Exercise therapy basics of dosing physical activity

Physical therapy, like any other method of treatment, can be effective if its dosage corresponds to the characteristics of the course of the disease, the objectives and period of treatment, as well as the functional capabilities of the patient and his fitness. Dosage in exercise therapy is understood as the total amount of physical activity when working on individual exercises, as well as on their combinations within a lesson or course. Physical activity should not exceed the patient's functional capabilities, but at the same time have a training effect.

The amount of physical activity during PH can be changed various methodological techniques: choosing a starting position for classes (lying, sitting or standing); the volume of muscle groups involved in the exercises; amplitude of movements; number of repetitions of individual exercises; the pace of their implementation; the degree of their complexity and muscle tension; rhythm of movements; accuracy of performing specified movements; alternating muscle groups; using static breathing and relaxation exercises; using sports equipment and other items and training equipment; duration of classes, emotional coloring. Dosing of other forms of exercise therapy (running, walking, health path, etc.) is carried out mainly by distance, pace, duration, terrain, number of stops and breathing exercises.

The total load during strength exercises is characterized by its intensity, duration, density and saturation. During exercise therapy, the load is limited by the patient’s physical performance, determined using bicycle ergometry (or another method). The threshold or peak load and the corresponding heart rate (HR) are determined by performing an increasing load on a bicycle ergometer until criteria for its intolerance appear. The difference between heart rate at threshold (maximum) load and heart rate at rest is the cardiac reserve (PC). Thus, a training load of 75% of the maximum is calculated by the formula: heart rate at rest + (heart rate max - heart rate at rest) x 75%. The maximum permissible heart rate for healthy individuals can be calculated using the formula: 220 subtract age (in years), and for patients: 190 subtract age (in years). It has been established that the general strengthening and therapeutic effect of physical exercise training will be optimal if the intensity of the load corresponds to 30-40% of the maximum tolerated (threshold) level at the beginning and 80-90% at the end of the course of treatment.

The duration of the load is calculated by the total time of strength training. But the load density expresses the percentage ratio of the duration of the actual exercise to the total total time allotted for the lesson. In exercise therapy, the load density can vary depending on the patient’s condition and the dynamics of the disease and is 20-25% at the beginning of the inpatient treatment period and 50-75% at its completion. In the treatment and health program, the load density increases impressively - up to 80-90%. It mainly depends on the duration of the breaks between the exercises that make up the exercise therapy program. The volume of load received represents the total work done in this lesson. It is measured in kilocalories or kilojoules. The total physical activity is, in addition, divided into:

1. large - without limiting the choice of exercise therapy means;
2. moderate (average) - excluding running, jumping and other complex exercises;
3. small (weak) - allowing the use of elementary gymnastic exercises in combination with breathing.

Local load exerts mainly local influence. Local loads include exercises for facial muscles, normalization of muscle tone, stretching contractures and other training included in exercise therapy courses.

1. Exercise therapy principles of load dosing
2. Exercise therapy principles of fatigue, overwork and overcompensation
3. Motor modes included in basic exercise therapy courses

Depending on the goals and periods of treatment, there are:

1. medicinal,
2. tonic (or supporting),
3. training load dosages.

Therapeutic dosage intended to provide a therapeutic effect on an organ or system, form compensation or prevent complications. At the same time, the overall load is insignificant and increases unnoticeably from training to training. Local load consists of special exercises and can be small or moderate. Signs of general fatigue, as a rule, are absent; fatigue of individual muscle groups may be observed. Shifts in the cardiovascular system and respiratory systems are not pronounced.

Tonic (maintenance) dosage used when the patient's condition is satisfactory. General and local loads are aimed at stimulating the function of the main systems of the body, providing a tonic effect, and supporting the achieved results. Physical activity of moderate and high intensity is used, which does not increase during the course of exercise therapy.

Training dosage is prescribed when there is a need for high function compensation or increased physical performance. This exercise therapy program involves physical activity (general developmental and special), which constantly increases from session to session until fatigue is reached. To calculate the volume of physical activity that has a training effect, various stress tests are used.

Exercise therapy principles of fatigue, overwork and overcompensation

Physical exercise training should be carried out taking into account the functional capabilities of the person and alternate with rest. If this important condition is not met, various deviations can occur, even painful conditions. Fatigue is manifested by a feeling of tiredness, decreased performance, deterioration of coordination of movements, shortness of breath, palpitations, etc. This is a temporary physiological (normal) reaction of the body to the work performed. After a short rest or when the intensity of the load decreases, these changes gradually disappear, and the body’s performance is restored, and for some time it may even exceed the initial one (supercompensation phase). Physical therapy exercises with patients should be carried out in such a way that physical activity does not cause pronounced signs of fatigue in them.

If new loads are prescribed during the period of incomplete recovery of performance, symptoms of fatigue accumulate and overwork occurs. This is a borderline state between a physiological phenomenon and pathology. It is based on a violation of the functional state of the central nervous system, which manifests itself in addition to the signs characteristic of fatigue, deterioration of well-being, lethargy, apathy, sleep disturbance, instability of blood pressure and cardiac rhythm, etc. In order to eliminate fatigue, it is enough to reduce the amount of load and/ or lengthen the rest time.

When applying a single physical load that exceeds a person’s functional capabilities, especially if he is insufficiently physically prepared or ill, acute overexertion may occur. This condition is most often manifested by cardiac or vascular failure: acute weakness, slight dizziness, possible darkening of the eyes, and sometimes in severe cases - nausea, vomiting, increased shortness of breath, and a drop in blood pressure. Acute overstrain of the central nervous system, respiratory organs, kidneys, etc. is also possible. In such situations, the patient must be provided with the necessary medical care and ensure complete rest. With prolonged use of inadequate training loads that exceed the capabilities of their implementation, the so-called state of chronic overstrain gradually develops. It is characterized by selective damage to individual organs or systems (central nervous system, cardiovascular system, kidneys, musculoskeletal system) and requires medical diagnosis and treatment.

Overtraining is a pathological condition that develops as a result of chronic physical overstrain and is manifested by a violation of the regulatory functions of the central nervous system with the development of neurotic reactions of the body. It is characterized by functional disorders in various organs and their systems, decreased immunity, and exacerbation of latent diseases. It is observed mainly in athletes as a result of improper dosing of training loads. Such patients need medical care and long-term quality rest.

For dosing and rationing of physical activity and drawing up treatment and rehabilitation complexes, motor modes have been developed and used. The motor regimen implies the prescription and rational distribution of various types of physical activity of the patient throughout the day and course of treatment in a certain combination and sequence with other means of complex therapy. Exercise therapy, the basis for the effectiveness of the treatment and rehabilitation process, largely depends on the construction of the movement mode. Competent and timely use of the appropriate motor mode stimulates adaptive mechanisms and adaptation of the patient’s body to increasing loads. For patients undergoing inpatient treatment, the following are used: 1) strict bed, 2) extended bed, 3) ward and 4) free modes, and for patients undergoing outpatient treatment or in a sanatorium - 1) gentle, 2) gentle training and 3) training modes.

“Strict bed rest” mode prescribed to seriously ill patients for a short period of time. Positions of the patient - lying on his back, on his back with the head of the bed raised, on his side, on his stomach. Maintenance (toilet, hygiene procedures, food, changing body position) is carried out only with the help of medical personnel. In the physical therapy program, a course of massage and passive exercises with incomplete and complete trajectory of movement for the limbs are used, usually 2-3 times a day for 5-10 minutes. If there are indications, static concentrated breathing is prescribed, performed 2-3 times every hour the patient is awake.

Extended bed rest indicated in the general satisfactory condition of the patient. Active turns in bed, short periods of sitting in a sitting position (usually 2-3 times a day for 5-15 minutes), first with support on pillows, and mastering self-care skills are allowed. As the condition improves, a longer stay in a sitting position is recommended (up to 1-2 hours 2-3 times a day), sitting with legs down on a bed or chair (2-4 times a day for 10-30 minutes). LH classes are carried out once a day for 15-20 minutes in the initial position lying on your back or on your side. Use physical exercises for small and medium muscle groups and joints, performed without effort with a limited and gradually increasing amplitude, in a slow rhythm, with a small number of repetitions; static and dynamic breathing exercises. The maximum permissible increase in heart rate is 12 beats per minute.

Ward course prescribed for the purpose of gradual adaptation of the cardiovascular system, respiratory systems and the body as a whole to increasing power load, prevention of complications associated with hypokinesia. It is characterized by being out of bed in a sitting position for 50% of the total waking time. Slow walking is allowed at a pace of about 60 meters per minute for a distance of up to 100-150 m, using the toilet and/or canteen. Exercise therapy is carried out in lying, sitting and standing positions. Exercises are carried out without objects or with equipment weighing up to 0.5 kg. Gradually include exercises for the muscles of the torso. Duration of classes - 20-25 minutes. The maximum permissible increase in heart rate is 18-24 beats per minute.

Free mode implies the principle of free movement within the department, walking up the stairs to the 3rd floor, if necessary, with rest on the landings. Dosed walking is allowed at a pace of 60-80 steps per minute for a distance of up to 1 km with rest breaks every 200 m. Exercise therapy is carried out in the office once a day for 25-30 minutes. The following is added to the training program:

1. exercises with objects weighing up to 1 kg,
2. sedentary games,
3. exercises in the pool (according to indications), we recommend the pool,
4. exercises on simulators (according to indications).

Upon admission to a sanatorium or medical rehabilitation department, the patient is prescribed one of the following regimens.

Gentle mode (No. 1) differs slightly from the free hospital regime and is a low physical activity regime. UGG and LH classes are planned according to the same program. Controlled walking on a smooth surface is allowed for a distance of 1.5 km to 3 km, walking speed is slow to medium. The total duration of walking is 30-60 minutes with pauses every 1/3 hour. Bathing, swimming and water procedures are allowed at water temperatures above 20°C for 5-10 minutes. A clear dosage of the used forms of the exercise therapy course is shown. Sports games, long-distance excursions and tourism are excluded.

Gentle training mode (moderate physical activity mode, tonic, No. 2) involves the use of exercises of greater load, intensity and duration. During LH training, a short increase in heart rate in the main phase of training is allowed by 42-48 beats per minute and an increase in maximum pressure by 30-35 mm Hg. Art. The intensity and density of classes can reach 70-75%, and their duration is up to 45 minutes. To a large extent, dosed walking at an average and fast rhythm for a distance of up to 4 km in 1 hour and a health path are used. It is allowed to use exercises with equipment weighing up to 3 kg, sports games (volleyball, tennis, badminton), swimming, skiing, boating. Sports games are played according to simplified and standard rules.

Training mode (heavy load regimen, No. 3) is prescribed to people without pronounced deviations in their state of health and physical development, with minor age-related changes and with minimal deviations in the functions of individual organs and their systems. LH, dosed walking, running, and sports games are recommended. In this group of patients, it is allowed to increase the pulse to 120-150 beats per minute, and increase the maximum pressure to 150 mmHg. Art., lowering the minimum blood pressure to 55 mm Hg. Art. In elderly people, the increased heart rate should not exceed 100-120 beats per minute.

Recently, when prescribing motor regimens to patients for the purpose of medical rehabilitation, physical fitness is more accurately assessed by determining physical performance and exercise tolerance.

The entire course of physical therapy is divided into three periods:

1. preparatory, or introductory (3-6 days), characterized by the use of gentle physical activity;
2. main, or training, when all available forms of exercise therapy are used in accordance with the motor mode to solve the problems of general or special training;
3. the final one (3-5 days), which involves teaching patients how to properly perform exercises at home.