The other day my colleague told me that she was "tortured" by a sports doctor. And one of the tests was a squat test. Made it myself today. Hmm, everything somehow recovered even in the first two minutes. I admit an error. But still nice :)
If it’s very interesting, then under the cut we look at how it’s all done.
and very
Evaluation of the functional abilities of the human body using functional tests.
The function of organs and systems, primarily the heart, which plays a leading role in the life of the body, in most cases is assessed on the basis of examinations at rest. At the same time, the reserve capacity of the heart can manifest itself only during work, which in intensity exceeds the usual load. This applies both to athletes, whose load dosing is impossible without determining physical performance, and to people who do not go in for physical culture and sports. Latent coronary insufficiency may not manifest itself clinically and electrocardiographically in a daily regimen. Physical activity is the physiological stress that makes it possible to determine the level of reserve capacity of the body.
Setting load tests:
a) determination of the functional capabilities of the body;
b) determination of working capacity and ability to engage in various sports;
c) assessment of the reserves of the cardiovascular, respiratory, etc. systems;
d) determining the likelihood of developing cardiovascular diseases, primarily identifying preclinical forms of coronary insufficiency, as well as predicting these diseases;
e) an objective assessment in the dynamics of the effectiveness of training programs for students;
f) development on the basis of a functional examination of optimal preventive, therapeutic, surgical and rehabilitation measures for diseases of the cardiovascular system;
g) assessment of the functional state and effectiveness of physical rehabilitation after injuries, acute and chronic diseases
Classification of functional samples
1. By type of load (physical exercises, changing body position, holding your breath, etc. All of them should be clearly dosed. Physical exercises are most often used.
2. By the number of loads:
a) one-time: test with 20 squats (Martinet test);
2-, 3-moment, combined tests, such as the Letunov test (20 squats in 30 seconds, 15 seconds running at maximum speed in place and 3 minutes running at a moderate pace, 180 steps per minute) (video 3) .
3. According to the type of indicators that are to be studied: the circulatory system, respiratory, autonomic nervous, endocrine systems, etc.
4. By the time of registration of the initial signal, that is, by the time of studying the reaction to the load:
a) directly during the load (for example, the submaximal test PWC170), while studying the immediate response to the load during execution (power testing);
b) after the load (test with 20 squats, Harvard steppe test), when the indicators are studied at the end of the load, that is, the nature of the recovery processes in the body is studied (recovery testing)
5. By type of load:
a) standard (squatting, running, jumping, lifting loads, etc.), which are performed at a certain pace;
b) dosed (measured W, kgm/min, 1 W/min = 6.12 kgm/min);
6. By the nature of the load:
a) uniform load (climbing steps during the Harvard step test);
b) gradually increasing load at intervals (submaximal test PWC170);
c) continuously increasing load (Navacca test)
7. According to the intensity of the load:
a) submaximal test (submaximal test PWC170);
b) maximum test - samples with maximum load (Navacca test), they are used only for highly qualified athletes
Rules for conducting functional tests
1. To study the function of the organism as a whole, individual functional systems or organs at rest. The results obtained are evaluated and compared with the necessary standard indicators characteristic of the corresponding age, sex, height, body weight, etc. In these cases, the assessment must be done very carefully due to the large individual difference and variability in normal values.
2. Examine the function of the whole organism, individual functional systems or organs under conditions of standard or dosed physical activity.
3. Evaluate the results of the studies received. The information obtained is necessary both for the choice of physical exercises and their dosage, and for studying the functional ability of the subject, his reserve capabilities.
4. Selected loads should correspond to the motor status of the subject
5. The complexes of indicators that are recorded should be relatively accessible for observation, sufficiently sensitive to physical stress and reflect the integral functions of the body of the subject.
When conducting stress tests, the usual assessment of their results is carried out by recording the heart rate, less often - blood pressure. If necessary, these indicators are supplemented by recording ECG, FCG, measuring gas exchange, pulmonary ventilation, some biochemical constants, and so on.
EXERCISE TESTS
During mass preventive examinations, staged medical control of athletes and athletes of the lower ranks, samples with moderate physical activity are used: samples with 20 squats or 60 jumps in 30 seconds; 15-second run in place at maximum speed, lifting the hips high; running in place for 3 minutes at a pace of 180 steps in 1 minute and so on. Each of them can be used both independently and in various combinations. For example, Letunov's combined test includes 20 sit-ups, a 15-second run at maximum speed, and a 3-minute run at a pace of 180 steps per minute.
Recently, the Rufier test has been used - 30 squats in 45 seconds. .
20 squat test (Martinet test)
Characteristics of the test with 20 squats in 30 seconds according to the classification of functional tests: this is a test in which physical exercises are used, one-stage, the state of the cardiovascular system is studied, indicators are collected after performing the load, the load is standard, uniform, medium intensity.
A test procedure with 20 squats in 30 seconds. The Martinet test is performed on practically healthy individuals. Therefore, after the exclusion of contraindications (the presence of complaints, diseases, reduced functionality, etc.), they begin to conduct a test.
Collection of initial data. The subject sits down with his left side to the doctor, puts his left hand on the table. A tonometer cuff is placed on his left shoulder according to generally accepted rules. After 1.5-2 minutes, the patient's pulse on the radial artery is counted for 10 seconds until it stabilizes, that is, the same figure does not repeat 2-3 times. After that, blood pressure is measured. The obtained indicators are entered into the medical control card.
Evaluation of initial data. Normal heart rate (HR) ranges from 72±12 beats per minute. Heart rate below 60 beats. For 1 min, that is, bradycardia, can be assessed in different ways. In trained athletes, bradycardia indicates the economization of cardiac activity, but it can be with overtraining and some heart diseases. The absence of complaints about overtraining and heart disease makes it possible to assess bradycardia as a result of an increase in the tone of the parasympathetic link of the autonomic nervous system that occurs in trained people.
Heart rate greater than 84, at rest is assessed as a negative phenomenon. This may be the result of heart disease, intoxication, overtraining in athletes.
The resting pulse should be rhythmic. There may be a respiratory arrhythmia, that is, an increase in the pulse during inhalation and a slowdown during exhalation. This phenomenon is assessed as physiological. It depends on the reflex influence from the receptors on the center of the vagus nerve. This is not a contraindication for the test. Often, after the test, respiratory arrhythmia is not recorded. Inconstant pulse numbers (10,12,12,11,12,12) may indicate the lability of the nervous system in the absence of cardiac arrhythmias in history.
Evaluation of blood pressure indicators. Blood pressure above 129/79 mm Hg. assessed as elevated, below 100/60 mm Hg. - as reduced. Elevated blood pressure figures can be a manifestation of the disease (hypertension, chronic nephritis, etc.), symptoms of overwork or violations of the regimen (smoking, drinking alcohol, etc.)
Reduced blood pressure in athletes can be physiological (hypotension of a high degree of fitness), or it can be a manifestation of a disease (hypotonic syndrome, intoxication from a focus of chronic infection - carious teeth, chronic tonsillitis, etc.). Hypotonic states can be with overwork, as evidenced by the athlete's complaints of weakness, fatigue, headache, etc.
Conducting a test. In the absence of contraindications, the test is started. Students in a practical lesson, before conducting a test, need to learn how to count and continuously record the pulse for every 10 s for
1 minute and quickly measure blood pressure (for 30-40 s).
Before the test, the patient is explained how he should perform the squat: deep squats are performed at a pace
2 squats in 3 s (the rhythm is set by a metronome or a doctor), while crouching you need to raise your hands forward, getting up - lower them.
After performing 20 squats in 30 seconds: for the first 10 seconds, count the pulse and record it under the first minute at the level of 10 seconds. Then - until the end of the first minute, they measure and record it at the level of blood pressure under the first minute. It is also necessary to calculate the respiratory rate for 15 seconds and, multiplying this number by 4, write it down under the first minute at the breath level.
Starting from 2 minutes, the pulse is counted and recorded by a continuous method until it returns to the original and stabilizes at this level (it will be repeated 2-3 times). After restoration and stabilization of the pulse, blood pressure is measured and recorded at the level of blood pressure under the minute at which it was finished measuring. If blood pressure has not returned to baseline, then it continues to be measured and recorded every minute until it is restored. At the end of the test, the respiratory rate is counted and recorded in the table (method - as 1 minute after the load).
Evaluation of test results. The evaluation criteria are the change in heart rate, the response of blood pressure and the time of their recovery to baseline. They make it possible to assess the adaptive capacity of the circulatory system to physical activity. The heart responds to physical activity with an increase in cardiac output. Adaptation to the load of the heart of a trained person occurs to a greater extent due to an increase in stroke volume and to a lesser extent due to an increase in heart rate (HR). In an untrained or undertrained person, it is the opposite: mainly due to an increase in heart rate and, to a lesser extent, due to an increase in stroke volume.
To evaluate the sample, the following indicators are used: pulse excitability, pulse recovery time, blood pressure response, blood pressure recovery time, change in respiratory rate.
The excitability of the pulse, that is, the percentage increase in heart rate after exercise, is determined by subtracting the difference between the heart rate before and after exercise, which is determined as a percentage. To do this, we make up a proportion where the pulse before the load is taken as 100% in our case 10), and by how much the pulse increased after the load (that is, 16-10 \u003d 6) for X
10 = 100%
16-10 = x% x=60%
Thus, the pulse after exercise increased by 60% relative to the original. A normal response to a test of 20 squats is considered to be an increase in heart rate within 60-80% of the original value. The more efficient the heart, the more perfect the activity of its regular mechanisms, the less the pulse quickens in response to dosed physical activity. An increase in the pulse above the norm indicates an irrational activity of the heart, which may be due to diseases (primarily of the heart), detraining, overwork in athletes or athletes.
The recovery time of the pulse makes it possible to find out the course of recovery processes after exercise. It is determined by the first indicator of a renewed and stable pulse. In our case, this
1 min 50 sec, that is, it is imperative to indicate the number of minutes and seconds in which a stable resumption of the pulse occurred. Normally, the recovery time of the pulse is no more than 2 minutes 40 seconds. An increase in the recovery time of the pulse indicates a slowdown in the recovery processes of the heart. Most often this is combined with an increase in the excitability of the pulse, which indicates a decrease in the reserve capacity of the heart and is assessed as an unfavorable reaction. An increase in one of these indicators is not a mandatory sign of a decrease in the reserve capacity of the circulatory system; it may be the result of a dysfunction of the regulatory mechanisms of the circulatory system (with neurocirculatory dystonia, detraining, overtraining, etc.).
In addition to the recovery time of the pulse, it is necessary to monitor how the recovery proceeds - gradually or in waves and to what numbers.
In the process of pulse recovery, the so-called “negative phase of the pulse” may occur, when the pulse in the first 2-3 minutes becomes lower than the original by 1-3 beats in 10 seconds. Such a slowdown in the pulse lasts at least three 10-second segments, and then again becomes more frequent and gradually returns to normal. The “negative phase” of the pulse is associated with the insufficiency of the activity of various parts of the nervous system, primarily the sympathetic and parasympathetic parts of the autonomic nervous system, which leads to a change in the sequence of recovery processes. Such deviations are recorded in persons with a labile nervous system, with neurocirculatory dystonia, in athletes with overtraining, after neuropsychic overstrain. If after the load the negative phase of the pulse persists for more than 3 minutes, then the reaction is assessed as unsatisfactory.
During the study of the process of pulse recovery, a situation may occur when the pulse before the load was higher (for example, 14.14.14 in 10 seconds), and after the load it decreased to lower numbers (for example, 12.12.12 in 10 seconds) and stabilized at this value .. Such cases can be recorded in individuals with a labile nervous system, in this case it is an increase in the tone of the sympathetic link of the autonomic nervous system. Physical activity contributes to the normalization of its functional state and the pulse resumes to the true indicators of the heart rate of the examiner.
Evaluation of the response of blood pressure (BP) to the Martinet test. In this case, it is necessary to evaluate separately changes in systolic, diastolic and pulse pressures. There may be different combinations of changes in these indicators. The most rational response to blood pressure is characterized by an increase in systolic blood pressure by 15-30% (with an initial systolic blood pressure of 120 mm Hg, this is no more than 40 mm Hg). Diastolic pressure remains unchanged or decreases by 10-15 percent (no more than 10 mm Hg with its average values).
As a result of an increase in systolic and a decrease in diastolic blood pressure, pulse pressure increases, which is the most favorable reaction. This indicates an increase in cardiac output and a decrease in peripheral vascular resistance, which is the most favorable reaction, because the minute volume of blood circulation increases.
The percentage increase in pulse pressure is determined in the same way as the excitability of the pulse. According to the example, blood pressure before exercise was
120/80 mm Hg, pulse - 40 (120-80). BP after exercise 140/75 mm Hg, pulse - 65 (140-75), that is, pulse pressure increased by 25 mm Hg. Art. (65-40). We make a proportion: 40 - 100%
25 - x% X = 62%.
Thus, the excitability of the pulse is 60%, the increase in pulse pressure is 62%. The synchronism of changes in these indicators indicates a good adaptation of the body to the performed load. A decrease in pulse pressure indicates an irrational response of blood pressure to physical activity and a decrease in the functional ability of the body.
The recovery time for blood pressure is determined by the minute at which he returned to the original after the exercise. In our example, this is 3 minutes. Norma - 3 min.
An increase in blood pressure above the norm and a prolongation of its recovery time can be recorded in patients with hypertension, neurocirculatory dystonia of the hypertensive type, in practically healthy individuals with the potential for hypertension (pre-disease stage), after significant physical exertion, after alcohol abuse and smoking . Our studies have shown that after drinking alcohol in practically healthy young people aged 18-20 years, elevated blood pressure is recorded at rest for 2-3 days, and the deviation of the response of blood pressure to the Martinet test upwards - for 4-6 days.
Conclusion based on the results of the test with 20 squats. When evaluating the response to the Martinet functional test, it is necessary to compare changes in heart rate and blood pressure in order to identify the mechanisms by which adaptation to the load occurs.
Comparison of pulse excitability with an increase in pulse pressure makes it possible to determine the synchronism of these changes. A rational response to physical activity is characterized by synchronous dynamics: the excitability of the pulse must coincide with an increase in systolic pressure, expressed as a percentage. This indicates an adequate response to physical activity.
According to the nature of the changes in the studied indicators after performing 20 squats in 30 seconds, they distinguish: favorable, unfavorable and transitional types of reactions. According to the classification, 5 main types of the reaction of the cardiovascular system to the Martinet test are distinguished:
- normotonic,
- hypertonic,
- dystonic,
- hypotonic (asthenic)
- stepped.
Types of reactions that some of the indicators do not fit into the 5 main types are classified as transitional.
Normotonic type. Favorable types of reaction include the normotonic type. It is characterized by the fact that adaptation to the load occurs due to an increase in pulse pressure, which indicates an increase in the stroke volume of the heart. An increase in systolic pressure reflects an increase in the systole of the left ventricle, a decrease in the minimum - a decrease in the resistance of arteriole tone, which provides better blood access to the periphery. The heart rate increases in sync with the pulse pressure. With a normotonic type of reaction:
1. Excitability of the pulse - up to 80%
2. Pulse recovery time - up to 2 minutes. 40 sec
3. Changes in blood pressure: systolic (SBP) - up to + 40 mm Hg
diastolic (DBP) - 0 or up to - 10
4. Recovery time for blood pressure - up to 3 minutes.
Adverse types of reaction to the Martinet test. For all unfavorable types, it is common that the adaptation of the cardiovascular system to the load occurs mainly due to an increase in the heart rate. Therefore, all unfavorable types are characterized by an increase in the excitability of the pulse by more than 80%, respectively, and the recovery time of the pulse will be greater than the norm (more than 3 minutes).
Unfavorable types of reaction include hypertonic, dystonic, hypotonic (asthenic), stepwise types of reaction. As mentioned above, the first two points for assessing the sample (excitability of the pulse and the time of its recovery) for all adverse types of reactions are the highest standards, so the difference between them will manifest itself in the response of blood pressure to the load.
In the hypertensive type: SBP rises much more than normal, DBP also rises.
With a dystonic type: SBP increases significantly, DBP decreases significantly, an “endless tone phenomenon” may occur when a pulsation is felt when measuring blood pressure even when the pressure gauge needle drops to zero.
In the hypotonic (asthenic) type: SBP and DBP change slightly, pulse pressure decreases or remains unchanged.
The stepwise type is characterized by a stepwise increase in blood pressure, when immediately after the load it does not change (or changes slightly), and increases in the next minutes after the load.
The respiratory rate after the test should change synchronously with the pulse: normally, 3-4 heart beats correspond to one respiratory movement. The same pattern should be preserved after the Martinet test.
Form 061 / y unified. Each indicator in the section “Functional tests of the heart and lungs” has its own place and is measured in the units generally accepted for the Martin test: pulse rate - for 10 s, respiratory rate - for 1 minute, blood pressure (BP) - in mm Hg. Art. Therefore, when registering a sample, it is necessary to indicate only numbers, without units of measurement.
After the test, it is necessary to note the nature of the pulse (rhythmic, satisfactory filling, arrhythmic) and auscultatory data of the heart in a standing position, and, if necessary, lying down.
Thus, the algorithm for performing a functional test with 20 squats includes the following sequence of actions:
1. Collection and evaluation of initial data.
2. Explanation to the patient of the technique for performing the test.
3. The patient performs a test with 20 squats in 30 seconds.
4. The study and registration of the studied indicators in the first minute after the load.
5. Study and registration of the studied indicators in the recovery period.
6. Evaluation of the obtained results.
7. Conclusion on the results of the test.
Use of the 20 squat test in practical medicine. The Martinet test is used in mass examinations of people who are engaged in physical culture and athletes of the lower ranks. In clinical practice, it can be used to study the functionality of the cardiovascular system in people of different age categories. Practical experience has shown that persons under 40 years old without pronounced deviations in health can be given 20 squats in 30 seconds, up to 50 years old - 15 squats in 22 seconds, more than 50 years old - 10 squats in 15 seconds. The functional features of the cardiovascular system are considered satisfactory if, when evaluating the sample, its results fit into the normotonic type of reaction described above.
You can use the Martinet test for diagnostic purposes: to determine the cause of tachycardia at rest. If after the test the indicators fit into an unfavorable type of reaction, then tachycardia is predetermined by diseases of the cardiovascular system. Sometimes, before the load, the pulse is labile and its recovery proceeds in waves, a negative phase of the pulse may occur, and often, the pulse after the load stabilizes at lower rates than before the load. This makes it possible to assume that tachycardia at rest is predetermined by violations of the functional state of the nervous system. If, before the load, the heart rate indicators are higher than normal, after the test, all indicators fit into the normotonic type of reaction, but the pulse is restored to the original numbers (as before the load, increased) - it can be assumed that tachycardia at rest is predetermined by hyperfunction of the thyroid gland. Subsequent purposeful in-depth examinations will make it possible to exclude, and more often - to confirm the results of functional tests.
ROUFIER TEST
Rufier's test has become widespread in sports medicine. It makes it possible to assess the functional reserves of the heart.
Methodology. The subject, who is in the supine position for 5 minutes, counts the number of pulsations in 15 seconds (P1). Then he is offered to perform 30 squats in 45 seconds (squatting - hands forward, getting up - lower them). After that, the subject lies down and his pulse is counted for the first 15 seconds (P1) and the last 15 seconds (P3) of the 1st minute after the load. The results obtained are substituted for the formula:
Rufier index \u003d 4 / P1 + P2 + P3 / - 200
10
The assessment of the functional reserves of the heart is carried out according to the table:
Assessment of the functional reserves of the heart
Ruffier index value
Athletic heart
0,1 <
The heart of an average person:
very good
Okay
0,1-5,0
5,1-10,0
Heart failure
medium degree
10,1-15,0
high degree
15,1-20,0
For example: P1 = 16, P2 = 26, P3 = 20
Rufier index = 4 (16+26+20) - 200
10
Conclusion: Ruffier index = 5.8. Average person's heart: good
To evaluate the sample, the Rufier-Dixon index is also used, which is a variant of the previous one:
Rufier-Dixon index = /4Р2 - 70/ + /4Р3 - 4Р1/
Evaluation of results: functionality of the heart:
from 0 - 2.9 - good 6.0-8.0 - below average
3.0-5.9 - average 8.0 - more - bad.
The use of Rufier's test in practical medicine. The results of the test make it possible to determine the reserve functionality of the heart. This takes into account the initial level of heart rate, which (in the absence of diseases) indicates the economy of the heart at rest. The pulse rate immediately after the load - gives a characteristic of the adaptive ability of the heart to physical activity, and its frequency at the end of the first minute - about the speed of the recovery processes of the cardiovascular system after the load. The sample can be used for diagnostic purposes, it is simple, accessible, highly informative.
TESTS WITH CHANGE OF BODY POSITION
Functional tests with a change in body position include orthostatic and clinostatic tests.
Orthostatic test is to study changes in heart rate after moving from a lying position to a standing position.
Methodology. After a 5-minute stay in the supine position, the subject is counted the pulse rate for 15 seconds, then they are asked to stand up slowly and already in the standing position, the pulse is counted twice for
15 s:
Sample evaluation. Each of the obtained indicators is multiplied by 4, determining the pulse rate for 1 minute.
An increase in the pulse rate by 10-16 beats per minute after standing up and its stabilization at a level greater by 5-8 beats from the initial one after 3 minutes of standing indicates a satisfactory functional state of the sympathetic link of the autonomic nervous system. A higher level of pulse rate immediately after a change in position indicates increased sensitivity, and after 3 minutes - about its increased tone. The latter is observed in insufficiently trained individuals and in individuals with a labile nervous system.
The lowest level of heart rate indicates a decrease in the sensitivity and tone of the sympathetic and an increase in the sensitivity and tone of the parasympathetic link of the autonomic nervous system. A weaker reaction, as a rule, accompanies the development of fitness. Such persons are less sensitive to the negative impact of extreme situations of an internal and external nature.
clinostatic test. It is carried out in the reverse order relative to orthostatic. After 5 minutes of standing, the pulse rate is counted for 15 seconds, then the subject slowly moves to the lying position, and in this position the pulse is counted 2 times for 15 seconds: immediately and after 3 minutes of being in the lying position.
Sample evaluation: each of the obtained indicators is multiplied by 4 and compared with each other. The normal reaction is a decrease in heart rate by 8-14 beats per minute immediately after the transition in the prone position and a decrease in this reaction by 6-8 beats after 3 minutes. A greater decrease immediately after a change in position indicates increased excitability, and after 3 minutes - an increased tone of the parasympathetic link of the autonomic nervous system. An increase in heart rate indicates a decrease in the reactivity and tone of the parasympathetic link of the autonomic nervous system.
Practical use. Tests with a change in body position are most often used to study the functional state of the autonomic nervous system. Repeated tests during training make it possible to prevent the occurrence of a state of overtraining, in which a violation of the functional state of the autonomic nervous system is one of the first signs. In weakened individuals, tests with a change in body position can be used to determine the functional state of the cardiovascular system at a time when other (more intense) loads are contraindicated.
BREATH-HOLD TESTS
Of the breath holding tests, the Stange and Genchi-Sabrase tests are most often used.
Stange test. Methodology: the subject in a sitting position takes a deep (not maximum) breath, pinches his nose with his fingers and holds his breath for as long as he can. The delay time is marked with a stopwatch, which will stop at the moment the exhalation begins. The maximum deep breath is not recommended, because it contributes to the expansion of the lungs, irritation of the vagus nerve, which can lead to accelerated irritation of the respiratory center and shortening the breath holding time.
Sample evaluation. In healthy, but not trained individuals, the breath holding time (inspiratory apnea) ranges from 40-60 s for men and 30-40 s for women. Trained athletes can hold their breath for 60-120 seconds for men and 40-95 seconds for women, and some of them for several minutes.
Genchi-Sabrase test. Methodology: after a normal (not excessive) exhalation, the subject pinches his nose with his fingers and holds his breath as much as possible. The duration of breath holding is marked with a stopwatch, which will stop at the beginning of inspiration.
Sample evaluation. The duration of breath holding in healthy untrained individuals during the Genchi-Sabraze test (expiratory apnea) ranges from 25-40 s in men and 15-30 s in women. Athletes have 50-60 s for men and 30-50 s for women.
Use in practical medicine. Cardiopulmonary apnotic tests provide information about the functional state of the cardio-respiratory system. At the same time, it is necessary to pay attention to the dependence of the test results on the volitional qualities of the subject. The ratio between the inspiratory and expiratory apnotic pause is 1:2. In the presence of deviations in the state of the cardiovascular system, the duration of breath holding is reduced by 50 percent or more. The ratio between these pauses can reach 1:1. The indicators of apnotic tests worsen in diseases of the respiratory and cardiovascular systems.
Description: algorutm fynkcionalnuh prob v sportivn med
Functional state - a set of properties that determine the level of vital activity of the organism, the systemic response of the organism to physical activity, which reflects the degree of integration and adequacy of the functions of the work performed.
In the study of the functional state of the body involved in physical exercises, the most important changes in the circulatory and respiratory systems, they are of primary importance for resolving the issue of admission to sports and the “dose” of physical activity, the level of physical performance largely depends on them.
The most important indicator of the functional state of the cardiovascular system is the pulse (heart rate) and its changes.
rest pulse : measured in a sitting position while probing the temporal, carotid, radial arteries or by cardiac impulse in 15-second segments 2-3 times in a row to get reliable numbers. Then recalculation is done for 1 min. (number of beats per minute).
Heart rate at rest on average in men (55–70) beats/min., in women - (60–75) beats/min. At a frequency above these figures, the pulse is considered rapid (tachycardia), at a lower frequency - (bradycardia).
Blood pressure data are also of great importance for characterizing the state of the cardiovascular system.
Arterial pressure . There are maximum (systolic) and minimum (diastolic) pressures. Normal blood pressure values for young people are: the maximum is from 100 to 129 mm Hg. Art., minimum - from 60 to 79 mm Hg. Art.
Blood pressure from 130 mm Hg. Art. and above for maximum and from 80 mm Hg. Art. and above for the minimum is called a hypertonic state, respectively, below 100 and 60 mm Hg. Art. - hypotonic.
To characterize the cardiovascular system, the assessment of changes in the work of the heart and blood pressure after exercise and the duration of recovery are of great importance. Such a study is carried out using various functional tests.
functional trials a- an integral part of the complex methodology of medical control of people involved in physical culture and sports. The use of such tests is necessary for a complete characterization of the functional state of the body of the trainee and his fitness.
The results of functional tests are evaluated in comparison with other medical control data. Often, adverse reactions to the load during a functional test are the earliest sign of a deterioration in the functional state associated with a disease, overwork, overtraining.
Here are the most common functional tests used in sports practice, as well as tests that can be used in independent physical education.
"20 sit-ups in 30 seconds". The trainee rests while sitting for 3 minutes. Then the heart rate is calculated for 15 s, converted to 1 min. (original frequency). Next, 20 deep squats are performed in 30 seconds, raising the arms forward with each squat, spreading the knees to the sides, keeping the torso in an upright position. Immediately after the squats, in a sitting position, the heart rate is again calculated for 15 s, recalculated for 1 minute. An increase in heart rate after squats is determined compared to the original.
Recovery of heart rate after exercise. To characterize the recovery period after performing 20 squats in 30 seconds, the heart rate is calculated for 15 seconds at the 3rd minute. recovery, recalculation is done for 1 min. and by the magnitude of the difference in heart rate before the load and in the recovery period, the ability of the cardiovascular system to recover is estimated (table 3).
Table 3 - Assessment of the functional state of the cardiovascular system
|
resting heart rate after 3 min. rest in position sitting, bpm | ||||||
|
20 squats in 30 seconds,% | ||||||
|
Pulse recovery after exercise, bpm | ||||||
|
Breath holding test (Stange test) | ||||||
|
HR × BP max /100 | ||||||
To assess the functional state of the cardiovascular system, the most widely used are the Harvard step test (HST) and the PWC-170 test.
Conduction (GST) consists in climbing and descending from a step of a standard size at a certain pace for a certain time. GST consists in climbing a step 50 cm high for men and 41 cm for women for 5 minutes. at a pace of 30 lifts / min.
If the subject cannot maintain a given pace for the specified time, then work can be stopped, its duration and heart rate recorded for 30 seconds of the 2nd minute. recovery.
According to the duration of the work performed and the number of heartbeats, the Harvard step test index (IGST) is calculated:
,
where t– ascent time in s;
ƒ 1, ƒ 2, ƒ 3 - heart rate for the first 30 s of the 2nd, 3rd, 4th min of recovery.
Assessment of the level of physical performance according to IGST is carried out using the data given in table 4.
Table 4 - The value of the level of physical performance according to IGST
The principle of assessment in the PWC-170 test is based on a linear relationship between heart rate and the power of the work performed, and the student performs 2 relatively small loads on a bicycle ergometer or in a step test (the PWC-170 test methodology is not given, since it is rather complicated and requires special knowledge, training, equipment).
Orthostatic test . The trainee lies on his back and his heart rate is determined (until stable numbers are obtained). After that, the subject calmly gets up and the heart rate is measured again. Normally, when moving from a lying position to a standing position, an increase in heart rate by 10–12 beats per minute is noted. It is believed that its increase is more than 20 beats / min. - an unsatisfactory reaction, which indicates insufficient nervous regulation of the cardiovascular system.
When performing physical exertion, oxygen consumption by working muscles and the brain increases sharply, in connection with which the function of the respiratory organs increases. Physical activity increases the size of the chest, its mobility, increases the frequency and depth of breathing, therefore, it is possible to assess the development of the respiratory system in terms of chest excursion (ECG).
The ECG is assessed by the increase in chest circumference (ECG) during maximum inhalation after a deep exhalation.
An important indicator of respiratory function is the vital capacity of the lungs (VC). The value of VC depends on gender, age, body size and physical fitness.
In order to evaluate the actual VC, it is compared with the value of the proper VC, i.e. the one that this person should have.
Men:
VC \u003d (40 × height in cm) + (30 × weight in kg) - 4400,
women:
VC \u003d (40 × height in cm) + (10 × weight in kg) - 3800.
In well-trained people, the actual VC ranges on average from 4000 to 6000 ml and depends on the motor orientation.
There is a fairly simple way to control “with the help of breathing” - the so-called Stange test. Take 2-3 deep breaths and exhale, and then, taking a full breath, hold your breath. The time from the moment of holding the breath to the beginning of the next breath is noted. As you train, the breath holding time increases. Well trained students hold their breath for 60-100 seconds.
Determination of physical performance to restore heart rate (Ruffier-Dixon test) . As the main criteria for evaluating performance in a system of tests using physical activity, followed by a study of the rate of recovery of heart rate, the standard reactions of the body to the load are taken into account, first of all: the efficiency of the reaction and quick recovery. The purpose of the work: to evaluate physical performance by the rate of heart rate recovery using the Rufier test. Equipment: Stopwatch. Progress of work: performance evaluation is as follows. The subject's pulse is counted while sitting at rest for 15 s. Then 30 squats are performed in 45 seconds. Then the pulse is again recorded at the first and last 15 from 1 minute of recovery. The index is calculated according to the formula and evaluated according to table 5:
,
where IR is the Rufier index;
P 1 - heart rate at rest sitting for 15 s;
P 2 - heart rate for the first 15 from the first minute of recovery;
P 3 - heart rate for the last 15 from the first minute of recovery.
Table 5 - Evaluation table for calculating the Rufier-Dixon index
FUNCTIONAL TESTS, TESTS
A comprehensive analysis of medical examination data, the results of using instrumental methods of research and materials obtained during functional tests, allow an objective assessment of the readiness of an athlete's body for competitive activity.
With the help of functional tests, which are performed both in the laboratory (in the functional diagnostics room), and directly during training in sports halls and stadiums, the general and specific adaptive capabilities of the athlete's body are checked. According to the test results, it is possible to determine the functional state of the organism as a whole, its adaptive capabilities at the moment.
Testing allows you to identify the functional reserves of the body, its overall physical performance. All medical testing materials are not considered in isolation, but in a complex with all other medical criteria. Only a comprehensive assessment of the medical fitness criteria allows one to reliably judge the effectiveness of the training process for a given athlete.
Functional tests began to be used in sports medicine in the early twentieth century. Gradually, the arsenal of samples expanded due to new tests. The main tasks of functional diagnostics in sports medicine are the study of the body's adaptation to certain influences and the study of recovery processes after the cessation of exposure. It follows from this that testing in general terms is identical to the "black box" study used in cybernetics to study the functional properties of control systems. This term conditionally denotes any object whose functional properties are unknown or insufficiently known. The "black box" has a number of inputs and a number of outputs. To study the functional properties of such a “black box”, an impact is applied to its input, the nature of which is known. Under the influence of the input action, response signals appear at the output of the "black box". Comparison of input signals with output signals makes it possible to evaluate the functional state of the system under study, conventionally designated as a “black box”. With perfect adaptation, the nature of the input and output signals is identical. However, in reality, and especially in the study of biological systems, the signals transmitted through the "black box" are distorted. By the degree of signal distortion during its passage through the "black box", one can judge the functional state of the system or complex of systems under study. The greater these distortions, the worse the functional state of the system, and vice versa.
The nature of signal transmission through "black box" systems is greatly influenced by side effects, which are called "noise" in technical cybernetics. The more significant the "noise", the less effective will be the study of the functional properties of the "black box", studied by comparing the input and output signals.
Let us dwell on the characteristics of the requirements that should be presented in the process of testing an athlete to: 1) input influences, 2) output signals and 3) "noise".
The general requirement for input actions is their expression in quantitative physical quantities. So, for example, if a physical load is used as an input, then its power should be expressed in exact physical quantities (watts, kgm / min, etc.). The characteristic of the input action is less reliable if it is expressed in the number of squats, in the frequency of steps when running in place, in jumps, etc.
The assessment of the body's response to a particular input effect is carried out according to the measurement data of indicators characterizing the activity of a particular system of the human body. Usually, the most informative physiological values are used as output signals (indicators), the study of which presents the least difficulty (for example, heart rate, respiratory rate, blood pressure). For an objective assessment of the test results, it is necessary that the output information be expressed in quantitative physiological quantities.
Less informative is the evaluation of the test results according to the data of a qualitative description of the dynamics of the output signals. This refers to the descriptive characteristics of the results of a functional test (for example, "the pulse rate is quickly restored" or "the pulse rate is slowly restored").
And, finally, about some requirements for "noise".
The “noises” during functional tests include the subjective attitude of the subject to the testing procedure. Motivation is especially important when conducting maximum tests, when the subject is required to perform work of extreme intensity or duration. So, for example, suggesting an athlete to perform a load in the form of a 15-second run in place at a maximum pace, we can never be sure that the load was really performed at maximum intensity. It depends on the desire of the athlete to develop the maximum intensity of the load for himself, his mood and other factors.
Classification of functional samples
I. By the nature of the input.
There are the following types of input actions used in functional diagnostics: a) physical activity, b) change in body position in space, c) straining, d) change in the gas composition of the inhaled air, e) administration of medications, etc.
Most often, physical activity is used as an input, the forms of its implementation are diverse. This includes the simplest forms of setting physical activity that do not require special equipment: squats (Martinet test), jumps (SCIF test), running in place, etc. In some tests conducted outside the laboratories, natural running is used as a load (test with repeated loads ).
Most often, the load in the tests is set using bicycle ergometers. Bicycle ergometers are complex technical devices that provide for an arbitrary change in the resistance to pedaling. The pedaling resistance is set by the experimenter.
An even more complex technical device is the "treadmill", or treadmill. With this device, the natural running of an athlete is simulated. Different intensity of muscular work on treadmills is set in two ways. The first of these is to change the speed of the "treadmill". The higher the speed, expressed in meters per second, the higher the intensity of the exercise. However, on portable treadmills, an increase in the intensity of the load is achieved not so much by changing the speed of the “treadmill”, but by increasing its angle of inclination with respect to the horizontal plane. In the latter case, running uphill is simulated. Accurate quantitative accounting of the load is less universal; it is required to indicate not only the speed of the "treadmill", but also its angle of inclination with respect to the horizontal plane. Both considered devices can be used in carrying out various functional tests.
When testing, non-specific and specific forms of exposure to the body can be used.
It is generally accepted that various types of muscular work, given in the laboratory, belong to non-specific forms of exposure. The specific forms of influence include those that are characteristic of locomotion in this particular sport: shadow boxing for a boxer, effigy throws for wrestlers, etc. However, such a subdivision is largely arbitrary, so that the reaction of the visceral systems of the body to physical activity is determined mainly by its intensity, and not by its form. Specific tests are useful for evaluating the effectiveness of skills acquired during training.
Changing the position of the body in space is one of the important disturbing influences used in orthoclinostatic tests. The reaction that develops under the influence of orthostatic influences is studied in response to both active and passive changes in the position of the body in space. It assumes that the subject moves from a horizontal position to a vertical position, i.e. rises.
This variant of the orthostatic test is not valid enough, since along with the change in the body in space, the subject performs certain muscular work associated with the standing up procedure. However, the advantage of the test is its simplicity.
Passive orthostatic test is carried out using a turntable. The plane of this table can be changed at any angle to the horizontal plane by the experimenter. The subject does not perform any muscular work. In this test, we are dealing with a “pure form” of the impact on the body of a change in body position in space.
Straining can be used as an input to determine the functional state of the organism. This procedure is performed in two versions. In the first, the straining procedure is not quantified (Valsalva test). The second option involves dosed straining. It is provided with the help of manometers, into which the subject exhales. The readings of such a manometer practically correspond to the value of intrathoracic pressure. The amount of pressure developed with such controlled straining is dosed by the doctor.
Changing the gas composition of the inhaled air in sports medicine most often consists in reducing the oxygen tension in the inhaled air. These are the so-called hypoxemic tests. The degree of reduction in oxygen tension is dosed by the doctor in accordance with the objectives of the study. Hypoxemic tests in sports medicine are most often used to study resistance to hypoxia, which can be observed during competitions and training in the middle and high mountains.
The introduction of medicinal substances as a functional test is used in sports medicine, as a rule, for the purpose of differential diagnosis. So, for example, for an objective assessment of the mechanism of occurrence of systolic murmur, the subject is asked to inhale vapors of amyl nitrite. Under the influence of such an impact, the mode of operation of the cardiovascular system changes and the nature of the noise changes. Assessing these changes, the doctor can talk about the functional or organic nature of the systolic murmur in athletes.
II. By type of output signal.
First of all, samples can be divided depending on which system of the human body is used to assess the response to a particular type of input. Most often, functional tests used in sports medicine examine certain indicators of the cardiovascular system. This is due to the fact that the cardiovascular system reacts very subtly to a wide variety of types of effects on the human body.
The external respiration system is the second most frequently used in functional diagnostics in sports. The reasons for choosing this system are the same as those given above for the cardiovascular system. Somewhat less often, as indicators of the functional state of the body, its other systems are studied: the nervous, neuromuscular apparatus, the blood system, etc.
III. By the time of the study.
Functional trials can be divided depending on when the body's responses to various stimuli are examined - either immediately during the exposure, or immediately after the cessation of exposure. So, for example, using an electrocardiograph, you can record heart rate throughout the entire time during which the subject performs physical activity.
The development of modern medical technology makes it possible to directly study the reaction of the body to a particular effect. And this serves as important information about the diagnosis of performance and fitness.
There are more than 100 functional tests, however, a very limited, most informative range of sports medical tests is currently used. Let's consider some of them.
Letunov's test. Letunov's test is used as the main stress test in many medical and physical education dispensaries. Letunov's test, as conceived by the authors, was intended to assess the adaptation of the athlete's body to high-speed work and endurance work.
During the test, the subject performs three loads in succession. In the first, 20 squats are done, performed in 30 seconds. The second load is performed 3 minutes after the first. It consists of a 15-second run in place, performed at a maximum pace. And finally, after 4 minutes, the third load is performed - a three-minute run in place at a pace of 180 steps in 1 minute. After the end of each load, the subject recorded the recovery of heart rate and blood pressure. Registration of these data is carried out throughout the entire period of rest between loads: 3 minutes after the third load; 4 min after the second load; 5 minutes after the third load. The pulse is counted in 10-second intervals.
Harvard step test. The test was developed at Harvard University in the USA in 1942. Using the Harvard step test, recovery processes are quantitatively evaluated after dosed muscle work. Thus, the general idea of the Harvard step test does not differ from S.P. Letunov.
With the Harvard step test, physical activity is given in the form of climbing a step. For adult men, the height of the step is assumed to be 50 cm, for adult women - 43 cm. The subject is asked to climb the step for 5 minutes with a frequency of 30 times in 1 minute. Each ascent and descent is composed of 4 motor components: 1 - lifting one leg onto the step, 2 - the subject stands on the step with both legs, assuming a vertical position, 3 - lowers the leg with which he started the ascent to the floor, and 4 - lowers the other leg to floor. For strictly dosing the frequency of ascents to the step and descent from it, a metronome is used, the frequency of which is set equal to 120 beats / min. In this case, each movement will correspond to one beat of the metronome.
PWC170 test. This test was developed at Karolinska University in Stockholm by Sjestrand in the 1950s. The test is designed to determine the physical performance of athletes. The name PWC comes from the first letters of the English term for physical performance (Physikal Working Capacity).
Physical performance in the PWC170 test is expressed in terms of the power of physical activity at which the heart rate reaches 170 beats/min. The choice of this particular frequency is based on the following two assumptions. The first is that the zone of optimal functioning of the cardiorespiratory system is limited by the pulse range from 170 to 200 beats / min. Thus, with the help of this test, it is possible to establish the intensity of physical activity that “brings” the activity of the cardiovascular system, and with it the entire cardiorespiratory system, to the area of optimal functioning. The second position is based on the fact that the relationship between heart rate and the power of physical activity performed is linear in most athletes, up to a pulse of 170 bpm. At a higher heart rate, the linear nature between heart rate and exercise power is broken.
Bicycle test. To determine the value of PWC170, Shestrand asked the subjects on a bicycle ergometer a step-like, increasing in power physical load, up to a heart rate of 170 beats/min. With this form of testing, the subject performed 5 or 6 loads of different power. However, this testing procedure was very burdensome for the subject. It took a lot of time, since each load was performed within 6 minutes. All this did not contribute to the wide distribution of the test.
In the 60s, the PWC170 value began to be determined in a simpler way, using two or three loads of moderate power for this.
The PWC170 test is used to examine highly qualified athletes. At the same time, it can be used to study individual performance in beginners and young athletes.
Variants of the PWC170 sample with specific loads. Great opportunities are presented by the variants of the PWC170 test, in which bicycle ergometric loads are replaced by other types of muscular work, in terms of their motor structure, similar loads used in natural conditions of sports activity.
Running test based on the use of track and field athletics as a load. The advantages of the test are methodical simplicity, the possibility of obtaining data on the level of physical performance with the help of quite specific loads for representatives of many sports - running. The test does not require maximum effort from the athlete, it can be carried out in any conditions in which a smooth athletics run is possible (for example, running in a stadium).
Bicycle test is carried out in the natural conditions of training cyclists on a track or highway. Two rides on a bicycle at a moderate speed are used as physical activity.
Swim test also methodologically simple. It allows you to evaluate physical performance with the help of specific loads for swimmers, pentathletes and water polo players - swimming.
Cross-country skiing test suitable for the study of skiers, biathletes and combined athletes. The test is carried out on a flat area protected from the wind by a forest or shrub. Running is best done on a pre-laid track - a vicious circle 200-300 m long, which allows you to adjust the speed of the athlete.
Rowing test proposed in 1974 by V.S. Farfel with employees. Physical performance is assessed in natural conditions when rowing on academic courts, rowing in a kayak or canoe (depending on the athlete's narrow specialization) using telepulsometry.
Ice skating test for figure skaters, it is carried out directly on a regular training ground. The athlete is invited to perform the "eight" (on a standard rink, the full "eight" is 176 m) - the element is the simplest and most characteristic for skaters.
Determination of maximum oxygen consumption. Estimation of maximum aerobic power is carried out by determining the maximum oxygen consumption (MOC). This value is calculated using various tests in which the maximum oxygen transport is achieved individually (direct determination of the MIC). Along with this, the value of the IPC is judged on the basis of indirect calculations, which are based on data obtained in the process of performing unlimited loads by an athlete (indirect determination of the IPC).
The value of the IPC is one of the most important parameters of the athlete's body, with the help of which the value of the overall physical performance of an athlete can be most accurately characterized. The study of this indicator is especially important for assessing the functional state of the body of athletes training for endurance, or athletes in whom endurance training is of great importance. For these types of athletes, observing changes in BMD can be of great help in assessing the level of fitness.
At present, in accordance with the recommendations of the World Health Organization, a method for determining the IPC has been adopted, which consists in the fact that the subject performs a step-like physical load that increases in power until the moment when he is unable to continue muscle work. The load is set either using a bicycle ergometer or on a treadmill. The absolute criterion for the achievement of the oxygen "ceiling" by the test subject is the presence of a plateau on the graph of the dependence of the oxygen consumption on the power of physical activity. Quite convincing is also the fixation of a slowdown in the growth of oxygen consumption with a continued increase in the power of physical activity.
Along with the unconditional criterion, there are indirect criteria for achieving the IPC. These include an increase in the content of lactate in the blood over 70-80 mg%. In this case, the heart rate reaches 185 - 200 beats / min, the respiratory coefficient exceeds 1.
Straining tests. Straining as a diagnostic method has been known for a very long time. Suffice it to point to the straining test proposed by the Italian physician Valsalva back in 1704. In 1921, Flack studied the effect of straining on the body by measuring heart rate. For dosing the straining force, any manometric systems are used, connected to the mouthpiece, into which the subject exhales. As a manometer, you can use, for example, a device for measuring blood pressure, to the manometer of which a mouthpiece is attached with a rubber hose. The test is as follows: the athlete is asked to take a deep breath, and then exhalation is simulated to maintain the pressure in the pressure gauge equal to 40 mm Hg. The subject must continue dosed straining "to failure". During this procedure, the pulse is recorded at 5-second intervals. The time during which the subject was able to perform the work is also recorded.
Under normal conditions, the increase in heart rate compared to the initial data lasts about 15 seconds, then the heart rate stabilizes. With insufficient quality of regulation of cardiac activity in athletes with increased reactivity, heart rate may increase throughout the test. In well-trained athletes, adapted to straining, the reaction to an increase in intrathoracic pressure is slightly expressed.
orthostatic test. The idea to use a change in the position of the body in space as an input for the study of the functional state, apparently belongs to Schellong. This test allows you to get important information in all those sports in which an element of sports activity is a change in body position in space. This includes artistic gymnastics, rhythmic gymnastics, acrobatics, trampolining, diving, high and pole vault, etc. In all these types of orthostatic stability is a necessary condition for sports performance. Orthostatic stability usually increases under the influence of systematic training.
Orthostatic test according to Schellong applies to active samples. During the test, the subject actively stands up when moving from a horizontal to a vertical position. The reaction to standing up is studied by recording heart rate and blood pressure values. Conducting an active orthostatic test is as follows: the subject is in a horizontal position, while his pulse is repeatedly counted and blood pressure is measured. Based on the data obtained, the average initial values are determined. Then the athlete gets up and is in a vertical position for 10 minutes in a relaxed position. Immediately after the transition to a vertical position, heart rate and blood pressure are again recorded. The same values are then recorded every minute. The reaction to the orthostatic test is an increase in heart rate. Due to this, the minute volume of blood flow is slightly reduced. In well-trained athletes, the increase in heart rate is relatively small and ranges from 5 to 15 beats / min. Systolic blood pressure either remains unchanged or decreases slightly (by 2–6 mm Hg). Diastolic blood pressure increases by 10 - 15% in relation to its value when the subject is in a horizontal position. If during the 10-minute study, systolic blood pressure approaches the initial values, then diastolic blood pressure remains elevated.
An essential addition to the tests carried out in the doctor's office are the studies of the athlete directly in the conditions of training. This allows you to identify the reaction of the athlete's body to the loads characteristic of the chosen sport, to assess its performance in the usual conditions. These tests include a test with repeated specific loads. Testing is carried out jointly by doctors and a trainer. Evaluation of test results is carried out according to performance indicators (by the trainer) and adaptation to the load (by the doctor). Working capacity is judged by the effectiveness of the exercise (for example, by the time it takes to run a particular segment), and adaptation is judged by changes in heart rate, respiration and blood pressure after each repetition of the load.Functional tests used in sports medicine can be used in medical and pedagogical observations to analyze the training microcycle. Samples are taken daily at the same time, preferably in the morning, before training. In this case, one can judge the degree of recovery after the training sessions of the previous day. For this purpose, it is recommended to conduct an ortho test in the morning, counting the pulse in the supine position (even before getting out of bed), and then standing. If it is necessary to evaluate the training day, the orthostatic test is performed in the morning and in the evening.
standards, anthropometric indices, nomograms, functional samples, exercise, tests to assess physical development and ... standards, anthropometric indices, nomograms, functional samples, exercise, tests to assess physical development and...
2.2 Functional tests and methods of control during the physical rehabilitation of the patient
The effectiveness of physical therapy exercises is in direct connection with the adequacy of the applied physical activity, corresponding to the functional state of the patient's body, therapeutic exercises, based on a targeted impact on the damaged organ or system.
To assess the functional state of the body, a survey of the patient is of great importance, which allows you to determine his motor capabilities and identify signs of chronic coronary or heart failure based on his tolerance to everyday stress.
Freestyle, in which everyday physical activity, slow walking causes pain in the heart, shortness of breath, weakness and palpitations, tests with physical activity are not carried out and their motor abilities are assessed as low - according to the survey. Patients who easily perform the entire volume of loads within daily life, and pain in the heart, shortness of breath and weakness appear only when walking fast or running at moderate intensity, or are absent during any physical exertion, to assess the functional state and reserves of the cardiorespiratory system, physical tests are performed. load.
Physical load tests allow you to determine physical performance and decide on the permissible total load when practicing various types of exercise therapy. Functional tests reveal the degree of dysfunction of a particular organ, with the help of functional tests, a particular method of therapeutic exercises is chosen, and special exercises are dosed.
The choice of functional test and load model is determined by:
1) the nature of the disease, the degree of dysfunction of the affected organ or system;
2) the presence of concomitant diseases;
3) the degree of physical fitness;
4) age and sex;
5) the stage of physical rehabilitation (hospital, clinic);
6) the ultimate goals of exercise therapy, a course of physical training.
Exercise tests.
Testing using physical activity in exercise therapy is based on various principles. The program of physical testing is intended: I) to assess the functional state and reserves of the cardiovascular and respiratory system in order to determine the total load when prescribing exercise therapy and choosing a physical training program; 2) assessment of physical performance to determine the suitability of the patient for various activities; 3) evaluation of the effectiveness of physical rehabilitation programs in recovering from acute diseases and in patients with chronic diseases of internal organs.
2 types of tests with physical activity are used: 1) tests, during which changes and terms of recovery of indicators of the cardiorespiratory system are determined after standard physical activity; 2) submaximal tests, when using which data on the cardiovascular and respiratory systems can be obtained directly during dosed loads, as well as in the recovery period.
The first type of tests includes various dynamic tests with jumps, squats, running and walking on the spot, during which changes and recovery times in heart rate, respiration, and blood pressure are taken into account. Although these tests do not solve any of the problems of physical testing listed above, they are widely used in practice due to their simplicity and availability.
The main task of recovery tests is to determine the response of the cardiovascular system to physical activity. The most standardized test is Martinet with 20 squats in 30 seconds. This test is carried out in persons with diseases of the internal organs in the stage of full compensation, when determining a medical group for physical education in educational institutions, with admission to classes in general physical training groups and in Health groups. With the help of the test, it is possible to determine the recovery time for the functions of the circulatory and respiratory system after a specific load. At the same time, a shorter recovery period (up to 3 minutes) indicates better physical fitness; when performing a load, a physically prepared patient has a lower pulse rate. The pulse rate and blood pressure are compared with baseline: the smaller the discrepancy, the better the function of the cardiovascular system. A test with 20 squats is evaluated taking into account changes in heart rate (HR) in the first 10 from the first minute after exercise and blood pressure as a percentage of the initial value, and the correspondence of the percentage of heart rate increase with the degree of change in all main parameters characterizing blood pressure is also compared.
Types of patients' reactions to physical activity are usually divided into physiological, intermediate and pathological (unfavorable). Pathological reactions to the load with regular physical training can turn into physiological ones. An increase in heart rate within 50-75%, an increase in systolic pressure by no more than 15-30% with a decrease in the minimum by 10-25% and an increase in pulse pressure by no more than 50-70% characterizes the normotonic type of reaction. This reaction is physiological and it is regarded as favorable. The percentage of pulse acceleration in this reaction corresponds to pulse pressure, which reflects changes in systolic and diastolic pressure and indirectly characterizes an increase in stroke volume of the heart.
Conclusion
Therapeutic physical culture is a scientific discipline. Exercise therapy as a branch of clinical medicine studies the rational use of physical culture and changes that occur in patients under the influence of physical exercises.
The integration of social, biological, physiological, hygienic and pedagogical knowledge with modern achievements in clinical medicine formed the basis of the theoretical positions of exercise therapy and is logically combined with the differentiated development of its methods.
The biological basis of exercise therapy is movement - the most important natural biological stimulus of the body. The role of the social factor in exercise therapy is due to the impact on human health. The influence of scientific and technological progress and urbanization, the role of diseases of civilization, etc. are taken into account. Exercise therapy contributes to the creation of an optimal ecological environment that is in accordance with the biological, mental and aesthetic needs of people. When using exercise therapy, the direct connection of man with nature expands.
The physiological basis of exercise therapy provides for a nosological approach for the most important diseases and an organ-systemic approach for differentiating particular issues. It reflects the tasks of the preventive and hygienic direction of medicine and has wide indications for use.
The hygienic foundations of exercise therapy are determined by its health-improving effect on patients. At the same time, the achievements of the hygiene of physical exercises and sports, as well as the hygienic foundations of training, are taken into account. The hygienic aspects of exercise therapy strengthen its connection with the formation of a healthy lifestyle.
Pedagogical and methodological principles of training in exercise therapy are used taking into account the condition of patients. They use the basics of teaching physical exercises, the development of motor skills and the education of physical qualities. The value of dosed physical training and its orientation (general and special training) are taken into account.
In assessing the therapeutic effect of physical exercises, it should be taken into account that their therapeutic effect is based on the ability to stimulate physiological processes in the body. The stimulating effect of physical exercises on the patient is carried out through the nervous and humoral mechanisms. The nervous mechanism is characterized by the strengthening of those neural connections that develop between the functioning muscular system, the cerebral cortex and subcortex, and any internal organ. These connections of the receptor apparatus with the central nervous system are determined not only by its functional state, but also by the state of the humoral environment.
That is why it is so important to carry out an individual selection of physical exercises based on the results of functional tests.
Bibliography
1. Therapeutic physical culture: Handbook / Epifanov V.A., Moshkov V.N., Antufieva R.I. and etc.; Ed. V.A. Epifanov. - M. Medicine, 1987.
2. Medical rehabilitation: A guide for doctors / Edited by V.A. Epifanov. - M. Medpress-inform, 2008.
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During medical control, functional tests with breath holding, tests with changes in body position in space and tests with physical activity are most often used.
1. Samples with breath holding
Breath holding test during inhalation (Stange test). The test is performed in a sitting position. The subject must take a deep breath and hold his breath as long as possible (squeezing his nose with his fingers). The duration of the pause in breathing is counted with a stopwatch. At the moment of exhalation, the stopwatch is stopped. In healthy, but untrained individuals, the breath holding time ranges from 40-60 seconds. in men and 30-40 sec. among women. For athletes, this time increases to 60-120 seconds. in men and up to 40-95 sec. among women.
Breath holding test during exhalation (Genchi test). After exhaling normally, the subject holds his breath. The duration of the pause in breathing is marked with a stopwatch. The stopwatch is stopped at the moment of inspiration. The breath holding time in healthy untrained individuals ranges from 25-40 seconds. in men and 15-30 sec. - among women. Athletes have significantly higher rates (up to 50-60 seconds in men and 30-50 seconds in women).
It should be noted that functional tests with breath holding characterize primarily the functional abilities of the cardiovascular system, the Stange test also reflects the body's resistance to oxygen deficiency. The ability to hold the breath for a long time depends in a certain way on the functional state and power of the respiratory muscles.
2. Tests with changes in body position in space
Functional tests with changes in body position make it possible to assess the functional state of the autonomic nervous system: sympathetic (orthostatic) or parasympathetic (clinostatic) of its divisions.
orthostatic test. After staying in the supine position for at least 3-5 minutes. in the subject, the pulse rate is calculated for 15 seconds. and the result is multiplied by 4. This determines the initial heart rate for 1 min. After that, the subject slowly (for 2-3 seconds) gets up. Immediately after the transition to a vertical position, and then after 3 minutes. standing (that is, when the heart rate stabilizes), his heart rate is again determined (according to the pulse data for 15 seconds, multiplied by 4).
A normal reaction to the test is an increase in heart rate by 10-16 beats per 1 minute. immediately after lifting. After stabilization of this indicator after 3 min. standing heart rate decreases somewhat, but by 6-10 beats per 1 min. higher than horizontal. A stronger reaction indicates an increased reactivity of the sympathetic part of the autonomic nervous system, which is inherent in undertrained individuals. A weaker reaction is observed in the case of reduced reactivity of the sympathetic part and increased tone of the parasympathetic part of the autonomic nervous system. A weaker reaction, as a rule, accompanies the development of a state of fitness. 
clinostatic test. This test is carried out in the reverse order: heart rate is determined after 3-5 minutes. quiet standing, then after a slow transition to the prone position, and finally, after 3 minutes. stay in a horizontal position. The pulse is also counted at 15 second time intervals, multiplying the result by 4.
A normal reaction is characterized by a decrease in heart rate by 8-14 beats per 1 minute. immediately after the transition to a horizontal position and a slight increase in the rate after 3 minutes. stabilization, but heart rate at the same time by 6-8 beats per 1 min. lower than vertical. A greater decrease in pulse indicates an increased reactivity of the parasympathetic part of the autonomic nervous system, a smaller one indicates a reduced reactivity.
When evaluating the results of ortho- and clinostatic tests, it must be taken into account that the immediate reaction after a change in body position in space indicates mainly the sensitivity (reactivity) of the sympathetic or parasympathetic divisions of the autonomic nervous system, while the reaction measured after 3 minutes. characterizes their tone.
3. Tests with physical activity
Functional tests with physical activity are mainly used to assess the functional state and functional abilities of the cardiovascular system.
Functional recovery tests :
When conducting functional tests for recovery, standard physical activity is used. As a standard load for untrained individuals, the Martinet-Kushelevsky test is most often used (20 squats in 30 seconds); in trained individuals - Letunov's combined test.
Martinet-Kushelevsky test (20 squats in 30 seconds).
In the subject before the start of the test, the initial level of blood pressure and heart rate in the sitting position is determined. For this, a tonometer cuff is applied to the left shoulder and after 1-1.5 minutes. (the time required for the disappearance of the reflex that may appear when applying the cuff) measure blood pressure and heart rate. The pulse rate is counted for 10 seconds. time interval until three identical digits in a row are received (for example, 12-12-12). The results of the initial data are recorded in the medical control card (f.061 / y).
Then, without removing the cuff, the subject is asked to perform 20 sit-ups in 30 seconds. (arms should be extended forward). After the load, the subject sits down and at the 1st minute of the recovery period during the first 10 seconds. his pulse rate is counted, and blood pressure is measured over the next 40 seconds. In the last 10 sec. 1st min. and on the 2nd and 3rd minutes of the recovery period for 10 seconds. time intervals again count the pulse rate until it returns to its original level, and the same result should be repeated three times in a row. In general, it is recommended to count the pulse rate for at least 2.5–3 minutes, since there is the possibility of a “negative phase of the pulse” (that is, a decrease in its value below the initial level), which may be the result of an excessive increase in the tone of the parasympathetic nervous system or a consequence of the autonomic dysfunction. If the pulse has not returned to its original level within 3 minutes (that is, for a period that is considered normal), the recovery period should be considered unsatisfactory and there is no point in counting the pulse in the future. After 3 min. BP is measured for the last time. 
Combined Letunov test.
The test consists of 3 consecutive multiple loads, which alternate with rest intervals. The first load is 20 squats (used as a warm-up), the second is running in place for 15 seconds. with maximum intensity (load on speed) and the third - running in place for 3 minutes. at a pace of 180 steps per 1 minute. (endurance load). The duration of rest after the first load, during which heart rate and blood pressure are measured, is 2 minutes, after the second - 4 minutes. and after the third - 5 min.
Thus, this functional test makes it possible to assess the body's adaptability to physical loads of a diverse nature and intensity.
Evaluation of the results of the above tests is carried out by studying types of reactions of the cardiovascular system for physical activity. The occurrence of one or another type of reaction is associated with changes in hemodynamics that occur in the body when performing muscular work.
