The Department of General
practice - Family medicine
Basics of Physical Rehabilitation
Physical Rehabilitation for Cardiovascular
and Pulmonary Diseases
Physical Rehabilitation and
Sports Medicine . Lecture#3
Physical rehabilitation
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Physical rehabilitation is a complex of
psychological and physical measures
aimed at the elimination of a structural
and functional abnormalities (result of
illness) in the human organism.
Main purpose of PhR
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Systematic use of physical exercise
therapy in the treatment promotes the
development of compensatory
mechanisms and adaptation of various
systems. It is very important for rapid
clinical and functional recovery.
Types of rehabilitation:
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medical rehabilitation;
professional rehabilitation;
social rehabilitation.
Medical rehabilitation (I)
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a) prevention of patient detraining
during his stay in the bed/hospital;
b) stimulate its internal resources in
the fight against disease;
c) accelerate regeneration of organs
and tissues;
Medical rehabilitation (II)
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d) accelerate development of compensatory
mechanisms;
e) the prevention and treatment of long bed
rest complications.
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The MAIN TASK OF MEDICAL
REHABILITATION
is full restoration of the functional capabilities
of the various systems of the body including
musculoskeletal system,
and the development of compensatory
adaptations to the conditions of everyday life
and work.
Professional rehabilitation
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PURPOSE:
Return the patient to the same
work/occupation;
Requalification and removal of
harmful and dangerous working
conditions.
Social rehabilitation
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SEVERE ILLNESS
Social disadaptation (broken links
with the family and society).
Main purpose: restoration of patient`s
status in the society and family.
SPECIAL PROBLEMS OF
REHABILITATION INCLUDE:
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1. Recovery of domestic capabilities of the
patient: the ability to moving, self-care and the
implementation of a simple homework;
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2. Restoration of working capacity:
reenable lost skills through the use and
development of the musculoskeletal system
functionality;
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3. Preventing the development of
pathological processes that lead to temporary
or permanent disability (secondary prophylaxis).
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THE MAIN MEANS OF PHYSICAL
REHABILITATION ARE EXERCISES
AND ELEMENTS OF THE SPORT
PHYSIOLOGICALLY DETERMINED
PRINCIPLES OF REHABILITATION:
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1. Individual approach to the
patient.
During designing a rehabilitation
program doctor must take into account
age, sex, profession of the patient, his
sport anamnesis, the nature and
duration of the pathologic process, the
functionality of the patient.
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2. Consciousness.
Only a conscious and active
participation of the patient in the
rehabilitation process creates the
necessary psycho-emotional
background and psychological mood,
which increases effectiveness of
these rehabilitation.
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3. The principle of gradualness (increasing
physical activity in all its parameters):
- volume,
- intensity,
- number of exercises,
- number of repetitions/sets,
- complexity of the exercises within the
same class, and throughout the
rehabilitation process
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4. Regularity of training during the whole
period of rehabilitation (months or years…).
5. Cyclicity. Work-rest cycle with optimal
interval (rest between the two exercises, or
between two classes of exercises).
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6. Serialization - sequential alternation of
starting positions and exercises for different
muscle groups.
7. Novelty and diversity in the choice
and application of exercises. 10-15% of
the exercises should be updated and 8590% - repeated.
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8. The principle of physical activity
moderation. Physical activity
should be adequate to the
capabilities and condition of the
patient (in some cases, should be
increased the duration of the
exercise, reduced its intensity or
split it into parts).
THE BASIC PRINCIPLES
OF REHABILITATION:
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1. Early initiation of rehabilitation
Сontraindications:
- severe condition of the patient,
- high temperature,
- severe intoxication ,
- severe cardiovascular and pulmonary failure,
- a sharp oppression of adaptive and compensatory
mechanisms.
Exception:
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inflating the balloons by patients to prevent
congestive pneumonia in the acute
postoperative period.
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2. Integrated use of all available and necessary
rehabilitation measures.
Medical rehabilitation require collaboration of many
professionals for adequate physical and mental
condition of the patient at different stages of
rehabilitation:
- physicians,
- surgeons,
- trauma surgeons,
- physiotherapists,
- physical rehabilitation physicians,
- psychologists,
- psychiatrists, etc.
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3. Individualization of rehabilitation programs
Depending on the reasons that require
rehabilitation, as well as features of patients or
disabled persons (their functionality, experience
of movement, age, gender), the number of
doctors and methods of rehabilitation will be
differ.
Rehabilitation requires an individual approach to
patients based on their response to it.
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4. Continuity and consistency at all
stages of rehabilitation
The patient's card is filled on each
stage of rehabilitation (methods and
means of treatment and rehabilitation,
the patient's functional state).
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5. Social orientation
The best result of medical
rehabilitation - complete
recovery of the patient and
return to the usual
professional work
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6. Using the control methods for
adequacy of loads and efficiency of
rehabilitation
Control methods:
a) medical diagnostics,
b) functional diagnostics,
c) motor diagnostics
d) psychodiagnostics
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MOTODIAGNOSIS - determination of motor
abilities of the patient, ability to domestic and labor
operations (postural tests, muscle testing).
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PSYCHODIAGNOSIS - the psychologist
determines the structure and degree of changes
in mental functions, types of memory disorders,
attention, thinking, emotional and volitional
characteristics, personality characteristics and
their impact on the rehabilitation process.
STAGES OF REHABILITATION
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Medical rehabilitation has 3 or 4
stages.
Three-step rehabilitation:
1. specialized hospital;
2. specialized rehabilitation center or
sanatorium;
3. Rehabilitation outpatient department.
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4-step rehabilitation (traumatology):
1. Specialized ambulance (prevention of
further complications by a specialized
ambulance staff);
2. specialized trauma hospital;
3. stationary rehabilitation center;
4. Outpatient department rehabilitation.
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MEANS OF PHYSICAL REHABILITATION
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- active,
- passive
- psycho-regulatory
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Active means include all forms of
therapeutic physical culture (TPC):
- a variety of exercises,
- sports training,
- walking, running and other cyclic
exercises,
- work in the gym,
- dance treatment,
- occupational therapy, etc.;
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Passive means:
- massage, manual therapy,
physiotherapy, and using of natural
environmental factors;
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Psycho-regulatory means:
- autogenous training, muscle relaxation, etc.
THERAPEUTIC PHYSICAL CULTURE (TPC)
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This is theoretical and practical,
medical and educational discipline
that studies the theoretical
foundations and methods of use
the physical culture for the
treatment, rehabilitation and
prevention of various diseases.
One of the main principles of physical
therapy is a DOSED WORKOUT
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There are a GENERAL and SPECIFIC training doses.
The general training dose is used for rehabilitation,
strengthening and general development of the body
(restorative and general development exercises).
Special training is the development and restoration
of body functions involved in the pathological process.
Applying special exercises that directly affect the
particular system (breathing exercises with
pneumonia, exercises for paralyzed limbs, etc.).
THE RATIO OF EXERCISES
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The ratio of exercises for general development
and breathing exercises depends on the period
of the disease.
Recovery reduces the number of breathing
exercises and increases the number of special
exercises.
During physical exercises, the patient's emotional
state is very important. It improves health, fitness
and reduce fatigue.
WORK THERAPY
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Work therapy is restoration of impaired functions with
the help of special work processes.
Types:
1. Restorative therapy improves the patient's vital
activity, promotes psychological rehabilitation;
2. Reconstructive therapy - aimed at preventing
disturbances of the patient's movement and
restoration of lost functions;
3. Professional therapy - restores disrupted working
skills, used at the final stage of rehabilitation
treatment.
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Device therapy - restoration of lost
functions with the help of special devices.
It is mainly used to prevent contractures
(stiffness) of the joints.
Gymnastic (physical) exercises - this is a
specially selected combination of natural
movements of a person, divided into
components.
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CLASSIFICATION OF PHYSICAL EXERCISES:
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1. Anatomical. Exercises for the muscles of
the head, neck, trunk, shoulders, upper limbs,
abdominal muscles and lower limbs;
2. Depending on activity.
- active (performed by the patient),
- passive (performed by the physiologist with
the patient's effort)
- active-passive exercises (performed by the
patient with the help of an instructor)
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active
passive
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active-passive exercises
CLASSIFICATION OF PHYSICAL EXERCISES:
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3. Breathing exercises (static, dynamic and
drainage)
- Static breathing exercises are performed in
different initial positions without moving the legs,
hands and trunk.
- Dynamic (work in conjunction with movements of
the limbs, trunk, etc.)
- Drainage. Breathing exercises specifically
designed to drain fluid from the bronchi.
Positions for Postural Drainage
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CLASSIFICATION OF PHYSICAL EXERCISES:
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4. Coordination and balance exercises used to
train the vestibular apparatus in hypertension,
neurological diseases and others.
Performed in the main Initial position: a
standard stand, on a narrow supporting surface,
standing on one leg, on the toes, with open and
closed eyes, with or without objects.
This also includes exercises that form the
household skills lost as a result of the disease.
INDICATIONS AND CONTRAINDICATIONS
TO EXERCISE THERAPY
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Training therapy is indicated for all diseases: in the
clinic of internal and nerve diseases, traumatology, in
surgical pathology, gynecological and other diseases.
Contraindications are extremely limited and in most cases
are temporary.
This refers to diseases associated with a severe general
condition of the patient due to shock, infection, blood loss,
serious injuries, etc.
Contraindications also include: severe pain, risk of
bleeding, fever above 37.5 °C and conservative treatment
of malignant tumors.
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PHYSICAL
REHABILITATION FOR
CARDIOVASCULAR
DISEASES
PHYSICAL REHABILITATION FOR
CARDIOVASCULAR DISEASES
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The purposes of training:
• increasing blood supply of the organs and
systems;
• restoration of impaired functions of the
blood supply;
• development of circulatory compensation
under the influence of dosage workout.
SPECIAL PHYSICAL THERAPY FOR
HYPERTENSION
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Exercises carried out:
• rhythmically;
• in quiet rate;
• without effort and expressed tension
with a large range of motion in the
joints.
SPECIAL PHYSICAL THERAPY FOR
HYPERTENSION
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Patient must use relaxation exercises and
function of full breath. Performing in the
style of autogenic training by Schultz to
achieve a sense of rest in the hands and
feet.
The amount and intensity of physical
exercise depends on the functional state
of the patient.
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PHYSICAL THERAPY FOR
CORONARY ARTERY DISEASE
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Rules of the implementation:
- in a calm rhythm;
- the number of each repetition of
exercises is moderate;
- the complexity of the exercises
increases within 3-4 days;
- alternation of exercises with breaks for
rest (30-40 seconds).
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ESPECIALLY PHYSICAL THERAPY FOR
CORONARY ARTERY DISEASE
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- The duration of the rehabilitation
program is 4-5 days (more serious
cases - 7-10 days). Place of the
rehabilitation - hospital;
- The number of physical exercises is
15-20.
PHYSICAL THERAPY PROGRAMS
AFTER MYOCARDIAL INFARCTION
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Physical rehabilitation programs
depend on the patient's regimen.
PHYSICAL THERAPY PROGRAMS
AFTER MYOCARDIAL INFARCTION
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Types of hospital regimes:
- strict bed rest;
- non-strict bed rest;
- ward mode;
- free mode.
PHYSICAL THERAPY PROGRAMS
AFTER MYOCARDIAL INFARCTION
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Duration of bed rest:
- in case of small focal uncomplicated
myocardial infarction - 3-4 weeks;
- in case of intramural uncomplicated
myocardial infarction - 4-5 weeks;
- in case of transmural myocardial
infarction - 6-8 weeks.
STRICT BED REST
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Exercise therapy is aimed to improve
peripheral circulation and prevention
complications.
STRICT BED REST METHODOLOGY FOR EXERCISE
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Exercises are held 2 times a day,
duration 7-10 minutes.
The patient's position - lying on his back.
The movement: in the small and
medium-sized joints of limbs.
STRICT BED REST METHODOLOGY FOR EXERCISE
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The patient learns easily, with an
exhalation turn to the right side.
The rate is slow, the number of
repetitions is 3-6 times (the number of
repetitions increases to 8-10).
BED REST
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Passive transition with the help of the
instructor to the sitting position, and
then active work by hands.
Exercises are carried out once a day for
15-17 minutes.
BED REST
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Complicating the exercises,
increasing their number, adding
exercises for the feet, they are
performed alternately by the right and
left legs.
Adding exercises for the muscles of
the body in the sitting position.
WARD MODE
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•Preparing the patient for getting up
and walking;
•Increasing the number of exercises for
the legs, simulating walking in a sitting
position;
•Adaptation of the patient to a standing
position;
WARD MODE
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Gradual increase of patient walking:
- The first few steps near the bed;
- then each exercise the number of steps
increases by 5-7 and reaches 40-50 meters.
- exercises are performed in a standing
position.
The training time is 15-20 minutes.
FREE MODE
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- adaptation of the cardiovascular
system to daily household load;
- increase in the number of exercises
performed in a standing position;
- total load from 50 to 200-500 meters;
- walking stairs a few steps up to 1-2
floors.
THE METHODOLOGY OF THE WALKING
EXERCISES (I)
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I stage. Occurrence.
Duration of the stage - 6-10 weeks.
Frequency of exercises - 5 times a week.
Speed -​ 25 min / 1 km. Distance - 1 km.
In a stable clinical picture can pass the
second phase.
THE METHODOLOGY OF THE WALKING
EXERCISES (II)
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II stage.
Duration of the stage about 12 weeks.
Frequency of exercises - 5 times a week.
Speed ​- 20 min / 1 km. distance - 2 km.
A set of exercises for myocardial infarction
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PHYSICAL
REHABILITATION FOR
PULMONARY
DISEASES
PHYSICAL REHABILITATION FOR
PULMONARY DISEASES
In case of pulmonary diseases
there is a disorders in the function
of external respiration, which leads
to the development of respiratory
failure.
RESPIRATORY FAILURE
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There is a decrease in the elasticity
of the lung tissue, a disturbances of
normal gas exchange between the blood
and alveolar air due to inflammatory and
sclerotic processes in the lungs.
Respiratory failure is pathological
syndrome, when the oxygen partial
pressure in the arterial blood (PaO2) is
less than 60 mmHg.
PHYSICAL REHABILITATION FOR RESPIRATORY
FAILURE
The goal of the Physical
Rehabilitation for Respiratory
failure is to maintain the process
of constant dosage training with
the use of voluntary regulation of
breathing.
PHYSICAL REHABILITATION FOR RESPIRATORY
FAILURE
Tasks of therapeutic gymnastics:
1. Recovery of the respiratory act in order to
maintain a more equable ventilation and increase
arterial oxygen saturation;
2. Development of compensatory mechanisms
conducing increased ventilation of lungs and
increase of gas exchange by:
a) strengthening of the respiratory muscles;
b) increased mobility of the thorax and spine;
c) improved posture.
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Therapeutic exercises used on the 4th-6th
day: twice a day for 12-20 minutes in the
first half of the course of treatment (7-10
days) and 25-40 minutes - in the second
(15-20 days).
2-3 exercises for recovery and 3-4 static and
dynamic breathing exercises for general
relaxation, then 2-3 corrective exercises for
the mobility of the spine and thorax.
DYNAMIC BREATHING EXERCISES
(LYING ON THE BACK)
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1. Diaphragmatic breathing. On inhalation,
raising arms up, lower them with exhalation.
Exhalation is twice longer then inhalation.
2. On inhalation, moving a straight leg to the
side, on exhalation return to the initial
position.
3. During the inhalation, the arms are dilated
to the sides. During the exhalation, the
knees are pulled to the abdomen with help
of hands.
EXERCISES ARE PERFORMED LYING DOWN, SITTING ON A CHAIR
and in STANDING POSITION
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Exercises: slopes,
crossing and
raising hands,
lifting legs,
turning the trunk
are repeated 610 times.
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The effectiveness criteria of the
rehabilitation measures for
cardiovascular and pulmonary diseases
is the positive dynamic of the health
state
(according to the Functional
Classification of Heart Failure of the
New York Heart Association (NYHA),
1994).
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The functional classification of
Respiratory failure corresponds to the
modified version of the NYHA
classification (WHO, 1998).
NYHA FUNCTIONAL CLASSIFICATION OF
HEART FAILURE, 1994 (NYHA FC).
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



I Cardiac disease, but no symptoms and no
limitation in ordinary physical activity (no shortness
of breath when walking, climbing stairs etc.)
II Mild symptoms (mild shortness of breath and/or
pain) and slight limitation during ordinary activity.
III Marked limitation in activity due to symptoms,
even during less-than-ordinary activity, e.g. walking
short distances (20–100 m). Comfortable only at rest.
IV Severe limitations. Symptoms even at rest.
Mostly bed rest patients.