Qualification of students after off-hospital pneumonia for academic physical education based on energy resource tests

PhD, Associate Professor I.A. Lazareva1
PhD, Associate Professor O.A. Sultanova1
N.N. Voronova1
E.V. Rozhnova1
1I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow

Keywords: students, off-hospital pneumonia, energy resource, qualification for academic physical education, special health group.

Introduction. The incidence among university students remains high, which is associated with inefficiency of adaptive responses against the background of constant stresses typical for this age, low motivation for health-saving behavior [2, 3, 4, 5, 8]. According to the results of preventive medical examination of university students, respiratory diseases occupy the first place in all regions of Russia (up to 40-60%) [2, 9, 10].

The functionality characteristics should be taken into account not only during treatment, but also during physical education classes, since physical loads place increased demands on all functional systems of the body [6, 7].

The lack of clear objective criteria for recovery and subsequent admission to physical education classes leads to the chronic sequel of off-hospital pneumonia, as well as overstrain of the body under physical loads, primarily, the cardiorespiratory system [1, 6].

Objective of the study was to analyze the energy resource of the students after off-hospital pneumonia by means of cycle ergometer tests to qualify them for academic physical education.

Methods and structure of the study. Sampled for the study were the 1-6-year Sechenov University students (n=61) aged 17-25 years (21.7±0.2 on average) split up into two groups. The Experimental Group (EG) was made of 39 subjects (20 males and 19 females) diagnosed with off-hospital pneumonia, the Reference Group (RG) included 22 apparently healthy students (12 males and 10 females).

The EG students were treated by the standard off-hospital pneumonia therapy. The first test was carried out during the 14th-17th day of disease, the second one – in a month, the third one – in 1.5 months upon the start of the disease, with the health condition tested by the standard combined tests plus spirographic, spiroergometric, ECG and cycle ergometer tests.

The individual physicality was tested by cycle ergometer Ergomedic 894E Peak Bike (Monark) test system rated for 25W with the workload stepped up by 25W every 3 min, with the test stopped on the relevant indications as recommended by the Expert Committee of the WHO (1970).

Gas exchange was rated by CARDIOVIT CS-200 Ergo-Spiro system Schiller electrocardiograph, with the following indicators registered every minute: the amount of load performed per kg of body weight (A/kg), respiratory rate, tidal volume, respiratory minute volume, oxygen consumption, respiratory coefficient, oxygen pulse, oxygen utilization coefficient, heart rate. All indicators were recorded in the initial state, after cycle ergometer tests and in the recovery period during the 10th and 30th minutes. The test data were processed by the standard variation statistics toolkit using the common formulae.

Results and discussion. Physical exercise tolerance in cycle ergometer tests in EG was characterized by a significant decrease in physical working capacity as compared to RG: for example, the amount of work performed in both groups was 94.66±1.98 and 193.6±3.57 kgm/kg, respectively (p<0.001).

According to the gas exchange analysis carried out in the first test, the EG external respiration indicators differed significantly from those in RG registered at rest, despite the signs of clinical recovery (Table 1).

Table 1. Gas exchange rates in EG and RG students in 1st test

Indicators

Initial state

After cycle ergometer tests

Recovery period

EG

RG

р

EG

RG

р

EG

RG

р

Respiratory rate, resp/min

23.2±0.8

17.1±1.03

<0.01

42.6±1.03

34.2±1.02

<0.001

30.05±1.06

20.8±0.95

<0.001

Respiratory minute volume, l/min

14.2±1.04

10.4±0.75

<0.01

83.05±3.01

72.05±2.42

<0.01

32.9±1.09

22.6±0.91

<0.001

Oxygen consumption, ml/min

243.0±17.3

310.0±33.04

<0.05

2070.6±72.02

2850.0±86.76

<0.001

530.3±28.94

408.6±19.26

<0.001

Tidal volume, l

362.0±52.19

550.0±63.5

<0.01

1550.5±121.9

2670.0±132.5

<0.001

645.6±37.4

750.0±43.2

<0.05

Respiratory coefficient

0.94±0.017

0.825±0.032

<0.01

1.21±0.012

1.15±0.014

<0.01

1.03±0.026

0.93±0.014

<0.01

Heart rate, bpm

84.6±3.83

73.1±2.97

<0.01

195.5±5.6

176.5±4.42

<0.01

129.0±4.09

109.01±2.08

<0.01

Oxygen pulse, ml/min/beat

3.17±0.18

4.03±0.17

<0.01

11.06±0.45

16.52±0.63

<0.01

5.02±0.27

6.4±0.15

<0.01

Oxygen utilization coefficient, ml/l

34.2±0.87

40.1±1.20

<0.001

39.7±1.03

45.3±1.32

<0.001

33.7±0.96

37.6±1.12

<0.01

The decrease in the oxygen consumption rates, low oxygen pulse values due to the increased heart rate and excessive ventilation indicate inefficient respiratory function and hemodynamics.

The decrease in the vital capacity rates in EG to 76.22+2.9% of proper vital capacity, as well as decreased maximum breathing capacity at the onset of clinical recovery testify to the violation of bronchial conductivity and functionality of the respiratory system.

Therefore, the 1st test found some significant gas exchange disorders in the EG students in their initial state, after cycle ergometer tests, and during the recovery period.

The 2nd test showed that at rest EG was still characterized by the increased respiratory rate. This led to significant hyperventilation and increased oxygen consumption to the level sufficient to provide body with oxygen. By this time, the EG students’ heart rate remained increased as opposed to the RG students, and since the oxygen consumption rates did not increase, oxygen pulse remained reduced, thus indicating the heart’s low efficiency.

During this period, the vital capacity and maximum breathing capacity rates in EG differed significantly from the proper rates and those obtained in RG (p<0.001 in all cases).

During cycle ergometer tests, the amount of work performed per kg of weight among the EG students (169.9±2.87 kgm/kg) did not reach the level demonstrated by the RG students (193.6±3.57 kgm/kg) and amounted to 87.76% of their result.

The significant increase in heart rate and respiratory minute volume without proper growth of oxygen consumption affected oxygen pulse and oxygen utilization coefficient, which indicated the reduction of the bodily reserve capacities contributing to the ventilation hemodynamic support of exercise performance. Therefore, there were some significant changes in the cardiorespiratory function in EG after cycle ergometer tests.

During the recovery period, EG was still characterized by the slow recovery rates, which indicated an insufficient restoration of the compensatory and reserve capabilities of the body in this period.

Conclusion. Normalization of clinical, laboratory, radiological data and most external respiration rates at rest is not deemed a criterion of full recovery of students with off-hospital pneumonia. Cycle ergometer tests and gas exchange analysis, making it possible to determine the degree of recovery after off-hospital pneumonia, are to be conducted to be able to find out students’ qualification for training and competitive loads. The indicators are normalized not sooner that 1.5 months upon the start of the disease, which can serve as an approximate period for qualification for the academic physical education sessions for special health groups. After off-hospital pneumonia, students are in need of long-term dynamic medical supervision, where respiratory minute volume, heart rate, oxygen pulse, and oxygen utilization coefficient are the most informative. Qualification for academic physical education, clearance for the preparatory and main groups, training and competitive loads should be made upon a comparative analysis of the functional indicators of the external respiration system at rest, during cycle ergometer tests and in the recovery period.

It is supported by the project aimed to improve the competitiveness of the leading universities of the Russian Federation among the world's leading research and education centers.

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Corresponding author: ialazareva@mail.ru

Abstract

The study was designed to analyze the energy resource of the students after off-hospital pneumonia by means of cycle ergometer tests to qualify them for the controlled-intensity-and-scope physical education service customized to the health condition. Sampled for the study were the 1-6-year Sechenov University students (n=61) aged 17-25 years (21.7±0.2 on average) split up into two groups. The Experimental Group (EG) was cured by the standard off-hospital pneumonia therapy, with the health condition tested by the standard combined tests plus spirographic, spiroergometric, ECG and VEN tests. The individual physicality was tested by cycle ergometer Ergomedic 894E Peak Bike (Monark) test system rated for 25W with the workload stepped up by 25W every 3min, with the test stopped on the relevant indications as recommended by the Expert Committee of the WHO (1970). Gas exchange was rated by CARDIOVIT CS-200 Ergo-Spiro system Schiller electrocardiograph. The test data were processed by the standard variation statistics toolkit using the common formulae. The test data and analyses found significant cardio-respiratory system functionality disorders in students after off-hospital pneumonia; and it was recommended to qualify them back to the academic physical education sessions for special health groups not sooner that 1.5 months upon the start of the disease. Later on they may be cleared for the preparatory/ main physical education group trainings by special medical examinations.