RU2700675C1 - Method of personalized physical rehabilitation of patients with atrial fibrillation at early postoperative period of radio-frequency ablation of mouths of pulmonary veins - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physical rehabilitation (PR), and can be used in patients with atrial fibrillation (AF) following a radiofrequency ablation surgery of pulmonary vein mouths (RFA PV). For this purpose, the PR program is started on the following postoperative day. It is carried out at the first stage of cardiac rehabilitation (CR) and II outpatient stage in the polyclinic, with transition to occupations at home. PR program consists of three periods. Preparation course includes 3 sessions at the first stage of the CR before discharge from the hospital, up to 25 sessions at the early II outpatient stage of the CR in the conditions of a polyclinic rehabilitation department. Main one, including up to 40 sessions, is performed at the II outpatient stage of the CR in the home environment. Maintenance period in the late stage II outpatient stage is not limited in time. During the preparatory period of the stationary stage, the patients perform exercises in the prone position on a flat solid surface on the abdomen, back or right side. At other stages – sitting or in vertical position. Set of exercises and number of their repetitions as a part of the therapeutic complex performed at the outpatient preparatory stage are varied taking into account individual patient's energy expenditures and clinical state. At all stages of exercise therapy, patients perform eye exercises, respiratory exercises with deep diaphragmatic breathing. During the main and supporting PR periods, the patients perform the exercises taking into account their energy costs for stretching at the gymnastic wall, step-training, exercises with burdening, dosed walking. PR efficiency is controlled by repeated VEM-test, questionnaire QPA-23+, hospital scale of anxiety and depression HADS, questionnaire of quality of life in 1 month, 3 months and 6 months after operation of RFA PV.

EFFECT: method enables the personalized physical rehabilitation of the patients with AF at the early stages of the RFA PV surgery is effective and safe due to the developed rehabilitation program which is selected taking into account the patient's functional class and is dosaged according to its individual energy costs.

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Description

The invention relates to medicine, rehabilitation of cardiological patients with atrial fibrillation (AF) after the operation of radiofrequency ablation of the mouth of the pulmonary veins (RF RF).

AF is one of the most common forms of cardiac arrhythmias in patients with cardiovascular disease (CVD). The development of AF is associated with a deterioration in the quality of life and working capacity of patients, an increase in the number of hospitalizations (60-67%), general mortality (1.8-2 times), stroke (5 times) and the progression of heart failure. The method of catheter RF RF is aimed at maintaining sinus rhythm. At the same time, it was found that in the postoperative period relapses of AF - “postablative tachycardia” develop in 35-52% of patients, and in patients with structural heart diseases in 47-74% of cases. The involvement of patients with AF after RF RF in rehabilitation programs is associated with many problems, primarily of a methodological nature. It is known that in most patients, an attack of AF can be triggered precisely by physical exertion (FN). In addition, the RFA RF procedure itself, which is a mechanical damage to tissues - “cauterizing” the lesion and the path of electric impulse from the drug to the atria (foci of necrosis is formed) in order to change the electrophysiological properties of both the drug and the left atrium, initiates a number of pathological processes - - a state of hypersympathicotonia, aseptic myo- and pericardial inflammation, oxidative stress, endothelial dysfunction and the development of fibrosis, contributing to structural remodeling of the atria and

reduce their contractility. This can lead to a decrease in ventricular contractility and, as a result, there is an increase in heart rate (HR) in order to maintain cardiac output. All these factors increase the risk of AF in the postoperative period. On the other hand, physical inactivity or low physical activity (FA) are also considered as factors that provoke the development of AF paroxysms. In this regard, it is not known what optimal dose of aerobic FN is useful for AF patients, what types of FA should be recommended to these patients, how physical rehabilitation programs should be constructed after invasive treatment of AF.

Physical rehabilitation is an integral part of cardiorehabilitation in patients with CVD.

The literature describes a method of rehabilitation of patients with coronary heart disease (CHD), which consists in conducting a stress test by performing FN with simultaneous registration of cardiac activity parameters and the implementation of additional training load by walking with a load (RF patent No. 2440085, publ. 01.20.2012). The method involves determining the threshold power of the FN, the selection of a certain type of training load (walking with a load), dosing the training power of the FN with the calculation of the individual walking speed. However, the therapeutic effect of this method is not known after heart surgery and heart rhythm disturbances. In addition, this method does not allow to achieve a stable therapeutic effect in a short time.

There is a method of rehabilitation of patients with coronary heart disease, which consists in conducting a stress test with simultaneous registration of parameters of cardiac activity, performing training FN and evaluating the effectiveness of the rehabilitation process (RF patent No. 2556485 according to class

IPC A61B 5/0402, publ. 07/10/2015). In this case, as a parameter of cardiac activity, a change in the ST segment shift is recorded, the ST index is calculated, and the training load is carried out in the form of a cycle of alternate clamping and restoration of blood flow in the peripheral vessels. This known method is also not used after heart surgery and heart rhythm disturbances.

There is a method of evaluating the effectiveness of the rehabilitation of patients with coronary heart disease, which consists in conducting a stress test by performing FN with simultaneous registration of cardiac activity parameters, performing a training load, conducting a second stress test, evaluating the effectiveness of rehabilitation by comparing the estimated indicators, and the value is used as such an indicator the concentration of heat shock protein with a molecular mass of 70 kDa (RF application No. 2016106888, publ. 05.22.2017). This method is suitable for patients with coronary artery disease of various etiologies, including after percutaneous coronary intervention, but is not used in the rehabilitation of patients with AF after surgery, RF RF. In addition, the known method is complex, requires additional time and financial costs for determining the level of heat shock protein, as an indicator of the effectiveness of the rehabilitation program.

Closest to the claimed by the authors method is the method of rehabilitation of patients with AF after RF RF, described in the article "Risom S.S., Zwisler A.D., Rasmussen T.B., Sibilitz K.L., et al. "The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation: the randomized CopenHeartRFA trial protocol", BMJ Open. 2013. 20. P. 3 ". Researchers suggest starting physical rehabilitation 1 month after RFA and continuing it until 12 weeks. Suggested forms of FT include: group exercises 3 times a week for 60 minutes, daily physical activity (YES) in

in the form of walks, cycling, gardening. The FT program used a set of general developmental exercises for warming up (warming up, stretching and relaxing), strength exercises for the upper body with an intensity of 30-40% of the maximum possible, strength exercises for the lower body with an intensity of 40-50% of the maximum, exercises on a stationary bike intensity of 60-80% of the maximum heart rate. The primary results of the use of the physical rehabilitation program in patients with AF after RF RF are evidence of its positive effect, which is achieved, apparently, through the use of standard bicycle training and an increase in daily physical activity (DA), familiar to each patient (walking, cycling, working in garden, swimming, etc.). The main disadvantages of this method are the onset of FT later (in 1 month), the lack of a personalized approach to the selection of physical exercises and the training process periods, the active use of isometric FN for the upper body, which can provoke the development of heart rhythm disturbances. In addition, the well-known program does not take into account possible negative consequences from physical effects on the left half of the chest and left shoulder girdle (area of surgical intervention).

The technical result of the claimed method for the rehabilitation of cardiac patients with AF after surgery, RF RF is to develop a personalized comprehensive program of early physical rehabilitation, selected taking into account the functional class (FC) of the patient and dosed according to the individual energy consumption of the patient; performing physical rehabilitation at two stages of cardiac rehabilitation (CR) (stage I - inpatient CD and stage II - outpatient CR, which becomes independent exercise at home); using physical

rehabilitation (RF), represented by three periods, where the transition from one period to another is carried out taking into account the clinical condition of the patient. At the same time, the indicated three periods of the training process (with a certain number of physical therapy classes and a length of time) performed at the inpatient and outpatient stages of the KR of patients with AF after RF RF are related to the principle of differentiation in the clinical course of the postoperative period of the disease. Taking into account the development of possible complications of a thromboembolic nature and “postablative cardiac arrhythmias” after RFA, several clinical periods of the disease are distinguished: a very early postoperative period - up to 3 days with the greatest risk of thromboembolic complications, an early postoperative period - “blind period” ( from 72 hours to 3 months) with the allocation of the first month, during which it is especially possible to observe an increase in heart rate, signs of chronotropic sinus node dysfunction with a decrease in parasympathetic about tone and increased sympathetic tone and the highest number of recurrences of arrhythmia, the late postoperative period - after 3 months (from 3 to 6 months), when late “postablative heart rhythm disturbances” may develop (however, there is no time interval after the operation, after which we can talk about the complete absence of risk of a "new" late recurrence of AF).

An important feature of the claimed method is early physical rehabilitation, which begins already in the hospital the day after RFA surgery, which contributes to the early adaptation of the patient to FN. Early rehabilitation allows the patient to feel more confident and acquire knowledge for the further acquisition of a stable DA stereotype. After discharge from the hospital physical rehabilitation

successfully continues on an outpatient basis (i.e., after discharge from the hospital) with no time limit for duration.

FR in the earliest possible time after RF RF was compiled taking into account possible negative consequences from physical impact on the surgical intervention area - the left half of the chest and the left part of the shoulder girdle.

In addition, the basis of the rehabilitation program is a personalized approach to the choice of form, content and dosage of training sessions, the style of their conduct, the compilation of rehabilitation exercises.

The FR program consists of three periods: preparatory, including 3 classes at the I stationary stage of the Kyrgyz Republic before discharge from the hospital, up to 25 classes at the early II outpatient stage of the Kyrgyz Republic, the main one - at the late II outpatient stage of the Kyrgyz Republic, including up to 40 classes, supporting the period at the late II outpatient stage of the Kyrgyz Republic, unlimited in time. In the preparatory period of the stationary phase, patients perform exercises while lying on a flat hard surface on the abdomen, back or right side, which helps to reduce or eliminate postoperative pain, maximize muscle relaxation and, accordingly, reduce the risk of early postoperative thromboembolic complications and relapses of AF , reduce the level of patient anxiety already at the 1st stage of CR in the hospital. At subsequent stages of RF, exercises are performed sitting or in an upright position in order to reduce the preload on the left ventricle of the heart and the risk of developing ischemia and arrhythmia.

At the stationary stage I, a theoretical explanation of the exercise technique is carried out, a posture lying on the stomach or on the right side, which is comfortable for the patient, is taught. The most important part of the claimed method

is to determine the functional class (FC), assess the clinical condition of the patient and calculate the energy consumption of each exercise of the complex and the complex as a whole for optimal consumption and replenishment of oxygen costs by the patient during the training program by taking into account his individual energy expenditure. It is this unique approach that made it possible already in the early stages after the RFA LV operation, before leaving the hospital, to determine for the patient a training load balanced in efficiency and safety for performing in the preparatory period on an outpatient basis. For this, a six-minute walk test (TSHX) is used. The load bicycle ergometry (VEM) test can be used to correct the selected training load, starting from the 2nd month after the RF RF operation. The set of exercises and the number of their repetitions in the complex of exercise therapy performed at the outpatient preparatory stage vary depending on the individual energy expenditure of a particular patient and his clinical condition.

During the main and supporting periods of RF, patients perform exercises without taking into account their energy consumption. At all stages of exercise therapy, patients perform exercises for the eyes that activate the vagus nerve, which leads to a decrease in heart rate and equalization of the existing imbalance between the parasympathetic and sympathetic parts of the nervous system. They also perform breathing exercises with deep diaphragmatic breathing. Selected physical exercises affect the motor-visceral reflexes of the segments of the spinal cord at the level of C ₃ -C ₄ and T ₁ -T ₈ , innervating the heart, and stimulate compensation mechanisms of both the central and peripheral circulatory system. The combined static-dynamic exercises, the gradual bringing of the exercise to a continuous pace during the course of training, provides the effect of cyclicity, which

allows you to increase aerobic efficiency from training sessions. All complexes of physical exercises used in KR are characterized by mobility and a variety of forms of DA, including at home, which increases the patient's interest in participating in rehabilitation. It is very important that personalized dosing of FN and FA in the rehabilitation program allows the patient to avoid excessive loads, take into account the features and area of surgical intervention, which makes training not only effective, but also safe.

The method is as follows.

Rehabilitation begins the day after the RFA operation and is not generally limited in duration. The RF program is carried out at two stages of the Kyrgyz Republic - stage I in the cardiology department, stage II outpatient in the outpatient rehabilitation department with the transition to the patient's individualized training program at home. The FR program consists of several periods:

- the preparatory period includes 3 classes before discharge from the hospital (performed at the I stationary stage of the Kyrgyz Republic, up to 3 days) and up to 25 classes after discharge from the hospital (performed at the early II outpatient stage of the Kyrgyz Republic, with 3 one-time classes - 8 weeks, with 2 single lessons - 12 weeks),

- the main period includes up to 40 lessons (performed at the late II outpatient stage of the Kyrgyz Republic, with 3 one-time classes - 13 weeks, with 2 one-time classes - 20 weeks),

- the supporting period contains an unlimited number of classes (performed at the late II outpatient stage of the Kyrgyz Republic).

It is important to note that the duration of the preparatory and main period as a whole is determined by the total number of classes.

Patients independently choose the number of visits per week that is most convenient for them, which ensures a state of “freedom” and comfort during FT classes.

The period of the training process is necessary for a gradual increase in the volume and intensity of physical activity: the preparatory period provides for a gentle training regime with a slow pace (16 times per minute) of exercise, the method of exercise is intermittent (with rest between exercises) at the hospital stage and continuous (without rest intervals ) at the outpatient stage; the main period is a gentle-training mode with an average pace (up to 24 times per minute) of exercises with sufficient rest between exercises, the method of performing exercises is intermittent; supporting period - a training mode with an average rate of exercise (up to 24 times per minute), the method of performing exercises is continuous. Such a scheme of the course makes FT safe and affordable for a larger number of patients, and also allows to achieve the level of intensity of neuromuscular function that is necessary to ensure a therapeutic effect.

The transition from one training period to another with an increase in the volume of FT and the variety of types of FN used is carried out taking into account the stage of the postoperative period of the disease, the stability of the patient’s clinical condition and the absence of angina pectoris, shortness of breath, lack of air, cyanosis, cold sweat, cough during exercise (or other signs of left ventricular failure), cardiac arrhythmias, high blood pressure (≥180 / 100 mmHg), the presence or appearance of a headache during FT, head servation, staggering, weakness.

Each training session includes an introductory, main and final part.

Stage I of the Kyrgyz Republic in the hospital: inpatient preparatory period for physical rehabilitation. The main tasks of the preparatory period are the removal of the psychological barrier formed against the background of an inadequate assessment of the severity of one’s condition, the creation of comfortable conditions (conditions, postures, posture during FT), the fight against congestion, if any, and the improvement of peripheral circulation and respiratory function.

Physical therapy classes (LFK) begin on the day after surgery RFA LV. These are individual physical therapy classes that are held once a day every day for 25 minutes. They begin with an individual lecture (5 minutes) every day before exercise therapy and include the following forms of FT (20 minutes training): breathing exercises with diaphragmatic breathing, special exercises for the eyes, and the “posture treatment” technique. The first 3 days after RFA, it is proposed to conduct a training session in the initial position (I.p.) of the patient lying on a firm and even surface, which ensures maximum relaxation of the patient’s muscular system, makes it possible to remove or reduce postoperative pain syndrome and allows not to overload the patient physically immediately after RFA intervention.

The introductory part of the training session of the preparatory period in the hospital is presented by an individual lecture, which includes a theoretical explanation of the proposed complexes, training in the technique of performing all stationary complexes - the LFK instructor tells and shows on himself and the patient the technique for performing the exercises.

The main part of the training session of the preparatory period in the hospital includes a complex of respiratory gymnastics with

diaphragmatic breathing, which at the stationary stage is performed in the initial position lying on the back or abdomen at the choice of the patient.

Changing breathing (switching to diaphragmatic breathing) increases the activity of the parasympathetic department of the autonomic nervous system, which is important for patients with AF. When performing breathing exercises, not only the lungs, intercostal muscles, but also the abdominal muscles and diaphragm are involved. The complex of respiratory gymnastics with diaphragmatic breathing is performed as follows:

- I.p. lying on your back, arms along the body; after a complete exhalation, inhale through the nose, stretching the diaphragm and protruding the stomach. The chest does not rise and does not expand, all the inhaled air goes "into the stomach." Exhalation occurs in the reverse order, through the nose, with a slight retraction of the abdomen. Start from the 1st minute, adding a minute every day, a maximum of 5 minutes.

- I.p. lying on the stomach, hands in front of the face are crossed on opposite elbows, the forehead on the forearms, the chest is slightly torn off the floor, the stomach is lying on the floor, the legs are together or apart, the feet are turned with the fingers outward or inward at the request of the patient. Feet relaxed. When inhaling - exhaling, pay attention to how the region of the lower back rises and falls, the chest expands and contracts, and the stomach is slightly squeezed and relaxed. Start from the 1st minute, adding a minute every day, a maximum of 5 minutes.

Special exercises for the eyes have an activating effect on the vagus nerve, which leads to a decrease in heart rate. Special exercises for the eyes include: relaxing the eyes, looking at the horizon, blinking, fixing the look at the tip of the nose, fixing the look at the eyebrow, fixing the look at the right or left shoulder, rotating the eyes, turning the eyes, alternately

fixation on a finger and horizon raised at the level of the head; alternate fixation on the tip of the nose and horizon. Each exercise is performed for no more than 30-45 seconds. At each lesson, 2 exercises are mastered. A set of special exercises for the eyes includes:

1. Eye relaxation exercises: I.p. lying on your back, arms and legs lie arbitrarily; It is desirable to exclude bright light sources from the field of view. Close your eyes and relax your eyelids - mentally stroke your eyes with warm, soft fingers, feel how the eyeballs lie completely passively in the eye sockets. At the same time, relax the face and body, which will give additional relaxation. All attention is focused on eye relaxation. The feeling of warmth and heaviness should change lightness, weightlessness, and in the future - a complete loss of sensation of the eyes. The relaxation time is not limited, in between other exercises for the eyes it can be 20-40 seconds, performed by itself - 3-5 minutes.

2. Exercise on the direction of looking at the horizon: I.p. lying on your back, arms and legs lie arbitrarily; direct a defocused look at the horizon, you can also stop looking at any distant object that is not irritating to the eye - a window, a nightstand, any object in the room. No need to focus on any object, on the contrary, look as though through it, without straining your eyesight. Perform a few minutes, after exercise, relax your eyes.

3. Blinking exercise, which is performed as long as they are performed easily, you can not bring yourself to extreme fatigue. I.p. I.p. lying on your back, arms and legs lie arbitrarily; quickly squeeze and unclench the eyelids (blink). Perform from 30 to 60 seconds. After exercise, relax your eyes.

4. Exercise to fix the gaze on the tip of the nose: I.p. lying on your back, arms and legs lie arbitrarily; fix the gaze on the tip

nose, with good mobility of the eyeballs, the wings of the nose and a strip of skin above the upper lip will be visible. Look carefully, without looking up, without straining the eyes and muscles of the eyelids and, if possible, without blinking. Do not lower your head down. Initially, the exercise is performed for 10-20 seconds, until light tearfulness and pain in the eyes, in the future, the ability to look at the tip of the nose for 3-5 minutes without any tension develops. After exercise, relax your eyes.

5. Exercise for fixing the gaze on the inter-eyebrow space: I.p. lying on your back, arms and legs lie arbitrarily; focus the eye in the space between the eyebrows. If it does not work out right away, you can close one eye, and use the other to consider the line of transition of the nose bridge to the upper edge of the eye socket. Then change the eyes and finally look with two eyes at the midpoint found. Watching in between the eyebrows calmly and without tension. Do not raise your head up, keep it straight. At first it will be difficult to hold your gaze between your eyebrows for more than a few seconds. In this case, you need to repeat the exercise several times. Gradually bring the runtime to a few minutes. After exercise, relax your eyes.

6. Exercise to fix the gaze on the right shoulder: I.p. lying on your back (pillow as flat as possible or without it), arms and legs lie arbitrarily; to look towards the right shoulder, focus on the right shoulder and carefully, if possible without blinking, look only at it. Do not turn your head to the right, keep your back straight. When unpleasant and painful sensations appear in the eyes, relax them, relax a bit and repeat the exercise. Gradually bring the fixation time to 2-4 minutes. After exercise, relax your eyes.

7. Exercise for fixing the gaze on the left shoulder: perform similarly to the previous exercise (No. 6), but in the opposite direction, fixing the gaze on the left shoulder.

8. Eye rotation exercise: I.p. lying on your back, arms and legs lie arbitrarily; look up and very slowly shift your gaze clockwise, describing with your gaze the circle of maximum radius. Eye movements should be smooth, without jerking. The head remains motionless all the time. First you need to learn how to make one complete circular rotation with eyes in each direction, avoiding jerking and loss of concentration. Over time, perform 2-3 turns clockwise and the same counterclockwise. After exercise, relax your eyes. If they are not tired, proceed immediately to the next exercise.

9. The exercise of quickly moving the gaze from one edge of the field of view to the opposite with a delay of several seconds in each position. It is necessary to perform eight movements that make up one cycle: look up, look down, look right, look left, look at the lower right corner, look at the upper left corner, look at the upper right corner, look at the lower left corner. In each position, hold your gaze for 1 to 5 seconds. Repeat for 2 to 5 minutes, holding your head still. Try to turn your eyes to the most extreme positions. After exercise, relax your eyes.

10. Exercise for alternately fixing the gaze on the finger and on the horizon: I.p. lying on your back, set your hand with your index finger up at the level of your head in front of you, about 30 cm from your eyes. Alternately look from your fingertip to the horizon line or to any remote point, lingering in each position for 2-3 seconds. The finger should be approximately in the same direction with the selected point, so that when you look, the eyeballs hardly move. Both the finger and the horizon must be watched carefully, achieving a clear

concentration. Perform from 1 to 3 minutes, and then go to the next exercise.

11. The exercise of fixing the gaze on the tip of the nose and on the horizon: performed similarly to the previous one, only the view is transferred from the tip of the nose and to the horizon and vice versa. After exercise, relax your eyes.

The final part of the training session (5 minutes) of the preparatory period in the hospital includes the “position treatment” technique. The “position treatment” technique is training in a special posture that helps to increase the volume of the chest and relax the muscles of its left half (the site of surgical intervention), which is aimed at reducing or eliminating postoperative pain. The patient himself chooses the most comfortable posture for himself, taken in a supine position:

- I.p. lying on his stomach, arms bent at the elbows, palm on palm, lie under the frontal or temporal part of the head or grab a pillow, socks are pulled out, all muscles of the body are relaxed;

- I.p. lying on the stomach, the right hand along the body, the left hand under the head or grasps the pillow;

- I.p. lying on the right side, the right hand is bent at the elbow, lies under the head or extended along the body, or is wound behind the head, the left hand is on the belt, bent at the elbow in front of the chest or wound behind the head;

On average, the duration of the posture is 1 minute, the number of repetitions, depending on the patient’s well-being, is 3-4 times before the pain is relieved, with pauses from 15 to 30 seconds.

The duration of physical rehabilitation in a hospital is up to 3 days - the patient's stay in the hospital after RF RF. Exercise control is carried out by the instructor / doctor of exercise therapy, who also adjusts the technique of exercises for their successful

perform as part of self-study at home. The proposed forms allow the patient to feel more confident, quickly master the proposed complexes, acquire knowledge for the formation of a stable DA stereotype, ease the condition after surgery, relieve pain postoperative syndrome, and prevent stagnation.

To determine the patient’s FC and the maximum tolerated FN at the stationary preparatory stage, before leaving the hospital after RFA, a six-minute walk test (TLC) is performed, and from the second month after RFA, a VEM test is performed.

TLC allows you to determine the patient’s FC based on the individual distance traveled by the patient in six minutes. The following are calculated: walking speed (in m / min) = number of meters passed / 6 min; oxygen consumption (VO ₂ in ml / kg / min) = 3.5 ml / kg / min + (walking speed m / min ⋅ 0.1); threshold level of energy expenditure (in cal / kg ⋅ min) = VO ₂ (in ml / kg / min) ⋅ 5 cal / min; 75% of the threshold level of energy expenditure (in cal / kg ⋅ min), which reflects the average energy expenditure of 1 minute of exercises in the exercise therapy complex; total energy consumption when calculating the exercise therapy complex, performed within 20 minutes (in cal / kg) = 75% of the threshold level of energy expenditure (in cal / kg ⋅ min) ⋅ 20 min.

Below, according to the TLC results, the characteristics of patients with different FCs, the threshold level of energy expenditures and the corresponding amount of energy expenditures when calculating the exercise therapy complex for a specific patient's FC are presented:

I FC - in TLC there are several groups of patients:

1) distance traveled ≥900 meters, threshold level of energy expenditures ≥92.5 cal / kg. Min., 75% of the threshold level of energy expenditures - average

energy expenditures of 1 minute of exercises in the complex of exercise therapy ≥69.38 cal / kg ⋅ min; total energy consumption when calculating the complex of exercise therapy ≥1387.5 cal / kg;

2) the distance traveled 800-899 meters, the threshold level of energy expenditure in the range of 84-92.4 cal / kg ⋅ min, 75% of the threshold level of energy expenditure - the average energy expenditure of 1 minute of exercises in the exercise therapy complex within 63-69.4 cal / kg ⋅ min; total energy consumption when calculating the complex of exercise therapy in the range of 1260-1387 cal / kg;

3) the distance covered is 650-799 meters, the threshold level of energy expenditures is in the range of 71 - 82.8 cal / kg ⋅ min., 75% of the threshold level of energy expenditures is the average energy expenditure of 1 minute of exercises in the exercise therapy complex within 52.5-62.1 cal / kg ⋅ min., total energy consumption when calculating the exercise therapy complex in the range of 1050-1242 cal / kg;

4) the distance covered is 451-649 meters, the threshold level of energy expenditure is in the range of 54.6-70 kcal / kg ⋅ min., 75% of the threshold level of energy expenditure is the average energy consumption of 1 minute of exercise in the exercise therapy complex within 41-52 cal / kg ⋅ min .; total energy consumption when calculating the complex of exercise therapy in the range of 820-1045 cal / kg.

II FC - at TSH: the distance covered is 350-450 meters, the threshold level of energy expenditure is 46.7-55 cal / kg ⋅ min., 75% of the threshold level of energy expenditure is the average energy consumption of 1 minute of exercise in the exercise therapy complex 35-41.3 cal / kg ⋅ min; total energy consumption when calculating the complex of exercise therapy 700-819 cal / kg.

III FC - at TSH: distance traveled 270-349 meters, threshold level of energy expenditures 40-46.6 cal / kg ⋅ min., 75% of the threshold level of energy expenditures - average energy expenditures 1 minute of exercises in the exercise therapy complex 30-34.9 cal / kg ⋅ min., total energy consumption when calculating the exercise therapy complex is 600-698 cal / kg.

Stage II of the Kyrgyz Republic on an outpatient basis: the outpatient preparatory period for physical rehabilitation. Patients are engaged in small groups by the flow method, when the exercises are performed continuously one after another (continuously), 2-3 times a week, the duration of the training session is 45 minutes.

The introductory part of a controlled training session (15 minutes) of the preparatory period is outpatiently represented by a complex of respiratory gymnastics with diaphragmatic breathing, including the following exercises with the number of repetitions of each 4-6 times:

- I.p. sitting on a chair, the back is pressed to the back of the chair, one palm of one arm is not on the stomach, the other on the chest: on account 1 - take a slow breath with your nose, puffing up your stomach, arching in the lower back, while pressing your hand on the stomach, on account 2 - slow exhale by mouth, lips with a tube, pressing with a hand on the chest. Do not throw your head back.

- I.p. sitting on a chair, the back is pressed to the back of the chair, one palm of one hand on one’s stomach, the other on the chest: on account 1 - take a slow breath with your nose, puffing your stomach, caving in the lower back, while pressing your hand on the chest, on the count 2 - slow exhale by mouth, lips with a tube, pressing a hand on a stomach. Do not throw your head back.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the abdomen are locked into the lock: on account 1 - take a slow breath with your nose (puffing your stomach, arching in the lower back) palms outward (fingers remain in the lock, elbows are straightened), at the expense of 2 - slow exhalation by mouth, lips with a tube, return your hands to their original position, "blowing off" the stomach with your hands. Do not throw your head back.

- I.p. sitting on a chair, the back is straight, pressed to the back of the chair, hands on the knees upside down: on account 1 - a slow breath with your nose, puffing your stomach, bending in the lower back while simultaneously compressing your fingers into

fists, on 2 - a slow exhale by mouth, lips with a tube, while unclenching fists.

- I.p. sitting on a chair, the back is straight, pressed to the back of the chair, hands hang freely: at the expense of 1 - a slow breath with your nose, puffing up your stomach, caving in the lower back, raising your hands up, at the expense of 2 - a slow exhale with your mouth, lips with a tube, lowering your hands in and .P.

- I.p. sitting on a chair, in an inclination, wrists at the shoulders, elbows touch the knees, chin to the cervical fossa: on account 1 - a slow breath with your nose, straightening and puffing up your stomach, arching in the lower back, drawing your elbows as far back as possible, 2 - slow breath out with your mouth, lips returning to ip

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the belt, thumbs to the side of the lower back: at the expense of 1 - a slow breath with your nose, pushing your elbows as far back and inflating the stomach arching in the lower back, 2 - slow exhalation with your mouth, lips with a tube, chin to the cervical fossa, leaning slightly forward, as if blowing off the stomach, bringing elbows in front of you, with sliding movements of the hands along the belt.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees are straightened at the elbows, the head is looking directly: at the expense of 1 - a slow breath with your nose, puffing up your stomach, arching in the lower back, chin to the neck fossa, at 2 - a slow breath out of your mouth, lips a tube, returning the head and lower back to the ip

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: on account 1 - a slow breath with your nose, puffing up your stomach, caving in the lower back, raising your hands forward and up, 2 - slow exhalation with your mouth, lips with a tube, leaning forward, lowering your hands through the sides clasping their legs under the knees.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: on account 1 - a slow breath with your nose, puffing your stomach, bending in the lower back,

raising relaxed arms upwards, by 2 - sharp exhalation by mouth, leaning forward and freely lowering his hands.

The main part of a controlled training session (20 minutes) of the outpatient preparatory period includes individual selection of a set of general developmental physical exercises dosed by energy expenditures, based on the method of D. Aronov. (Aronov D.M. Zhukova L.V. Physiotherapy physical exercise and walking walking at the outpatient stage of rehabilitation of patients with coronary heart disease. Cardiology. - 1991. - No. 2. - P. 107-112.) And modified for patients with AF after RFA LV. In the group of patients with AF after RFA, the following exercise sets were experimentally selected, dosed by energy expenditures, of a certain duration, frequency of repetitions and alternations.

Exercises are selected based on the calculation of the patient’s FC and the threshold level of energy expenditure. This makes it possible to apply a personalized approach to drawing up a physical rehabilitation program taking into account a certain percentage (75% for TLC and 60% for VEM test) of the individually allowable energy consumption for a particular patient. General developmental exercises, dosed according to energy expenditures, in the rehabilitation program are combined with walking at a different pace.

To determine the maximum patient tolerance of FN starting from the second month after RF RF, a VEM test is performed based on the generally accepted classification of D. Aronov. The results of the VEM test are the achieved load power (in kgm / min. And W), the number of metabolic units (ME ), calculation of VO ₂ (in ml / kg / min) = amount of ME ⋅ 3.5 ml O ₂ / kg / min, threshold level of energy expenditure (in cal / kg ⋅ min) = VO ₂ (in ml / kg / min) ⋅ 5 cal / min - allow you to carry out the correction of the selected

training load. It is known that VEM testing provides great information about the physical performance of the patient and allows you to more accurately determine the state of adaptation of the cardiovascular system to FN. With an increasing load during the VEM test, the increase in oxygen consumption is more significant than during the TLC, therefore, when calculating the complex of exercise therapy based on the results of the VEM test, the 60% level of energy consumption from their threshold value is used, and then the total energy consumption for 20 minutes is calculated. implementation of the exercise therapy complex (in cal / kg) = 60% of the threshold level of energy expenditure (in cal / kg ⋅ min) ⋅ 20 min.

Below, based on the results of the VEM test, the characteristics of the patients, the threshold level of energy expenditure and the corresponding amount of energy expenditure when calculating the exercise therapy complex for a particular patient are presented:

Group I - with the VEM test: ME ≥7.0; power of the last load stage ≥750 kgm / min. (≥125 W), threshold level of energy expenditure ≥122.5 cal / kg ⋅ min., 60% of the threshold level of energy expenditure - average energy expenditure of 1 minute of exercise therapy complex ≥73.5 cal / kg ⋅ min., Total energy consumption when calculating the complex Exercise therapy ≥1470 cal / kg.

Group II - with the VEM test: ME 4.0-6.9; the power of the last stage of the load with a VEM test is 450-600 kgm / min. (75-100 W), the threshold level of energy expenditure is 70-121 cal / kg ⋅ min., 60% of the threshold level of energy expenditure is the average energy expenditure of 1 minute of exercise therapy complex 42.5-72.6 cal / kg ⋅ min., Total energy expenditure when calculating the complex of exercise therapy 820-1452 cal / kg.

According to the VEM test, patients from group II are further divided into three subgroups, taking into account ME:

1) with ME 6.0-6.9, the threshold level of energy expenditure is 105-121 cal / kg ⋅ min., 60% of the threshold level of energy expenditure is the average energy expenditure of 1 minute of exercise complex 63-72.6 cal / kg ⋅ min. , total energy consumption when calculating the complex of exercise therapy 1260-1452 cal / kg;

2) with ME 5.0-5.9, the threshold level of energy expenditure is 87.5-103.5 cal / kg ⋅ min., 60% of the threshold level of energy expenditure is the average energy expenditure of 1 minute of exercises of the exercise therapy complex 52.5-62.1 cal / kg ⋅ min., total energy consumption when calculating the complex of exercise therapy 1050-1259 cal / kg;

3) with ME 4.0-4.9, the threshold level of energy expenditure is 70-85.6 cal / kg ⋅ min., 60% of the threshold level of energy expenditure is the average energy expenditure of 1 minute of exercise complex exercises 42.5-51.5 cal / kg ⋅ min., total energy consumption when calculating the complex of exercise therapy 820-1045 cal / kg.

Group III - with a VEM test: ME 2.0-3.9, power of the last load stage with a VEM test 300 kgm / min. (50 watts); threshold level of energy expenditures <52.5-68.25 cal / kg ⋅ min., 60% of the threshold level of energy expenditures - average energy expenditures of 1 minute of exercise complex exercises <32-40.95 cal / kg ⋅ min .; total energy consumption when calculating the complex of exercise therapy <630-819 cal / kg.

According to the VEM test, patients from group III are further divided into two subgroups, taking into account ME:

1) with ME 3.0-3.9, the threshold level of energy consumption 52.5-68.25 cal / kg ⋅ min., 60% of the threshold level of energy consumption - average energy consumption 1 minute of exercise complex exercise therapy 31.5-40.95 cal / kg ⋅ min .; total energy consumption when calculating the complex of exercise therapy 630-819 cal / kg;

2) with ME 2.0-2.9, the threshold level of energy expenditures <52.5 cal / kg ⋅ min., 60% of the threshold level of energy expenditures - the average energy expenditure of 1 minute of exercise complex exercises <32 cal / kg ⋅ min .; total energy consumption when calculating the complex of exercise therapy <630 cal / kg.

Based on the results of the TLC or VEM test, a specific exercise therapy complex dosed according to energy expenditures is assigned to a specific patient, the total number of basic exercise therapy complexes is six. The set of exercises and the number of repetitions of the proposed basic exercise therapy complexes can be changed taking into account the individual energy expenditure of a particular patient and his clinical condition.

The complex of exercise therapy No. 1 is prescribed to patients with a traveled distance of ≥900 meters at TLC (recommended achievement of total energy expenditure at exercise therapy ≥1387.5 cal / kg), or ME ≥7 at VEM test (recommended achievement of total energy expenditure at exercise therapy ≥1470 cal / kg) ; the characteristic of the basic complex of exercise therapy No. 1: total energy consumption - 1396.2 cal / kg, energy expenditure of 1 minute of exercises - 69.81 cal / kg ⋅ min., the duration of the complex - 20 minutes:

- Initially walking 130 steps per min. within 180 seconds, energy expenditure in three minutes of walking 222 cal / kg ⋅ min, then the following set of exercises:

- I.p. standing, arms down, legs apart, at the expense of 1-2 raise your hands up, take your leg back to the toe, bend, inhale with your nose, at the expense of 3-4 return to the IP, exhale with your mouth, the same with the other leg, the number of repetitions 10, the execution time of one repetition of 6.0 seconds, the energy expenditure of the exercise is 5.6 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 56 cal / kg ⋅ min,

- I.p. standing, arms down, legs shoulder-width apart, count 1 - inhale, spread your arms to the sides, count 2 - tilt to the leg, touching the floor - exhale, count 3-4 the same to the other leg, number of repetitions 12, time performing one repetition of 5.0 sec, the energy expenditure of the exercise is 6.0 cal / kg, the energy expenditure per minute of performing the exercise with a given number of repetitions is 72 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs apart, at the expense of 1-2 turning the torso to the side with the abduction of the hand in the same direction, inhaling with your nose, at the expense of 3-4 return to the ip, exhaling with your mouth, the same way, the number of repetitions 15, the time it takes to complete one repetition of 4 seconds, the energy expenditure of the exercise is 3.0 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 45 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs apart, circular movements of the pelvis in four counts to the right, left, arbitrary breathing, the number of repetitions is 12, the time for performing one repetition is 5 seconds, the energy expenditure of the exercise is 4.34 cal / kg, the energy expenditure per minute of the exercise for a given amount repetitions of 52.08 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs together, at the expense of 1 - do in ip inhalation through the nose, on account 2 - put one leg to the side on the toe, tilting the torso in the same direction, raise the opposite hand upward, exhale through the mouth, counting 3-4 the same way, the number of repetitions is 12, the time it takes to perform one repetition 5 sec, the energy expenditure of the exercise is 3.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 46.8 cal / kg ⋅ min,

- I.p. standing, arms down, legs together, at the expense of 1 - raise your hands to the sides with your palms down, inhale your nose, at the expense of 2 - move your hands forward, swing one foot forward, touch your palm with your toe, exhale with your mouth, at the expense of 3-4 the same other foot, number of repetitions 15, the time it takes to complete one repetition of 4 seconds, the energy expenditure of the exercise is 6.43 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 96.45 cal / kg ⋅ min

- I.p. standing, arms down, legs apart, at the expense of 1-2, spread your arms to the sides, inhale with your nose, at the expense of 3-4, lower your hands down, relax, exhale with your mouth, number of repetitions 12, the time for performing one repetition is 5 seconds,

exercise energy expenditure of 2.85 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 34.2 cal / kg ⋅ min,

- I.p. standing, arms bent at the elbows in front of the chest, legs apart, at the expense of 1-2 make two jerks with your elbows to the sides, at the expense of 3-4 turn your torso to the side, making two jerks with your arms apart, breathing is arbitrary, the number of repetitions is 15, time performing one repetition of 4.0 seconds, the energy expenditure of the exercise is 3.05 cal / kg, the energy expenditure per minute of performing the exercise with a given number of repetitions of 45.75 cal / kg ⋅ min,

- I.p. standing, arms on the waist belt shoulder-width apart, counting 1 breath, counting 2-3-4 circular movements with the body exhaling, number of repetitions 12, time for one repetition 5 seconds, energy expenditure 4.73 cal / kg, energy expenditure per minute performing exercises with a given number of repetitions 56.76 cal / kg ⋅ min,

- I.p. standing, arms down, legs together, at the expense of 1 - do in ip inhalation with the nose, on account 2 - lunging forward with one foot, hands to the sides, exhaling with the mouth, on account 3 - spreading the arms out to the sides, inhaling with the nose, at the expense of 4 - returning to the mouth, exhaling with the mouth, the same with the other leg, the number of repetitions of 15, the time to complete one repetition of 4 seconds, the energy expenditure of the exercise is 6.4 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 96 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart, at the expense of 1-2 raise your hands up, take your leg back to the toe, bend, inhale with your nose, at the expense of 3-4 return to the IP, exhale with your mouth, the same with the other leg, the number of repetitions 12, the execution time of one repetition is 5.0 seconds, the energy expenditure of the exercise is 5.6 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 67.2 cal / kg ⋅ min,

- I.p. standing, arms apart, legs apart, circular movements with straight arms for four counts (the range of movements is full) forward, backward, arbitrary breathing, number of repetitions 12, time to complete one repetition 5 sec, energy expenditure 4.4 cal / kg, energy expenditure minute of exercise with a given number of repetitions 52.8 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart, feet in parallel, at the expense of 1 - do in ip nasal inhalation, sit down at the expense of 2-3, hands forward, exhale with the mouth, at the expense of 4 - return to ip, the number of repetitions is 24, the time for performing one repetition is 5 seconds, the energy expenditure of the exercise is 7.24 cal / kg, energy expenditure for 2 minutes of exercise with a given number of repetitions 173.76 cal / kg ⋅ min,

- Walking 120 steps per minute. within 60 sec. Energy consumption per minute of walking 70 cal / kg ⋅ min, then running for 120 seconds, energy consumption for 2 minutes of running 209.4 cal / kg ⋅ min.

The complex of exercise therapy No. 2 is prescribed for patients with a covered distance of 800-899 meters with TLC (recommended achievement of total energy expenditure with exercise therapy 1260-1387 cal / kg), or ME 6.0-6.9 with VEM test (recommended achievement of total energy expenditure with exercise therapy 1260 -1452 cal / kg); the characteristic of the basic complex of exercise therapy No. 2: total energy consumption - 1290.4 cal / kg, energy expenditure of 1 minute of exercises - 64.52 cal / kg ⋅ min., the duration of the complex - 20 minutes:

- Initially walking 120 steps per min. within 60 seconds, energy expenditure per minute of walking 76 cal / kg ⋅ min, then the following set of exercises:

- I.p. standing, arms down, legs apart, on account 1 - raise your hands forward, inhale your nose, on account 2 - raise your hands up, exhale your nose, on account 3 - lower your hands to the sides, inhale your nose, on account 4 - return to and. p., exhale by mouth, number of repetitions 15, execution time of one repetition 4 seconds,

exercise energy expenditure of 3.45 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 51.75 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart, at the expense of 1-2 to spread your arms to the sides, inhale with your nose, at the expense of 3-4 to lower your hands down, relax, exhale with your mouth, number of repetitions 10, time for one repetition of 6 seconds, energy expenditure of exercise 3, 38 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 33.8 cal / kg кг min,

- I.p. standing, hands on the belt, legs together, at the expense of 1 - do in ip inhalation with the nose, at the expense of 2-3, lunge with one foot to the side, exhale with the mouth, at the expense of 4 - go back to the ip, the same way, the number of repetitions is 12, the time for one repetition is 5.0 seconds, the energy expenditure of the exercise 8.33 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 99.96 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs apart, circular movements of the pelvis in four counts to the right, left, arbitrary breathing, number of repetitions 10, time to complete one repetition of 6 seconds, energy expenditure of exercise 5.18 cal / kg, energy expenditure per minute of exercise with this amount repetitions of 51.8 cal / kg ⋅ min,

- I.p. standing, feet shoulder-width apart, at the expense of 1 - spread your arms to the sides, at the expense of 2-3-4 springy inclinations forward, touching the floor with your hands, and return to I. p. - exhalation, the number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of the exercise is 7.3 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 87.6 cal / kg ⋅ min,

- Walking 120 steps per minute. for 60 seconds, energy expenditure per minute of walking 76 cal / kg ⋅ min, then the following exercises:

- I.p. standing, arms down, legs apart, at the expense of 1-2 raise your hands up, take your foot back to the toe, bend, inhale with your nose, at the expense of 3-4

return to ip, exhale with the mouth, the same with the other leg, number of repetitions 10, time to complete one repetition of 6.0 seconds, energy expenditure of the exercise 6.76 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 67.6 cal / kg ⋅ min

- I.p. standing, hands on the waist belt shoulder-width apart, counting 1 breath, counting 2-3-4 circular movements with the body exhaling, number of repetitions 12, execution time of one repetition 5 seconds, energy expenditure of exercise 5.7 cal / kg, energy expenditure per minute performing exercises with a given number of repetitions of 68.4 cal / kg ⋅ min,

- I.p. standing, arms bent at the elbows in front of the chest, legs apart, at the expense of 1-2 make two jerks with your elbows to the sides, at the expense of 3-4 turn your torso to the side, making two jerks with your arms apart, breathing is arbitrary, the number of repetitions is 15, time performing one repetition of 4.0 seconds, the energy expenditure of the exercise is 3.77 cal / kg, the energy expenditure per minute of performing the exercise with a given number of repetitions is 56.55 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart, at the expense of 1 - do in ip inhalation through the nose, tilt the body to the right 2-3-4, the opposite hand slides along the body to the armpit, exhale through the mouth, the same way, the number of repetitions is 12, the time it takes to perform one repetition is 5.0 seconds, the energy expenditure is 3.9 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 46.8 cal / kg ⋅ min,

- I.p. standing, hands lowered legs together, at the expense of 1 - spreading the arms to the sides, at the same time swing one foot to the side, inhale the nose, at the expense of 2 to return to I. p. exhaled by the mouth, at the expense of 3-4 the same with the other foot, the number of repetitions 12, the execution time of one repetition of 5.0 seconds

exercises 6.48 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions of 77.76 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart, feet in parallel, at the expense of 1 - do in ip nasal inhalation, sit down at the expense of 2-3, hands forward, exhale with the mouth, at the expense of 4 - return to ip, the number of repetitions is 20, the time for performing one repetition is 3 seconds, the energy expenditure of the exercise is 7.56 cal / kg, energy expenditure per minute performing the exercise with a given number of repetitions of 151.2 cal / kg ⋅ min,

- Walking 120 steps per minute. 60 sec, energy consumption per minute of walking 76 cal / kg ⋅ min, then the following exercises:

- I.p. standing, one arm is raised up, the other is lowered, legs apart, jerking hands on each count, changing hands in two counts, breathing arbitrary, number of repetitions 15, time to complete one repetition 4 sec, energy expenditure 3.74 cal / kg, energy expenditure minute of exercise with a given number of repetitions 56.1 cal / kg ⋅ min,

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, on the count of 1 spread your arms to the sides, inhale, on the count of 2-3-4 hands on your knees, resting your hands on your knees, stand up and sit down - exhale, the number of repetitions is 10, the execution time of one repetition is 6 seconds, the energy cost of the exercise is 4.82 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 48.2 cal / kg ⋅ min,

- I.p. sitting on the edge of the chair, hands on his knees, 1-2 to lean back in the chair, straighten and spread legs and arms to the sides, inhale with your nose, 3-4 to return to the IP, exhale with your mouth, the number of repetitions is 10, the execution time of one repetition is 6.0 seconds, the energy expenditure of the exercise is 4.32 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 43.2 cal / kg ⋅ mi,

- I.p. sitting on the edge of the chair, legs bent at the knees, hands on the chair seat at the back, at the expense of 1 - inhale, at the expense of 2-3-4, straighten the legs to the position of a right angle, return to I. p. - exhalation, the number of repetitions 12, the time to complete one repetition of 5.0 seconds, the energy expenditure of the exercise is 3.64 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 43.68 cal / kg ⋅ min,

- I.p. sitting on a chair, back pressed to the back of the chair, hands on his knees; legs are slightly diluted, on the bill 1-2 to spread the arms to the sides, inhale the nose, on the bill 3-4 to grab the knee with your hands and pull the leg to the chest - exhale, number of repetitions 12, time to complete one repetition 5 sec, energy expenditure exercises 3.9 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 46.8 cal / kg ⋅ min,

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, circular movements of the head in four counts to the right and left, breathing is arbitrary, the number of repetitions is 12, the time for performing one repetition is 5 seconds, the energy expenditure of the exercise is 2.6 cal / kg, energy expenditure per minute performing an exercise with a given number of repetitions of 31.2 cal / kg ⋅ min.

The complex of exercise therapy No. 3 is prescribed to patients with a covered distance of 650-799 meters at TLC (recommended achievement of total energy expenditure at exercise therapy 1050-1242 cal / kg), or ME 5.0-5.9 at VEM test (recommended achievement of total energy expenditure at exercise therapy 1050 -1259 cal / kg); the characteristic of the basic complex of exercise therapy No. 3: total energy consumption - 1073.68 cal / kg, energy expenditure of 1 minute of exercises - 53.68 cal / kg ⋅ min., the duration of the complex - 20 minutes:

- I.p. sitting, hands on your knees; legs bent and divorced; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4 grab the knee with your hands and pull your leg to the chest - exhale, number of repetitions 12, execution time

one repetition of 5 seconds, the energy expenditure of the exercise is 3.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 46.8 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent, on the count of 1 hands spread apart - inhale, on the count of 2-3-4 hands on knees, stand up and sit down - exhale, number of repetitions 12, time to complete one repetition 5 sec, energy expenditure of exercise 4.82 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 57.84 cal / kg ⋅ min,

- I.p. standing, arms to shoulders, legs apart; circular movements in the shoulder joints into four counts, voluntary breathing, the number of repetitions of 10, the time to perform one repetition of 6.0 seconds, the energy expenditure of the exercise 5.92 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions 59.2 cal / kg ⋅ min

- Walking 100 steps per minute. within 60 seconds, energy expenditure per minute of walking 65.8 cal / kg ⋅ min, then the following exercises:

- I.p. standing, arms down, legs apart; at the expense of 1-2 raise your hands up, take your leg back to the toe, bend down - inhale, at the expense of 3-4 return to the ip, the same with the other leg, the number of repetitions 10, the time it takes to complete one repetition of 6.0 seconds, energy consumption exercises 6.76 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions 67.6 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart; count 1 - inhale, count 2–3–4 the body tilts to the right and left, the opposite arm slides along the body to the armpit - exhale, “pump”, number of repetitions 12, time for one repetition 5.0 seconds, energy expenditure of exercise 3 , 9 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 46.8 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs apart; on the account 1-2, turn the case to the side with the abduction of the hand in the same direction - inhale, on the account 3-4, return to I. p. - exhalation, the number of repetitions of 15, the time it takes to complete one repetition of 4 seconds, the energy expenditure of the exercise is 4.28 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 64.2 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs apart; circular movements of the pelvis in four counts, arbitrary breathing, the number of repetitions of 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 5.18 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 51.8 cal / kg ⋅ min,

- I.p. standing, legs together, arms down, at the expense of 1 spreading the arms to the sides, at the same time swing one leg to the side - inhale, at the expense of 2 - return to I. p. exhale, at the expense of 3-4 the same with the other leg, the number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of the exercise is 6.48 cal / kg, the energy expenditure per minute of the exercise with this number of repetitions is 77.76 cal / kg ⋅ min

- I.p. standing, hands on the belt, legs together; on set 1, inhale, on account 2, put one leg to the side on the toe, tilt the body in the same direction, raise the opposite hand up - exhale, count 3-4 on the other side, number of repetitions 15, time for one repetition 4 sec, the energy expenditure of the exercise is 5.1 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 76.5 cal / kg ⋅ min,

- I.p. standing, feet shoulder width apart, arms on the belt; on the count of 1 breath, on the count of 2-3-4 circular movements with the body - exhale, the number of repetitions is 12, the time for performing one repetition is 5 seconds, the energy expenditure of the exercise is 5.7 cal / kg,

energy consumption per minute of doing the exercise with a given number of repetitions of 68.4 cal / kg ⋅ min,

- I.p. standing, one arm raised up, the other lowered, legs apart; jerking hands on each account, changing hands after two counts, breathing arbitrary, number of repetitions 15, time to complete one repetition 4 seconds, energy expenditure of exercise 3.74 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 56.1 cal / kg ⋅ min

- I.p. standing, arms down, legs apart; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4, lower your hands down, relax - exhale, the number of repetitions 12, the time to complete one repetition of 5 seconds, the energy expenditure of the exercise is 3.38 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 40.56 cal / kg ⋅ min,

- Walking 100 steps per minute. within 60 seconds, energy expenditure per minute of walking 65.8 cal / kg ⋅ min, then the following exercises:

- I.p. sitting on the edge of a chair, hands on his knees, legs bent; 1-2 to lean back in the chair, straighten and spread legs and arms to the sides - inhale, 3-4 to return to the IP, the number of repetitions 10, the time to complete one repetition of 6.0 seconds, the energy expenditure of exercise 4, 34 cal / kg, energy consumption per minute of the exercise with a given number of repetitions 43.4 cal / kg ⋅ min,

- I.p. sitting on the edge of a chair; the legs are bent at the knees, the hands on the back of the chair; at the expense of 1-breath, at the expense of 2-3-4, straighten the legs to the position of a right angle, return to I. p. - exhalation, the number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of the exercise is 3.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 46.8 cal / kg ⋅ min,

- I.p. sitting with support on the back of a chair; hands on hips, legs straightened; at the expense of 1 spread your arms to the sides, bend down - inhale, at the expense of 2-3 tilt

forward, hands stretch to the socks - exhale, at the count of 4 - return to ip, the number of repetitions is 12, the time to complete one repetition is 5.0 seconds, the energy expenditure of the exercise is 3.54 cal / kg, the energy expenditure per minute of the exercise with this amount repetitions of 42.48 cal / kg ⋅ min,

- I.p. sitting on a chair; hands on knees, legs bent; on account 1 - straighten the left leg in the knee and lift up, at the same time take the right hand to the side, on account 2 - return to the p., on account 3-4 the same with the right foot and left hand, breathing is arbitrary, the number of repetitions is 12 , the execution time for one repetition of 5 seconds, the energy expenditure of the exercise 3.27 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions of 39.24 cal / kg ⋅ min,

- I.p. sitting on a chair, arms down, legs straightened; circular motions of the feet and hands on each count, arbitrary breathing, the number of repetitions of 15, the time to complete one repetition of 4 seconds, the energy expenditure of the exercise is 1.96 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 29.4 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent; on the bill 1-2, spread your arms to the sides - inhale, on the bill 3-4, lower your hands down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy cost of the exercise is 2.72 cal / kg, energy consumption per minute of execution exercises with a given number of repetitions of 27.2 cal / kg ⋅ min.

The complex of exercise therapy No. 4 is prescribed to patients with a distance of 451-649 meters with TLC (recommended achievement of total energy expenditure with exercise therapy 820-1045 cal / kg), or ME 4.0-4.9 with VEM test (recommended achievement of total energy expenditure with exercise therapy 820 -1045 cal / kg); characteristics of the base complex LFK No. 4: general

energy expenditures - 825.6 cal / kg, energy expenditures of 1 minute of exercises - 41.28 cal / kg ⋅ min., the duration of the complex - 20 minutes:

- I.p. sitting, hands on knees, legs bent; squeezing and unclenching the brushes into a fist for each account with simultaneous bending and extension of the feet, arbitrary breathing, the number of repetitions of 20, the time to complete one repetition of 3 seconds, the energy expenditure of the exercise is 1.11 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 22, 2 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4, lower your hands down, relax - exhale, the number of repetitions 12, the time to complete one repetition of 5 seconds, the energy expenditure of the exercise 2.72 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 32.64 cal / kg ⋅ min,

- I.p. sitting, legs bent; on account 1 - arms to the shoulders with tension, on account 2 - arms to the sides, on the count of 3 hands to shoulders with tension, on the count of 4 arms lower down, relax, breathing arbitrary, number of repetitions 12, time for one repetition 5 , 0 sec, energy expenditure of the exercise 2.42 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions 29.04 cal / kg ⋅ min,

- I.p. sitting, hands on the belt, legs bent; 1-2 count elbows to the sides and back - inhale, 3-4 counts bring elbows together - exhale, number of repetitions 12, time to complete one repetition 5 seconds, energy expenditure of exercise 2.59 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 31.08 cal / kg ⋅ min,

- I.p. sitting on the edge of the chair, hands on the chair at the back, legs bent, on the count of 1 — raise the leg bent at the knee, on the count of 2 — straighten the raised leg, on the count of 3 — bend the raised leg, on count 4 - lower the leg, return to ip, the number of repetitions 10, the execution time of one repetition of 6 seconds,

exercise energy expenditures 3.07 cal / kg, energy expenditures per minute of the exercise for a given number of repetitions 30.7 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent, at the expense of 1-2 taking the arm to the side with the body turning in the same direction - inhale, at the expense of 3-4 return to I. p. - exhalation, the number of repetitions 15, the execution time of one repetition of 4 seconds, the energy expenditure of the exercise is 2.4 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 36 cal / kg ⋅ min,

- I.p. sitting with support on the back of a chair; hands on hips, legs straightened; on account 1, spread your arms to the sides, bend down - inhale, on the account 2-3 lean forward, arms reach out to the socks - exhale, on the count 4 - return to I.p., number of repetitions 12, time for one repetition 5.0 sec , the energy expenditure of the exercise is 3.54 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 42.48 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs together; count 1 - inhale, count 2 - put one foot to the side on the toe, tilt the body in the same direction, raise the opposite hand up - exhale, count 3-4 in the same direction, the number of repetitions is 12, the execution time of one repetition of 5 seconds, energy expenditure of exercise 5.0 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 60 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart; counting 1 breath, counting 2-3-4 the body tilts to the right and left, the opposite arm slides along the body to the armpit - exhale, “pump”, number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of exercise 3, 9 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions of 46.8 cal / kg ⋅ min,

- I.p. standing, legs together, arms lowered, at the expense of 1 - spreading the arms to the sides, at the same time swing one foot to the side - inhale, at the expense of 2 - return to I. p. exhale, at the expense of 3-4 the same with the other leg, the number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of the exercise is 6.48 cal / kg, the energy expenditure per minute of the exercise with this number of repetitions is 77.76 cal / kg ⋅ min

- I.p. standing, arms down, legs apart, feet in parallel; on account 1 - inhale, on account 2-3 crouch, hands forward - exhale, on account 4 - return to ip, number of repetitions 15, time to complete one repetition 4 seconds, energy expenditure of exercise 7.56 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 113.14 cal / kg ⋅ min,

- Walking 80 steps per minute. within 60 seconds, energy consumption per minute of walking 59.4 cal / kg ⋅ min, then the following exercises:

- I.p. standing, arms down, legs apart; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4, lower your hands down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 3.38 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 33.8 cal / kg ⋅ min,

- I.p. sitting, hands on the belt, legs bent, on the count 1 - inhale, on the count 2-3-4 circular movement of the body - exhale, the same in the opposite direction, the number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of exercise 2 , 73 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 32.76 cal / kg ⋅ min,

- I.p. sitting on the edge of a chair, hands on his knees, legs bent; 1-2 to lean back in the chair, straighten and spread legs and arms to the sides - inhale, 3-4 to return to the IP, the number of repetitions 10, the time to complete one repetition of 6.0 seconds, the energy expenditure of exercise 4, 34

cal / kg, then passive rest, energy consumption per minute of doing the exercise with a given number of repetitions of 43.4 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent, circular head movements in four counts, number of repetitions 10, time to complete one repetition 6 sec, energy expenditure of exercise 2.6 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 26 cal / kg ⋅ min

- I.p. sitting on a chair, arms down, legs straightened; Circular movements of the feet and hands on each count, arbitrary breathing, the number of repetitions of 15, the time to complete one repetition of 4 seconds, the energy expenditure of the exercise is 1.96 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 29.4 cal / kg ⋅ min,

- I.p. sitting, arms to shoulders; knees are divorced; on the score 1-2, spread the elbows to the sides - inhale, on the score 3-4, lower both elbows on one knee, lean forward - exhale, the same on the other knee, the number of repetitions 10, the time it takes to complete one repetition of 6 seconds, the energy expenditure of exercise 3, 2 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 32 cal / kg ⋅ min,

- I.p. sitting, hands on your knees; the legs are bent; alternate breeding in the direction of socks and heels into four accounts; return to I.p. also into four counts, the number of repetitions of 20, the time to complete one repetition of 3 seconds, the energy expenditure of the exercise is 1.28 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 25.6 cal / kg ⋅ min,

- I.p. sitting on the edge of the chair, the shoulder blades touch the back of the chair, hands on the upper square of the abdomen; on account 1 - the wall of the abdomen protrudes - inhale, on the account 2-3-4 the wall of the abdomen retracts - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy expenditure of 2.14

cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 21.4 cal / kg ⋅ min, passive rest.

The complex of exercise therapy No. 5 is prescribed for patients with a covered distance of 350-450 meters with TLC (the recommended achievement of total energy expenditure with exercise therapy 700 - 819 cal / kg), or ME 3.0-3.9 with a VEM test (recommended achievement of total energy expenditure with exercise therapy 630 -819 cal / kg); characteristic of the basic complex of exercise therapy № 5: total energy consumption - 791.65 cal / kg, energy expenditure of 1 minute of exercises - 39.58 cal / kg ⋅ min., the duration of the complex - 20 min .:

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, on the bill 1-2 to spread the arms apart with tension, inhale the nose, on the bill 3-4 to lower the arms down, relax, exhale, the number of repetitions is 12, one execution time repetition of 5 seconds, energy expenditure of the exercise 2.19 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions 26.28 cal / kg ⋅ min,

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, knees are connected, alternating breeding in the sides of the socks and heels into four counts, return to I.P. also into four counts, breathing is arbitrary, the number of repetitions is 30, the time it takes to complete one repetition of 2 seconds, the energy expenditure of the exercise is 0.98 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 29.4 cal / kg ⋅ min,

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, on the account 1-2 take the arm to the side with the body turned, inhale the nose, on the count 3-4 return to the ip, exhale the nose, the same way , the number of repetitions 15, the time it takes to complete one repetition of 4 seconds, the energy expenditure of the exercise is 1.81 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 27.15 cal / kg ⋅ min,

- I.p. sitting on a chair, back pressed to the back of the chair, hands on his knees; legs are slightly diluted, on the bill 1-2 to spread the arms to the sides, inhale the nose, on the bill 3-4 grab the knee with your hands and pull the leg to the chest - exhale, the number of repetitions 10, the time it takes to complete one repetition of 6 seconds, the energy expenditure of the exercise is 3.33 cal / kg, energy consumption per minute of the exercise for a given number of repetitions 33.3 cal / kg ⋅ min,

- I.p. sitting on the edge of the chair, arms are lowered, one leg is bent at the knee, the other is straightened, the position of the legs is changed by two counts, breathing is arbitrary, the number of repetitions is 12, the time it takes to perform one repetition is 5.0 seconds, energy expenditure is 3.46 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 41.52 cal / kg ⋅ min,

- I.p. sitting, hands on the belt; legs are spread wider than shoulders, on account 1 - to spread your arms to the sides, inhale with your nose, on the account 2-3-4 tilt the body forward to one knee, putting your hands on the knee, exhale with your mouth, the other leg, the number of repetitions 10, time perform one repetition of 6 seconds, the energy expenditure of the exercise is 3.22 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 32.2 cal / kg ⋅ min,

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the belt, on the count of 1 breath, on the count of 2-3-4 circular movement of the body for four counts in one direction and the other, exhale, the same in the other direction, the number of repetitions is 12, the execution time of one repetition is 5.0 seconds, the energy expenditure of the exercise is 2.43 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 29.16 cal / kg ⋅ min,

- I.p. sitting on the edge of the chair, hands grasp the back of the chair at the back, on account 1 - raise the leg bent at the knee, inhale with the nose, on account 2 - straighten the raised leg, exhale through the mouth, on account 3 - bend the raised leg, inhale through the nose, on account 4 - return to ip, exhale by mouth, number of repetitions 12, time to complete one repetition 5 sec, energy expenditure 2.9

cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 34.8 cal / kg ⋅ min,

- I.p. sitting on the edge of the chair, hands on his knees, 1-2 to lean back in the chair, straighten and spread legs and arms to the sides, inhale with your nose, 3-4 to return to the IP, exhale with your mouth, the number of repetitions is 10, the duration of one repetition is 6.0 seconds, the energy expenditure of the exercise is 3.72 cal / kg, then the passive rest is 1-2 minutes, the energy expenditure per minute of the exercise with a given number of repetitions is 37.2 cal / kg ⋅ min,

- I.p. sitting on the edge of the chair, arms down, imitation of walking, raising the knee high, arm movements sweeping, breathing arbitrary, number of repetitions 20, time to complete one repetition 3 sec, energy expenditure 2.31 cal / kg, energy expenditure per minute for this exercise repetitions 46.2 cal / kg ⋅ min,

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, on the count of 1 spread your arms to the sides, inhale, on the count of 2-3-4 hands on your knees, resting your hands on your knees, stand up and sit down - exhale, the number of repetitions is 10, the execution time of one repetition is 6 seconds, the energy expenditure of the exercise is 4.64 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 46.4 cal / kg ⋅ min,

- Walking 90 steps per minute. within 60 seconds, energy consumption per minute of walking 58.2 cal / kg ⋅ min, then the following exercises:

- I.p. standing, arms down, legs apart, at the expense of 1 to do in ip inhalation through the nose. at the expense of 2-3-4, tilt the torso to the right, the opposite arm slides along the torso to the axilla, exhale through the mouth, the same way, the number of repetitions is 12, the time it takes to perform one repetition is 5.0 seconds, the energy expenditure of the exercise is 3.34 cal / kg , energy consumption per minute

performing an exercise with a given number of repetitions of 40.08 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart, at the expense of 1-2 raise your hands up, take your leg back to the toe, bend, inhale with your nose, at the expense of 3-4 return to the IP, exhale with your mouth, the same with the other leg, the number of repetitions 10, the execution time of one repetition of 6.0 seconds, the energy expenditure of the exercise is 6.18 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 61.8 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs together, at the expense of 1 - do in ip inhalation through the nose, on account 2 - put one leg to the side on the toe, tilting the body in the same direction, raise the opposite hand upward, exhale through the mouth, counting 3-4 the same way, the number of repetitions 12, the time it takes to complete one repetition 4 sec, the energy expenditure of the exercise is 4.24 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 50.88 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs apart, circular movements of the pelvis in four counts to the right, left, arbitrary breathing, number of repetitions 10, time to complete one repetition of 6 seconds, energy expenditure of exercise 4.9 cal / kg, energy expenditure per minute of exercise with this quantity repetitions of 49 cal / kg ⋅ min,

- I.p. standing sideways to the back of the chair, one hand on the back of the chair, the other on the belt, at the expense of 1 breath, at the expense of 2-3-4 swing one foot back and forth - (the range of movements is complete), exhale, the same with the other foot, the number of repetitions 12, the execution time of one repetition of 5 seconds, the energy expenditure of the exercise is 6.24 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 74.88 cal / kg ⋅ min,

- I.p. sitting on a chair, back pressed to the back of the chair, hands on his knees, circular movements of the head in four counts to the right and left, breathing

arbitrary, the number of repetitions 10, the execution time of one repetition of 6 seconds, the energy expenditure of the exercise 2.2 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions 22 cal / kg ⋅ min,

- I.p. sitting on a chair, arms down, legs straightened, circular movements of the feet and hands on each count, arbitrary breathing, number of repetitions 15, time to complete one repetition 4 seconds, energy expenditure of exercise 1.9 cal / kg, energy expenditure per minute of exercise with this amount repetitions of 28.5 cal / kg ⋅ min,

- I.p. sitting on a chair, the back is pressed to the back of the chair, arms to shoulders, to the count of 1-2 to extend the elbows to the sides and back, inhalation of the nose, to the count of 3-4 to bring the elbows together, exhale, the number of repetitions 10, the time it takes to complete one repetition 6 , 0 sec, energy expenditure of the exercise 2.27 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions 22.7 cal / kg ⋅ min.

The complex of exercise therapy No. 6 is prescribed to patients with a distance of 270-349 meters with TLC (recommended achievement of total energy expenditure at exercise therapy 600-698 cal / kg), or ME 2.0-2.9 with VEM test (recommended achievement of total energy expenditure at exercise therapy < 630 cal / kg); the characteristic of the basic complex of exercise therapy No. 6: total energy consumption - 611.22 cal / kg, energy expenditure of 1 minute of exercise - 32.97 cal / kg ⋅ min., the duration of the complex - 20 min .:

- I.p. sitting, hands on knees, legs bent; on the bill 1-2, spread your arms to the sides - inhale, on the bill 3-4, lower your hands down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 2.19 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 21.9 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent; squeezing and unclenching the hands into a fist for each account with simultaneous flexion and extension of the feet, arbitrary breathing, number of repetitions 30, time to complete one repetition 2 sec, energy expenditure of exercise 1.0 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 30 cal / kg ⋅ min

- I.p. sitting on the edge of the chair, arms down, one leg bent at the knee, the other straightened; change the position of the legs by 2 accounts, arbitrary breathing, the number of repetitions of 10, the time to complete one repetition of 6.0 seconds, the energy expenditure of the exercise is 3.46 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 34.6 cal / kg ⋅ min,

- I.p. sitting, hands on your knees; legs bent and divorced; on the bill 1-2, spread your arms to the sides - inhale, on the bill 3-4 grab the knee with your hands and pull your leg to the chest - exhale, the number of repetitions 10, the time it takes to complete one repetition 6 seconds, the energy expenditure of the exercise is 3.33 cal / kg, energy expenditure minute of exercise with a given number of repetitions 33.3 cal / kg ⋅ min,

- I.p. sitting, arms to shoulders, legs bent; circular movements in the shoulder joints four counts back and forth, breathing arbitrary, the number of repetitions 10, the time to complete one repetition of 6.0 seconds, energy expenditure of exercise 3.62 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 36.2 cal / kg ⋅ min

- I.p. sitting, hands on your knees; the legs are bent; alternate breeding in the direction of socks and heels into four accounts; return to ip also into four accounts, the number of repetitions is 30, the time it takes to complete one repetition of 2 seconds, the energy expenditure of the exercise is 1.0 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 30 cal / kg ⋅ min,

- I.p. sitting, arms to shoulders; knees are divorced; on the score 1-2, spread the elbows to the sides - inhale, on the score 3-4, lower both elbows on one knee, lean forward - exhale, the same on the other knee, the number of repetitions 10, the time it takes to complete one repetition of 6 seconds, the energy expenditure of exercise 3, 12 cal / kg, energy consumption per minute of the exercise with a given number of repetitions of 31.2 cal / kg ⋅ min,

- I.p. sitting on the edge of the chair, hands on the belt; the legs are bent; straighten and count one leg to the side, 2-go back to ip, count 3-4 with the other foot, number of repetitions 10, time to complete one repetition 6 sec, exercise energy 3.47 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 34.7 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent, at the expense of 1-2 taking the arm to the side with the body turning in the same direction - inhale, at the expense of 3-4 return to I. p. - exhalation, the number of repetitions 12, the execution time of one repetition of 5 seconds, the energy expenditure of the exercise is 1.81 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 21.72 cal / kg ⋅ min,

- I.p. sitting, hands on the belt, legs bent; 1-2 count elbows to the sides and back - inhale, 3-4 counts elbows together - exhale, number of repetitions 10, time to complete one repetition of 6 seconds, energy expenditure of exercise 1.81 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 18.1 cal / kg ⋅ min,

- I.p. sitting, hands on the belt, legs bent, at the expense of 1-breath, at the expense of 2-3-4 circular movement of the body - exhale, the same in the opposite direction, the number of repetitions 10, the time it takes to perform one repetition of 6.0 seconds, the energy expenditure of exercise 2 , 43 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 24.3 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent, on the count of 1 hands spread apart - inhale, on the count of 2-3-4 hands on knees, stand up and sit down - exhale, number of repetitions 10, time for one repetition 6 seconds, energy expenditure of exercise 4 , 64 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions of 46.4 cal / kg ⋅ min,

- Walking 70 steps per minute. for 60 seconds, energy consumption per minute of walking 46.1 cal / kg ⋅ min, then the following exercises:

- I.p. standing, arms down, legs apart; count 1 - inhale, count 2–3–4 the body tilts to the right and left, the opposite arm slides along the body to the armpit - exhale, “pump”, number of repetitions 10, time to complete one repetition 6.0 sec, energy expenditure of exercise 3 , 34 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 33.4 cal / kg ⋅ min,

- I.p. standing, hands on the belt, legs apart; circular movements of the pelvis in four counts, arbitrary breathing, the number of repetitions of 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise 4.90 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions 49 cal / kg ⋅ min,

- I.p. standing, arms down, legs apart; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4, lower your hands down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 3.1 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 31 cal / kg ⋅ min,

- I.p. sitting, hands on your knees; legs bent, feet together; on account 1 - spread the knees to the sides (without spreading the stop) - inhale, on the score 2-3-4 bring the knees together, squeezing them with your hands - exhale, the number of repetitions 10, the time it takes to complete one repetition of 6.0 seconds, the energy expenditure of exercise 1, 69

cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 16.9 cal / kg ⋅ min,

- I.p. sitting on a chair, arms down, legs straightened; circular motions of the feet and hands on each count, arbitrary breathing, the number of repetitions of 15, the time it takes to complete one repetition of 4 seconds, the energy expenditure of the exercise is 1.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 28.5 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent; circular movements of the head into four counts, the number of repetitions of 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise 2.2 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions of 22 cal / kg ⋅ min,

- I.p. sitting, hands on knees, legs bent; on the bill 1-2, spread your arms to the sides - inhale, on the bill 3-4, lower your hands down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 2.19 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 21.9 cal / kg ⋅ min.

The final part of a controlled training session (10 minutes) of the preparatory outpatient period includes performing special exercises for the eyes both in the position of the patient sitting or standing, depending on the choice of comfort for him, as well as walking the patient at an arbitrary pace.

A set of special exercises for the eyes No. 1:

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands are hanging freely, head is straight: eye movements up to the limit, up and down and to the side with open eyes. The number of repetitions of 10.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands are hanging freely, head is straight: movement of the eyes to the limit up, down and to the side with eyes closed. The number of repetitions of 10.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely, head straight: circular movements of the eyes (left, up, right, down, in the opposite direction) with open eyes. The number of repetitions of 10.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely, head straight: circular movements of the eyes (left, up, right, down, in the opposite direction) with closed eyes. The number of repetitions of 10.

- I.p. sitting on a chair, the back is pressed to the back of the chair, fingers on the eyelids of the head are straight: lightly stroking closed eyes in a circle to the nose. The number of repetitions is 10. At the end of the exercise, blink several times.

- I.p. sitting on a chair, the back is pressed to the back of the chair, fingers on the eyelids of the head are straight: lightly stroking closed eyes in a circle from the nose. The number of repetitions is 10. At the end of the exercise, blink several times.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely, head straight: squeezing and unclenching the eyelids with effort. The number of repetitions is 10-15.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely, head straight: fixing the look on the tip of the nose for 15-20 seconds. The number of repetitions is 4-6.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands are hanging freely, head is straight: fixing the gaze on the eyebrow space for 15-20 seconds. The number of repetitions is 4-6.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands are hanging freely, head is straight: rotation of the head with a fixed look in front of itself in one direction. The number of repetitions is 4-6. Head rotation with fixed gaze in front of you. The number of repetitions is 4-6.

- I.p. sitting on a chair, back pressed to the back of the chair, arms hanging, chin to the cervical fossa, eyes closed, neck muscles relaxed: calm sitting. The number of repetitions up to 30 seconds 1 time.

A set of special exercises for eyes No. 2 (the main stance (OS) in exercises means - heels together, socks apart, knees straight, back straight, shoulders straightened):

- I.p. OS: look straight ahead for 2-3 seconds, “put” the finger of the right hand along the midline of the face at a distance of 25-30 centimeters from the eyes, look at the end of the finger and look at it for 3-5 seconds, lower your hand. The number of repetitions is 10-12.

- I.p. OS: stretch the arm forward along the midline of the face, look at the end of the finger and slowly bring it closer without taking your eyes until the finger begins to “double”. The number of repetitions is 6-8.

- I.p. OS: “put” the finger of the right hand in the midline of the face at a distance of 25-30 centimeters from the eyes, look at the end of the finger with two eyes for 3-5 seconds, cover the left eye with the palm of your left hand for 3-5 seconds, remove the palm, watch with two eyes on the end of the finger 3-5 seconds .. The number of repetitions 5-6.

- I.p. OS: "put" the finger of the left hand in the midline of the face at a distance of 25-30 centimeters from the eyes, look with both eyes at the end of the finger for 3-5 seconds, cover the right eye with the palm of your right hand for 3-5 seconds, remove the palm, watch with two eyes on the end of the finger 3-5 sec. The number of repetitions is 5-6.

- I.p. OS: move your hand to the right side, slowly move the finger of a half-bent hand from right to left, and with a motionless head, look at the finger. Slowly move the finger of a half-bent arm from left to right, and with an immovable head, follow it. The number of repetitions is 10-12.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees: tightly screw up your eyes for 3-5 seconds, then open for 3-5 seconds .. The number of repetitions is 6-8.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees: quickly blink for 15 seconds .. The number of repetitions is 3-4.

- I.p. sitting on a chair, the back is pressed to the back of the chair, arms hang freely: close your eyes and massage your eyelids with circular finger movements for 1 minute.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: with three fingers of each hand, it is easy to press the upper eyelid of both eyes, after 1-2 seconds remove fingers from the eyelid. The number of repetitions is 3-4.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: with index fingers fix the skin of the superciliary arches. Slowly close your eyes, fingers, while holding the skin, show resistance. The number of repetitions is 8-10.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: arms are bent in front of you, at a distance of 25-30 centimeters, palms to the face, fingers together, palms together. Look in the palm of your hand for 3-5 seconds, spread your arms to the sides and watch 3-5 seconds. right in front of you. The number of repetitions is 8-10.

For individual training at home in the preparatory period of the outpatient phase, it is recommended that you independently perform the following complex of breathing exercises in the morning (as a form of morning exercises) performed by the patient in a sitting position, with a number of repetitions of each exercise 4-6 times:

 - I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely (or grab the seat of the chair with your hands, if balance is difficult to keep): at the expense of 1 - a slow breath with your nose, inflate your stomach, bending

in the lower back and at the same time straighten the legs in the knee joints (pull socks), at the expense of 2 - a slow breath in the mouth, lips with a tube, return the legs to their original position. Do not throw your head back.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees: on the count of 1 - a slow breath in with your nose, puffing up your stomach, arching in the lower back, on the count of 2 - slow out breath in your mouth in portions (3 portions), lips with a tube.

- I.p. sitting on a chair, the back is straight, pressed to the back of the chair on the chair, the back is pressed to the back of the chair, hands on the knees: on the count 1 - a slow breath with your nose, puffing your stomach, caving in the lower back, while turning your head to the right shoulder, on the count 2 - slow exhalation by mouth, lips with a tube, returning the head to ip, at the expense of 3-4 the same in the other direction.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: on the count of 1 slow nose inhale, puffing up the stomach, caving in the lower back, raising hands forward and up, on the count of 2 - slow exhale through the mouth, lips with a tube, lowering hands through the sides, raising a leg bent at the knee, clasping her hands under the knee and leaning forward, at the expense of 3-4 - the same with the other leg.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands near the shoulders, elbows are pressed to the ribs: on account 1 - a slow breath with your nose, puffing up your stomach, arching in the lower back, straightening your arms down, at the expense of 2 - a slow exhale with your mouth, lips with a tube, returning hands in ip

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: on account 1 - a slow breath with your nose, puffing up your stomach, arching in the lower back, put your foot on your leg, on the count 2 slow exhale with your mouth, go back to the ip, on the count 3-4 - the same with the other leg.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the stomach are locked into the lock: on account 1 - a slow breath with your nose, puffing up your stomach, caving in the lower back, spreading your arms wide to the side with your palms forward at shoulder level, on account 2 - a slow breath out , lips with a tube,

returning the hands to their original position, blowing off their stomach. Do not throw your head back.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands at the shoulders, shoulders parallel to the floor: at the expense of 1 - a slow breath with your nose, inflating the stomach, arching in the lower back, put your elbow behind your head, at the expense of 2 - a slow exhale with your mouth, return the elbow to and .p., at the expense of 3-4 - with the other hand.

- I.p. sitting on a chair, the back is pressed against the back of the chair, the wrists are at the shoulders, the elbows are pressed to the ribs: on account of 1 slow inhalation with the nose, inflating the stomach, arching in the lower back, raise both elbows up, by 2 - slow exhalation with the mouth, return the elbows to and .P.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: on account 1 - a slow breath with your nose, puffing up your stomach, caving in the lower back, raising your hands forward and up, on account 2 - a slow exhale with your mouth, leaning forward and lowering your hands through the sides .

The program of individual FT recommended for the home also includes a set of special exercises for the eyes, which are performed by the patient, preferably 1.5-2 hours before bedtime, while sitting or standing at the patient’s choice (the technique is described above in the final part of the controlled training session in outpatient preparatory period).

Patients 2 times a week on free days from FT in a medical institution are recommended dosed walking on flat terrain in compliance with a number of rules. The first 2-3 lessons require mastery of rhythmic walking skills, consistent with uniform breathing. Approximate rhythm of steps: 2-3 steps - inhale, 4-6 steps - exhale. In the preparatory period, the pace of walking can be slow - 80-90 steps per minute, medium - 100-120 steps per minute and fast - 130-150 steps per minute. The first 3-4 days will be sufficient distance of 500-700 meters at the optimum pace, with rest sitting for 3-5 minutes at

half way. Then the distance increases after 3-5 days by 200 meters. Rest time is reduced to 2-3 minutes. After a month of regular classes of dosed walking, you can increase the pace of walking, not exceeding 90 steps per minute, and gradually increase the distance to 4000 meters per day.

Stage II of the Kyrgyz Republic on an outpatient basis: the outpatient main period of physical rehabilitation lasts up to 40 lessons. The objectives of this period are: stimulation of interstitial metabolism and strengthening the muscular system, further adaptation to household loads and preparation for work. Patients study in groups. Classes are held 2-3 times a week. Duration increases to 60 minutes by increasing the number of exercises and the number of repetitions. The initial position of the patient during the exercise in the main period, the first 20 classes - sitting and standing with mandatory support, and the next 20 classes - sitting, standing without support and walking.

During the main and subsequent period of RF, the need for a strict calculation of the energy expenditure of physical exercises disappears, because by this time the patient after RF RF had completed the early postoperative “blind” period of the clinical course of the disease, which was associated with an increased risk of heart complications and the need for exercise in gentle mode.

The introductory part of a controlled training session (15 minutes) of the main period of the outpatient phase includes a complex of respiratory gymnastics with diaphragmatic breathing. For a variety of classes, it is advisable to alternate the following complexes and No. 2: one lesson - I.p. patient sitting (complex number 1), and another lesson I.p. standing patient (complex number 2). Complex

breathing exercises with diaphragmatic breathing No. 1 includes the following exercises with the number of repetitions of each 4-6 times, performed in the patient's sitting position:

- I.p. sitting on a chair, the back is pressed to the back of the chair: on account 1 - a slow breath with your nose, puffing up your stomach, while turning your head to the right shoulder, 2 - slow breath out through your mouth, lips with a tube, returning your head to I. p. 3-4 the same in the other direction.

- I.p., sitting on a chair, the back is pressed to the back of the chair, hands at the shoulders, elbows are pressed to the ribs: on account 1 - a slow breath in with your nose, puffing up your stomach, straightening your arms down, on account 2 - a slow out breath, mouth lips, returning hands to ip

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the stomach are locked in the lock: on account 1 - a slow breath with your nose puffing your stomach, turn your palms outward (fingers remain in the lock, elbows are straightened), on account 2 - a slow breath out, lips with a tube, return your hands to their original position, "blowing off" the stomach with your hands.

- I.p. sitting on a chair, the back is straight, pressed to the back of the chair, hands on the knees with the palms upwards: on account 1 - a slow inhalation with the nose, inflating the stomach, while simultaneously clenching your fingers into fists, on account 2 - a slow exhalation by the mouth, lips with the tube, while unclenching fists.

- I.p. sitting on a chair, the back is straight, pressed to the back of the chair, hands hang freely: on account 1 - a slow breath with your nose, puffing up your stomach, raising your hands up, on account 2 - a slow exhale through your mouth, lips with a tube, lowering your hands in and.

- I.p. sitting on a chair, in an inclination, wrists at the shoulders, elbows touch the knees, chin to the cervical fossa: at the expense of 1 - a slow breath with your nose, straightening and puffing up your stomach, taking your elbows as far back as you can, at the expense of 2 - a slow exhale with your mouth, lips with a tube, returning in ip

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the belt, thumbs to the side of the lower back: on account 1 - a slow breath with your nose, pushing your elbows as far back and inflating your stomach, on account 2 - a slow exhalation with your mouth, lips with a tube, chin to the neck the fossa, leaning slightly forward, as if blowing off the stomach, bringing elbows in front of him, with sliding movements of his hands along his belt.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees are straightened at the elbows, the head looks directly: at the expense of 1 slow nose inhale, puffing up his stomach, tilting his head forward (chin to the cervical fossa), at the expense of 2 - slow exhalation with the mouth, lips with a tube, returning the head to the ip

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: on account 1 - a slow breath with your nose, puffing up your stomach, raising your hands forward and up, on account 2 - a slow exhale with your mouth, lips with a tube, leaning forward, lowering your hands through the sides clasping their legs under the knees.

- I.p. sitting on a chair, the back is pressed to the back of the chair, hands hang freely: on account 1 - a slow breath with your nose, puffing up your stomach, raising your relaxed hands up, on account 2 - a sharp exhale with your mouth, leaning forward and freely lowering your hands.

The respiratory gymnastics complex with diaphragmatic breathing No. 2 includes the following exercises with the number of repetitions of each 4-6 times, performed in the patient's standing position:

- I.p. standing: at the expense of 1 - a slow inhalation with the nose, inflating the stomach, the right leg forward on the toe, at the expense of 2 - the slow exhalation with the mouth, lips with the tube, returning the leg to the IP, at the expense of 3-4 - with the other leg.

- I.p. standing: at the expense of 1 - a slow inhalation with the nose, inflating the stomach, right leg back on the toe, at the expense of 2 - the slow exhalation with the mouth, lips with the tube, returning the leg to the IP, at the expense of 3-4 - with the other leg.

- I.p. standing: at the expense of 1 - a slow inhalation with the nose, inflating the stomach, the right leg forward on the heel, at the expense of 2 - the slow exhalation with the mouth, lips with the tube, returning the leg to the IP, at the expense of 3-4 - with the other leg.

- I.p. standing: At the expense of 1, a slow breath with the nose, inflating the stomach, the right leg to the right on the toe, at the expense of 2 - the slow exhalation with the mouth, lips with the tube, returning the foot to the IP, at the expense of 3-4 - with the other leg.

- I.p. standing: at the expense of 1 - a slow breath in with your nose, puffing up your stomach, bringing your elbows in front of you (without leaning forward), at the expense of 2 - a slow breath out with your mouth, lips with a tube, returning your elbows to the ip, bringing the shoulder blades together.

- I.p. standing: at the expense of 1 - a slow inhalation with the nose, inflating the abdomen, drawing the elbows as far back as possible, at the expense of 2 - the slow exhalation with the mouth, lips with the tube, bringing the elbows in front of you, blowing the belly with your hands with sliding hands.

- I.p. standing: at the expense of 1 slow breath with your nose, puffing your stomach, while slowly squeezing your fingers with force into fists, at the expense of 2 - slow exhalation with your mouth, lips with a tube, while slowly unclenching your fists.

- I.p. standing: at the expense of 1 - a slow inhalation with the nose, inflating the stomach, spreading his arms wide to the side at shoulder level, palms forward, at the expense of 2 - the slow exhalation by mouth, lips with a tube, hugging himself over the shoulders.

- I.p. standing: at the expense of 1 - a slow inhalation with the nose, inflating the stomach, at the expense of 2 - the slow exhalation with the mouth, lips with a tube, pressing with your hands on the stomach (blowing the stomach with your hands). Do not throw your head back.

- I.p. standing: at the expense of 1 - a slow inhalation with the nose, puffing up the stomach, raising relaxed hands up, at the expense of 2 - the slow exhalation with the mouth, lips with the tube, freely returning the hands to the person.

The main part of the controlled training session (30 minutes) of the main period of the outpatient phase. At this stage, the complex of training includes stretching exercises,

performed with mandatory support (for example, at the gymnastic wall) during the first 20 classes.

A set of exercises for stretching at the gymnastic wall:

- I.p. stand with your back to the wall at a step distance: at the expense of 1-2 hands with arcs forward, up, back, touch the rail, rise on toes, bend; score 3-4 return to I.p.

- I.p. stand with your back to the wall: at the expense of 1-2 grab your hands on the rail at head level, straightening your arms, stretch forward; at the expense of 3-4 return to I.p.

- I.p. stand facing the wall at a distance of a step, grasping the rail at the level of the belt with your hands: on account of 1 swing with the right foot back, on account of 2 return to I.p .; at the expense of 3-4 the same with the left foot.

- I.p. the stand is facing the wall, the socks of the legs are close to the wall, the hands grab the rail at the level of the belt: straighten your hands for 1-2, bend back, press your hips against the wall; at the expense of 3-4 return to I.p.

- I.p. standing with his back to the wall: on the count of 1 swing the right thigh up, on the count of 2 return to I.p .; at the expense of 3-4 the same left thigh.

- I.p. stand with your left side to the wall, grab with your right hand over the rail above your head, with the left bottom at the level of the belt: at the expense of 1-2 straightening your arms tilt to the left; at the expense of 3-4 return to I.p.

- I.p. stand with your left side to the wall, grab your hand by the rail at the level of the belt, right hand up: to the count of 1 swing with the right foot to the side, right hand to the side; to account 2 return to I.p.

- I.p. stand with your left side to the wall, grab with your right hand over the rail above your head, with the left bottom at the level of the belt: at the expense of 1-2 straightening your arms tilt to the left; at the expense of 3-4 return to I.p.

- I.p. the stand is facing the wall at a step distance, legs apart, hands grasping the rail at the level of the belt, at the expense of 1 forward tilt; to account 2 return to I.p.

- I.p. stand with your back to the wall, grabbing your hands behind the rail from below at the level of the belt: on account of 1 swing with the right foot forward, stretch forward; to account 2 return to I.p .; at the expense of 3-4 the same with the left foot.

- I.p. stand with the left side to the wall, the left foot on the rail (preferably at the level of the belt), hands on the belt: on account 1-2 lean forward, bending, arms to the sides; at the expense of 3-4 return to I.p.

- I.p. the stand is facing the wall, the socks of the legs are close to the wall, hands grab the rail at the level of the belt: 1-2 squats count, with straight arms, shoulders back; at the expense of 3-4 return to I.p.

- I.p. stand with your left side to the wall, grab your hand by the rail at the level of the belt, right hand up: to the count of 1 swing with the right foot to the side, right hand to the side; to account 2 return to I.p.

- I.p. stand with the left side to the wall, the right foot on the rail (preferably at the level of the belt), hands on the belt: at the expense of 1-2 lean forward, bending, arms to the sides; at the expense of 3-4 return to I.p.

- I.p. standing facing the wall at a step distance, grab your hands on the staff at the level of the belt: put 1-2 on the left foot on the 3-5th staff, the pelvis forward and up, right on the toe; at the expense of 3-4 return to I.p .; into the account 5-8. same with the right foot.

With a high level of patient coordination, it is possible to use the complex for stretching without support. The essence of these exercises is to stretch the different parts and the whole body in the appropriate directions, which leads to a change in short-term muscle tension and relaxation. This allows you to relax in a short time and regain an active working condition.

The stretching complex without support is performed for 10 minutes and includes the following exercises (the main stance (OS) in the exercises means standing, heels together, socks apart, knees straight, back straight, shoulders straightened):

- I.p. OS, hands “in the lock” below: we raise straight arms upward, turning our palms outward, springing our hands behind our heads, do not bend our elbows.

- I.p. OS, hands “in the lock” forward: we raise straight arms upward, turning our palms outward, palms at the level of our heads, we pull straight arms upward, our feet are as tense as possible, our heels are pulled downward. Do not bend your knees.

- I.p. OS, hands “in the lock” are stretched forward with palms turned outward: the angle of inclination is 90 °.

- I.p. OS, arms “in the lock” up, with outstretched palms outward: tilt to the right - tilt to the left. Elbows, do not bend your knees. Palms strictly above the head.

- I.p. OS, hands “in the lock” below: tilts of the body as far forward as possible, with palms turned outward, trying to reach the floor. Slopes are springy. Do not bend your knees.

- I.p.- legs are widely spaced, hands are “locked” below: with palms turned outward, we first try to get the foot of one leg, then we change the leg. Do not bend your knees.

- I.p. OS, arms below: torso to the knees, hands under the knees. Trying to reach your knees with your forehead. Do not bend your knees.

- I.p. one leg is bent at the knee, the support is completely on the foot, the second is forward and straight, with support on the heel, the hands “in the lock” with their palms turned outward, press on the knee: try to bend the knee in the opposite direction. We change the position of the legs.

- I.p. one leg is bent at the knee, the support is completely on the foot, the second is forward, straight, with support on the heel, hands are “locked”: try to grab the foot “locked”, pull the foot towards you. The knee is maximally straightened. We change the position of the legs.

- I.p. support on one leg, the second raised 90 on the support, hands "locked": we press our palms on the knee, the sock on ourselves. Do not bend the knee of the supporting leg. A passive option is possible.

- I.p. deep lunge: push the hand on the thigh of the hind leg. The knee is straight. Deep lunge. We spring our arms back, the supporting leg is bent at the knee, we sit on it, the second leg is straight laid aside. We press on the knee. We change the position.

In the program for the physical rehabilitation of patients with AF after RF RF in the main stage, with a good clinical condition and the absence of any cardiac arrhythmias, original sets of exercises of special effects with weights (dumbbells or weights located on the upper limbs at the shoulder level) are introduced, which for a change it is advisable to alternate. These exercises affect the motor-visceral reflexes of the segments of the spinal cord at the level of the vertebrae C ₃ -C ₄ and T ₁ -T ₈ , innervating the heart and stimulating the mechanisms of compensation of the central and peripheral circulatory system, with working muscles (neck, trapezoid, scalene, large and small rhomboid, supra- and infraspinatus, intercostal, as well as small muscles of the hand and fingers). These exercises are cyclical in nature, and relate to exercises of low or moderate intensity (depending on the patient’s FC). Cycling in the implementation of complexes of exercise therapy with dumbbells is achieved due to the continuity of the exercises. In ordinary life, patients often have to perform just such everyday activities, and they should be prepared for this.

Patients with AF after RFA surgery are recommended a combined static-dynamic load with dumbbell retention - weighing 1.5-2 kg by patients of FC I-II and weighing 0.5-1 kg by patients of FC III. The essence of such a combined static-dynamic load is

alternating gymnastic exercises with weights with exercises of a dynamic nature, breathing exercises and exercises with muscle relaxation (for patients of FC III with the simultaneous release of an aggravating shell from the hands).

A set of exercises with dumbbells No. 1 (the main stance (OS) in exercises means standing, heels together, socks apart, knees straight, back straight, shoulders straightened) with the number of repetitions of exercises 10 times:

- I.p. OS, arms to the sides, palms down: springy movements with straight arms up and down by 20-25 cm. Respiration is arbitrary.

- I.p. OS, straight arms in front of the chest, palms down: springy movements with straight arms up and down by 20-25 cm. Respiration is arbitrary.

- I.p. OS, straight arms in front of the chest, palms up: springy movements with straight arms up and down by 20-25 cm. Respiration is arbitrary.

- I.p. OS, arms to the sides, down, without touching the body, in tension, palms up: springy movements with straight arms with maximum amplitude, not reaching the extreme points below and above. The breath is arbitrary.

- I.p. OS, arms below, relaxed: raise straight arms through the sides just above shoulder level, return to I.p. The breath is arbitrary.

- I.p. OS, arms above, strictly above the head, palms connected by the back: lower straight arms through the sides just below shoulder level, return to I. p. The breath is arbitrary.

- I.p. OS, arms below: raise straight arms in front of you just above shoulder level, return to I.p. The breath is arbitrary.

- I.p. OS, arms above, strictly above the head, palms forward: lower your arms in front of you just below shoulder level, return to I.P. The breath is arbitrary.

- I.p. OS, arms below: raise your arms through the sides up, joining your palms strictly above your head, return to I.P. The breath is arbitrary.

- I.p. standing, arms side up, feet shoulder width apart: alternately bending the arm bent around the corner of the opposite shoulder blade. The breath is arbitrary.

- I.p. standing, arms side up, legs shoulder width apart: simultaneously bent arms around the corner of the opposite shoulder blade. The breath is arbitrary.

- I.p. standing, arms to the sides, elbows bent, elbows at shoulder level, feet shoulder width apart: bring your elbows in front of your chest, elbows at shoulder level, touch each other, return to ip The breath is arbitrary.

- I.p. standing, arms to the sides, palms down, legs shoulder-width apart: lower the straight arm down. The breath is arbitrary. Same thing the other way.

- I.p. standing, arms to the sides, palms forward, feet shoulder-width apart: pulling the arms back at shoulder level, crouching in the lower back, slow nose inhale, "hug" yourself, slouch, slow mouth exhalation.

Patients of FC III perform a set of exercises with dumbbells No. 1 in I.p. - sitting on a chair.

A set of exercises with dumbbells No. 2 (the main stance (OS) in exercises means standing, heels together, socks apart, knees straight, back straight, shoulders straightened) with the number of repetitions of exercises 10 times:

- I.p. standing, straight arms with palms facing each other in front at chest level, legs shoulder width apart: spread straight arms to the sides at shoulder level; return to I.p. The breath is arbitrary.

- I.p. standing, straight arms with palms to each other at the top, strictly above the head, legs shoulder-width apart: to spread straight arms to the sides, not reaching the level of the shoulders; return to I.p. The breath is arbitrary.

- I.p. standing in a torso of 90 °, arms hang freely, burden shoulder-width apart, head tilted: spread straight arms to the sides at shoulder level; return to I.I. Breathing is arbitrary, do not raise your head.

- I.p. standing bent back, head thrown back, arms hanging freely, legs shoulder-width apart: spread straight arms to the sides, not reaching shoulder level; return to I.p. The breath is arbitrary.

- I.p. standing arms are coupled with dumbbells below, legs shoulder-width apart: raise straight arms up directly above your head, pulling up your stomach and arching in the lower back; return to I.p. The breath is arbitrary.

- I.p. OS, arms below, palms forward: bending the arms at the elbows, touching the hands of the shoulders, elbows lowered, but in weight, do not touch the body; return to I.p. The breath is arbitrary.

- I.p. OS, straight arms before the chest at shoulder level, palms up: bending the arms at the elbows, touching with the hands of the shoulders, elbows at shoulder level; return to I.p. The breath is arbitrary.

- I.p. OS, arms down, to the sides, palms up: bending of the arms at the elbows, touching with the hands of the shoulders, the elbows low down, but on the hinge, do not touch the body; return to I.p. The breath is arbitrary.

- I.p. OS, straight arms to the sides, at shoulder level, palms up: bending the arms at the elbows, touching with the hands of the shoulders, elbows at shoulder level, return to I.p. The breath is arbitrary.

- I.p. OS, arms to the sides at shoulder level: circular rotation with straight arms in the shoulder joints back and forth with medium amplitude. The breath is arbitrary.

- I.p. OS, arms bent at the elbows in front of the chest, elbows at shoulder level, palms down: extension of the elbows in front of the chest, shoulders not connected, return to I.p. The breath is arbitrary.

- I.p. OS, arms bent at the elbows in front of the chest, elbows at shoulder level, palms down: raising the forearm upward, at 90 ° to the shoulder, the elbow at shoulder level, the arm does not retract to the side; return to I.p. The breath is arbitrary. Same thing the other way.

- I.p. OS, arms bent at the elbows in front of the chest, elbows at the level of the shoulders with the palms of the hands: raising the forearm of the right hand up, at 90 ° to the shoulder, the elbow at shoulder level, the arm does not go sideways; return to I.p. The breath is arbitrary. Same thing the other way.

- I.p. OS, arms to the sides at shoulder level: circular rotation with straight arms in the shoulder joints back and forth with maximum amplitude. The breath is arbitrary.

- I.p. OS, arms down: alternately instituting a bent arm around the corner of the opposite scapula, return to I.p. The breath is arbitrary. The same with the other hand.

The physical rehabilitation program of the main period is supplemented by a step training with a single approach to the step platform (step height 20 cm). Using steppes provides aerobic exercise. A step load is a "step" on a step of a certain height at a given pace. Each climb to the step is performed as follows: 1 - put one foot on the step; 2 - put on the step the second leg; 3 - lower one leg to the floor; 4 - lower the second leg to the floor. When using a step platform or steps, you should not focus on the order of the right and left legs. It is advisable for the patient to provide the opportunity to choose, otherwise an insufficient level of coordination does not always prevent the continuous execution of the load, diverting attention to the order of the legs.

The duration of the step load in the first to 20 lessons is 5-7 minutes, depending on the patient's well-being (pace - 12 lifts per minute for each leg).

In the second half of the main period (after 20 lessons), during one training session, repeated approaches to the step platform (2 times for 5-7 minutes) can be recommended with an increase in the pace of strides to fast (up to 16 lifts per minute for each leg) and using intervals for rest (if necessary), during which breathing exercises are performed in I. p. standing or walking. It is possible to increase the intensity of the load due to the use of hand work at a constant pace: in free-hanging hands, dumbbells from 0.5 to 1.0 kg, or arm movements, but not higher than the shoulders, because this can lead to an increase in heart rate that does not reflect energy expenditure - creating the illusion of intense training. After a heavy load, you can use stretching exercises as a relaxing remedy.

The final part of a controlled training session (10 minutes) of the main period of the outpatient phase includes the implementation of special exercises for the eyes according to the method described above.

For individual training at home in the main period of the outpatient phase, patients are advised to independently perform daily respiratory gymnastics with diaphragmatic breathing in the morning (as a form of morning exercises), alternating optionally complex No. 1 or complex No. 2 (the method is described above in the water part of the controlled training sessions of the main period), a set of special exercises for the eyes 1.5-2 hours before bedtime (the technique is described above in the final part of the controlled training session outpatient care

preparatory period). Dosed walking on days off from FT in a medical institution is recommended 2 times a week - 20 lessons and then 3 times on flat terrain and stairs.

The distance will be 2000 m for stable patients and 1200 m for “problem” patients. First, the walking pace is 80-90 steps per minute, then speed up to 90-100 steps per minute at a distance of 100-200 meters, if there is no unpleasant sensation. In the main period, the distance is 4000 meters and 6000 meters.

At home, the step load can be performed using stairs. The height of the stairs is calculated in accordance with the body weight (kg) and patient's FC, it is presented in the following table:

FC patient Weight, kg 60-63 64-65 66-67 68-69 70-71 72-73 74-75 76-77 78-79 80-83 84-87 88-89 90-91 92-93 94-95 96-97 98
-101 The height of the stairs, cm I FC 28 19 eighteen eighteen 17 24 23 22 22 21 twenty 19 19 eighteen eighteen eighteen 17 II FC twenty 19 eighteen eighteen 17 17 16 16 fifteen fifteen fourteen fourteen 13 13 13 12 12 III FC 8 7 7 7 7 7 7 6 6 6 6 6 5 5 5 5 5

So, patient I FC with a body weight of 98-101 kg needs a step height of 17 cm, II FC - 12 cm, III FC - 5 cm. And for patients of the same FC, but with a body weight of 60-63 kg - 28 cm, 20 cm and 8 cm, respectively. The greater the body weight and lower the FC, the lower the step height. The duration of the load in the first 8-10 lessons is 3 minutes, then 5-7 minutes, the pace of the exercise is 12 rises per minute for each leg.

Stage II of the Kyrgyz Republic on an outpatient basis: the supporting period of physical rehabilitation is not limited in duration. The objectives of this period is to maintain and possibly enhance the achieved clinical effect. Patients study in groups.

Classes are held 2-3 times a week. Duration increases to 90 minutes by increasing the number of exercises and the number of repetitions. The initial position of the patient during the exercise in the main period without restrictions. Also, patients are encouraged to continue individual lessons at home.

The introductory part of the training session (15 minutes) of the supporting period of the outpatient phase includes a respiratory gymnastics complex with diaphragmatic breathing (any of the proposed complexes No. 1 or No. 2 in the main period).

The main part of the training session (60 minutes) in the support period of the outpatient phase includes 2-3 approaches to the step platform, lasting up to 10 minutes each and a fast pace of execution 16 times per leg. In this case, only in patients with FC I-II, to increase the load on the step platforms, weights for arms or dumbbells weighing 0.5-1 kg can be used during stripping. Patients of FC III may be recommended a load with weighting agents for the legs at an individual pace, since subjectively it is transferred by the patient much more comfortably.

The intervals between approaches to step training should be used to perform special exercises with dumbbells, stretching exercises both at the support (at the gymnastic wall) and without it (at the discretion of the patient himself).

The FR program of the main period is supplemented by a step training with 2-3 approaches to the step platform. Using steppes provides aerobic exercise. At the same time, regardless of the choice of the complex, it is necessary to monitor full breathing during stretching exercises, eliminating respiratory retention. This will allow for a short time (3-5 minutes) to lower heart rate and continue the training session.

In the final part of the training session (15 minutes) of the supporting period, a complex of breathing exercises with diaphragmatic breathing in any position of the patient (sitting, standing) at the patient’s choice, depending on his state of health and clinical condition, is recommended.

Individual training at home in the supporting period of the outpatient phase provides for the patient to perform daily a complex of respiratory gymnastics with diaphragmatic breathing in the morning (as a form of morning gymnastics), alternating optionally complex No. 1 or complex No. 2 (the method is described above in the water part of a controlled training classes of the main period), a set of special exercises for the eyes 1.5-2 hours before bedtime (the technique is described above in the final part of the controlled training lessons in the outpatient preparatory period). Dosed walking on days off from FT in a medical institution is recommended at least 3 times a week (daily). The required walking pace is calculated by the formula D.M. Aronova:

TX = 0.042xM + 0.15xHSS + 65.5,

where is the tx-pace of walking, in minutes

M - maximum load during VEM test in kgm / min,

Heart rate - heart rate at maximum load with a VEM test

In the support period, the walking time is chosen arbitrarily. The walking pace can be increased to 100-120 steps per minute, after a week of training on certain segments, you can increase the walking speed to 130-150 steps per minute. The total distance is up to 9000 meters in fractional doses of 3000 meters 3 times a day or 5000 and 4000 meters 2 times a day.

A feature of the developed physical rehabilitation program lies in the possibility of its application both in full and in separate fragments (fragmentary). The forms of FT at the outpatient stage (classes with a physical therapy instructor and home independent classes) are distinguished by a variety of DAs, the presentation of specific sets of exercises that have a multifunctional effect on both the muscular system and the functional activity of the patient's cardiovascular system. This allows you to increase the interest of students, to avoid excessive loads, as well as to unify this method and program with further use in cardiac rehabilitation.

Monitoring of the training load and, if necessary, its correction was carried out after 1 month, 3 months and 6 months after the operation of RF RF by the results of TLC and VEM tests. When dosing the load for patients, it is necessary to proceed from the fact that when performing a unit of physical work, healthy and sick people spend different amounts of energy: healthy ones are less than patients with FC I; the latter are smaller than patients with FC II. This is due to the lower efficiency of physical work in patients, its high energy cost and, accordingly, a large oxygen consumption per unit of work. In patients II - III FC at the time of loading, oxygen consumption per unit of work is approximately the same as in patients with FC I, but this is a misleading impression. The fact is that the physical load of these patients is performed to a certain extent under anaerobic conditions, so they accumulate "oxygen debt", the degree of which is directly proportional to the severity of the load and the severity of the patient's condition. To overcome the “oxygen debt”, patients are forced to stop working very quickly, and after its termination they consume more for a long time (several times longer than healthy ones) than at rest,

amount of oxygen. The total oxygen consumption (at the time of loading and increased consumption until the elimination of “oxygen debt”) in patients exceeds the corresponding indicator for both healthy individuals and patients with FC I and II. In this regard, in order to achieve optimal oxygen consumption and replenish oxygen debt, physical activity is distributed taking into account the patient’s energy expenditure. So, in patients with FC I, energy expenditures are significantly higher than in patients with FC III. Accordingly, the former can perform high intensity physical exercises. The use of such a technique for selecting exercises in the early stages of rehabilitation also made it possible to virtually eliminate the underestimation of the patient's condition.

The safety monitoring of the ongoing rehabilitation program is intense. Patients keep a diary of self-control, also during the period of FT, blood pressure and heart rate are monitored. During the implementation of the entire rehabilitation program, heart rate was monitored by taking an electrocardiogram and daily monitoring of ECG by Holter.

 The efficiency of FT was monitored by TLC and a VEM test (initial stage 25 W, then load increment 25 W / min until fatigue). These methods were also used to evaluate the final effect of a personalized physical rehabilitation program in patients with AF after RF RF. The effectiveness of the developed program was also evaluated through various questionnaires and questionnaires. Patients independently answered questions from the DA ODA23 + questionnaire (Patent for the invention of the Russian Federation No. 2485895, 2013), QOL questionnaire (D. Aronov. Method for assessing the quality of life of patients with cardiovascular diseases / D. Aronov, V. P. Zaitsev / / Cardiology. 2002. No. 5. P. 92-95), "Hospital scale of anxiety and

Depression (HADS) ”(Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta. Psychiatr. Scand. 1983. V. 67. P. 361-370).

The ODA-23 + questionnaire consists of 35 questions, 23 of which serve directly to determine the level of YES. The questionnaire also contains questions about disability, bad habits, etc. Several answers are offered to answer the questions, for each of which points are awarded. YES is defined as very high, moderate, low, very low by the total score of the questionnaire. As a result, the sum of points can be scored: ≤38 (very low), 39-61 (low), 62-84 (moderate), 85-108 (high), ≥109 (very high).

To identify the clinical and subclinical manifestations of anxiety and depression, the Hospital Anxiety and Depression Scale (HADS) was used. It consists of 14 questions, which are divided into two groups: the first 7 for assessing anxiety include questions on anxiety, nervousness, the second 7 for assessing depression are devoted to assessing the patient's emotional state and attitude towards himself and others. The maximum number of points that can be scored in each group of questions is 21. When the total score is from 0 to 7, the norm, the absence of reliably expressed symptoms of anxiety and depression. With a score of 8 to 10 - subclinical manifestations of anxiety and depression. With a total score of 11 or more - clinically pronounced symptoms of anxiety and depression. This questionnaire helps to track the level of anxiety and manifestations of depression, the effect of AF on them and the dynamics of indicators after the intervention.

Questionnaire for the quality of life according to D. Aronov (Aronov D.M. Methodology for assessing the quality of life of patients with cardiovascular diseases / D.M. Aronov, V.P. Zaitsev // Cardiology. - 2002. - No. 5. - P. 92-95) was used to determine the quality patients' lives. It contains 17 questions aimed at assessing the usefulness of a patient’s life,

the presence or absence of any restrictions on his daily and professional activities, the answers to which allow to determine the level of quality of life of patients. Answers to the proposed questions are given by patients independently. Items containing an answer about the existence of restrictions, a decrease in the usefulness of life, are assigned a negative score, while the opposite points are positive. As a result, a sum of points from -27 to +9 can be scored. When analyzing the indicators of quality of life, it is taken into account that the higher (i.e., positive) the total score, the better the quality of life, and, conversely, the smaller and more negative the total score, the worse the quality of life. The questionnaire used makes it possible to assess the dynamics of the level of quality of life and the effectiveness of the treatment.

Patients underwent echocardiography (ECHOCG) to assess the structural and functional state of the myocardium of the heart according to the standard method (in two-dimensional and M-modal modes) using an Agilent apparatus with measurement of the ejection fraction of the left ventricle (LVEF), wall thickness and sizes of heart cavities in the systole and diastole phases were carried out in the M-mode (PennConvent) according to the formula of the generally accepted Simpson method.

The dynamics of the levels of such blood parameters as C-reactive protein was assessed — before RF RF, after 3-4 days, after 6 and 12 months; NT-pro-BNP (the final part of the natriuretic peptide) - 3-4 days after RF RF, 6 and 12 months later; Aldosterone - 3-4 days after RF RF and 6 months later; Angiotensin II - 3-4 days after RFA and after 6 months; Transforming Growth Factor (TGF-β) - 3-4 days after RF RF and 6 months later; Fibrinogen - before RFA, after 3-4 days, after 6 and 12 months; The lipid spectrum of the blood - after 3-4 days, 6 and 12 months. Monitoring of FT at home was carried out according to the individual diary of the patient with the date

and the duration of classes, blood pressure and heart rate before, during and after a set of exercises, well-being, as well as according to the testimony.

The method is confirmed by examples.

Example 1

Patient T., 56 years old, Hypertension. Paroxysmal form of AF. In 2013, RFA was conducted. The patient the next day after the operation was included in stage I of inpatient CD and began to implement the program of physical rehabilitation of the inpatient preparatory period (duration 3 days).

Before discharge from the hospital, the patient underwent TLC. The following indicators are calculated: total number of meters passed 400; walking speed - number of meters / 6 min. equal to 66.7 m / min; the oxygen consumption of VO ₂ according to the formula: 3.5 ml / kg / min + (walking speed m / min ⋅ 0.1) was 10.17 ml / kg / min; the threshold level of energy expenditure (in cal / kg ⋅ min) according to the formula VO ₂ ml / kg / min ⋅ 5 cal / min was 50.85 cal / kg ⋅ min; 75% of the threshold level of energy expenditure, that is, the average energy expenditure of 1 minute of exercises in the exercise therapy complex should be 38.14 cal / kg ⋅ min; total energy consumption when calculating the exercise therapy complex, performed within 20 minutes (75% of the threshold level of energy expenditure cal / kg ⋅ min энерг 20 min.) Should be 762.8 cal / kg.

According to the results of TLC, II FC was determined. Based on the results of TLC, a specific exercise therapy complex No. 5, dosed according to energy consumption, was assigned to a specific patient. After discharge from the hospital, the patient was transferred to the early stage II of the CR in an outpatient setting. For a month, the patient carried out a physical rehabilitation program for the outpatient preparatory period, including the exercise therapy complex No. 5, dosed according to energy consumption. After a month, the patient underwent a VEM test to assess the patient’s clinical condition and resolve the issue of

the need for correction of the training program. VEM test results: load power - 100 W (600 kgm / min), ME - 5.1. The oxygen consumption of VO _{2 was} calculated by the formula ME ⋅ 3.5 ml O ₂ / kg / min = 17.9 ml / kg / min, the threshold level of energy expenditure by the formula VO ₂ in ml / kg / min ⋅ 5 cal / min = 89 , 3 cal / kg ⋅ min. and the patient’s recommended 60% level of training load from the threshold value of energy expenditures, i.e., the average energy expenditure of 1 minute of exercise therapy complex exercises should be in the zone of 53.6 cal / kg ⋅ min. The total energy expenditure when calculating the exercise therapy complex should be 1071 cal / kg The patient was assigned a complex of exercise therapy No. 3.

After completing 25 lessons for 8 weeks, the patient was transferred to the late II outpatient stage of the Kyrgyz Republic with a recommendation to implement a physical rehabilitation program for the outpatient main period. In the future, after 40 lessons (within 13 weeks), the patient, as part of the late II outpatient stage of CR, was included in the FR program of the support period.

After 6 months of regular physical training, an increase in the patient’s physical performance indicators was noted: according to repeated VEM tests lasting 37.5% (from 8 minutes to 11 minutes) and power by 25% (up to 125 W) of the load, daily DA according to the questionnaire by 31.6% (from low - 47.2 points to moderate - 62.0 points); decrease in anxiety (from 8 points to 2 points) and symptoms of depression (from 4 points to 2 points); improvement in QOL indicators (from -5 to 0 points). A positive effect of the physical rehabilitation program on markers of inflammation (a decrease in the highly sensitive C-reactive protein from 3.4 mg / L to 2.3 mg / L) and thrombogenic risk indicators (a decrease in fibrinogen from 3.4 g / L to 2.9 g were revealed). / l), markers of myocardial fibrosis (decrease in the level of the sodium urethic peptide - NT-proBNP from 25.0 pg / ml to 11.0 pg / ml). The patient is recommended to continue the FR program.

Example 2

Patient M., 62 years old, Hypertension. Paroxysmal form of AF. In 2014, RFA was conducted.

The patient the next day after the operation was included in stage I of inpatient CD and began to implement the program of physical rehabilitation of the inpatient preparatory period (duration 3 days).

Before discharge from the hospital, the patient underwent TLC. The following indicators are calculated: total number of meters passed 320; walking speed - number of meters / 6 min. equal to 53.3 m / min; the oxygen consumption of VO ₂ according to the formula: 3.5 ml / kg / min + (walking speed m / min ⋅ 0.1) was 8.83 ml / kg / min; the threshold level of energy expenditure (in cal / kg ⋅ min) according to the formula VO ₂ ml / kg / min ⋅ 5 cal / min was 44.15 cal / kg ⋅ min; 75% of the threshold level of energy expenditure, that is, the average energy expenditure of 1 minute of exercises in the exercise therapy complex should be 33.11 cal / kg ⋅ min; total energy consumption when calculating the exercise therapy complex, performed within 20 minutes (75% of the threshold level of energy expenditure cal / kg ⋅ min мин 20 min.) Should be 662.2 cal / kg. According to the results of TLC, III FC was determined.

Based on the results of TLC, a specific exercise therapy complex No. 6, dosed according to energy consumption, was assigned to a specific patient. After discharge from the hospital, the patient was transferred to the early stage II of the CR in an outpatient setting. For a month, the patient carried out a physical rehabilitation program for the outpatient preparatory period, including the exercise therapy complex No. 6, dosed according to energy consumption.

A month later, the patient underwent a VEM test in order to clarify the clinical condition and address the need for correction of the training program. VEM test results: load power - 50 W (300 kgm / min), ME - 3.1. Calculated oxygen consumption VO ₂ by

formula, the amount of ME ⋅ 3.5 ml O ₂ / kg / min = 10.85 ml / kg / min, the threshold level of energy expenditure according to the formula VO ₂ in ml / kg / min ⋅ 5 cal / min = 54.25 cal / kg ⋅ min and the patient’s recommended 60% level of training load from the threshold value of energy expenditure, i.e., the average energy expenditure of 1 minute of exercise therapy complex exercises should be in the zone of 32.55 cal / kg ⋅ min. The total energy consumption when calculating the complex of exercise therapy should be 651 cal / kg. The patient was recommended to continue classes according to the program of exercises dosed by energy expenditure, in the form of a complex of exercise therapy No. 6.

After completing 25 lessons for 8 weeks, the patient was transferred to the late II outpatient stage of the Kyrgyz Republic with a recommendation to implement a physical rehabilitation program for the outpatient main period. In the future, after 40 lessons (within 13 weeks), the patient, as part of the late II outpatient stage of CR, was included in the FR program of the support period.

After 6 months of regular physical training, a significant increase in physical performance indicators was noted: according to the repeated VEM test, the duration increased by 66.7% (from 3 minutes to 5 minutes) and the power by 50.0% (up to 75 W) of the daily load YES according to the questionnaire by 81.2% (from low - 44.1 points to high - 79.9 points); decrease in anxiety (from 12 points to 1 point) and symptoms of depression (from 8 points to 0 point); improvement of QOL indicators (from - 6 to - 3 points). The FR program had a positive effect on markers of inflammation (a decrease in the highly sensitive C-reactive protein from 4.7 mg / L to 3.2 mg / L), thrombogenic risk indicators (a decrease in fibrinogen from 3.6 g / L to 3.0 g / l), markers of myocardial fibrosis (decrease in the level of the sodium urethic peptide - NT-proBNP from 21.4 pg / ml to 10.1 pg / ml). It is recommended that the patient continue the physical rehabilitation program.

The proposed method of personalized physical rehabilitation of patients with AF in the early stages after RFA LV surgery - individual selection and exercise at different periods of the rehabilitation program contributes to a uniform increase in physical fitness without a drastic change in the number of repetitions of exercises, it also allows you to increase the aerobic effect of a training session, and enhance the special effect of physical exercises. The developed program allows you to avoid excessive patient stress, takes into account the features and area of surgical intervention, is effective and safe.

Claims (122)

1. The method of physical rehabilitation (RF) of patients with atrial fibrillation (AF) after the operation of radiofrequency ablation of the mouth of the pulmonary veins (RFA), including a set of therapeutic physical exercises (exercise therapy) and a gradual increase in daily physical activity (YES) of the patient, characterized in that the FR program is started the day after the operation, it is carried out at the I stationary stage of cardiorehabilitation (KR) and the II outpatient stage of the KR in the clinic, with the transition to classes at home; The FR program consists of three periods: preparatory, which includes 3 classes at the I stationary stage of the Kyrgyz Republic before discharge from the hospital, up to 25 classes at the early II outpatient stage of the Kyrgyz Republic in the conditions of the outpatient rehabilitation department, the main, including up to 40 classes, at the II outpatient stage of the Kyrgyz Republic home conditions, supportive period in the late II outpatient stage of the Kyrgyz Republic, unlimited in time; at the same time, in the preparatory period of the stationary phase, patients perform exercises in a supine position, on a flat firm surface on their stomach, back or right side, at other stages - sitting or in an upright position; at the I stationary stage, they carry out a theoretical explanation of the technique for performing the exercises, teach them a posture that is comfortable for the patient lying on their stomach or right side, before discharge from the hospital after RF RF, they individually select the exercise therapy complex to perform in the preparatory period on an outpatient basis by determining the functional class (FC) , assessing the clinical condition of the patient and calculating the energy expenditure of each exercise of the complex and the complex as a whole for each patient, while to assess the clinical condition of the patient uses a six-minute walk test (TSHX), and if the distance traveled during TSH is from 451 meters to 900 meters or more, the total amount of energy is recommended when calculating the exercise therapy complex from 820 cal / kg to more than or equal to 1387.5 cal / kg; when the distance traveled during the TLC 350-450 meters recommend total energy consumption when calculating the exercise therapy complex, amounting to 700-819 cal / kg, with the distance traveled 270-349 meters during the TLC recommend total energy consumption when calculating the exercise therapy complex 600-698 cal / kg; starting from the second month after the RF RF, a bicycle ergometry (VEM) test and the patient’s number of metabolic units (ME) are used to assess the clinical condition of the patient, while for ME greater than or equal to 7.0, the total energy expenditures for calculating the exercise therapy complex are more or equal 1470 cal / kg, for ME 4.0-6.9 they recommend total energy consumption when calculating exercise therapy complex 820-1452 cal / kg, for ME 2.0-3.9 recommend total energy expenditures when calculating exercise therapy complex up to 819 cal / kg, while the set of exercises and the number of repetitions of the complex exercise therapy, performed cured at the outpatient preparatory stage, vary taking into account the individual energy expenditure of a particular patient and his clinical condition; at all stages of exercise therapy, patients perform exercises for the eyes, breathing exercises with deep diaphragmatic breathing; during the main and supporting periods of the RF, patients perform exercises without taking into account their energy consumption for stretching near the gymnastic wall, step training, weight training, dosed walking, and monitoring the effectiveness of the RF by means of a repeated VEM test, an ODA-23 + questionnaire, and an hospital alarm scale and depression HADS, a quality of life questionnaire 1 month, 3 months, and 6 months after surgery, RF RF. 2. The method according to p. 1, characterized in that in the preparatory period on an outpatient basis, patients with a distance greater than or equal to 900 meters with TLC, or ME greater than or equal to 7, perform a set of exercises with the VEM test, the total energy consumption of which is 1396.2 cal / kg, energy expenditure of 1 minute of exercises - 69.81 cal / kg⋅min, the duration of the complex is 20 minutes: - walking 130 steps per minute for 180 seconds, energy consumption for three minutes of walking 222 cal / kg⋅min, then: - starting position (I.p.) standing, arms lowered, legs apart, at the expense of 1-2 raise your hands up, take your foot back to the toe, bend, inhale with your nose, at the expense of 3-4 return to I.p., exhale by mouth, the same with the other leg, the number of repetitions of 10, the time to complete one repetition of 6.0 seconds, the energy expenditure of the exercise is 5.6 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 56 cal / kg⋅min, - I.p. standing, arms down, legs shoulder-width apart, count 1 - inhale, spread your arms to the sides, count 2 - tilt to the leg, touching the floor - exhale, count 3-4 the same to the other leg, number of repetitions 12, time performing one repetition of 5.0 sec, the energy expenditure of the exercise is 6.0 cal / kg, the energy expenditure per minute of performing the exercise with a given number of repetitions is 72 cal / kg⋅min, - I.p. standing, hands on the belt, legs apart, at the expense of 1-2 turning the body to the side with the abduction of the hand in the same direction, inhaling with your nose, at the expense of 3-4 return to I.p., exhaling with the mouth, the same way, the number of repetitions 15, the time it takes to complete one repetition of 4 seconds, the energy expenditure of the exercise is 3.0 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 45 cal / kg⋅min, - I.p. standing, hands on the belt, legs apart, circular movements of the pelvis in four counts to the right, left, arbitrary breathing, the number of repetitions is 12, the time for performing one repetition is 5 seconds, the energy expenditure of the exercise is 4.34 cal / kg, the energy expenditure per minute of the exercise for a given amount repetitions of 52.08 cal / kg⋅min, - I.p. standing, hands on the belt, legs together, at the expense of 1 - do in I.p. inhalation through the nose, on account 2 - put one leg to the side on the toe, tilting the torso in the same direction, raise the opposite hand upward, exhale through the mouth, counting 3-4 the same way, the number of repetitions is 12, the time it takes to perform one repetition 5 sec, the energy expenditure of the exercise is 3.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 46.8 cal / kg⋅min, - I.p. standing, arms down, legs together, at the expense of 1 - raise your hands to the sides with your palms down, inhale your nose, at the expense of 2 - move your hands forward, swing one foot forward, touch your palm with your toe, exhale with your mouth, at the expense of 3-4 the same other foot, number of repetitions 15, the time it takes to complete one repetition of 4 seconds, the energy expenditure of the exercise is 6.43 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 96.45 cal / kg⋅min, - I.p. standing, arms down, legs apart, at the expense of 1-2 to spread your arms to the sides, inhale with your nose, at the expense of 3-4 to lower your hands down, relax, exhale with your mouth, number of repetitions 12, the time it takes to perform one repetition of 5 seconds, the energy expenditure of exercise 2, 85 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 34.2 cal / kg⋅min, - I.p. standing, arms bent at the elbows in front of the chest, legs apart, at the expense of 1-2 make two jerks with your elbows to the sides, at the expense of 3-4 turn your torso to the side, making two jerks with your arms apart, breathing is arbitrary, the number of repetitions is 15, time performing one repetition of 4.0 seconds, the energy expenditure of the exercise is 3.05 cal / kg, the energy expenditure per minute of performing the exercise with a given number of repetitions of 45.75 cal / kg⋅min, - I.p. standing, arms on the waist belt shoulder-width apart, counting 1 breath, counting 2-3-4 circular movements of the body, exhaling, number of repetitions 12, the time it takes to complete one repetition 5 seconds, energy expenditure 4.73 cal / kg, energy expenditure minute of exercise with a given number of repetitions 56.76 cal / kg⋅min, - I.p. standing, arms down, legs together, at the expense of 1 - make in I.p. inhalation through the nose, on account 2 — lunging forward with one foot, arms to the sides, exhaling through the mouth, on account 3 — spreading the arms apart, inhaling through the nose, on the count 4 — return to I.p., exhaling through the mouth, with the other leg, the number of repetitions of 15, the time to complete one repetition of 4 seconds, the energy expenditure of the exercise is 6.4 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 96 cal / kg /min, - I.p. standing, arms down, legs apart, at the expense of 1-2 raise your hands up, take your leg back to the toe, bend, inhale with your nose, at the expense of 3-4 return to I.p., exhale with your mouth, the same with the other leg, the number of repetitions 12, the execution time of one repetition is 5.0 seconds, the energy expenditure of the exercise is 5.6 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 67.2 cal / kg⋅min, - I.p. standing, arms apart, legs apart, circular movements with straight arms full amplitude for four counts, forward, backward, breathing arbitrary, number of repetitions 12, time to complete one repetition 5 seconds, energy expenditure exercises 4.4 cal / kg, energy expenditures per minute of execution exercises with a given number of repetitions of 52.8 cal / kg⋅min, - I.p. standing, arms down, legs apart, feet in parallel, at the expense of 1 - do in I.p. inhale through the nose, sit down at the expense of 2-3, hands forward, exhale with the mouth, at the expense of 4 - go back to I.p., the number of repetitions is 24, the time for performing one repetition is 5 seconds, the energy expenditure of the exercise is 7.24 cal / kg, energy expenditure for 2 minutes of exercise with a given number of repetitions 173.76 cal / kg⋅min, - walking 120 steps per minute for 60 seconds, energy consumption per minute of walking 70 cal / kg⋅min, then running for 120 seconds, energy consumption for 2 minutes of running 209.4 cal / kg⋅min. 3. The method according to p. 1, characterized in that in the preparatory period on an outpatient basis, patients with a distance of 800-899 meters with TLC, or ME 6.0-6.9 with a VEM test, perform a set of exercises, the total energy consumption of which is 1290 , 4 cal / kg, energy expenditure of 1 minute of exercises - 64.52 cal / kg⋅min, the duration of the complex is 20 minutes, then: - walking 120 steps per minute for 60 seconds, energy consumption per minute walk 76 cal / kg⋅min, - I.p. standing, arms down, legs apart, on account 1 - raise your hands forward, inhale your nose, on account 2 - raise your hands up, exhale your nose, on account 3 - lower your hands to the sides, inhale your nose, on account 4 - return to I. item, mouth exhalation, number of repetitions 15, time to complete one repetition of 4 seconds, energy expenditure of the exercise 3.45 cal / kg, energy expenditures per minute of the exercise for a given number of repetitions 51.75 cal / kg⋅min, - I.p. standing, arms down, legs apart, at the expense of 1-2 to spread your arms to the sides, inhale with your nose, at the expense of 3-4 to lower your hands down, relax, exhale with your mouth, number of repetitions 10, time for one repetition of 6 seconds, energy expenditure of exercise 3, 38 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 33.8 cal / kg⋅min, - I.p. standing, hands on the belt, legs together, at the expense of 1 - do in I.p. inhale with your nose, at the expense of 2-3, lunge with one foot to the side, exhale with your mouth, at the expense of 4 - return to I.p., the same way, the number of repetitions is 12, the time for one repetition is 5.0 seconds, the energy expenditure of the exercise 8.33 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 99.96 cal / kg⋅min, - I.p. standing, hands on the belt, legs apart, circular movements of the pelvis in four counts to the right, left, arbitrary breathing, number of repetitions 10, time to complete one repetition of 6 seconds, energy expenditure of exercise 5.18 cal / kg, energy expenditure per minute of exercise with this amount repetitions of 51.8 cal / kg⋅min, - I.p. standing, feet shoulder-width apart, at the expense of 1 - spread your arms to the sides, at the expense of 2-3-4 springy bending forward, touching the floor with your hands, and return to I.p. - exhalation, the number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of the exercise is 7.3 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 87.6 cal / kg⋅min, - walking 120 steps per minute for 60 seconds, energy consumption per minute walk 76 cal / kg⋅min, - I.p. standing, arms down, legs apart, at the expense of 1-2 raise your hands up, take your leg back to the toe, bend, inhale with your nose, at the expense of 3-4 return to I.p., exhale with your mouth, the same with the other leg, the number of repetitions 10, the duration of one repetition of 6.0 seconds, the energy expenditure of the exercise is 6.76 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 67.6 cal / kg⋅min, - I.p. standing, hands on the waist belt shoulder-width apart, counting 1 breath, counting 2-3-4 circular movements of the body, exhaling, number of repetitions 12, execution time of one repetition 5 seconds, energy expenditure of exercise 5.7 cal / kg, energy expenditure minute of exercise with a given number of repetitions 68.4 cal / kg⋅min, - I.p. standing, arms bent at the elbows in front of the chest, legs apart, at the expense of 1-2 make two jerks with your elbows to the sides, at the expense of 3-4 turn your torso to the side, making two jerks with your arms apart, breathing is arbitrary, the number of repetitions is 15, time performing one repetition of 4.0 sec, the energy expenditure of the exercise is 3.77 cal / kg, the energy expenditure per minute of performing the exercise with a given number of repetitions is 56.55 cal / kg⋅min, - I.p. standing, arms down, legs apart, at the expense of 1 - make in I.p. inhalation through the nose, tilt the body to the right 2-3-4, the opposite hand slides along the body to the armpit, exhale through the mouth, the same way, the number of repetitions is 12, the time it takes to perform one repetition is 5.0 seconds, the energy expenditure is 3.9 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 46.8 cal / kg⋅min, - I.p. standing, arms down, legs together, at the expense of 1 - spreading the arms to the sides, simultaneously swing one foot to the side, inhale your nose, at the expense of 2 return to I.p. exhaled by mouth, at the expense of 3-4 the same with the other leg, the number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of the exercise is 6.48 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 77.76 cal / kg ⋅min - I.p. standing, arms down, legs apart, feet in parallel, at the expense of 1 - do in I.p. inhale through the nose, sit down at the expense of 2-3, hands forward, exhale with the mouth, at the expense of 4 - return to I.p., the number of repetitions is 20, the time for performing one repetition is 3 seconds, the energy expenditure of the exercise is 7.56 cal / kg, energy expenditure per minute performing an exercise with a given number of repetitions of 151.2 cal / kg⋅min, - walking 120 steps per min 60 sec, energy consumption per minute of walking 76 cal / kg⋅min, - I.p. standing, one arm is raised up, the other is lowered, legs apart, jerking hands on each count, changing hands in two counts, breathing arbitrary, number of repetitions 15, time to complete one repetition 4 sec, energy expenditure 3.74 cal / kg, energy expenditure minute of exercise with a given number of repetitions 56.1 cal / kg⋅min, - I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, on the count of 1 spread your arms to the sides, inhale, on the count of 2-3-4 hands on your knees, resting your hands on your knees, stand up and sit down - exhale, the number of repetitions is 10, the time to complete one repetition is 6 seconds, the energy cost of the exercise is 4.82 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 48.2 cal / kg⋅min, - I.p. sitting on the edge of the chair, hands on his knees, 1-2 count back in the chair, straighten and spread legs and arms to the sides, inhale with your nose, 3-4 count back in I.p., exhale with your mouth, number of repetitions 10, the duration of one repetition of 6.0 seconds, the energy expenditure of the exercise is 4.32 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 43.2 cal / kg⋅min, - I.p. sitting on the edge of the chair, legs bent at the knees, hands on the chair seat at the back, at the expense of 1 - inhale, at the expense of 2-3-4, straighten the legs to the position of a right angle, return to I.p. - exhalation, the number of repetitions 12, the execution time of one repetition of 5.0 seconds, the energy expenditure of the exercise is 3.64 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 43.68 cal / kg⋅min, - I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, legs slightly apart, 1-2 to spread the arms apart, inhale the nose, 3-4 to grab the knee with your hands and pull the leg to the chest - exhale, number of repetitions 12 , the duration of one repetition is 5 seconds, the energy expenditure of the exercise is 3.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 46.8 cal / kg⋅min, - I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, circular movements of the head in four counts to the right and left, breathing is arbitrary, the number of repetitions is 12, the time for performing one repetition is 5 seconds, the energy expenditure of the exercise is 2.6 cal / kg, energy expenditure per minute performing an exercise with a given number of repetitions of 31.2 cal / kg⋅min, 4. The method according to p. 1, characterized in that in the preparatory period on an outpatient basis, patients with a distance of 650-799 meters with TLC or ME 5.0-5.9 with a VEM test perform a set of exercises, the total energy consumption of which is 1073, 68 cal / kg, energy expenditure of 1 minute of exercise - 53.68 cal / kg⋅min, the duration of the complex - 20 minutes: - I.p. sitting, hands on your knees; legs bent and divorced; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4 grab the knee with your hands and pull your leg to the chest - exhale, the number of repetitions is 12, the time for one repetition is 5 seconds, the energy expenditure of 3.9 cal / kg, energy expenditure minute of exercise with a given number of repetitions of 46.8 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent, on the count of 1 hands spread apart - inhale, on the count of 2-3-4 hands on knees, stand up and sit down - exhale, number of repetitions 12, time to complete one repetition 5 sec, energy expenditure of exercise 4.82 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 57.84 cal / kg⋅min, - I.p. standing, arms to shoulders, legs apart; circular movements in the shoulder joints into four counts, arbitrary breathing, the number of repetitions of 10, the time to complete one repetition of 6.0 seconds, the energy expenditure of the exercise is 5.92 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 59.2 cal / kg⋅ min - walking 100 steps per minute for 60 seconds, energy consumption per minute of walking 65.8 cal / kg⋅min, - I.p. standing, arms down, legs apart; to the account 1-2, raise your hands up, take your leg back to the toe, bend - inhale, to the account 3-4 to return to I.p., the same with the other foot, the number of repetitions 10, the time to complete one repetition of 6.0 seconds, energy consumption exercises 6.76 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions 67.6 cal / kg⋅min, - I.p. standing, arms down, legs apart; count 1 - inhale, count 2–3–4 the body tilts to the right and left, the opposite arm slides along the body to the armpit - exhale, “pump”, number of repetitions 12, time for one repetition 5.0 seconds, energy expenditure of exercise 3 , 9 cal / kg, energy expenditures per minute of the exercise for a given number of repetitions of 46.8 cal / kg⋅min, - I.p. standing, hands on the belt, legs apart; on the account 1-2, turn the body to the side with the abduction of the hand in the same direction - inhale, on the account 3-4 return to I. - exhalation, the number of repetitions 15, the execution time of one repetition of 4 seconds, the energy expenditure of the exercise is 4.28 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 64.2 cal / kg⋅min, - I.p. standing, hands on the belt, legs apart; circular movements of the pelvis in four counts, arbitrary breathing, the number of repetitions of 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 5.18 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 51.8 cal / kg⋅min, - I.p. standing, legs together, arms down, at the expense of 1 spreading the arms to the sides, at the same time swing one foot to the side - inhale, at the expense of 2 - return to I. p., exhale, at the expense of 3-4 the same with the other leg, the number of repetitions 12, the execution time of one repetition is 5.0 seconds, the energy expenditure of the exercise is 6.48 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 77.76 cal / kg⋅min, - I.p. standing, hands on the belt, legs together, on the count of 1 breath, on the count of 2 put one foot to the side on the toe, tilt the body in the same direction, raise the opposite hand up - exhale, on the count of 3-4 the same to the other side, the number of repetitions 15, the execution time of one repetition of 4 seconds, the energy expenditure of the exercise is 5.1 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 76.5 cal / kg⋅min, - I.p. standing, feet shoulder width apart, arms on the belt; count 1 breath, count 2-3-4 circular body movements - exhale, number of repetitions 12, time to complete one repetition 5 seconds, energy expenditure of the exercise 5.7 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 68.4 cal / kg⋅min, - I.p. standing, one arm raised up, the other lowered, legs apart; jerking hands on each account, changing hands after two counts, breathing arbitrary, number of repetitions 15, time to complete one repetition 4 seconds, energy expenditure of exercise 3.74 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 56.1 cal / kg ⋅min - I.p. standing, arms down, legs apart; on the bill 1-2, spread your arms to the side-inhale, on the bill 3-4, lower your arms down, relax - exhale, the number of repetitions 12, the time to complete one repetition of 5 seconds, the energy expenditure of the exercise is 3.38 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 40.56 cal / kg⋅min, - walking 100 steps per minute for 60 seconds, energy consumption per minute of walking 65.8 cal / kg⋅min, - I.p. sitting on the edge of a chair, hands on his knees, legs bent; 1-2 to lean back and straighten and spread legs and arms to the sides — inhale, 3-4 to return to I. p., number of repetitions 10, time to complete one repetition 6.0 sec, energy expenditure of exercise 4, 34 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 43.4 cal / kg⋅min, - I.p. sitting on the edge of a chair; the legs are bent at the knees, the hands on the back of the chair; at the expense of 1 - a breath, at the expense of 2-3-4, straighten the legs to the position of a right angle, return to I.p. - exhalation, the number of repetitions 12, the time to complete one repetition of 5.0 seconds, the energy expenditure of the exercise is 3.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 46.8 cal / kg⋅min, - I.p. sitting with support on the back of a chair; hands on hips, legs straightened; on account 1, spread your arms to the sides, bend down - inhale, on the account 2-3 lean forward, arms reach out to the socks - exhale, on the count 4 - return to I.p., number of repetitions 12, time for one repetition 5.0 sec , the energy expenditure of the exercise is 3.54 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 42.48 cal / kg - I.p. sitting on a chair; hands on knees, legs bent; on account 1 - straighten the left leg and raise up, at the same time take the right hand to the side, on account 2 - return to I.p., on the score 3-4 - with the same right foot and left hand, arbitrary breathing, number of repetitions 12 , the execution time of one repetition is 5 seconds, the energy expenditure of the exercise is 3.27 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 39.24 cal / kg⋅min, - I.p. sitting on a chair, arms down, legs straightened; circular movements of the feet and hands to each count, arbitrary breathing, number of repetitions 15, time to complete one repetition of 4 seconds, energy expenditure of exercise 1.96 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 29.4 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent; on the bill 1-2, spread your arms to the sides - inhale, on the bill 3-4, lower your hands down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy cost of the exercise is 2.72 cal / kg, energy consumption per minute of execution exercises with a given number of repetitions of 27.2 cal / kg⋅min. 5. The method according to p. 1, characterized in that in the preparatory period on an outpatient basis, patients with a distance of 451 - 649 meters with TLC or ME 4.0-4.9 with a VEM test perform a set of exercises, the total energy consumption of which is 825, 6 cal / kg, energy expenditure of 1 minute of exercise - 41.28 cal / kg⋅min, the duration of the complex is 20 minutes: - I.p. sitting, hands on knees, legs bent; squeezing and unclenching the brushes into a fist for each account with simultaneous bending and extension of the feet, arbitrary breathing, the number of repetitions of 20, the time to complete one repetition of 3 seconds, the energy expenditure of the exercise is 1.11 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions of 22 2 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4, lower your hands down, relax - exhale, the number of repetitions 12, the time to complete one repetition of 5 seconds, the energy expenditure of the exercise 2.72 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions 32.64 cal / kg⋅min, - I.p. sitting, legs bent; on account 1 - hands to shoulders with tension, on account 2 - hands to sides, on account 3 - hands to shoulders with tension, on account 4 hands lower, relax, breathing arbitrary, number of repetitions 12, time for one repetition 5 , 0 sec, energy expenditure of the exercise 2.42 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 29.04 cal / kg⋅min, - I.p. sitting, hands on the belt, legs bent; 1-2 count elbows to the sides and back - inhale, 3-4 counts bring elbows together - exhale, number of repetitions 12, time to complete one repetition 5 seconds, energy expenditure of exercise 2.59 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 31.08 cal / kg⋅min, - I.p. sitting on the edge of the chair, hands on the chair at the back, legs bent, on account 1 - raise the leg bent at the knee, on account 2 - straighten the raised leg, on account 3 - bend the raised leg, on account 4 - lower the leg, return to I.p., the number of repetitions 10, the time it takes to complete one repetition of 6 seconds, the energy expenditure of the exercise is 3.07 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 30.7 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent, 1-2 counting arm to the side with a torso turning in the same direction - inhale, 3-4 counting back to I.p. - exhalation, the number of repetitions 15. The duration of one repetition is 4 seconds, the energy expenditure of the exercise is 2.4 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 36 cal / kg⋅min, - I.p. sitting with support on the back of a chair; hands on hips, legs straightened; on account 1, spread your arms to the sides, bend down - inhale, on the count 2-3 lean forward, arms reach out to the socks - exhale, on the count 4- go back to ip, the number of repetitions is 12, the time for performing one repetition is 5.0 seconds, exercise energy expenditure of 3.54 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 42.48 cal / kg⋅min, - I.p. standing, hands on the belt, legs together; count 1 - inhale, count 2 - put one foot to the side on the toe, tilt the body in the same direction, raise the opposite hand up - exhale, count 3-4 in the same direction, the number of repetitions is 12, the execution time of one repetitions of 5 seconds, the energy expenditure of the exercise is 5.0 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 60 cal / kg⋅min, - I.p. standing, arms down, legs apart; counting 1 breath, counting 2-3-4 the body tilts to the right and left, the opposite arm slides along the body to the armpit - exhale, “pump”, number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of exercise 3, 9 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions of 46.8 cal / kg⋅min, - I.p. standing, legs together, arms lowered, at the expense of 1 - spreading the arms to the sides, at the same time swing one foot to the side - inhale, at the expense of 2 - return to I.p. exhalation, at the expense of 3-4 the same with the other leg, the number of repetitions 12, the time to complete one repetition of 5.0 seconds, the energy expenditure of the exercise 6.48 cal / kg energy expenditure per minute of the exercise with a given number of repetitions of 77.76 cal / kg⋅min , - I.p. standing, arms down, legs apart, feet in parallel; on account 1 - inhale, on account 2-3 - crouch, hands forward - exhale, on account 4 - return to I.p., number of repetitions 15, time to complete one repetition 4 seconds, exercise energy expenditures 7.56 cal / kg, energy expenditures per minute of exercise with a given number of repetitions 113.14 cal / kg⋅min, - Walking 80 steps per minute for 60 seconds, energy consumption per minute of walking 59.4 cal / kg⋅min, - I.p. standing, arms down, legs apart; on the bill 1-2, spread your arms to the side-inhale, on the bill 3-4, lower your arms down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 3.38 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 33.8 cal / kg⋅min, - I.p. sitting, hands on the belt, legs bent, on the count 1 - inhale, on the count 2-3-4 circular movement of the body - exhale, the same in the opposite direction, the number of repetitions 12, the time it takes to perform one repetition of 5.0 seconds, the energy expenditure of exercise 2 , 73 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 32.76 cal / kg⋅min, - I.p. sitting on the edge of a chair, hands on his knees, legs bent; 1-2 to lean back and straighten and spread legs and arms to the sides - inhale, 3-4 to return to I.p., number of repetitions 10, time to complete one repetition 6.0 seconds, energy expenditure of exercise 4.34 cal / kg, then passive rest, energy expenditure per minute of the exercise for a given number of repetitions of 43.4 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent, circular head movements in four counts, number of repetitions 10, time to complete one repetition of 6 seconds, energy expenditure of exercise 2.6 cal / kg, energy expenditure per minute of exercise with a given number of repetitions 26 cal / kg⋅ min - I.p. sitting on a chair, arms down, legs straightened, circular movements of the feet and hands on each count, arbitrary breathing, number of repetitions 15, time to complete one repetition 4 seconds, energy expenditure of exercise 1.96 cal / kg, energy expenditure per minute of exercise with this amount repetitions of 29.4 cal / kg⋅min, - I.p. sitting, arms to shoulders; knees are divorced; on the score 1-2, spread the elbows to the sides - inhale, on the score 3-4, lower both elbows on one knee, lean forward - exhale, the same on the other knee, the number of repetitions 10, the time it takes to complete one repetition of 6 seconds, the energy expenditure of exercise 3, 2 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 32 cal / kg⋅min, - I.p. sitting, hands on your knees; the legs are bent; alternate breeding in the direction of socks and heels into four accounts; return to I.p., also four counts, the number of repetitions of 20, the time to complete one repetition of 3 seconds, the energy expenditure of the exercise is 1.28 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 25.6 cal / kg⋅min, - I.p. sitting on the edge of the chair, the shoulder blades touch the back of the chair, hands on the upper square of the abdomen; at the expense of 1 - the abdominal wall protrudes - inhale, at the expense of 2-3-4 the abdominal wall retracts - exhale, the number of repetitions 10, the time it takes to perform one repetition of 6 seconds, the energy expenditure of the exercise is 2.14 cal / kg, the energy expenditure per minute of the exercise for this the number of repetitions of 21.4 cal / kg⋅min. 6. The method according to p. 1, characterized in that in the preparatory period on an outpatient basis, patients with a distance of 350-450 meters with TLC or ME 3.0-3.9 with a VEM test perform a set of exercises, the total energy consumption of which is 791, 65 cal / kg, energy expenditure of 1 minute of exercises - 39.58 cal / kg⋅min, the duration of the complex - 20 minutes: - I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, on the bill 1-2 to spread the arms apart with tension, inhale the nose, on the bill 3-4 to lower the arms down, relax, exhale, the number of repetitions is 12, one execution time repetitions of 5 seconds, energy expenditure of the exercise 2.19 cal / kg, energy expenditure per minute of the exercise with a given number of repetitions of 26.28 cal / kg⋅min, -I.p sitting on a chair, the back is pressed to the back of the chair, hands on the knees, knees are connected, alternating breeding in the sides of the socks and heels into four counts, return to I.p., also into four counts, breathing is arbitrary, the number of repetitions is 30, one execution time repetitions of 2 seconds, the energy expenditure of the exercise is 0.98 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 29.4 cal / kg⋅min, - I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, on the account 1-2 take your hand to the side with a turn of the body, inhale your nose, on the account 3-4 return to I.p., exhale with your nose, the same way , the number of repetitions 15, the time it takes to complete one repetition of 4 seconds, the energy expenditure of the exercise is 1.81 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 27.15 cal / kg⋅min, - I.p. sitting on a chair, back pressed to the back of the chair, hands on his knees; legs are slightly diluted, on the bill 1-2 to spread the arms to the sides, inhale the nose, on the bill 3-4 grab the knee with your hands and pull the leg to the chest - exhale, the number of repetitions 10, the time it takes to complete one repetition of 6 seconds, the energy expenditure of the exercise is 3.33 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 33.3 cal / kg⋅min, - I.p. sitting on the edge of the chair, arms are lowered, one leg is bent at the knee, the other is straightened, the position of the legs is changed by two counts, breathing is arbitrary, the number of repetitions is 12, the time it takes to perform one repetition is 5.0 seconds, energy expenditure is 3.46 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 41.52 cal / kg⋅min, - I.p. sitting, hands on the belt; legs are spread wider than shoulders, on account 1 - to spread your arms to the sides, inhale with your nose, on the account 2-3-4 tilt the body forward to one knee, putting your hands on the knee, exhale with your mouth, the other leg, the number of repetitions 10, time perform one repetition of 6 seconds, the energy expenditure of the exercise is 3.22 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 32.2 cal / kg⋅min, - I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the belt, on the count of 1 breath, on the count of 2-3-4 circular movement of the body for four counts in one direction and the other, exhale, the same in the other direction, the number of repetitions is 12, the execution time for one repetition is 5.0 seconds, the energy expenditure of the exercise is 2.43 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 29.16 cal / kg⋅min, - I.p. sitting on the edge of the chair, hands grasp the back of the chair at the back, on account 1 - raise the leg bent at the knee, inhale with the nose, on account 2 - straighten the raised leg, exhale through the mouth, on account 3 - bend the raised leg, inhale through the nose, on account 4 - return to I.p., exhale with a mouth, the number of repetitions is 12, the time it takes to complete one repetition of 5 seconds, the energy expenditure of the exercise is 2.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 34.8 cal / kg⋅min, - I.p. sitting on the edge of the chair, hands on his knees, 1-2 count back in the chair, straighten and spread legs and arms to the sides, inhale with your nose, 3-4 count back in I.p., exhale with your mouth, number of repetitions 10, the duration of one repetition is 6.0 seconds, the energy expenditure of the exercise is 3.72 cal / kg, then the passive rest is 1-2 minutes, the energy expenditure per minute of the exercise with a given number of repetitions is 37.2 cal / kg⋅min, - I.p. sitting on the edge of the chair, arms down, imitation of walking, raising the knee high, arm movements sweeping, breathing arbitrary, number of repetitions 20, time to complete one repetition 3 sec, energy expenditure 2.31 cal / kg, energy expenditure per minute for this exercise repetitions 46.2 cal / kg⋅min, - I.p. sitting on a chair, the back is pressed to the back of the chair, hands on the knees, on the count of 1 spread your arms to the sides, inhale, on the count of 2-3-4 hands on your knees, resting your hands on your knees, stand up and sit down - exhale, the number of repetitions is 10, the execution time of one repetition is 6 seconds, the energy expenditure of the exercise is 4.64 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 46.4 cal / kg⋅min, - Walking 90 steps per minute for 60 seconds, energy consumption per minute of walking 58.2 cal / kg⋅min, - I.p. standing, arms down, legs apart, at the expense of 1 do in I.p. inhalation through the nose, tilt the torso to the right at the expense of 2-3-4, the opposite hand slides along the torso to the axilla, exhale through the mouth, the same way, the number of repetitions is 12, the duration of one repetition is 5.0 seconds, the energy expenditure of the exercise is 3.34 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 40.08 cal / kg⋅min, - I.p. standing, arms down, legs apart, at the expense of 1-2 raise your hands up, take your leg back to the toe, bend, inhale with your nose, at the expense of 3-4 return to I.p., exhale with your mouth, the same with the other leg, the number of repetitions 10, the execution time of one repetition of 6.0 seconds, the energy expenditure of the exercise is 6.18 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 61.8 cal / kg⋅min, - I.p. standing, hands on the belt, legs together, at the expense of 1 - do in I.p. inhalation through the nose, on account 2 - put one leg to the side on the toe, tilting the body in the same direction, raise the opposite hand upward, exhale through the mouth, counting 3-4 the same way, the number of repetitions 12, the time it takes to complete one repetition 4 sec, the energy expenditure of the exercise is 4.24 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 50.88 cal / kg⋅min, - I.p. standing, hands on the belt, legs apart, circular movements of the pelvis in four counts to the right, left, arbitrary breathing, number of repetitions 10, time to complete one repetition of 6 seconds, energy expenditure of exercise 4.9 cal / kg, energy expenditure per minute of exercise with this quantity repetitions of 49 cal / kg⋅min, - I.p. standing sideways to the back of the chair, one hand on the back of the chair, the other on the belt, at the expense of 1 breath, at the expense of 2-3-4 swing one foot back and forth, the range of motion is complete, exhale, the same with the other foot, the number of repetitions is 12, the time to complete one repetition is 5 seconds, the energy expenditure of the exercise is 6.24 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 74.88 cal / kg⋅min, - I.p. sitting on a chair, the back is pressed to the back of the chair, hands on his knees, circular movements of the head in four counts to the right and left. Arbitrary breathing, the number of repetitions of 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise 2.2 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions 22 cal / kg⋅min, - I.p. sitting on a chair, arms down, legs straightened, circular movements of the feet and hands on each count, arbitrary breathing, number of repetitions 15, time to complete one repetition 4 seconds, energy expenditure of exercise 1.9 cal / kg, energy expenditure per minute of exercise with this amount repetitions of 28.5 cal / kg⋅min, - I.p. sitting on a chair, the back is pressed to the back of the chair, arms to shoulders, to the count of 1-2 to extend the elbows to the sides and back, inhalation of the nose, to the count of 3-4 to bring the elbows together, exhale, the number of repetitions 10, the time it takes to complete one repetition 6 , 0 sec, the energy expenditure of the exercise is 2.27 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 22.7 cal / kg⋅min. 7. The method according to p. 1, characterized in that in the preparatory period on an outpatient basis, patients with a distance of 270-349 meters with TLC or ME 2.0-2.9 with a VEM test perform a set of exercises, the total energy consumption of which is 611, 22 cal / kg, energy expenditure of 1 minute of exercise - 32.97 cal / kg⋅min, the duration of the complex is 20 minutes: - I.p. sitting, hands on knees, legs bent; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4, lower your hands down, relax - exhale, the number of repetitions of 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 2.19 cal / kg. Energy expenditures per minute of the exercise for a given number of repetitions of 21.9 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent; squeezing and unclenching the hands into a fist for each account with simultaneous flexion and extension of the feet, arbitrary breathing, number of repetitions 30, time to complete one repetition 2 sec, energy expenditure of exercise 1.0 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 30 cal / kg⋅min, - I.p. sitting on the edge of the chair, arms down, one leg bent at the knee, the other straightened; change the position of the legs by 2 accounts, arbitrary breathing, the number of repetitions of 10, the time to complete one repetition of 6.0 seconds, the energy expenditure of the exercise is 3.46 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 34.6 cal / kg⋅min, - I.p. sitting, hands on your knees; legs bent and divorced; on the bill 1-2, spread your arms to the sides - inhale, on the bill 3-4 grab the knee with your hands and pull your leg to the chest - exhale, the number of repetitions 10, the time it takes to complete one repetition 6 seconds, the energy expenditure of the exercise is 3.33 cal / kg, energy expenditure minute of doing the exercise with a given number of repetitions 33.3 cal / kg⋅min, - I.p. sitting, arms to shoulders, legs bent; circular movements in the shoulder joints four counts back and forth, breathing arbitrary, the number of repetitions 10, the time to complete one repetition of 6.0 seconds, energy expenditure of exercise 3.62 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 36.2 cal / kg⋅min, - I.p. sitting, hands on your knees; the legs are bent; alternate breeding in the direction of socks and heels into four accounts; return to I.p. also into four accounts, the number of repetitions is 30, the time it takes to complete one repetition of 2 seconds, the energy expenditure of the exercise is 1.0 cal / kg, the energy expenditure per minute of the exercise with this number of repetitions is 30 cal / kg⋅min - I.p. sitting, arms to shoulders; knees are divorced; on the count of 1-2, stretch the elbows to the sides - inhale, on the count of 3-4 lower both elbows on one knee, lean forward - exhale, the same to the other knee, number of repetitions 10 time to complete one repetition of 6 seconds, energy expenditure of exercise 3.12 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 31.2 cal / kg⋅min, - I.p. sitting on the edge of the chair, hands on the belt; the legs are bent; on account 1 - straighten and at the same time take your leg to the side, on account 2 - return to I.p., on account 3-4 - with the other leg, number of repetitions 10, time to complete one repetition 6 sec, energy expenditure of exercise 3.47 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions of 34.7 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent, 1-2 counting arm to the side with a torso turning in the same direction - inhale, 3-4 counting back to I.p. - exhalation, the number of repetitions 12, the execution time of one repetition of 5 seconds, the energy expenditure of the exercise is 1.81 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions is 21.72 cal / kg⋅min, - I.p. sitting, hands on the belt, legs bent; 1-2 count elbows to the sides and back - inhale, 3-4 counts elbows together - exhale, number of repetitions 10, time to complete one repetition of 6 seconds, energy expenditure of exercise 1.81 cal / kg, energy expenditure per minute of exercise with a given number of repetitions of 18.1 cal / kg⋅min, - I.p. sitting, hands on the belt, legs bent, at the expense of 1 - inhalation, at the expense of 2-3-4 circular movement of the body - exhale, the same in the opposite direction, the number of repetitions 10, the time it takes to perform one repetition of 6.0 seconds, the energy expenditure of exercise 2 , 43 cal / kg, energy expenditures per minute of the exercise for a given number of repetitions of 24.3 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent, on the count of 1 hands spread apart - inhale, on the count of 2-3-4 hands on knees, stand up and sit down - exhale, number of repetitions 10, time for one repetition 6 seconds, energy expenditure of exercise 4 , 64 cal / kg, energy expenditures per minute of the exercise for a given number of repetitions of 46.4 cal / kg⋅min, - Walking 70 steps per minute for 60 seconds, energy consumption per minute of walking 46.1 cal / kg⋅min, - I.p. standing, arms down, legs apart; count 1 - inhale, count 2–3–4 the body tilts to the right and left, the opposite arm slides along the body to the armpit - exhale, “pump”, number of repetitions 10, time to complete one repetition 6.0 sec, energy expenditure of exercise 3 , 34 cal / kg, energy expenditures per minute of the exercise for a given number of repetitions of 33.4 cal / kg⋅min, - I.p. standing, hands on the belt, legs apart; circular movements of the pelvis in four counts, arbitrary breathing, the number of repetitions of 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise 4.90 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions 49 cal / kg⋅min, - I.p. standing, arms down, legs apart; at the expense of 1-2, spread your arms to the sides - inhale, at the expense of 3-4, lower your hands down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 3.1 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 31 cal / kg⋅min, - I.p. sitting, hands on your knees; legs bent, feet together; on account 1 - spread the knees to the sides, without spreading the stop - inhale, on the score 2-3-4, bring the knees together, squeezing them with your hands - exhale, the number of repetitions 10, the time for one repetition 6.0 seconds, the energy expenditure of the exercise 1.69 cal / kg, energy expenditure per minute of the exercise for a given number of repetitions 16.9 cal / kg⋅min, - I.p. sitting on a chair, arms down, legs straightened; circular motions of the feet and hands on each count, arbitrary breathing, the number of repetitions of 15, the time to complete one repetition of 4 seconds, the energy expenditure of the exercise is 1.9 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions is 28.5 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent; circular movements of the head into four counts, the number of repetitions of 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise 2.2 cal / kg, the energy expenditure per minute of the exercise for a given number of repetitions 22 cal / kg⋅min, - I.p. sitting, hands on knees, legs bent; on the bill 1-2, spread your arms to the sides - inhale, on the bill 3-4, lower your hands down, relax - exhale, the number of repetitions 10, the time to complete one repetition of 6 seconds, the energy expenditure of the exercise is 2.19 cal / kg, the energy expenditure per minute of the exercise with a given number of repetitions of 21.9 cal / kg⋅min