Sudden Death In Sports: Modern Concepts

Regular physical activity provides significant health benefits and reduces the risk of premature death from any cause, including cardiovascular diseases (CVD). However, physical activity may provoke sudden cardiac death (SCD), especially in presence of unrecognized diseases. It is essential to identify risk factors that contribute to SCD in athletes and to implement effective prevention of such episodes. For this purpose, SCD registries are being created, medical terminology is being unified, and schedules of medical examination are being developed. The best strategy to combat SCD during sport activities is a combination of primary prevention by screening examination to identify athletes with CVD at risk and a proper planning of first aid measures during sports events, including the availability of an automatic external defibrillator on site.

The Efficacy of Telemedicine Rehabilitation Programs In Regard Of Risk Factors Control In Patients With Paroxysmal Atrial Fibrillation Aftercatheter Ablation

Aim      To evaluate changes in traditional risk factors (RF) during cardiac rehabilitation (CR) programs with remote support in patients with paroxysmal atrial fibrillation (AF) after catheter ablation (CA).Material and methods  The lack of control of cardiovascular RFs is a predictor for AF recurrence after CA, development of complications, and decreased life expectancy. Telemedical CR programs may improve the control of RF and enhance the CR efficacy. This randomized controlled clinical study in three parallel groups included 135 patients aged 35 to 79 years. In groups 1 and 2, CR programs with remote support were performed, which included a single personal consulting for the disease, achieving control of all patient's RFs, and remote support during 3 months (group 1, by phone and group 2, by e-mail). Participants of group 3 received standard recommendations. Body weight, blood pressure (BP), blood lipids, smoking status, and physical activity (PA) were determined at baseline and at 12 months after CA with the IPAQ questionnaire.Results In both intervention groups at 12 months, there were positive changes in RF: body weight index decreased by 3.6 % in group 1 (р=0.01) and by 2.3 % in group 2 (р=0.002) vs. 0 in the control group; systolic BP decreased by 7.1 % (p<0.001) and 1.5 % (p=0.003) in groups 1 and 2 (vs. increases by 3.3 % in group 2); total cholesterol decreased by 9.4 % (p<0.001) and by 6.3 % (p=0.003), respectively, (vs. 0 in group 3); values of metabolic equivalents (METs) used for walking increased by 55.0 % (р=0.014), 75.0 % (р=0.001), and 1.4 % in groups 1, 2 and 3, respectively. No significant intergroup differences in the frequency of AF recurrence, repeated CA, and hospitalizations were found.Conclusion      CR programs with remote support provide improved control of BP, body weight, blood cholesterol, and AF in patients with AF after CA, according to the results of the one-year follow-up.

Complex treatment of patellofemoral pain syndrome in athletes after reconstruction of the anterior cruciate ligament of the knee joint

Patellofemoral pain syndrome (PFPS, patellar chondromalacia) after knee surgery is an important problem in sports medicine, solutions to which have not been developed enough.

Objective: to determine the effect of complex treatment using an injectable chondroprotector and special exercise therapy on the functional state, statokinetic stability and severity of PFPS in athletes after reconstruction of the anterior cruciate ligament (ACL) of the knee joint.

Patients and methods. An observational randomized controlled trial included 40 athletes after ACL reconstruction. The patients were divided into two groups. In the control group (n=20), a special rehabilitation technique was used after ACL reconstruction. In the main group (n=20), along with a similar method of rehabilitation, patients received a course of intramuscular injections of Alflutop (1 ml, No. 20). The duration of rehabilitation treatment was 1 month.

Pain was assessed using a numerical rating scale and knee joint function using the Kujala questionnaire, statokinetic stability was assessed before and after complex rehabilitation treatment.

Results and discussion. One month after the start of rehabilitation measures, both groups showed a significant decrease in pain intensity and an improvement in the functional state of the knee joint according to the Kujala questionnaire. The study of statokinetic stability indicators showed that after the course of rehabilitation in both groups, when standing with open eyes, there was a decrease in the area of the common center of pressure — CCOP (p<0.05) and an improvement in statokinetic stability, and when standing with eyes closed, a decrease in the CCOP area (p<0.05). At the same time, the difference in the results before and after the course of rehabilitation in the main group was significantly greater than in the control (p<0.05). The speed of the CCOP movement with open eyes in both groups did not change significantly: when standing with eyes closed, its positive dynamics was revealed after the course of rehabilitation (p<0.05).

Conclusion. Intramuscular SYSADOA injection therapy, which was used as part of a rehabilitation program, reduced pain and improved the function of the knee joint and had a positive effect on statokinetic stability in athletes after ACL reconstruction.

[Determination of cobalt in plasma blood samples by the ICP-MS method after oral intake of dietary supplements containing low doses of cobalt]

Salts of inorganic cobalt (Со) prevent the degradation of the alpha subunit of the hypoxia-inducible factor (HIF), imitating the state of hypoxia in the body and increasing the production of the endogenous hormone erythropoietin (EPO), and are used as doping substances that increase blood oxygen capacity and endurance, which give competitive advantages in sports. Currently, a large number of dietary supplements, including Co-containing ones, are offered on free sale. Their uncontrolled intake can affect not only the professional career of athletes, but also their health, due to the fact that this trace element and its salts are the strongest inorganic poisons and carcinogens. Despite this, their availability on the pharmaceutical market, a noticeable effect of erythropoiesis stimulation and a convenient oral form of administration lead to the need for their detection in modern doping control. The purpose of this research was to develop an approach to differentiate cobalt from vitamin B12, present in the body in its natural state, from the intake of cobalt salts by quantifying and comparing blood levels of vitamin B12 and total cobalt. Methods. The study involved 9 healthy volunteers (women and men) aged 25 to 45 years, leading an active lifestyle. Three of them took 2500 μg/day of cobalamin for 20 days (comparison group), three - dietary supplement containing cobalt asparaginate (100 μg/day in terms of pure cobalt), and the rest - dietary supplements with cobalt sulfate heptahydrate (100 μg/day in terms of pure cobalt) (administration groups) at the same time after meals. Blood samples were taken at baseline and on days 5, 9, 14 and 20. The concentrations of total cobalt in blood plasma samples of volunteers were measured by inductively coupled plasma mass-spectrometry (ICP-MS), the levels of cobalamin were determined on a Cobas 6000 immunochemical analyzer using the Elecsys Vitamin B12 II Assay ELISA kits. Results. It was found that oral intake of of cobalamin at a therapeutic dose significantly exceeding the recommended daily intake (3 μg), there was a regular slight increase in the blood concentration of total cobalt (1.1 times). At the same time intake of dietary supplements containing cobalt in the form of sulfate or asparaginate (about 100 μg per day in terms of pure cobalt) was accompanied by 4-6.7 fold increase in the concentration of total cobalt while unchanged vitamin B12 plasma concentration was observed. The detection of such changes can reliably indicate the use of prohibited salts and, of course, will be in demand for anti-doping control. Conclusion. Long-term monitoring of vitamin B12 and total cobalt levels, similar to hematological module of the Athlete Biological Passport program, will unambiguously detect possible abuse of cobalt salts and can be an additional evidence of the presence of these doping substances to other analytical methods, such as a combination of liquid chromatography and ICP-MS (LC-ICP-MS).

Efficacy of secondary prevention and rehabilitation programs with distant support in patients with atrial fibrillation after intervention procedures: impact on psychological status

Aim      To evaluate the effectivity of secondary prevention/rehabilitation programs with remote support for the psychological condition of patients with paroxysmal atrial fibrillation (AF) following interventional procedures (radiofrequency catheter ablation and cryoablation).

Material and methods  This prospective, controlled, randomized clinical study was performed in three parallel groups. Each group consisted of 45 patients with AF after interventional procedures. In groups 1 and 2, secondary prevention/rehabilitation programs with remote support were performed, including a single individual in-hospital counseling (on risk factors of AF and their control and on major aspects of the disease, treatment and prevention of complications) and three months of remote support (by phone in group 1 and by e-mail in group 2). Patients of group 3 (control group) received standard recommendations at discharge from the hospital. The psychological status was evaluated using the Hospital Anxiety and Depression Scale, the PHQ-9 questionnaire, the Spielberg-Hanin scale for reactive and personal anxiety, and the visual analogue scale for stress assessment. The follow-up duration was 12 months.

Results At the end of the follow-up period, the proportion of patients with anxiety symptoms considerably decreased in both intervention groups (р<0.001 for each group) and was significantly less than in the control group (р<0.001 for both comparisons). Also, in intervention group 1, the proportion of patients with clinically pronounced anxiety symptoms was significantly decreased. For 12 months of follow-up, the severity of depressive symptoms significantly decreased in all three groups. However, in both intervention groups, this decrease was significantly greater than in the control group (р<0.001 for group 1 and р=0.020 for group 2). In both intervention groups at 12 months, the stress level was significantly reduced whereas in the control group, it remained practically unchanged. The greatest (50% on average) decrease in the stress level was observed in intervention group 2.

Conclusion      Secondary prevention and rehabilitation programs with remote support during a 12-month follow-up resulted in improvement of the psychological status in patients with AF after interventional procedures.

[New treatments and technologies in cardiac rehabilitation programs]

The article presents a review of literature data reflecting the relevance and modern views on the effectiveness and expediency of using various options for rehabilitation programs for cardiovascular diseases. The issues of the history of the development of cardiac rehabilitation both abroad and in Russia are consecrated. The article also presents alternative models for conducting cardiac rehabilitation, in particular, using remote and telemedicine technologies. The widespread use of smartphones and high-speed Internet access contributed to the further introduction and use of telemedicine technologies in cardiac rehabilitation. The article discusses the possibilities of telerehabilitation of cardiological patients and shows its comparable effectiveness with traditional cardiac rehabilitation.

[Mitochondrial aspects of fatigue in sports]

National literature on fatigue in sports related to mitochondrial activity and possible drug and non-drug correction approaches over the past 5 years was reviewed. The significance of acidosis as a factor limiting muscle activity, energy production, adenosine triphosphate utilization, and activation of lipid peroxidation was shown. The results of ultrastructure studies in the modulation of gene expression related to the characteristics of tonic and phasic muscles and a histochemical method of assessing the types of these muscle fibers are presented. Options of overtraining prevention in sports by drug and non-drug methods are evaluated.

[The use of electromyostimulation in motion in the treatment of post-traumatic edema of the ankle joint]

Injuries of the ligamentous apparatus of the ankle joint are one of the most common injuries of the ODA. A large number of complications and a long period of disability require the development of modern methods of physiotherapy treatment that can reduce the number of relapses and reduce the duration of rehabilitation.

OBJECTIVE

Evaluation of the effectiveness of the use of electromyostimulation in motion in the treatment of post-traumatic edema of the ankle joint.

MATERIAL AND METHODS

51 athletes with post-traumatic edema of the ankle joint were examined. The main complaints were the presence of pronounced edema in the area of injury, pain, restriction of movement in the joint. The patients were randomly divided into 2 groups: the 1st group (25 patients) received treatment with electromyostimulation in motion (while performing therapeutic gymnastics); the 2nd (control) group (26 patients) performed therapeutic gymnastics recommended for the treatment of patients with lymphovenous insufficiency. The method of laser Doppler flowmetry was used to study microcirculatory disorders in the area of injury. Peripheral hemodynamics was evaluated by the RVG method. The severity of edema was assessed by measuring the circumference of the lower leg in the lower third of the injured and healthy limb. The thickness of subcutaneous fat was assessed by ultrasound. The subjective feelings of athletes were evaluated using CIVIQ-2 questionnaires and pain syndrome assessment according to VAS.

RESULTS AND CONCLUSION

The use of electromyostimulation in motion in patients with post-traumatic edema of the ankle joint helped to reduce pain, relieve soft tissue edema, increase the volume of movements in the affected joint, increase motor activity and improve the quality of life.

[Application of kinesis-taping and low frequency pulse magnetic therapy in medical rehabilitation of athletes with post-traumatic edema of the lower extremities]

In the conditions of increasingly stringent anti-doping rules, the development of new non-drug methods of treatment and rehabilitation of athletes is of particular importance.

OBJECTIVE

Development of new methods of medical rehabilitation of athletes after injury.

MATERIAL AND METHODS

Thirty-three athletes with knee injuries were examined. The main complaints were the presence of pronounced edema in the area of injury. All patients were randomly divided into 2 groups: in group 1 (16 patients) lymphatic drainage kinesis-taping was performed; in the 2nd group (17 patients) - complex treatment including lymphatic drainage kinesis-taping and low-frequency pulse magnetic therapy. Using laser Doppler flowmetry a study of microcirculatory disorders in the area of injury was carried out. The severity of edema was assessed by measuring the circumference of the knee joint of the diseased and healthy limbs. The assessment of the subjective feelings of athletes using questionnaires CIVIQ2 andVAS.

RESULTS AND CONCLUSION

Based on the obtained subjective and objective data, a medical complex was developed using lymphatic drainage kinesis-taping and low-frequency pulse magnetic therapy, which affects different steps in the pathogenesis of edema formation. Data obtained resultedin more pronounced positive effect during complex treatment compared with monotherapy with kinesis-taping.

[Basic principles and approaches to medical rehabilitation of patients with atherosclerosis obliterans of lower limb arteries]

The review presents current data on the management of patients with atherosclerosis obliterans of the lower extremities. The main approaches to medical rehabilitation of patients with diseases of the arteries of the lower extremities are considered, tools for determining the rehabilitation potential depending on the stage of lower limb ischemia are proposed. The programs of physical and psychological rehabilitation, as well as the methods of physical and balneotherapy in accordance with the stages of medical rehabilitation, are determined. Modern rehabilitation methods are presented.

[Physical training integration with physiotherapeutic methods of myocardial metabolism recovery in the rehabilitation of patients after acute coronary syndrome and cardiosurgical myocardial revascularization]

Successes achieved in the treatment of patients with coronary heart disease (CHD) after acute coronary syndrome and cardiosurgical interventions require the development of new, more advanced methods for their rehabilitation. This is because of metabolic disturbances persistence in the deeply ischemic myocardium in patients with coronary heart disease even after restoration of blood flow through the coronary arteries by surgical or endovascular methods due to the development of the phenomenon of «stunning» and hibernation. The discovery of the development of their own adaptation to ischemia phenomenon opens up new possibilities in the correction of the metabolism of the ischemic myocardium, which significantly increases the efficiency of patient postoperative rehabilitation.

PURPOSE OF THE STUDY

The scientific rationale for improved cardiac rehabilitation programs for patients after acute coronary syndrome and cardiac surgery.

MATERIAL AND METHODS

120 patients who were randomized to 3 groups (40 patients each) were examined: the main and two control, comparable in the major clinical manifestations of the disease. Improved methods of physical training with the inclusion of interval cyclic training for the first time in cardiology on treadmills and sensory tracks and therapeutic exercises in the gym (daily, 5 times a week, for a course of 10 procedures) were performed for patients of the 1st control group. Therapeutic procedures that improve metabolic processes in the ischemic myocardium were used in patients of the 2nd control group: enhanced external counterpulsation, general dry air carbon dioxide, infrared matrix laser therapy. Rehabilitation by the complex of the above physical training and factors which restored metabolic processes in the ischemic myocardium was carried out to patients of the main group. Methods had a cardioprotective effect and increase myocardial adaptation to ischemia.

RESULTS

The greatest anti-ischemic, antianginal, antihypoxic effects were achieved in patients of the main group compared with the control groups. What may be due to the correction of metabolic disorders and the development of cardioprotection of ischemic myocardium. The consequence is a significant increase in the rehabilitation effect of improved cardiovascular training.

CONCLUSION

The achieved result is due to the integration of improved cardiac training techniques and a procedure package aimed at cardioprotection and metabolic myocardium adaptation to ischemia, which included enhanced external counterpulsation, general dry air carbon dioxide and infrared matrix laser therapy.

[Exploiting dietary supplements with antioxidant properties for enhancing physical efficiency at the state of physical fatigue in sports]

The aim of the review was to analyze the current scientific data concerning the dietary supplements (DS) with antioxidant activity to be recommended for using in order to improve physical performance in professional athletes experiencing fatigue. Material and methods. Online publications reviewing has been performed using the PubMed, Web of Science, Google Scholar databases, eLibrary platform, Cyberleninka. Results. Maintaining an athlete organism various systems functioning at the optimum level is known to be represented enough effective only with application of dietary supplements. The results of comprehensive up-to-date foreign and domestic scientific researches concerning dietary supplements including components with antioxidant activity to be recommended for delaying fatigue onset and improving physical performance in athletes have been analyzed. Application of such dietary supplements is dictated by the necessity to increase antioxidant organism defense, to maintain the normal functioning of a number of enzymes and prevent oxidative stress. The effectiveness of dietary supplements containing such components as vitamins E, A, and C; selenium, succinic and alpha-lipoic acid, coenzyme Q10, glutathione and other natural sources of antioxidants have been discussed in the review. The analysis of the data presented in the current scientific literature have confirmed the urgency of additional researches with the aim of receiving sufficient pieces of evidences of effectiveness of a number of dietary supplements with antioxidant activity in physical fatigue. Conclusion. For postponing fatigue and improving physical efficiency in sports there appear to be reasonable to use dietary supplements possessing antioxidant properties with effectiveness confirmed by scientific researches.

[Medical rehabilitation of patients with pneumonia associated with the new COVID-19 coronavirus infection]

Effective medical rehabilitation of patients with pneumonia caused by the new SARS-CoV-2 coronavirus is critical for the recovery and optimization of emergency and specialty care outcomes. In this regard, it is relevant to develop a scientifically based medical rehabilitation program for patients with the coronavirus infectious disease COVID-19, whose composition and structure includes methods and tools that have proven effectiveness.

AIM

To develop evidence-based approaches to medical rehabilitation for patients with pneumonia associated with the new COVID-19 coronavirus infection.

RESULTS

The clinical effects and suggested mechanisms of action of rehabilitation technologies in patients with pneumonia, including those associated with the new COVID-19 coronavirus infection, are considered in Detail. The most studied of the physical methods that have a proven effect are physical exercises, breathing exercises, the complex effect of factors of resort therapy, hydrotherapy, which affect the main clinical manifestations of the underlying disease, astheno-neurotic syndrome and increasing immunity. Clinical recommendations for medical rehabilitation are proposed and its promising methods are considered.

CONCLUSION

Regular generalization and analysis of high-quality randomized controlled clinical trials to evaluate various physical methods of treatment of patients with pneumonia associated with the new COVID-19 coronavirus infection is Necessary, which serve as a basis for the development of future valid clinical recommendations. Timely and adequate specialized medical rehabilitation care is critical to maintaining the health, reducing disability and mortality of patients with pneumonia associated with the new COVID-19 coronavirus infection.

[Use of enhanced external counterpulsation in the treatment and rehabilitation of patients with atherosclerosis obliterans of the lower extremity]

BACKGROUND

Cardiovascular diseases occupy a leading place in the structure of morbidity in Russia and other developed countries of the world.

AIM

To study the efficiency of using enhanced external counterpulsation in the comprehensive rehabilitation treatment of patients with stages I-IIB obliterating atherosclerosis of the lower extremities (OALE).

SUBJECTS AND METHODS

A total of 68 patients aged 50 to 78 years with stages I-IIb oale in the presence of clinical symptomatology of arterial insufficiency were examined and treated. According to the method of treatment, the patients were divided into two groups: 1) 32 people received a standard drug therapy (a control group). 2) 36 patients had an enhanced external counterpulsation therapy cycle during the standard therapy (a study group). The frequency of characteristic complaints, pain-free walking distance, peripheral hemodynamics, and the ankle-brachial index (abi) were assessed.

RESULTS

Posttreatment leg pain on walking persisted in 11 (30.6%) and 25 (78.1%) patients in the study group and in the control one, respectively; there were leg cramps in 9 (25.0%) and 14 (43.8%) people and cold feet in 5 (13.9%) and 25 (78.1%) patients, respectively (p<0.05). In the study group, the considerable increase in pain-free walking distance as compared to baseline values averaged 250±31.2 m (p<0.05), while that in the control group was only 64.5±25.1 m (p>0.05). The posttreatment increase in the leg and foot rheographic indices averaged 23.9 and 23.2%, respectively, in the study group and 11.9 and 12.3%, respectively, in the control group. The increases in abi in the anterior and posterior tibial arteries were 31.4 and 35.2%, respectively, in the study group (p<0.05), and 16.0 and 13.0%, respectively, in the control group (p>0.05).

CONCLUSION

The findings suggest that the use of enhanced external counterpulsation in the combination therapy of patients with stages I-IIb oale is a clinically effective and safe treatment.

[The application of bioresonance therapy for the correction of the overtrained athlete syndrome]

BACKGROUND

Physical overload results in the development of pathological changes in the organs and systems and thereby causes their dysfunction. This leads to disadaptation, vegetative imbalance, and disturbances in the cardiovascular, nervous, endocrine and other systems. Taken together, these changes give rise to a syndrome of overtraining. In this context, the pathogenetically sound method of therapy appears to be the most suitable for the management of this condition based on the physiotherapeutic non-invasive interventions for the correction of physiological characteristics and the psycho-emotional status of the patients. One such method is bioresonance therapy (BRT).

AIM

The objective of the present study was to evaluate the influence of bioresonance therapy (BRT) on the health status of the athletes presenting with the overtraining syndrome.

MATERIAL AND METHODS

The study included 60 athletes presenting with the overtraining syndrome. They were divided into two groups each comprised of 30 subjects of comparable age, sex, sport, and sports qualification. Group I was composed of 30 athletes who were treated by means of bioresonance therapy. Group II (control) contained the athletes who received placebo procedures (i.e. the procedures with the use of a non-functioning device). All the athletes were examined before and after the treatment with the application of the clinical and instrumental methods.

RESULTS

The study has demonstrated that the use of bioresonance therapy significantly increases the parasympathetic influence on the rhythm of the heart, reduces the stress on the central contour of its regulation, contributes to the 'economization' of the cardiac activity; has an antihypertensive effect (more pronounced with respect to systolic blood pressure (SBP)), has a normalizing effect on the variability of blood pressure (BP) in the patients with initial BP instability, and significantly decreases the time index in connection with monitoring blood pressure; moreover, BRT has a normalizing effect on the circadian rhythm of BP and corrects the rate of the morning rise in diastolic blood pressure (DBP).

CONCLUSION

Bioresonance therapy can be considered as a method for the correction of the syndrome of overtraining in the athletes with the enhanced activity of the sympathetic nervous system.

[The modern trends in the treatment and prevention of lymphedema of the lower extremities]

This article was designed to describe the main pathogenetic factors underlying the development of lymphedema of the lower extremities, the social implications of this condition, its prevalence throughout the world, and the impact of this disease on the quality of life of patients. In addition, the review presents the modern data on the management of patients with chronic lymphatic edema of the lower extremities. Special attention is given to the principles and methods of its combined conservative treatment, including the use of medications, compression therapy, physiotherapy, thalassotherapy, and balneotherapy. Moreover, the results of the analysis of the effectiveness of the treatment as a whole and of the individual methods, such as intermittent pneumatic compression (SPC), electrical myostimulation, laser therapy, magnetic-laser therapy (MLT) are reported with special reference to their outcomes when applied as isolated interventions and the components of the combined therapy. The review is devoted to the systematization of information about the currently available methods for the prevention and treatment of lymphadema of the lower extremities and the evaluation of the treatment regimens applied in this country and leading foreign clinical centres. Also considered are both the classical scheme of the combined treatment of lymphedema of the lower extremities and the schemes including novel therapeutic modalities. The most promising methods for the treatment of this condition including those proposed during a few recent years (such as kinesiotaping, LPG-engineering, and gravity therapy) are highlighted, and their influence on the generally accepted schemes of the combined treatment of lymphedema of the lower extremities is evaluated. The basic principles of modern pharmacotherapy and its role in the system of methods for the treatment of lymphedema of the lower extremities including phlebotomies, lymphokinesia, antibacterial drugs are considered.

[The implementation of the method of enhanced external counter pulsation for the treatment of cardiovascular diseases]

The cardiovascular diseases occupy a leading place in the structure of overall morbidity affecting the population not only of Russia but also of the majority of the developed countries throughout the world; they thus impose the heavy social and economic burden on both the public healthcare services and the modern society in general. At the same time, systemic atherosclerosis is considered to be one of the most common, severe, and life-threatening condition. Despite the presence of a large number of pharmaceutical and surgical methods for the treatment of this pathology, they are not infrequently lacking the desired effectiveness. The use of the shunting operations and endovascular methods failed to radically resolve the problem of managing systemic atherosclerosis and atherosclerosis of the lower limbs. A relatively novel approach which currently begins to find the ever increasing application for the treatment of patients presenting with cardiovascular pathology is based on the enhanced external counter-pulsation method although both the clinical and theoretical prerequisites of its application were developed rather long ago. This non-invasive therapeutic method allows to increase the perfusion pressure in the coronary arteries in diastole and to reduce the resistance to the cardiac ejection in the systole. The objective of this review article was to perform the analysis of the available literature publications on the use of the enhanced external counter-pulsation technique for the treatment of the patients presenting with the diseases of the cardiovascular system and to evaluate the clinical effectiveness of this approach as well as the availability of the treatment for the patients.

[Actual liquid consumption by highly qualified athletes in the mode of the training process]

The purpose of the study was to evaluate the actual intake of fluids by athletes of various sports during the day with one and two training sessions before, during and after workout. The dietary intake, including consumption of various types of liquid foods and beverages, was evaluated by the method of 24-hour recall in 280 athletes of high qualification (candidates for masters and masters of sports) of both gender of various sports during the training period. It has been established that the main drink of rehydration was drinking bottled water. Bottled water was consumed on average by 86% of athletes. It was consumed by 95-96% of sportsmen from the group of single combats and power kinds, whereas in other groups the share of water consumers was less - 67-79%. In second place in terms of percentage of consuming was tea. Consumption of sports drinks was observed only during training by athletes from the group of cyclic sports (31%) and single combat (11%). Calculating the per capita fluid intake of athletes who had 2 workouts a day showed that athletes from the martial arts group consumed the largest volumes of fluid in the mode of both training sessions as compared to representatives of other sports. Athletes of other sports consumed on average less liquid in the 2nd training mode compared to the 1st one. The total fluid intake during two training sessions was maximum in the group of martial arts and was minimum in the group of complex coordination sports. It should be specially noted a small proportion of athletes who consumed specialized sports drinks - only 17% of athletes and more than half of them - cyclical sportsmen. Consumption of liquid food outside training has been observed in 76% of athletes. The mean volume of consumed liquid products varied by the user from 382 and 437 ml in complex coordination and game sports up to 504-553 ml in other sports. The daily fluid intake was maximum (2326 ml) in athletes engaged in martial arts, minimum (1009 ml) - in athletes of complex coordination sports.

[The individual approach to energy consumption among the sambo sportsmen]

In the present survey the results of energy expenditure investigation of 14-16 years old (n=100) male sambo athletes', studying at Center of Sport and Education "Sambo-70", at the stage of the instant arrangement for startup, are presented. Serious differences in the level of athletes' energy expenditure depending on training load have been identified in the course of investigations. On the ground of the pre-contest stage training model the combinations of the most common conditioning exercises are determined. By the analysis of energy expenditure out of training and during the training activity, the average data of general (daily) energy expenditure in accordance with the amount and the direction of training load are deduced. The difference between the roughest and the rest day amounted to 2075 kcal a day. The significant varies in energy expenditure of different weight category athletes have been found. It has been revealed that during the single training load execution of the same volume and intensity, the representatives of the lightweight athletes (45-50 kg) burn, at the average, 377 kcal less than the heavy-weight ones (81-85 kg), which amounts not less than 15% of the energy value of average daily ration.

[Certain molecular effects of physical exercises]

According to the current concept, therapeutic physical exercises provide a simple and efficacious tool for reducing the risk of development of cardiovascular diseases and their complications. The main beneficial effects of regular physical training include positive dynamics of atherogenesis and angiogenesis, improved rheological properties of blood, decreased left ventricular myocardial hypertrophy and re-modeling. The present review is focused on some of the modern views of the molecular mechanisms underlying the influence of therapeutic physical exercises on the above processes with special reference to the activation of nitrous oxide production, regulation of the functions of the progenitor cells, and stimulation of the resident stem cells in the myocardium.

[Statokinesitherapy in the patients presenting with coronary heart disease associated with arterial hypertension]

The introduction of statokinesitherapy with biological feedback into combined rehabilitative treatment of the patients presenting with coronary heart disease associated with arterial hypertension and clinical manifestations of dyscirculatory encephalopathy and/or vertebrobasilar insufficiency reduced the severity of clinical symptoms of cerebral syndromes. Specifically, it resulted in the decreased frequency of dizziness and shaky walk, improved coordination and sense of equilibrium, enhanced postural stability in the vertical position. The positive dynamics of clinical manifestations was confirmed by the results of stabilometry that suggested decreased deviation from the centre of pressure in the frontal and saggital directions and diminished total area of the statokinesiogram.

[Optimization of the treatment of the patients presenting with chronic venous insufficiency in the lower extremities with the use of the modern methods of thalassotherapy]

The introduction of thalassotherapy (seaweed wraps cold) into the standard drug therapy and elastic compression techniques increases the effectiveness of conservative treatment of the patients presenting with chronic venous insufficiency due to the influence of biologically active components of brown algae that help to improve microcirculation, lymphatic drainage function, and peripheral hemodynamics. These effects lead to a decrease in the severity of hypoxia, enhancement of tissue trophism, promotion of inflammatory processes, reduction of the clinical manifestations of the disease, and improvement of the patients' quality of life.

[Electrical pulse therapy for the treatment of the patients with obliterative atherosclerosis of the vessels in the lower extremities]

The authors report the results of the application of electrical pulses to the region of lumbar ganglia for the treatment of patients with obliterative atherosclerosis of the blood vessels in the lower extremities. It was shown that the temporary blockade of sympathetic regulation of the lower limb arteries promotes reduction of vascular tone in the distal segments of the lower extremities, stimulates collateral blood flow, and improves microcirculation in ischemic tissues(specifically, following reconstructive surgery on the lower limb arteries).

[Topical problems of the diagnosis and rehabilitative treatment of lymphedema of the lower extremities]

The present review of the literature data highlights modern approaches to and major trends in diagnostics and conservative treatment of lymphedema of the lower extremities based on the generalized world experience. Patients with lymphedema of the lower extremities comprise a "difficult to manage" group because the disease is characterized by steady progression and marked refractoriness to various conservative therapeutic modalities creating problems for both the patient and the attending physician. Modern methods for the diagnosis of lymphedema are discussed with special reference to noninvasive and minimally invasive techniques (such as lymphoscintiography, computed tomography, MRT, laser Doppler flowmetry, etc.). During the last 20 years, combined conservative therapy has been considered as the method of choice for the management of different stages and forms of lymphedema of the lower extremities in foreign clinics. The basis of conservative therapy is constituted by manual lymph drainage (MLD), compression bandages using short-stretch materials, physical exercises, and skin care (using the method of M. Foldi). Also reviewed are the main physiobalneotherapeutic methods traditionally widely applied for the treatment of lymphedema of the lower extremities in this country. Original methods for the same purpose developed by the authors are described including modifications of cryotherapy, pulsed matrix laserotherapy, hydro- and balneotherapy. Mechanisms of their therapeutic action on the main pathogenetic factors responsible for the development of lymphedema (with special reference to lymph transport and formation) are discussed. The principles of combined application of physiotherapeutic methods for the rehabilitative treatment of patients presenting with lymphedema of the lower extremities are briefly substantiated. Special emphasis is laid on their influence on major components of the pathological process.

[Non-medicamentous methods for the treatment of chronic venous insufficiency: current state of the art]

Physical and balneotherapy along with medicamentous and compression therapy are basic components of conservative treatment of patients with chronic venous insufficiency of the lower extremities. Modern rehabilitative medical technologies help to prevent complications of this pathology, enhance clinical efficiency of the treatment, and improve the patients' quality of life provided they are applied with due regard for the stage of the disease and underlying pathogenetic factors.

[Current state-of-the-art of rehabilitative treatment of chronic obliterative arterial diseases of the lower extremities]

Up-to-date approaches and methods for balneotherapy of chronic obliterative arterial diseases of the lower extremities are discussed with special reference to their confirmed clinical efficiency. The necessity of differential application of physical agents to the treatment and rehabilitation of the patients with these diseases is substantiated.

[Electric impulse therapy of hypertensive patients]

Patients with mild arterial hypertension and hypersympathicotonia treated with electroimpulse therapy improved their clinicofunctional state, blood pressure (especially systolic pressure), its variability, sympathic activity, central regulation of cardiac rhythm, capillary reserves.

[Physiotherapy in correction of proatherogenic shifts in long-term administration of beta-blockers and thiazide diuretics]

A physiotherapeutic complex (laser therapy, dry carbon dioxide and iodine-bromine baths) addition to a course treatment with beta-blockers and thiazide diuretics produced positive changes in the levels of triglicerides, total cholesterol, beta- and alpha-cholesterol, lipid peroxidation in patients with proatherogenic shifts in the lipid spectrum and lipid peroxidation system secondary to long-term therapy with beta-blockers and thiazide diuretics, and therefore can be used for partial correction and prevention of the above shifts.

[Laser therapy as a method of eliminating tolerance to nitrates and potentiation of their action]

Infrared laser therapy was examined for the ability to eliminate tolerance to nitrates and to potentiate their action. Laser radiation (0.85 micron) reduced tolerance to nitrates and potentiated nitrates action. This was evident from a rise in threshold load power, less frequent and weaker myocardial ischemia.

[The laser therapy of patients with hypertension in combination with coronary insufficiency]

Hypertensive patients with coronary insufficiency have received infrared (lambda = 0.85 microns) laser radiation to the skin. The treatment is shown to have antianginal, antihypertensive effects, to improve cardiac performance, myocardial contractility, to increase myocardial, coronary and aerobic reserves. This clinicofunctional efficacy is accompanied by positive shifts in lipid metabolism, lipid peroxidation activity, antioxidant defense, hemocoagulation and microcirculation.