Physiotherapy is quite powerful remedy impact on the body. Treatment with natural factors involves not only the use of climate and natural mineral waters.

Man has learned to put at his service natural phenomena that you cannot touch, lick or see. With the help of special equipment, we can receive different beams for treatment - magnetic, light, ultrasonic, energy of electricity, water and many other physical factors. The use of physiotherapy methods allows you to expand the possibilities of influencing the body. They are rarely used as the only treatment, but in combination with other methods they give a good result. What does this section of practical medicine offer us for the treatment of obesity?

Water comes to the rescue

Basic physical method- hydrotherapy. Water affects a person as a result of a combination of three factors - temperature, mechanical and chemical (if mineral water is used). The mechanical factor is understandable: Charcot's shower is known to many overweight people, and everyone knows very well how powerfully a jet of water affects fat deposits under the skin. But here it is necessary to talk not only about the mechanical effect - with such a “massage” blood circulation in the deep layers of the skin, including in the subcutaneous adipose tissue, increases, the production of heat in it, and therefore, the energy consumption increases. There is a stream of reflex influences, as a result of which the work of the nervous system is normalized, and it, in turn, acts on the endocrine organs, cholesterol levels and many other metabolic processes in the body.

Contraindications to hydrotherapy are elevated body temperature, malignant neoplasms, pustular and fungal diseases of the skin.

We will return to shower treatment, but now let's talk about other methods of water treatment. Its first option is balneotherapy, or therapy with the help of baths. There are many of them, but not all are effective for treating obesity. What can be used?

Carbonated baths.

These are special baths, the water in which is enriched with carbon dioxide bubbles. In this case, the skin is affected by the temperature difference between warm water (36-37 °C) and carbon dioxide (12-13 °C): there is an effect of a kind of massage with bubbles. In addition, carbon dioxide penetrates the skin and, entering the bloodstream, causes vasodilation, which unloads the heart muscle. Over time, this leads to normalization of blood pressure.

Under the influence of baths, breathing becomes deeper, metabolism changes, skin condition improves. The balance between the sympathetic and parasympathetic divisions of the autonomic nervous system is regulated. A course of 12-15 baths contributes to the "restructuring" of metabolism, which helps to follow a diet aimed at combating excess fat. The duration of the procedures gradually increases (from 7 minutes to 12-15). Sessions are carried out either every other day, or two days in a row with a break for the third.

Carbon dioxide baths can also be dry, without the use of water. In this case, the person is in a special booth or bath, the top of which is covered with a gas-tight film. The head, of course, remains outside, since it is impossible to breathe air with such a high concentration of carbon dioxide. Due to the lack of water pressure, these baths are safer for people suffering from severe heart disease. Dry carbon dioxide baths improve blood flow in the muscles, brain, heart vessels, and have a powerful effect on the state of the autonomic nervous system. And what after them velvety skin! Improving blood circulation and gas exchange in all organs and systems significantly speeds up metabolism, which contributes to faster weight loss.

Contraindication for carbon dioxide baths serve as a severe course of hypertension (in such cases, physiotherapy is not indicated at all), as well as severe angina pectoris and cardiac arrhythmias.

In this case, the effect of hydrogen sulfide is used, which enters the body through the skin and lungs. Having a reflex effect on the central nervous system, hydrogen sulfide normalizes its activity, and it, in turn, regulates the work of the cardiovascular, respiratory and digestive systems. At the same time, the vessels expand, the pulse slows down, high blood pressure decreases, and the work of the heart improves. It is important for us that hydrogen sulfide enhances the extraction of fats from lipid depots and stimulates their excretion from the body.

Baths are taken every other day, the duration of one procedure is 12-15 minutes. Course - 10-14 procedures.

Indications for hydrogen sulfide baths are obesity of the 1st-3rd degree, especially in combination with damage to the musculoskeletal system, chronic inflammatory diseases of the female genital area, skin diseases and many other conditions. Contraindications are common to all baths.

Radon baths (alfa therapy).

Radon has a multifaceted effect on the body: enhances the breakdown of fats, stimulates the immune system, improves the contractile strength of the heart muscle, normalizes blood clotting (this prevents the development of blood clots and improves blood supply to organs). The effect of radon on the peripheral nerves weakens, and sometimes completely eliminates the pain characteristic of neuropathy, which is used in the treatment of patients with diabetes mellitus complicated by polyneuropathy.

The effect of radon on the functioning of the liver and the exchange of uric acid improves the condition with gout, the normalization of immunity reduces the severity of arthritis. This method is widely recommended for the treatment of inflammatory diseases of the female genital area. As a result of such a complex effect on the body, the well-being of patients improves significantly, the intensity of metabolic processes increases, and body weight decreases. The course of treatment consists of 12-15 baths lasting 10-15 minutes.

Radon baths are contraindicated with a reduced number of leukocytes (white blood cells) and after a long stay in conditions of increased radioactive radiation.

Iodine and bromine, penetrating into the blood through the skin, directly affect the metabolic processes in the body, putting in order, including fat metabolism. At the same time, inhibition in the work of the nervous system increases, blood clotting normalizes, the activity of the adrenal glands and pituitary gland increases, and this is a direct effect on the endocrine system. All this increases resistance to stress, normalizes the adaptive reactions of the body. Along with these effects, itching of the skin, inflammation of the genital organs in both women and men are reduced.

The course of treatment is 15-20 baths, the duration of the procedure is 10-15 minutes.

Iodine-bromine baths are contraindicated with increased thyroid function, initially low blood pressure, gout, severe heart disease.

Turpentine oil stimulates aerobic and anaerobic metabolic pathways, normalizes the tone of the sympathetic nervous system, stimulates metabolism, improves blood circulation and adrenal function. Adding to the treatment complex turpentine baths reduces body weight by 30-40% more effectively than without them.

The course consists of 15-16 procedures of 10 minutes each.

Contrast baths are a very effective means of combating excess weight: one such procedure results in a decrease in body weight by 200-400 g. During the bath, due to the action of changing temperatures, the muscles alternate between relaxing and increasing their tone. This significantly increases energy costs, strengthens blood vessels and the heart, and improves the condition of the nervous system. For the procedure, two baths are used - one with hot water (38-41 ° C), the second with cold water (18-23 ° C). In young patients, the temperature difference can be 20 ° C, in the elderly it should be less - up to 13-15 ° C. You need to do three immersions in each bath (the last one is always in hot water). The duration of the course is 12-20 procedures performed every other day.

Contrast baths are contraindicated for obesity of the 4th degree or more, chronic inflammation of the appendages in women, exacerbations of diseases of the musculoskeletal system. And of course, there are general restrictions - as for all other baths.

Another type of hydrotherapy is hydrotherapy - treatment with a shower. The action of the shower is based on mechanical stimulation of skin receptors and skin massage to a certain depth. Charcot shower (jet shower) has the most powerful effect. The underwater shower-massage acts a little less intensively, the circular shower, fan-shaped, needle-shaped, and in last place is rain shower, even weaker. The temperature and duration of the procedure are selected based on the task set. Long hot and cold showers increase metabolism, warm showers have a calming effect. A short shower tones the muscles and the cardiovascular system, after which there is a feeling of cheerfulness. After a cool and cold shower, you should definitely rub yourself with a terry towel - this will have a beneficial effect on the cardiovascular system and at the same time prevent colds. The use of hydrotherapy in the treatment of obesity can increase weight loss by another 3-4 kg.

Thanks to the successful combination of warm water and mechanical massage, it is possible to achieve a much greater effect than with conventional classical massage. Water relaxes the muscles of the body, which allows the hot jet to massage the tissues much deeper, causing a more intense increase in blood flow. At the same time, patients tolerate deep massage less painfully than usual, muscles relaxed under the influence of warm water are less injured. Sessions are held every other day. In total, the course requires 10-20 procedures for 15-45 minutes each.

If there is no opportunity to visit specialized physiotherapy centers, a "hydropathic" can be arranged at home. For this, procedures such as dousing and rubbing are used. Douching begins with water, the temperature of which reaches 33-34 ° C, gradually reducing it during each procedure by 1-2 ° C and bringing it up to 20 ° C. Do this daily or every other day. The dousing itself is carried out so that the water flows more or less evenly over the front and back surfaces of the body. At the same time, the head is not doused - a bucket of water is held at shoulder level. One pouring will require 2-3 buckets of water.

Wiping differs from dousing in that you first need to rub. To do this, use a sheet or towel soaked in water, the temperature of which is gradually reduced from 32 ° C to 20 ° C and below. After a general wiping, it is advisable to douse yourself with water, the temperature of which will be 1-2 ° C lower than that used during the wiping. The procedure lasts 2-3 minutes, and it is better to do it daily for 1-1.5 months.

Swimming in the sea or a pool of sea water gives a magnificent effect.

Swimming in a pool with ordinary water also has a beneficial effect on the body, but the weight does not decrease. Sea water allows not only to improve the state of the cardiovascular and respiratory systems, but also to stabilize weight, and with long courses to achieve its reduction. It is better to swim in the sea in the morning, when the air temperature is not less than 20 ° C, the water temperature is not lower than 18 ° C and the wind speed is not more than 15 m per second. They start from 5-7 minutes, with each procedure increasing the stay in the water and bringing it up to 20-25 minutes. If a person does not know how to swim, you can just do exercises. Which one? Take a look at chapter 8. The main thing is to constantly move vigorously in the water. Tired? The session must be completed and rest on the shore.

After getting out of the water, be sure to wipe yourself with a towel. It is advisable to dry slightly in the sun (so that the feeling of freshness is preserved), and then relax in the shade. Such bathing is recommended to be carried out 2 times a day. A break for one day is possible, but no more.

Patients often ask the question "Can I go to the bath or sauna?" It is possible, unless, of course, there are severe cardiovascular complications. At the same time, one cannot count on the fact that adipose tissue will “leave”, but it will be possible to get rid of excess fluid. Moreover, the sauna is more effective in this case; at low humidity and high temperature, a person sweats more easily and loses more fluid than at lower temperature and high humidity, which is typical for the Russian bath. In one session of "sweating" in the sauna, you can get rid of 400-1000 ml of liquid. In the Russian bath during the same time you will not leave more than 500 ml.

It must be remembered that both the sauna and the bath give a very decent load on the heart and blood vessels, so you should not get carried away with them.

A good therapeutic effect can be achieved with the use of other methods of physiotherapy. Pelotherapy, or mud therapy, has become widespread.

Therapeutic mud has a complex effect on the body due to its chemical composition and mechanical properties. It is rich in macro- and microelements, vitamins, hormone-like substances, biological stimulants. Under the influence of therapeutic mud, general metabolism improves, healing processes accelerate, immunity increases, metabolism in the skin and ligamentous apparatus of the joints increases, which has a beneficial effect on their condition. The mineral salts and organic compounds contained in the mud normalize the skin microflora, have an anti-inflammatory and exfoliating effect.

To enhance the effect of dirt it is combined with electrical and ultrasonic methods of treatment (at the same time, by the way, the consumption of the dirt itself is reduced). Widely used mud masks applied by vacationers on the beaches Dead Sea on the whole body, they give only a cosmetic effect, and even then it is very doubtful, since they are not aged temperature conditions and the time of the procedures, the methodology for their implementation is not observed. Meanwhile, therapeutic manipulations involve the imposition of mud applications on strictly defined areas of the body; with obesity against the background of impaired adrenal function - only on the collar zone. During the first procedures, the mud is heated to 38 ° C, the duration of exposure is 10-15 minutes. In the future, the temperature of the mud is gradually brought to 40-42 ° C, and the time is increased to 20 minutes. The course is 10-12 procedures. With the preserved function of the adrenal glands, in addition to the collar zone, the lumbar region is also involved. All other rules of the procedure remain the same. It is possible to carry out endonasal (through the nose) mud electrophoresis, which helps to normalize the work of the appetite and satiety centers, eliminate sleep disorders.

Sand baths are also good at the seaside resort. Take them in the afternoon, when the sand warms up. In addition, solar activity is on the decline by 4-5 pm - this time is optimal for the procedure.

During the sand bath, the patient lies in such a way that his head is in the shade. The body is covered with a thick layer of heated clean sand, but in such a way that the chest is free. Initially, a person feels heat from hot sand, then it is replaced by a feeling of coolness. When the sensation of warmth begins to return, it is time to finish the procedure. On average, it takes 15-30 minutes - everyone has their own time.

With diabetes, such procedures are not indicated: it is impossible to ensure the sterility of the sand and the smallest scratch on the skin after a bath can become a source of a serious problem for many months.

TO physical methods Treatment also includes climatotherapy, in other words - treatment in the conditions of one or another specific climate (mountain, sea, forest), and this does not necessarily have to be overseas resorts in hot countries. Moreover, climatotherapy should be started after 3-5 days of acclimatization, and we, as a rule, break out to the sea for 1-2 weeks. While acclimatizing, it's time to pack your bags again...

If we still talk about such treatment, it is most realistic in local sanatoriums. At least there is no need to get used to the new climate, and all the days of a short vacation will be used to the fullest. For those who are not limited in time, trips to mountain and sea resorts, of course, will benefit. Just don't force things. And don't use the sun either. Six months later, roasting on a lounger can respond with a set of 10-20 kilograms: this will be the revenge of the hypothalamus, tired by the sun.

Let's not forget about the massage in its classic version. The effect of the massage consists of a complex of mechanical, reflex and biochemical effects. A professionally done massage can make a person relax or, conversely, cheer up. At the same time, the nutrition of surface tissues improves, and due to the reflex effect, changes in work occur. internal organs. Massage enhances blood circulation, increasing the speed of metabolic processes - about the same as during intense physical work. It is necessary to trust the massage only to a qualified specialist - a physician, since fat man, as a rule, has concomitant diseases that require special techniques and sparing techniques, which take into account the individual characteristics of the patient.

It is best to massage in the morning after a light breakfast. The intensity and duration of the procedures should be increased gradually, taking into account the tolerance, which is individual for each person. General massage, covering the whole body, is undesirable to do more than 2 times a week. If the state of health worsens, it is temporarily canceled, and after the condition is normalized, it is resumed. In order to get a full-fledged massage course, you don’t have to travel far: there are a lot of specialists who are good at this method in any region.

There is an interesting variation of this technique.- cupping massage, the so-called local vacuum therapy. When exposed to fire, a negative pressure is created inside the jar, which has the necessary therapeutic effect: blood circulation is enhanced not only in the skin directly in the area of ​​the jar, but also in deeper layers. As a result, erythrocytes move from the blood to the skin under the jar, which stimulates the nutrition of tissues in this area, improves local and general immunity, has an anti-inflammatory effect, and reduces pain sensitivity. Increased blood flow at the site of exposure leads to an accelerated metabolism of fats. By moving the jar over the body, they process the necessary surface, which allows not only to fight cellulite in general, but also to correct the figure.

Absolutely accessible to many and such a physiotherapeutic method as electrotherapy. It is used for obesity, not only to enhance the effect of therapeutic mud.

An electric current of a certain type, passing through the tissues of the body, itself gives a vasodilating effect, improves the conduction of impulses along the nerve fiber and muscles, improves tissue nutrition, enhancing metabolic processes in them, including brain nutrition.

In the treatment of obesity, electrosleep, endonasal electrophoresis of vitamin B6 and lithium, electrophoresis of bromine, magnesium, calcium on the collar zone, a galvanic collar according to Shcherbak, and a low-frequency alternating magnetic field are indicated. Each method has its own characteristics. Taking them into account, the physiotherapist will select an individual electrotherapy program for the patient.

A variety of physiotherapy treatment is reflexology. The authors of this technique were ancient Chinese doctors. This is a whole philosophy that reflects the understanding of not only the inner essence of our body, but also the place of man in general in nature - the Cosmos. Secrets have always been zealously guarded in the East, which is probably why the Chinese set forth all their wisdom in such a way that only the initiated could understand them. Trying to speak in modern language about what the effect of reflexology on painful processes in the body is based on is a thankless task. It is impossible to explain the essence only by direct irritation of nerve endings, signal transmission along the fiber of the nerve conductor and the response of the target organ, although this certainly takes place.

Treatment, as a rule, is carried out by introducing needles into active points, however, it can also be acupressure, and other types of exposure to such points. Reflexotherapy has no independent value in the treatment of obesity, but as an aid it is good, because it balances the processes of inhibition and excitation in the nervous system, normalizing appetite, mood and vitality in general, especially when combined with psychotherapeutic methods.

There are currently a lot of acupuncture rooms - any large hospital has its own specialist in this field. As a rule, these are neurologists who are well aware of the intricacies of the relationship between the parts of the nervous system and their anatomical location. However, you can also meet a “reflexotherapist” who does not have a medical education at all - there are many such specialists in beauty salons who seek to attract clients by any means. Therefore, before starting treatment, ask what the “doctor” did before he began to be called a reflexologist. If this is really a specialist, time and money will be well spent: a combination of modern methods of treating obesity, the experience of ancient physicians and your perseverance in achieving your goal will certainly give a good result. Just pay attention to the needles: they must be for individual use. You can order and buy your own set and come to the procedure with it.

Obesity Treatment Methods

Introduction

general description of work

1.1 Characteristics of obesity

1.1.1 Etiology and pathogenesis

1.1.4 Clinical picture

1.3.2 Massage

1.4 Diet therapy

1.5 Psychotherapy

2.1 Research methods

2.1.4 Methods of mathematical statistics

2.2 Organization of the study

Conclusion

Scroll symbols

BP syst. - systolic blood pressure

BP diast. - diastolic blood pressure

DR - motor rehabilitation

VC - vital capacity of the lungs

BMI - Quetelet body mass index

I. p. - starting position

CG - control group

LG - therapeutic gymnastics

EG - experimental group

Introduction

Since the second half of the 20th century, economically developed countries ah the world has a completely new problem - the rapid growth of diseases caused by overnutrition. Hippocrates noted that excessively obese people live less, and overweight women are barren. According to foreign studies, if people were not obese, then average duration life in the world would increase by four years.

The number of obese people in the world has increased. The data of the latest study conducted by the Organization for Economic Cooperation and Development in 30 developed countries of the world indicate that in many countries the problem of obesity of the nation is becoming very serious and requires an immediate solution. According to the World Health Organization (WHO), about 60% of obese people live up to 60 years old, only 30% - up to 70 years old, and 10% can hardly live another 10 years. WHO is already studying obesity as an epidemic that is spreading very dynamically around the world. Over the past 20 years, in most EU countries, the number of overweight people has increased by 50%.

A rapid increase in obesity is also noted in athletes after the cessation of systematic specific training. Obesity has a very adverse effect on the body, leads to a decrease in working capacity, to a reduction in life expectancy and the period of active creative activity.

Prevention, treatment and rehabilitation of obese patients are important public health tasks, a real measure for the prevention of a number of diseases, primarily cardiovascular diseases.

Obese patients spend more days on sick leave, have more complications after anesthesia and surgical interventions, more often die in car accidents and disasters. It has been established that if humanity could solve the problem of obesity, the average life expectancy would increase by 4 years.

Among persons aged 50 to 59 years, whose body weight exceeded the norm by 15-24%, mortality was 17% higher than the average. If the excess body weight was 24-34%, then mortality increased by 41%. Death from cardiovascular diseases in obese people is 2 times, and from stroke 3 times more often than in people with normal body weight. With obesity, diabetes mellitus occurs 3-4 times more often.

There is no doubt that the cultural and technological revolution, accompanied by mechanization and automation production processes greatly contributes to the spread of obesity. The improvement of means of transportation, the steady increase in the number of professions associated with hypokinesia, cannot but be considered as factors leading to energy imbalance and contributing to the emergence of obesity.

The urgency of the problem of obesity lies also in the fact that the number of overweight people is progressively increasing. This growth is 10% of their previous number for every 10 years. It is estimated that if this trend continues, then by the middle of the next century, the entire population of economically developed countries will be obese.

physical rehabilitation obesity woman

general description of work

Purpose: normalization of body weight, improvement of the state of the cardiorespiratory system and psycho-emotional state of women with exogenous obesity of I-II degree by using the training program at the "School of the Patient with Obesity".

Tasks:

1.Based on the analysis of scientific and methodological literature, to identify effective means of physical rehabilitation for obese women.

2.Develop and theoretically justify the training program in the "School of the patient with obesity", based on a combination of organized theoretical and practical exercises and self-study.

.Show the effectiveness of the developed educational program in the form of "School of the patient with obesity".

Object of study: the rehabilitation process of obese women.

Subject of study: physical and psycho-emotional state of obese women.

Statements for the Defense: A Comprehensive Physical Rehabilitation Program for Obese Women.

The structure and scope of the thesis:the thesis has the following sections: introduction, general characteristics works, chapter 1 "Current state of rehabilitation of patients with obesity", chapter 2 "Methods and organization of the study", chapter 3 "Research results and discussion", conclusion, list of sources used, applications.

The diploma work is made on 58 pages of printed text. IN thesis 42 literary sources were used.

Chapter 1. The current state of rehabilitation of patients with obesity

1.1 Characteristics of obesity

1.1.1 Etiology and pathogenesis

The term "obesity" refers to a condition in which excess body weight is 10% or more above the physical norm exceeds the physiological norm by less than 10%, it is considered excessive. If the body weight

Obesity -a group of diseases and pathological conditions characterized by excessive deposition of fat in the subcutaneous adipose tissue and other tissues and organs, caused by metabolic disorders, and accompanied by changes in the functional state of various organs and systems. The most commonly used diagnostic criterion for obesity is an excess of total body weight in relation to the norm, established statistically. However, we emphasize that the value that largely determines the severity of the course of the disease is not so much the body weight itself, but the excess fat mass. This excess can vary significantly even among patients of the same age, height and weight.

Numerous etiological factors can be divided into exogenous (overeating, decreased motor activity) and endogenous (genetic, organic lesions of the central nervous system (CNS), hypothalamic-pituitary region). It has now been established that the regulation of fat deposition and mobilization in fat depots is carried out by a complex neurohumoral (hormonal) mechanism, which involves the cerebral cortex, subcortical formations, the sympathetic and parasympathetic nervous systems, and endocrine glands. Fat metabolism is strongly influenced by stress factors (psychic trauma) and CNS intoxication.

The regulation of food intake is carried out by the food center, localized in the hypothalamus. Lesions of the hypothalamus of an inflammatory and traumatic nature lead to an increase in the excitability of the food center, increased appetite and the development of obesity. In the pathogenesis of obesity, a certain role belongs to the pituitary gland. Speaking about the development of obesity, one should not underestimate the importance of hormonal factors, since the processes of fat deposition mobilization are closely related to the functional activity of most endocrine glands. Obesity develops in various diseases of the pituitary gland, thyroid gland, adrenal glands and the islet apparatus of the pancreas (diabetes mellitus), which are actively involved in the regulation of lipid metabolism. A decrease in the functions of the thyroid and sex glands leads to obesity. Strengthening the activity of the islet apparatus of the pancreas leads to increased synthesis of sugar into glycogen, its transition to fat and inhibits the mobilization of the latter from the depot. Cortisone, which is a hormone of the adrenal cortex, also enhances fat deposition. Violation in any link of this complex regulation leads to a violation of fat metabolism and the development of certain forms of obesity.

We can assume that the presence of a hereditary predisposition to the development of obesity implies the existence of factors provoking the onset of the disease. Such factors can be overeating, low physical activity, damage to the central nervous system, etc. Reduced physical activity naturally leads to a decrease in energy expenditure and unoxidized fats in most cases are deposited in fat depots, which leads to obesity.

Dietary fats directly contribute to the creation of triacylglyceride reserves in adipose tissue. This is evidenced by the fact that the composition of unsaturated fatty acids of fatty depots gradually acquires similarities with the composition of unsaturated fatty acids of exogenous food fats. However, carbohydrates are the main factor in lipogenesis in obesity. Glucose entering the blood (as a result of absorption from the intestines) in quantities that exceed the needs of the liver or the capacity of the glycogen storage process is primarily used for the synthesis of fatty acids. The most important site for the formation of endogenous, predominantly saturated fatty acids is the liver cells. Excess glucose and triacylglycerides coming from the liver are captured by adipose tissue cells, in which additional amounts of fatty acids are synthesized. The esterification of fatty acids that penetrate into the cells of adipose tissue, as well as fatty acids synthesized in the adipose tissue itself, depends on the conversion of incoming glucose into an acceptor - α- glycerophosphate. In the adipose tissue of the mast, increased conversion of glucose into α- glycerophosphate is combined with inhibition of its oxidation by mitochondrial dehydrogenase. As a result, the proportion of glucose used to form glycerol increases, and the esterification of fatty acids begins to predominate over the release of free fatty acids from the cells.

In obese people, there is a significant increase in the content of insulin in the circulating blood, as well as an excessive reaction to the flow of glucose into the gastrointestinal tract. The combination of excess nutrition with hyperinsulinism not only promotes the uptake of glucose by adipose tissue, but also induces the synthesis of a number of enzymes (an enzyme that breaks down citrate, acetyl-CoA - carboxylase and fatty acid synthetase) in the cells of the liver and adipose tissue, which leads to stimulation of lipogenesis. In addition, an increase in insulin concentration inhibits hormone-sensitive lipase, which causes a further shift in the disturbed balance towards fat deposition.

Alimentary-constitutional obesity develops as a result of overnutrition and a sedentary lifestyle. At the same time, more energy substances enter the body than they are consumed. The source of increased fat deposition is not only overeating or a large amount of fat in the diet, but also excessive consumption of carbohydrates. Rare, irregular meals and eating mainly in the evening leads to overeating. And during rest and sleep, as you know, energy consumption is low, so excess nutrients from food are deposited in the form of fat in adipose tissue. Thus, the development of the alimentary-constitutional form of obesity is closely related to motor activity and the amount of energy supplied with food.

1.1.2 Anatomical characteristics of adipose tissue

Adipose tissue performs trophic, deposition, shaping and thermoregulatory functions. Adipose tissue is divided into two types: white, formed by unilocular adipocytes, and brown, formed by multilocular adipocytes. Groups of fat cells are combined into lobules, separated from each other by partitions of loose fibrous unformed connective tissue, in which vessels and nerves pass. In turn, each adipocyte is wrapped in a network of collagen and reticular fibers, in the loops of which numerous blood capillaries pass and connective tissue (including mast) cells lie. The number of adipocytes is genetically determined, and also depends on the rational supply of nutrients to the body during the prenatal period and in the early childhood .

In humans, white adipose tissue predominates, part of it surrounds the organs, maintaining their position in the human body (kidneys, lymph nodes, eyeball, etc.), fills the spaces of not yet functioning organs (mammary gland), replaces the red bone marrow in the epiphyses of long tubular bones. When losing weight, the adipose tissue that performs these functions changes relatively little. Most of the adipose tissue is reserved (subcutaneous base, omentums, mesentery, colonic fat suspensions, subserous base). The amount of brown adipose tissue in humans is small (it is present mainly in a newborn child). Brown adipose tissue is located in the neck, in the armpit, in the circumference of the subclavian artery, under the skin of the back and sides of the body, in the mediastinum and mesentery. Like white adipose tissue, brown adipose tissue is also formed in the form of lobules formed by multilocular adipocytes. Abundant blood, lymphatic vessels and sympathetic nerve fibers pass through the interlobular septa, blood capillaries surround multilocular adipocytes, among which there are single-lobe adipocytes. The brown color is due to the many blood capillaries, the abundance of mitochondria and lysosomes in multilocular adipocytes. The main function of brown adipose tissue is heat production. Brown adipose tissue maintains the body temperature of animals during hibernation and the temperature of newborns. .

Adipose tissue performs three important functions:

synthesis of triglycerides from serum lipids and glucose;

their preservation in fat depots;

release of free fatty acids (lipolysis).

Fat cells in obese people are significantly different from normal fat cells. Not only their number is increased, but also their size, and they appear to be more filled with lipids. What's more, these crowded cells metabolize glucose less efficiently than normal fat cells. In obesity, hypertrophy and hyperplasia of fat cells are observed.

Fat deposits perform the following functions:

) isolate deeply located tissues from excessive exposure to cold and heat;

) protect bones, tissues and internal organs from shocks and blows;

) "smooth out the sharp corners" of the skeleton, giving the forms of the body that gentle roundness, which seems aesthetic and attractive .

1.1.3 Classification of obesity, determination of the degree of obesity

Currently, the most common classification according to D.Ya. Shurygin, taking into account the polyetiology of obesity:

1.forms of primary obesity:

a) alimentary-constitutional;

b) neuroendocrine: hypothalamic-pituitary; adipose-genital dystrophy (in children and adolescents)

2.forms of secondary obesity:

a) cerebral

b) endocrine

c) diencephalic

With cerebral obesity, there is a gross (organic) lesion of the brain regions responsible for the regulation of fat metabolism. At the same time, all signs of the disease progress. Diencephalic obesity occurs as a complication after inflammatory diseases of the diencephalon and is accompanied by signs of impaired function. Endocrine obesity occurs as a result of a violation of the activity of certain endocrine glands. In this case, obesity is secondary, and other, more severe signs of the disease come to the fore.

According to the nature of the course, obesity is divided into:

ü progressive

ü slowly progressive

ü persistent

ü regressive

There are also 4 degrees of obesity:

1 degree - exceeding the due weight by 10-29%

degree - 30-49%

degree - 50-100%

degree - above 100% of body weight

The World Health Organization has adopted the following classification, presented in Table 1.1.

Table 1.1 - Classification of overweight and obesity by body mass index (WHO, 1998):

Body weight types MIMI Risk of concomitant diseases Underweight under 18.5 There is a risk of other diseases Normal body weight 18.5 - 24.9 Usual overweight (preobesity) 25.0 - 29.9 Moderate obesity 1st degree 30.0 - 34.9 Increased obesity 2nd degree 35.0 - 39.9 High grade 3 obesity 40.0 very high

Table 1.2 - Classification of overweight and obesity by body fat content:

1.1.4 Clinical picture

Excessive fat deposition adversely affects the function of the cardiovascular system and leads to myocardial dystrophy, damage to the vessels of the brain and lower extremities, contributes to the development of atherosclerosis and increased blood pressure. When blood circulation is disturbed in obese patients, shortness of breath occurs, congestion in peripheral vessels is observed, as a result of which patients experience dizziness and drowsiness. On the basis of coronary sclerosis, patients develop angina pectoris. Obese patients are 2-3 times more likely to suffer from myocardial infarction than people with a normal metabolism.

Already in the early stages, shortness of breath appears after minor physical exertion due to changes in the mobility of the diaphragm and the expansion of the chest itself. These changes lead to a decrease in vital capacity, deterioration of lung ventilation and pathology of gas exchange with the development of hypoxemia. Subsequently, against this background, patients develop drowsiness, periodically shallow breathing, cyanosis, right ventricular hypertrophy and the progressive development of circulatory failure. Violation of pulmonary ventilation against the background of a decrease in nonspecific resistance is often accompanied by the development of long-term inflammatory processes in the bronchopulmonary system (bronchitis, emphysema, pneumonia, tuberculosis).

Diseases of the gastrointestinal tract (chronic cholecystitis, cholelithiasis, chronic colitis) are detected. Intestinal motility is disturbed, which is a consequence of a sedentary lifestyle, weakness of the abdominal muscles, excessive deposition of fat in the mesentery and omentum. Clinically, these disorders are manifested by atonic constipation, excessive gas formation, diffuse pain in the abdomen. The liver in such patients is usually enlarged due to fatty infiltration and stagnation, there is deposition of fat in the hilum, liver capsule, in the interlobar spaces, in the hepatocyte itself, in the cells of the reticuloendothelial system of the liver and a progressive decrease in the amount of glycogen in it. These changes are manifested by a feeling of heaviness in the right hypochondrium, a decrease in glucose tolerance, a tendency to ketone formation, and an increased formation of cholesterol.

Obese patients are characterized by a deterioration in the mobility of nervous processes with a predominance of inhibitory reactions. A depressive state may occur: complaints of poor health, mood swings, lethargy, drowsiness, shortness of breath, pain in the heart, swelling, etc.

Obesity also affects the musculoskeletal system. Excess fat deposits in the greater omentum contribute to an increase in the lumbar lordo behind,resulting in compensatory thoracic kyphosis. With an increase in weight, the load on the joints increases, as a result of which arthrosis of the knee and hip joints, flat feet, herniated discs (osteochondrosis) develop. Diabetes develops, disorders occur menstrual cycle, amenorrhea, infertility, gout. In some cases, violations of water-salt metabolism are manifested by pastosity and edema.

The course of pregnancy against the background of obesity is often accompanied by pathology. The frequency of toxicosis increases; fruits, as a rule, are born large, but with signs of prematurity; relatively often develops eclampsia; there is a prematurity or overmaturity of pregnancy. In the postpartum period, there is a lack of sufficient lactation.

In obese patients, thermoregulation is also disturbed. Heat loss in obese people is mainly due to sweating, which in hot weather reaches 2-3 liters per day. Obese people do not tolerate heat well and are more prone to heat stroke. The body's resistance to infections in obese patients is reduced. Also reduced physical activity and mental performance.

1.1.5 Calculation of normal body weight

Body weight is one of the indicators of human physical development. It depends on age, morphological and physiological properties of the organism (genetic factors), on the social status of a person (lifestyle) and allows one to judge the state of health relatively. Body weight is determined on a medical scale while standing. It is recommended that this procedure be carried out in same conditions .

For people of mature age, a fairly objective way to calculate is the Quetelet body mass index (BMI). Its formula is quite simple:

BMI = weight (kg) / height ² (m ² )

If the BMI in men is more than 27.2-27.8, and in women 26.9-27.3, then this means that body weight exceeds the norm.

There is another point of view: BMI in the range of 18.5-24.9 corresponds to normal body weight. If the BMI is 25.0-28.4, this indicates the presence of overweight (preobesity). The simplest and most accessible method for determining the ideal body weight for persons whose height is in the range of 155-170 centimeters can be Broca's indicator:

Weight = height (cm) - 100

A convenient and easy-to-calculate method for estimating body weight according to the T. Brughi method. From a height of 165 centimeters, subtract 100 centimeters, from a height of 165-175, subtract 105 centimeters, from a height of 175, subtract 110 centimeters. It is believed that T. Brughi indices are very accurate.

Academician Amosov N.M. believes that it would be ideal for a person to maintain the same weight as he had at the age of 20 years.

Normal body weight, determined by the Breitman index, is equal to height in centimeters multiplied by 0.7, minus 50.

In addition to height-weight indicators, the method for determining the skin fold proposed by Korovin can be used. According to this technique, the thickness of the skin fold in the epigastric region is determined (normally 1.5-2 cm). An increase in the thickness of the fold up to 3 cm indicates overweight.

To calculate body weight standards, it is proposed to use the tables developed by A.A. Pokrovsky (table 1.3), M.N. Egorov and L.M. Levitsky (table 1.4).

Рост, смУзкая грудная клеткаНормальная грудная клеткаШирокая грудная клеткаМужчиныЖенщиныМужчиныЖенщиныМужчиныЖенщины152,5-47,8-54,0-59,0155,049,349,256,055,262,261,6157,551,750,858,057,064,063,1160,053,552,160,058,566,064,8162,555,353,861,760,168,066,3165,057,155,363,561,869,567,8167,559,356,665,863,071,869,0170,060,557,867,864,073,870, 0172,563,359,069,765,276,871,2175,065,360,371,766,577,872,5177,567,361,573,867,779,873,7180,068,962,775,268,981,274,9182,570,9-77,2-83,6-185,072,8-79,2-85,2-

Note - at the age of over 30, an increase in weight is allowed compared to the above table for men by 2.5 - 6 kg, for women - by 2.5 - 5 kg.

Table 1.4 - The maximum normal body weight in different age groups with a normosthenic physique, kg

Рост, смВозраст, годы20-2930-3940-4950-5960-69Муж-чиныЖен-щиныМуж-чиныЖен-щиныМуж-чиныЖен-щиныМуж-чиныЖен-щиныМуж-чиныЖен-щины14850,848,455,052,356,654,756,053,253,952,215051,348,956,753,958,156,558,055,757,354,815253,151,058,755,061,559,561,157,660,355,915455,353,061,659,164,562,463,860,261,959, 015658,555,864,461,567,366,065,862,463,760,915861,258,167,365,870,467,968,264,567,062,416062,959,869,268,572,369,969,765,868,264,616264,661,671,070,874,472,272,768,769,166,516467,363,673,971,877,274,075,672,072,270,016668,865,274,573,778,076,576,573.874,371,516870,868,576,275,879,678,277,974,876,073,317072,769,277,777,081,079,879,676,876,975,017274,172,879,379,082,881,781,177,778,376,317477,574,380,879,984,483,782,579,479,378,017680,876,883,382,486,084,684,180,581,979,117883,078,285,683,988,086,186,582,482,880, 918085,180,988,087,789,088,187,584,184,481,618287,283,390,689,491,489,389,586,585,482,918489,185,592,089,492,990,991,687,488,085,318693,189,295,091,096,692,992,889,689,087,818895,891,897,094,498,095,095,091,591,588,819097,192,399,595,6100,097,499,495,694,892,9

Note - for persons with an asthenic constitution, 3-5% of the mass indicated in the table is subtracted, with hypersthenic constitution, 1 - 2% is added.

1.1.6 Types of energy metabolism

The fact that the pathogenesis of obesity may be associated with a violation of energy expenditure, as a hypothesis, seems quite logical. And it is no coincidence that the state of energy expenditure in obese patients has been studied comprehensively.

A sufficiently large number of works have shown that energy expenditure at rest in obese patients is not less, but, on the contrary, more than in persons with normal weight. There are three main types of energy metabolism balance, similar to the three types of human constitution.

1.2 Treatment and prevention of obesity

If the treatment of obesity were a simple matter that did not require a certain attitude and tension from the patient, and from a doctor of control and constant correction of prescriptions, perhaps there would be no problem itself, and our patients, obeying such a natural desire to lose weight, would long ago have got rid of excess weight.

Despite the large number of proposed and such different ways to reduce excess weight, the only thing that really leads to a decrease in fat mass is an energy deficit, that is, the predominance of energy expenditure over its intake. In this case, fat, as a form of stored energy, begins to be spent to cover the resulting deficit.

The simplest, most understandable, and most importantly, reproducible way to create an energy deficit is a hypocaloric diet. Other proposed methods of treating obesity - physical activity, the use of tonic drugs and drugs that reduce appetite, psychotherapy, reflexology, etc., without special fixation on dieting, are effective only in a small percentage of cases (less than 10-20%) and usually lead to small, unstable and difficult to control weight loss (less than 5-6% of the original).

All of the above methods can only complement diet therapy, namely, either enhance its effect or improve treatment tolerance. It should be noted that if, with a decrease in fat mass, one can expect an improvement in the control of such formidable diseases as arterial hypertension, diabetes mellitus, atherosclerosis, and coronary heart disease, then the treatment of obesity can undoubtedly be considered as an effective method of treating these diseases. And since obesity, according to modern concepts, is the cause of these diseases, such treatment can rightfully be called etiotropic.

The main way to combat obesity is the desire of the patient himself, a complex treatment that combines diet therapy with physiotherapy exercises.

It is advisable to combine systematic physical exercises in combination with dietary nutrition with periodic treatment of the patient in a sanatorium and at a resort. Treatment of obese patients can be carried out both in northern and southern sanatoriums and resorts, where therapeutic nutrition and physical rehabilitation are carried out, which are not contraindicated for the patient due to concomitant diseases. The best resorts are Sestroretsk, Lipetsk, Darasun, Kislovodsk, Essentuki, Pyatigorsk and others.

For the normal functioning of the body, it is important not only the balance between the energy that it receives from food and the energy that it expends, but also a certain ratio of proteins, fats, carbohydrates, vitamins and minerals, depending on gender, age, character labor activity .

Physical activity plays a major role in the prevention and treatment of obesity. Everyone should choose for themselves an acceptable type of exercise. Physical activity is strictly individual. Too much load is harmful, and insufficient load is useless. Therefore, it is necessary to dose the volume of the load, taking into account age, health status, and physical fitness.

Under no circumstances should you overeat. It is useful to develop the habit of getting up from the table half-starved. A slight feeling of hunger after eating is soon replaced by a feeling of satisfaction while maintaining performance. With a feeling of satiety, working capacity decreases, there is a desire to rest, lie down, fall asleep, which naturally leads to obesity. The dependence of excessive food intake on the background of insufficient physical activity and the appearance of a persistent imbalance between the intake and expenditure of energy has been established.

1.3 Physical rehabilitation for obesity

1.3.1 Motor rehabilitation

In patients with obesity, physical activity is predominantly aerobic in nature and long in time. Apply morning hygienic gymnastics, therapeutic exercises, exercises on simulators, health path, dosed walking, special physical exercises Vpool, swimming inopen water, running, hiking, rowing, cycling, skiing, skating, outdoor and sports games.

Morning hygienic gymnastics

Hygienic gymnastics classes are held from various starting positions, but mostly standing. Available physical exercises are used that work out the entire muscular system with a full range of motion in all joints, breathing exercises and relaxation exercises. Recommend gymnastic exercises for the limbs, torso, on shells, turns, torso, exercises that strengthen the abdominal muscles. When performing exercises, breathing is monitored, it should be free, without delay.

Be sure to take after class water procedures: wet rubdown or shower followed by rubbing the body with a terry towel until the skin turns red.

Physiotherapy

In the treatment and rehabilitation of patients with obesity, a complex of methods is used, the most important of which are exercise and diet.

Indications:exogenous-constitutional obesity I, II, III, IV degree, neuroendocrine form of obesity with diencephalic or CSF-hypertension syndrome.

Contraindications:hypertensive and diencephalic crises, exacerbation of concomitant diseases.

Remedial gymnastics classes are held in the form of macrocycles, which are divided into two periods: introductory, or preparatory, and main. The total physical load should be submaximal and individualized in accordance with the functional capabilities of the patient's body. For greater efficiency, various forms of therapeutic exercises alternate throughout the day. The duration of each procedure of therapeutic exercises is from 5 to 45-60 minutes. When performing exercises, gymnastic objects and equipment are used - medical balls (1-4 kg), dumbbells (1-3 kg), expanders, etc. The weight of the shells should be increased gradually. It is recommended to repeat each exercise at the beginning of the course of classes 4-5 times, and in the future, gradually increase repetitions up to 20 times.

Movements are performed with a large amplitude, large muscle groups are involved in the work, swings, circular movements in large joints, exercises for the body (tilts, turns, rotations), exercises with objects are used. The rhythmic contraction of large muscle groups causes an increase in energy consumption and oxygen absorption, stimulates the work of the motor, cardiovascular systems, and tissue metabolism. Exercises on shells and on special devices are also very useful. The use of motor rehabilitation means is due to the fact that physical exercises increase energy consumption, stimulate metabolic processes, normalize the activity of the cardiovascular and respiratory systems, increase the general and emotional tone of patients, the working capacity and body resistance. Particular attention in the process of training is given to breathing training. Breathing exercises help to increase the supply of oxygen to the body, which is necessary to enhance oxidative processes and more active combustion of fatty acids in tissues. All physical exercises should alternate with breathing exercises. The release of muscle tissue from fat increases its contractility. Gradual reduction of fat deposition in the abdominal cavity increases the mobility of the diaphragm - a powerful extracardiac circulatory factor. All this contributes to the prevention of congestion in organs and tissues.

An important role is played by exercises that strengthen the abdominal muscles and the pelvic floor, which not only keep the abdominal organs in a normal physiological position, but also improve intestinal motility, contributing to their emptying.

General strengthening exercises for the muscles of the limbs and trunk, in addition, increase the overall tone of the central nervous system and normalize the functional connections between the cerebral cortex, subcortex and internal organs that were disturbed during the course of the disease, normalize metabolic processes in the body.

Dosed running, jogging

Running is effective tool training of the heart and the whole body. When running, a large number of skeletal muscles take part in the work and this stimulates the functions of organs, significantly increasing energy metabolism. A running lesson is structured as follows: before running, a warm-up is carried out (10-15 minutes), then a dosed run for 5-6 minutes plus walking (2-3 minutes); then rest (2-3 minutes) - and so 2-3 times for the entire lesson. Gradually, the intensity of running increases, and the duration decreases to 1-2 minutes, the number of series is brought to 5 - 6, and the pause between them increases. After 2-3 weeks (or more) of training, they move on to a longer run of moderate intensity up to 20-30 minutes with 1-2 rest intervals.

Dosed walking

Natural and feasible walking is beneficial for all vital functions of the body. When walking, the work of the heart improves, breathing deepens, ventilation of the lungs increases. During walking, more than 50% of the entire muscles of the body are included in the work. Depending on the pace and type of walking, energy costs increase by 3-10 times.

Walking happens: very slow - from 60 before 70 steps/min (from 2 to 3 km/h) with III degree obesity; slow - from 70 up to 90 steps/min (2 to 3 km/h) with III degree obesity; medium - from 90 to 120 steps / min (from 4 to 5 .6 km / h) with obesity II-I degree; fast - from 120 to 140 steps / min (from 5,6 up to 6.4 km / h) with obesity II-I degree; very fast - more than 140 steps / min. It is used for people with good physical fitness.

Swimming and rowing

Swimming has many different effects on the body. Swimming is a means of physical training and hardening, which is also of great practical importance. It develops endurance, increases the vital functions of the body, as studies have shown, the energy consumption when maintaining the body on water alone exceeds the rest exchange by 2-3 times or more. At the time of swimming, energy consumption increases. Its value depends on swimming speed, distance, water temperature and other factors.

Rowing calms the nervous system, has a general strengthening effect on the body, trains the cardiovascular system, and the respiratory apparatus. It strengthens the muscles of the upper and lower extremities, torso. Rowing is emotional, easily dosed.

Swimming, like rowing, also has a positive effect on obesity, since these sports lead to significant energy expenditure. Rowing and swimming lessons can be organized at the sanatorium and polyclinic stages. If necessary, use rowing machines. Swimming lesson consists of 3 parts: introductory (10 - 15 min) - lesson in the hall ("dry" swimming); the main (30 - 35 min) - swimming of moderate intensity in various ways with pauses for rest and breathing exercises (5 - 7 min) and the final (5-7 min) - exercises at the side to restore the functions of blood circulation and respiration.

Sports and outdoor games

Sports (football, hockey, basketball, volleyball, tennis, etc.) and outdoor games in the prevention of obesity belongs to one of the first places. During games there is no continuity of effort: periods of relative exertion alternate with pauses for rest. Games are held with great emotional uplift, having a strong impact on the central nervous system, increase the functionality of the most important internal organs. They contribute to the development of such qualities as speed of reaction, endurance, strength, balance, coordination of movements, etc. If games are played outdoors under various weather conditions, they also give a hardening effect. During games, depending on the pace, the balance of power between the teams, the emotional state of the player, weight loss ranges from several hundred grams to 2-3 kg.

In case of obesity, games with an inflatable ball are used (beating, catching, throwing), as well as relay races (on the spot, with the transfer of objects and with running). Of the sports games, depending on the state of health and fitness, the following are recommended: towns, tennis, badminton, volleyball, etc.

Training on simulators

Contraindications to exercise onsimulators: obesity of any etiology IV degree; concomitant diseases accompanied by circulatory failure II and III stage; hypertensive and diencephalic crises, exacerbation of calculous cholecystitis, increased blood pressure above 200/120 mmrt. Art., deceleration of the pulse to 60 per minute.

In the complex treatment of obesity, exercises on simulators occupy a significant place.The best results in reducing body weight in patients with exogenous constitutional obesity of the 1st degree are given by exercises on simulators (exercise bike, rowing bicycle ergometer, treadmill). Patients with II degree of obesity, who have functional changes in the cardiovascular system or signs of myocardial dystrophy, with concomitant hypertension not higher than stage IA or arterial hypertension, previously engaged in physical culture or sports, under the age of 40 years, while exercising on simulators, physical activity is recommended, causing an increase in heart rate by 75% of the original heart rate (at rest). In this case, 5-minute loads should be alternated with 3-minute pauses for rest. The duration of the lesson is 30-90 minutes. Course - 18-20 procedures.

Patients with exogenous-constitutional obesity of III degree with concomitant diseases (hypertension stage IIA in remission, circulatory failure not higher than stage I), physically unprepared, under the age of 60 lay down during training on simulators, physical activity is recommended, causing an increase in heart rate by 50 % of baseline heart rate (at rest). In this case, you should alternate 3-minute loads with 5-minute rest breaks. The duration of the lesson is 20-60 minutes. Course - 18-20 procedures.

Classes on simulators should be combined with therapeutic exercises, special physical exercises in the pool to influence the abdominal muscles and other forms of motor rehabilitation.

At the same time, it should be taken into account that systematic physical exercises performed on simulators (alternating every 3-5 minutes of work and rest) for 60-90 minutes of training have a positive effect on clinical parameters and most effectively affect lipid metabolism.

In the course of classes, a system of monitoring the state of health and self-control is mandatory. For this purpose, heart rate and blood pressure are measured, health indicators are assessed and functional tests are carried out (Martinet test, bicycle ergometric test, breathing tests of Stange, Genchi, etc.).

1.3.2 Massage

Massage actively affects metabolism: it increases the excretion of mineral salts and nitrogenous substances, incompletely oxidized metabolic products from the body, enhances the absorption of oxygen and other metabolites by tissues.

Massage causes the expansion of functioning capillaries, the opening of reserve capillaries, which creates a more abundant irrigation with blood not only of the massaged area, but also of the area associated with it reflexively. As a result, gas exchange between blood and tissue increases. Under the influence of massage, the elasticity of muscle fibers and their contractile function increase, and muscle atrophy slows down. Massage also has a significant effect on the redox processes in the muscles, increases the flow of oxygen, the assimilation function of muscle tissue cells, and improves muscle performance.

Massage is useful after taking a bath or steam bath with soap. Self-massage (in a standing position) in water gives a good result, as well as for 20-25 minutes with the help of the Tonus, Sport massager, etc.

Methodical instructions:

1. Best time for therapeutic massage for obesity - in the morning, especially for patients with disorders of the pulmonary and cardiac activity, and in the evening - for those who have a disease of the liver or gallbladder.

Take into account the clinic of diseases, such as weakness of the abdominal press, constipation, as well as the age of the patient. In this regard, some techniques should not be used (for example, percussion).

The intensity and duration of the procedures should be gradually increased taking into account the patient's response.

In case of deterioration of the state, well-being, the appearance of weakness and other adverse effects, the massage should be reduced or temporarily canceled according to the dosage.

After each procedure, give the patient a rest for 15-20 minutes, especially for people with diseases of the cardiovascular system.

If allowed by the doctor, then widely use massage in the bath with a visit to the steam room.

Self-massage is recommended, which increases energy consumption. Self-massage is most effective in places of the greatest deposition of adipose tissue (self-massage or massage of the abdomen, gluteal muscles, thighs, etc.). Self-massage techniques are carried out in the following sequence: stroking, kneading, shaking, rubbing, movements, percussion techniques. The massage ends with stroking.

1.3.3 Physiotherapy treatment

Wraps

During general wrapping, a naked patient is laid with his back on a couch covered with a cloth blanket and on top with a linen sheet moistened with water at a temperature of 25 - 30 ° C and well wrung out. Then it is wrapped in a damp sheet. On top of the sheet, the patient is wrapped in blankets, the neck is covered in front with a dry towel, a cold compress is applied to the forehead. After the procedure, the patient is thoroughly wiped and left to lie covered with a dry sheet and blanket. The duration of the procedure for metabolic disorders is 50-60 minutes or more. The course of treatment - 15-20 procedures.

souls

They are hydrotherapy procedures in which the human body is affected by jets of water of various shapes, temperatures and pressures.

Charcot shower (jet) is a high pressure shower. During the procedure, the patient stands at a distance of 3.5-4 meters from the shower pulpit. A jet of water is alternately directed to the legs, back, front and side surfaces of the body from the bottom up, first with a fan, then with a compact jet. To obtain the desired effect, these manipulations in the same order are carried out several times. Finish the procedure with a fan jet of optimal temperature. Avoid hitting the jet on the head, spine, heart area, mammary glands, genitals. Water temperature at the beginning of the course of treatment - 32-35°C, at the end - 20-15°C; pressure from 150-200 kPa to 250-300 kPa. The duration of the procedure is from 1-2 to 3-5 minutes. The course of treatment is 15-20 procedures. Charcot's shower is used to increase muscle tone and reduce the thickness of the fat layer.

Underwater massage shower is a special type of hydrotherapy procedures in which the patient's body, immersed in a bath, is massaged with a jet of water supplied under pressure. Massage with a water jet causes pronounced reddening of the skin, improves blood and lymph circulation, stimulates metabolism in tissues.

Contrast baths

The use of contrast baths in the treatment of obese patients is based on the phenomenon of nonspecific adaptation various systems body (sympathetic-adrenal, thermoregulation, peripheral circulation) to a series of stimuli, which helps to reduce body weight due to the activation of lipolysis processes, improve the neuroendocrine regulation of the body, positive changes in metabolic parameters, and improve the psycho-emotional state of patients. During the procedure, patients are alternately immersed in a pool of hot water (40°C), then in a pool of cold water (20°C), a total of 3 immersions; active motor mode is used in cold bath. Length of stay in hot cold water is respectively 3 and 1, 2 and 2, 1 and 3 minutes. After the procedure, the body is thoroughly rubbed with a dry towel. Course 10-12 baths daily. At the end of the procedure, the patient is advised to rest for 30 minutes.

Underwater intestinal lavage

It is carried out using an apparatus of the APKP type in a bath with a capacity of 400-600 liters or in a special pool, which should be in a separate room with a shower and toilet. Water with the addition of medicines, chamomile decoction, table salt, Epsom salt, Karlovy Vary salt and other drugs in the amounts indicated by the doctor is injected into the intestine in portions from 0.5 to 1.5 liters. The water temperature is 38-39°C, the duration of the procedure is 30-40 minutes. During this time, up to 8-10 liters of water is passed through the colon at the beginning of treatment and up to 12-15 liters at the end of it. Usually, no more than 6-10 procedures are carried out, 1-2 per week. Bowel lavage should be done on an empty stomach or not earlier than 3-5 hours after eating. After the procedure, the patient should take a shower and rest lying on the couch with a warm heating pad on the stomach.

The bath has been used as an excellent means of maintaining health since ancient times. It has a beneficial effect on the central nervous system, neuromuscular apparatus, blood circulation, skin and other organs. Under the influence of the bath, microcirculation increases (the number of functioning capillaries increases), venous congestion is eliminated, tissue regeneration processes improve, skin temperature rises, muscle tone decreases, and pain decreases.

The bath actively affects gas exchange, mineral and protein metabolism, increasing the excretion of urea and lactic acid from the body. All this has a positive effect on the function of internal organs and the vital activity of the body. With sweat, decay products are excreted from the body. There is a mobilization of the protective and adaptive mechanisms of the body.

Magnetotherapy

Ultrasound Therapy

Ultrasound therapy is used as a factor of local action on local deposits of adipose tissue. Improves local blood and lymph circulation, which contributes to an increase in tissue oxygenation and metabolism. The area of ​​the anterolateral surface of the thighs or the anterior wall of the abdomen is exposed to an ultrasonic frequency of 880 kHz, an intensity of 1.0-1.2 W/cm ² in a constant mode by a labile method. They act on the stomach or thighs, the duration is 15 minutes in the first case and 8 minutes on each side in the second case. The procedure is carried out daily only 10-12 per course.

1.4 Diet therapy

The goal of therapeutic nutrition is the mobilization of fats from fat depots, reducing the excitability of the food center (appetite) and inhibiting the synthesis of fats in the body from easily digestible carbohydrates.

The treatment of obesity and, subsequently, the maintenance of normal body weight is not an episode, but a therapeutic measure that is carried out throughout life. The patient himself must take an active part in maintaining and improving his health. From the usual food regimen to a new one, they move gradually, for a long time changing the nature of nutrition, eating habits, and not a temporary restriction on the use of certain foods. The amount of food consumed and its calorie content are reduced in such a way that patients do not have a feeling of pronounced hunger, so that the treatment does not cause severe weakness and nervous irritation.

An important place in the treatment and rehabilitation of obesity is occupied by a balanced diet with a restriction of fats and carbohydrates. The amount of fat in the daily diet is reduced to 0.7-0.8 g / kg, while vegetable fats (1.3-1.4 g / kg) must be present, the amount of carbohydrates is sharply limited to 2.5-2.7 g / kg (daily rate 5.2-5.6 g / kg), primarily due to the exclusion of sugar, bread, confectionery, sugary drinks. The amount of proteins in food is increased, which prevents the loss of tissue protein, increases energy expenditure due to the absorption of proteins, and creates a feeling of satiety.

ü eat less fatty foods;

ü give up sweets (chocolate, sweets, confectionery, sugary drinks), limit your sugar intake (one or two sugary meals per week);

ü eat more low-calorie bulky and high-fiber foods (raw vegetables, fruits), wholemeal breads;

ü prefer lean meat, poultry, fish;

ü limit flour dishes, including bread and pastries, reduce the consumption of potatoes;

ü limit the intake of sodium salts, the sources of which are: table salt, various pickles, canned beef and pork, sausages, ham, bacon, sausages, cheese, canned soups and vegetables, sauces. Take table salt up to 5-8 g per day, mainly using it for salting during meals;

limit free fluid intake to 1-1.2 liters per day, this will increase the breakdown of fat as a source of "internal" water;

exclude from the diet foods that stimulate appetite;

exclude alcoholic beverages that increase appetite and are sources of energy;

rare and plentiful meals are excluded, especially its main meal for dinner, so in no case do not eat before bedtime;

it is forbidden to alternate periods of limited nutrition with uncontrolled consumption of large amounts of food rich in fats and carbohydrates;

you should not immediately eat up "to your fill." You need to leave the table with a feeling of insufficient satiety;

eat slowly, relaxed, in a calm, pleasant environment. Chew your food thoroughly and spend at least 20 minutes with each meal. Remember that this is the time it takes to feel full. The slower the meal, the less likely to overeat;

periodically (1-2 times a week) arrange fasting days.

Complete fasting has no advantage over a reduction subcalorie diet. It is contraindicated in children, people suffering from diabetes mellitus, liver and kidney diseases, cardiovascular diseases and chronic respiratory failure.

1.5 Psychotherapy

In accordance with modern ideas about the etiology and pathogenesis of obesity, psychotherapy, of course, is not the leading method of treating this disease, however, with the help of psychotherapeutic methods of treatment, a patient can develop a new dietary stereotype and a new lifestyle stereotype, and develop a constructive attitude towards his problem. , the value of the task of reducing body weight has been increased, which, undoubtedly, will further strengthen and consolidate the effect of treatment.

The patient must be convinced that everything will be fine in the future, that he will be able to overcome all the difficulties that he will encounter during the treatment, and that at the end of the treatment he will be rewarded with a good appearance and good health. And the effect of treatment largely depends on how much the doctor manages to control the thoughts and feelings of his patient.

The most commonly used by doctors is the so-called rational psychotherapy in the form of behavioral therapy. The patient is taught safe eating habits, taught to moderate their food cravings, and eventually eat only as much as necessary so as not to gain weight. Typically, such methods allow you to consolidate the result, increase the period of remission and reduce the number of relapses of obesity. In some medical centers of the West, along with individual work (doctor - patient), the method of the medical team is practiced, in which patients exchange experience in solving difficulties that arise when following a diet and regimen. physical activity, together find ways out of certain life situations preventing weight loss. .

1.6 Surgical treatments

Surgical methods of treatment are used in severe cases of obesity, when the use of other methods of treatment has been unsuccessful. There are several options for surgical treatment: removal of the greater omentum, resection or temporary shutdown of part of the small intestine, the formation of a small stomach, gastric bypass, and others. As a rule, these methods give a cosmetic effect against the background of a high risk of complications. In addition, in recent years, a method of aspiration of subcutaneous fat, called liposuction, has been used.

Liposuction is a method of removing subcutaneous fat deposits in a particular part of the body in order to improve the shape of the figure. The fat is removed through small incisions. There are different methods of liposuction. Their choice depends on the amount of fat to be removed. Liposuction is easily tolerated and gives an excellent cosmetic effect. However, while maintaining the same lifestyle, the weight of patients gradually returns to the original.

Thus, the analysis is scientifically -The methodological literature on the problem under study showed that today there are a large number of various means and methods for the treatment of obesity. Most experts insist on the complex use of a hypocaloric diet and optimal physical activity. However, the main problem is the requirement for physical activity performed - they must be systematic and constant for a long time. This remains to date a little-studied problem, to which we devoted our further study.

Chapter 2. Methods and organization of research

2.1 Research methods

To solve the problems posed in the work, the following research methods were used:

analysis of scientific and methodological literature;

pedagogical experiment;

questioning;

biomedical methods;

methods of mathematical statistics.

2.1.1 Analysis of scientific and methodological literature

Works of domestic and foreign authors were studied. Abstracts of dissertations, scientific and methodological manuals, guidelines, scientific articles were used, which made it possible to substantiate the relevance of the research topic, summarize the available research results, determine the goal and objectives, and develop a comprehensive program of physical rehabilitation for patients with obesity.

2.1.2 Pedagogical experiment

An experiment is a research method by which, by systematically managing the conditions of the situation under study, hypotheses about causal relationships phenomena.

A pedagogical experiment is a study in the course of which we ourselves evoke the phenomena of interest to us and create the necessary and sufficient conditions for the manifestation and measurement of their connection between ourselves and the circumstances of human life.

In the course of the study, a pedagogical experiment was carried out in natural conditions in order to determine the effectiveness of the developed method of physical rehabilitation.

Two groups of subjects were formed: experimental and control. The control group was trained according to the generally accepted methodology, the experimental group - according to a specially developed program of physical rehabilitation.

2.1.3 Biomedical and psychological methods research

The following tests were used during the work:

1.Body weight measurement

2.Height measurement

.Measurement of body volumes

.BP measurement

.Measurement of VC

.Anxiety score

.Assessment of motivation for recovery

Body weight measurement

Measurement of body weight is carried out on medical scales (lever or electric). Weighing should be carried out under the same conditions, on the same scales, on an empty stomach, after emptying the bladder and intestines, without clothes. Body weight is measured in kilograms (grams).

Height measurement

Height is measured with a stadiometer, in centimeters. The subject stands on the platform of the stadiometer with his back to the rack with the scale and touches it with three points: heels, buttocks, interscapular space. Measurement of height in a sitting position is carried out by a stadiometer having a folding bench fixed at a distance of 40 centimeters from the floor. The subject touches the rack with the sacrum and interscapular space, the hips should be horizontal to the floor.

Measurement of body volumes

Measurement of volumes is carried out using a rubberized centimeter tape, in centimeters.

Waist circumference is measured 3-4 centimeters above the iliac crests and 1 centimeter above the navel, in a standing position. During measurements, the subject should not retract or protrude the stomach. .

Determining the pulse and counting the heart rate

The pulse is examined on the radial, temporal, carotid, femoral, popliteal arteries, as well as on the arteries of the rear of the foot. The most convenient way is to determine the pulse on the radial artery. To do this, place the second, third, fourth fingers under the radial artery, at the base of the outer third of the wrist from the side of the thumb. The heart rate is counted for 30-60 seconds.

During exercise, the heart rate is higher, so it is enough to count it for 10 to 15 seconds. Then the resulting value is converted from the calculation per minute, i.e. multiplied by 6 (if the heart rate was counted for 10 seconds) or 4 (if the heart rate was counted for 15 seconds). Normal heart rate is 60-80 beats per minute.

Taylor Anxiety Scale

Designed to measure the level of anxiety. This test is a self-questionnaire consisting of 50 statements, which must be answered "yes" or "no". Evaluation of the results of the study according to the questionnaire is carried out by counting the number of responses of the subject, indicating anxiety. Each "yes" answer to statements 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 230, 31, 32, 33, 34, 35, 36 , 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 and the answer "no" to statements 1, 2, 3, 4, 5, 6, 7, 8 , 9, 10, 11, 12, 13 is worth 1 point. Then the total score is calculated.

A total score of 40 - 50 points is considered as an indicator of a very high level of anxiety; 20-40 points indicate a high level of anxiety; 15-25 points - about the average (with a tendency to high) level; 5-15 points - about the average (with a tendency to low) level and 0 - 5 points - about a low level of anxiety. (Annex 3)

Questionnaire "Restoration of locus of control"

Developed as a tool for indirect assessment of the patient's level of motivation for recovery. The test is based on taking into account the patient's opinion regarding his own role in recovery. The patient, after reading the statements, must express the degree of agreement with each of the statements presented in the questionnaire. Answers to questions 1-5 are evaluated as follows: "strongly agree" - 4 points, "agree" - 3 points, "don't know" - 2 points, "disagree" - 1 point, "strongly disagree" - 0 points; answers to questions 6 - 9 are evaluated in a "mirror" order ("strongly agree" - 0 points, "agree" - 1 point, "don't know" - 2 points, "disagree" - 3 points, "strongly disagree" - 4 points). The total score can vary from 0 to 36; a higher score indicates a higher level of motivation to achieve improvement in one's own health. (Annex 2)

To identify the effectiveness of the developed rehabilitation program, the following were determined:

Average:

where n is the number of subjects.

Standard deviation:

where s is the standard deviation;

The maximum value of the table;

The minimum value of the table;

k - coefficient.

Standard error of the arithmetic mean:

where S is the standard error of the arithmetic mean;

s - standard deviation;

n is the number of subjects.

Student's coefficient:

where t is Student's coefficient; - arithmetic mean before the experiment; - arithmetic mean after the experiment; S1 - standard error of the arithmetic mean before the experiment; S2 - standard error of the arithmetic mean after the experiment.

2.2 Organization of the study

At the first stage (2005 - 2008) of the study, the analysis of scientific and methodological literature was carried out, a rehabilitation program was developed, and methods for monitoring the effectiveness of the rehabilitation program were determined. At the second stage (2009) a pedagogical experiment was carried out on the basis of physical culture -health-improving complex on the basis of JSC "Slonim Meat Processing Plant" (July - December 2009).

At the third stage (January -March 2010) carried out statistical processing and analysis of the data obtained, the presentation of the results of the work.

The study involved 20 people. Two groups were formed by random sampling: 10 people made up the control group and 10 people - the experimental group. All subjects were women between the ages of 22 and 34.

The CG patients were trained according to the program of the general physical training group ("Health" group), with a primary emphasis on body shaping and normalization of body weight.

Patients from the EG studied according to the training program developed by us in the form of the "School of the Obese Patient". Organized classes were held three times a week for two months - July and August 2009. In the future, the patients received the necessary knowledge and practiced on their own until the end of the year.

Retesting was conducted in both groups in December 2009.

Chapter 3. Results of the study and their discussion

3.1 Development of a comprehensive physical rehabilitation program

At all stages of the rehabilitation program, an appeal to the patient's personality, a combination of biological and psychosocial forms of therapeutic restorative effects is provided.

To compile it, it is necessary to take into account the whole complex of changes: morphological, psychological. When developing a rehabilitation program for patients with obesity, an individual approach to the patient is required with the setting of realistically achievable goals and objectives. The condition and physical fitness of the patient and the presence of concomitant diseases are also taken into account.

Physical activity helps to reduce the mass of adipose tissue, the volume of visceral fat, maintain the achieved body weight, reduce insulin resistance, normalize carbohydrate and lipid metabolism and improve the physical and psycho-emotional state of patients.

General tasks of physical activity in obesity of the 1st degree:

-activate redox processes

-increase the adaptive capacity of the body

increase energy costs

Massage and physiotherapy methods contribute not only to weight loss, but also improve metabolic processes, have a beneficial effect on the cardiovascular and central nervous system, improve tissue trophism, reduce congestion, increase muscle tone, improve psycho-emotional state.

An important element of a comprehensive program of physical rehabilitation for patients with obesity of the 1st degree is diet therapy. The basis of the treatment of obesity is a balanced natural hypocaloric diet. A gradual, long-term change in the nature of nutrition, eating habits is recommended, and not a temporary restriction on the use of certain foods.

Currently, in the world medical practice it is recognized that one of the progressive approaches to solving problems associated with treatment various diseases, is the organization of a system of patient education, which can be carried out both in a hospital and on an outpatient basis. The latter is cheaper for the medical institution and allows you to create a flexible work schedule for the convenience of patients.

Participation in the educational program forms a correct understanding of the disease, the risk factors for its occurrence and the conditions of the progressive course, which allows the patient to more clearly follow the set of recommendations for a long time, forms an active life position of the patients themselves in the further process of recovery.

Observations on the conduct of classes in the conditions of a sports and recreation center, conversations with instructors-methodologists in physical rehabilitation showed that today there are no training programs for patients with obesity.

Based on the foregoing, we have developed a training program in the "School of the Patient with Obesity", designed for 25 lessons under the guidance of an instructor-methodologist in physical rehabilitation - two months, three times a week. At the same time, one lesson per week is theoretical and two are practical. In addition to these organized classes, patients are engaged in dosed walking, perform self-massage and visit the bath.

The theoretical lesson is carried out either in the form of a conversation or in the form of a methodical lesson.

The practical session is a therapeutic gymnastics.

The basis of therapeutic exercises are exercises for large muscle groups, performed at a slow and medium pace with a large number of repetitions, with the mandatory inclusion of a large number of breathing exercises with an emphasis on diaphragmatic breathing.

Remedial gymnastics classes are divided into two periods: introductory, or preparatory, and main.

During the introductory period, the following tasks are performed:

overcome reduced adaptation to physical activity

-restore motor skills and physical performance that are usually lagging behind age standards

achieve the desire to actively and systematically engage in physical education

-increase non-specific resistance.

Tasks of the main period:

improvement and normalization of metabolism, in particular, fat metabolism;

-reduction of excess body weight;

-adaptation of the body to increasing physical activity;

normalization of the functions of the cardiovascular, respiratory, digestive and other body systems suffering from obesity;

improvement and normalization of the patient's motor sphere.

An approximate set of exercises is presented in tables 3.1 and 3.2

In addition, patients were required to self-administer dosed walking.Dosed walking is carried out on days when there are no classes in therapeutic exercises. It is recommended to walk in the morning or in the evening in the park, in picturesque places. The load is dosed individually and every day increases by 300-400 meters. Each walk should begin and end at a calm pace.

For obesity I - II degree, the average pace of walking is used - from 90 to 120 steps / min (from 4 to 5 .6 km/h); fast - from 120 to 140 steps / min (from 5,6 up to 6.4 km/h); very fast - more than 140 steps / min. It is used for people with good physical fitness. Particular attention should be paid to breathing: breathe deeply and rhythmically, exhale belonger than inhalation 2-3-4 step - inhale, on 3-4-5 steps - exhale). The first weeks of training in walking requires a short rest 2-3 min for breathing exercises.

Table 3.1 - A set of exercises for obese patients of the 1st degree

Introduction (10 minutes) 1. Walkingregular on toes with a high hip lift in a half squat 2. Runningnormal with shin overlap with high thigh lift cross right side cross left side with acceleration 3. Walking exercises1-2 - hands up, inhale 3-4 - hands down, exhale 4. I.p. - stand legs apart, hands on the belt1 - turn of the torso to the right 2 - i.p. 3 - turn of the torso to the left 4 - i.p. 5. I.p. - stand legs apart 1-2 - opposite circles with hands, left forward 3-4 - the same, but right forward 6. I.p. -Same1 - bend forward, bending forward, hands on the belt - hands to the sides - hands up - ip 1 min 2 min 4 times 8-10 times 10 times 6-8 times Measure heart rate Arms up Hands on the belt Arms to the sides Arms in front of the chest The pace of walking is slow Breathing is arbitrary Perform movements with a large amplitude Look ahead Main part (30 minutes)7. I.p. -o.s. Spread your arms to the sides - inhale, press your bent leg at the knee with your hands to your stomach - exhale. 8. I.p. - stand legs apart, hands on the belt 1 - bending the left, tilting to the right, left hand up 2-i.p. 3-4 - the same in the other direction 9. I.p. -o.s. 1-max right and grab the ankle 2-3-keep 4-ip. 5-8 - the same, from the other leg 10. I.p. - lying on your back, arms along the body 1-2 - simultaneous abduction of straight arms and legs to the sides - inhale 3-4 - ip, exhale 11. I.p. -SameAlternate flexion and extension of the legs in the knee and hip joints (bicycle) 12. I.p. - lying on your back, legs bent at the knee and hip joints 1 - bend, tearing the pelvis off the surface 2-3 - hold 4 -ip. 13. I.p. - lying on your back1 - grouping 2-7 - rolls in grouping 8 - i.p. 14. Stand on the shoulder blades 15. I.p. - lying on your backAlternate lifting of straight legs up (vertical scissors) 16. I.p. - lying on your back, arms along the body 1-2 - raise your hands up - inhale 3-4 - sp. -exhalation 17. I.p. -Same1 - seated at an angle, arms to the sides 2-3 - hold 4 - i.p. 18. I.p. - lying on your back, hands behind your head 1 - bend your legs 2 - straighten 3-4 - slowly lower into ip. 19. I.p. - lying on your back1 - right leg up, touch the floor on the left side 2 - sp. 3 - left leg up, touch the floor on the right side 4 - sp. 20. I.p. -SameDeep diaphragmatic breathing 21. I.p. - emphasis on knees1 - right leg back, left arm up 2 - sp. 3-4 - the same with the other leg and hand 22. I.p. -Same1-2 - unbending legs, pull back 3-4 - sp. 23. I.p. - emphasis lying1 - with the body turning to the right, the right hand to the side - inhale 2 - ip, exhale 3-4 - the same in the other direction 24. I.p. - lying on the stomach, arms along the body1 - pressing with palms on the floor, bend 2-3 - hold 4 - i.p. 25. I.p. - lying on the stomach, hands up1 - bend 2-3 - hold 4 - i.p. 26. I.p. - emphasis sitting behind, legs apart - inhale1 - bend forward, touch the feet with the brushes - exhale 2 - ip 4 times 10 times 6-8 times 4 times 30 seconds 8-10 times 6-8 times 30 seconds 8-10 times 4 times 8 times 8 times 10 times 4 times 8-10 times 10 times 6 times 8 times 6-8 times 4 times Measure heart rate Slow pace With each leg in turn Maximum amplitude, do not hold your breath Do not lean forward, keep your back straight Inhale through the nose, exhale through the mouth Full amplitude, breathing is arbitrary Bend over as much as possible Chin is pressed to the chest Legs are straight The pace is slow, do not raise the legs high Inhale through the nose, exhale through the mouth Legs higher, back straight Legs do not raise high The pace is average Right hand on the chest, left hand on the stomach Stretch as much as possible forward and upward, stretching the back Slow pace Look in the direction of the turn Do not take your legs off the surface Raise your arms and legs higher Heart rate measurement Calm, rhythmic breathing Final part (5 minutes) 27. Calm walking 28. I.p. - squat on the right, left to the side on the toe, hands on the belt1-2 - transfer the body weight in a squat to the left 3-4 - reverse movement i.p. 29. Shaking arms and legs 30. Slow walking1-2 min 6 times 10 times 1 min Breathing is free The pace of execution is slow, the back is straight Measurement of heart rate Relax the limbs as much as possible

Table 3.2 - A set of exercises for obese patients of the 1st degree (with a stuffed ball)

Lesson PartsContentsDosageWMD Preparatory part (10 minutes)1. Walking calm with a gradual acceleration and deceleration of the pace 2. I.p. - stand legs apart, hands on the belt 1 - turn the torso to the right 2 - sp. 3-4 - the same, in the other direction 3. I.p. - the same 1 - torso tilt to the right 2 - sp. 3 - torso tilt to the left 4 - i.p. 4. I.p. - the same 1 - tilt forward 2 - tilt back 3 - squat, arms to the sides 4 - sp. 5. I.p. -o.s., hands in front of the chest 1-2 - jerks with the hands in front of the chest 3-4 - jerks with straight arms back 6. I.p. - stand legs apart, hands on the belt 1-2 - squat, hands forward 3-4 - sp. 7. I.p. - stand legs apart, arms forward - to the sides 1 - max right to left hand 2 - sp. 3 swings of the left hand to the right hand 4 -p.p.1-2 min 6-8 times 6-8 times 8 times 10 times 10 times 8-10 times Heart rate measurement Perform turns with a gradual increase in amplitude Bend lower When tilting the leg at the knees do not bend your arms do not lower, do jerks sharply Back straight, the pace is slow Do not lower your arms, try to touch your arm with your foot, do not bend over Main part (30 - 45 minutes) 8. I.p. -o.s., ball down 1 - ball to the chest 2 - ball forward 3 - ball to the chest 4 - i.p. 9. I.p. - leg stand apart, ball down 1 - ball up, look at the ball 2 - ball behind the head 3 - ball up 4 - sp. 10. I.p. - stand legs apart, ball in front of the chest 1 - tilt forward, touch the floor with the ball - exhale 2 - sp. - inhale 11. I.p. - o.s., ball down 1-3 -slowly squat, ball forward 4 -ip. 5 - squat, ball forward 6-8 - stand up slowly, i.p. 12. I.p. - narrow leg stance apart, the ball below Turns of the body with a sweeping movement of the arms to the sides, raise the ball to shoulder height 13. I.p. - o.s., ball in front of the chest 1 - ball up, rise on toes - inhale 2 - i.p. -exhale 14. I.p. - o.s., the ball is at the bottom Podsok from one side to the other with simultaneous tossing (beating) of the ball not high up 15. I.p. -o.s., the ball is on the bent right hand, the left is laid aside 1-2 - slightly crouching, throw the ball up over your head 3-4 - catch the ball with both hands 5-8 - the same with the other hand 16. I.p. - lying on your back, the ball between the feet, hands at the top 1-2 - sit, hands forward - exhale 3-4 - sp. - breath 17. I.p. - lying on the back, the ball on the hips 1-4 - slowly circle the ball to the right 5-8 - the same to the left 18. I.p. - lying on your back, the ball between the feet, arms along the body 1-2 - bend the legs forward 3-4 - sp. 19. I.p. - emphasis on kneeling, hands on the ball 1 - unbending in a half-tilt, ball up 2-3 - hold 4 - sp. 20. I.p. - emphasis lying, feet on the ball Flexion and extension of the arms in the emphasis lying 21. I.p. -sed, arms to the sides 1-2 - sit in a group, exhale 3-4 - sp. , breath 22. I.p. - emphasis sitting behind, the ball between the feet 1 - bend the legs 2 - sp. 23. I.p. -sed, ball on hips 1 - ball forward 2-3 - two springy slopes, ball 4 - sp. 24. I.p. - emphasis sitting behind, the ball between the feet 1 - sitting at an angle 2 - sp. 3 - sitting angle, arms to the sides 4 - sp. 5 - sit at an angle 6-7 - hold 8 - i.p. 25. I.p. - lying on the stomach, the ball is at the top 1-2 - bend, the ball is up 3-4 - sp. 5 - bend 6-7 - hold 8 - sp. 26. I.p. - sit down, arms to the sides, the ball is on the floor from behind closer to the body 1-2 - lie down on the ball, bend over, arms to the sides - inhale 3-4 - ip, exhale 27. I.p. - kneeling, the ball is at the top 1 - with the torso turned to the right in an arc forward, the ball is back to the thigh 2 - the reverse movement in the sp. 3-4 - the same, in the other direction 28. I.p. - lying on the back, the ball is at the top 1-2 - raising the legs, moving the ball under the hips 3-4 - reverse movement i.p. 29. I.p. - wide leg stance apart, ball at the top 1-3 - three springy tilts to the left 4 - sp. 5-8 - the same, to the right 30. I.p. -o.s., ball down 1 - deep lunge with the right, ball up 2 - tilt back 3 - straighten up 4 - push with the right sp. 5-8 - the same, from the other leg 31. I.p. - the same 1 - the ball forward and with a swing of the right to touch the toe of the ball 2 - i.p. 3-4 - the same, from the other leg 32. I.p. -o.s., the ball is sandwiched between the legs Jumping with the ball 33. I.p. -o.s., hands in front of the chest 1-2 - turn the torso to the side with simultaneous spreading of the arms - inhale 3-4 - ip, exhale 5-8 - the same, in the other direction 10 times 10 times 4-6 times 10 times 10-12 times 4 times 8-10 times 8 times 6 times 6 times 10-12 times 8-10 times 10-16 times 4 times 10-12 times 8-10 times 8 times 8-10 times 4 times 8- 10 times 8 times 8-10 times 6-8 times 6-8 times 8-10 times 3 times Heart rate measurement Breathing is uniform, do not lower your arms Tempo is average Tempo is slow Back is straight, look forward Legs slightly bend and unbend when turning Tempo is slow ) the ball with both hands Throw the ball 0.5 -1 meter in height Do not tear the ball off the floor Do not tear off the shoulder blades from the floor, press the heels to the floor, keep the arms straight The pelvis does not tear off the floor The pace is medium, breathing is uniform The torso is straight, elbows along the body, brush under the shoulder Inhale - through the nose, exhale - through the mouth Bending and unbending the legs, do not touch the floor with the ball Try to touch the knees of straight legs with your chest Legs straight, keep your back straight Take your legs off the floor Breath calmly Do not move your knees, do not lean in the direction of rotation Swing with straight legs Bend as low as possible Standing leg straight Swing with straight leg, ball at shoulder height Slow pace, do not hold your breath Heart rate measurement Final part (5 minutes)34. Walking at a slow pace with "shaking" arms and legs 35. I.p. - stand legs apart 1-2 - spread your arms to the sides - inhale 3-4 - grab your chest with your hands, tilting your head and body forward - exhale 36. I.p. - the same 1 - raise the right hand up 2 - raise the left hand up 3-4 - relax the arms and lower down 37. Calm walking 2 min 4 times 6 times 1 min Breathing calmly Slow pace Slow pace Heart rate measurement

After exercise, patients performed self-massage.

Massage for obesity is not indicated, as it does not lead to weight loss. Self-massage is recommended, which increases energy consumption. The body or its individual parts can be massaged with hands, a special apparatus, and also with water.

Self-massage, like massage, is contraindicated at elevated body temperature, febrile, skin and fungal diseases. In no case should you massage if the skin is dirty.

Self-massage, like massage, is performed from the periphery to the center towards the nearby lymph nodes. They are located in the elbow, knee joints, armpits and groin. Areas of lymph nodes should not be massaged.

A necessary condition is the adoption of such a position before the massage, in which the maximum relaxation of the muscles of this area would be achieved.

The foot is massaged while sitting, clasping it with both hands and vigorously stroking it several times from the fingertips to the lower leg. Then, the toes, the back of the foot, the sole and the ankle joint are rubbed in the same direction. Rub in a circle, with the fingers of both hands at the same time. The sole is rubbed with a fist.

The massage ends with a general stroking of the foot. Then each finger is individually bent, unbent and taken to the side.

The lower leg is also massaged while sitting, bending the leg at the knee. With one hand they clasp the front surface, with the other - the back and at the same time stroke the entire lower leg from the bottom up to the knee joint.

The knee joint is massaged while sitting, with half-bent knees. First, the joint area is stroked, and then rubbed in a circular motion. The popliteal fossa should not be massaged.

The thigh is massaged with a slightly bent leg, first they stroke the outer, and then its inner surface from the knee joint upwards, not reaching the inguinal region. The thigh is rubbed in a circular motion, more vigorous on the outer surface. Apply and kneading the thigh. To do this, with one or the other hand, they grab it into longitudinal folds and squeeze it.

The massage ends with stroking from the bottom up, without affecting the groin area. Massaging the legs with dilated veins is not recommended.

The gluteal region is massaged while standing, putting aside on the toe and relaxing the right leg and buttock. Stroke and knead the right buttock with the right hand, then massage the left.

The lumbar region is massaged while standing, slightly leaning back, stroking and rubbing it with both hands at the same time. Massage movements are circular, transverse and longitudinal.

The brush of one hand is massaged with fingers and the palm of the other. Stroke on the back, and then the palmar surface from the fingertips to the forearm. Stroking is replaced by rubbing. With the “pad” of the thumb, the palm is rubbed, each finger separately, the back of the hand and the wrist joint. The massage ends with stroking the hand, as if putting on tight gloves.

The forearm is massaged by slightly bending the arm at the elbow and turning it with the palm first down and then up.

All movements are done longitudinally, circularly from the wrist joint towards the elbow.

The elbow is stroked and rubbed with a bent arm in a circular motion.

The shoulder is massaged by lowering the hand down. The outer surface of the shoulder is stroked and rubbed from the bottom up from the elbow, capturing the elbow joint. When stroking and rubbing the inner surface of the shoulder, do not reach the armpit.

The chest is massaged while sitting. The hand of the massaged half of the body is lowered. The fingers of the other hand stroke half of the chest along the intercostal spaces from front to back. Do the same on the other half. The breast cannot be massaged.

The abdomen can be massaged only on an empty stomach or two hours after eating. The abdomen is massaged lying on the back, bending the legs at the knees. In this position, the abdominal wall relaxes. First, stroking is performed, describing a series of circles from right to left in a clockwise direction. The force of pressure, initially insignificant, gradually increases, especially in obese. Stroking is followed by kneading. Produce small rotational movements from the lower abdomen to the right. Centimeter by centimeter, the fingers move up to the ribs, then across the abdomen and further down.

Finish kneading on the left lower abdomen. After "and kneading again, circular strokes are performed. You can stroke the stomach at the same time with both hands from the sides to the navel, as if raising the stomach.

Massage of the abdomen should be completed with active gymnastic exercises that strengthen the abdominal press. During menstruation, during pregnancy and diseases of the gallbladder, you can not massage the stomach.

Bathvisited 1-2 times a week. You should go to the bath 3-4 hours after eating, but not on an empty stomach. The purpose of the bath procedure for obesity is to remove water from the body through the skin and respiratory tract, to enhance metabolic processes and the "burning" of fat deposits. When visiting the bath, you must follow certain rules: create conditions for good sweating; adhere to the principles of moderation and gradualism.

Before you go to steam, you need to wash yourself in the shower with warm water. It is not recommended to use soap before the steam room and wet your head. Entering the steam room, you first need to warm up: sit, and if possible, then lie down, so that the head and legs are at the same level or that the legs are higher. After warming up for 5-10 minutes, you should not suddenly get up on your feet. After a 10-20 minute rest in the locker room, they take a broom (preferably two) and go to the steam room for another 5-10 minutes. You can bathe with any broom (birch, oak, nettle, juniper). They whip the back, legs, chest, abdomen, arms. It is necessary to touch the body with a broom gently. Often in the bath, various decoctions of herbs (sage, eucalyptus, plantain, coltsfoot, oregano) are used for aroma. Before entering the steam room, you can not wash with soap, wet your head - too. Steam should be sitting, better - lying down. Usually the partner takes two brooms and makes light tangential movements from the back of the head to the feet and back, then the broom is lightly tapped, rubbed, patted, after which the brooms are simply shaken over the body, waved and quickly placed on the lower back, back and pressed tightly (pressed with both hands) and so repeat several times. Rubbing with a broom starts from the buttocks to the cervical spine and back, then they rub the legs from the heel tendon to the gluteal fold, then they whip the feet. They finish steaming with a general stroking (light touch) with a broom of the whole body.

Self-massage is carried out after the first entry into the steam room. The duration of the massage is no more than 10-15 minutes. Apply stroking, shaking and shallow kneading.

A bath (sauna) should take no more than 2 hours (2-4 visits to the steam room, each visit lasting no more than 10 minutes, followed by a shower, swimming in the pool and relaxing). You can stay in the steam room no more than 30 - 35 minutes. After the bath, hot tea, birch sap, as well as cranberries and lingonberries are good.

3.2 Studying the effectiveness of the developed rehabilitation program for obesity

The developed training program in the "School of the patient with obesity" was used for two months. At the beginning of the pedagogical experiment, anthropometric indicators were assessed - height, body weight, waist circumference.

Given that obesity is a disease in which the cardiorespiratory system suffers, we measured blood pressure and lung capacity. The study also assessed the level of anxiety (according to Taylor) and motivation for recovery. The results obtained at the beginning of the pedagogical experiment are presented in tables 3.3 - 3.6.

Table 3.3 - Anthropometric indicators in the EG and CG at the beginning of the pedagogical experiment

№ p/pKG EG body mass BMI waist circumferencebody weight BMI waist circumference1. 7325.56885724.67692. 6727.89806527.41773. 10235.291087027.34764. 6926.29756024.65745. 6626.78758530.85936. 8127.06817628.61877. 6527.41738632.77968. 8431.621018832.72959. 5724.03747526.577910. 6930.67788628.4189 X±SX73.3±4.2528.26±1.1183.3±4.0474.8±3.8328.4±0.9883.52±3.22

From the data presented in Table 3.3 it can be seen that both in the CG and in the EG the women participating in the experiment are overweight. In the CG, the Quetelet body mass index at the beginning of the pedagogical experiment was 28.26±1.11 kg/m 2, in the EG - 28.4±0.98 kg/m 2. If the BMI is greater than 26.9, then this indicates the presence of the initial stage of obesity.

Table 3.4 - Indicators of the cardiorespiratory system in the EG and CG at the beginning of the pedagogical experiment

No. p/pKG EGAD sysAD diastGELAD sysAD diastGEL1. 15010022001459027002. 1559525001409530003. 1409028001208031004. 1459527001308522005. 150100180014010019006. 155100170015010021007. 14090270016010025008. 1509523001559518009. 1501002600150100220010. 130802100140952300 X±SX146.5±2.6194.5±2.142340±128.81143.0±3.9494.0±2.332380±146.4

Table 3.4 shows that the majority of patients in both groups have elevated blood pressure - both systolic and diastolic. This is consistent with the literature that excessive fat deposition adversely affects cardiovascular function. -vascular system and, first of all, contributes to the development of arterial hypertension.

Patients with obesity already in the early stages develop shortness of breath after minor physical exertion due to changes in the mobility of the diaphragm. These changes lead to a decrease in VC, deterioration of ventilation and the development of hypoxemia.

In patients participating in the study. VC parameters are on average within the normal range. This indicator also reflects the degree of fitness of the body. Therefore, we used this indicator to assess the effectiveness of ongoing activities.

Table 3.5 - Indicators of the psycho-emotional state and the level of motivation in the EG and CG at the beginning of the pedagogical experiment

No. p/pKGEGAnxietyMotivationAnxietyMotivation1. 351143122. 351143103. 41935124. 421140125. 381137106. 41104387. 421240108. 451137129. 4112411110. 35114011 X±SX39.5±1.1810.9±0.2939.9±0.9410.8±0.44

In the CG, at the beginning of the pedagogical experiment, 4 patients out of 10 have a high level of anxiety, 6 have a very high level. In the EG, the level of anxiety was high in 2 patients, and very high in 8 patients. According to the test "Restoration of the locus of control" in the CG, the average score for the group is 10.9±0.29 points, in the EG - 10.8±0.44 points. The maximum score on this test is 36 points, therefore, in both groups, the results are below the average. Next, we compared the indices of the EG and CG and assessed the significance of differences (Table 3.6).

Table 3.6 - Investigated indicators at the beginning of the study in the EG and CG

Parameters CG (X±Sx) EG (X±Sx) Reliability of differences (at t Crete. = 2,1) Body weight, kg73.3±4.2574.8±3.83t obs. = 0.26 p>0.05 BMI, kg/m 228.26±1.1128.4±0.98t obs. = 0.1 p>0.05 Waist circumference, cm83.3±4.0483.52±3.22t obs. = 0.04 p>0.05 BP syst. 146.5±2.61143.0±3.94t obs. = 0.74 p>0.05 BP diast. 94.5±2.1494.0±2.33t obs. = 0.16 p>0.05 VC, ml2340±128.812380±146.4t obs. = 0.21 р>0.05 Anxiety, score 39.5±1.1839.9±0.94t obs. = 0.27 p>0.05 Motivation, score10.9±0.2910.8±0.44t obs. = 0.19 p>0.05

Table 3.4 shows that at the beginning of the pedagogical experiment, no significant differences were found for all the studied indicators, which allows them to be further compared.

After carrying out rehabilitation measures, we re-tested for the same indicators (tables 3.7 - 3.10). In both groups, there is a positive dynamics of results in almost all studied indicators (Figure 3.1).

Table 3.7 - Anthropometric indicators in the EG and CG at the end of the pedagogical experiment

№ p/pKG EG body mass BMI waist circumferencebody weight BMI waist circumference1. 7124.86875021.64602. 6627.47805221.93683. 10034.601075621.88664. 6725.53765221.37665. 6526.37746824.68856. 7926.40806223.33787. 6426.99727127.05868. 8230.861007327.14869. 5623.61735820.557010. 6830.22776922.7980 X±SX71.8±4.1327.69±1.1082.6±3.9861.1±2.8923.2±0.7874.5±3.21

From the data presented in Table 3.7, it can be seen that in the CG the body mass index improved, but still the average result for the group exceeds the norm. In the EG, the indicator improved significantly and corresponds to the norm.

Table 3.8 - Indicators of the cardiorespiratory system in the EG and CG at the end of the pedagogical experiment

No. p/pKG EGAD sysAD diastGELAD sysAD diastGEL1. 15010023001308031502. 15510026001208034503. 1409029001108035004. 1409027501208027005. 15010018501209023006. 15510018001259025007. 1408027001309029008. 1508522001408022009. 150100260012580260010. 140802100125852700 X±SX147.0±2.1192.5±2.862380±128.67124.5±2.6683.5±1.582800±149.3

Table 3.8 shows that most patients in the CG have elevated blood pressure - both systolic and diastolic. In the EG, the result improved significantly and in most patients the pressure returned to normal.

Improvement in both anthropometric indicators and the state of the cardiorespiratory system could not but affect the psycho-emotional state (Table 3.9).

Table 3.9 - Indicators of the psycho-emotional state and the level of motivation in the EG and CG at the end of the pedagogical experiment

No. p/pKGEGAnxietyMotivationAnxietyMotivation1. 301530302. 271225323. 351018314. 351128305. 261517326. 351820257. 381825308. 451117329. 4013183110. 35122528 X±SX34.6±1.9313.5±0.9622.3±1.6230.1±0.73

In the CG at the end of the pedagogical experiment, 2 out of 10 patients have a very high level of anxiety, 8 have a high level. In the EG, 2 patients had a high level of anxiety, and 8 had an average level. According to the test "Restoration of the locus of control" in the CG, the average score for the group is 13.5±0.96 points, in the EG - 30.1±0.73 points. The maximum score for this test is 36 points, therefore, in the CG the result is below the average, and in the EG it is above the average.

Table 3.10 - Investigated indicators at the end of the study in the EG and CG

ParametersCG (X±Sx) EG (X±Sx) Reliability of differences (at t Crete. = 2,1) Body weight, kg71.8±4.1361.1±2.89t obs. = 2.12 p<0,05BMI, kg/m 227.69±1.1023.2±0.78t obs. = 3.31 r<0,05Waist circumference, cm82.6±3.9874.5±3.21t obs. = 1.58 p>0.05 BP syst. 147.0±2.11124.5±2.66t obs. = 6.63 r<0,05BP diast. 92.5±2.8683.5±1.58t obs. = 2.75 r<0,05VC, ml2380±128.812800±149.30t obs. = 2.13 p<0,05Anxiety, score34.6±1.9322.3±1.62t obs. = $4.88<0,05Motivation, score13.5±0.9630.1±0.73t obs. = $13.79<0,05

From the data presented in Table 3.10, it can be seen that at the end of the pedagogical experiment, the results in the EG significantly exceed the results in the CG in all indicators, except for waist circumference, where the differences are not significant.

Figure 3.1 - Growth of indicators in the process of pedagogical experiment in the CG and the EG

Assessing the dynamics of the results in the course of the pedagogical experiment, we can say that in the EG, for all indicators, there were pronounced improvements in all the studied indicators - both directly in body weight, and in the state of the cardiorespiratory system and psycho-emotional state. In the CG, the changes in both body weight and blood pressure indicators remained practically unchanged. A particularly pronounced improvement occurred in indicators characterizing the level of the patient's motivation for recovery. This is primarily due to the use of the training program in the "School of the Obese Patient".

Thus, as a result of the analysis of the conducted pedagogical experiment, the obvious advantage of the training program developed by us in the form of the "School of the patient with obesity" was revealed, both in terms of body weight, the state of the cardiorespiratory system, and the reduction of anxiety and a significant increase in motivation for recovery. It can be concluded that the most effective way to combat obesity is the desire of the patient himself, the necessary knowledge, as well as complex treatment that combines diet therapy and optimal physical activity.

Conclusion

The results of the study allow us to draw the following conclusions:

.Based on the analysis of scientific and methodological literature, it was revealed that the most effective means of physical rehabilitation used in a comprehensive program for the treatment of obesity are therapeutic exercises, massage, physiotherapy, diet therapy, swimming, dosed walking, running, sauna, training on simulators, sports and outdoor games.

2.The developed training program in the form of the "School of the patient with obesity" is a combination of theoretical and practical classes under the guidance of an instructor-methodologist in physical rehabilitation, self-study dosed walking, self-massage and a visit to the bath.

.The results of the pilot study confirmed the advantages of the program developed by us. The level of differences in body weight, BMI, blood pressure, VC, anxiety and motivation for recovery is significant with a probability of p≤0.05. Based on this, it can be concluded that the developed program in the form of the "School of the patient with obesity" is effective for the treatment of obesity of I-II degrees and overweight.

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Julia K, A 32-year-old woman came to the clinic for propaedeutics of childhood diseases with complaints of overweight, daily headaches, and an increase in blood pressure up to 160/100 mm. rt. Art., menstrual disorders, stiffness and pain in the cervical spine.
During an objective examination, the height was 166 cm, weight 115 kg. Excess body weight (60%) - obesity of the III degree, BMI=41.8 kg/m 2 FROM - 108 cm, ABOUT - 118 cm. Subcutaneous fat is overdeveloped, distributed mainly on the abdomen (abdominal type of obesity). The skin is of normal color, moist, on the skin of the chest, shoulders, abdomen, striatal syndrome.
In a laboratory examination in a biochemical blood test: total cholesterol - 6.9 mmol/l, β-lipoproteins - 4.5 mmol/l, triglycerides - 2.0 mmol/l. There is an increase in the level of total cholesterol.

Clinical diagnosis - Hypothalamic obesity III degree, progressive course.
Complication - Metabolic syndrome.
Related - Osteochondrosis of the cervical spine
Treatment - Education at the weight control school (4 lessons), hypocaloric diet (1200 kcal), exercise therapy, treatment of arterial hypertension.
At the same time, transcranial magnetotherapy - 3 sessions daily with a procedure duration of 5 to 15 minutes (with an increase in duration with each subsequent procedure).
Then continued transcranial magnetotherapy, adding transcranial electrical stimulation to it - 10 sessions with a procedure duration of 15 minutes. The apparatus "AMO-ATOS-E" was used.
In parallel with the methods of transcranial exposure, electrical stimulation was performed on the region of the anterior abdominal wall and thighs using the Miovolna apparatus.
The duration of the first 3 procedures is 10-15 minutes in the soft stimulation mode (mode-). The next 7 procedures with a duration of 15-20 minutes in the hard stimulation mode (mode - ). Only 10 sessions.
A re-examination 1 month after the end of the course of treatment showed a clear positive trend. A second course of physiotherapy after 3 months is recommended. When re-examined after 6 months, the positive effect was preserved.

Dynamics of clinical and metabolic parameters of Yulia K, 32 years old

Options	before treatment	after 1 month	in 6 months
Body weight (kg)
Waist circumference (cm)
Hip circumference (cm)
Arterial pressure
Cholesterol	6.9(N<6,0 ммоль/л)
β-lipoproteins	4.5(N<4,9 ммоль/л)
triglycerides	2.0(N<2,0 ммоль/л)

For the treatment of concomitant pathology - osteochondrosis of the cervical spine, the same apparatus "AMO-ATOS-E" with a paired prismatic emitter of a traveling magnetic field was used.
The emitter was located paravertebral in the cervical region, the patient was located lying on her stomach. Magnetic field mode - variable (), modulation frequency 1-10 Hz with a smooth increase from session to session, exposure time 15 minutes, number of sessions per course - 10.

After the first 5 sessions, the patient felt relief, stiffness disappeared. At the end of the course, the symptoms of chronic osteochondrosis were stopped.

Along with diet therapy and motor regimen, the prescription of natural and preformed physical factors is justified for obese patients. According to many experts, physical means occupy the second most important place in the complex therapy of obesity.

Objectives of physiotherapy: to influence the main links in the pathogenesis of the disease, to promote the normalization (correction) of the endocrine system, gradually reduce body weight, stimulate adaptive-compensatory mechanisms, contribute to the normalization of metabolism, increase the energy consumption of the body, improve the functions of the nervous, cardiovascular and respiratory systems , prevent the development of complications and diseases - companions of obesity.

A large place in complex physiotherapy belongs to diaphoretic procedures. They are indicated for obese patients who do not have cardiovascular disorders.

General light baths can be used as diaphoretic procedures. They are carried out at a temperature of 55-60 ° C for 15-20 minutes every other day (10-15 procedures per course of treatment). It is good to alternate light baths with chloride, sodium (marine) baths. To obtain a diaphoretic effect, general wet wraps are used (45-60 minutes daily). For the same purpose, dry-air and steam hot procedures are used.

It should be remembered that these procedures, especially the steam room (Russian bath), are very burdensome for obese patients. Therefore, they are used only in patients with obesity I-II degree without symptoms of circulatory failure. Stay in the sauna is 8-12 minutes, it is repeated during the procedure 2-3 times. When using the Russian bath, stay in the steam room should not exceed 10 minutes at a temperature on the shelf of 69-70 ° C and a relative humidity of 30-40%. To stimulate sweating, you can also use some other thermotherapy procedures (mud and steam baths, paraffin applications, etc.).

Of fundamental importance (in the absence of contraindications) is the inclusion in the treatment complex of hydro- and balneotherapy, which contribute to weight loss, improve metabolic processes of blood circulation, maintain muscle and psycho-emotional tone, have a tonic and hardening effect, increase the patient's motor activity.

The most active are contrast baths, in which it is desirable to combine the action of the temperature factor and movement. These baths normalize blood pressure, improve the contractile function of the myocardium, the state of the central nervous system, and increase the body's heat production.

In obesity, showers are widely used: Charcot's shower, circular, fan, Scottish, underwater shower-massage. Under these influences, along with thermal irritation, mechanical irritation of skin receptors also plays a certain role. The water jet produces a deep tissue massage, improves blood and lymph circulation, and helps to reduce body weight.

Of the balneological procedures, patients are shown carbonic, sulfide, radon, turpentine and other baths. They stimulate metabolic processes, improve capillary blood circulation and tissue respiration function, have a normalizing effect on the central nervous system, neuroendocrine regulation of metabolism.

Mineral waters are also used for underwater intestinal lavages. For these purposes, hydrocarbonate mineral waters are most often used. They contribute to the normalization of the motor function of the sigmoid colon and the cessation of constipation, eliminate violations of the acid-base and electrolyte balance. They are especially justified in the first degree of obesity, when habitual constipation is observed and there are no signs of cardiorespiratory insufficiency.

Weight loss is facilitated by the use of oxygen cocktails (foam) enriched with vitamin C. Oxygen foam is taken 3 times a day 1-1.5 hours before meals, 1-1.5 liters (until you feel full). You can replace food with 6-7 times the intake of oxygen foam on fasting days. The course of treatment is 25-30 days. On an outpatient basis, 2 unloading oxygen days are arranged once a week or a decade.

Of the procedures of general action, used both in resorts and in non-resort conditions for the treatment of obese patients, climatotherapy should be mentioned.

Climatic factors affect the thermoregulatory apparatus, improve neuroendocrine regulation, respiratory and circulatory functions, increase the intensity of redox processes in tissues, normalize the body's reactivity, have a hardening and training effect on the body as a whole and its individual systems. Climatotherapy is carried out in the form of aero-, helio- and thalassotherapy.

The effectiveness of complex treatment of obese patients is increased by sea bathing (or swimming in fresh water). They are applied according to the mode of moderate (temperature not lower than 18 °C) or more often according to the mode of weak (water temperature not lower than 20 °C) impact.

In order to stimulate the whole organism, improve the mood and performance of the patient, normalize metabolism, including fat metabolism, ultraviolet rays can also be used. General ultraviolet irradiation is used according to the main or delayed scheme (up to 2-2.5 biodoses, 20-24 procedures).

To improve the state of carbohydrate, lipid and water-salt metabolism, to eliminate the manifestations of ketoacidosis, drinking mineral waters are indicated. For drinking treatment of obese patients, low-mineralized or medium-mineralized waters of various chemical compositions are used: bicarbonate, sodium chloride, sulfate-calcium-magnesium, carbonic, salt-alkaline, etc. They contribute to an increase in the glycogen-forming function of the liver, a decrease in the elevated level of various lipid fractions, balance, increase the body's alkaline reserves. Mineral waters reduce the resorption of dietary fats and have a laxative and diuretic effect, favorably affect concomitant diseases of the digestive system.

Conclusions on the second chapter

One of the main causes of obesity, along with a violation of the diet, is a decrease in a person’s physical activity, therefore, rehabilitation with the use of physical exercises for this disease seems to be sufficiently reasoned. An important role in this, in addition to a balanced diet with a restriction of fats and carbohydrates, is given to the method of conducting physical exercises for obesity in accordance with the state of each student, on the development of methods for individual physical activity programs.

As the most effective, a complex of physiotherapy exercises in the form of macrocycles is proposed, which are divided into two periods: introductory, or preparatory, and main. At the same time, it is advisable to use moderate-intensity physical activity, which contributes to an increased consumption of carbohydrates and activation of energy supply due to the breakdown of fats.

The complex of physiotherapy exercises includes dosed walking, jogging, dosed running, swimming, rowing, training on simulators. With obesity, self-massage is also shown.

At the same time, it should be taken into account that this complex is not generally indicative, each patient needs an individual approach, taking into account his physical and psychological characteristics.

Another method of physical rehabilitation for obesity is massage, the task of which is to improve blood and lymph circulation in tissues and organs, to reduce body fat in certain areas.

Along with diet therapy and motor regimen, the prescription of natural and preformed physical factors is justified for obese patients. Among them: diaphoretic procedures, hydro- and balneotherapy (showers, carbonic, sulfide, radon, turpentine and other baths), the use of oxygen cocktails, climatotherapy, the use of ultraviolet rays, drinking mineral water.

2.3. Fractures of the bones of the lower extremities

2.4. Massage and physiotherapy for fractures of long bones and bones of the shoulder girdle

3. Physical rehabilitation for joint injuries

3.1. Rehabilitation for injuries of the shoulder joint

3.2. Dislocations in the shoulder joint

3.3. Physical rehabilitation for habitual dislocation of the shoulder (rvp)

3.4. Elbow joint injuries

3.5. Knee joint injuries

Approximate lg complex in the exercise therapy room

Approximate set of physical exercises in the pool

3.6. Ankle injuries

4. Physical rehabilitation for fractures of the spine and pelvis

4.1. Spinal fractures

4.2. Pelvic fractures

The duration of individual periods of exercise therapy (days) depending on the nature of pelvic fractures

5. Physical rehabilitation for hand and foot injuries

5.1. Metacarpal fractures

5.2. Foot injuries

5.3. Achilles tendon injuries

6. Physical rehabilitation for maxillofacial injuries, damage to the ENT organs and eyes

6.1. Oral and maxillofacial injuries

6.2. Damage to ENT organs

6.3. Eye injury

7. Physical rehabilitation of patients with burns and frostbite

7.1. burns

7.2. Frostbite

8. Basic principles of rehabilitation of athletes with injuries and diseases of the musculoskeletal system

9. Physical rehabilitation for violations of posture, scoliosis and flat feet

9.1. Rehabilitation for violations of posture

Test card for the detection of posture disorders

9.2. Rehabilitation for scoliosis

9.3. Rehabilitation for flat feet

9.4. Games for violations of posture, scoliosis and flat feet

III physical rehabilitation in diseases of the cardiovascular system

1. General data on diseases of the cardiovascular system

1.1. Mechanisms of therapeutic and rehabilitation action of physical exercises

1.2. Fundamentals of the methodology of physical exercises in the treatment and rehabilitation of patients with cardiovascular diseases

2. Physical rehabilitation for atherosclerosis

3. Physical rehabilitation for coronary heart disease

3.1. Determination of tolerance to physical activity (tfn) and the functional class of a patient with coronary artery disease

3.2. Methods of physical rehabilitation of patients with coronary artery disease at the sanatorium stage

3.3. Physical rehabilitation of patients with coronary artery disease IV functional class

4. Physical rehabilitation for myocardial infarction

4.1. Stages of rehabilitation of patients with myocardial infarction

4.2. Stationary stage of rehabilitation of patients

Classes of severity of patients with myocardial infarction

Terms of appointment for patients with myocardial infarction of various degrees of activity depending on the severity class of the disease

4.3. Sanatorium stage of rehabilitation of patients

The program of physical rehabilitation of patients with myocardial infarction at the sanatorium stage (L.F. Nikolaeva, D.K. Aronov, N.A. Belaya, 1998)

4.4. Dispensary-polyclinic stage of rehabilitation of patients

5. Physical rehabilitation for hypertension (gb)

5.1. Etiology and pathogenesis of GB

5.2. Degrees and forms of GB, clinical course

5.3. Mechanisms of the therapeutic effect of physical exercises

5.4. Basic principles of treatment and rehabilitation of patients with hypertension

6. Physical rehabilitation for hypotension and neurocircular dystonia

6.1. The concept of hypotension

6.2. The concept of neurocircular dystonia (NCD)

6.3. Method of physical rehabilitation

7. Physical rehabilitation for acquired heart defects

8. Physical rehabilitation for obliterating endarteritis and varicose veins

8.1. Obliterating endarteritis

8.2. Varicose veins

IV Physical Rehabilitation for Respiratory Diseases

1. Physical rehabilitation for bronchial asthma

1.1. Clinical and physiological substantiation of the use of physical rehabilitation means

1.2. Means of physical rehabilitation

2. Physical rehabilitation for emphysema

3. Physical rehabilitation for bronchitis and bronchiectasis

4. Physical rehabilitation for pneumonia

5. Physical rehabilitation for pleurisy

6. Physical rehabilitation for pneumosclerosis

V physical rehabilitation for diseases of the digestive system, metabolism, joints and urinary organs

1. Physical rehabilitation for gastritis and peptic ulcer of the stomach and duodenum

1.1. Physical rehabilitation for gastritis

The pathogenesis of chronic gastritis

1.2. Physical rehabilitation for peptic ulcer of the stomach and duodenum

2. Physical rehabilitation for dysfunctions of the intestines and biliary tract, enterocolitis and prolapse of the abdominal organs

2.1. Inflammatory diseases

2.2. Intestinal dyskinesia

2.3. Biliary dyskinesia

2.4. Physical rehabilitation for prolapsed abdominal organs

3. Physical rehabilitation for metabolic disorders

3.1. Physical rehabilitation for obesity

3.2. Physical rehabilitation for gout and diabetes

4. Physical rehabilitation for diseases of the joints

5. Physical rehabilitation for diseases of the urinary organs

6. Games for diseases of internal organs (respiratory, cardiovascular, digestive systems)

VI physical rehabilitation during surgical interventions on the organs of the chest and abdominal cavity

1. Physical rehabilitation during surgical interventions on the heart, large vessels and lungs

1.1. Exercise therapy in surgical interventions for heart defects

1.2. Exercise therapy in coronary artery bypass grafting and resection of postinfarction aneurysm of the left ventricle

1.3. Exercise therapy for surgical interventions on large vessels

1.4. Physical rehabilitation during surgical interventions on the lungs.

2. Physical rehabilitation during surgical interventions on the abdominal organs

2.1. Clinical and physiological rationale for the use of exercise therapy

VII. Physical rehabilitation for diseases and injuries of the nervous system

1. Characteristics of changes in diseases and injuries of the nervous system

2. Physical rehabilitation in cerebrovascular pathology

2.1. System of staged rehabilitation of patients with cerebrovascular pathology

3. Physical rehabilitation for traumatic disease of the spinal cord (tbsm)

3.1. Clinic of traumatic disease of the spinal cord (tbsm)

3.2. Mechanisms of the rehabilitation effect of physical exercises and features of the methods of their application

3.3. Physical rehabilitation up to 12 months

3.4. Principles of rehabilitation in the late period of TBSM

3.5. Methods of physical rehabilitation in the late period of TBSM

3.6. Features of physical rehabilitation of persons with cervical spine injury in the late period of TBSM

4. Physical rehabilitation for osteochondrosis of the spine

4.1. Clinical picture of osteochondrosis

4.2. Treatment and rehabilitation of patients with osteochondrosis

5. Physical rehabilitation for diseases and injuries of the peripheral nervous system

5.1. Rehabilitation of patients with neuritis

5.2. Neuritis of the facial nerve

5.3. Brachial plexus injury

5.4. Neuritis of the ulnar nerve

5.5. Neuritis of the tibial and peroneal nerves

6. Physical rehabilitation for traumatic brain injury

7. Physical rehabilitation for neuroses

8. Games for patients with diseases and injuries of the nervous system

VIII Physical Rehabilitation for Diseases and Injuries in Children and Adolescents

1. Anatomical and physiological characteristics of the child's body in different age periods

2. Rehabilitation of children with congenital developmental anomalies

2.1. Congenital dislocation of the hip

2.2. Congenital muscular torticollis (CM)

2.3. congenital clubfoot

2.4. Umbilical hernia

3. Rehabilitation of children with age-related infectious diseases and their prevention

4. Rehabilitation for diseases of the cardiovascular system in children _

4.1. Rheumatism

4.2. Myocarditis

43. Functional disorders (changes) in the work of the heart in children

Heart rate at rest for children of different ages

5. Rehabilitation of children with respiratory diseases

5.1. Exercise therapy for bronchitis in children

5.2. Chronic (recurrent) bronchitis

5.3. Exercise therapy for pneumonia

5.4. Bronchial asthma in children

6. Rehabilitation of children with diseases and injuries of the nervous system

6.1. Infantile cerebral palsy (CP)

6.2. Therapeutic exercise for myopathy

7. Outdoor games in the system of rehabilitation of children

IX features of physical exercises during pregnancy, childbirth and the postpartum period. Therapeutic exercise for gynecological diseases

1. Major changes in a woman's body during pregnancy

2. Gymnastics during pregnancy

Contraindications to exercise during pregnancy

Criteria for the distribution of pregnant women into groups for gymnast classes (according to A.K. Poplavsky)

Features of methods of physical exercises in three groups of pregnant women (according to A.K. Poplavsky)

3. Gymnastics in childbirth

4. Gymnastics in the postpartum period

An approximate set of special exercises for the wrong position of the uterus (backward bend)

X rehabilitation of the disabled

1. The concept of disability. Different categories of disabled people

2. Psychological and pedagogical features of work on the rehabilitation of disabled people

3. Rehabilitation of disabled people with injuries and defects of the musculoskeletal system

3.1. Amputation

Approximate set of special exercises after leg amputation (3-4 weeks)

3.2. Polio

5. Rehabilitation of disabled people with sensory speech disorders

5.1. Hearing disorders

5.2. visual impairment

XI Physical Culture and Recreational Sports for the Disabled

1. Structure and content of physical culture and sports for the disabled

2. Means, methods and forms of physical education of the disabled

3. Features of the development of physical qualities in various groups of disabled people

4. Organization of recreational sports for the disabled

5. Organization and holding of competitions in sports for the disabled

3.1. Physical rehabilitation for obesity

Obesity- a group of diseases and pathological conditions characterized by excessive deposition of fat in the subcutaneous adipose tissue and other tissues and organs, due to metabolic disorders, and accompanied by changes in the functional state of various organs and systems. According to WHO, 25-30% of adults and 12-20% of children in the world are obese. Obesity diseases occupy a leading place in the structure of general morbidity and disability.

Classification and degrees of various types of obesity. Currently, the most common classification according to D.Ya. Shurygin, taking into account the polyetiology of obesity:

1) forms of primary obesity: a) alimentary-constitutional; b) neuroendocrine: hypothalamic-pituitary; adipose-genital dystrophy (in children and adolescents).

2) forms of secondary (symptomatic) obesity: cerebral, endocrine.

According to the nature of the course, obesity is divided into progressive, slowly progressive, persistent and regressive. There are also 4 degrees of obesity: I degree - excess of due weight up to 29%, II degree - 30-49%, III degree - 50-100%, IV degree - above 100% of body weight.

Etiology and pathogenesis. Numerous etiological factors can be divided into exogenous(overeating, reduced physical activity) and endogenous(genetic, organic lesions of the central nervous system, hypothalamic-pituitary region). It has now been established that the regulation of fat deposition and mobilization in fat depots is carried out by a complex neurohumoral (hormonal) mechanism, which involves the cerebral cortex, subcortical formations, the sympathetic and parasympathetic nervous systems, and endocrine glands. Fat metabolism is strongly influenced by stress factors (psychic trauma) and CNS intoxication.

The regulation of food intake is carried out by the food center, localized in the hypothalamus. Lesions of the hypothalamus of an inflammatory and traumatic nature lead to an increase in the excitability of the food center, increased appetite and the development of obesity. In the pathogenesis of obesity, a certain role belongs to the pituitary gland. Speaking about the development of obesity, one should not underestimate the importance of hormonal factors, since the processes of fat deposition mobilization are closely related to the functional activity of most endocrine glands. Reduced physical activity naturally leads to a decrease in energy consumption and unoxidized fats in most cases are deposited in fat depots, which leads to obesity.

Obesity is a serious disease requiring special treatment; it can significantly affect all the most important organs and systems, being a risk factor for the development of cardiovascular diseases (CHD, atherosclerosis, hypertension), for example, heart failure. In addition, there is a relationship between the degree of obesity and the severity of respiratory failure; The high position of the diaphragm in obese individuals reduces its excursion and contributes to the development of inflammatory processes (bronchitis, pneumonia, rhinitis, tracheitis) in the bronchopulmonary system. Diseases of the gastrointestinal tract (chronic cholecystitis, cholelithiasis, chronic colitis) are detected. The liver in such patients is usually enlarged due to fatty infiltration and stagnation. Due to obesity, the static load on the musculoskeletal system (joints of the lower extremities, spine) increases, arthrosis of the knee and hip joints, flat feet, herniated discs (osteochondrosis) occur. Diabetes develops, menstrual irregularities, amenorrhea, infertility, gout occur. Obesity can underlie functional disorders of the nervous system (memory impairment, dizziness, headaches, drowsiness during the day and insomnia at night). A depressive state may occur: complaints of poor health, mood swings, lethargy, drowsiness, shortness of breath, pain in the heart, swelling, etc.

In the treatment and rehabilitation of patients with obesity, a set of methods is used, the most important of which are exercise and diet, aimed at performing the following tasks:

Improvement and normalization of metabolism, in particular, fat metabolism;

Reducing excess body weight;

Restoring the body's adaptation to physical stress;

Normalization of the functions of the cardiovascular, respiratory, digestive and other body systems suffering from obesity;

Improvement and normalization of the patient's motor sphere;

Increasing nonspecific resistance.

An important place in the treatment and rehabilitation of obesity is occupied by a balanced diet with a restriction of fats and carbohydrates. The amount of fat in the daily diet is reduced to 0.7-0.8 g / kg, while vegetable fats (1.3-1.4 g / kg) should be present, the amount of carbohydrates is sharply limited to 2.5-2.7 g / kg (daily rate 5.2-5.6 g / kg), primarily due to the exclusion of sugar, bread, confectionery, sugary drinks, etc. The amount of protein in food remains normal - 1.3-1.4 g /kg or slightly higher, which prevents the loss of tissue protein, increases energy consumption due to the absorption of proteins, creates a feeling of satiety. In addition, the diet should include:

1. Restriction in the daily intake of free fluid to 1-1.2 liters, which enhances the breakdown of fat as a source of "internal" water.

2. Limiting the amount of table salt to 5-8 g per day. Food is prepared almost without salt, adding it during meals, excluding salty foods.

3. Exclusion of alcoholic beverages, which weaken self-control over food intake and are themselves a source of energy.

4. Exclusion of appetizing dishes and products: spices, strong broths and sauces.

5. Mode of 5-6 meals a day (fractional) with the addition of vegetables and fruits to the diet between the main meals.

6. The use of food products (prunes, dried apricots, beets) that contribute to normal bowel movement, self-massage of the abdomen, crawling on all fours are good for this purpose.

A necessary condition for successful treatment, and even more so for the recovery of obese patients, is the correct mode of physical activity. The exercise therapy method is pathogenically determined, and therefore an important and integral element of the complex rehabilitation of obese patients. When choosing physical exercises, determining the speed and intensity of their implementation, it should be borne in mind that endurance exercises (long-term moderate loads) contribute to the consumption of a large amount of carbohydrates, the release of neutral fats from the depot, their breakdown and transformation! Exercise therapy is prescribed in all available forms, their selection should correspond to the age and individual characteristics of patients, providing increased energy consumption. It is advisable to use moderate-intensity physical activity, which contributes to an increased consumption of carbohydrates and activation of energy supply due to the breakdown of fats.

Physiotherapy exercises are carried out in the form of macrocycles, which are divided into two periods: introductory, or preparatory, and main. IN introductory (preparatory) period, the main task is to overcome the reduced adaptation to physical activity, to restore motor skills and physical performance that usually lag behind age standards / achieve a desire to actively and systematically engage in physical education. For this purpose, the following forms of exercise therapy are used: therapeutic exercises (with the involvement of large muscle groups), dosed walking in combination with breathing exercises, self-massage. Main Period designed to solve all other problems of treatment and recovery. In addition to LH, UGG, patients are recommended dosed walking and running, walking, sports games, and the active use of exercise equipment. Subsequently, physical exercises are aimed at maintaining the achieved results of rehabilitation; running, rowing, swimming, cycling are used, in winter - skiing. One of the important factors in the prevention and treatment of obesity is proper breathing: in order for fats to release the energy contained in them, they must undergo oxidation.

Classes should be long (45-60 minutes or more), movements are performed with a large amplitude, large muscle groups are involved in the work, swings are used, circular movements in large joints, exercises for the body (tilts, turns, rotations), exercises with objects. A large proportion in the activities of overweight people should be occupied by cyclic exercises, in particular

walking and running. In doing so, the following must be taken into account:

1) walking and running can be recommended to patients with III degree of obesity very carefully, since excessive static load can lead to disorders in the musculoskeletal system, in this case, patients can be recommended rowing and exercise bike, swimming;

2) admission to classes, especially running, is carried out by a doctor with a satisfactory functional state of those involved, in the process of classes, systematic medical and pedagogical control is necessary.

Dosed walking: very slow - from 60 to 70 steps / min (from 2 to 3 km / h) with III degree obesity; slow - from 70 to 90 steps / min (from 2 to 3 km / h) with obesity of the III degree; medium "- from 90 to 120 steps / min (from 4 to 5.6 km / h) with obesity II-I degree; fast - from 120 to 140 steps / min (from 5.6 to 6.4 km / h) with obesity I-I degree; very fast - more than 140 steps / min. It is used for people with good physical fitness. Particular attention should be paid to breathing: breathing should be deep and rhythmic, exhalation should be longer than inhalation (2-3-4 steps - inhale, exhale for 3-4-5 steps.) The first weeks of walking training require a short rest of 2-3 minutes to perform breathing exercises.

Jogging, metered running. A running lesson is structured as follows: before running, a warm-up is carried out (10-12 minutes), then jogging for 5-6 minutes plus walking (2-3 minutes); then rest (2-3 minutes) - and so 2-3 times for the entire lesson. Gradually, the intensity of running increases, and the duration decreases to 1-2 minutes, the number of series is brought to 5-6, and the pause between them increases. After 2-3 weeks (or more) of training, they move on to a longer run of moderate intensity up to 20-30 minutes with 1-2 rest intervals.

An approximate scheme of FR classes is as follows:

Patients with grade III obesity and a satisfactory state of the cardiovascular system are engaged in LH 3 times a week, dosed walking and sports games once a week.

Patients with obesity II-I degree with concomitant diseases, but with a satisfactory state of the cardiovascular system: 2 times a week - LH, 2 times - dosed walking (DH), once dosed running (DB) and sports games (SI) .

Patients with II-I degree obesity without concomitant diseases: 2 times - LH, 1 time - DC, 2 times - DB, 1 time - SI.

Swimming, like rowing, also has a positive effect on obesity, since these sports lead to significant energy expenditure. Rowing and swimming lessons can be organized at the sanatorium and polyclinic stages. If necessary, rowing machines are used. Swimming lesson consists of 3 parts: introductory (10-15 minutes) - lesson in the hall ("dry" swimming); the main (30-35 min) - swimming of moderate intensity in various ways with pauses for rest and breathing exercises (5-7 min) and the final (5-7 min) - exercises at the side to restore the functions of blood circulation and respiration.

Training on simulators. In the complex treatment of obesity, exercises on simulators occupy a significant place. At the same time, it should be taken into account that systematic physical exercises performed on simulators (alternating every 3-5 minutes of work and rest) for 60-90 minutes of training have a positive effect on clinical parameters and most effectively affect lipid metabolism. At the same time, heart rate under load should not exceed 65-75% of the individual maximum heart rate.

In the course of classes, a system of monitoring the state of health and self-control is mandatory. For this purpose, heart rate and blood pressure are measured, health indicators are assessed and functional tests are carried out (Martinet test, bicycle ergometric test, breathing tests of Stange, Genchi, etc.).

With endocrine and cerebral forms of obesity, the load is moderate, the duration of classes is 20-30 minutes, exercises for the middle muscle groups and breathing exercises (diaphragmatic breathing) are used. Endurance exercises are prescribed later, and rather cautiously, strength exercises are not recommended. Massage, water procedures, and other physiotherapy according to indications are also used.

In case of obesity, self-massage is indicated, it is most effective in places of the greatest deposition of adipose tissue (self-massage or massage of the abdomen, gluteal muscles, thighs, etc.). Self-massage techniques are carried out in the following sequence: stroking, kneading, shaking, rubbing, movements, percussion techniques. Massage ends with stroking