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BUKOVINІАN STATE MEDICAL UNIVERSITY
“Approved”
on the Methodological Meeting
of the Department of Internal medicine,
Physical rehabilitation and Sport medicine
Bukovinian State Medical University
“____” ____________________ 20___
Minutes No_______
Deputy Chief of the Department,
Doctor of Medical Science
V.K. Tashchuk
METHODOLOGICAL INSTRUCTIONS
to the practical class on the topic:
“ RESEARCH AND ESTIMATION OF THE FUNCTIONAL STATE OF
CARDIO-VASCULAR, PULMONARY AND VEGETATIVE NERVOUS
SYSTEMS WITH USING THE FUNCTIONAL TESTS. TYPES OF
REACTION.”
Chernivtsi - 2010
1. Topic of the Class: Determination of the functional state of the vegetative
nervous systems respiratory and cardiovascular systems to the sportsmen, athletes and
persons which wish to get busy in one of sporting sections is the primary task at the
primary medical inspection in a medically-athletic dispensary. Only after a careful
review and analysis of functional possibilities of the systems of organism it is possible
to draw conclusion about the state of health in general, about the reactions of
organism, physical preparation to employments in the varied sporting sections.
2. Duration of the class: 4 .
3.Objectives:
To know:
 functional tests with the physical loading, which are used in sport medicine;
 tests with the change of position of body
 tests time-lagged breathing for determination the functional state of the
respiratory system at children;
 classification of the physical loadings;
Вe able to:
 to estimate functional backlogs of heart after the test of Martine-Kushelevsky
 to conduct determination of the functional state respiratory system at
sportsmen, athletes;
 to conduct and analyse the results of tests Shtange, Gencha reflexes at athletes;
 to estimate the results of test of Rozentalya
4. Advices to the student.
There are 1-, 2-, 3-moment‘s tests in sport medicine.
1-momemt‘s tests includes:
1. the 20 squat for 30 sec. (test of Martine-Kushelevsky).
2. 60 jumpings for 30 sec.
3. 2 minutes of running in a rate 180 steps for a min.
4. 5 minutes of running (4 minutes slowly, in a rapid rate on the last minute).
In 2-moment‘s physical tests loading makes 2 times with the small interval of
time between them. For example: PWC 170, PWC 150, PWC 130 etc.
During the inspection of sportsmen rationally to use 3-moment‘s test of
Letunov with different intensity and duration the physical loadings:
1) the 20 squat for 30 sec;
2) the 15-second
horizontal level);
running on the same place in a maximal rate (a leg rises to the
3) running on the same place during 3 minutes in a rate 180 steps for a minuts.
The first loading is a limbering-up, second - finds out a capacity for rapid
adaptation of the cardio-vaskular system, directed on strengthening of blood
circulation. Third - finds out ability of organism proof to support the increased of
blood circulation at high level during long time in great while.
Important is individual determination of the threshold loading is that frequency
of heart rates, which arises up for implementation of the physical loading and
accompanied appearance of the negative subjective feelings in person (great head
pain, beauty-spot before eyes, nausea, vomit, great pain in the area of heart, stuffiness
etc).
The maximal physical loading is calculated after a formula:
Mах heart rates = 220 - age (in years).
The submaximal loading is frequency of heart rates, which answers 75 - 85 %
maximal heart rates and is an important criterion at implementation of diagnostic test
on a veloergometer, treadmill or to the step test and others.
Optimum physical loading - it 60 - 70 % from Mах heart rates. In such mode it
is made to order to work patients on hypertantion, with vegeto-vaskular dystonia after
a hypertensive type. If hypertantion developed on a background of VVD, and also for
patients more senior 40 years with the presence of factors of risk of development
VVD before setting of procedures physical training it is necessary to conduct one of
the higher adopted tests on tolerance to the physical loading and physical capacity.
The minimum loading is that loading which causes the increase of heart rates
on 3О - 50 % from the level of rest. It is made to order at hypertantion desease II and
hypernantion on a background of VVD to the improvement of the state sick and
appearance of training effect in a complex with medicinal treatment.
After the reaction of the cardio-vaskular system on loading there are favourable
(normotonic, hyperreactive) and unfavorable (hyper-, hypo- and dystonic) reactions.
The normotonic type of reaction is characterized the acceleration of pulse on
60-80%, with the increasing of systolic BP on 15-30%, diastolic BP does not change,
or diminishes on 10-20%, pulse pressure grows. ECG-signs: a rhythm is sine correct,
the segment of PQ diminishes or does not change (not less than 0,12 sec), a complex
QRS does not change or some diminishes, interval of QТ no more guilty (after the
formula of Bazett) ± 0,04 sec. The indent of Р is Flattened And, amplitude of indent
of Р III grows, depression of segment SТ no more than 0,08 sec.
The hypotonic type of reaction is an acceleration of pulse > 100%, systolic BP
rises insignificantly, or does not change, pulse pressure diminishes (adaptation to
loading due to the increasing of heart rates).
The hypertensive type of reaction is characterized by the acceleration of pulse >
80%, and main - sharp getting up of systolic BP (> 30% initial level), diastolic BP
also can be increased on 10%. Meets at hypertansion (VVD, symptomatic
hypernantion on a background of VVD ). ECG-criteria of stopping tests with the
physical loading: depression of segment SТ, appearance negative, oblate, twophase
indent of Т, appearance of violations of rhythm and conductivity (extrasystolia of
high gradations after classification of Laun, blinking arrhythmia, blockades of legs of
bunch of Gisa).
A dystonic type of reaction is the sharp diminishing of diastolic pressure (socalled phenomenon of unfinished tone of Korotkov) later than through 20 sec after
loading, at the considerable increase of systolic BP and acceleration of heart rates.
Skhidcepodibna reaction, as a variant of dystonic, - if in the period of restitution of
systolic BP continues to rise, arriving at a most value on 2-3 min. Characteristically
for an overstrain, overtraining, VVD.
Presently In sport medicine apply the test of Ruf'e also, during the leadthrough
of which count up frequency of pulse only. Conducting a test, in probed which is in
lying positoin on the back during 5 min, determine the number of pulsations after 15
seс (Pl). Then during 45 sec the probed executes 30 squats after 45 sec. After it he
lies down and for him again count up a pulse for the first 15 с (R2), and then - for the
last 15 from the l-st minute of period of renewal (Rz).
Index of Ruf'e = 4 (P1 + R2 + Rz) - 200 .
10
The estimation of functional backlogs of heart is conducted after such table:
Estimation of functional backlogs of
heart
Athletics heart
Value of index of Ruf'e
0 and <
Heart of middle man:
very well
well
0,1-5,0
5,1-10,0
Cardiac insufficiency:
middle degree
10,1-15,0
high degree
15,1-20
At questioning of students, attention applies on tests time-lagged breathings
(Shtange, Gencha), which utillize for determination of sensitiveness of organism to
hypoxia, hypercapnia, volitional qualities of patient, and also for establishment of the
functional state of the breathing system. Taking a deep breath (but not maximal-50%
from LCL) the probed detains breathing as possible more long (before appearance of
the first imperative urge to breathe out). From the moment of breath-holding by a
stop-watch determine time of breathing interruption, in the moment of exhalation a
stop-watch is stopped (test of Shtange). Maximal time of breath-holding after
exhalation (before appearance of the first imperative urge to breathe) is fixed during
the leadthrough of test of Genchi. Time of breath-holding for healthy persons on
inhalation (test of Shtange) makes for the men of 40-60 с, for the women of 30-40 с;
on видоху (test of Genchi) hesitates within the limits of 25-40 с for men and 15-20 с
for women, for sportsmen they can arrive at considerable sizes (for example test of
Shtange - 120 and anymore с). In the case of diseases of the respiratory and серцевосудинної systems these indexes diminish considerably, depending on weight of
motion of disease.
A dynamic spirometery is determination of changes of LCL under act of the
physical loading. Defining the initial size of LCL, it is offered to probed to execute
one of standard tests, for example: 2th minute running on the spot in a rate 180 steps
for 1 minute at getting up of thigh under the corner of 60-80 degrees, or any other
loading. After it again measure LCL. Depending on the functional state of the system
of the external breathing and circulation of blood of LCL will not or change, or will
diminish, or increased. Accordingly, the results of dynamic spirometery are estimated
satisfactorily (if the results of change of LCL hesitate within the limits of  150 мл
from an initial value), unsatisfactorily (if the value of LCL diminished on 200 мл and
anymore), or well (when the size of LCLwas increased on 200 мл and anymore).
Implementation of 2th minute running on the spot in quality the physical loading
during employments in an audience most comfortably. At the use of this test during
medical-pedagogical supervisions last it is expedient to conduct after implementation
of any control exercises or training on the whole.
A test of Rozentalya (test on fatigueability of respiratory muscles) is the
fivefold measuring of LCL, which is conducted through each 15 seconds. This test
looks like a dynamic spirometery, but unlike the last the physical loading here is
directly on the кістково-м'язевий vehicle of the system of the external breathing.
Depending on his functional state the size of LCL in the process of successive
changes behaves variously: at good increased, at satisfactory remains without
changes, and at unsatisfactory - diminishes. The estimation of results of test is such,
as well as in a dynamic spirometery.
5. Review Questions:
1.
Classification of the physical loadings.
2.
Classification of functional tests.
3.
Estimation results test of Genchi.
4
Types of reaction.
5.
What is test of Letunova.
6.
What is threshold loading.
7.
Describe submaximal, optimal, minimal physical loading.
6. References:
1. Thompson D.R. Coronary disease. Management of the post-myocardial infarction
patient: rehabilitation and cardiac neurosis. Heart. 2000 Jul;84(1):101-5.
2. Jackson L. Getting the most out of cardiac rehabilitation: a review of referral and
adherence predictors. Heart. 2005 Jan;91(1):10-4.
3. Gayda M. Long-term cardiac rehabilitation and exercise training programs improve
metabolic parameters in metabolic syndrome patients with and without coronary heart
disease. Nutr Metab Cardiovasc Dis. 2006 Dec 1.