Zaporožskij Medicinskij Žurnal (Aug 2013)
Clinicopathogenetic reasoning of the use of therapeutic dosed “Nordic walking” in patients with combined cardiovascular disease
Abstract
The problem of using the methods of climatotherapy and kinetotherapy when providing medical rehabilitation for patients with combined cardiovascular abnormity is connected with cardiovascular adaptive abilities decrease in patients, low rehabilitation potential, that generates negative outlook on ability to work, quality of life and overall cardiovascular risk. The aim of the study: reasoning of the use of therapeutic dosed “Nordic walking” in rehabilitation of the patients with combined cardiovascular disease. Materials and methods of research: On sanatorium-resort stage of medical rehabilitation 30 patients with coronary heart disease associated with arterial hypertension of 1-3 degrees, were under dynamic observation. In the observed group, 12 (40%) patients were female and 18 (60%) male, mean age of the patients was (54.00 ± 1.65) years. All patients received complex treatment: diet therapy (diet number 10), magnetotherapy of segmental areas of the heart, massage of collar area, classes of therapeutic dosed «Nordic» walking. If necessary, patients received drug therapy (ACE inhibitors, beta-blockers, antiplatelet agents). To study the possibility of applying and the principles of dosing of the therapeutic dosed "Nordic" walking, clinical condition of the patient, the main indicators of the electrocardiogram, changes in heart rate and blood pressure before, during and after classes, were studied in dynamics (on day 1, the third and last day of application of the proposed methods). Ambulatory blood pressure monitoring, assessment of tolerance to physical loads and degree of reduction in physical performance were done before and after treatment. Results and discussion: analysis of the dynamics of growth of heart rate in response to the classes of therapeutic dosed «Nordic» walking, its growth was marked and this indicator reaches its largest value by the end of the sanatory stage of treatment (p<0.05). Such dynamics shows the training progress. Analysis of heart rate frequency after exercise showed positive dynamics for the restoration of its values, which indicates an increase of adaptive capacity of cardiovascular system. Analysis of the dynamics of the mean values of systolic and diastolic blood pressure, measured before the training, and right after it, showed moderate increase in systolic blood pressure and gradual decrease in diastolic blood pressure after classes (р<0.05). We observed a significant reduction in the incidence of pathological types of reaction and increased frequency of eutonic type of reaction (p <0.05) after the sanatory-resort treatment which included classes of therapeutic dosed "Nordic" walking. As the main criterion of effectiveness of sanatorium stage of treatment in patients with combined cardiovascular abnormity we suggested physical performance degree of reduction indicator. Accurate positive dynamics of physical performance decrease was observed in the group of patients as it reduced in 1.6 times (p<0.05), which was accompanied by general health improvement and exercise tolerance of patients. Thus, medical rehabilitation with the use of classes of therapeutic dosed "Nordic" walking in patients with coronary heart disease and arterial hypertension promotes formation of adequate response of the cardiovascular system to physical activity and is well tolerated. Classes of therapeutic dosed "Nordic" walking have normalizing effect on the overall and peripheral hemodynamics, which is reflected in the normalization of systolic blood pressure (р < 0.05) and formation of its adequate dynamics in response to exercise, as well as the restoration of diastolic blood pressure (р<0.05) after exercise. Course application of classes of therapeutic dosed "Nordic" walking allows to correct pathologic types of reactions of cardiovascular system during exercise, in particular, the transition from the pathological types of reaction to eutonic, and significantly improves physical performance and helps to improve the overall health of patients.
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