weights, while the complex uses dumbbells from 0.5 to 3.0 kg for the arms, and then weights for the legs from 0.5 to 3.0 kg, which will allow you to develop not only general, but also strength endurance, strengthening the strength of the muscles of the arms and legs. Each exercise of the third complex is performed 6 times.

The fourth and fifth complexes are aimed at the patient's musculoskeletal system. The fourth complex is performed in the initial position “standing at the chair” with support and includes 15 consecutive exercises to restore the mobility of the joints of the whole body and strengthen them, which provides an impact on the musculoskeletal system due to the load on the muscles and ligaments. Each exercise is performed 6 times.

The fifth complex is designed to stretch the muscles of the spine and includes 10 consecutive exercises, each exercise is performed 1 time for 30 seconds without rest intervals between exercises, not earlier than 45 minutes after eating. It allows, after using the fourth complex, to relieve tension that has arisen after prolonged inactivity of the muscles.

The sixth complex is aimed at the nervous system, is a set of exercises for relaxation and calming, and includes 15 consecutive exercises, 30 seconds each. The impact on the nervous system is provided by a set of relaxation and calming exercises aimed at relaxing the muscular system and reducing the anxiety level of patients that is typical for those who have undergone COVID-19.

At the preparatory stage, patients perform twice a day under the guidance of an instructor a complex of rehabilitation gymnastics with elements of full breathing at 10 am and 5 pm, while on the 6th and 7th day of the 1st week, they also master the technique of stepping on a step platform under the guidance of an exercise therapy instructor height of 25 cm once a day for 20 minutes in the form of self-study no later than 16 hours and no earlier than 45 minutes after eating.

At the main stage, all 6 sets of exercises are performed three times a day: in the morning, afternoon and evening, while rehabilitation exercises with elements of full breathing during the 1st and 2nd weeks of this stage are performed in the same mode as at the preparatory stage. Starting from the 3rd week of the main stage, rehabilitation gymnastics with elements of full breathing is performed in the morning once a day, and on weeks 5,6,7 in the morning, but only on the day when there are no classes, and on the 6th and 7th th week, rehabilitation gymnastics is performed during the day as part of a daytime lesson, but its duration is reduced by reducing the number of repetitions from 6 to 4, performing the function of a warm-up before strength work with weights on step platforms. On the 1st week of the main stage, walking on a step platform for 30 minutes is used during the day, and on the 2nd, 3rd week of this stage, the second complex is used. The second set of exercises for restoring general endurance on the step-platform in total in time reaches 30 minutes. The third complex on the step platform with weights for the entire duration of the main stage in total in time reaches 20 minutes on the 4th week of the main stage, 35 minutes on the 5th week, 45 minutes on the 6th and 7th weeks. At the 4th week, dumbbells are used to weight the arms from 0.5 to 3.0 kg, and at 5.6 and 7 weeks, both dumbbells for the arms and leg weights weighing from 0.5 to 3.0 kg. The weight of weights is selected for patients by trial method, weight gain was allowed no more than 0.5 kg per session. The fourth set of exercises to restore mobility and strengthen the joints is used in the afternoon session at 1, 2, 3 and 4 weeks of the main stage. The fifth set of exercises, which allows you to remove the negative consequences after the load, is used at 3,4,5,6 and 7 weeks of the main stage. The sixth set of exercises for relaxation and calming in order to reduce the level of anxiety is used in the evening 1.5-2 hours before bedtime at 1,2,3,4 and 5 weeks without fail, and at 6 and 7 weeks - with feelings of anxiety and anxiety in the patient according to the results of the Spielberger-Khanin Personal Anxiety Questionnaire. At 1,2,3 weeks, daytime classes are held daily, and at 4,5,6,7 weeks of the main stage - every other day.

After passing the main stage, in order to ensure the consolidation of the achieved effect, and, consequently, the subsequent improvement in the quality of life of patients, according to the results of medical studies, as well as taking into account the results of the six-minute walk test (TSWT) of each patient, it is recommended to long-term stabilization of the intensity of aerobic exercise through regular 3 one-time classes per week according to the program of daytime classes 7 weeks of the main stage with the possibility of feedback from the attending physician and the instructor of physical therapy (exercise therapy).

Thus, the use of a comprehensive program of physical rehabilitation will increase the functionality of the respiratory muscles with the development of maximum compensatory capabilities due to the recruitment of a large volume of lung tissue into gas exchange, which provides secondary prevention of the occurrence of complications of the bronchopulmonary and other systems at the post-stationary stage, which will reduce the terms of disability sheets. in able-bodied patients and reduce the number of repeated hospitalizations in older patients.

Implementation of the invention

The program of complex physical rehabilitation with simultaneous impact on the respiratory, cardiovascular, musculoskeletal and nervous systems of patients with the help of complexes of physical exercises used depending on the timing of the start of rehabilitation, and therefore, the level of physical fitness, is designed for a period of at least 8 weeks, performed in two stages: preparatory for 1 week, main for 1-7 weeks and includes 6 complexes. The first of the complex is aimed at the respiratory system and is a rehabilitation gymnastics with elements of full breathing; the second and third are aimed at the cardiovascular system, while the second complex is designed to restore the patient's general endurance, and is performed on a step platform, and the third complex is performed on a step platform with weights to develop general and strength endurance; the fourth and fifth are aimed at the patient's musculoskeletal system, while the fourth complex is designed to restore the mobility of the joints of the whole body and strengthen them, and the fifth complex is designed to stretch the muscles of the spine to relieve negative consequences after removing the load; the sixth complex is aimed at the patient's nervous system, includes exercises for relaxation and calming, allowing to reduce the level of anxiety.

At the preparatory stage, patients began with the first complex - rehabilitation gymnastics with elements of full breathing, which was performed twice a day in the morning and evening: at 10 am and 5 pm, lasting 15 minutes under the guidance of an instructor. For rehabilitation gymnastics with elements of full breathing, a new, quite accessible way of performing full breathing is used not as a single exercise, but as a sequence of three types of breathing (upper, middle, lower), alternating in strict order with one type of breathing, therefore the complex is called "Respiratory gymnastics with elements of complete breathing. The complex of exercises that affects the respiratory system is based on full breathing, but in a technique simplified for execution, which allows the complex to be performed by all patients.

Performing full breathing in the form as it is popularized (set tempo-rhythm of the drill step, mandatory number of repetition cycles, breath holding) is impossible for patients with poor health as a result of a disease with a large area of damage by pulmonary fibrosis.

Of the recommended respiratory gymnastics techniques, the most promising is full breathing, since it includes three types (clavicular, internal thoracic, diaphragmatic) and allows you to use all parts of the lungs in the act of breathing, which improves respiratory function, frees the bronchial system from sputum and reduces the likelihood of complications due to deep ventilation of the lungs and minimizing the load on the heart, which is especially important for patients who have had a coronavirus infection. These factors justified the choice of a respiratory gymnastics complex.

Rehabilitation gymnastics with elements of full breathing is performed in the initial position “sitting on a chair”: the back is straight, pressed against the back of the chair, to reduce physical stress on the spine, and includes 20 consecutive exercises:

on the first hand on their knees, throw their heads back, look up, take a slow breath through their mouths, tilt their heads forward, touching the cervical fossa with their chin, look down, slowly exhale through their nose;

on the second, the arms hang freely, raise the shoulders up, stretch the diaphragm as much as possible, take a slow breath through the nose, then sharply lower the shoulders, relaxing them, perform a quick exhalation through the mouth;

on the third, the fingers are clasped on the stomach into a lock, draw in the stomach, pressing on it with their hands, perform a slow breath with the nose, then sharply push the hands out with the stomach, perform a quick exhalation with the mouth;

on the fourth, the fingers are clasped on the stomach in a lock, inflate the stomach, bending in the lower back, take a slow breath through the nose, then slowly deflate the stomach with the help of the hands, return the lower back to the back of the chair, and slowly exhale through the mouth;

on the fifth, the fingers are locked on the stomach, turn the palms outward and stretch forward, the fingers remain locked, the elbows are straightened, the head is tilted forward, the arms are at shoulder level, take a slow breath in through the nose, then quickly lower the hands, perform a quick exhalation through the mouth;

on the sixth hand at the shoulders, elbows at shoulder level, bring the elbows forward, take a slow breath through the nose, take the elbows back as much as possible, bringing the shoulder blades together, perform a slow exhalation through the mouth;

on the seventh, the hands are at the shoulders, the elbows are pressed to the ribs, the arms are sharply lowered down, the fingers are as tense and spread as possible, the shoulders are raised, the stomach is tightened, they take a quick breath through the nose, the arms relax, the hands return to the shoulders, they slowly exhale through the mouth, lips with a tube;

on the eighth hand at the shoulders, bring the right elbow up behind the head, perform a slow breath through the nose, then sharply lower the elbow, perform a quick exhalation through the mouth, repeat the exercise with the left hand;

on the ninth hand at the shoulders, perform circular movements in the shoulder joints with arms bent at the elbows forward and backward, 4 circles forward, 4 circles back, repeat 2 times, arbitrary breathing.

on the tenth, hands on their knees with palms up, clench their fists with maximum force, perform a slow inhalation through the nose, then unclench their fists, perform a slow exhalation through the mouth;

on the eleventh, the arms hang freely, spread straight arms to the sides at shoulder level, palms forward, take a slow breath in through the nose, then hug themselves by the shoulders with maximum strength, perform a slow exhalation through the mouth;

on the twelfth, hands on the hips, closer to the groin, straighten the elbows, stretching the back up, perform a slow breath through the nose, then sharply bend the elbows, relax the back, perform a quick exhalation through the mouth;

on the thirteenth, hands on the belt, thumbs towards the waist, bring the elbows forward without tilting the body, the hands slide along the belt, take a slow breath through the nose, take the elbows back, connecting the thumbs on the lower back, bring the elbows as close as possible, perform a slow exhalation through the mouth;

on the fourteenth, the arms hang freely, raise straight arms forward and upward, perform a slow breath through the nose, lower the arms down, clasping the knee of the raised and bent leg, the back is pressed against the back of the chair, perform a slow exhalation through the mouth, do the same with the other leg, repeat exercise 3 -4 times;

on the fifteenth, the arms hang freely, straighten one leg forward and hold it in the air, pull on the toe, the second leg goes under the chair, then change legs to the count of one-two-three-four, breathing is arbitrary;

on the sixteenth, the arms hang freely, raise the leg bent at the knee, perform a slow breath in through the nose, then sharply lower the leg down, perform a quick exhalation through the mouth, repeat the exercise with the other leg;

on the seventeenth hand at the shoulders, bend the elbows to the knees, the neck muscles are relaxed, the chin is at the cervical fossa, take a slow breath in through the nose, straightening up, take the elbows back, throw the head back, perform a slow exhalation through the mouth;

on the eighteenth, the arms are bent at the elbows, the elbows are pressed to the ribs, tensing, raise the shoulders up, take a slow breath in through the nose, leaning forward, rest the forearms on the knees, tilt the head, perform a slow exhalation through the mouth;

on the nineteenth, the arms hang freely, the head is turned to the shoulder, turning the head to the other shoulder, take a slow breath in through the nose, reaching the shoulder, exhale quickly through the mouth, do the same in the other direction;

on the twentieth, the hands hang freely, relaxed hands raise up, take a slow breath through the nose, freely lower the hands down, perform a quick exhalation through the mouth.

Each exercise of the first complex is performed 4-6 times. For a better discharge of sputum from the bronchi on exhalation, it is recommended to open your mouth wide and exhale, as it were, from the depths of the pharynx.

Due to the rational use of the lungs, the heart rate at the end of the complex should be equal to or less than it was before the lesson. An increase in their frequency indicates an incorrect implementation of the complex. Restoration of lung function in full will allow stabilizing and improving the metabolic processes of the body, reducing foci of inflammation and straightening collapsed areas in lung tissues, eliminating local congestion, increasing immunity to resist respiratory diseases in postoperative conditions with diseases of the respiratory and cardiovascular systems and eliminating the development hypokinesia.

On the 6th and 7th days of the 1st week of the preparatory stage, during classes with an instructor, they master the technique of stepping on a step platform 25 cm high (if necessary, you can use support on the back of a chair in front of the step platform) once a day for 20 minutes in the form of an independent classes no later than 16 hours and no earlier than 45 minutes after eating.

After the end of the preparatory stage, patients begin to perform the main stage lasting 7 weeks and including the performance of all 6 complexes three times a day: in the morning, afternoon and evening, while the respiratory gymnastics complexes for 1.2 weeks of this stage are performed in the same mode as on preparatory stage, the 3rd week once a day in the morning, and then at 4,5,6 weeks only in the morning on the day when there were no exercise therapy classes. Rehabilitation gymnastics with elements of full breathing is also used on weeks 6 and 7 as part of a daily lesson, its duration is reduced by reducing the number of repetitions from 6 to 4, performing the function of a warm-up before strength work with weights on step platforms. The second set of exercises to restore general endurance on the step platform on the 2nd-3rd week of this stage is determined in total by 30 minutes. The third complex on the step platform with weights for the development of general and strength endurance for the entire duration of the main stage in total reaches 45 minutes starting from 20 minutes at week 4, 35 minutes at week 5 and then 45 minutes. The fourth complex is used to restore joint mobility and strengthen them at 1,2,3,4 weeks lasting 15 minutes. The fifth complex is used to reduce the negative consequences for the muscles after exercise at 4,5,6,7 weeks of the main stage in a daily lesson lasting 10 minutes. The sixth set of exercises for relaxation and calming is used throughout the main stage, but at 1-5 weeks without fail, and at 6.7 weeks with feelings of anxiety and anxiety in the patient according to the results of the Spielberger-Khanin personal anxiety questionnaire. At 1,2,3 weeks, daytime classes are held daily, and at 4,5,6,7 weeks of the main stage every other day.

Coronavirus causes severe consequences for the heart, lungs, brain, kidneys and other vital systems and organs of a person, and complications can develop in any form of the course of the disease.

The most common complications after a coronavirus infection are increased fatigue, a constant feeling of weakness, shortness of breath, and, as a result, low physical activity, which can last up to six months. Therefore, it is recommended to gradually restore the level of physical activity: moving from breathing exercises to aerobic exercises that develop the overall endurance of the body, which manifests itself not only when performing physical exercises, but also in various forms of work and household activities, therefore it is so necessary to restore it as one of the foundations of quality patients' lives.

Endurance develops when performing exercises of a cyclic nature of moderate power due to the participation in the work of at least 70% of the muscles (running, walking, swimming, exercise bike, treadmill). Walking on a step platform is a complete alternative to any known exercise of a cyclic nature, since this physical activity involves large groups of muscles and joints, and compensates for the lack of exercise equipment.

Large muscles play the role of a "peripheral heart", improving the movement of blood to the heart from the legs and abdominal organs, where it tends to accumulate during low physical activity.

At the main stage, stepping increases to 30 minutes in the 1st week and is an integral part of the lesson, and not as an independent load, is performed during the day.

Stepping with the step platform, which allows you to train aerobic endurance, has a lot in common with walking up the stairs: the double support period is increased, the free leg moves in a bent position, the supporting leg straightens only after the vertical moment. This makes it possible to master this type of load for patients in the early stages of rehabilitation and further form: aerobic or general endurance (strengthening and development of the cardiovascular and respiratory systems), stable balance, joint mobility, a high level of coordination, the ability to rhythmically coordinate simple and complex movements, much needed in everyday life.

The multifunctional effect when using the step platform determined its choice as a simulator for the development of endurance. Achieving the effect became possible using the didactic principle "from simple to complex". As you master the technique of stepping on the step platform at the main stage (2nd, 3rd weeks), to restore general endurance, the second set of exercises is used to restore general endurance on the step platform, which includes 12 consecutive exercises:

on the first, standing in front of the step platform sideways to the narrow side, legs together, hands on the belt, thumbs towards the waist: on count 1 - put one foot in the middle of the step, on count 2 - put the other foot on, on count 3 - put one foot on the floor on the other narrow side, at the expense of 4 - put the other foot;

on the second, standing in front of the step platform sideways to the narrow side, legs together, hands on the belt, thumbs towards the waist: on account 1 - put one foot to the side-forward on the floor from the wide side, in the middle, on account 2 - attach the other leg, on count 3 - put one foot back on the middle of the step platform, on count 4 - put the other foot on, on count 5 - put one foot back on the floor, on count 6 - put the other foot, on count 7 - put one foot in the middle of the step platform, at the expense of 8 - put the other foot;

on the third, standing on the step platform facing the wide side, legs together, hands on the belt, thumbs towards the lower back: on count 1 - step with one foot to the side on the edge of the step platform, on count 2 - step with the other foot to the side on the edge of the step platform, at the expense of 3 - half-squat, at the expense of 4 - straighten your knees;

on the fourth, standing on the step platform facing the wide side, legs wide apart, hands on the belt, thumbs towards the waist: on count 1 - tilt the body down without bending the knees, trying to touch the step platform with your hands, on count 2 - return to the starting position, at the expense of 3 - bend back in the lower back, without throwing back the head, bringing the elbows together as much as possible, at the expense of 4 - return to the starting position;

on the fifth, standing on the step platform facing the wide side, legs wide apart, hands on the belt, thumbs towards the waist: on count 1 - put one foot in the middle of the step platform, on count 2 - put the other foot, on the count 3 - lower one leg back to the floor, count 4 - lower the other leg forward to the floor, count 5 - put one foot on the step platform, count 6 - put the other foot on the step platform, count 7 - step one foot to the side on the edge of the step platform, at the expense of 8 - step with the other foot to the side to the edge of the step platform;

on the sixth, repeat with a change in the position of the legs back and forth;

on the seventh, standing on the step platform facing the wide side, legs wide apart, hands on the belt, thumbs towards the waist: on count 1 - put one foot back on the floor in the middle of the step platform, on count 2 - put the other foot, on account 3 - sit down, touching the step platform with your hands, on account 4 - straighten your knees, hands on your belt, thumbs towards the waist;

on the eighth, standing in front of the step platform facing the wide side, legs together, hands on the belt, thumbs towards the waist: on count 1 - put one foot in the middle of the step platform, on count 2 - raise the other leg bent at the knee up above the step platform with the simultaneous lifting of straight arms up, at the expense of 3 - lower the bent leg to the floor, hands on the belt, thumbs towards the lower back, at the expense of 4 - put the other leg on the floor;

on the ninth, repeat with the rise of the other leg;

on the tenth, standing in front of the step platform facing the wide side, legs together, hands on the belt, thumbs towards the waist: on count 1 - step over the step platform forward with one foot, on count 2 - put the other foot on, on count 3 - semi-squat, hands forward at shoulder level, count 4 - straighten your knees, hands on the belt, thumbs towards the waist, count 5 - step over the step platform back with one foot, count 6 - put the other leg on, count 7 - semi-squat, hands forward at shoulder level, at the expense of 8 - straighten your knees, hands on your belt, thumbs towards the waist;

on the eleventh, standing in front of the step platform facing the wide side, hands on the belt, thumbs towards the waist: on count 1 - put one foot in the middle of the step platform, on count 2 - throw the shin of the other leg to the buttock above the step platform , simultaneously with spreading the arms to the sides at shoulder level, at the expense of 3 - lower the bent leg to the floor, hands on the belt, thumbs towards the lower back, at the expense of 4 - put the other leg on the floor;

on the twelfth, repeat with throwing the lower leg of the other leg.

Each exercise is performed 6 times, and the number of repetitions of the entire complex reaches a total of 30 minutes. After the 4th repetition, pauses for rest or a transition to normal stepping are possible, which will allow you to restore breathing and continue the complex.

As the level of fitness increased, on the 4th week of the main stage, the third set of exercises on the step platform was used with a higher level of coordination using weights, which made it possible to train not only general, but also strength endurance, as well as activate muscles that were previously inactive. The third complex includes 12 consecutive exercises:

on the first, standing on the step platform in the middle sideways to the wide side, legs together, hands with dumbbells below in front of you at groin level, palms turned towards each other, elbows slightly bent: on count 1 - put one foot on the floor while raising your arms through the sides up to shoulder level, at count 2 - put the other foot on the floor from the opposite side, at count 3 - put one foot on the step platform with the hands returning to its original position, at count 4 - put the other foot on the step platform.

on the second, standing on the step platform in the middle sideways to the wide side, legs together, hands with dumbbells below in front of you at the level of the groin, palms turned towards each other, elbows slightly bent: on count 1 - put one foot on the floor, while lifting arms bent at the elbows to shoulder level, at the expense of 2 - semi-squat with the inclusion of both legs, at the expense of 3 - straighten the knees, at the expense of 4 - put the leg on the step platform with the simultaneous return of the hands to the starting position, at the expense of 5, 6, 7 , 8 - repeat with the other leg;

on the third, standing on the step platform in the middle sideways to the wide side, legs together, hands with dumbbells below in front of you at groin level, palms turned towards each other, elbows slightly bent: on count 1 - put one foot on the floor, on count 2 - put the other foot on the floor on the opposite side, on the count of 3 - semi-squat with simultaneous lifting of the arms through the front position to shoulder level, on the count of 4 - straighten the knees, return the hands to the starting position, on the count of 5 - put one foot on the step platform , at the expense of 6 - put the other leg on the step platform, at the expense of 7 - tilt the body down without bending the knees while pulling straight arms back, at the expense of 8 - straighten up;

on the fourth, standing on the step platform in the middle sideways to the wide side, legs together, with dumbbells below: on account 1 - abduction of one leg to the side-up while raising the arm of the same name to shoulder level, on account 2 - put the foot on the step platform by returning the hand to its original position, on account 3 - abduction of the other leg to the side-up with the simultaneous lifting of the arm of the same name to shoulder level, on account 4 - put the foot on the step platform with the return of the arm to its original position, on account 5 - semi-squat, straight arms at chest level, at the expense of 6 - straighten your knees with the return of the arms to their original position, at the expense of 7 - lower one leg to the floor, at the expense of 8 - lower the other leg to the floor from the opposite side;

on the fifth, standing, step between the legs, hands with dumbbells below: on account 1 - lifting one leg, bent at the knee, above the level of the hip joint with simultaneous lifting of straight arms up through the front position, on account 2 - return to the starting position, on count 3 - lifting the other leg, bent at the knee, above the level of the hip joint with simultaneous lifting of straight arms up through the front position, count 4 - return to the starting position;

on the sixth, standing, step-platform between the legs, hands with dumbbells below: on account 1 - put the foot of one leg in front of the foot of the other leg while bending the arms at the elbows, trying to touch the shoulder joints of the same name with the heads of the dumbbells, on account 2 - return to the starting position position, at the expense of 3 - change the position of the legs, placing the foot in front of the foot on the other side while bending the arms at the elbows, trying to touch the shoulder joints of the same name with the dumbbell heads, at the expense of 4 - return to the starting position;

on the seventh, standing, step-platform between the legs, hands with dumbbells below: on account 1 - put the foot of one leg on the toe behind the foot of the other leg with a simultaneous semi-squat and spreading the arms to the sides at shoulder level, on account 2 - return to the starting position , at the expense of 3 - repeat with the other leg, at the expense of 4 - return to the starting position,

on the eighth, standing, step-platform between the legs, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - raise the leg, bent at the knee, above the hip joint; on account 2 - lower to the floor, on account 3 - raise the other leg, bent at the knee, above the hip joint, on account 4 - lower to the floor;

on the ninth, standing, step platform between the legs, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - turning to face the step platform, put one foot on the edge of the step platform, on count 2 - put the other leg on the opposite edge of the step platform, at the expense of 3 - tilt the body down, the head is tilted, straight arms between the legs, at the expense of 4 - straighten up with the simultaneous return of the arms to their original position;

on the tenth, standing on the step platform facing the wide side, legs wide apart, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - put one foot forward on the floor in the middle of the step platform, on count 2 - put the other foot forward to the floor, while bringing straight arms in front of the chest, palms turned towards each other, on count 3 - put one foot back on the edge of the step platform, on count 4 - put the other foot back on the opposite edge of the step platform with simultaneous breeding straight arms to the sides at shoulder level, palms down;

on the eleventh, standing on the step platform facing the wide side, legs wide apart, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - put one foot back on the floor on the toe at the opposite edge of the step platform with a simultaneous semi-squat and lowering the arms down, at the expense of 2 - return to the starting position, at the expense of 3 - repeat with the other leg, at the expense of 4 - return to the starting position;

on the twelfth, standing on the step platform facing the wide side, legs wide apart, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - put one foot back on the floor in the middle of the step platform, on count 2 - put the other foot back on the floor in the middle of the step platform, lowering your hands down, on count 3 - put one foot on the edge of the step platform, on count 4 - put the other foot on the opposite edge of the step platform with the hands returning to their original position.

Each exercise of the third complex is performed 6 times, and the number of repetitions of the entire complex should in total reach 20 minutes on week 4 of the main stage, 35 minutes on week 5, and 45 minutes on weeks 6 and 7. At the 4th week, dumbbells are used to weight the arms from 0.5 to 3.0 kg, and at 5.6 and 7 weeks both for the arms and leg weights weighing from 0.5 to 3.0 kg. The weight of weights is selected for patients by trial method, weight gain was allowed no more than 0.5 kg per session.

Complexes of exercises for the musculoskeletal system are recommended to strengthen the joints, load the muscles, ligaments, as well as to remove the negative effects on the muscles after prolonged forced inactivity.

To restore joint mobility and strengthen them at 1-4 weeks of the main stage, the fourth set of exercises was used, which does not focus on a specific joint, and allows maintaining the elasticity of muscles and ligaments of the whole organism. It is performed in the initial position “standing at the chair” with a support, the gentle load of which allows you to perform the entire complex without pauses for rest between exercises. The fourth complex includes 15 consecutive exercises:

on the first, standing facing the back of the chair, hands resting on the wall, legs wide apart, feet slightly outward, rise on toes, return to the starting position;

on the second, standing facing the back of the chair, hands resting on the back, legs wide apart, feet slightly outward, perform a semi-squat, without lifting the heels from the floor, return to the starting position;

on the third, standing facing the back of the chair, hands resting on the back, legs wide apart, feet slightly outward, alternately bending the knee of one leg, without lifting the feet from the floor;

on the fourth, standing facing the back of the chair, hands rest on the back, legs together, lunge with one foot back, knee touches the floor, return to the starting position, repeat with the other foot, then return to the starting position;

on the fifth, standing facing the back of the chair, hands resting on the back, legs together, perform alternate circular rotations with the leg bent at the knee, in the hip joint outward, the knee above the hip joint;

on the sixth, standing facing the back of the chair, hands rest on the back, feet shoulder-width apart, perform simultaneous rotations of both legs in the knee joints in one direction and the other;

on the seventh, standing facing the back of the chair, hands resting on the back, legs shoulder-width apart, at the expense of 1-2-3, springy semi-squats are performed, lifting the heels off the floor, at the expense of 4, they perform a full gray, without lifting the heels from the floor;

on the eighth, facing the back of the chair, hands rest on the back, legs together, bend the arms at the elbows, touching the back of the chair with the chest while throwing the lower leg to the buttock, return to the starting position, then repeat with the other leg, return to the starting position;

on the ninth, standing facing the back of the chair, legs together, straight arms at the top with palms forward, tilt the body forward and down, placing the palms on the seat, return to the starting position;

on the tenth, standing with their backs to the back of the chair, hands rest on the back, legs together, lunge with one foot forward, bending the knee, the other leg is straight, return to the starting position, then repeat with the other foot, return to the starting position;

on the eleventh, standing with their backs to the back of the chair, hands rest on the back, legs shoulder-width apart, perform a semi-squat, without lifting the heels from the floor, bending the elbows as much as possible, return to their original position;

on the twelfth, standing with your back to the back of the chair at arm's length, legs shoulder-width apart, turn to the back of the chair without moving your feet, do push-ups, return to the starting position, then repeat in the other direction, return to the starting position;

on the thirteenth, standing sideways to the back of the chair, one arm is supported, the other arm is to the side at shoulder level, palm up, they stretch their arm above their head, trying to reach the shoulder joint of the opposite arm, return to their original position, then repeat, standing with the other side, return to starting position;

on the fourteenth, standing sideways to the back of the chair, one hand in support, the other hand to the side at shoulder level, palm back, stretching the hand behind the back, trying to reach the elbow of the opposite hand, return to the starting position, then repeat standing with the other side, return to the starting position position;

on the fifteenth, standing facing the back of the chair, legs together, straight arms at the top, palms forward, bend back without throwing back the head, bend over the back of the chair, leaning on the seat with forearms, return to the starting position.

Each exercise is performed 6 times. The fourth set of exercises covers almost all the joints of the body, and will allow not only to “work out” them, improving blood circulation and reducing pain, but also to increase the elasticity of the surrounding muscle joints, its duration is 15 minutes.

The fifth set of exercises for stretching the muscles of the spine (to relieve pain, tension, fatigue) is performed starting from the 3rd week of the main stage and up to the 7th week inclusive. This set of exercises, due to the alternation of muscle tension and their relaxation, slow static stretching, removes muscle spasms, increases the height of the intervertebral discs, eliminating or reducing pressure on the roots of the intervertebral nerves, and increases blood circulation. This complex is based on static tension without a sharp change in postures, a small amplitude of movements, sparing the initial position. The choice of this particular complex is justified by the need to maintain positive emotions from physical education, which is impossible with muscle discomfort or pain. The fifth complex for stretching the muscles of the spine includes 10 consecutive exercises:

on the first, lying on your back, arms up, legs straight together, stretch your arms up, straining your fingers as much as possible, palms look at each other, tighten your stomach, stretch your heels down;

on the second, lying on your back, legs bent at the knees resting on the floor, arms along the body, pull the knees as close as possible to the chest, clasping the arms, bending the elbows as much as possible, tearing the pelvis off the floor, and without taking the head off;

on the third, lying on the back, arms along the body, legs straight together, raise the head, chin to the chest, arms along the body in weight, fingers as tense as possible, toes of the feet “towards you”;

on the fourth, lying on your back, arms along the body, legs bent at the knees with support on the floor, raise the upper part of the body, pull the hands to the knees, fingers as tense as possible;

on the fifth, lying on your back, arms along the body, legs bent at the knees with support on the floor, straighten one knee, clasping hands in a “lock” under the thigh, raise a straight leg to the chest with resistance, toe of the foot “away from you”, head and the pelvis is not torn off the floor, the exercise is repeated with the other leg. With insufficient training, a slight bending of the knee joint is possible, while it is necessary to ensure that the toe is pulled “away from you”;

on the sixth, standing on all fours, palms slightly forward in relation to the shoulder joints, sit on the heels, stretching the hands forward, lower the head to the elbows, the neck muscles are relaxed;

on the seventh, standing on all fours, palms at the level of the shoulder joints, pull the knee to the chin, foot on weight, head tilted, chin to the cervical fossa, repeat the exercise with the other leg;

on the eighth, lying on the stomach, the chin on the back surface of the palms laid on top of each other, legs straight together, bend the leg at the knee joint, lift it slightly above the hip joint, sliding along the floor, trying to bring the ilium as close to the floor as possible, repeat the exercise with the other leg ;

on the ninth, lying on your back, arms along the body, legs straight together, pull one leg bent at the knee, as much as possible to the chest, raise the second slightly from the floor, pull the toes of the feet towards you, do not tear your head and pelvis off the floor (“bicycle” ), the exercise is repeated by changing the position of the legs;

on the tenth, lying on your back, arms straight up, legs straight together, stretching your arms up, straining your fingers as much as possible, palms looking at each other, tightening your stomach, pointing your toes away from you.

Each exercise is performed 1 time for 30 seconds without rest intervals between exercises, the duration of the complex is 10 minutes.

Limitation of motor activity due to objective reasons, self-isolation in a pandemic, being in a hospital, 14-day quarantine after a hospital significantly reduces energy costs, leading to a decrease in muscle strength and their performance; reduce impulses from the muscles, which causes a violation of the accuracy and coordination of movements; change the state of the bone apparatus, accompanied by a violation of protein-phosphorus-calcium metabolism in the bones and a decrease in bone strength; reduce joint mobility, leading to the development of arthrosis and arthritis.

These factors, as a rule, are perceived by patients more in a theoretical aspect, since the manifestation of the consequences takes time. And the problem of increased anxiety, which is typical for a significant part of patients who have undergone COVID-19, requires an immediate solution from their point of view, therefore, the set of exercises undertaken to relax and calm down are perceived positively by those involved, thereby forming a general positive attitude during physical education and contributing to a decrease in the level anxiety.

Neuro-emotional stress, a state of anxiety, worsening a person's well-being, violate the mechanism of self-regulation, which requires the ability to remove excitement. Therefore, the most important way to get rid of nervous tension can be considered muscle relaxation skills. At the same time, inhibition in the corresponding structures of the central nervous system increases, and recovery processes are activated in the nerve endings. The higher the ability to relax the muscles, the higher their ability to recover. Therefore, after completing a set of exercises for the musculoskeletal system, they proceed to the sixth set of exercises for relaxation and calming, aimed at the nervous system, which includes 15 consecutive exercises:

on the first, sitting on the edge of the chair, grab the back, straighten your arms, legs slightly apart, tilt your torso forward without bending in the lower back, stretching your shoulders, upper back, chest for 30 seconds, then return to the starting position, relax;

on the second, sitting on a chair, leaning on the back, legs slightly apart, arms below, stretching up with both hands, then stretching forward, slightly tilting the torso, arms at shoulder level, head tilted at elbow level, then leaning their chest on their knees, hanging arms at the sides and stretch down without trying to touch the floor for 30 seconds, then return to their original position, relax;

on the third, sitting on a chair, leaning on the back, legs slightly apart, arms below, stretching up with one hand, lowering the other to the floor without tension, look at the raised arm for 30 seconds, then return to the starting position, relax, then repeat in the other side for 30 seconds, then return to the starting position, relax;

on the fourth, sitting on a chair, leaning on the back, legs slightly apart, hands in the “lock” behind the head, elbows slightly brought together, take the elbows back for 30 seconds, then return to their original position, relax;

on the fifth, sitting on a chair, leaning on the back, legs slightly apart, arms slightly bent at the elbows, in a “lock” above the head, tilt the torso to one side for 30 seconds, then return to the starting position, relax, then repeat in the other side for 30 seconds, then return to the starting position, relax;

on the sixth, sitting on a chair, leaning on the back, legs together, take the seat of the chair, raise the legs bent at the knees, leaning on the seat of the chair for 30 seconds, then return to their original position, relax;

on the seventh, sitting on a chair, leaning on the back, legs together, take the seat of the chair, straighten the leg at the knee joint, raising it to the level of the seat, the toe “toward” for 30 seconds, then return to its original position, relax, after repeat with the other leg for 30 seconds, then return to the starting position, relax;

on the eighth, sitting on a chair, tilt the torso forward without arching the lower back, legs wide apart, crossed arms on the knees on the side from the inside, press the palms on the knees, resisting for 30 seconds, then return to the starting position, relax;

on the ninth, sitting on a chair, legs slightly apart, hands on hips, straighten the elbows, resting the base of the palms, stretching up for 30 seconds, then return to the starting position, relax;

on the tenth, sitting on a chair, legs wide apart, arms hanging freely, stretching to the floor with one hand to the side across the body for 30 seconds, then returning to the starting position, relaxing;

on the eleventh, sitting on a chair, legs together, take the seat of the chair, turn to the side, rotating in the belt, without taking your hands off the support for 30 seconds, then return to the starting position, relax; then repeat in the other direction for 30 seconds, then return to the starting position, relax;

on the twelfth, sitting on a chair, leaning on the back, legs together, hands hanging freely, clasping the knee with palms, pull the leg up for 30 seconds, then return to the starting position, relax, then repeat with the other leg for 30 seconds, then return to starting position, relax;

on the thirteenth, sitting on a chair, leaning on the back, legs together, arms bent at the elbows, palms facing each other with fingers up, raise your arms up above your head, squeezing your palms as high as possible for 30 seconds, then slowly release without tension and return to their original position;

on the fourteenth, sitting on a chair, legs together, arms bent at the elbows, to the sides at shoulder level, palms down, move the elbows to the sides, clenching fists for 30 seconds, then return to their original position, relax;

on the fifteenth, sitting on a chair, leaning on the back, legs slightly apart, arms hanging freely, then gently dropping the chin on the chest, fixing this position and closing the eyes for 30 seconds.

Before you tense your muscles in any exercise, you need to take a calm breath. With relaxation of the muscles, a calm long exhalation is made.

The detailed content of the classes according to the comprehensive program of physical rehabilitation at the main stage is presented in Table 1. Taking into account the results of the TSHH of each patient, long-term stabilization of the intensity of aerobic loads is recommended through regular 3-times classes per week according to the program of daytime classes for 7 weeks of the main stage with the possibility of feedback from the attending physician and instructor of physiotherapy exercises (LFK).

An important advantage of the proposed invention is the availability regardless of age, gender, disease, the possibility of using both for therapeutic and prophylactic purposes, the absence of contraindications, preliminary training, and due to the aggravation of the epidemiological situation, it is possible to use by children, as it is easy and affordable to learn. It is performed both under the guidance of an instructor, parents, and independently at a conscious age.

EXAMPLES OF CARRYING OUT THE INVENTION

The study included 12 patients of three age groups (young, middle, elderly), with the same number of men and women in each age group, who were discharged from the hospital to go home in compliance with 14-day self-isolation and did not engage in therapeutic physical culture during it.

Patient Inclusion Criteria:

- confirmed diagnosis of COVID-19;

- saturation, i.e. the level of blood oxygen saturation, not less than 94%, without artificial oxygen delivery for at least 14 days;

- CT scan of the lungs according to the terms corresponding to the discharge from the covid hospital;

- negative test for polymerase chain reaction (PCR) no more than 72 hours;

- no complications requiring hospitalization;

- the patient's ability to participate in the study for at least 8 weeks.

All patients included in the study, at the time of signing the informed consent, were inpatients of the Federal State Budgetary Institution "NMIC TPM" of the Ministry of Health of the Russian Federation under the program "Recovery after COVID-19". This made it possible at the initial stage of rehabilitation not only to teach the technique of exercises, but also to control the correctness of the implementation of the proposed complexes, to find out personal characteristics that provide a full-fledged contact "doctor-patient".

According to the recommendations of the Ministry of Health of the Russian Federation, the physical rehabilitation program should be designed for a period of at least 8 weeks and include two stages, which made it possible to determine the following terms: Stage I - initial or preparatory, 1 week; Stage II - basis, 7 weeks.

At the preparatory stage, patients for the 1st week twice a day under the guidance of an instructor performed a complex of rehabilitation exercises with elements of complete breathing, lasting 15 minutes, consisting of 20 exercises, 6 repetitions each in the initial position, at 10 am and 5 pm. On the 6th and 7th day of the week, under the guidance of an instructor, the patients mastered the technique of stepping on a step platform 20-25 cm once a day for 20 minutes as an independent lesson. 3 sessions per day, short in time, allowed the load to be dispersed, facilitating the process of adaptation to physical activity.

At the main stage, the detailed content of which is presented in Table 1, the load became more localized due to the addition of new complexes, performing them one after the other, and, consequently, increasing the duration of the daily lesson. At the same time, complexes of rehabilitation gymnastics with elements of full breathing in the 1st and 2nd weeks of this stage were performed in the same mode as at the preparatory stage in the morning and evening.

In order to avoid emotional overload from physical exercises, which is possible for patients who have not previously been engaged in regular physical education, it is recommended to perform a new set of exercises for relaxation and calming separately from the evening complex of rehabilitation gymnastics with elements of full breathing, 1.5-2 hours before bedtime, which allows not only relieve muscle tension accumulated during the day, but also provide faster falling asleep.

3, 4, 5, 6, 7 weeks - a complex of rehabilitation gymnastics with elements of complete breathing is not performed in the evening.

From the 3rd week, a complex of rehabilitation gymnastics with elements of complete breathing is performed once a day, daily in the morning, and at 4,5,6,7 weeks only on the day when there are no classes; in addition, at 6.7 weeks, it is also used as part of a daily workout, but the duration is reduced by reducing the number of repetitions from 6 to 4, performing the function of a warm-up before strength work with weights on step platforms.

The length of hospital stay varied between 12 and 15 days, which provided an instructor-led familiarization with the main stage complexes, which allowed effective continuation of classes at home during the remaining 6 weeks of the main stage.

After going through all the stages of the complex (preparatory and main) to ensure the consolidation of the achieved effect, and consequently, the subsequent improvement in the quality of life of patients, based on the results of medical studies, recommendations are given on physical activity in everyday life with the possibility of feedback from the attending physician and exercise therapy instructor.

Three times before the start of participation in the program, after the preparatory, after the main stages, the following studies were carried out:

- forced vital capacity (FVC);

- frequency of respiratory movements (RR);

- the level of oxygen in the blood SO ₂ ;

- 6-minute walk test TShH;

- the level of personal anxiety (Spielberger-Khanin questionnaire).

The Spielberger-Khanin test for the level of personal anxiety is an informative way of self-assessment of personal anxiety (as a stable personality characteristic).

Personal anxiety is understood as a stable individual characteristic that reflects the subject's predisposition to anxiety and suggests that he has a tendency to perceive a fairly wide "fan" of situations as threatening, in this case the covid itself and its consequences, as a rather unexplored phenomenon.

The Personal Anxiety Questionnaire consists of 40 statements, each statement has 4 possible answers.

The final indicator can be from 20 to 80 points. Approximate estimates of anxiety:

- up to 30 points - low;

- 31 -44 - moderate;

- 45 and more - high.

After the end of the main stage, computed tomography (CT) of the lungs is additionally performed.

The results of the study after the preparatory stage (Table 2) led to the conclusion that regular breathing exercises are not enough to fully restore the body after COVID-19, despite a significant change in the exponential pulmonary system for the better: FVC, NPV, SO ₂ . The TSH indicators remained practically unchanged, since the restoration and development of general endurance is of a longer-term nature due to the cumulative effect to a greater extent.

The indicator of personal anxiety also did not undergo significant changes, since it is directly related to a person's confidence in their own abilities, including physical ones. And since the period of the preparatory stage is insignificant, there is no formed stereotype in the implementation of the complexes, there is uncertainty, including in coordination, the ability to master a long program, a complex training.

The results of the studies after the main stage (Table 3, preparatory and main) made it possible to confirm the correct choice in the direction of the recovery program: a complex effect on the respiratory, cardiovascular, musculoskeletal, and nervous systems.

Claims (105)

A method for recovering patients who have undergone COVID-19 using a comprehensive physical rehabilitation program, which includes various complexes of therapeutic exercises for coronavirus infection, aimed at the respiratory, cardiovascular, musculoskeletal and nervous systems of patients, characterized in that it is performed in two stages: preparatory lasting one week and the main duration seven weeks, and includes 6 complexes: the first complex of which is aimed at the patient's respiratory system and is a rehabilitation gymnastics with elements of full breathing, performed in the initial position "sitting on a chair", which includes 20 consecutive exercises: on the first hand on their knees, throw their heads back, look up, take a slow breath through their mouths, tilt their heads forward, touching the cervical fossa with their chin, look down, slowly exhale through their nose; on the second, the arms hang freely, raise the shoulders up, stretch the diaphragm, take a slow breath in through the nose, then lower the shoulders, relaxing them, perform a quick exhalation through the mouth; on the third, the fingers are clasped on the stomach in a lock, draw in the stomach, pressing on it with their hands, perform a slow breath with the nose, then push the hands out with the stomach, perform a quick exhalation with the mouth; on the fourth, the fingers are clasped on the stomach in a lock, inflate the stomach, bending in the lower back, take a slow breath through the nose, then slowly deflate the stomach with the help of the hands, return the lower back to the back of the chair, and slowly exhale through the mouth; on the fifth, the fingers are locked on the stomach, turn the palms outward and stretch forward, the fingers remain locked, the elbows are straightened, the head is tilted forward, the arms are at shoulder level, take a slow breath in through the nose, then quickly lower the hands, perform a quick exhalation through the mouth; on the sixth hand at the shoulders, elbows at shoulder level, bring the elbows forward, take a slow breath through the nose, take the elbows back, bringing the shoulder blades together, perform a slow exhalation through the mouth; on the seventh, the hands are at the shoulders, the elbows are pressed to the ribs, the arms are lowered, the fingers are tense and splayed, the shoulders are raised, the stomach is tightened, they take a quick breath through the nose, the arms relax, the hands return to the shoulders, they slowly exhale through the mouth, lips with a tube; on the eighth hand at the shoulders, bring the right elbow up behind the head, perform a slow breath through the nose, then lower the elbow, perform a quick exhalation through the mouth, repeat the exercise with the left hand; on the ninth hand at the shoulders, perform circular movements in the shoulder joints with arms bent at the elbows forward and backward, 4 circles forward, 4 circles back, repeat 2 times, arbitrary breathing; on the tenth, hands on their knees with palms up, clench their fists with force, perform a slow inhalation through the nose, then unclench their fists, perform a slow exhalation through the mouth; on the eleventh, the arms hang freely, spread straight arms to the sides at shoulder level, palms forward, take a slow breath in through the nose, then hug themselves by the shoulders with force, perform a slow exhalation through the mouth; on the twelfth, hands on the hips, closer to the groin, straighten the elbows, stretching the back up, take a slow breath through the nose, then bend the elbows, relax the back, exhale quickly through the mouth; on the thirteenth, hands on the belt, thumbs towards the waist, bring the elbows forward without tilting the body, brushes slide along the belt, take a slow breath through the nose, take the elbows back, connecting the thumbs on the lower back, bring the elbows together, perform a slow exhalation through the mouth; on the fourteenth, the arms hang freely, raise straight arms forward and upward, perform a slow breath through the nose, lower the arms down, clasping the knee of the raised and bent leg, the back is pressed against the back of the chair, perform a slow exhalation through the mouth, do the same with the other leg; on the fifteenth, the arms hang freely, straighten one leg forward and hold it in the air, pull on the toe, the second leg goes under the chair, then change legs to the count of one-two-three-four, breathing is arbitrary; on the sixteenth, the arms hang freely, raise the leg bent at the knee, perform a slow breath through the nose, then lower the leg down, perform a quick exhalation through the mouth, repeat the exercise with the other leg; on the seventeenth hand at the shoulders, bend the elbows to the knees, the neck muscles are relaxed, the chin is at the cervical fossa, take a slow breath in through the nose, straightening up, take the elbows back, throw the head back, perform a slow exhalation through the mouth; on the eighteenth, the arms are bent at the elbows, the elbows are pressed to the ribs, tensing, raise the shoulders up, take a slow breath in through the nose, leaning forward, rest the forearms on the knees, tilt the head, perform a slow exhalation through the mouth; on the nineteenth, the arms hang freely, the head is turned to the shoulder, turning the head to the other shoulder, take a slow breath in through the nose, reaching the shoulder, exhale quickly through the mouth, do the same in the other direction; on the twentieth, hands hang freely, relaxed hands raise up, take a slow breath through the nose, freely lower the hands down, perform a quick exhalation through the mouth; each of the exercises of the first complex is repeated 4 to 6 times, while for a better discharge of sputum from the bronchi on exhalation, exhale with an open mouth, the second and third complexes of which are aimed at the patient's cardiovascular system, while the second complex includes 12 consecutive exercises to restore overall endurance on the step platform: on the first, standing in front of the step platform sideways to the narrow side, legs together, hands on the belt, thumbs towards the waist: on count 1 - put one foot in the middle of the step, on count 2 - put the other foot, on count 3 - put one foot on the floor on the other narrow side, at the expense of 4 - put the other foot; on the second, standing in front of the step platform sideways to the narrow side, legs together, hands on the belt, thumbs towards the lower back: on account 1 - put one foot to the side-forward on the floor from the wide side, in the middle, on account 2 - attach the other leg, on count 3 - put one foot back in the middle of the step platform, on count 4 - put the other foot on, on count 5 - put one foot back on the floor, on count 6 - put the other foot, on count 7 - put one foot in the middle of the step platform, at the expense of 8 - put the other foot; on the third, standing on the step platform facing the wide side, legs together, hands on the belt, thumbs towards the lower back: on count 1 - step with one foot to the side on the edge of the step platform, on count 2 - step with the other foot to the side on the edge of the step platform, at the expense of 3 - half-squat, at the expense of 4 - straighten your knees; on the fourth, standing on the step platform facing the wide side, legs wide apart, hands on the belt, thumbs towards the waist: on count 1 - tilt the body down without bending the knees, trying to touch the step platform with your hands, on count 2 - return to the starting position, at the expense of 3 - bend back in the lower back, without throwing back the head, bringing the elbows together, at the expense of 4 - return to the starting position; on the fifth, standing on the step platform facing the wide side, legs wide apart, hands on the belt, thumbs towards the waist: on count 1 - put one foot in the middle of the step platform, on count 2 - put the other foot, on the count 3 - lower one foot back to the floor, at the expense of 4 - lower the other leg forward to the floor, at the expense of 5 - put one foot on the step platform, at the expense of 6 - put the other foot on the step platform, at the expense of 7 - step one foot to the side on the edge of the step platform, at the expense of 8 - step with the other foot to the side to the edge of the step platform; on the sixth, repeat with a change in the position of the legs back and forth; on the seventh, standing on the step platform facing the wide side, legs wide apart, hands on the belt, thumbs towards the waist: on count 1 - put one foot back on the floor in the middle of the step platform, on count 2 - put the other foot, on account 3 - sit down, touching the step platform with your hands, on account 4 - straighten your knees, hands on your belt, thumbs towards the waist; on the eighth, standing in front of the step platform facing the wide side, legs together, hands on the belt, thumbs towards the waist: on count 1 - put one foot in the middle of the step platform, on count 2 - raise the other leg bent at the knee up above the step platform with the simultaneous lifting of straight arms up, at the expense of 3 - lower the bent leg to the floor, hands on the belt, thumbs towards the lower back, at the expense of 4 - put the other leg on the floor; on the ninth, repeat with the rise of the other leg; on the tenth, standing in front of the step platform facing the wide side, legs together, hands on the belt, thumbs towards the waist: on count 1 - step over the step platform forward with one foot, on count 2 - put the other foot on, on count 3 - semi-squat, arms forward at shoulder level, count 4 - straighten your knees, hands on the belt, thumbs towards the waist, count 5 - step over the step platform back with one foot, count 6 - put the other leg, count 7 - semi-squat, hands forward at shoulder level, at the expense of 8 - straighten your knees, hands on your belt, thumbs towards the waist; on the eleventh, standing in front of the step platform facing the wide side, hands on the belt, thumbs towards the waist: on count 1 - put one foot in the middle of the step platform, on count 2 - throw the shin of the other leg to the buttock above the step platform , simultaneously with spreading the arms to the sides at shoulder level, at the expense of 3 - lower the bent leg to the floor, hands on the belt, thumbs towards the waist, at the expense of 4 - put the other leg on the floor; on the twelfth, repeat with throwing the lower leg of the other leg, each of the exercises of the second complex is performed 6 times, while after the 4th repetition, either pauses for rest are performed, or a transition is made to normal stepping, which will restore breathing and continue the complex, and the third complex is aimed at developing general and strength endurance and includes 12 consecutive exercises on a step platform with weights: on the first, standing on the step platform in the middle sideways to the wide side, legs together, hands with dumbbells below in front of you at the level of the groin, palms turned towards each other, elbows bent: on count 1 - put one foot on the floor while raising your arms through sides up to shoulder level, at the expense of 2 - put the other foot on the floor on the opposite side, at the expense of 3 - put one foot on the step platform with the return of the hands to its original position, at the expense of 4 - put the other foot on the step platform; on the second, standing on the step platform in the middle sideways to the wide side, legs together, hands with dumbbells below in front of you at the level of the groin, palms turned towards each other, elbows bent: on count 1 - put one leg on the floor, while lifting the bent in the elbows to shoulder level, at the expense of 2 - semi-squat with the inclusion of both legs, at the expense of 3 - straighten the knees, at the expense of 4 - put the leg on the step platform with the simultaneous return of the hands to the starting position, at the expense of 5, 6, 7, 8 - repeat with the other leg; on the third, standing on the step platform in the middle sideways to the wide side, legs together, hands with dumbbells below in front of you at groin level, palms turned towards each other, elbows bent: on count 1 - put one foot on the floor, on count 2 - put the other foot on the floor on the opposite side, at the expense of 3 - semi-squat with simultaneous lifting of the arms through the front position to shoulder level, at the expense of 4 - straighten the knees, return the hands to their original position, at the expense of 5 - put one foot on the step platform, at the expense of 6 - put the other foot on the step platform, at the expense of 7 - tilt the torso down without bending the knees while pulling straight arms back, at the expense of 8 - straighten up; on the fourth, standing on the step platform in the middle sideways to the wide side, legs together, with dumbbells below: on account 1 - moving one leg to the side-up while raising the arm of the same name to shoulder level, on account 2 - put the foot on the step platform with the return of the hand to its original position, at the expense of 3 - abduction of the other leg to the side-up with the simultaneous lifting of the arm of the same name to shoulder level, at the expense of 4 - put the foot on the step platform with the return of the arm to its original position, at the expense of 5 - semi-squat , straight arms at chest level, at the expense of 6 - straighten your knees with the return of the arms to their original position, at the expense of 7 - lower one leg to the floor, at the expense of 8 - lower the other leg to the floor from the opposite side; on the fifth, standing, step between the legs, arms with dumbbells below: on account 1 - lifting one leg, bent at the knee, above the level of the hip joint with simultaneous lifting of straight arms up through the front position, on account 2 - return to the starting position, on count 3 - lifting the other leg, bent at the knee, above the level of the hip joint with the simultaneous lifting of straight arms up through the front position, on count 4 - return to the starting position; on the sixth, standing, step-platform between the legs, arms with dumbbells below: on account 1 - put the foot of one leg in front of the foot of the other leg while bending the arms at the elbows, trying to touch the same shoulder joints with the dumbbell heads, on account 2 - return to the starting position, on account 3 - change the position of the legs, placing the foot in front of the foot on the other side while bending the arms at the elbows, trying to touch the shoulder joints of the same name with the heads of the dumbbells, on account 4 - return to the starting position; on the seventh, standing, step-platform between the legs, hands with dumbbells below: on count 1 - put the foot of one foot on the toe behind the foot of the other leg with a simultaneous semi-squat and spreading the arms to the sides at shoulder level, on count 2 - return to the starting position , at the expense of 3 - repeat with the other leg, at the expense of 4 - return to the starting position; on the eighth, standing, step-platform between the legs, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - raise the leg, bent at the knee, above the hip joint; on account 2 - lower to the floor, on account 3 - raise the other leg, bent at the knee, above the hip joint, on account 4 - lower to the floor; on the ninth, standing, step platform between the legs, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - turning to face the step platform, put one foot on the edge of the step platform, on count 2 - put the other leg on the opposite edge of the step platform, at the expense of 3 - tilt the body down, the head is tilted, straight arms between the legs, at the expense of 4 - straighten up with the simultaneous return of the arms to their original position; on the tenth, standing on the step platform facing the wide side, legs wide apart, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - put one foot forward on the floor in the middle of the step platform, on count 2 - put the other foot forward to the floor, while bringing straight arms in front of the chest, palms turned towards each other, on count 3 - put one foot back on the edge of the step platform, on count 4 - put the other foot back on the opposite edge of the step platform with simultaneous breeding straight arms to the sides at shoulder level, palms down; on the eleventh, standing on the step platform facing the wide side, legs wide apart, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - put one foot back on the floor on the toe at the opposite edge of the step platform with a simultaneous semi-squat and lowering the arms down, at the expense of 2 - return to the starting position, at the expense of 3 - repeat with the other leg, at the expense of 4 - return to the starting position; on the twelfth, standing on the step platform facing the wide side, legs wide apart, arms with dumbbells to the sides at shoulder level, palms down: on count 1 - put one foot back on the floor in the middle of the step platform, on count 2 - put the other foot back on the floor in the middle of the step platform, lowering your hands down, on count 3 - put one foot on the edge of the step platform, on count 4 - put the other foot on the opposite edge of the step platform with the hands returning to their original position, each exercise of the third complex is performed 6 times, while the complex first uses dumbbells from 0.5 to 3.0 kg for the arms, and then weights for the legs from 0.5 to 3.0 kg, the fourth and fifth complexes of which are aimed at the patient's musculoskeletal system, while the fourth complex for restoring the mobility of the joints of the whole body and strengthening them is performed in the initial position "standing at the chair" with support and includes 15 consecutive exercises: on the first, standing facing the back of the chair, hands rest on the wall, legs wide apart, feet outward, rise on toes, return to the starting position; on the second, standing facing the back of the chair, hands rest on the back, legs wide apart, feet outward, perform a semi-squat, without lifting the heels from the floor, return to the starting position; on the third, standing facing the back of the chair, hands resting on the back, legs wide apart, feet outward, alternately bending the knee of one leg, without lifting the feet from the floor; on the fourth, standing facing the back of the chair, hands rest on the back, legs together, lunge with one foot back, knee touches the floor, return to the starting position, repeat with the other foot, then return to the starting position; on the fifth, standing facing the back of the chair, hands resting on the back, legs together, perform alternate circular rotations with the leg bent at the knee, in the hip joint outward, the knee above the hip joint; on the sixth, standing facing the back of the chair, hands rest on the back, feet shoulder-width apart, perform simultaneous rotations of both legs in the knee joints in one direction and the other; on the seventh, standing facing the back of the chair, hands resting on the back, legs shoulder-width apart, at the expense of 1-2-3, springy semi-squats are performed, lifting the heels off the floor, at the expense of 4, they perform a full gray, without lifting the heels from the floor; on the eighth, facing the back of the chair, hands rest on the back, legs together, bend the arms at the elbows, touching the back of the chair with the chest while throwing the lower leg to the buttock, return to the starting position, then repeat with the other leg, return to the starting position; on the ninth, standing facing the back of the chair, legs together, straight arms at the top with palms forward, tilt the body forward and down, placing the palms on the seat, return to the starting position; on the tenth, standing with their backs to the back of the chair, hands rest on the back, legs together, lunge with one foot forward, bending the knee, the other leg is straight, return to the starting position, then repeat with the other foot, return to the starting position; on the eleventh, standing with their backs to the back of the chair, hands rest on the back, legs shoulder-width apart, perform a semi-squat, without lifting the heels from the floor, bending the elbows, return to their original position; on the twelfth, standing with your back to the back of the chair at arm's length, legs shoulder-width apart, turn to the back of the chair without moving your feet, do push-ups, return to the starting position, then repeat in the other direction, return to the starting position; on the thirteenth, standing sideways to the back of the chair, one arm is supported, the other arm is to the side at shoulder level, palm up, they stretch their arm above their head, trying to reach the shoulder joint of the opposite arm, return to their original position, then repeat, standing with the other side, return to starting position; on the fourteenth, standing sideways to the back of the chair, one hand in support, the other hand to the side at shoulder level, palm back, reach out behind the back, trying to reach the elbow of the opposite hand, return to the starting position, then repeat, standing with the other side, return to starting position; on the fifteenth, facing the back of the chair, legs together, straight arms at the top, palms forward, bend back without throwing back their heads, bend over the back of the chair, leaning on the seat with their forearms, return to their original position, each of the exercises of the fourth complex is performed 6 times for 15 minutes, the fifth complex is designed to stretch the muscles of the spine and includes 10 consecutive exercises: on the first, lying on your back, arms up, legs straight together, stretching your arms up, straining your fingers, palms look at each other, tighten your stomach, stretch your heels down; on the second, lying on your back, legs bent at the knees resting on the floor, arms along the body, pulling their knees to their chest, clasping their hands, bending their elbows, tearing the pelvis off the floor and not taking their heads off; on the third, lying on the back, arms along the body, legs straight together, raise the head, chin to the chest, arms along the body in weight, fingers tense, toes of the feet "toward"; on the fourth, lying on your back, arms along the body, legs bent at the knees with support on the floor, raise the upper part of the body, pull the hands to the knees, fingers are tense; on the fifth, lying on your back, arms along the body, legs bent at the knees with support on the floor, straighten one knee, clasping hands in a “lock” under the thigh, raise a straight leg to the chest with resistance, toe of the foot “away from you”, head and the pelvis is not torn off the floor, the exercise is repeated with the other leg; on the sixth, standing on all fours, palms forward in relation to the shoulder joints, sit on the heels, stretching the hands forward, lower the head to the elbows, the neck muscles are relaxed; on the seventh, standing on all fours, palms at the level of the shoulder joints, pull the knee to the chin, foot on weight, head tilted, chin to the cervical fossa, repeat the exercise with the other leg; on the eighth, lying on the stomach, the chin on the back of the palms laid on top of each other, legs straight together, bend the leg at the knee joint, raise it above the hip joint, sliding along the floor, trying to bring the ilium closer to the floor, repeat the exercise with the other leg; on the ninth, lying on your back, arms along the body, legs straight together, pull one leg bent at the knee to the chest, lift the second from the floor, pull the toes of the feet towards you, do not tear your head and pelvis off the floor (“bicycle”), the exercise is repeated by changing the position of the legs; on the tenth, lying on your back, arms straight up, legs straight together, stretch your arms up, straining your fingers, palms look at each other, tighten your stomach, toes of the feet are directed “away from you”, each exercise of the fifth complex is performed 1 time for 30 seconds without rest intervals between exercises, the sixth complex of which is aimed at the nervous system, is a set of exercises for relaxation and calming and includes 15 consecutive exercises performed for 30 seconds: on the first, sitting on the edge of the chair, they clasp the back, straightening their arms, legs apart, tilt the torso forward without bending in the lower back, pulling the shoulders, upper back for 30 seconds, chest, then return to the starting position, relax; on the second, sitting on a chair, leaning on the back, legs apart, arms below, stretching up with both hands, then stretching forward, tilting the torso, arms at shoulder level, head tilted at elbow level, then leaning their chest on their knees, hanging their arms over sides and stretch down, without trying to touch the floor, for 30 seconds, then return to their original position, relax; on the third, sitting on a chair, leaning on the back, legs apart, arms below, stretching up with one hand, lowering the other to the floor without tension, look at the raised arm for 30 seconds, then return to the starting position, relax, then repeat in the other side for 30 seconds, then return to the starting position, relax; on the fourth, sitting on a chair, leaning on the back, legs apart, hands in the “lock” behind the head, elbows together, take the elbows back for 30 seconds, then return to their original position, relax; on the fifth, sitting on a chair, leaning on the back, legs apart, arms bent at the elbows, in a “lock” above the head, tilt the torso to one side for 30 seconds, then return to the starting position, relax, then repeat in the other direction for 30 seconds, then return to the starting position, relax; on the sixth, sitting on a chair, leaning on the back, legs together, grab the seat of the chair, raise the legs bent at the knees, leaning on the seat of the chair for 30 seconds, then return to the starting position, relax; on the seventh, sitting on a chair, leaning on the back, legs together, take the seat of the chair, straighten the leg at the knee joint, raising it to the level of the seat, the toe “toward” for 30 seconds, then return to its original position, relax, after repeat with the other leg for 30 seconds, then return to the starting position, relax; on the eighth, sitting on a chair, tilt the torso forward without arching the lower back, legs wide apart, crossed arms on the knees on the side from the inside, press the palms on the knees, resisting for 30 seconds, then return to the starting position, relax; on the ninth, sitting on a chair, legs apart, hands on hips, straighten the elbows, resting on the base of the palms, stretching up for 30 seconds, then return to the starting position, relax; on the tenth, sitting on a chair, legs wide apart, arms hanging freely, stretching to the floor with one hand to the side across the body for 30 seconds, then returning to the starting position, relaxing; on the eleventh, sitting on a chair, legs together, take the seat of the chair, turn to the side, rotating in the belt, without taking your hands off the support for 30 seconds, then return to the starting position, relax; then repeat in the other direction for 30 seconds, then return to the starting position, relax; on the twelfth, sitting on a chair, leaning on the back, legs together, hands hanging freely, clasping the knee with palms, pull the leg up for 30 seconds, then return to the starting position, relax, then repeat with the other leg for 30 seconds, then return to starting position, relax; on the thirteenth, sitting on a chair, leaning on the back, legs together, arms bent at the elbows, palms facing each other with fingers up, raise your arms up above your head, squeezing your palms as high as possible for 30 seconds, then slowly lower them without tension and return to their original position; on the fourteenth, sitting on a chair, legs together, arms bent at the elbows, to the sides at shoulder level, palms down, move the elbows to the sides, clenching fists for 30 seconds, then return to their original position, relax; on the fifteenth, sitting on a chair, leaning on the back, legs apart, arms hanging freely, then dropping their chin on their chest, fixing this position and closing their eyes for 30 seconds, at the preparatory stage, under the guidance of physical therapy instructors (exercise therapy), patients perform rehabilitation exercises twice a day with elements of complete breathing, lasting 15 minutes at 10 am and 5 pm, while on the 6th and 7th day of the first week during daytime classes with an exercise therapy instructor master the technique of stepping on a step platform 25 cm high, once a day for 20 minutes as an independent lesson no later than 16 hours, but not earlier than 45 minutes after eating, at the same time, rehabilitation gymnastics with elements of full breathing during the 1st and 2nd weeks of this stage is performed in the same mode as at the preparatory stage, at the same time, starting from the 3rd week of the main stage, rehabilitation gymnastics with elements of full breathing is performed in the morning once a day, and on the 5th, 6th, 7th week in the morning, but only on the day when there are no classes, and on the 6th and the 7th week, rehabilitation gymnastics is performed during the day as part of a daytime lesson, but its duration is reduced by reducing the number of repetitions from 6 to 4, performing the function of a warm-up before strength work with weights on step platforms, at the same time, on the 1st week of the main stage, stepping on the step platform is used during the day, lasting 30 minutes, and on the 2nd, 3rd week of this stage, the second set of exercises is used to restore overall endurance on the step platform, in total time reaching 30 minutes , while the third complex on the step platform with weights for the entire duration of the main stage in total time reaches 20 minutes on the 4th week of the main stage, 35 minutes on the 5th week, 45 minutes on the 6th and 7th weeks, and on the 4th week dumbbells are used for hand weights from 0.5 to 3.0 kg, and at 5, 6 and 7 weeks both dumbbells for the hands and leg weights weighing from 0.5 to 3.0 kg, at the same time, the fourth set of exercises to restore mobility and strengthen the joints is used in the daytime session at 1, 2, 3 and 4 weeks of the main stage, while the fifth set of exercises, which allows you to remove the negative consequences after the load, is used at 3, 4, 5, 6 and 7 weeks of the main stage, at the same time, the sixth set of exercises for relaxation and calming is used in the evening 1.5-2 hours before bedtime at 1, 2, 3, 4 and 5 weeks without fail, and at 6 and 7 weeks with feelings of anxiety and anxiety in the patient according to the results of the Spielberger-Khanin personal anxiety questionnaire, and at 1, 2, 3 weeks daytime classes are carried out daily, and at 4, 5, 6, 7 weeks of the main stage every other day, after passing the main stage, 3 sessions per week are carried out according to the program of daily classes for 7 weeks of the main stage with the possibility of feedback from the attending physician and exercise therapy instructor.