The use of physical exercises for therapeutic purposes began in ancient times in the conditions of primitive communal system, in the slave-owning society.
From ancient sources we know that physical exercises were used for therapeutic and preventive purposes in China (breathing exercises) and India (hatha – yoga) for 2 thousand years BC. An important stage in the development of therapeutic exercise was the heyday of Greek and Roman culture.
Hippocrates (460 – 377 BC) described in detail the use of physical exercise in diseases of the heart, lungs, metabolism, surgical and other diseases.
Avicenna (980 – 1037) in his encyclopedia “Canon of Medicine” divided physical exercises into small and large, strong and weak, fast and slow.
During the Renaissance (XIV-XVI) humanists promoted physical exercise for preventive and curative purposes.
In pre-revolutionary Russia leading scientists and educators: M. Lomonosov, A. Radishchev, V. Belinsky, A. Herzen developed ideas about physical education and its use for preventive and therapeutic purposes. Prominent figures of Russian national medicine such as M.Y. Mudrov, N.I. Pirogov, S.P. Botkin, G.Y. Zakharin, P.F. Lesgaft argued for the need of unity of mental and physical education for the harmonious development of man.
Before the revolution, physical therapy and massage were used only in private hospitals.
In the Soviet Union a school of physical therapy was established. In 1926 I. M. Sarkizov – Sarazin organized the first department of physical therapy at the Moscow Institute of Physical Education.
TPT became especially important during the Great Patriotic War as one of the methods of functional rehabilitation of the wounded.
In 50-60s the number of TPT specialists had increased, all medical preventive institutions gave birth to TPT specialists. In 70-80s all polyclinic institutions gave birth to LFC rooms, departments of medical rehabilitation, where TPT took the leading part.
Modern medicine attaches great importance to therapeutic exercise, it is used for rehabilitation of patients, starting from the hospital and at all stages of treatment until the patient is completely recovered, it is used in combination treatment, along with medication, physiotherapy and balneotherapy methods of treatment. It is used in the treatment of a variety of diseases and injuries, in all types of hospitals, at all stages of development.
There are four types of therapeutic effects of physical exercise:
1. tonic;
2. trophic;
3. forming compensations;
4. normalization of functions
Therapeutic exercise uses patient training to achieve therapeutic results. The process of dosed training is carried out in compliance with the following physiologically grounded rules: consistency, regularity, rational duration, alternation of periods of work and rest, sequential increase in physical activity throughout the course of treatment, combination of loads with proper breathing, compliance with hygiene rules, individualization in method of application and dosage of physical exercises.
Forms of therapeutic physical training
The forms of physical therapy are: hygienic gymnastics, therapeutic gymnastics, individual therapeutic exercise, walking and weight-bearing walking, mass physical training: sports games, swimming, rowing, skiing, hiking, etc.
1. Hygienic gymnastics – (morning hygienic gymnastics, morning exercises) – a form of therapeutic physical training, which provides a smooth transition from sleep to wakefulness, organizing and stimulating effect on the body. It is carried out in accordance with the daily schedule of the hospital, sanatorium or rehabilitation center in specially designated hours and is the most common form of therapeutic exercise. It lasts from 5 to 15 minutes and is conducted with all patients, except those in a comatose condition. It is conducted in a well-ventilated room, in sports clothes, it can be carried out with musical accompaniment – this increases its effectiveness. The therapy shall include exercises of an applied nature. 2.
Therapeutic exercise – (therapeutic exercise class, therapeutic exercise procedure) – the basic form of therapeutic exercise and the most accessible tool, because it has a large variety of physical exercises. It is used in almost every disease and every age and under all conditions: in the ward, bedside, LFC room, in the air, in the water.
Classes are individual, small group and group method.
Individual sessions are conducted with severely ill patients. This method is not permanent for these patients; as they recover, they are transferred to a group.
The small-group method (3-5 people) is conducted with patients united on the principle of a single disease_ (therapeutic, traumatological, etc.). Classes are conducted in ventilated wards.
The group method (8-15 persons) is conducted with patients who are on the same regime, at the same period of the disease, when similar tasks are solved. Classes are held in the LFC room, it is possible on a physical training platform. This method is the most effective, since it allows us to influence a large number of patients at once.
Each TPT session is conducted according to a certain plan that includes three sections: preparatory (introductory), main and final.
The introductory section has the character of a warm-up and has the goal of preparing the student to perform special exercises. From the standpoint of muscular activity physiology, this section accelerates the warm-up, i.e. it mobilizes the vegetative functions and sets the best relationship between the N.S., motor apparatus and vegetative functions that ensure movements. According to its duration, it takes from 20 to 10 % of the total time.
The main section addresses the main therapeutic tasks, which consist of influencing both the affected organs and systems and the entire organism. It consists of special exercises, which alternate with general developmental ones, and takes 60 to 80% of the total class time.
The final section performs the task of gradually reducing the load. It takes 10-20% of the total time.
When conducting LG classes, it is necessary to regulate the physical load by observing the response of the organism. For this purpose physiological load curve is used, it is a graphical representation of changes in P frequency during classes. The highest rise of P is observed at the end of the main section of classes.
The density of the exercise is important in dosing. It is determined by the time of the actual exercise and is expressed as a percentage of the total class time. For in-patients it must not exceed 50 per cent, and in the first days of the class it must be 20-25% (low density). For persons with a training regime and in sanatoriums is allowed a density of 80-90%.
3. The next form of TPT is individual self-training – they enhance and supplement LFC.
4. Dosed walking – is used for patients with diseases of the OPA, respiratory organs, CCS and for adaptation to physical load. It is dosed by the length of the distance, speed of step, terrain relief.
Trekking – dosed climbs and descents on special routes.
Principles of TPT
For the best efficiency of classes, the pedagogical principles used are
– An individual approach;
– The conscious and active participation of the patient in his own treatment;
– Graduality (increase in the number and intensity of physical exercises;
– Duration (without interruptions until full recovery);
– consistency and sequence of rules: from the simple to the complex, from the easy to the difficult and from the known to the unknown;
– alternativeness (general developmental alternates with special ones, so that there is a rest and a pause, they help to achieve a therapeutic effect) apply all possible means;
– clarity and accessibility;
– Compliance with the cycle;
– principle of comprehensiveness.
An TPT doctor, an TPT methodologist and an TPT instructor work in the office. Logistic base: The office must have an area of at least 4 square meters per one person occupying at least 20-24 square meters, it is desirable to have a sports ground, tracks, mini stadiums, swimming pools for therapeutic swimming.
Special equipment should meet the standards. Documentation is needed for accounting and reporting. This includes: medical history, patient records, logbook of the office, the instructor and methodologist. The main working document is the outline of therapeutic physical training and hygienic gymnastics classes.
The quality of the therapeutic measures is determined by the effectiveness of treatment.
Counter-indications for physical therapy classes are more often temporary.
1. Acute period of illness.
2. General serious condition (all serious irreversible progressive diseases).
3. Elevated body temperature.
4. Severe pain.
5. Danger of bleeding.
6. Intoxication.
7. In conservative treatment of malignant tumors.
8. Presence of foreign objects near vessels and nerve trunks.
9. Mental diseases and pronounced oligophrenia.
Therapeutic physical exercises
The remedies include specially selected and organized human movements – physical exercises.
All exercises are divided into 3 groups: gymnastic, sports-applied games.
1. Gymnastic exercises are specially separated exercises, which achieve selective action on certain muscles physiologically related to their internal organs. Their implementation involves a particular initial position, direction of motion, its amplitude, speed, measure of muscle tension. The largest group of gymnastic exercises are general developing (strengthening), he used to improve physical fitness, recovery, improve the physical qualities of the body. They activate blood circulation and respiration, increase neuro-moral tone, leading the body into a favorable functional state and facilitate the therapeutic effect of special exercises.
All exercises are divided into four large groups:
– Dynamic – in which there is a contraction and relaxation of the muscle by changing its length.
– Isometric exercises are performed without movements in the form of muscle tension without changing its length, with subsequent relaxation. They are economical, performed without energy expenditure and in a short time you can build muscle mass. They are used for paresis and paralysis t in the immobilization period of fractures for better repositioning and faster formation of the bone callus.
– Relaxation – after doing exercises you need to relax, as there will be no increase in physical performance when doing exercises. They have a multi-faceted effect on the body: there is a decrease in pathological overexcitation, improved vegetative regulation of the body.
– Ideomotor exercises – the mental representation of the movement causes quite imperceptible for the performers and observers reduction of relaxation of all muscle groups that usually participate in the actual performance of the movement, they have a therapeutic effect on all the organs of the body. They can be of preparatory character and are performed before the direct active action, and this increases the therapeutic effect of LFC classes – of training character, they are performed in a greater volume than the patient can perform in the active action at the moment.
Dosage of physical activity
The application of each therapeutic measure is based on its dosage. This also applies to therapeutic exercise. By dosage in LFC is understood the establishment of the total value of physical activity, as in the application of a single exercise, and the entire lesson, as well as all motor activity during the day.
The difficulty in dosage is that it is necessary to give the optimal load, not exceeding the strength and capabilities of a particular patient.
Physical activity depends on:
1. P.P. (supine, lying, sitting, standing).
2. Size and number of muscle groups involved in the exercise (the less ” groups, the less load).
3. Amplitude of the movement (in full contraction of the muscle full amplitude movement).
4. The number of repetitions of the exercise is the easiest way to dose the load.
5. Exercise tempo (slow medium fast)
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6. Rhythm (it facilitates performance if automaticity is developed).
7. Accuracy of the exercise (increase the load at the beginning, and then make it easier).
8. Difficult exercises require a lot of will and attention – create a load, fatigue.
9. Relaxation exercises and static breathing exercises reduce the load.
10. Positive emotions help to perform exercises and the therapeutic effect comes more quickly.
11. The degree of effort in training paretic muscles requires more effort.
12. The principle of dispersed load helps and prevents the development of fatigue.
13. The use of objects and implements in performing exercises increases the load. It is possible to dose the load relatively accurately, knowing the regime of movements of the patient and carrying out medical and pedagogical observations. It should be remembered that the patient load should be slightly less than optimal.
The total load at LFC classes is determined by its intensity, duration, density and volume.
The threshold intensity is not determined by the ergometer. The duration of the load is determined by the total exercise time.
Density is the time of actual exercise performance.
Load volume represents the total work performed per class.
Mode of motion in the hospital
I – bed rest:
a) bed strict with observance of rest mode;
b) bed rest regime, light (extended) with a gradual expansion of the patient’s motor activity (turns, transition to a sitting position in bed).
Regimen content:
Staying in bed more often in supine or half-sitting position. When the patient is well, active turning in bed, staying in bed for a short period of time (2 or 3 times a day, 5-30 minutes) in the sitting position, eating and toileting with the help of the nursing staff are allowed. UGH and LH in bed depending on medical indications, mandatory ventilation and damp cleaning of the room several times a day.
Allowed increase in heart rate after exercise by 12 beats.
II – Semi-bed rest (ward).
Regimen content:
Transition to a sitting position on the bed with legs down or in a chair (2 – 4p per day for 10-30 minutes). After a few days – change to standing position and walk around the room, followed by resting in sitting or lying down position. Makes changes of position in bed, chair, toileting and eating independently. Alternates between walking and resting in a chair. UGH, LH on individual basis. Allowed increase in heart rate after exercising LH for 18-20 beats.
III – free (general).
The content of the regime:
Free walking on the ward and stairs from the 1st to the 3rd floor with rest. Walks in the air for 15-30 minutes with rest. UGH and LH is applied on medical grounds. Allowed increase in heart rate by 32 beats.
Mode of motion is set strictly on an individual basis, depending on the personality of the patient, the peculiarities of the nature of the disease.
Polyclinic and sanatorium regimes:
– sparing
– sparing – training
– training.
