A.S. Ivashchenko¹
Dr. Med., Professor V.V. Ezhov¹
PhD A.Y. Tsarev¹
Dr. Biol. B.A. Dyshko^2
1Academic Research Institute of Physical Methods of Treatment, Medical Climatology and Rehabilitation named after I.M. Sechenov, Yalta, Republic of Crimea
²Sport Technology LLC, Moscow

Keywords: coronary heart disease, respiratory muscle training in motion, New Breath respiratory muscle training in motion trainer system, medical rehabilitation, physical therapy

Background. Coronary heart disease is one of the main causes of mortality, disability and temporary disability in Russia [4, 7, 1]. It is the pathological changes in the cardiovascular system triggered by the coronary heart disease including the regresses in the coronary arteries with the growth of organs and tissue hypoxia [7, 1] that urge the health research community look for new medical rehabilitation methods and tools  [7, 1]. Presently the traditional medical rehabilitation programs are still in need of direct methods to control the tissue hypoxia and ischemia in the cardiovascular system organs – such as special respiratory function training systems designed to improve the rehabilitation process efficiency by increasing the blood oxygen capacity [2]. To meet the demand, Sports Technology Company designed a New Breath training system that controls mechanical resistance, generates low-frequency vibration in the exhaled flow, and, most importantly, serves for the respiratory muscle training in motion in varied-intensity physical practices. The training system effectively prevents air traps, facilitates secretion in the bronchi, prevents or mitigates atelectasis and improves absorption of drugs used in the inhalation therapy [3]. The respiratory muscle training in motion method has proved beneficial for athletic performance efficiency improvements in different sports [3]. The combined controlled physical trainings of respiratory, cardiovascular and musculoskeletal systems are known to improve the oxygen consumption rate and external respiration function and stimulate the oxygen-dependent energy exchange function [2, 3].

Objective of the study was to rate benefits and offer practical guidelines for the respiratory muscle training in motion technology application in sanatoria/ resort medical rehabilitation for patients with coronary heart disease.

Methods and structure of the study. Our sample of 30-80 (64 on average) year-old patients with coronary heart disease (n=275) was 11% male and 89% female. The sampling criteria were the following: I20-25/ I25.1 МКB-10 with permanent angina pectoris, atherosclerotic cardiosclerosis, function class FC I-II, and 0/1 degree heart failure, with clinical records of at least 18 days, and average sick record of 14.5 years. The sample was tested, on special consents, prior to and after the sanatoria/ resort medical rehabilitation therapy by clinical and laboratory spirographic, electrocardiographic and physical fitness test to obtain the biochemical and functionality test rates. We also used Rieder and Beck tests to rate psychological health, SF36 life quality questionnaire, and rated 19 ICF (International Classification of Functioning) domains using our own method [6, 5].

The sample was split up into Reference Group (n=242) and Experimental Group (n=33), and the both groups received a full course of sanatorium-resort therapy as required by the diagnoses. The EG therapy with the remedial gymnastics course was supplemented by New Breath respiratory muscle training in motion trainer system, with the respiratory muscle training in motion course designed to strengthen the diaphragmatic breathing, train key motor functions, agility, mobility and joint flexibility, with cyclic moderate-pace walking practices to achieve the HR growth by 25 bpm limited by 110-120 bpm. On the whole, the respiratory muscle training in motion course averaged 10.7±0.3 30-minute training sessions.

Results and discussion. The EG was found to satisfactorily tolerate the New Breath respiratory muscle training in motion trainer assisted course, with most of the patients reporting mood improvements, surge of energy and feel of vitality. However, 2 patients (6.1%) reported short-term heart rate disorders in trainings, and 1 patient (3.0%) reported at the startup or the first training session with increased vomitus reflex with nausea, involuntary swallowing, tearing and salivation – and we had to stop his respiratory muscle training in motion trainings and move him to the RG. Variations of the functionality test rates in the New Breath trainer assisted respiratory muscle training in motion course are given in Table 1 hereunder.

Table 1. Variations of the functionality test rates in the New Breath trainer assisted respiratory muscle training in motion course for the coronary heart disease patients (М±m, r)

Note: M – group average; m – error of the mean; r – correlation ratio; * - statistically significant (p <0.05) variation; § - statistically significant (p <0.05) variation in the group domain values; ! - positive domain variation indicative of function improvement; ? - negative domain variation indicative of the function regress

As demonstrated by the Table, the New Breath trainer assisted respiratory muscle training in motion course was beneficial for the EG as verified by the positive variations in 3 domains including the blood circulation system function (b430), oxygen transportation function (b4301), and stress coping and other psychological pressure tolerance (d240). The method resulted in the statistically meaningful negative variations in 3 domains: heart rate (b4101), respiratory function (b440), and immune system functions and others detailed (b435).

Conclusion. The New Breath trainer assisted respiratory muscle training in motion course was found beneficial as demonstrated by progress in the main clinical and functionality test rates of patients with coronary heart disease in the sanatorium/ resort medical rehabilitation, and progress of patients with cardiovascular pathologies, particularly in the blood system function and oxygen transport function test rates, with improvements in the stress coping and other psychological pressure tolerance rates.

References

1. Aleksandrov V.V., Demyanenko S.A., Mizin V.I. Fundamentals of restorative medicine and physiotherapy. Study guide . 2nd ed., sup. M.: GEOTAR-Media publ., 2018. 208 p.
2. Goranchuk V.V., Ivanov N.I., Sapova A.O. Hypoxic Therapy. St. Petersburg: Olbi-SPb publ., 2003. 536 p.
3. Dyshko B.A., Kochergin A.B., Golovachev A.I. Innovative respiratory system training technologies. M.: Teoriya i praktika fiz. kultury i sporta publ.. 2012. 122 p.
4. Health care in Russia. 2015. Stat. sb. Rosstat. Moscow, 2015. 174 p.
5. Mizin V.I., Severin N.A., Dudchenko L.Sh. et al. Methodology for assessing rehabilitation potential and effectiveness of medical rehabilitation in patients with cardiorespiratory system pathology of in accordance with "International Classification of Functioning, Disability and Health". Proc. PHF RK “Academic Research Institute of Physical Methods of Treatment, Medical Climatology and Rehabilitation named after I.M. Sechenov. Yalta, 2016. v XXVII. pp. 1-22.
6. Ponomarenko G.N. International classification of functioning, disability and health - tool for scientific evaluation of effectiveness of medical rehabilitation. Voprosy kurortologii, fizioterapii i lechebnoy fizicheskoy kultury. 2013. no. 90 (2). pp. 57-62.
7. Ponomarenko G.N. [ed.] Physical and rehabilitation medicine: national guide. Moscow: GEOTAR – Media publ., 2016.  688 p.

Corresponding author: sporttec@yandex.ru

Abstract

Coronary heart disease is one of the main causes of mortality, disability and temporary disability in Russia.

The article presents the results of study of the effectiveness of training with the use of "The New Breath" simulator for training breathing muscles in motion in terms of the sanatorium medical rehabilitation of patients diagnosed with coronary heart disease. Sampled for the study were 275 patients: males - 11%, females - 89%. The mean age was 64 years; the average duration of the disease was 14.5 years. All the patients, who made up the Control and Experimental Groups, received the entire complex of sanatorium-resort care with due regard to their individual characteristics. The Experimental Group subjects were additionally trained on the simulator for respiratory training in motion. "The New Breath" simulators were used during remedial gymnastics. The subjects were to perform a set of exercises to develop diaphragmatic breathing, gross motor skills, agility, mobility and flexibility of the joints, as well as cyclic loads in the form of walking at a moderate pace with an allowable increase in heart rate up to 25 bpm and maximum heart rate of 110 - 120 bpm. The training session lasted 30 minutes. The average number of procedures per treatment course was 10.7±0.3.

The study showed that the use of the simulators for respiratory training in motion significantly improves the blood system functionality and its oxygen transport capacity, stress coping skills, including various psychological stresses, reduces fatigue and expressed negative feelings associated with the functioning of the cardiovascular and respiratory systems.