Simulators.

   One form of exercise therapy sessions patients are at the gym and block devices (Fig. 2).  They are designed to develop strength, muscle endurance, joint development, that is to increase mobility in the joint (joints).

   Applied exercises in the gym working on certain (individual) groups of muscles and joints.  In addition, the performance of these exercises requires some initial position.  Classes at the gym (and lighter devices) contribute to the development of major movements in the joints and strengthen muscles.  Properly organized training on simulators should not cause pain.

   Block Devices and various adaptations for gymnastics are especially important to restore the function hand, fingers, big joints, etc. (see Fig. 2).

Fig. 2. Approximate set of exercises performed on the block simulator

   Recent years simulators are widely used in the rehabilitation of athletes with the consequences of injuries and diseases of the musculoskeletal system, as well as after surgery. But training on simulators must begin no earlier than 2-3 weeks of treatment and in combination with cryomassage.

  At an early start of the exercise at the gym (eg, after meniscectomy) possible deterioration (slow) regeneration of cartilage, an increase of synovitis (joint effusion), limitation of movement, the emergence of pain, especially if the load on the lower limbs. Excluded such exercises squats, jumping, etc. for 4-6 months.  Initially carried out remedial gymnastics, massage, running (in conjunction with walking) in water.  With obesity, osteochondrosis training on simulators, use of sauna (bath), diet, walking and running provide a significant positive result.

   Exercises at the gym, sparing the spine (IP prone, half-sitting, etc.) combined segmental-reflex massage, cryomassage shown in scoliosis degree I and II (on Chaklin), useful way to swim breaststroke.

Caution should be applied exercises at the gym (block devices) to patients with diseases of the joints (arthritis, polyarthritis, etc.), especially when they contraindicated coxarthrosis. In any case, classes should be with small loads, low voltage and in combination with cryomassage joint (joints), frequent recurrence (2-3 times a day), but short-lived (10-15 minutes).

  Pain syndrome, reflex contraction, increased blood pressure, myocardial infarction, gastric ulcer and duodenal ulcer in the acute stage, thrombophlebitis, aortic aneurysm, myocarditis, heart diseases, acute infectious diseases, angina decubitus, pregnancy, myopia (more than 3 units) diabetes, obliterating endarteritis is a contraindication to employment at the gym!

  In diseases of the cardiovascular, pulmonary systems are also undesirable exercise at the gym. Such patients show a more cyclical activities (jogging, skiing, cycling, etc.).

  When you assign a patient to exercise therapy clinic (or WFM, outpatient clinics, at home) should take into account its motor activity (fitness) in daily life, profession, age and gender.

  In a state of relative physical rest (sitting and standing), the average power consumption is about human 1-1,25 kcal / min.  This value varies depending on the height, weight, gender and the environment (air temperature).

  It is known that for good health, maintaining high physical health and normal course of oxidative-metabolism person should spend on the motor activity of approximately 1200-2000 kcal per day in excess of basal metabolic rate, which is typically 1600-1800 kcal.

  But the energy value of diet for most people than the power consumption, which leads to metabolic disturbances and the occurrence of obesity, diabetes, deterioration of cardio-respiratory system, gastrointestinal tract and other organs.

  The intensity of physical activity, their scope should be akin to physical activity prescribed by your doctor: sparing regimen, gently-coaching and coaching.

  When testing patients before discharge from the hospital determine exercise tolerance. With self-physical exercises (walking, running, breathing and General developing exercises, swimming, etc.) also need to know the response.

  When calculating energy expenditure during exercise therapy sessions should take into account the ratio of heart rate achieved at a load of energy expenditure (Table 3, 4).

Table 3

 Estimated energy consumption for metered loads

  With spa treatment physical activity for patients with cardiovascular diseases is: when sparing mode - 4-5 hours, with gently-trainee - 5-7 hours, with coaching mode - 6-8 hours

 One or another kind of physical activity the patient is monitored for heart rate during preliminary testing on a bicycle ergometer (or treadmill, step test), which is defined by its tolerance to physical exertion. Testing to judge the functional status of the cardiorespiratory system, which is largely dependent patients tolerated exercise.

  Achieved at the threshold exercise heart rate, electrocardiographic parameters, blood pressure, are initial data for dispensing exercise (gymnastics, walking, jogging, games and other forms of physical activity).

  As a threshold heart rate is recorded when a negative (pathological) changes in the electrocardiogram, performing physical activity in everyday and professional activity (work) as well as coaching in the performance of physical activity can prevent such changes in the heart.

  Must respect the principle of gradual increase in physical activity in order to adapt it to the cardiorespiratory system.

  Monitoring the reactions of the cardiorespiratory system of patients on exercise allows you to select appropriate physical activities and evaluate their effectiveness in comprehensive rehabilitation, often cyclical (dosed walking, horse-country skiing, jogging, swimming, etc.).

Table 4

Calculation of energy expenditure (kcal / min) on heart rate

(A. Buskirik, 1960)

  In cardiovascular disease control heart rate (especially remote) allows you to avoid congestion at the same time maintaining the desired restorative effect of the use of physical activity.

  To expand the motor mode in patients with cardio-vascular system (the transition from bed rest to ward and then to coaching mode) use the orthostatic test and the Romberg test to assess the response of the cardiovascular system to physical stress.

  Patients with injuries and diseases of musculoskeletal system, as well as surgical patients in the postoperative period, the effectiveness of exercise therapy estimated by monitoring the state of the neuro-muscular (muscle tone, dynamometry pnevmometriya, etc.).

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