Physical Exercise: Benefit and Harm

Exercises stimulate the change and adaptation of human tissues to physical activity, and rest and recovery make it possible for these changes and adaptations to occur. Rest after exercise is also important, as is the patient's desire to perform these physical exercises. Regular physical activity reduces the frequency of the main causes of death and the likelihood of injury, improves physical fitness. Certain exercises are also prescribed for the rehabilitation of patients after MI, major surgery, musculoskeletal injury. Regardless of the indications for the appointment of physical exercises, the following two principles must be taken into account:

• the goals of physical activity must be patient-specific, taking into account motivation, need, physical possibilities and psychology for its maximum interest and participation in achieving the desired result;
• the amount of physical activity must be adequately calculated to achieve the desired effect, it should be sufficient to adapt to a higher functional state, but not excessive, so as not to cause damage. In accordance with the principle of decreasing repetitions, a lot of physical exercises are not always good; too little or too much - equally bad.

When assigning physical exercises, it is necessary to clarify their intensity (load level), volume (amount of work per session), frequency (number of occupations) and gradual additional load (either increasing the duration of one element or more, or increasing the actual load). The balance of these elements depends on individual endurance and physiological principles (for example, with increasing intensity, a decrease in volume and frequency may be required). Strength, volume and frequency can be increased simultaneously, but up to a certain limit, since the endurance of a person is not limited. It is necessary to establish an amount of exercise that is optimally useful and consistent with the patient's goals. Unchanging and traditional recommendations (for example, 3 times 10-12 repetitions, running 30 minutes 3 times a week) are not optimal enough and may not meet the individual and specific needs of the patient.

[1], [2], [3], [4], [5], [6], [7],

Stretching and Flexibility

Flexibility is important for safe and comfortable physical activity. Specific exercises for flexibility include slow and static stretching of muscle groups without a jerk and jump; these exercises can be performed before or after other forms of training or as an independent program, as in yoga or respiratory gymnastics. Despite the fact that stretching before physical exercises prepares a person mentally for doing exercises, there is no reason to say that it reduces the risk of damage. Do not dissuade the patient from stretching as a workout, if he likes it. General warm-up (for example, performing low intensity exercises, jogging, gymnastics or other light physical exercise that increases the body's internal temperature) is more effective as a warm-up than stretching. Exercise stretching is preferable after exercises, since already warmed up tissues are better stretched; this can be useful in strength training to increase the volume of movements and helps to relax the muscles.

Strength Exercises

Strength exercises (exercises with resistance) include a strong contraction of muscles against the load, usually when lifting free or fixed on the simulators load. Such exercises increase muscle strength, endurance and muscle volume and improve functional ability and performance in aerobic conditions. Stamina and elasticity of the cardiovascular system increase simultaneously.

Usually the volume is divided into categories: the amount of lifting weight, the number of approaches and repetitions. However, no less important is the parameter, such as the duration of the load, the total duration of raising and lowering the weight in one approach. The optimal loading time is about 60 s for normal conditions and 90-120 s for rehabilitation after injuries. To increase the force, load time is more important than the number of repetitions, the number of repetitions can be changed within the time of loading due to the technique and duration of the approach. When the patient reaches a stress time of at least 60 s with good technique, the weight (resistance) can be increased so that a stress time of at least 60 s will be acceptable for the next weighing level. The number of approaches is determined by the intensity of training.

Intensity is basically a subjective parameter of the received stress and how much the person approached to exhaustion for this approach. The intensity can be objectively characterized by the weight of the raised, expressed as a percentage of the maximum possible for this person, with 1 repetition (1 MP) of this exercise. This means that for a person whose limit is 100 kg at a time, 75 kg is 75% MP. Raising <30-40% of MP provides a minimum increase in strength, although aerobic preparation can occur with sufficient time of stress and effort. Intensity is limited by the motivation and endurance of the patient. For many patients undergoing rehabilitation, discomfort, pain and untrained use lead to a lesser load than they could overpower. That is why it is recommended to use more approaches to achieve good results. However, long trainings with high intensity are unproductive even for trained athletes. Exercise exercises until exhaustion to get the benefit of power loads are not needed. The intensity of training should be changed regularly in order to ensure mental and physical harmony.

Good technique is very important for safety; avoid jerking and sudden weight loss, which can lead to minor tissue trauma due to a sharp muscle effort; control breathing, which prevents dizziness (and sometimes fainting), which are possible when taking Valsalva. Patients should exhale when lifting the weight and inhale when it is lowered. If the movement is slow, such as lowering the weight in 5 seconds, the patients may need more than one time to inhale and exhale, but still the breathing needs to be planned so that the inhalation is before the weight lifting phase and the exhalation is at the end. Arterial pressure increases during exercise with resistance, but quickly returns to normal after completion. The increase is minimal, when the breathing technique is correct, no matter how hard the person has trained.

Exercises on balance

Equilibrium exercises include finding the center of gravity when training in unstable positions, for example, standing on one leg or using balancing or loosening straps. Although special equilibrium exercises can help some people with a disregard for proprioception, they are often misused to prevent falling in elderly patients. For most elderly patients, the exercise program for flexibility and strength under controlled conditions (for example, slow movements using resistance simulators or rubber bands) is more effective. Such a program develops the strength of the joints and helps patients maintain the body in a stable position while standing and walking. If a person has difficulties in maintaining standing and walking due to poor balance, even more complex balance exercises, such as standing on a swaying board, are more likely to lead to injuries and are contraindicated to such patients.

[8], [9], [10], [11]

Importance of water in training

Sufficient hydration is important, especially if the load was long or passed at a high ambient temperature. People should be well hydrated before the start of training, they need to drink regularly during a prolonged load and compensate for any deficiency that has developed after it. During the training, the intake of about 120-240 ml (the volume of one glass) of liquid every 15-20 min will be adequate, depending on the heating and the level of the load. However, hyperhydration should be avoided, which can cause hyponatraemia with the development of seizures. The fluid deficit that follows the load can be calculated by comparing the body weight before and after the workout, compensating for the loss one to one (for example, 1 liter of fluid per loss of 1 kg). In most cases, normal water is suitable. Electrolyte sports drinks can be preferred. However, liquids with a carbohydrate content> 8% can slow the emptying of the stomach, which is accompanied by a decrease in the rate of fluid absorption. In most cases, it is best to mix ordinary water with sports drinks in a ratio of 1: 1, which will accelerate the absorption of glucose and electrolytes. Patients with signs of heat loss or dehydration may require oral or intravenous replacement of electrolytes.