Assessment of exercise tolerance in patients with coronary heart disease for justification of kinesotherapy modes at the stage of primary prosthesis

Authors:

Kantemirova Raisa Kantemirovna, doctor of medical Sciences (Dr. Med. Sci), Honored head therapy Department of clinic of Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Professor, Department of Gerontology and geriatrics sorth-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg State University, Professor, Department of Hospital therapy, Universitetskaya Embankment, 7-9, 199034 St. Petersburg, Russian Federation. E-mail: terapium@yandex.ru

Sviridova Elena Olegovna, PhD-student of Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Bestuzhevskaya street 50, 195067 Saint-Petersburg, Russian Federation

Burnos Alexander A., Head of the therapeutic Department of the St. Petersburg state budgetary institution of health care “City hospital № 20”, Gastello street, house 2, 196135 St. Petersburg, Russian Federation

Suslaev Vadim Gennadievich, candidate of medical Sciences (PhD Med. Sci), head of Department of prosthetics and orthotics lower limb of Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Bestuzhevskaya street 50, 195067 Saint-Petersburg, Russian Federation

Sokurov Andrei Vladimirovich, doctor of medical Sciences (Dr. Med. Sci), head of the Department of normative and legal regulation and organization of rehabilitation and habilitation of Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Bestuzhevskaya street 50, 195067 Saint-Petersburg, Russian Federation

Fidarova Zalina Danilovna, candidate of medical Sciences (PhD Med. Sci), associate Professor of Department of therapy of Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Bestuzhevskaya street 50, 195067 Saint-Petersburg, Russian Federation

Annotation:

Introduction. Combined damage of coronary arteries and lower limb arteries is noted in more than 30% of patients with coronary heart disease. Rehabilitation of patients with combined lesions of the coronary arteries and arteries of the lower extremities, including amputation, is not sufficiently studied.

Aim. To determine the optimal functional test to assess the state of the cardiovascular system, exercise tolerance and reserve capacity of the body, to select the optimal motor mode and the selection of the lower limb prosthesis modules.

Materials and methods. 43 patients after lower limb amputations due to obliterating atherosclerosis in combination with coronary artery disease were examined: 74 women and 155 men aged 61 to 87 years. The rehabilitation complex included specially developed programs of physical exercises, as well as basic medical therapy.

Results. The degree of tolerability of physical activity and, accordingly, the possibility of using the prosthesis were determined based on the results of manual Bicycle ergometry. All patients were treated to prepare the General somatic state for the upcoming physical activity and preparation of the stump to unnatural loads in the prosthesis.
According to the results of repeated veloergometry after the treatment the modes of use of the prosthesis were established. After learning to stand on the prosthesis, patients started dosed walking.

Conclusion. Patients who underwent amputation on the background of critical ischemia, diabetic angiopathy in the vast majority of cases have damage to other organs and systems. However, the severity of the main and combined pathology, their importance for the prosthetics process may differ significantly, and in this category of patients will affect the choice of the group of motor activity, the timing and complexity of prosthetics, minimizing the risks of cardiovascular complications. Taking into account these advantages, the use of the technique can help to reduce economic costs and increase the number of patients actively using prostheses.

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