Hypertonic type of reaction to physical activity. Types of reactions of the cardiovascular system to the load

The hypertonic type of reaction is associated with the phenomena of overwork or overtraining. It can also be a sign of a pre-hypertensive state, but it can also be observed in quite healthy, well-trained athletes who show changes mainly in the values ​​​​of maximum blood pressure. Cause. This is in an increase in hemodynamic impact, proportional to the kinetic energy with which blood is ejected from the heart into the vessels. During exercise, the kinetic energy of cardiac output always increases, and therefore the hemodynamic impact increases significantly (in some athletes it can reach 25-40 mm 64T. St

The hypotonic type of reaction is characterized by a slight increase in maximum blood pressure, in response to the load, accompanied by a sharp increase in heart rate on the 2nd and 3rd loads (up to 170-190 beats / min). Recovery of heart rate and blood pressure is slowed down. These changes seem to be related to the fact that the increase in minute volume is provided mainly by an increase in heart rate, while the increase in systolic volume is small. This type of reaction is considered unfavorable.

The dystonic type is characterized mainly by a decrease in the minimum blood pressure, which after the 2nd and 3rd loads becomes equal to zero ("the phenomenon of infinite tone"). The maximum blood pressure in these cases rises to 180-200 mm 64T. Art. The initial idea that this type of reaction is observed in individuals with impaired vascular tone (hence the name - dystonic reaction) has not been confirmed. Most likely, the "phenomenon of infinite tone" has a methodological origin. The fact is that Korotkov's tones, heard when measuring blood pressure, arise due to the fact that "vortices" (turbulent fluid flow) are formed in the blood flowing through the artery narrowed by the cuff. As soon as the lumen of the vessel becomes normal, the blood flow in it normalizes and the movement of blood becomes laminar; The "sounding" of the artery stops. During exercise, when the volumetric velocity of blood flow increases sharply, a turbulent flow can occur in a vessel with a normal diameter. Therefore, if you listen with a phonendoscope to the "sound" of the arteries in the area of ​​the elbow bend directly under load, then the sound phenomenon will naturally be detected during any fairly intense work. Thus, the "endless tone phenomenon" is a normal phenomenon for loading conditions and the very beginning of the recovery period. As a negative sign, it is considered only in cases where the "sounding" of the arteries

And finally, during the test, there may be a reaction with a stepwise rise in maximum blood pressure. This type of reaction is characterized by the fact that the maximum blood pressure, which usually decreases during the recovery period, in some athletes increases at 2-3 minutes compared to the value at the 1st minute of recovery. This type of reaction is most often observed after a 15-second run. Experience shows that it is associated with a deterioration in the functional state of the athlete's body. At the same time, it can be an indicator of the inertia of the systems that regulate blood circulation. The fact is that the period of working out, according to a number of indicators of the cardiovascular system, lasts 1-3 minutes. It follows from this that during 15 seconds of work, the activity of the cardiovascular system does not reach a steady state, and in some individuals, despite the termination of the load, the deployment of the circulatory function may continue for some time. The considered criteria used to evaluate the results of testing an athlete's fitness have different values ​​at different stages of the training macrocycle. They are most informative in the competitive period, when the appearance of certain atypical reactions may be the result of a violation of the training regimen or its incorrect construction. At the beginning of the preparatory period, with an insufficient level of functional readiness, atypical reactions are detected more often.

Table 1 Protocol for a three-stage combined functional test by S.P. Letunova (normotonic type of reaction)

BMI = body weight (kg) / height2 (m)

Body mass index (BMI) is used to measure weight in relation to height and provides an acceptable estimate of total body fat in studies involving certain populations. In addition, BMI correlates with both morbidity and mortality, so it provides a direct indicator of health status and morbidity risk.

The method does not provide information about the distribution of fat in different parts of the body, it is difficult to explain to the client and it is difficult to plan the actual loss of body weight due to changes in BMI. In addition, BMI has been shown to overestimate body fat mass in muscular individuals (eg, many athletes) and underestimate in individuals with muscle wasting (eg, the elderly).
Excess weight is defined when BMI is 25 - 29 kg/m2, and obesity - when BMI is greater than 30 kg/m2. In people with a BMI greater than 20 kg/m2, mortality from many health conditions increases with weight.
World Health Organization (WHO), for men and women, recommended BMI, 20 - 25 kg/m2

Vegetative index (Kerdo index)

VI \u003d (1 - ADD / HR) X 100
VI is considered to be one of the simplest indicators of the functional state of the autonomic nervous system, reflecting the ratio of the excitability of its sympathetic and parasympathetic divisions (excitation and inhibition, respectively - SSF). The value of VI in the range from -15 to +15 indicates the balance of sympathetic and parasympathetic influences. A VI value greater than 15 indicates the predominance of the tone of the sympathetic division of the autonomic nervous system and indicates satisfactory adaptation to the workload, a VI value less than minus 15 indicates the predominance of the tone of the parasympathetic division of the autonomic nervous system, which is a sign of the presence of a dynamic mismatch (Rozhentsov, Polevshchikov, 2006; S. - 156).
In a trained person, VI before class is usually with a minus sign, or is in the range from - 15 to + 15.
An excessive increase in VI usually indicates a hypertonic reaction of a person to a load - a discrepancy between the proposed load and the level of fitness. Such loads should not be frequent even for well-trained athletes.
A decrease in VI also indicates poor exercise tolerance. VI values ​​below - 15 indicate the most unfavorable type of reaction of the autonomic nervous system to the load - hypotonic.

Blood pressure (BP)

It is measured at rest, so there should be no activity for 15 minutes before its determination. If the systolic pressure exceeds 126 mm Hg. Art., and diastolic - 86 mm Hg. Art., measure it again after hyperventilation (five maximum deep and rapid breaths of exhalation). if the pressure remains elevated, check the cuff width and read again after 15 minutes. If it continues to be elevated, conduct a deeper examination.
Gender differences do not affect the level of blood pressure, but after puberty (16-18 years), blood pressure in men is slightly higher than in women. Daily fluctuations in blood pressure are at least 10 - 20 mm Hg. Art. and decrease during nighttime sleep.
The horizontal position of the body, physical and mental rest are factors that reduce blood pressure. Eating, smoking, physical and mental stress lead to an increase in blood pressure. With great physical exertion, blood pressure can increase significantly. The reaction of ADD is especially important. In trained athletes, intense exercise is accompanied by a decrease in blood pressure.
BP in obese individuals is higher than in people with normal or underweight (muscle mass). In athletes living in a cold climate, blood pressure is 10 mm Hg. Art. higher, with warm weather, there are tendencies to reduce blood pressure.
Normally, there is asymmetry of pressure: blood pressure on the right shoulder is slightly higher than on the left. In rare cases, the difference reaches 20 or even 40 mm Hg. Art.

Systolic pressure (SBP)

Systolic pressure is considered normal at values ​​from 90 to 120 mm Hg.

• A value below 90 is hypotension, most often observed in women due to a small absolute mass of muscles and the body in general, as well as short stature. It may also indicate malnutrition (starvation, non-physiological diet).
• Values ​​from 120 to 130 mm Hg - moderately elevated blood pressure. Moderately elevated blood pressure can be observed at rest in individuals with high values ​​of height, body weight and / or muscle mass (especially with a sharp increase in body weight). May be the cause of a person's arousal before exercise, white coat syndrome, or caused by a recent meal.
• 140 and above are a sign of hypertension, but multiple measurements are required throughout the day to clarify the diagnosis. If the diagnosis is confirmed, the doctor is obliged to recommend taking medications that normalize blood pressure.

Diastolic pressure (DBP)

It is considered normal at values ​​​​from 60 to 80 mm Hg of the column.

• Values ​​from 80 to 90 mm Hg indicate a moderately elevated BPD.
• ABP of 90 mm Hg and above is a sign of hypertension.

It should be noted that the final conclusion is made not on the best, but on the worst of the indicators. Thus, both 141 over 80 and 130 over 91 indicate hypertension.

Pulse pressure (PP)

It is defined as the difference between systolic and diastolic pressure. Other things being equal (the same peripheral resistance, blood viscosity, etc.), the pulse pressure changes in parallel with the value of the systolic blood volume (an indirect indicator of myocardial load). Normally, it is 40 - 70 mm Hg. Art. Pulse pressure may increase as a result of an increase in blood pressure or a decrease in blood pressure.

Mean arterial pressure (MAP)

GARDEN \u003d ADD + 1/3 (ADS - ADD)
All changes in mean arterial pressure are determined by changes in minute volume (MO) or total peripheral resistance (TPS)
GARDEN \u003d MO x OPS
A normal systolic blood pressure can be maintained against the background of a decrease in TPS due to a compensatory increase in the MO.

Five Types of Cardiovascular System (CVS) Response to Exercise
(Kukolevsky, 1975; Epifanov. 1990; Makarova, 2002)

1. Normotonic type of CCC reaction on physical activity is characterized by:

• adequate intensity and duration of the work performed by an increase in heart rate, within 50 - 75% (Epifanov, 1987);
• an adequate increase in pulse blood pressure (the difference between systolic and diastolic blood pressure) due to an increase in systolic blood pressure (no more than 15 - 30% (Epifanov, 1987)) and a small (within 10 - 35% (Makarova, 2002), 10 - 25 % (Epifanov, 1987)) by a decrease in diastolic blood pressure, an increase in pulse pressure by no more than 50–70% (Epifanov, 1987).
• fast (i.e., within the specified rest intervals) recovery of heart rate and blood pressure to the original values

The normotonic type of reaction is the most favorable and reflects the body's good adaptability to physical activity.

2. Dystonic type of reaction , as a rule, occurs after loads aimed at developing endurance, and is characterized by the fact that diastolic blood pressure is heard to 0 (the "infinite tone" phenomenon), systolic blood pressure rises to values ​​of 180 - 200 mm Hg. Art. (Karpman, 1980). It is possible that a similar type of reaction may occur after a repeated load after class.
With the return of diastolic blood pressure to the initial values ​​for 1-3 minutes of recovery, this type of reaction is regarded as a variant of the norm; while maintaining the phenomenon of "infinite tone" for a longer time - as an unfavorable sign (Karpman, 1980; Makarova, 2002).

3. Hypertonic type of reaction characterized by:

• inadequate load increase in heart rate;
• inadequate load increase in systolic blood pressure to 190 - 200 (up to 220) mm Hg. Art. more than 160 - 180% (Epifanov, Apanasenko, 1990) (at the same time, diastolic pressure also slightly increases by more than 10 mm Hg (Epifanov, Apanasenko, 1990) or does not change, which is due to a significant hemodynamic impact during exercise in some athletes (Karpman, 1980));
• slow recovery of both indicators.

The hypertonic type of reaction indicates a violation of the regulatory mechanisms that cause a decrease in the efficiency of the functioning of the heart. It is observed in chronic overstrain of the central nervous system (neurocirculatory dystonia of the hypertensive type), chronic overstrain of the cardiovascular system (hypertensive variant) in pre- and hypertensive patients.

4. step response maximum blood pressure is characterized by:

• a sharp increase in heart rate;
• an increase in systolic blood pressure that continues in the first 2–3 minutes of rest compared with the 1st minute of recovery;

This type of reaction is unfavorable. It reflects the inertia of regulatory systems and is recorded, as a rule, after high-speed loads (Makarova, 2002). Experience indicates that the given type of reaction is associated with a deterioration in the functional state of the athlete's body (Karpman, 1980., P 113). The load execution time (30 s) may be insufficient for the development of the cardiovascular system, which, according to a number of indicators, lasts 1–3 minutes. In some individuals, despite the termination of the load, the deployment of the circulatory function may continue for some time (Karpman, 1980, ibid.). Thus, this type of reaction is most likely to occur after the first 20-squat trial, which is performed before the session.

5. Hypotonic type of reaction characterized by:

• a sharp, inadequate load increase in heart rate (up to 170 - 190 bpm (Karpman, 1980); more than 100% (Epifanov, Apanasenko, 1990); up to 120 - 150% (Epifanov, 1987));
• the absence of significant changes in blood pressure (systolic pressure slightly or does not increase at all, and sometimes even decreases, pulse pressure decreases (Epifanov, Apanasenko, 1990));
• delayed recovery of heart rate and blood pressure.

The hypotonic type of reaction is the most unfavorable. It reflects a violation (decrease) in the contractile function of the heart (“hyposystole syndrome” in the clinic) and is observed in the presence of pathological changes in the myocardium (Makarova, 2002). Apparently, the increase in minute volume is provided mainly by an increase in heart rate, while the increase in systolic volume is small (Karpman, 1980).
Pathological reactions to stress during regular physical training can turn into physiological ones (Epifanov, 1987., P 50). For unfavorable types of reactions, which most often appear at the beginning of the preparatory period (Karpman, 1980., C 114), additional (clarifying) pressure measurements are possible, described (Richard D. H. Backus, and David C. Reid 1998., C 372 ).

Additional Information.

If high-intensity training sessions are planned (especially preparation for competitions) it is necessary that the client undergo a complete medical examination (including a dentist).
To check the state of the cardiovascular system, it is necessary to perform an ECG under stress. Possible pathologies of the myocardium reveals Echocardiogram.
Be sure to evaluate the diet (an analysis of everything that was eaten for a week or more) and the daily regimen - the possibility of organizing an adequate recovery.
It is strictly forbidden to prescribe medicines to a client (especially hormonal ones) - this is the duty of the doctor.

Referral of the client for echocardiography and stress ECG to rule out cardiac pathology is recommended under the following circumstances:

• Positive answers to questions about the symptoms of CVD diseases
• Slow recovery of heart rate and/or respiration during introductory session
• High heart rate and blood pressure with little exercise
• Adverse type of reaction to physical activity
• History of cardiovascular disease (previous)

Before receiving test results:

• The pulse when walking is not higher than 60% of the maximum (220 - age). If possible, introduce additional aerobic exercise on days free from strength training, gradually increasing its duration to 40-60 minutes.
• The strength part of the lesson is 30-40 minutes, follow the technique of performing exercises, use a pace of 3: 0.5: 2: 0, while controlling breathing (avoid holding your breath). Use alternating exercises for the "top" and "bottom". Don't rush to increase the intensity
• Of the available control methods necessarily use blood pressure measurements before and after training, heart rate before and after (if there is a heart rate monitor, then during the lesson). Observe the rate of recovery of breathing, before it normalizes, do not start the next approach.

The article was prepared by Sergey Strukov

Catad_tema Arterial hypertension - articles

Influence of antihypertensive agents of different pharmacological groups on blood pressure response under stress testing conditions Part I

E. A. Praskurnichiy, O.P. SHEVCHENKO, St. MAKAROVA, V.A. ZHUKOVA, S.A. SAVELYEVA
Russian State Medical University. 117437 Moscow, st. Ostrovityanova, 1

Effect of Antihypertensive Agents From Various Pharmacological Groups on Blood
Pressure Reaction During Stress-Testing. Part I. Comparative Characteristics of Medications, Exerting Effect of Sympathoadrenal Block

E.A. PRASKURNITCHY, O.P. SHEVTCHENKO, S.V. MAKAROVA, V.A. ZHUKOVA, S.A. SAVELIEVA

Russian State Medical University; ul. Ostrovityanova 1, 117437 Moscow, Russia

The level of blood pressure at rest and the data of 24-hour blood pressure monitoring (ABPM) are still the criteria for verifying arterial hypertension (AH), the main parameters characterizing the degree of its severity, as well as the most informative indicators reflecting the effectiveness of antihypertensive measures. At the same time, it has been repeatedly emphasized that the usual recording of blood pressure by the Korotkov method or under conditions of daily monitoring leaves a significant part of cases of increased blood pressure and uncontrolled course of hypertension that are stress-induced in nature beyond the diagnosed scope.

The pronounced dependence of the level of blood pressure on the degree of physical activity and the psycho-emotional state of the patient is most clearly manifested in the onset of hypertension, but can be expressed at all stages of the progression of the disease. The significant variability of hemodynamic parameters present in these cases causes low reproducibility of the results of clinical measurements and ABPM. At the same time, exercise testing data reflecting the hemodynamic response to modeling different stress exposure options make it possible to more accurately assess the feasibility and effectiveness of using various approaches to antihypertensive therapy. It is in this regard that there has been a trend towards a wider use of the results of stress testing in the clinical diagnostic process.

Since the 90s of the last century, the prognostic value of an increase in blood pressure in terms of stress testing has been widely discussed. However, a number of studies have produced mixed results. In particular, in the Framingham study during a four-year follow-up, a hypertensive response of systolic blood pressure to physical activity in men was associated with an increased risk of developing AH, while this trend could not be traced in women. At the same time, the results of most studies indicate that a pronounced increase in blood pressure during exercise - more than 200/100 mm Hg. at a power level of 100 W during a bicycle ergometric (VEM-) test - is associated with a significant increase in the risk of damage to target organs, the development of cardiovascular complications and death.

Taking into account the prognostic value of blood pressure during exercise, as well as the possibility of its significant increase in these conditions with normal blood pressure at rest and with a standard assessment by the Korotkoff method, the detection of a hypertensive reaction during stress testing should be considered as an urgent task of diagnosis and monitoring. AH, and its elimination is an important tactical task of antihypertensive therapy.

In clinical practice, the response of blood pressure to physical activity is most widely studied during the VEM test. Some studies have demonstrated the high information content of the isometric load test. At the same time, a pronounced increase in blood pressure, recorded during various stress testing options, is associated with a high level of activation of neurohumoral systems, in particular, the sympathetic-adrenal system. Therefore, in situations of development of hypertensive reactions under conditions of stress testing, the most rational step towards optimizing therapy is to consider the possibility of using β-blockers and other agents that provide sympathetic-adrenal blockade.

The aim of the study was to compare the effectiveness of β-blockers metoprolol and carvedilol and the I 1 -imidazoline receptor agonist moxonidine in reducing the stress-induced increase in blood pressure that occurs under conditions of static and dynamic physical activity.

Material and methods

The study included 81 patients aged 44 to 65 years with mild to moderate hypertension. The exclusion criteria from the study included clinical manifestations of coronary artery disease, congestive heart failure, renal failure, diabetes mellitus, bronchial asthma, as well as a history of myocardial infarction, acute and transient cerebrovascular accident.

Patients were randomized to antihypertensive therapy groups. Representatives of the 1st group (n=32) received moxonidine at a dose of 0.2-0.4 mg/day, patients of the 2nd group (n=28) - metoprolol at a dose of 100-150 mg/day, patients of the 3rd group (n=21) - carvedilol (Acridilol®, Akrikhin) 50-75 mg/day. All drugs were administered as monotherapy; combination with other antihypertensive agents was not allowed.

All patients were followed up on an outpatient basis for 12 weeks, examinations were performed during 4 visits: visit 1 (randomization), visit 2 (week 2), visit 3 (week 6), visit 4 visit (12th week). The start of active treatment was preceded by a two-week control period, during which the previously prescribed antihypertensive therapy was cancelled.

At baseline and at the end of the 12th week, the patients underwent examination, which included the collection of anamnestic data, an objective examination, ABPM, VEM test, assessment of heart rate variability (HRV). During other visits, clinical monitoring of blood pressure was performed, subjective and objective symptoms were assessed, as well as patient adherence to treatment.

In order to calculate the reference values ​​of parameters of cardiovascular testing, a control group of practically healthy individuals was examined, consisting of 28 people aged 27-60 years (average 51.4±7.2 years) with clinical BP (BPcl.) less than 140/90 mm. rt. Art., average daily blood pressure less than 125/80 mm. rt. Art., as well as with a normotensive type of blood pressure reaction under the conditions of the VEM test.

ADcl. was measured by auscultation according to the Korotkov method, in the position of the subject sitting after a 5-minute rest. ABPM was performed using the CardioTens-01 device (Mediteck, Hungary) on weekdays for 24±0.5 hours, with an interval of 15 minutes during the day, 30 minutes at night, and 10 minutes in the early morning hours. All patients kept an individual diary of well-being, physical and mental activity, time and quality of sleep. We analyzed such parameters as average daily, average daily, average nighttime levels of systolic BP (SBP) and diastolic BP (DBP), as well as indicators of pressure load (time index and area index of hypertension), BP variability and daily index. The level of average daily blood pressure is 130 mm Hg. or more for CAD and 80 mmHg. or more for DBP was considered elevated.

An isometric test was carried out as follows. Using a dynamometer, the maximum force in the patient's right hand was determined. Then, for 3 minutes, the patient squeezed the dynamometer with a force of 30% of the maximum. Heart rate (HR) and blood pressure were recorded immediately before the test and at the end of the 3rd minute of dynamometer compression. Evaluated parameters: maximum SBP, DAP, HR measured at the end of the 3rd minute of the test, increase in SBP, DBP, HR - the difference between the maximum SBP, DBP, HR and initial values.

The VEM test was performed on an ERGOLINE D-72475 bicycle ergometer (Bitz, Germany) in the position of the subject lying on his back, in the morning after a light breakfast using the method of stepwise increasing load. The test was started with a load of 25 W, the power of which was increased by 25 W with an interval of 3 min. BP and heart rate were recorded at baseline and then at 1-minute intervals during exercise and at every minute of the recovery period. ECG monitoring in 12 conventional leads was carried out during the entire test, registration - at the 3rd minute of each stage of the load. An increase in blood pressure of more than 200/100 mm Hg was considered the criterion for a hypertensive reaction during the exercise test. with a VEM test against a load of 100 W and an excess of blood pressure of more than 140/90 mm Hg. at the 5th minute of the recovery period.

HRV was studied by analyzing ECG recordings recorded for 5 minutes using the VNS-Rhythm Neurosoft equipment (Russia) in the morning at rest 15 minutes after the patient was in the supine position. HRV analysis was performed using statistical methods (SDNN, ms - standard deviation from the average duration of all sinus R-R intervals; RMSSD, ms - root-mean-square difference between the duration of adjacent sinus R-R intervals; pNN50, % - proportion of adjacent R-R intervals that differ by more than 50 ms obtained over the entire recording period) and spectral analysis (total power of the spectrum - T P, high-frequency component of the spectrum - HF, low-frequency component of the spectrum - L F, very low-frequency component of the spectrum - VLF, relative value of HF%, LF%, VLF% of the total spectrum power, index of vago-sympathetic interaction - LF/HF).

When conducting an active orthostatic test, the patient, after a 15-minute rest in a horizontal position with a low headboard, on command, without delay, took a vertical position and stood without undue stress for 6 minutes. The level of blood pressure and heart rate was measured immediately before the orthostatic test at rest, immediately after the transition from a horizontal to a vertical position, at the end of the 1st, 3rd and 6th minutes of taking a standing position. ECG was recorded throughout the entire test for 6 min.

Statistical analysis was performed using the Excel 7.0 software package and BIOSTAT using the recommended criteria. Differences were considered significant at p results

Initially, the results of treatment with the I 1 -imidazoline receptor agonist moxonidine, the β1-selective blocker metoprolol, and the non-selective β-blocker with α1-adrenergic blockade properties carvedilol were analyzed. The use of these drugs in medium doses was characterized by comparable antihypertensive efficacy. A negative chronotropic effect was noted only in groups of individuals who received β-blockers metoprolol and carvedilol. The dynamics of blood pressure and heart rate according to clinical measurements is presented in Table. 1. The number of patients who managed to achieve a decrease in blood pressure less than 140/90 mm Hg in the groups of moxonidine, metoprolol and carvedilol did not differ significantly and amounted to 59%, 64% and 69%, respectively.

Table 1. Dynamics of blood pressure and heart rate during therapy according to clinical measurements

According to the results of the dynamic assessment of ABPM indicators, the decrease in SBP was approximately equally pronounced against the background of the use of all compared drugs and was due to their predominant effect on the average daily level of SBP (Table 2). There was no significant increase in blood pressure at night before the appointment of therapy, and the antihypertensive effect of drugs at night was minimal. At the same time, carvedilol therapy was accompanied by a more pronounced decrease in DBP than with the appointment of moxonidine and metoprolol, although it was in the 3rd group that this indicator was significantly more changed initially. A negative chronotropic effect was recorded only against the background of the use of β-blockers.

Table 2. Dynamics of indicators of daily monitoring of blood pressure against the background of ongoing therapy

Taking into account the task set before the study (assessment of the effect of the studied drugs on the stress-induced increase in blood pressure), an analysis was made of the dynamics of hemodynamic parameters recorded during exercise testing during therapy with moxonidine, metoprolol, and carvedilol. The results of the isometric exercise test generally reflected a comparable effect of the compared drugs in suppressing the hypertensive response (Fig. 1).

Rice. 1. Dynamics during therapy of maximum blood pressure, registered during the isometric test.

SBP - systolic blood pressure; DBP - diastolic blood pressure. *-p

Meanwhile, of particular interest is the analysis of the dynamics of hemodynamic parameters recorded during the VEM test (Table 3). Attention is drawn to the fact that with comparable antihypertensive efficacy in relation to the effect on the level of blood pressure at rest, the studied drugs correct blood pressure to varying degrees during exercise. In particular, the I1-imidazoline receptor agonist moxonidine did not significantly affect the hypertensive response that occurs during the HEM test. Blockers of β-adrenergic receptors, on the contrary, significantly reduce the maximum and SBP, and DBP, which are achieved when performing this variant of stress testing. Moreover, 85% of patients in the metoprolol group and 89% of patients in the carvedilol group eliminated the hypertensive type of response to exercise.

Table 3. Dynamics of hemodynamic parameters recorded during the VEM test

The decrease in maximum blood pressure during a test with dynamic physical activity under the influence of therapy with β-adrenergic blockers metoprolol and carvedilol (Fig. 2) is ensured due to a decrease not only in blood pressure recorded immediately before testing, but also in the degree of increase in both blood pressure and heart rate in conditions of increasing intensity dynamic type of physical activity. The I 1 -imidazoline receptor agonist moxonidine does not significantly affect these parameters.

Rice. Fig. 2. Dynamics of the increase in blood pressure against the background of therapy, recorded during the VEM test when the load power reaches 100 W

VEM - bicycle ergometric; SBP - systolic blood pressure, DBP - diastolic blood pressure, * -p

When evaluating the hemodynamic parameters recorded at a load power of 100 W, it was shown that carvedilol significantly more than metoprolol causes a decrease in maximum blood pressure and an increase in blood pressure at the height of the load, and this applies to both SBP and DBP.

An analysis of the effect of moxonidine, metoprolol, and carvedilol on HRV parameters made it possible to identify diametrically opposite trends characterizing these groups of antihypertensive drugs. Both β-blockers increased the total power of the spectrum, pNN 50%; metoprolol significantly increased SDNN, which generally reflects an increase in HRV. Metoprolol, to a significantly greater extent than carvedilol, caused a shift in the sympathovagal ratio towards the predominance of vagal influence, although the changes in this indicator were unidirectional and significant in both groups. The use of moxonidine was accompanied by a decrease in the total spectrum power, the RMSSD indicator, reflecting the trend towards a decrease in HRV.

The effect of drugs on the vegetative provision of vascular tone was also studied during the orthostatic test. The nature of fluctuations in hemodynamic parameters during therapy with moxonidine and metoprolol was close to physiological, while during the use of carvedilol, there was no increase in SBP recorded at the time of transition to a vertical position. At the same time, under these conditions, no pronounced decrease in blood pressure was noted, while in the patients we observed, such hemodynamic changes were not accompanied by clinically significant manifestations. In addition, when using β-blockers during the orthostatic test, a significant decrease in heart rate was recorded, while moxonidine did not significantly affect this indicator.

Rice. 3. Dynamics of heart rate recorded during the orthostatic test

HR - heart rate, * -p

Rice. 4. Dynamics of maximum SBP recorded during the orthostatic test

SBP - systolic blood pressure. The difference in the values ​​of the indicator against the background of therapy with all drugs with the initial data is significant (p

Discussion

The study of changes in hemodynamic parameters in response to physical activity and the effect of various antihypertensive drugs on them is of key importance for the choice of drug treatment for patients with hypertension. The results of the analysis of the characteristics of the response of the circulatory system in these conditions open up possibilities for optimizing antihypertensive therapy by including drugs with the most favorable hemodynamic characteristics in this clinical situation. At the same time, it should be emphasized that recommendations based on the results of stress testing to change the structure of antihypertensive treatment should not conflict with its fundamental principles, namely, the focus on achieving the target level of blood pressure.

In the light of the above, the results of this study are of great importance, indicating a comparable antihypertensive efficacy of the I 1 -imidazoline receptor agonist moxonidine and β-blockers metoprolol and carvedilol according to clinical measurements of blood pressure. Monotherapy based on the use of these drugs, in a significant proportion of cases of non-severe hypertension, allows you to achieve target blood pressure values.

The drugs studied in this study are characterized by different mechanisms of suppression of sympathetic-adrenal activity. I 1 -imidazoline receptor agonists are drugs of the central type of action, highly selective for I 1 -imidazoline receptors found in the nuclei of the reticular formation, the rostral-ventrolateral region of the medulla oblongata (subtype 1). A decrease in blood pressure and a decrease in heart rate are associated with a sympatholytic effect, which is due to the activation of I 1 -imidazoline receptors. The effect on the sympathetic-adrenal system of β-blockers is in competitive antagonism with catecholamines in relation to β-adrenergic receptors. Currently, third-generation β-blockers with additional vasodilatory properties are widely used in cardiology. In particular, carvedilol, being a combined β1- and β2-adrenergic blocker and providing a1-adrenergic blocking effect, provides a more pronounced vasodilating effect. Obviously, it was the additional vasodilatory effect of the drug that provided it with an advantage over other drugs in our study, in which, according to the results of ABPM, carvedilol was superior to comparators in terms of the effect on the average daily level of DBP.

It was assumed that the known features of the hemodynamic profile of the compared antihypertensive drugs would be most demonstratively manifested during exercise testing.

At the same time, during the test with an isometric load, no advantages of any drug in terms of the effect on blood pressure and heart rate were noted. As is known, isometric muscle tension during static load is accompanied by an inadequate increase in blood pressure and an increase in heart rate. Endothelial dysfunction is considered as a possible mechanism that determines the similar nature of hemodynamic disorders. The corrective effect of antihypertensive drugs, including sympatholytics, on endothelial dysfunction in AH has been demonstrated in many studies and, apparently, plays an important role in suppressing the hypertensive response induced by static exercise.

In contrast to the isometric test, stress testing using a dynamic type of physical activity revealed significant differences in the hemodynamic effects of the compared drugs. The superiority of the β-adrenoblockers metoprolol and carvedilol in suppressing the hypertensive response to exercise over the I 1 -imidazoline receptor agonist moxonidine was evident. At the same time, β-blockers effectively reduced the stress-induced increase in both SBP and DBP. Therefore, at least in terms of correcting hypertensive reactions induced by dynamic exercise, agonists of I 1 -imidazoline receptors, despite the available information about the effect of sympathetic-adrenal blockade, cannot be considered as an alternative to β-blockers.

The key role of activation of neurohumoral systems, in particular the sympathetic-adrenal system, in the pathogenesis of stress-induced increase in blood pressure is well known. In this regard, it would be logical to assume that the effect of I 1 -imidazoline receptor agonists and β-blockers on the functional status of the sympathetic and parasympathetic parts of the autonomic nervous system can fundamentally differ, and that these differences can play an important role in the modification of stress-induced hypertensive reactions to background of therapy with these drugs.

The results of assessing the effect of moxonidine, metoprolol and carvedilol on HRV parameters - one of the most informative and practical methods for assessing the state of the autonomic support of cardiovascular processes - confirm the above assumption about the existence of fundamental differences in the effects of these drugs in relation to the sympatho-vagal balance.

Comparing the features of the influence of representatives of various classes of antihypertensive drugs on the vegetative status with the nature of the modification of stress-induced hypertensive reactions, we can come to the following conclusions. A decrease in the severity of stress-induced hypertensive response under the influence of β-blockers metoprolol and carvedilol is associated with their optimizing effect on the main parameters of HRV, including the sympathovagal ratio (LF / HF), which ultimately serves as a manifestation of sympathetic-adrenal blockade when using these drugs. Against the background of a pronounced suppression of the activity of the sympathetic-adrenal system, the studied β-blockers not only eliminated the hypertensive type of reaction in response to physical activity, but also decreased the increase in blood pressure during exercise. The absence of an effect on the stress-induced increase in blood pressure under conditions of dynamic load against the background of moxonidine therapy was stated along with signs of an increase in heart rhythm rigidity, reflecting an increase in the contribution of the sympathetic division of the autonomic nervous system to the control of heart activity.

Determining a β-blocker as the optimal drug for suppressing stress-induced hypertensive response caused by dynamic exercise, one should take into account the large number of representatives of this pharmacological group at the present stage and the wide variety of their pharmacological properties. The discussion about the clinical significance of certain characteristics of a β-blocker is not the subject of this publication. At the same time, it should be noted that with the advent of new generation β-adrenergic receptor blockers, which provide an additional vasodilating effect, the possibilities of antihypertensive therapy based on the use of drugs of this class have significantly expanded.

The issue of the advantages of β-blockers with additional vasodilatory properties over the “classical” β1-selective blockers is considered in this work in the context of assessing their comparative effectiveness in limiting the stress-induced hypertensive response in people with hypertension. In general, the results of the VEM test indicated the benefits of the β- and α1-blocker carvedilol in terms of suppression of the hypertensive response that occurs under the conditions of this stress testing variant. Therefore, under conditions of clinically effective β-adrenergic blockade, the vasodilation effect, due in this case to the anti-α1-adrenergic action, provides the drug with additional opportunities to suppress the hypertensive response during exercise testing.

Along with the achievement of a pronounced antihypertensive effect, an important condition for the pharmacotherapy of hypertension is the exclusion of orthostatic hypotensive reactions that are fraught with adverse consequences against the background of adequate dosages of drugs. In order to clarify the degree of risk of such episodes, as well as to characterize the features of autonomic regulation that play an important role in their development, a dynamic analysis of the results of the orthostatic test was carried out.

During the transition from a horizontal position to a vertical position, blood flow to the right parts of the heart decreases, and the central blood volume decreases by an average of 20%, and the cardiac output - by 1-2.7 l / min. Then, during the first 15 contractions of the heart after moving to a vertical position, the heart rate increases due to a decrease in the tone of the vagus, and after about 20-30 seconds, the parasympathetic tone is restored and reaches the greatest degree (relative bradycardia is recorded). Approximately 1-2 minutes after the transition from a horizontal to a vertical position, catecholamines are released and the tone of the sympathetic division of the autonomic nervous system increases, in connection with which an increase in heart rate and peripheral vascular resistance is noted. After that, the renin-angiotensin mechanism of hemodynamic control is activated.

Preservation of the nature (close to physiological) of hemodynamic changes recorded during the orthostatic test during therapy with moxonidine and metoprolol indicates the relative safety of these drugs in relation to the development of orthostatic hypotensive reactions. This property of antihypertensive drugs is of great importance when choosing drugs that are acceptable for inclusion in the therapy of persons with a low adaptive potential of blood circulation.

In this regard, the data obtained in the carvedilol treatment group are of particular interest. In general, the absence of a pronounced increase in systolic blood pressure, apparently, should be considered as a manifestation of a pronounced vasodilating effect of this drug, which is probably due to its α1-adrenergic blocking effect. In turn, the β-adrenergic blocking component in the pharmacological profile of carvedilol largely eliminates the described side effects. Nevertheless, we consider it necessary to point out the undesirability of prescribing this drug to patients who have a tendency to develop orthostatic hypotensive reactions during functional tests.

Thus, the results of the study made it possible to demonstrate that, with comparable antihypertensive efficacy according to casual measurements and ABPM, antihypertensive drugs of different pharmacological groups have different ability to suppress the stress-induced hypertensive response that occurs during exercise testing.

conclusions

1. Drugs with the properties of sympathetic-adrenal blockade - the agonist of I 1 -imidazoline receptors moxonidine, β-blockers metoprolol and carvedilol - reduce the severity of the hypertensive reaction recorded during an isometric stress test.
2. In contrast to the I 1 -imidazoline receptor agonist moxonidine, at doses that provide a comparable antihypertensive effect, β-blockers carvedilol and metoprolol cause suppression of the stress-induced hypertensive response that occurs under dynamic exercise conditions.
3. A decrease in the increase in blood pressure recorded during a bicycle test during therapy with β-blockers is associated with an increase in heart rate variability, while the absence of an effect on the stress-induced increase in blood pressure under these conditions when prescribing moxonidine, on the contrary, is combined with signs of a decrease in heart rate variability, noted while taking this drug.
4. With comparable antihypertensive efficacy, according to the data of daily monitoring of blood pressure and casual measurements of blood pressure, the non-selective β-adrenergic blocker with the property of a1-adrenergic blockade carvedilol (Acridilol®) has a higher corrective ability to reduce the hypertensive response under stress testing conditions than selective β1- adrenoblocker metoprolol.
5. The I 1 -imidazoline receptor agonist moxonidine, β-blockers metoprolol and carvedilol, when taken regularly, do not provoke the development of postural phenomena in persons who do not have hypotensive conditions prior to the appointment of these drugs during an orthostatic test.

Treadmill test

Treadmill (treadmill) - a device that allows you to reproduce walking or running at a certain speed with a certain slope (see fig. ). The speed of the tape, and hence the subject, is measured in m / s or km / h. In addition, the treadmill is equipped with a speedometer, slope meter and a number of control devices.

The regularity of control over the main clinical and physiological parameters is the same as with the submaximal step test and the test on a bicycle ergometer.

1) horizontal belt level with increasing speed from 6 km/h to 8 km/h, etc.;

2) constant speed with a stepwise increase in slope of 2.5 degrees, and in this case two options are possible: walking at a speed of 5 km/h and running at a speed of 10 km/h.

The treadmill reproduces the usual human activity. It is preferred when examining children and the elderly.

A group of labor physiologists who noted the coincidence of the results of various tests with an identical load. Thus, in the examined young healthy men, the MPK was 3.68 ± 0.73 on the step test, 3.56 ± 0.71 on the bicycle ergometer, and 3.81 ± 0.76 l/min on the treadmill; HR, respectively, 188 ± 6.1; 187 ± 9; 190 ± 5 in 1 min. The content of lactic acid in the blood - 11.6 ± 2.9; 12.4 ± 1.7; 13.5 ± 2.3 mmol/l.

The definition and evaluation of the functional state of the organism as a whole is called functional diagnostics.

In connection with the intensification of the training process and the growth of sports results, frequent starts, especially international ones, the need for a correct assessment of the functional state of athletes becomes obvious, and on the other hand, the importance of determining the adequacy of training for a given individual.

The study of the functional state of people involved in physical education and sports is carried out by using various functional tests. With a functional test (test), the reaction of organs and systems to the influence of any factor, more often physical activity, is studied.

The main (mandatory) condition for this should be its strict dosage. Only under this condition it is possible to determine the change in the reaction of the same person to the load in a different functional state.

For any functional test, first determine the initial data of the studied indicators characterizing a particular system or organ at rest, then the data of these indicators immediately (or during the test) after exposure to one or another dosed factor and, finally, after the termination of the load until the subject returns to the original state. The latter allows you to determine the duration and nature of the recovery period.

Most often, in functional diagnostics, samples (tests) are used with such physical activity as running, squatting, jumping, climbing and descending steps (step test) and others. All these loads are dosed both by pace and duration (duration).

In addition to tests with physical activity, other tests are also used: orthostatic, clinostatic, Romberg's test.

It should be noted that it is impossible to correctly assess the functional state of the athlete's body using any one indicator.

Only a comprehensive study of the functional state, including testing with physical activity, ECG recording, biochemical analyzes, etc., makes it possible to correctly assess the functional state of an athlete.

Functional tests are divided into specific and non-specific. Such functional tests are called specific, the influence factor in which are the movements characteristic of a particular sport. For example, for a runner, such a breakdown will be running (or running on a treadmill), for a swimmer - on a hydrochannel, etc. Non-specific (inadequate) include tests that use movements that are not characteristic of a particular sport. For example, for a wrestler - bicycle ergometric load, etc.

Classification of functional tests

Classification of functional (stress) samples (tests). Functional tests can be simultaneous, when one load is used (for example, running on the spot for 15 seconds, or 20 squats, or throwing a stuffed animal in a wrestling match, etc.); two-moment - when two loads are given (for example, running, squats), three-moment - when three tests (loads) are given sequentially one after the other, for example, squats, 15 s. running, and a 3-minute run in place. In recent years, one-stage tests (tests) are more often used and estimates (preliminary competitions) are carried out with the measurement of various indicators (heart rate, blood pressure, EKG, lactate, urea and other indicators).

It is very important when performing tests (tests) with physical activity that they are performed correctly and dosed according to the pace and duration.

When studying the reaction of the organism to a particular physical activity, attention is paid to the degree of change in the determined indicators and the time they return to the initial level. A correct assessment of the degree of reaction and the duration of recovery allows you to accurately assess the condition of the subject.

According to the nature of changes in heart rate and blood pressure (BP) after testing, five types of reactions of the cardiovascular system are distinguished (distinguished): normotonic, hypotonic (asthenic), hypertonic, dystonic and stepped (Fig. ).

Types of reactions of the cardiovascular system to physical activity and their assessment: 1 - normotonic; 2 - hypotonic; 3 - hypertonic; 4 - dystonic; 5 - speed

Normotonic type of reaction The cardiovascular system is characterized by an increase in heart rate, an increase in systolic and a decrease in diastolic pressure. Pulse pressure increases. Such a reaction is considered physiological, because with a normal increase in the pulse, adaptation to the load occurs due to an increase in pulse pressure, which indirectly characterizes an increase in the stroke volume of the heart. The rise in systolic blood pressure reflects the effort of left ventricular systole, and the decrease in diastolic blood pressure reflects a decrease in arteriolar tone, providing better blood access to the periphery. The recovery period with such a reaction of the cardiovascular system is 3-5 minutes. This type of reaction is typical of trained athletes.

Hypotonic (asthenic) type of reaction The cardiovascular system is characterized by a significant increase in heart rate (tachycardia) and, to a lesser extent, an increase in the stroke volume of the heart, a slight rise in systolic and unchanged (or a slight increase) in diastolic pressure. Pulse pressure goes down. This means that an increase in blood circulation during exercise is achieved more due to an increase in heart rate, and not an increase in stroke volume, which is irrational for the heart. The recovery period is getting longer.

Hypertonic type of reaction on physical activity is characterized by a sharp increase in systolic blood pressure - up to 180-190 mm Hg. Art. with a simultaneous rise in diastolic pressure up to 90 mm Hg. Art. and above and a significant increase in heart rate. The recovery period is getting longer. The hypertonic type of reaction is assessed as unsatisfactory.

Dystonic type of reaction cardiovascular system on physical activity is characterized by a significant increase in systolic pressure - above 180 mm Hg. st and diastolic, which after the cessation of the load can drop sharply, sometimes to "0" - the phenomenon of infinite tone. The heart rate rises significantly. Such a reaction to physical activity is regarded as unfavorable. The recovery period is getting longer.

Stepwise type of reaction characterized by a stepwise rise in systolic pressure at the 2nd and 3rd minutes of the recovery period, when the systolic pressure is higher than at the 1st minute. Such a reaction of the cardiovascular system reflects the functional inferiority of the regulatory circulatory system, therefore it is assessed as unfavorable. The recovery period for heart rate and blood pressure is delayed.

Important in assessing the response of the cardiovascular system to physical activity is the recovery period. It depends on the nature (intensity) of the load, on the functional state of the subject and other factors. The response to physical activity is considered good when, with normal initial data on heart rate and blood pressure, there is a recovery of these indicators at the 2-3rd minute. The reaction is considered satisfactory if recovery occurs at 4-5 minutes. The reaction is considered as unsatisfactory if hypotonic, hypertonic, dystonic and stepwise reactions appear after the load and the recovery period is delayed up to 5 minutes or more. Lack of recovery of heart rate and blood pressure within 4-5 minutes. Immediately after the load, even with a normotonic reaction, it should be assessed as unsatisfactory.

The Nowakki test is recommended by WHO for widespread use. For its implementation, a bicycle ergometer is used. The essence of the test is to determine the time during which the subject is able to perform a load (W / kg) of a specific, depending on its own weight, power. In other words, the load is strictly individualized.

On fig. the test scheme is shown: the load starts from 1 W/kg of mass, every 2 minutes it increases by 1 W/kg until the subject refuses to perform work (load). At this moment, oxygen consumption is close to or equal to the MPK, heart rate also reaches maximum values.

Novakki's test: W - load power; t - time

Table Novakki test parameters estimates of the results of testing healthy individuals are given. The Nowakki test is suitable for studying both trained and untrained individuals, and can also be used in the selection of rehabilitation means after injuries and diseases. In the latter case, the test should be started with a load of 1/4 W/kg. In addition, the test is also used in the selection in youth sports.

Novakki test parameters

* see picture .

Cooper test

Cooper test (K. Cooper). The 12-minute Cooper test involves covering the maximum possible distance by running in 12 minutes (on flat terrain without ups and downs, usually in a stadium). The test is terminated if the subject has signs of overload (severe shortness of breath, tachyarrhythmia, dizziness, pain in the heart area, etc.).

The test results are highly consistent with the MPK value determined when testing on the treadmill (Table 1). Gradations of physical condition according to the results of a 12-minute test).

Gradations of physical condition according to the results of a 12-minute test*

* In parentheses is the distance (in km) covered by women in 12 minutes (according to K. Cooper, 1970).

To assess the functional state of the body by the value of the MPK, various gradations are proposed. G.L. Strongin and A.S. Turkish (1972), for example, based on the use of maximum load tests in men, four groups of physical performance are distinguished: low - with an MPK of less than 26 ml / min / kg, reduced - with 26-28 ml / min / kg, satisfactory - with 29- 38 ml / min / kg and high - at more than 38 ml / min / kg.

Depending on the value of the MPK, taking into account age, K. Cooper (1970) distinguishes five categories of physical condition (very poor, poor, satisfactory, good, excellent). The gradation meets practical requirements and allows taking into account the dynamics of the physical condition when examining healthy people and people with minor functional impairments. K. Cooper's criteria for various categories of the physical condition of men in terms of MPK are given in Table. Assessment of the physical condition by the value of the MPK.

Assessment of the physical condition by the value of the MPK (ml / min / kg)

The Cooper test can be used to select schoolchildren in the section for cyclic sports, as well as to control fitness (Table 1). Correlation between the results of the 12-minute test and the MPK). The test makes it possible to determine the functional state of the athlete and those involved in physical education.

Correlation between the results of the 12-minute test and the MPK (according to K. Cooper)

Samples and assessments of the condition of athletes

Flack test(determination of the indicator of physical performance). The patient takes a breath into the mouthpiece of the air manometer, holding his breath at a manometer reading of 40 mm Hg. Art. The duration of breath holding is noted, where every 5 s the heart rate is calculated in relation to the level of rest. Sample evaluation: in well-trained people, the maximum increase in heart rate does not exceed 7 beats per 5 s; with an average level of fitness - 9 beats; in a mediocre condition - 10 beats. and more. An increase in heart rate, followed by its fall, indicates the unsuitability of the subject for intense muscle exercise. A significant increase in heart rate, and then its slowdown occurs in individuals with increased nervous tone. They can be highly efficient.

Flack's test reflects the functional state of the right heart.

Sample V.I. Dubrovsky tests resistance to hypoxia. The subject is placed on the chest and on the abdominal wall of the cuff connected to the scribe. After a deep breath, the breath is held and the first ascillations are recorded on the kymograph, indicating a contraction of the diaphragm. The length of the breath hold indicates the degree of resistance to hypoxia. The higher it is, the better the functional state of the athlete.

Krempton test. The subject moves from a prone position to a standing position, and his heart rate and blood pressure are measured immediately for 2 minutes. The results of this test are expressed using the formula:

Krempton exponent = 3.15 + PA = Sc / 20

where RA - systolic blood pressure, Sc - heart rate. The data obtained is evaluated according to the table:

Orthostatic test is carried out as follows. The athlete lies on the couch for 5 minutes, counts the pulse. Then he gets up and the pulse is counted again. Normally, when moving from a lying position to a standing position, an increase in heart rate by 10-12 beats / min is noted. Up to 20 beats/min is a satisfactory response, more than 20 beats/min is unsatisfactory, which indicates insufficient nervous regulation of the cardiovascular system.

Clinostatic test- transition from a standing position to a lying position. Normally, there is a slowdown in the pulse, not exceeding 6-10 beats / min. A sharper slowing of the pulse indicates an increased tone of the parasympathetic nervous system.

Circulation economy factor (KEK)- This is essentially a minute volume of blood.

KEK \u003d (BP max. - BP min.) x heart rate

Normally, KEK = 2600, it increases with fatigue.

Temporal arterial pressure (TAP) is measured according to Ravinsky-Markelov a special cuff 4 cm wide. Normally, it is equal to 1/2 of the maximum blood pressure. With fatigue, temporal pressure indicators increase by 10-20 mm Hg. Art.

Endurance Factor (KV) determined by the Kvas formula. The test characterizes the functional state of the cardiovascular system. This test is an integral value that combines heart rate and systolic and diastolic pressure. Calculated using the following formula:

CV \u003d (HR x 10) / pulse pressure

Normally, KV = 16. An increase in it indicates a weakening of the activity of the cardiovascular system, a decrease indicates an increase.

Valsalva test is as follows. The athlete, after a full exhalation and a deep breath, exhales into the manometer mouthpiece and holds his breath at around 40-50 mm Hg. Art. During exercise, blood pressure and heart rate are measured. With tension, diastolic pressure rises, systolic pressure decreases, and heart rate increases. With a good functional state, the duration of stress increases, with fatigue it decreases.

Kerdo Index (IK) is the ratio of blood pressure, D and P, that is:

IK \u003d 1 - [(D / P) x 100]

where D - diastolic pressure, P - pulse. In a healthy person, it is close to zero, with the predominance of sympathetic tone, an increase is noted, while parasympathetic tone decreases, becomes negative. When the state of the autonomic nervous system is in equilibrium, IK = 0.

With a shift in balance under the influence of the sympathetic nervous system, diastolic blood pressure falls, heart rate rises, IK = 0. With enhanced functioning of the parasympathetic nervous system, IK< 0. Исследование необходимо проводить в одно и то же время суток (например, утром после сна). ИK информативен в игровых видах спорта, где высоко нервно-психическое напряжение. Kроме того, этот показатель надо рассматривать в комплексе с другими показателями, в частности, с биохимическими (лактат, мочевина, гистамин, гемоглобин и др.), с учетом активности физиологических функций. Необходимо учитывать уровень подготовки спортсмена, функциональное состояние, возраст и пол.

mean arterial pressure

mean arterial pressure- one of the most important parameters of hemodynamics.

SBP = BP diast. + BP pulse / 2

Observations show that with physical fatigue, the average blood pressure rises by 10-30 mm Hg. Art.

Systolic volume (S) and minute volume (M) calculated according to the formula of Lilienstrand and Zander:

S = (Pd x 100) / D ,

where Pd - pulse pressure; D - average pressure (half the sum of the maximum and minimum pressures); M = S x P, where S is the systolic volume; P - heart rate.

Response quality index (RQR) Kushelevsky and Zislin are calculated by the formula:

RCC \u003d (RA 2 - RA 1) / (P 2 - P 1)

where R 1 and RA 1 - the magnitude of the pulse and pulse amplitude in a state of relative rest before the load; P 2 and RA 2 - the magnitude of the pulse and pulse amplitude after exercise.

Ruffier index. The pulse is measured in a sitting position (P 1), then the athlete performs 30 deep squats for 30 seconds. After this, the standing pulse is counted (P 2), and then after a minute of rest (P 3). The index is evaluated according to the formula:

I \u003d [(P 1 + P 2 + P 3) - 200] / 10

The index is estimated:< 0 - отлично, 1-5 - хорошо, 6-10 - удовлетворительно, 11-15 слабо, >15 - unsatisfactory.

Functional test according to Kverg includes 30 sit-ups in 30 seconds, maximum running in place - 30 seconds, 3-minute running in place with a frequency of 150 steps per minute and jumping rope - 1 minute. The complex load lasts 5 minutes. Immediately after the load in the sitting position, heart rate is measured for 30 s (P 1), again after 2 (P 2) and 4 minutes. (R 3).

The index is estimated by the formula:

[working time (in sec) x 100] /

> 105 = very good, 99-104 - good, 93-98 - fair,< 92 - слабо.

Skibinskaya index. The vital capacity (VC) (in ml) and breath holding (in s) are measured. With the help of a combined test, the cardio-respiratory system is assessed according to the formula:

[(VC / 100) x breath hold] / pulse rate (in minutes)

Index score:< 5 - очень плохо, 5-10 - неудовлетворительно, 10-30 - удовлетворительно, 30-60 - хорошо, >60 is very good.

For highly qualified athletes, the index is more than 80.

English
functional tests– functional tests
test on treadmill (treadmill) - test on treadmill (treadmill)
classification of functional tests
Novakki test - test Novakki
test Kupera - test Kupera
tests and assessment of the condition of athletes - test and assessment of athletes
mean arterial pressure

39613 0

Physical activity requires a significant increase in the function of the cardiovascular system, on which to a large extent (usually in close relationship with other physiological systems of the body) the provision of working muscles with a sufficient amount of oxygen and the removal of carbon dioxide and other products of tissue metabolism from tissues depends. That is why, with the beginning of muscular work, a complex set of neurohumoral processes occurs in the body, which, due to the activation of the sympathoadrenal system, leads, on the one hand, to an increase in the main indicators of the circulatory system (heart rate, stroke and minute blood volumes, systemic blood pressure, circulating blood volume, etc.). .), and on the other hand, it predetermines changes in vascular tone in organs and tissues. Changes in vascular tone are manifested in a decrease in tone and, accordingly, expansion of the vessels of the peripheral vascular bed (mainly hemocapillaries), which ensures blood delivery to working muscles.

At the same time, in some internal organs there is an increase in tone and narrowing of small vessels. The above changes reflect the redistribution of blood flow between functionally active and inactive organs under load. In functionally active organs, blood circulation increases significantly, for example, in skeletal muscles by 15-20 times (at the same time, the number of functioning hemocapillaries can increase by 50 times), in the myocardium - by 5 times, in the skin (to ensure adequate heat transfer) - by 3- 4 times, in the lungs - almost 2-3 times. In organs that are functionally inactive under load (liver, kidneys, brain, etc.), blood circulation is significantly reduced. If in a state of physiological rest the blood circulation in the internal organs is about 50% of the cardiac output (MOV), then with maximum physical activity it may decrease
up to 3-4% MOS.

Determining the type of response of the cardiovascular system to physical activity. To determine the type of reaction of the cardiovascular system, the following parameters are taken into account:
1. Excitability of the pulse - an increase in the pulse rate in relation to the initial value, is determined as a percentage;
2. The nature of changes in blood pressure (BP) - systolic, diastolic and pulse;
3. Time for the return of heart rate and blood pressure to the initial level.

There are 5 main types of reactions of the cardiovascular system: normotonic, hypotonic, hypertonic, dystonic and stepped.

The normotonic type of reaction is characterized by an acceleration of the pulse rate by 60-80% (on average by 6-7 beats per 10 s); moderate increase in systolic blood pressure up to 15-30% (15-30 mm Hg); a moderate decrease in diastolic blood pressure by 10-30% (5-15 mm Hg), which is predetermined by a decrease in total peripheral resistance as a result of vasodilation of the peripheral vascular bed to provide the working muscles with the necessary amount of blood; a significant increase in pulse blood pressure - by 80-100% (which indirectly reflects an increase in cardiac output, i.e. stroke volume and indicates its increase); the normal period of the recovery process: with the Martin test in men is up to 2.5 minutes, in women - up to 3 minutes.

The normotonic type of reaction is considered favorable, as it indicates an adequate mechanism for adapting the body to physical activity. The increase in cardiac output (MOV) during such a reaction occurs due to the optimal and uniform increase in heart rate and stroke volume (SV).

The hypotonic (asthenic) type of reaction is characterized by a significant increase in heart rate - more than 120-150%; systolic blood pressure at the same time slightly increases, or does not change, or even decreases; diastolic blood pressure often does not change, or even increases; pulse blood pressure often decreases, and if it increases, then slightly - by only 12-25%; the recovery period slows down significantly - more than 5-10 minutes.

This type of reaction is considered unfavorable, since the supply of working muscles and organs with blood in this variant is achieved only by increasing the heart rate with a slight change in the EOS, that is, the heart works inefficiently and with high energy costs.

This type of reaction is observed most often in untrained and poorly trained individuals, with vegetovascular dystonia of the hypotonic type, after past illnesses, in athletes against the background of overwork and overstrain. However, in children and adolescents, this type of reaction, with a decrease in diastolic blood pressure with a normal duration of the recovery period, is considered a variant of the norm.

For the hypertonic type of reaction, the characteristic is: a significant acceleration of the pulse - more than 100%; a significant increase in systolic blood pressure up to 180-200 mm Hg. and higher; a slight increase in diastolic blood pressure - up to 90 mm Hg or more, or a tendency to increase; increase in pulse blood pressure (which in this case is predetermined by increased resistance to blood flow as a result of spasm of peripheral vessels, which indicates a significant tension in myocardial activity); the recovery period slows down significantly (more than 5 minutes).

The type of reaction is considered unfavorable due to the fact that the mechanisms of adaptation to the load are unsatisfactory. With a significant increase in systolic volume against the background of an increase in total peripheral resistance in the vascular bed, the heart is forced to work with a sufficiently large voltage. This type occurs with a tendency to hypertensive conditions (including latent forms of hypertension), vegetative-vascular dystonia of the hypertensive type, initial and symptomatic hypertension; vascular atherosclerosis, with overwork and physical overstrain in athletes. The tendency to a hypertensive type of reaction when performing intense physical activity can cause the occurrence of vascular "catastrophes" (hypertensive crisis, heart attack, stroke, etc.).

It should also be noted that some authors, as one of the variants of the hypertonic reaction, distinguish the hyperreactive type of reaction, which, unlike hypertonic, is characterized by a moderate decrease in diastolic blood pressure. With a normal recovery period, it can be considered conditionally favorable. However, this type of reaction indicates an increase in the reactivity of the sympathetic part of the autonomic nervous system (sympathicotonia), which is one of the initial signs of a violation of the autonomic regulation of cardiac activity and increases the risk of pathological conditions during intense exercise, in particular, physical overstrain in athletes .

The dystonic type of reaction is characterized by a significant acceleration of the pulse - more than 100%; a significant increase in systolic blood pressure (sometimes above 200 mm Hg); a decrease in diastolic blood pressure to zero (“the phenomenon of infinite tone”), which lasts for more than 2 minutes (the duration of this phenomenon within 2 minutes is considered a variant of the physiological reaction); slow recovery period.

This type of reaction is considered unfavorable and indicates excessive lability of the circulatory system, which is predetermined by a sharp violation of the regulation of the vascular bed. It is observed in violations of the autonomic nervous system, neuroses, after infectious diseases, often in adolescents in the puberty period, with overwork and physical overstrain in athletes.

A stepwise type of reaction is characterized by a sharp increase in the pulse - more than 100%; stepwise increase in systolic blood pressure, that is, systolic blood pressure measured immediately after exercise - at the first minute - lower than at 2 or 3 minutes of the recovery period; slow recovery period.

This type of response is also considered to be unfavorable because the mechanism for adapting to the load is unsatisfactory. It indicates a weakened circulatory system that is not able to adequately and quickly provide the redistribution of blood flow necessary to perform muscle work. Such a reaction is observed in the elderly, with diseases of the cardiovascular system, after infectious diseases, with overwork, with low physical fitness, as well as insufficient general fitness among athletes.

Hypotonic, hypertonic, dystonic and stepwise type of reaction are considered pathological types of the reaction of the cardiovascular system to physical activity. The normotonic type of reaction is also considered unsatisfactory if the recovery of pulse and blood pressure takes longer than 3 minutes.

Currently, based on the assessment of the results of functional stress tests of the cardiovascular system, instead of five types of reaction, three types of pulse and blood pressure reactions are distinguished (Karpman V.L. et al., 1988, Zemtsovsky E.V., 1995): physiological adequate, physiological inadequate and pathological. In this case, in addition to changes in heart rate and blood pressure, ECG indicators are taken into account to determine the type of reaction.

The physiologically adequate type is characterized by an adequate increase in heart rate and systolic blood pressure in response to a stress test and a rapid recovery of values ​​after the cessation of the load. There are no ECG changes and pathological arrhythmias. This type of reaction is typical for healthy and well-trained athletes.

The physiologically inadequate type, when performing a load, is characterized by a predominantly chronotropic response to the load, an inadequate rise in systolic blood pressure and a slow recovery of the pulse. The ECG may reveal minor (diagnostic) changes and rhythm disturbances (single extrasystoles). This type of reaction is inherent in healthy, but ill-prepared or overtrained athletes.

The pathological or conditionally pathological type is characterized by a drop or inadequate rise in blood pressure during exercise or during the recovery period. There may be marked changes in the ECG and clinically significant changes in the arrhythmia. With this variant of the reaction, three subtypes are distinguished depending on changes in blood pressure: hypotensive - in the case of an insufficient rise or even a fall in blood pressure during exercise; urgent hypertensive - with the appearance of hypertension in the process of performing the load; delayed hypertensive - with a rise in blood pressure in the recovery period.

The quality of the response of the cardiovascular system to the load can also be assessed by calculating the response quality index (RQR):

RCC (according to Kushelevskiy) = RD 2 - RD 1 / P2 - P1 /,

Where RD1 - pulse pressure before the load; RD2 - pulse pressure after exercise; P1 - pulse before the load; P2 - pulse after exercise.

RCC score: 0.1-0.2 - irrational reaction; 0.3-0.4 - satisfactory reaction; 0.5-1.0 - good reaction; >1.0 - irrational reaction.

Ruffier test. Currently, this test is widely used in sports medicine. It allows you to evaluate the functional reserves of the heart. When conducting a test, only changes in the pulse are taken into account. In the subject, who is in the supine position, after 5 minutes, the pulse is recorded for 15 s (P1). Then, within 45 seconds, he is asked to perform 30 squats. After that, the patient lies down and his pulse is again recorded for the first 15 s (P2), and then for the last 15 s (P3) of the 1st minute of the recovery period.
Next, the Ruffier index is calculated.

Ruffier index \u003d - 4 (P1 + P2 + P3) - 200 / 10

Ruffier-Dixon index \u003d (4 P2 - 70) + (4 P3 - 4 P1).

Sakrut V.N., Kazakov V.N.