Effectiveness of physical rehabilitation on sphygmography and blood pressure

Cardiovascular Diseases (CVD) have become the leading cause of death worldwide: for no other reason as many people die every year from CVD. This problem affects low and middle-income countries to varying degrees. More than 80% of deaths from CVD occur in these countries, almost equally among men and women, however, patients who survived after Myocardial Infarction (MI) are at high risk of death. According to the main facts of the WHO, 17.9 million people died from CVD in 2016, which accounted for 31% of all deaths in the world. In this connection, it is necessary to improve medical rehabilitation and physical rehabilitation, in particular for CVD, especially on an outpatient basis. Competent physical rehabilitation and cardiac rehabilitation in patients with myocardial infarction are associated with improved survival and effectiveness of quality of life, as well as prevention of recurrent MI. There is a legislative framework FZ-No. 323 of 21.11.2011 “On the basics of health protection of citizens in the Russian Federation” concerning medical rehabilitation and “Procedure for organizing medical rehabilitation” No. 1705n of 29.12.2012.

This study shows physical rehabilitation methods of health path and Nordic walking. Terrenkur is a method of sanatorium-and-spa treatment, which provides for dosed physical activity in the form of walking tours (5 km - 6 km daily at 12.00 - 13.00). Nordic walking - walking with sticks, a type of physical activity that uses a certain training methodology and walking technique with the help of specially designed sticks (5 km - 6 km daily at 12.00 - 13.00).

Multiple meta-analyses showed that Cardiovascular Rehabilitation (CVR) reduces mortality in patients with coronary artery disease. Despite the recommendations and recommendations for the use of programs for patients with previous MI, patient participation in these programs remains low, which has led to the development of alternative models of medical rehabilitation.

To conduct and study the effect of each method separately, as well as to carry out a comparative analysis of the methods of therapeutic physical activity used in restorative medicine in patients, who underwent myocardial infarction on an outpatient basis. Evaluate the effectiveness of remote access cardiac rehabilitation programs [1-4]. Determine, which of the rehabilitation methods is most effective.

Research objectives<

1. To study the hemodynamics of each method in patients with MI before and after physical rehabilitation.

2. To assess the quality of life of patients, who underwent myocardial infarction in dynamics: before and after physical rehabilitation.

In our study, we performed physical rehabilitation using the methods of therapeutic physical activity (health path).

The selection of patients with a previous MI and the research part of the work was carried out in the rehabilitation department of the CVMiR “Berezovaya Roscha” FKUZ Medical Unit of the Ministry of Internal Affairs of Russia in Moscow in the period from January 2017 to December 2019 with a referral diagnosis from the hospital after 2 months of inpatient treatment - “Myocardial infarction”, post-infarction period, were examined for participation in the Study [5-8].

This study was approved by the local ethics committee.

The patients were performed:

− ECG (heart rate, heart rate) at the beginning and at the end of the physical rehabilitation program (4 months); All study participants were carried out daily:

− Measurement of heart rate indicators at rest and after exercise;

− Measurement of blood pressure before and after exercise.

Patients in our study were distributed according to the WHO age classification as follows: mean age from 51 to 59 years - 13 patients (11.3%), advanced age from 60 to 74 years - 78 patients (67.8%), old age from 75 to 87 years old - 24 patients (20.9%). Thus, there were significantly more elderly patients with previous MI than middle-aged and old-aged patients (p < 0.001) (Table 1).

Normal body mass index (hereinafter - BMI) - 18.5 - 25.0 comprised of 3 groups in 7 patients (6.1%); pre-obesity BMI – 25 kg - 30 kg/m² was found in 66 patients (57.4%); obesity 1 degree BMI - 30 kg - 34.9 kg/m² was detected in 33 patients (28.7%); 8 patients (6.9%) had grade 2 obesity. Obesity grade 3 (BMI <40 kg/m²). There are no significant differences in BMI between groups (p = 0.222).

When examining blood pressure in the studied groups, we did not find a significant difference (p = 0.302).

In group, I, the blood pressure of the diastas was not significantly increased. Hence there is a tendency. All patients were predominantly elderly, with a predominance of men, height above average, weight and BMI indicating obesity of the 1st degree, heart rate within normal limits and SBP/DBP were average.

The results of physical rehabilitation in patients with myocardial infarction in groups, as well as the dynamics of MR indicators - terrenkur, Scandinavian walking, before and after exercise.

Patients of groups I and II, who underwent myocardial infarction practiced daily (terrenkur, Scandinavian walking) during MR under the guidance of an exercise therapy doctor. After the completion of the MR course, repeated structural and functional studies were carried out (Table 2).

The effectiveness of medical rehabilitation by the terrenkur method, the heart rate from the mean did not exceed the maximum allowable values (p < 0.001), SBP/DBP is not a large excess of the maximum values for this category of patients (p < 0.001) (Tables 3,4).

The effectiveness of medical rehabilitation by the Nordic walking method the heart rate from the mean value did not exceed the maximum permissible values (p < 0.001), SBP/DBP is not a large excess of the maximum values for this category of patients (p < 0.001) compared with terrenkur, in Scandinavian, walking the maximum SBP is higher by 5.9% (Table 5).

This medical rehabilitation involves over 90% of the muscles. Just like in terrenkur, heart rate variability. At the initial stage of this method, an individual approach is mandatory to control the correctness of walking and its dosage in order to neutralize medical contraindications for this group of patients. The principle of gradualness and efficiency comes faster than terrainkur, which indicates the control of this method with remote access. Observe the principles of adequate exercise - this provides for a strict individual load. The simplest method for dosing the heart rate load is the method proposed by A. Viru. For beginners and those with a low level of fitness, it is advisable to start with a terrain course (Table 6).

Visualization and comparison of each group by the Kruskal-Wallis criterion indicates, that the heart rate in group II is higher than group I by 1.1%, the indicator (p = 0.154) each method showed as a balanced load for patients with MI; SBP in groups I and II is 10.7% more (p = 0.001); DBP in groups I and II is 5.3% higher, which indicates the norm for the age category (p = 0.003) (Table 7).

Recovery time in the group I heart rate (2.5 ± 1.3 min.), p = 0.114 and BP (2.5 ± 0.71 min.), p = 0.116. A convenient method of rehabilitation for this category of patients with a fast recovery range, but requires maintaining posture during movement and stability of the pace of movement. In group II, heart rate (3.5 ± 1.9 min.), p = 0.114 and blood pressure (4.5 ± 0.71 min.), p = 0.116. This method of rehabilitation in restoring heart rate and blood pressure is less terrenkur and more Nordic walking.

Each method is unique and simple, but the most effective and simple method of physical rehabilitation is the health path - a gentle load that leads to the fitness of the cardiovascular system and quick adaptation to this load, as well as high-quality and quick recovery of the pulse. Nordic walking is a new, little-studied method for restoring the cardiovascular system. Since the upper part of the muscles works with the help of sticks, the cardiovascular system is more loaded, so it is worth using this method on an individual basis.

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