Vol 27, No 4 (2024)

Cardiac rehabilitation is an effective method for restoring and improving cardiovascular function in patients with cardiovascular diseases. Rehabilitation exercises not only enhance physical endurance and improve patients’ psycho-emotional state but also play a key role in myocardial remodeling. This article explores the molecular and cellular mechanisms through which physical activity influences cardiac tissue repair, including the regulation of cardiomyocyte apoptosis, angiogenesis, fibrosis, and inflammatory processes. The review analyzes current research data confirming the positive impact of exercise on the morphological and functional state of the heart, as well as the prospects for using rehabilitation training as an adjunctive strategy to optimize myocardial remodeling. Particular attention is given to the role of non-coding RNAs, signaling pathways, and intercellular interactions in these processes. The study also identifies gaps in our understanding of the mechanisms underlying exercise-induced improvements in pathological cardiac remodeling, highlighting the need for further research. The use of modern methods, such as high-throughput sequencing and analysis of individual cells, may open up new perspectives in studying the mechanisms responsible for the beneficial effects of rehabilitation exercises. These technologies make it possible to detail the mechanisms of adaptation of the cardiovascular system to physical activity and identify potential therapeutic targets for the development of new drugs and non-medicinal interventions.

ВACKGROUND: Changes in the body, such as sarcopenia and sarcopenic obesity, are common in people with chronic heart failure, which complicates the course of the disease and worsens the prognosis.

АIM: Evaluation of the effectiveness of the proposed rehabilitation method, which includes a hypocaloric but protein-rich diet, individually selected physical activity and breathing exercises for patients with pre-disease-pre-stage CHF.

MATERIALS AND METHODS: The study involved 80 patients over 50 years of age, treated in the endocrinology department of the State Healthcare Institution of the Voronezh Regional Clinical Hospital No. 1, the observation lasted 6 months. The SARC-F questionnaire was used for the primary diagnosis of sarcopenia. The Katz index, clinical frailty scale (CFS), grip strength (HGS), SPPB test battery and 6-minute walking distance (6MWD) were also assessed. Patients were divided into 4 groups: the main group (with and without sarcopenic obesity) and the control group (with and without sarcopenic obesity).

RESULTS: In the first group of patients, after rehabilitation, there was a significant decrease in weight (from 89.7 kg to 82.9 kg; p <0.001) and BMI (33.3 kg/m² to 31.1 kg/m²; p <0.001), accompanied by an increase in absolute (from 15.3 kg to 16.7 kg; p <0.001) and relative muscle mass (from 17% to 21.5%; p <0.001), as well as an improvement in the BMI/BMI ratio (from 0.461 to 0.572; p <0.001). Improvement in quality of life was noted. In the second group, a decrease in weight (from 79.9 kg to 75.0 kg; p=0.001) and BMI (from 27.4 kg/m² to 26.3 kg/m²; p <0.001) was also recorded.

CONCLUSION: The rehabilitation program proved to be successful both for patients with and without sarcopenic obesity, in terms of improving the muscular component of body composition and quality of life, and preventing the development of the nosology of chronic heart failure.

BACKGROUND: Mental disorders are currently a serious problem for society and require a systematic approach to prevention, treatment and rehabilitation. Among these disorders, 51.0% are non-psychotic. The application of the International Classification of Functioning (ICF) allows a fairly objective assessment of the severity of disorders that limit the life activity of patients and their dynamics, characterizing the effectiveness of treatment and rehabilitation. However, the use of the ICF in psychiatric practice is limited.

AIM: To evaluate the effectiveness of inpatient rehabilitation of patients with non-psychotic disorders based on the use of ICF.

MATERIALS AND METHODS: The object of the study was 317 psychiatric inpatients with non-psychotic disorders. The severity of life activity limitations according to the ICF at admission and discharge was studied. Inclusion criteria: age under 18; patient refusal to participate; acute psychotic symptomatology, gross cognitive defect. Statistical analysis was performed using application programs in Microsoft Office Excel 2010.

RESULTS: Women accounted for 59.9% (190 people) of those examined. In the age structure, people under 30 years of age accounted for 32.5% (103 people), 30–39 and 40–49 years — 21.8% and 20.2% (69 and 64 people, respectively), 50–59 years — 11.7% (37 people), 60 years and older — 13.8% (44 people). In the nosological structure, patients with neurotic, stress-related, and somatoform disorders accounted for 30.6% (97 people), mood disorders and personality and behavior disorders in adulthood — 25.3% (81 people) and 24.4% (74 people), respectively; with behavioral syndromes — 20.5% (65 people). The mean ICF scores at the beginning of treatment were: on impulse urges control — 1.52±0.19, emotion regulation — 1.59±0.18, motivation function — 1.40±0.21, appetite — 1.36±0.25, ability to overcome crisis situations — 1.90±0.19, coping with stress — 1,74±0.20, solving complex problems — 1.68±0.18, managing own activity — 1.59±0.16, regulating behavior during interaction — 1.07±0.22, maintaining child-parent relations — 1.12±0.18.

CONCLUSION: The use of ICF in psychiatric practice allows to determine the patient’s actual problems and their dynamics, which is necessary for the correction of therapy and assessment of its effectiveness.