Alphabetical index. Exercise therapy in combination with other treatment methods Combination of exercise therapy

Publishing house "Medicine", Moscow, 1968
Given with abbreviations

As is known, the main uniqueness of the method of therapeutic physical culture is the performance of active physical exercises by patients. In sanatoriums and resorts, the patient’s activity is determined by the use of various forms of therapeutic physical culture: morning hygienic gymnastics, therapeutic exercise procedures, walks, health paths, short-range tourism, dosed sports exercises (swimming, rowing, skiing, skating, cycling, etc.), as well as games, both outdoor and some sports.

Modern medicine has become more active in all its manifestations. Over the past 10-15 years, interest in both the general and therapeutic and preventive effects of physical exercise on the body of a healthy and sick person has increased significantly. This is due to the study of the influence of muscle activity on the human body. Thus, the works of I.A. Arshavsky shows the role of muscle activity in the formation of the reaction of the cardiovascular system. In a number of works, the most important links have been clarified and the mechanism of regulation of autonomic functions during muscle activity has been studied (M.R. Mogendovich, V.V. Frolkis, N.N. Yakovlev, N.K. Vereshchagin, etc.). Information on issues of active recreation has been studied and systematized (I.V. Muravov and others). All this has greatly advanced and justified the use of therapeutic physical culture, in particular, in the system of sanatorium-resort treatment.

The main factors of the sanatorium-resort environment are: a) a changed environment compared to domestic and professional ones; b) implementation of active elements of the regime in combination with sparing and protective regime; c) climatotherapy, d) balneotherapy; e) internal use of mineral waters.

With all the listed factors of sanatorium-resort treatment of patients, therapeutic physical culture finds a reasonable combination. a) Changing the professional and everyday environment to a sanatorium-resort one is the most important factor in switching therapy, contributing to the creation of new environmental reflexes and the development of positive emotions (I.P. Pavlov, G.A. Zakharyin, S.P. Botkin, V.F. Zelenin etc.). It is quite natural that the most complete switching to the perception of the new resort environment is ensured under the condition of active movement of the patient (walking, health path, short-range tourism, swimming, rowing, skiing, skating, games, etc.), and not during rest mode.

In conditions of active movement, the patient is in greater contact with external environmental factors, constantly changing impressions (chorological factor), which, on the one hand, helps to relieve neuropsychic stress, and on the other, has a general health-improving and restorative effect on the patient’s entire body.

B) The implementation of the principles of an active regime in sanatoriums and resorts does not exclude its combination with rest, both mental and physical. In each individual case, due to the characteristics of the disease, the patient’s profession, and his age, the issue of constructing a rest and treatment regimen is decided individually. The thoughtful attitude of the doctor to the organization of complex treatment requires a dynamic and individual approach to the combined use of various factors, in particular movement and rest.

It is always necessary to take into account that in the system of sanatorium-resort treatment, rest and movement do not exclude, but always complement each other, they are links in a single process aimed at restoring the patient’s strength. The contrast in the understanding of rest and movement in the complex treatment of patients in sanatoriums leads to the division of a single treatment process into treatment and follow-up treatment, which negatively affects the correct organization of treatment and reduces therapeutic success. Of course, in a number of cases, especially in the first days, some patients need to use predominantly passive rest, but then it (if appropriate indications) is gradually replaced by the use of active forms of the regime. The use of various forms of therapeutic physical culture requires combination with passive rest and mainly in the fresh air, in conditions of good ventilation function of the lungs.

In the summer period of the year (resort season), active forms of the regime are used mainly in the morning and early evening, and passive ones - in the hot part of the day (resting in the shade in the air - couches, sun loungers, hammocks, armchairs, etc.). The ratio of active and passive elements in each patient’s regimen is determined individually. c) Climatotherapy is the main factor in sanatorium-resort treatment. It consists of the combined use of aerotherapy, heliotherapy and, to a certain extent, hydrotherapy (sea, river, lake).

The listed three treatment methods are usually combined with therapeutic physical culture, since during the stay, as well as organized treatment of patients in sanatoriums and resorts, patients are complexly influenced by air, sun, water and movement in their various combinations. As you know, the task of complex treatment in sanatoriums and resorts includes training and hardening.

Modern studies of the influence of physical exercise (N.V. Zimkin, A.V. Korobkov, N.N. Yakovlev, etc.) increasingly confirm that the most convenient way to nonspecifically increase the body’s resistance to adverse factors is physical training. The latter, in the conditions of sanatorium treatment of patients, supplemented with elements of hardening, ensures not only an increase in the general working capacity of the patient, but also his resistance to adverse environmental factors. The organization of the treatment process in sanatoriums and resorts must necessarily include the combined use of dosed physical training and hardening. In this regard, therapeutic physical culture, various types of physical exercises find a bright combination with elements of climatotherapy.

First of all, therapeutic physical training is organically combined with aerotherapy (on verandas, sleeping on the seashore, walking, rowing, swimming and other forms of therapeutic physical training, air baths). It is quite obvious that the effect of meteorological factors on the body will depend on whether the patient is at rest or in a state of active movement. In the latter case, the effect of temperature, humidity, air movement, etc. seems to organically merge with the effect of physical exercise and changes the body’s reaction to the specified complex of stimuli.

The use of various dosed loads during aerotherapy procedures enhances their effect on the body, since this activates all physiological processes and stimulates thermoregulatory mechanisms. In this regard, it is advisable (in order to enhance adaptive processes) to include exercises in self-massage, gymnastic exercises, walking, etc. in air bath procedures. It must be taken into account that the ambient temperature, perceived by the body at rest as cool, is felt as adequate when measured movements are carried out .

It should be added to the above that the use of various forms of therapeutic physical culture in sanatoriums and resorts in different seasons of the year should be considered as “active aerotherapy”, regardless of whether the patient’s body is naked or not. In this case, the positive influence of fresh air is combined simultaneously with the multifaceted effect of dosed physical training on the body. Because of this, in sanatoriums and resorts, throughout the entire course of treatment and rest of patients, there should be a combined use of training and hardening, carried out in accordance with medical indications, the season of the year and weather conditions.

Therapeutic physical culture is not immune to the influence of both direct and diffuse sunlight (heliotherapy) on patients. Carrying out active forms of therapeutic physical education throughout the day (walking, sea bathing, swimming, rowing, skating, skiing, etc.) puts patients under the direct influence of sunlight, both direct and diffuse. And here the role of sun treatment cannot be limited only to the framework of formal sunbathing, but take into account the patient’s stay in the air, taking into account the season, time of day and weather conditions.

Thus, performing gymnastics, games, hiking, rowing, etc. in a semi-naked form, carried out in various conditions (veranda, sports ground, park, forest, mountains, sea), enhances the tonic, training, hardening and emotional effect (V.N. Sergeev).

The combination of therapeutic physical culture with hydro- and thalassotherapy is quite obvious and with clear therapeutic expediency. The use of physical exercise in water is increasingly used and, in particular, in sanatoriums and resorts. This is explained by the fact that moving in water is much easier than in a normal environment, which is determined by the peculiarities of the mechanical and thermal influence of the aquatic environment on the body (Archimedes, Pascal). This method of using therapeutic exercises has been tested by a number of clinical observations (T.S. Zatsepin, M.I. Kuslik, V.A. Moshkov, Yu.K. Mirotvortsev, D.F. Kaptelin, etc.). Gymnastics in water has found wide application in our resorts (Tskaltubo, Tbilisi, Caucasian Mineralnye Vody, etc.) and in the resorts of Czechoslovakia (Piestany, Karlovy Vary, Marianske Lazne, etc.), which have equipped swimming pools for therapeutic exercises.

In sanatoriums and resorts, physical exercises in water are used, ranging from local warm baths, general baths or half-baths to bathing and swimming, as well as a number of physical exercises in pools, rivers, lakes and especially in the sea.

Here, as with aerotherapy, physical exercises in water, where the influence of the aquatic environment and movement are organically combined, help to enhance therapeutic success.

Therapeutic physical culture also finds a successful combination with balneotherapeutic procedures (hydrogen sulfide, carbon dioxide, radon baths, etc.), as well as with mud and peat therapy.

When taking mineral baths, circulation and redistribution of blood, an increase in systolic and minute volume, activation of general metabolism, oxidative processes, pulmonary ventilation, etc. are enhanced. Physical exercise also causes changes in the same direction, complementing skin hyperemia with more active deep hyperemia of the muscles and stimulation of all parts nervous system. The more pronounced exercise and training effect of physical exercise successfully complements the effect of balneotherapeutic procedures, promoting the development of adaptive processes in patients.

If the question of the combination of therapeutic physical culture and balneotherapy in the treatment of patients at resorts was within the framework of empirical ideas, then through the efforts of specialists in therapeutic physical culture a certain clarity has been brought to it. Thus, an experimental study by A.I. Zolnikova showed that moderate physical activity followed by the use of a H2S bath with a 30-minute interval increases the excitability of the nervous system, while heavy physical activity followed by the use of a H2S bath increases inhibition.

The study of the issue of the sequence and timing of the break in the procedures of therapeutic exercises and H2S baths showed that the most appropriate for stage I hypertension (according to A.L. Myasnikov) should be considered the following sequence of H2S baths, and then the procedure of therapeutic exercises with an hour break. In stage II of the disease, the reverse sequence is most justified (I.I. Khitrik). For lumbosacral or cervicothoracic radiculitis with significantly severe pain, the most favorable combination should be considered the use of therapeutic exercises followed by the use of H2S baths. Clinical observations also convince of the advisability of using therapeutic exercises for this category of patients after the procedures of H2S-radon baths and mud application with a gap of 2-3 hours; when combined with massage, therapeutic exercises precede massage (N.A. Belaya).

As the pain syndrome subsides, the sequence of therapeutic exercises and massage procedures is not decisive (N.A. Belaya). Other authors (I.B. Temkin and O.A. Sheinberg) recommend the use of therapeutic exercises for radiculitis immediately after an H2S bath or mud application, which, obviously, should be used for milder forms of the disease.

The question of combining therapeutic physical culture with mud and peat therapy is more convincing. Extensive experience and a number of clinical observations convince us that for various dysfunctions of the musculoskeletal system, it is necessary to use physical exercises after mud or peat therapy. Thus, for infectious polyarthritis of unknown etiology in young people with a satisfactory state of the cardiovascular system, the use of therapeutic exercises is allowed after mud application. With a more severe clinical course of infectious polyarthritis and in the presence of pronounced changes in the cardiovascular system, as well as in relation to elderly people, the sequence is more justified: therapeutic exercises - mud application, with approximately an hour's interval (V.M. Andreeva).

The action of mud or peat application provides intense heating of tissues in the area of ​​application, increased metabolism, reactive hyperemia, decreased pain, etc., which creates a favorable background for the subsequent development of movement function through physical exercises. In this regard, during mud and peat therapy (as well as ozokerite, paraffin), it is necessary to strive to bring the time of treatment closer together, reducing the gap between them if possible. Of course, the latter is determined by medical indications (the patient’s condition, tolerance of the mud procedure, etc.), but still, the practical gap between procedures should be considered 5-45 minutes.

In connection with the above (in organizational terms), it is always necessary to have physical therapy rooms on the basis of mud baths. Therapeutic physical training is also combined with the internal use of mineral waters. First of all, the need to come to the source 3 times a day creates good conditions for moderate stimulation of physiological processes, against the background of which the effect of mineral water is enhanced. In addition, repeated exercise several times a day in itself is a factor in the healing of the entire body. As for the sequence of taking therapeutic exercises and drinking mineral water, clinical observations show that with a decrease in the secretory function of the stomach, achylia, as well as hypocidal gastritis, therapeutic exercises are carried out 20-40 minutes before drinking mineral water.

This sequence is justified by the need to stimulate the functions of various body systems and, in particular, improve gastric circulation. When the secretory function of the stomach increases, therapeutic exercises should be carried out between the daily intake of mineral water and lunch in order to accelerate the evacuation of water from the stomach into the duodenum, which will contribute to the inhibitory effect of mineral water on gastric secretion (V.D. Zipalov and A.I. Lidskaya ).

In the conditions of treating patients in sanatoriums and resorts, therapeutic physical culture organically merges with the influence of the chorological factor on patients (landscape therapy, landscape factor). The influence of this factor is most clearly manifested in the conditions of an active regime with the use of various forms of therapeutic physical culture (walking, health path, excursions, short-range tourism, swimming, rowing, skiing, etc.). When moving around the area there is a constant change of impressions. The patient is influenced by the various beauties of nature and changing landscapes. Some of them calm the nervous system, help eliminate tension, nervousness, and in some cases excite.

Of great importance in the therapeutic effect of the chorological factor is the distraction of the patient from going into illness and switching attention to the visual and auditory perception of the surrounding nature (P.G. Mezernitsky, V.A. Aleksandrov, etc.). The influence of the latter is intertwined with the influence of the phytoncidal properties of plants (A.K. Gritsenko), and it should be taken into account that the impact of these factors on patients occurs against the background of a moderate intensification of physiological processes due to various types of physical exercise.

The use of various forms of therapeutic physical culture in sanatoriums and resorts must be linked with the mediation of landscape influences, which comprehensively helps to improve the reactivity of the body and balance its relationship with various environmental factors of resorts and sanatoriums.

The given data on the combination of therapeutic physical culture with various resort factors confirm, on the one hand, the insufficient knowledge of this issue, and on the other hand, the need to take into account possible and useful combinations to enhance the effectiveness of complex treatment of patients in sanatoriums and resorts. It is necessary to take into account that the sequence of procedures and the interval between them cannot be standard and are determined by medical indications, taking into account the characteristics of the disease, its severity and functional disorders, the state of the cardiovascular system, the severity of pain, the age and adaptation of the patient to physical activity .

Treatment with the simultaneous use of various means and methods of treatment is called complex treatment. The complex of means and methods used by modern medicine includes therapeutic physical culture, which should be skillfully combined with other types of therapy (diet, exercise regimen, reflexology, medications, psychotherapy, physiotherapy, etc.) so that some of them complement and enhance the effect of others.

In order to normalize functions and increase the reactivity of the body, as well as to cure malignant tumors, X-ray therapy (treatment using X-rays) and radiation therapy (the use of all types of ionizing radiation of various energies) are currently successfully used.

Classes Exercise therapy may enhance the effect of dietary nutrition. For example, in diabetes mellitus, when the patient’s blood sugar level is pathologically elevated, therapeutic nutrition with a low carbohydrate content is combined with physical exercises that increase sugar consumption; for atonic constipation, a special diet and physical exercise increase intestinal motility; with vitamin C deficiency, increase the amount of vegetables and fruits rich in vitamin C, and general developmental physical exercises promote its absorption.

Combination drug treatment with physical therapy exercises also in many cases increases the effectiveness of their action. For example, in case of spastic paralysis, when the patient is unable to extend the arm due to increased muscle tone, the introduction of curare-like substances reduces muscle tone. Performing this exercise strengthens the extensors of the arm, and in the future movements become possible without the administration of drugs.

For some diseases, medications and exercise should have the opposite effect. In these cases, taking medications and engaging in therapeutic physical education should not coincide in time. For example, exercise should be done first and then medications should be administered.

Exercise therapy is often used in combination with physiotherapy. As a rule, classes are carried out before physiotherapeutic procedures, but in some cases the best effect is achieved in the reverse sequence. For example, when joint mobility is limited, a good therapeutic effect is obtained by combining thermal procedures (paraffin, mud) with special physical exercises, especially when they directly follow thermal procedures. However, it must be borne in mind that dirt and paraffin have a significant effect on the cardiovascular system, so the load when performing physical exercises should be light. A good effect is also achieved when engaging in therapeutic physical education after physiotherapeutic procedures that reduce pain.

During classes, therapeutic massage is often used. Some massage techniques are used between physical exercises (for example, for paralysis). Massage is widely used during activities with infants. But in medical practice, massage is more widely used as an independent procedure. However, the best results are obtained when combined with exercise.

Mechanotherapy increases the effectiveness of therapeutic exercises in cases where it is necessary to obtain a pronounced local effect, for example, to increase mobility in a joint or strengthen a particular muscle group. By working with special devices, an enhanced local effect is achieved, and during therapeutic exercises, more time can be devoted to solving other problems. Mechanotherapy can be carried out as a separate procedure or included in therapeutic exercises (usually at the end of the main part of the session).

Occupational therapy also successfully combined with therapeutic physical culture. With this combination, the restoration of the patient’s impaired functions is facilitated by movements associated with the production of labor products or the performance of certain tasks (cleaning the territory, etc.). Therapeutic physical education prepares the patient for occupational therapy, allows you to select the most appropriate work processes and correctly dose physical activity. Occupational therapy helps restore adaptation to physical activity.

The beneficial effect also shows spa treatment. This is due to the effect on the patient of the combination of therapeutic agents of a given resort with rest, a change of environment, therapeutic nutrition, and a physical regimen.

The combination of various therapeutic agents requires the appointment of rational timing and sequence. Morning hygienic exercises are carried out after sleep. The time between breakfast and lunch is most favorable for doing therapeutic exercises, and the second half of the day is for other forms of therapeutic physical education (dosed walking, sports exercises and games). Therapeutic physical education classes should not be carried out immediately after meals and such physiotherapeutic procedures that cause significant changes in the body.

Combination of therapeutic use of physical exercises with other therapeutic agents and methods.

Therapeutic physical culture should be fully combined with all main types of treatment: surgery, medical regimen, therapeutic nutrition, physiotherapy, drug therapy, etc. The combined use of all therapeutic agents and methods indicated for a particular disease should be based on knowledge of the mechanisms and essence influence of their simultaneous or sequential use.

Data on the combination of therapeutic physical culture with surgical interventions, which have very specific features for various types of pathology, are presented in each of the subsequent chapters.

The content of treatment regimens is determined based on ideas about the protective and tonic effect of individual components of the regimen and about fluctuations in the state of physiological functions due to the patterns of the daily dynamic stereotype. The concept of “therapeutic regimen”, along with the daily routine, includes measures: preventing the adverse effects of certain environmental factors on the patient (noise, loud conversations, bright light, uncomfortable bed, etc.); deepening protective inhibition in the indicated cases (medicinal and physiological extended sleep, etc.); toning the patient (an external environment that creates positive emotions, the use of specially organized broadcasts on local radio, etc.). According to the predominance of individual components, the regimes are divided into therapeutic-protective and protective-tonic.

An integral part of the treatment regimen is the entire complex of motor activity of the patient, or motor mode. If it is necessary to exclude the effect of excessive activity, strict bed rest, light bed rest, ward and free rest are prescribed in a hospital setting. In sanatorium-resort institutions and in outpatient treatment settings, regimens with limited, low, medium and significant muscle load are prescribed.

An appropriate motor regimen should provide a tonic effect on the body and the prevention of pathological phenomena that can develop when the patient’s motor activity is limited (constipation, congestion in the lungs, muscle atrophy, contractures, etc.). The motor mode, if chosen correctly, can be used to consolidate compensation or normalize the functions of organs involved in the disease process.

If recovery proceeds vigorously, motor modes with medium and large muscle loads can be of a training nature, for example, in a patient who has undergone abdominal surgery. A regime of low or medium muscle load can contribute to the formation of compensation in the event of an irreversible decrease in the functional usefulness of an organ (for example, a condition after lung surgery).

Therapeutic physical culture is used both in therapeutic-protective and protective-tonic regimes.

It is carried out: under strict bed, light bed and ward conditions (and, accordingly, under conditions with limited and low load) in the form of therapeutic and hygienic gymnastics; in ward and free modes (and modes with moderate and significant physical activity) in the form of therapeutic and hygienic gymnastics and therapeutic walking, and in the conditions of sanatorium-resort institutions, in addition, walks and sports exercises.

When combining physical exercises with therapeutic nutrition, they take into account: increasing the effectiveness of enhanced protein nutrition in combination with physical exercises for dystrophies of a nutritional nature; a more effective effect of physical exercise on tissue regeneration processes with a diet rich in complete proteins; increasing the effectiveness of enhanced fortification when combined with physical exercise; greater activation of muscle glycogen synthetic function with food rations rich in carbohydrates.

When determining the ratio of the time of physical therapy exercises to the time of meals, one should proceed from the fact that significant muscle load immediately preceding a meal can have an inhibitory effect on the secretion of juices in the stomach and intestines; exercise, even with a moderate load, but carried out shortly after eating, can sharply accelerate its evacuation from the stomach and increase intestinal motility.

The simultaneous use of physical therapeutic agents and physical exercises can either increase or decrease the effect of their isolated use. For example, the hardening effect of air baths and general physiological changes during them are more pronounced when used in isolation than when used in combination with physical exercise; swimming has a greater effect on increasing energy expenditure and metabolism than the sum of separately used fresh baths of the same temperature and gymnastic exercises similar in muscle load to swimming movements.

Staying patients in a hospital disrupts adaptation to the combined influence of muscle loads and climatic factors and leads to loss of hardening. The immediate use of physical exercises and hardening physical agents restores both adaptation to muscle loads and the body’s hardening to unfavorable microclimatic conditions.

The combination of physical exercises with physical and balneological therapeutic agents should provide a combination that increases the overall effectiveness of their therapeutic action. For paralysis and paresis, the combination with electrical stimulation and electro-gymnastics is of particular importance.

Significantly increases the effectiveness of the therapeutic effect of physical exercise when combined with psychotherapeutic effects. The psychotherapeutic effect is based on the fact that a word for a person is the same real conditioned stimulus as everyone else. Suggestion forms foci of irritation and contributes to the creation of new temporary connections. Verbal influence also affects the subcortex, reticular formation and all somatic and endocrine-vegetative functions. The combined effect of verbal suggestion with a stimulus that provides the unconditioned reflex effect referred to in the suggestion is higher than the sum of their influence when used separately.

In order to combine suggestion and the direct effect of physical exercises, the essence of the therapeutic effect of physical exercises is explained to the patient in a previous conversation, and during the subsequent exercises and at the end of the classes, individual aspects of their beneficial effect are repeatedly verbally confirmed. This technique is called psychotherapeutic mediation of the therapeutic effect of physical exercise.

In the preoperative period, for special indications, learning exercises in a hypnoid state can be used. In the acute postoperative period, the same exercises are used after taking painkillers, and sometimes during medicinal sleep. At the same time, the tonic effect of exercises on the cortical part of the central nervous system is sharply reduced and the protective effect of narcotic substances is not disrupted.

Ed. V. Dobrovolsky

“Combination of exercise therapy with other treatment methods” - article from the section

Therapeutic physical education (PT) is a method of treatment using physical exercises for faster and more complete restoration of health, ability to work and prevention of complications of the disease.

The use of exercise therapy in Soviet medicine is not limited to the scope of health-improving effects; it also pursues the goal of cultivating a number of qualities - accelerating reaction, strength, endurance, coordination, necessary for the patient in the conditions of social and labor activity. The best therapeutic results are obtained by combining exercise therapy with streamlining the daily routine and especially the movement regimen. Modern medicine considers exercise therapy as a method of general, nonspecific pathogenetic and functional therapy. A characteristic feature of exercise therapy is the use of physical exercises, placing patients in conditions of active participation in the complex process of exercise. This active participation of the patient in the implementation of the treatment process, the unity of manifestation of his mental and somatic functions is a feature of this method and distinguishes it from all other treatment methods.

A characteristic feature of exercise therapy is dosed training of patients, i.e., the patient’s gradual adaptation to increasing physical activity. Unlike sports training, the training of patients using exercise therapy is strictly dosed. It is divided into general and special. General training provides for the general health-improving and general strengthening effects of physical exercise. Special training aims to develop functions impaired due to illness or injury (for example, exercises for the left hand when the bones of the left forearm are fractured, etc.).

The development of exercise therapy is closely related to the physical education movement, which theoretically and practically enriched exercise therapy, especially in the early stages of its development. Modern exercise therapy, using thousands of years of experience in therapeutic gymnastics, based on modern concepts of the Soviet physiological and clinical school, has become a recognized therapeutic method. Soviet specialists and scientists in the field of exercise therapy, overcoming conservatism in medicine (in particular, exaggeration of the role of rest), developed a number of exercise therapy techniques and clinically and physiologically substantiated them.

During the Great Patriotic War, exercise therapy was used as a mandatory treatment method in hospitals and played an important role in the full restoration of the combat effectiveness of the wounded. Currently, exercise therapy is considered as one of the active methods of treatment and recovery, as well as the prevention of a number of functional disorders and diseases. It is used in combination with other treatment methods.

During physical exercise, a dominant movement arises in the cerebral cortex, which has a diverse effect on the entire body. This is the “working principle of the centers” according to A. A. Ukhtomsky, “the main reactive activity of the body”, which is closely related to all systems of the body (corrective function of the cerebral cortex). Physical exercises are accompanied by a feeling of cheerfulness, joy, distract a person from going into illness, and help eliminate anxiety, uncertainty, restlessness, fear, and neurotic conditions. These positive, joyful emotions have not only a healing, but also a preventive value: “Raising the mood of a sick person is half curing him” (S. I. Spasokukotsky).

With the help of physical exercises, it is possible to direct the conditioned reflex activity of the patient in the desired direction and actively influence the regulation of body functions in various painful conditions. The use of physical exercise develops and improves various physiological mechanisms and contributes to the compensation of functions, improvement and improvement of the patient’s performance.

The development of therapeutic success with the use of physical exercises is also based on their ability to influence excitation processes in the cerebral cortex (Fig. 1), changing the mobility of nervous processes either in the direction of increasing them or decreasing them (A. N. Krestovnikov).

Rice. 1. Changes in the electroencephalogram under the influence of therapeutic exercises for hypertension: 1- before therapeutic exercises: alpha activity is almost not expressed; there is a diffuse change in the bioelectrical activity of the cortex with a predominance of fast asynchronous potentials; 2 - after therapeutic exercises: well-defined synchronous alpha rhythm - normal bioelectrical activity of the cortex. D - brain currents of the right occipital lobe; S - brain currents of the left occipital lobe (in mV).

The principle of exercise of the affected systems underlies the development of compensation of functions, which is achieved only with the involvement of cortical mechanisms (E. Asratyan). The basis of the functional restructuring of the nervous system during exercise therapy is the high plasticity of the cerebral cortex (I. P. Pavlov), against the background of which the generalization of conditioned reflex activity during training contributes to the formation of new motor stereotypes with a more complete implementation of the function. From the perspective of the doctrine of parabiosis (N. E. Vvedensky), physical exercise should be considered as a factor characterized by an antiparabiotic effect that increases the mobility of physiological processes and the lability of the neuromuscular system (Fig. 2).

Rice. 2. Increase in neuromuscular lability (n. tibialis dexter) under the influence of therapeutic exercises: at the top - before gymnastics; below - after gymnastics.

When assessing the therapeutic effect of physical exercise, it should be borne in mind that the muscular system and its function are an important mechanism for regulating autonomic functions (blood circulation, breathing, etc.). The effect of physical exercise on internal organs is due to the strengthening of nervous and humoral connections that develop between the functioning muscular system, the cortex and subcortex and any internal organ. In the process of performing physical exercises, a close connection is established between the receptor zones of the internal organs and the functioning muscular system, due to the closure of the foci of excitation in the cerebral cortex (motor-visceral connections).

Thus, the effect of physical exercise on the coordination of functions, carried out primarily through the nervous mechanism, is also supplemented by the humoral mechanism, which includes nonspecific (metabolic products during muscle activity) and specific (hormones) substances. The interaction of the nervous and humoral mechanisms ensures the unity of the body and the overall response of the patient to various types of physical activity and environmental factors.

Treatment methods used in modern medicine are widely combined with the therapeutic use of physical exercise.

Therapeutic physical education is an integral part of all motor regimens. The selection of physical exercises, the form of their implementation and the load in classes in each individual case must correspond to the physical activity allowed by individual modes.

On strict bed rest Therapeutic exercises are used as a means of preventing the adverse effects of adynamia (congestion in the lungs, vascular thrombosis, disturbances in the gastrointestinal tract, etc.). Special exercises, mainly breathing, are included in some cases in a set of methods of so-called intensive therapy or resuscitation measures (for example, after severe injuries, after operations on the heart, lungs and abdominal organs, with damage to the central nervous system and cerebral hemorrhages, with extensive myocardial infarction).

Therapeutic gymnastics provides preparation for the expansion of strict bed rest: for changing (independently or with the help of medical personnel) position in bed, for sitting in bed without lowering your legs, for eating, washing, etc.

In ward mode during therapeutic and hygienic gymnastics, which provides general tonic, trophic and formative compensation, the patient is prepared to move to a sitting position in bed with his legs down, to move to a chair or armchair, to stand up and slowly walk within the ward.

In free mode Based on observations of the patient’s reactions during therapeutic and hygienic gymnastics and therapeutic walking, his physical activity is dosed: the length and pace of walking, going up and down stairs, the total duration of stay in motion, etc. In some cases, the issue of the patient’s participation in certain types of simple sports games and entertainment (table tennis, croquet, etc.) can be resolved.

With a gentle motor regimen in sanatorium-resort and outpatient clinic conditions loads in therapeutic physical training should not exceed the patient’s reduced adaptability to muscle activity and at the same time should counteract the unfavorable manifestations of physical inactivity. With a tonic regimen during physical exercise, the patient’s motor activity gradually expands. Loads are applied that contribute to subsequent supercompensation of energy costs and improvement of the functions and morphological structures of the body. In a training regime, therapeutic physical training should ensure restoration of performance and serve as one of the main means of rehabilitation.

Therapeutic physical education should be combined with patient care. There are various ways to do this. It is necessary to produce ventilation wards and rooms of therapeutic physical culture before classes.

Most patients have impaired adaptation to the combined influence of muscle loads and climatic factors. Simultaneous use of physical exercises and hardening physical factors better restores both adaptation to muscle loads and the body’s hardening. Classes under appropriate climatic conditions and indications are conducted with open vents, windows or on verandas and platforms. In the cases shown, patients exercise in light tracksuits or naked to the waist.

In bed rest it is necessary prepare the patient's bed for classes: throw back the blanket, straighten the sheet, correctly place or remove excess pillows, etc. With appropriate clinical data at the end of classes the patient should be placed in a position that has therapeutic value: put on straps for traction in case of a spinal fracture, bandage a temporarily removed splint in case of a fracture of the forearm bones, transfer a patient who has suffered a myocardial infarction to a sitting position on a chair (chair), help move to a lying position (for example, after walking a patient with a hip fracture if there is high plaster cast), etc. It is necessary to lead monitoring your condition and well-being each student before, during, and after classes. In case of adverse reactions, the load should be reduced, the time of training should be reduced (if possible, unnoticed by the patient). In these cases, the therapeutic physical education instructor must inform the attending physician about the observations and activities carried out on the same day.

Combination of physical exercises with physical and balneological treatments should ensure an increase in their overall effectiveness. For example, for paralysis and paresis, the combination of physical exercises with electrical stimulation of muscles and electro-gymnastics is of particular importance; Exercises in water, and especially swimming, increase energy expenditure and metabolism more than the sum of separately applied water baths of the same temperature and gymnastic exercises, similar in muscle load to swimming movements. The correct sequence or simultaneous use of physiotherapeutic procedures and therapeutic exercises is extremely important. For example, thermal procedures (paraffin or mud applications, Sollux, etc.) used for contractures should precede therapeutic exercises. Iontophoresis of most medicinal substances should be used with some interruption after therapeutic exercises. In some cases, it is advisable to use therapeutic exercises during a physiotherapeutic or balneological procedure (for example, in a mineral bath for polyarthritis; in a local thermal bath for the hand and fingers with a sharp limitation of movements in them).

When combining therapeutic physical training with therapeutic nutrition under the influence of exercise, the effectiveness of enhanced protein nutrition for dystrophy increases; tissue regeneration processes occur more quickly with a diet rich in complete proteins; the effectiveness of enhanced fortification increases; The activity of muscle glycogen-forming function increases with food rations rich in carbohydrates. When determining the time of physical therapy exercises, it should be taken into account that significant muscle load immediately preceding a meal can have an inhibitory effect on the secretion of juices in the stomach and intestines; exercise, even with a moderate load, carried out shortly after eating, can sharply speed up its evacuation from the stomach and increase intestinal motility.

The effectiveness of the therapeutic effects of physical exercise increases significantly at their combination with psychotherapeutic influence.

When using suggestion and physical exercises in a complex manner (potentiation), the patient should, in a previous conversation, outline the essence of the therapeutic effects of physical exercises, and during the subsequent exercises and at the end of the classes, they should repeatedly confirm certain aspects of their beneficial effects.

For special indications you can exercise while in a hypnoid state. In this case, the effect of exercise on the cortical part of the central nervous system is eliminated or sharply reduced and motor-visceral reflexes are activated.

Medicinal the use of physical exercise must be combined with occupational therapy. For example, when restoring the normal range of motion in individual joints, therapeutic exercises can be combined with the performance of individual labor operations. It is advisable to combine therapeutic physical education classes with various types of work activity, culminating in the production of certain labor products or the performance of specific tasks.

The total muscle load when combining therapeutic physical education and occupational therapy should not exceed the level of motor activity corresponding to the motor regimen prescribed to the patient. Successes in restoring functions and forming motor and autonomic compensations; achieved during physical exercises are expanded and consolidated in the process of occupational therapy and contribute to the rehabilitation of patients.

Full combination of drug therapy with exercise ensures an increase in the effectiveness of the therapeutic effect of the latter. Various options for this combination are possible. After obtaining some effect, the course of drug therapy is supplemented by the therapeutic use of physical exercises. For example, after using cardiac medications for some time for circulatory failure of stages I-II, therapeutic exercises are prescribed. As a result, the degree of circulatory failure decreases in most cases faster than with the isolated use of these drugs. If blood circulation improves significantly, drug therapy is discontinued with continued use of physical therapy.

Exercise can be done soon after taking medications. For example, in a patient with spastic paresis after a decrease in muscle tone, which occurred under the influence of taking appropriate medications, special exercises that activate intestinal motility are carried out 1 1/2 -2 hours after taking a saline laxative (they enhance the effect of its action); Therapeutic gymnastics classes are carried out soon after the analgesic effect of the medication taken appears in a patient with neuritis.

With the appropriate training methods, the effect of the medicinal substance and at the same time the corresponding effect from the therapeutic use of physical exercises are preserved. For example, when using sleeping pills and painkillers, a patient who has undergone severe gastric surgery can be prescribed simple breathing and other gymnastic exercises. In this case, the activation of respiration, intestinal motility and blood circulation is ensured while maintaining the protective inhibition that has developed under the influence of drugs.

Wide combines the therapeutic use of physical exercise with surgical interventions. In the preoperative period, therapeutic exercises are carried out, preparing for the use of postoperative exercises and helping to obtain the best effect from surgical intervention. In the early postoperative period immediately following the operation, therapeutic exercises for a number of interventions can be one of the means of special intervention that is resuscitative in nature (heart surgery, lung surgery, etc.). Postoperative gymnastics is very important for the prevention of various complications, especially in older people. In the long-term postoperative period, therapeutic physical culture activates the processes of healing, restoration of impaired functions or the formation of compensation and promotes the fastest rehabilitation of patients.