Orthostatic test evaluates. Determination and assessment of functional status

It gives an idea of the sympathetic department of the autonomic nervous system; it is often used when studying the cardiovascular system of an athlete, as it allows one to judge the regulation of vascular tone. An orthostatic test involves moving the body from a horizontal position to a vertical position or close to it. In this case, the direction of the main vessels will coincide with the direction of gravity, which causes the occurrence of hydrostatic forces that impede blood circulation. The influence of the Earth's gravitational field on the activity of the cardiovascular system is quite significant when the adaptive capacity of the circulatory system decreases: the blood supply to the brain may significantly suffer, which is expressed in the development of the so-called orthostatic collapse. The orthostatic test as a method of functional diagnostics is often used in clinical practice. It is carried out during the examination of work ability, in the diagnosis of hypotonic conditions and in other cases. It has found wide application in the examination of pilots and astronauts. The orthostatic test, carried out in various variants, turned out to be very promising when examining athletes. When moving from a horizontal to a vertical position, blood flow in the lower half of the body becomes difficult. It is especially difficult in the veins, which leads to the deposition of blood in them, the degree of which depends on the tone of the veins. The return of blood to the heart is significantly reduced, and therefore systolic output may decrease by 20-30%. At the same time, the heart rate increases compensatory, which allows maintaining the minute volume of blood circulation at the same level.

In the regulation of the function of the cardiovascular system, an important role has been revealed for the cerebral cortex (if its functional state is disturbed, for example in neurosis, a disorder of these regulatory influences occurs) and humoral factors, among which catecholamines have the main effect on vascular tone. A decrease in venous tone, observed during overfatigue, overtraining, and a painful condition, is associated with incoordination of the links that ensure both its regulation and the activity of the heart. In this case, the adaptation of the circulatory function to disturbing influences suffers; as a result, a sharp drop in the venous return of blood to the heart and the development of a fainting state can be observed.

When skeletal muscles contract, blood in the veins, due to the one-way function of their valves, is pushed towards the heart. This is one of the important factors preventing stagnation in the limbs. Other factors include the influence of the residual energy of the cardiac impulse, negative pressure in the chest cavity and, to some extent, arteriovenous shunts that make direct connections between small arteries and veins are important for the movement of blood through the veins.

It is known that the deep veins are surrounded by muscles, and even in a calm state there is some contraction of them, exerting enough pressure on the veins to push blood through the venous valves towards the heart. With more frequent and active movements, especially those of an intermittent nature, for example when walking, running, the efficiency of the muscle pump increases sharply. Blood flow to the heart also increases when the abdominal muscles contract (blood is displaced from the vessels of the liver, spleen, and intestines).

Normally, in well-trained athletes, during an orthostatic test, systolic pressure decreases slightly - by 3-6 mmHg. Art. (may not change), and diastolic increases within 10-15% relative to its value in a horizontal position. The increase in heart rate does not exceed 15-20 beats/min. A more pronounced reaction to an orthostatic test may be observed in children.

Orthostatic test according to Shellong is an active test in which the subject independently moves from a horizontal to a vertical position and then stands motionless. To reduce the muscle tension observed in this case, Yu.M. Stoyda (1974) proposed changing the vertical position of the subject to another, in which his legs are at a distance of one foot from the wall, and the subject rests his back on it; a roller with a diameter of 12 cm is placed under the sacrum. With this position, more pronounced muscle relaxation is achieved. The angle of inclination of the body relative to the horizontal plane is about 75°.

To perform a passive orthostatic test, a rotary table is required. It can be carried out in various modifications at an angle of inclination of the table from 60 to 90° and the duration of the subject’s stay in an upright position for up to 20 minutes. When conducting an orthostatic test, heart rate (HR) and blood pressure (BP) are usually recorded, however, if appropriate equipment is available, the study can be supplemented, for example, by recording a polycardiogram and plethysmogram.

Based on numerous data from studies of orthostatic stability in highly qualified athletes, we proposed to evaluate it as good if the heart rate by the tenth minute of the orthostatic position increases by no more than 20 beats/min in men and 25 beats/min in women (compared to the heart rate in lying position), the transition process for heart rate ends no later than the 3rd minute of the orthostatic position in men and the 4th minute in women (i.e., the minute-by-minute fluctuation in heart rate does not exceed 5%), pulse pressure decreases by no more than 35 %, feeling good. With satisfactory orthostatic stability, the increase in heart rate by the 10th minute of the test is up to 30 beats/min in men, and up to 40 beats/min in women. The transition process for heart rate is completed in men no later than the 5th minute, and in women - in the 7th minute of the orthostatic position. Pulse pressure decreases by 36-60% (relative to the supine position), and the patient feels good. Unsatisfactory orthostatic stability is characterized by a high increase in heart rate by the 10th minute of the orthostatic position (30-40 beats/min), a decrease in pulse pressure by more than 50%, the absence of a steady state for heart rate, poor health, pale face, and dizziness. The development of orthostatic collapse is evidence of a particularly unfavorable reaction to the test (to prevent it, the test should be stopped if your health worsens and dizziness occurs).

Numerous studies suggest that an increase in heart rate values during an orthostatic test of more than 100-110 beats/min (regardless of the initial heart rate in the supine position) is usually accompanied by a sharp deterioration in well-being, the appearance of complaints of severe weakness, and dizziness. If the test is not stopped, orthostatic collapse develops. We noted such reactions during forced training (especially those carried out in mid-mountain areas), in a state of overexertion, overtraining, and also during the period of recovery after illness.

Other testing options are also possible. So, after counting the pulse in a lying position (for 15 seconds, recalculated per minute), the athlete is asked to smoothly stand up and 10 seconds after this, the pulse is calculated for 15 seconds, recalculated per minute. Normally, its increase is 6-18 beats/min (in well-trained athletes - usually within 6-12 beats/min). The higher the pulse is in a vertical position, the higher the excitability of the sympathetic part of the autonomic nervous system.

A.F. Sinyakov proposes the following technique for conducting an orthostatic test. The subject rests in a lying position for 10 minutes. At the 11th minute, the pulse is calculated for 20 seconds, recalculated by 1 minute. Then stand up, lean your back against the wall, so that your legs are one foot away from the wall. You need to stay in this position for 10 minutes, counting your pulse every minute and noting how you feel. Data is recorded in protocol format.

The test can be simplified by adjusting it immediately after getting up, that is, for 1 minute in a vertical position, then for 5 and 10 minutes.

According to the author, with good orthostatic stability, the pulse in the 10th minute of the orthostatic position increases by no more than 20 beats per minute for men and 25 beats for women compared to the pulse value in the supine position, the state of health is good. With satisfactory orthostatic stability, the pulse quickens by 30 beats per minute in men, in women up to 40 beats, the state of health is good. If unsatisfactory, the pulse may increase by 40-50 beats per minute or more, dizziness, poor health are noted, the face turns pale, and fainting may even develop. Therefore, if your health worsens, the test should be canceled to avoid orthostatic collapse.

Deterioration of orthostatic stability can be observed with overfatigue, overtraining, after illnesses, with vegetative-vascular dystonia, etc.

Clinical orthostatic test . This test is carried out in reverse order. After standing for 10 minutes, the subject lies down again. Immediately after moving to a horizontal position, and then 3-5 minutes, pulse and blood pressure are measured.

The range of normal limits for increased heart rate during an orthostatic test is 10-40 beats per minute. Systolic pressure does not change or decreases at the beginning of standing by 5-15 mm Hg, and then gradually increases. Diastolic pressure usually increases by 5-10 mm Hg. With a clinical orthostatic test, the changes are of the opposite nature.

The main role in the reaction of the heart when changing body position is played by the so-called Starling mechanism (“law of the heart”). Increased venous blood flow to the heart in the supine and upside down position results in “volume loading of the ventricles,” increasing the force of heart contraction. In a standing position, venous return (blood flow) decreases, and “ventricular volume underload” develops, accompanied by phase signs of physical inactivity.

Ruffier test represents a fairly significant load. The athlete's pulse is measured in a sitting position (after a 5-minute rest) (P1), then he performs 30 squats in 30 seconds, after which the pulse is immediately measured in a standing position (P2). Then the subject rests while sitting for a minute and the pulse is counted again (P3 ). All calculations are carried out at 15 second intervals. The value of the Ruffier sample index is calculated using the formula

J= 4*(P1+ P2+ P3)-200

When the index value is less than 0, adaptability to load is assessed as excellent, 0-5 - mediocre, 11-15 - weak, 15 - unsatisfactory.

Sample S.P. Letunova . This is a combined functional test, widely used both in self-monitoring of health and in the practice of medical supervision.

The test is intended to assess the adaptation of the human body to speed work and endurance. The test consists of three loads: the first – 20 squats performed in 30 seconds; second – 15 seconds running in place at maximum pace; the third is a three-minute run in place at a pace of 180 steps per minute. After the end of each load, the recovery of heart rate and blood pressure is recorded in the subject. These data are recorded throughout the entire rest period between exercises.

Evaluation of the test results by S.P. Letunova is not quantitative, but qualitative. It is carried out by studying the so-called types of reactions.

Healthy and physically trained people most often have a normotonic type of reaction to the test. It is expressed in the fact that under the influence of each load, a pronounced increase in heart rate is noted to varying degrees. So, after 1 load in the first 10 seconds, the heart rate reaches 100 beats/min, and after 2 and 3 loads 125-140 beats/min.

Types of reactions

With a normotonic type of reaction to all types of stress, the maximum blood pressure increases and the minimum blood pressure decreases. These changes in response to 20 squats are small, but in response to 15 seconds and 3 minutes of running are quite pronounced. Thus, in the 1st minute of the recovery period, maximum blood pressure rises to 160-210 mm Hg. Art. An important criterion for a normotonic reaction is the rapid restoration of heart rate and blood pressure to resting levels.
Other types of reactions to S.P. Letunov’s test are designated as atypical. Some may experience a so-called hypertensive type of reaction: a sharp increase in systolic blood pressure to 180-210 mm Hg. Art., and diastolic blood pressure either does not change or increases. The hypertensive type of reaction is associated with the phenomenon of overwork or overtraining.

Hypotonic type of reactions characterized by a slight increase in systolic blood pressure, in response to the load, accompanied by a rare increase in heart rate at the 2nd and 3rd loads (up to 170-190 beats/min). Recovery of heart rate and blood pressure is slow. This type of reaction is considered unfavorable.
Dystonic type of reaction is characterized mainly by a decrease in minimum blood pressure, which after the 2nd and 3rd loads becomes equal to zero (“infinite current phenomenon”). Systolic blood pressure in these cases rises to 180-200 mm Hg.

When the functional state of the body deteriorates, a reaction with a stepwise increase in systematic blood pressure may be observed. This type of reaction is characterized by the fact that systolic blood pressure, which should decrease during the recovery period, on the contrary, increases at the 2nd, 3rd minutes compared to the value at the 1st minute of recovery.

An indicator of the activity of the cardiovascular system is endurance coefficient (EF). Grade HF is based on an analysis of heart rate, systolic and diastolic pressure and is calculated according to Kwasi's formula:

We remind you that - pulse blood pressure = systolic blood pressure – diastolic blood pressure.
Normally, the CV value is 10-20 conventional units. Its increase indicates a weakening of the activity of the cardiovascular system, and its decrease indicates an increase in the activity of the cardiovascular system.

There is some interest circulatory efficiency coefficient (CEC) , characterizing the minute volume of blood (the minute volume of blood indicates the intensity of work of all circulatory systems and increases in proportion to the severity of the work performed. On average, the minute volume is -35 l/min.).
KEC= pulse blood pressure * heart rate

Normally, the KEK value is 2600. With fatigue, the KEK value increases.
An indicator of the state of the autonomic nervous system, which regulates the cardiovascular system, is Kerdo index.

Kerdo Index: Minimum blood pressure: heart rate

In healthy people, the Kerdo index is equal to 1. When the nervous regulation of the cardiovascular system is disturbed, the Kerdo index becomes either more than 1 or less than 1.

The simplest, most accessible, and at the same time indicative, is the so-called Harvard step test allowing you to objectively assess physical performance (a step test is climbing up and down steps.). The essence of this method is that climbing and descending a one-step staircase is determined by the pace, time and height of the step depending on age.

For children under 8 years old, the height of the step should be 35 cm, the time of ascent and descent should be 2 minutes; for 8-11 year olds – step height 35 and time – 3 minutes; for 12-18 year old boys - 50 cm, for girls of this age 40 cm, time for both - 4 minutes; over 18 years old – men – step height – 50 cm, time – 5 minutes; for women, respectively – 45 and 4 minutes. The rate of ascent is constant and equals 30 cycles per minute. Each cycle consists of 4 steps: put one foot on the step, substitute the second; We lower one leg and put the other one on.

After performing the test during the recovery period, the heart rate is determined three times during the first 30 seconds of the second minute, then during the first 30 seconds of the third minute and also for 4 minutes (the subject is sitting on a chair).

If during the test the subject shows external signs of excessive fatigue: pale face, stumbling, etc., then the test should be stopped.

The result of this test is expressed quantitatively by the index Harvard Step Test (IGST). It is calculated by the formula:

IGST= ; where t is the ascent time in seconds.

The number of pulse beats in the first 30 seconds in the second, third and fourth minutes of recovery, respectively.

During mass examinations, you can use an abbreviated formula for calculating IGST, which provides for only one pulse count in the first 30 seconds of the second minute of recovery.

IGST= ;where the designations are the same

Physical performance is assessed as weak if the IGST is less than 55; below average – 55-64; average – 65-79; good – 80-89; excellent – 90 or more.

Cooper's 12-minute running test is an endurance test. During the test, you need to cover (run or walk) as much distance as possible (you must not overexert yourself and avoid shortness of breath).

Only sufficiently prepared people can undergo testing. Compare the results obtained with the data in Table 5.

Table 5

12-minute test for men (distance, km)

The essence of the test is to transfer the body from a horizontal to a vertical position.

Indications for an orthostatic test

It is prescribed to patients suffering from sudden changes in body position, dizziness, low blood pressure and even fainting. The orthostatic test is designed to record these sensations based on physiological characteristics.

Methods of conducting

Patient on a special tilt table

The test should be carried out before meals, preferably in the morning. Perhaps the doctor will prescribe you to carry out tests over several days, then you need to carry them out at the same time.

The diagnosed person stays lying down for at least 5 minutes, and then slowly rises to his feet. This method is called an active orthostatic test.

In addition, there is another option for conducting an orthostatic test, which is called an oblique test - this is a passive orthostatic test. In this case, the person being diagnosed is placed on a special rotating table. The technique itself is the same: 5 minutes in a horizontal position, then a quick transfer of the table to a vertical position.

During the study, the pulse is measured three times:

(1) in a horizontal body position,
(2) when rising to your feet or moving the table to a vertical position,
(3) three minutes after transition to a vertical position.

Evaluation of results

Based on the heart rate values and their differences, conclusions are drawn about the functional state of the cardiovascular system.

The norm is an increase in heart rate of no more than 20 beats per minute. It is permissible to reduce the upper pressure (systolic), as well as a slight increase in the lower (diastolic) pressure - up to 10 mm Hg. Art.

If, after rising to a vertical position, your heart rate increased per minute or even less, and then after three minutes of standing it stabilized to +0-10 beats from the initial (measured while lying down), then your orthostatic test readings are normal. In addition, this indicates good training.
A greater change in heart rate (up to +25 beats per minute) indicates poor fitness of the body - you should devote more time to physical exercise and a healthy diet.
An increase in heart rate of more than 25 beats per minute indicates the presence of diseases of the cardiovascular and/or nervous systems.

Orthostatic test to assess the autonomic nervous system

An orthostatic test is a technique for examining and diagnosing the functioning of the organs of the cardiovascular and nervous systems when lifting the body into a vertical position. The principle of this slant test is aimed at establishing dysfunctions in the activity of the three parts of the sympathetic nervous system.

Pathological changes in the general and regional movement of blood through the vessels, resulting from hydrostatic pressure in different areas of the circulatory system, are caused by improper distribution of blood flow throughout the body under the influence of gravity. When standing, more blood is concentrated in the veins of the lower extremities. This helps to reduce venous return to the heart, which in turn ensures minute volume of blood circulation.

Orthostatic blood flow dysfunctions

In the presence of orthostatic hypotension, the principle of action of compensatory reactions is based on an increase in heart rate and spasm of elastic tubular formations, which create a closed system that transports blood throughout the body. This maintains acceptable blood pressure levels. If there are dysfunctions of protective processes, a malfunction occurs in the circulatory system.

Orthostatic hypotension. Characterized by impaired blood supply to the brain. Since the head is the extreme point on top of the body, if hemodynamic processes are disrupted, the main organ of the central nervous system is most susceptible to this pathology. Darkening in the eyes, instant, causeless weakness and unsteadiness signal the likelihood that a short-term loss of consciousness may soon occur. In the case of a rapid decrease in systemic hemodynamics, nausea appears, the skin turns pale and the release of moisture from the sweat glands increases.
Orthostatic tachycardia. When standing up, the intensity of blood flow decreases, thereby reducing the volume of liquid mobile connective tissue flowing directly to the heart.

Orthostatic test: classification, basic concepts and types of loads

The main purpose of the inclined test is to identify pathologies in the process of blood movement through the vessels, which arises as a result of hydrostatic pressure in various parts of the circulatory system. With normal operation of all body systems, these indicators do not suffer significant changes when a person rises and are acceptable within normal limits.

In the presence of pathological changes, two forms of the opposite nature are distinguished:

Hypersympathicotonic type of pathology. It is characterized by a pronounced reaction to gravitational changes in the position of the body. This results in increased blood pressure and increased heart rate.
Hyposympathicotonic type. Accompanied by a rapid decrease in blood pressure, at which the pulse becomes less frequent and less pronounced.

In medical practice, the following types of loads are used to conduct an orthostatic test:

Active. In this case, the patient independently takes a vertical position from a horizontal one. During this diagnosis, contractions of the muscular skeleton have a special effect. The most common type of this examination is the Martinet test.
Passive. It is carried out using a special device, which ensures that the contribution of skeletal muscle contractions is excluded. With such an examination, the patient can be connected to ECG and plethysmography sensors. This approach allows us to more thoroughly study the activity of the heart and the dynamics of blood supply to individual organs.

Orthostatic blood flow disorders are also diagnosed using a pharmacological method. It consists of taking adrenergic agonists and other medications that affect the tone of the veins. Next, the results of orthostatic tests are compared before and after taking the drugs.

In medical practice, orthostatic tests are used in diagnosing:

Dysfunctions of the autonomic nervous system.
Hypertension.
Coronary heart disease.

This examination also helps to establish monitoring of health status during drug therapy, which can cause orthostatic blood flow disorders.

In every person's life, there have been repeated cases of weakness or dizziness when suddenly assuming a vertical position of the body. This is how the body reacts to the redistribution of blood as a result of gravity. In order to find out how normal the ratio of blood flow throughout the body is, it is recommended to carry out orthostatic tests.

The results of this examination are determined based on heart rate indicators and their difference in the horizontal and vertical position of the body. A normal indicator is an increase in heart rate of no more than 20 beats in 60 seconds. The doctor provides a final conclusion only after a complete study of the complex of results, which consist of indicators of systolic and diastolic blood pressure, pulse pressure and autonomic manifestations.

Orthostatic tests

Orthostatic test to assess functional status

The orthostatic test is used to analyze the work of the cardiovascular system when standing up and helps to determine how the sympathetic division of the autonomic nervous system functions. Today, the Schellong test is actively used in sports related to changing the body in space, for example, in gymnastics, diving, freestyle, etc. Also, this test can be used to determine the dysfunction of the cardiovascular and nervous systems.

Carrying out an orthostatic test

So, the subject takes a lying position and rests for 5 minutes. Then you need to measure the heart rate for 15 seconds (multiply by 4 to get the value for 1 minute) and blood pressure. After this, the subject is asked to stand up slowly. Pulse and blood pressure are measured again. Heart rate is measured at 1 and 3 minutes in a standing position, and pressure is measured at 3 and 5 minutes. You can even make an assessment based on heart rate indicators.

Evaluation of the orthostatic test

Normally, in healthy people, the heart rate increases by 14 - 16 beats per minute immediately after getting up and stabilizes after 3 minutes (usually 6 - 10 beats / min higher than when lying down). If the reaction is more pronounced, this may indicate about the increased reactivity of the sympathetic division of the autonomic nervous system. This reaction is typical for untrained individuals. For athletes and well-trained individuals, the difference in heart rate during an orthostatic test can range from 5 to 15 beats / min.

As for blood pressure, the systolic normally rises slightly or remains unchanged, and the diastolic increases within 10-15% compared to the state of rest in the supine position. After 10 minutes, diastolic blood pressure returns to its original value, but diastolic blood pressure may remain elevated.

Thus, the results of the orthostatic test make it possible to easily and quickly assess the regulation of peripheral circulation and, in some way, judge the functioning of the cardiovascular and nervous systems. The convenience of this functional test is that no special equipment is required, and the procedure itself takes no more than 10 minutes.

Determination and assessment of functional status. Tests with changes in body position in space

Orthostatic test

1. Assessment of changes in heart rate and blood pressure or only heart rate during the first s after transition to a vertical position;

2. Assessment of changes in heart rate and blood pressure or only heart rate after 1 minute of being in an upright position;

3. Assessment of changes in heart rate and blood pressure or only heart rate during the first s after transition to a vertical position, and then at the end of 3 minutes of being in a vertical position.

The normal reaction to the test is an increase in heart rate per beat for 1 minute immediately after getting up. After stabilization of this indicator, after 3 minutes of standing, the heart rate decreases slightly, but remains 6-10 beats per 1 minute higher than in a horizontal position.

Normosympathicotonic excellent - increase in heart rate up to 10 beats/min;

Normosympathicotonic good - increase in heart rate per beat/min;

Normosympathicotonic satisfactory - increase in heart rate per beat/min;

Hypersympathicotonic unsatisfactory - increase in heart rate more than 22 beats/min;

Hyposympathicotonic unsatisfactory - decrease in heart rate by 2-5 beats/min.

Orthostatic test and other methods of health monitoring

Subjective and objective methods of self-control

Self-control is carried out by subjective (based on personal feelings) and objective methods; the scope of self-control includes data (indicators) of daily, weekly and monthly observations.

The “well-being” indicator reflects the state and activity of the body as a whole, the state of physical and spiritual forces, and subjectively evaluates the state of the central nervous system. With skillful and regular training, a person’s well-being is usually subjectively good: cheerful, cheerful, eager for activity (study, work, sports), high performance.

For self-control, the length of the working day is noted (divided into production and household employment) and a separate assessment of working capacity is given.

Sleep is considered normal if it occurs soon after a person goes to bed, fairly sound, with awakening giving a feeling of vigor and relaxation. Poor sleep is characterized by taking a long time to fall asleep or waking up early or waking up in the middle of the night. After such a dream there is no feeling of vigor and freshness.

Physical exercise and proper routine help improve sleep. An hour of sleep during the day has a good effect on the body, this is especially good for older and older people. The duration of sleep and its quality are recorded: disturbances, falling asleep, awakening, insomnia, dreams, intermittent or restless sleep.

Very subtly characterizes the state of the body. Good, normal, decreased, increased appetite or lack thereof is recorded. Other signs of indigestion, if any, are noted, as well as increased thirst.

Objective control method

The weight of an adult is calculated using Broca's criterion - the number 100 for men and 105 for women (for heights up to 175 cm) is subtracted from the body height (in cm); number 110 (if height is more than 175 cm). Body weight can change during the day, so it is necessary to weigh yourself at the same time, in the same clothes, preferably in the morning, on an empty stomach.

Body dimensions are health parameters related to body weight, but showing its distribution over body volume. Measurement of body circumferences - chest, neck, shoulder, thigh, lower leg and abdomen - is carried out using a centimeter tailor's tape.

When measuring the circumference of the chest, the tape is applied from behind - at the angles of the shoulder blades, and in front - along the lower edge of the parapapillary circles (in men and children) and above the mammary glands (at the place of attachment of the 4th rib to the sternum in women). It is measured either during a deep inhalation, or a deep exhalation, or during a respiratory pause, but always in the same phase. The difference between the chest circumference during inhalation and exhalation is called chest excursion.

When determining, the tape is applied horizontally under the thyroid cartilage - the Adam's apple. The dimensions of the shoulder are determined in its middle third (in a relaxed state); The circumference of the thigh and lower leg is measured while standing, the tape is applied horizontally under the gluteal fold and around the largest volume of the lower leg.

Body size in the abdominal area is a very important and informative indicator of the condition.

The volume of the abdomen is measured at the level of the navel (normally it should not exceed the volume of the chest at the level of the nipples).

Pulse is an extremely important indicator.

Counting the pulse rate and assessing its quality reflect the activity of the cardiovascular system. Pulse of a healthy untrained man at rest, beats per minute, women. Most often, the pulse is determined by feeling with three fingers at the base of the hands, above the radius bone or at the base of the temporal bones. Typically, the pulse is counted for 6 or 10 seconds and multiplied by 10 and 6, respectively (counting for 6 seconds is used at the height of the load).

During physical activity, a healthy person is not recommended to exceed the maximum number of heartbeats, calculated by the formula: HRmax = person’s age. Patients have corresponding restrictions in frequency.

Immediately after physical activity, the pulse may increase twice as fast as at rest, which is quite natural, but after 2 minutes its frequency should not exceed one and a half deviations, and after 10 minutes it should approach the original one. When counting the pulse rate, you need to simultaneously pay attention to its rhythm; any doubts about this should be resolved with your doctor.

Trained people at rest have a lower heart rate than people who do not engage in physical activity, including sports.

A decrease in the number of heart rate beats as a result of training can be noted by anyone who has begun to exercise regularly (after 6-7 months, the heart rate can decrease by 3-4, and after a year - by 5-8 beats or more per minute).

It is convenient to count your breathing rate by placing your hand on your chest. Count for 30 seconds and multiply by two. Normally, in a calm state, the breathing rate of an untrained person is equal to inhalations and exhalations per minute. You should strive to breathe at a frequency of 9-12 breaths per minute.

Vital capacity (VC) is the amount of air that can be exhaled after the deepest breath has been taken. The value of vital capacity characterizes the strength of the respiratory muscles, the elasticity of the lung tissue and is an important criterion for the performance of the respiratory organs. As a rule, vital capacity is determined using a spirometer in an outpatient setting.

A functional test is a way to assess the fitness of certain body systems using a control test.

Standard loads are used, followed by analysis of the results of measurements of parameters and characteristics of the body’s condition (for example, heart rate, respiration, etc.) immediately before and after the test. As a result of comparison with standard norms of change, the degree of training and adaptability to a given factor is judged.

To assess the fitness of the cardiovascular system, the following tests are used.

When the body position changes from horizontal to vertical, blood redistribution occurs. This causes a reflex reaction in the circulatory regulation system, ensuring normal blood supply to organs, especially the brain.

A healthy body responds to changes in body position quickly and efficiently, so fluctuations in heart rate (and blood pressure) in different body positions are small. But if the mechanism of regulation of peripheral blood circulation is disrupted, fluctuations in pulse and blood pressure (blood pressure) when moving from a horizontal to a vertical position are more pronounced. With vegetative-vascular dystonia, orthostatic collapse (fainting) is possible.

The test is carried out as follows. The pulse is counted repeatedly (if possible, the blood pressure is also measured) until a stable result is obtained in a standing and lying position, then they stand up and make the same measurements while standing - immediately after changing the body position and after 1, 3, 5 and 10 minutes.

These measurements are necessary to assess the speed of heart rate recovery. Usually the pulse reaches its original value (the frequency that was in a standing position before the test). Tolerability of the test is considered good when the pulse increases by no more than 11 beats, satisfactory when the pulse increases, and unsatisfactory when the pulse increases by 19 beats or more.

Squat test (Martinet test).

The resting heart rate is calculated. After 20 deep (low) squats (feet shoulder-width apart, arms extended forward), which must be done within 30 seconds, the percentage of heart rate increase from the initial level is determined.

Sample evaluation. The state of the cardiovascular system is assessed as good when the heart rate increases by no more than 25%, satisfactory - by 50-75%, unsatisfactory - by more than 75%.

After the test, with a healthy response to physical activity, systolic (upper) blood pressure increases by mmHg. Art., and the diastolic (lower) either remains at the same level or decreases slightly (by 5-10 mm Hg. Art.). Pulse recovery lasts from 1 to 3, and blood pressure - from 3 to 4 minutes.

Lack of oxygen in the body is accompanied by a sharp increase in breathing and a feeling of lack of air (shortness of breath). The level of stress that causes shortness of breath is used to judge a person’s physical performance.

The simplest way to determine physical performance is by the occurrence of shortness of breath when climbing stairs. If you climb at a calm pace to the 4th floor without stops or difficulties, you have good performance.

If the rise is accompanied by shortness of breath, rise while monitoring your pulse. After ascending to the 4th floor, a pulse below 100 beats/min is assessed as evidence of excellent performance, from 100 to good, from 130 to mediocre, above unsatisfactory, indicating that training is almost completely absent.

Let's consider tests for psychological stability (volitional preparedness) of the state of the respiratory and cardiovascular systems.

Breath-hold test.

While standing, count your pulse for one minute. Then, after inhaling, exhale the air, close your nostrils with your fingers and hold your breath for as long as you can. This is holding your breath - apnea. Write down your pulse and apnea data (in seconds) as a fraction: pulse/apnea.

Test with breath holding and squats.

Do 10 squats or 10 chair stands (if your general health allows). The pace of movement is average (a second to squat, a second to stand up, inhale and exhale, respectively). After completing the test, rest while sitting for 4 minutes, breathing freely. Perform a breath-hold test and assess apnea. If the indicator is less than what was recorded, say, a month ago, it means that the body’s resistance under the influence of your training is increasing. If the indicator increases, you should temporarily reduce the load, and sometimes consult a doctor.

Yes, I answered my wards’ question about the need to keep scrupulous, “accounting” records of indicators in the self-control diary. It's not a matter of form, but of essence.

Self-control is, perhaps, the only way to understand the “secrets” of health, to practically navigate the state of your body, and most importantly, to provide a truly individual approach to prevention and training.

Self-control also means self-discipline, strong-willedness, and understanding of your lifestyle. You can verify all this by looking at the approximate diary diagram given here. As for the content of the records, well-being, performance, appetite, pulse pattern, etc. are assessed daily. Functional tests are the object of monthly observations, and as weekly tests we can recommend an assessment of weekly (general) well-being and body weight.

An example of a self-monitoring diary entry

Orthostatic test, methods of conducting, evaluation of results

Tests with changes in body position in space include orthostatic (straight, vertical) and clinostatic (oblique). In both tests we are talking about a change in the position of the body relative to the gravity vector. The transition from a lying position to a standing position is called an orthostatic test, a change in position from vertical to horizontal is called a clinostatic test. There are two options for conducting these tests, in particular active and passive orthostatic tests. Active orthotest: a person stands up himself with the help of his kinesthetic analyzer, and maintains a vertical posture himself. Passive orthotest: transfer to a vertical state is carried out using special rotary tables, when the participation of skeletal muscles in changing body position is excluded.

Determination of physical performance according to the PWC-170 test. MIC as the most important indicator of the aerobic capacity of the body, the procedure for its determination

The International Biological Program (IBP) for the Study of Human Adaptability recommends using information on the value of aerobic performance, an indicator of which is MOC (maximum oxygen consumption), to judge physical performance. The MPC value very reliably characterizes the physical performance of an athlete, or, more precisely, the so-called aerobic performance. Research of this indicator is especially important for assessing the functional state of the body of athletes training for endurance. Currently, in accordance with WHO recommendations, a method for direct determination of MIC has been adopted.

After a 5-10 minute intensive warm-up on a bicycle ergometer, the subject performs work that gradually increases in power. Disadvantages of this method. The definition is methodologically difficult, the procedure itself is sometimes life-threatening. During it, athletes may lose consciousness, some experience convulsions and vomiting. Trainers should know that determining the IPC is a medical procedure; a doctor must be present during it (an experiment on the edge of life and death). At the same time, the needs of sports practice are such that it is necessary to frequently determine physical performance in order to monitor the dynamics of growth of the athlete’s functional state. Therefore, biological testing of physical performance based on heart rate has become most widespread. Methods for indirect determination of the IPC. By indirect or indirect methods for determining MOC we mean those in which, using single or double submaximal loads, various indicators are determined by which aerobic capacity is determined using formulas or nomograms: Astrand nomograms, Formulas for calculating MOC through the value of PWC 170. Dobeln's formula.

Sample PWC170. This submaximal functional test is recommended for in-depth medical and biological examination of qualified athletes. The subjects performed 6 sequentially step-increasing loads on a bicycle ergometer, every 6 minutes of work. At the end of each work, heart rate was determined. The greater the power of work, the less the increase in heart rate, because. the sinus node is exhausting its ability to generate impulses more and more often. Each of us has our own maximum heart rate limit, which is largely determined by age.

The PWC170 test is a functional test to determine physical performance, measured by slave power, which the test subject is able to perform at heart rate = 170 beats per minute.

Orthostatic tests

Orthostatic tests provide important information in those sports that are characterized by a change in body position in space (gymnastics, acrobatics, diving, pole vaulting, freestyle, etc.) In all these sports, orthostatic stability is a necessary condition sports performance. Usually, under the influence of systematic training, orthostatic stability increases, and this applies to all athletes, and not just representatives of those sports in which changes in body position are a mandatory element.

Orthostatic reactions of the athlete’s body are associated with the fact that when the body moves from a horizontal to a vertical position, a significant amount of blood is deposited in its lower half. As a result, the venous return of blood to the heart worsens and, consequently, blood emission decreases (by 20-30%). Compensation for this adverse effect is carried out mainly by increasing heart rate. Changes in vascular tone also play an important role. If it is reduced, then the decrease in venous return can be so significant that when moving to a vertical position, a fainting state may develop due to a sharp deterioration in blood supply to the brain.

In athletes, orthostatic instability associated with decreased venous tone develops extremely rarely. However, during a passive orthostatic test it can be detected. Therefore, the use of orthostatic tests to assess the functional state of the body of athletes is considered appropriate.

Simple orthostatic test characterizes the excitability of the sympathetic division of the autonomic nervous system. Its essence lies in the analysis of changes in heart rate in response to changes in body position during the transition from horizontal to vertical. Pulse indicators are determined in a supine position and after the first minute of being in an upright position. The evaluation of the results is presented in Table 3.

Table 3 – Evaluation of the results of the 1st minute of the orthostatic test

(Makarova G.A., 2003)

With normal excitability of the sympathetic department of the autonomic nervous system, the pulse increases by 12 - 18 beats/min, with increased excitability - more than 18 beats/min.

Active orthostatic test according to Schellong: the subject performs the transition from a horizontal to a vertical position actively, standing up. The response to standing up is studied based on changes in heart rate and blood pressure (BP). These indicators are measured in a lying position, and then for 10 minutes in a standing position.

A natural reaction to an orthostatic test is an increase in heart rate. Due to this, the minute volume of blood flow is slightly reduced. In well-trained athletes, the heart rate increases by 5–15 beats/min. In less trained individuals, this reaction may be less pronounced. Systolic blood pressure remains unchanged or decreases slightly (by 2-6 mm Hg). Diastolic blood pressure increases by 10–15% relative to its value in a horizontal position. During the 10-minute study, systolic pressure returns to baseline values, but diastolic pressure remains elevated.

Modified orthostatic test according to Yu.M. Stoyde When conducting an active orthostatic test, the reaction of the cardiovascular system is to a certain extent associated with muscle tension during 10 minutes of standing. To reduce the influence of this factor, the usual vertical position of the body is changed. The subject stands at a distance of one foot from the wall, leaning his back against it; a cushion with a diameter of 12 cm is placed under the sacrum. This allows the subject to be in a state of significant relaxation (the angle of inclination of the body in relation to the horizontal plane is approximately 75-80°). The results of this test are close to those obtained with a passive orthostatic test.

Passive orthostatic test allows you to most accurately determine orthostatic stability. Changing body position occurs using a turntable. The subject is secured with straps to the table top, which rotates 90° in the vertical plane. Due to this, the position of the body in space changes. The pulse response to a passive test is more pronounced than to an active one.

With normal orthostatic stability during a 10-minute study, the pulse rate does not exceed 89 beats/min. A pulse equal to beats/min indicates a decrease in orthostatic stability. A pulse exceeding 95 beats/min is a sign of low orthostatic stability, which can lead to orthostatic collapse.

In highly qualified athletes, orthostatic stability can be assessed as good, satisfactory and unsatisfactory:

1) good - pulse by 10 minutes of orthostatic position increases by no more than 20 beats/min in men and 25 beats/min in women (compared to the pulse value in a lying position), stabilization of pulse indicators ends no later than the 3rd minute of orthostatic position positions in men and 4 minutes in women, pulse pressure decreases by no more than 35%, well-being is good.

2) satisfactory - the pulse increases by the 10th minute of a vertical position to 30 beats/min in men and 40 beats/min in women. The transition process for the pulse ends no later than the 5th minute in men and the 7th minute in women. Pulse pressure decreases by%, feeling good.

3) unsatisfactory - characterized by a high increase in heart rate by the 10th minute of the orthostatic position: more than 30 beats/min in men and 40 beats/min in women. Pulse pressure decreases by more than 50%. Feeling unwell: dizziness and pallor appear.

Kerdo Vegetative Index (VI) is one of the simplest indicators of the functional state of the autonomic nervous system, in particular, the ratio of the excitability of its sympathetic and parasympathetic departments.

The Kerdo index is calculated based on the values of pulse and diastolic pressure using the formula:

The assessment of the vegetative index is presented in Table 4.

Evaluation of the orthostatic test

The test can be simplified by adjusting it immediately after getting up, that is, for 1 minute in a vertical position, then for 5 and 10 minutes.

According to the author, with good orthostatic stability, the pulse in the 10th minute of the orthostatic position increases by no more than 20 beats per minute for men and 25 beats for women compared to the pulse value in the supine position, the state of health is good. With satisfactory orthostatic stability, the pulse quickens by 30 beats per minute in men, in women up to 40 beats, the state of health is good. If unsatisfactory, the pulse may increase in beats per minute or more, dizziness, poor health are noted, the face turns pale, and fainting may even develop. Therefore, if your health worsens, the test should be canceled to avoid orthostatic collapse.

Deterioration of orthostatic stability can be observed with overfatigue, overtraining, after illnesses, with vegetative-vascular dystonia, etc.

Clinical orthostatic test. This test is carried out in reverse order. After standing for 10 minutes, the subject lies down again. Immediately after moving to a horizontal position, and then 3-5 minutes, pulse and blood pressure are measured.

The range of normal limits for increased heart rate during an orthostatic test is equal to beats per minute. Systolic pressure does not change or decreases at the beginning of standing by 5-15 mm Hg, and then gradually increases. Diastolic pressure usually increases by 5-10 mm Hg. With a clinical orthostatic test, the changes are of the opposite nature.

Ruffier test represents a fairly significant load. The athlete's pulse is measured in a sitting position (after a 5-minute rest) (P1), then he performs 30 squats in 30 seconds, after which the pulse is immediately measured in a standing position (P2). Then the subject rests while sitting for a minute and the pulse is counted again (P3 ). All calculations are carried out at 15 second intervals. The value of the Ruffier sample index is calculated using the formula

When the index value is less than 0, adaptability to load is assessed as excellent, 0-5 – mediocre, – weak, 15 – unsatisfactory.

Sample S.P. Letunova. This is a combined functional test, widely used both in self-monitoring of health and in the practice of medical supervision.

Evaluation of the test results by S.P. Letunova is not quantitative, but qualitative. It is carried out by studying the so-called types of reactions.

Other types of reactions to S.P. Letunov’s test are designated as atypical. Some may experience a so-called hypertensive type of reaction: a sharp increase in systolic blood pressure up to 100 m Hg. Art., and diastolic blood pressure either does not change or increases. The hypertensive type of reaction is associated with the phenomenon of overwork or overtraining.

Hypotonic type of reactions is characterized by a slight increase in systolic blood pressure, in response to the load, accompanied by a rare increase in heart rate at the 2nd and 3rd loads (bpm). Recovery of heart rate and blood pressure is slow. This type of reaction is considered unfavorable.

Dystonic type of reaction is characterized mainly by a decrease in minimum blood pressure, which after the 2nd and 3rd loads becomes equal to zero (“infinite current phenomenon”). Systolic blood pressure in these cases increases by 100 m Hg.

An indicator of the activity of the cardiovascular system is endurance coefficient (EF). Grade HF is based on an analysis of heart rate, systolic and diastolic pressure and is calculated according to Kwasi's formula:

We remind you that - pulse blood pressure = systolic blood pressure – diastolic blood pressure.

Normally, the CV value is conventional units. Its increase indicates a weakening of the activity of the cardiovascular system, and its decrease indicates an increase in the activity of the cardiovascular system.

There is some interest circulatory efficiency coefficient (CEC), characterizing the minute volume of blood (the minute volume of blood indicates the intensity of work of all circulatory systems and increases in proportion to the severity of the work performed. On average, the minute volume is -35 l/min.).

KEC= pulse blood pressure * heart rate

Normally, the KEK value is 2600. With fatigue, the KEK value increases.

An indicator of the state of the autonomic nervous system, which regulates the cardiovascular system, is Kerdo index.

In healthy people, the Kerdo index is equal to 1. When the nervous regulation of the cardiovascular system is disturbed, the Kerdo index becomes either more than 1 or less than 1.

For children under 8 years old, the height of the step should be 35 cm, the time of ascent and descent should be 2 minutes; for 8-11 year olds – step height 35 and time – 3 minutes; for one-year-old boys - 50 cm, for girls of this age 40 cm, time for both - 4 minutes; over 18 years old – men – step height – 50 cm, time – 5 minutes; for women, respectively – 45 and 4 minutes. The rate of ascent is constant and equals 30 cycles per minute. Each cycle consists of 4 steps: put one foot on the step, substitute the second; We lower one leg and put the other one on.

If during the test the subject shows external signs of excessive fatigue: pale face, stumbling, etc., then the test should be stopped.

The result of this test is expressed quantitatively by the index Harvard Step Test (IGST). It is calculated by the formula:

IGST= ; where t is the ascent time in seconds.

The number of pulse beats in the first 30 seconds in the second, third and fourth minutes of recovery, respectively.

During mass examinations, you can use an abbreviated formula for calculating IGST, which provides for only one pulse count in the first 30 seconds of the second minute of recovery.

IGST= ;where the designations are the same

Physical performance is assessed as weak if the IGST is less than 55; below average – 55-64; average – 65-79; good – 80-89; excellent – 90 or more.

Cooper's 12-minute running test is an endurance test. During the test, you need to cover (run or walk) as much distance as possible (you must not overexert yourself and avoid shortness of breath).

Only sufficiently prepared people can undergo testing. Compare the results obtained with the data in Table 5.

12-minute test for men (distance, km)

Hemodynamic functional tests to study the regulation of peripheral circulation

Orthostatic test according to Schellong I

When the body is in an upright position, the blood, according to the law of gravity, falls down, which leads to a decrease in pressure in the carotid sinus. This causes the appearance of a reflex of self-regulation of blood circulation in two directions:

a) In the venous bed in the area of the celiac nerve, blood is mobilized from the depot and supplied to the heart; at the same time, normal pulse volume is maintained and arterial blood supply is ensured, especially to the brain; systolic pressure is almost unchanged. The contraction of the muscles of the legs also promotes the outflow of blood.

b) In the arterial system, contraction of collateral vessels occurs, which is clinically manifested by an increase in diastolic pressure.

With an orthostatic test, the pulse quickens.

Execution method. In a supine position, the patient's systolic and diastolic pressure is measured repeatedly at one-minute intervals (using the auscultatory method on the right arm) and the pulse is counted.

Then the patient gets up and stands for 10 minutes without any tension. Now, upon getting up and then at the end of every minute, blood pressure and pulse are checked. Finally, the patient lies down, and after 1/2, 1, 2 and 3 minutes his blood pressure and pulse rate are measured again.

The cuff of the blood pressure device remains on the arm during the study; The cuff must be completely deflated with each measurement.

Grade. In healthy people, the optimal circulatory response should be considered the same indices in a standing and lying position.

Physiological limits of fluctuations: for pulse (especially in adolescence) - an increase of 10, 20 and up to 40 beats per minute, for systolic pressure - no change or an initial decrease of at most 15 mm Hg, followed by leveling off to normal.

The pathological reaction is shown in Fig. 13, B. The course of the curve more clearly reflects the reaction of blood circulation than absolute digital indicators.

Orthostatic test as a functional test for varicose veins. Varicose veins develop mainly in the lower extremities, which are especially susceptible to hydrostatic pressure, and arise due to damage to the vascular walls (disappearance of the muscle layer), and dilation of the veins with the appearance of insufficiency of the venous valves. When standing, a significant amount of blood is retained in the areas of varicose veins, which is therefore excluded from the general circulation. Blood pressure drops significantly. When a patient works in a standing position, signs of brain hypoxia appear (feeling of fatigue, dizziness, blurred vision). An idea of blood retention in varicose veins can be obtained using an orthostatic test.

Execution method. With the body in a horizontal position, the legs are bandaged with an elastic bandage from bottom to top and the pulse and blood pressure are repeatedly determined. After this, the patient stands up, and all measurements are taken on him, as with the Shellong I test.

After 5 minutes of standing, the bandages are removed. Blood pressure immediately drops abruptly, and patients usually complain of dizziness.

Note. They do the same thing when they want to find out the role of relaxation of the abdominal muscles in the hypotonic symptom complex.

To do this, the torso is tightly bandaged, starting from the bottom, with a wide strip of material, and then further examination is carried out in the same way as in the case of a test for varicose veins.

The results of these tests allow us to come to therapeutic conclusions (wearing elastic bandages, rubber stockings, correctly applied bandage).

Problems with the cardiovascular system are a mandatory reason to seek medical help. Such diseases often lead to severe complications, disability and even death. For this reason, it is necessary to be examined in time and begin treatment. Pathologies of the cardiovascular system can occur for many reasons and have various manifestations. Some patients have an asymptomatic course of ailments, which makes timely diagnosis difficult and often leads to decompensation of the process. There are many examinations to assess the state of the cardiovascular system. One of them is the orthostatic test. It is carried out in patients in whom it is difficult to identify the disease or its cause due to the absence of a characteristic picture or the initial stage.

Orthostatic test: indications for the study

The study is carried out in various diseases associated with dysfunction of the cardiovascular system and its innervation. An orthostatic test is necessary to assess blood flow, since in pathologies it can slow down or, conversely, increase. Most often in diseases there is a delay in venous return. As a result, various orthostatic disorders occur. They are expressed by the fact that a person may experience discomfort when changing the position of the body from horizontal (or sitting) to vertical. The most common are dizziness, darkening of the eyes, low blood pressure and fainting. Complications of orthostatic disorders are: with the development of angina pectoris and myocardial infarction, collapse. The reasons can be not only changes in the blood flow itself, but also in the nervous structures responsible for it. In this regard, disorders can be associated with both cardiac pathology and the central nervous system. The main indications are: changes in blood pressure (both hyper- and hypotension), blood circulation, autonomic nervous system.

Types of orthostatic tests

Research can be carried out in different ways. There is both an active and a passive orthostatic test. The difference lies in the functional load on the patient's muscular apparatus. An active test implies an independent transition of the patient from a horizontal to a vertical position. As a result of this, almost everything is reduced. For a passive test, a special table is required, to which the patient is fixed. In this case, the load on the muscles can be avoided. This study allows you to assess the state of hemodynamics before and after a change in body position. Normally, for each person, the main indicators change due to a slight change in pressure, as well as due to physical activity. In case of insufficiency of the cardiovascular system, an increase (less often a decrease) in the difference between blood pressure and heart rate is observed before and after the test.

Methods for conducting an orthostatic test

Depending on the type of orthostatic test, the methods used differ slightly from each other. The most common is the Shellong method. This method is regarded as an active orthostatic test. How to conduct a study on Shellong?

Interpretation of results

Despite the fact that changes in hemodynamic parameters when changing body position occur in every person, there are average indicators. Deviation from the norm in the direction of increasing and decreasing heart rate and blood pressure indicates disturbances in the functioning of the cardiovascular or nervous system. When the patient is lying down or sitting, the blood is distributed throughout the body and slows down. When a person gets up, it starts to move and goes through the veins to the heart. When blood stagnates in the lower extremities or abdominal cavity, the orthostatic test indicators differ from normal. This indicates the presence of the disease.

Orthostatic test: norm and pathology

When assessing the results, pay attention to systolic and diastolic blood pressure, heart rate, and autonomic manifestations. The ideal indicator is an increase to 11 beats/min, a slight increase in other parameters and the absence of reactions from the nervous system. Light sweating and constant blood pressure before and after the examination are allowed. An increase in heart rate of 12-18 beats/min is considered satisfactory. An orthostatic test with a large increase in pulse and diastolic pressure, severe sweating and tinnitus, and a decrease in systolic blood pressure indicates serious hemodynamic disturbances.

Study of primary indicators.

– Pulse counting;
– Blood pressure measurement: diastolic, systolic, pulse, average dynamic, minute blood volume, peripheral resistance;

Study of initial and final indicators during test actions:

– Ruffier's test - dynamic load tolerance; endurance coefficient);
Vegetative status assessment:

–
–
Calculated index of the adaptive potential of the cardiovascular system.
– Index R.M. Baevsky et al., 1987.

DESCRIPTION OF METHODS

STUDY OF PRIMARY INDICATORS.
Assessment of the degree of tension of regulatory mechanisms:
– Pulse counting;
– Blood pressure measurement: diastolic, systolic, pulse, average dynamic, minute blood volume, peripheral resistance;
Pulse counting. Normal indicator: 60 – 80 beats. per minute
Diastolic or minimum pressure (MP).
Its height is mainly determined by the degree of patency of the precapillaries, heart rate and the degree of elasticity of the blood vessels. The greater the resistance of the precapillaries, the lower the elastic resistance of large vessels, and the greater the heart rate, the higher the DD. Normally, in a healthy person, DD is 60-80 mm Hg. Art. After loads and various types of influences, DD does not change or decreases slightly (up to 10 mm Hg). A sharp decrease in the level of diastolic pressure during work or, conversely, its increase and a slow (more than 2 minutes) return to initial values is regarded as an unfavorable symptom. Normal indicator: 60 – 89 mm. rt. Art.
Systolic or maximum pressure (MP).
This is the entire energy reserve that a blood stream actually possesses in a given area of the vascular bed. The lability of systolic pressure depends on the contractile function of the myocardium, the systolic volume of the heart, the state of elasticity of the vascular wall, hemodynamic shock and heart rate. Normally, in a healthy person, DM ranges from 100 to 120 mm Hg. Art. With load, DM increases by 20-80 mmHg. Art., and after its cessation returns to the original level within 2-3 minutes. Slow recovery of initial DM values is considered as evidence of insufficiency of the cardiovascular system. Normal indicator: 110-139 mm. rt. Art.
When assessing changes in systolic pressure under the influence of load, the resulting shifts in maximum pressure and heart rate are compared with the same indicators at rest:
(1)

SD		SDR - SDP		100%
		SDP

Heart rate		CzechSr - ChSSp		100%
		HRSp

where SDr, heart rate is systolic pressure and heart rate during work;
MDP, HRSP - the same indicators at rest.
This comparison allows us to characterize the state of cardiovascular regulation. Normally, it is carried out due to changes in pressure (1 greater than 2); in heart failure, regulation occurs due to an increase in heart rate (2 greater than 1).
Pulse pressure (PP).
Normally, in a healthy person it is about 25-30% of the minimum pressure. Mechanocardiography allows you to determine the true value of PP, equal to the difference between the lateral and minimum pressure. When determining PP using the Riva-Rocci apparatus, it turns out to be somewhat overestimated, since in this case its value is calculated by subtracting the minimum value from the maximum pressure (PD = SD - PP).
Mean dynamic pressure (SDP).
It is an indicator of the consistency of the regulation of cardiac output and peripheral resistance. In combination with other parameters, it makes it possible to determine the state of the precapillary bed. In cases where the determination of blood pressure is carried out according to N. S. Korotkov, the ADD can be calculated using the formulas:
(1)

SDD		PD		DD

SDD = DD + 0.42 x PD.
The value of the SDD calculated using formula (2) is slightly higher. Normal indicator: 75-85 mm. rt. st.
Minute blood volume (MO).
This is the amount of blood pumped by the heart per minute. MO is used to judge the mechanical function of the myocardium, which reflects the state of the circulatory system. The value of MO depends on age, gender, body weight, ambient temperature, and intensity of physical activity. Normal value: 3.5 – 5.0 l.
The MO norm for the resting state has a fairly wide range and significantly depends on the determination method:
The simplest way to determine the MO, which allows you to roughly determine its value, is to determine the MO using the Starr formula:
CO = 90.97 + 0.54 x PD – 0.57 x DD – 0.61V;
MO = CO-HR
where CO is the systolic blood volume, Ml; PP - pulse pressure, mm Hg. st; DD - minimum pressure, mm Hg. Art.; B - age, in years.
Liljetrand and Zander proposed a formula for calculating MO, based on the calculation of the so-called reduced pressure. To do this, first determine the SDD using the formula:

hence MO = RAD x HR.
In order to possibly more objectively assess the observed changes in MO, you can also calculate the proper minute volume: DMO = 2.2 x S,
where 2.2 is cardiac index, l;
S is the surface of the subject’s body, determined by the Dubois formula:
S = 71.84 M ° 425 R 0725
where M is body weight, kg; P - height, cm;
or

DMO		preschool educational institution

where DOO is the proper basal metabolic rate, calculated in accordance with the data of age, height and body weight according to the Harris-Benedict tables.
A comparison of MO and DME allows us to more accurately characterize the specifics of functional changes in the cardiovascular system caused by the influence of various factors.
Peripheral resistance (PR).
Determines the constancy of the average dynamic pressure (or its deviation from the norm). Calculated using the formulas:

where SI is the cardiac index, equal on average to 2.2 ±0.3 l/min-m2.
Peripheral resistance is expressed either in conventional units or in dynes. Normal indicator: 30 - 50 conventional units. units The change in PS during work reflects the reaction of the precapillary bed, depending on the volume of circulating blood.

STUDY OF INITIAL AND FINAL INDICATORS WHEN CARRYING OUT TEST IMPACTS.
Assessment of functional reserves:
– Martinet test - assessment of the ability to recover after physical exercise. loads;
– Squat test - a characteristic of the functional usefulness of the cardiovascular system;
– Flack test - allows you to evaluate the function of the heart muscle;
– Ruffier's test - dynamic load tolerance; endurance coefficient;
1. Martinet's test(simplified technique) is used in mass studies and allows assessing the ability of the cardiovascular system to recover after physical activity. Depending on the population of subjects, 20 squats at 30C and squats at the same pace for 2 minutes can be used as a load. In the first case, the period lasts 3 minutes, in the second - 5. Before the load and 3 (or 5) minutes after its completion, the subject’s heart rate, systolic and diastolic pressure are measured. The sample is assessed based on the difference between the studied indicators before and after the load:
if the difference is no more than 5 - “good”;
with a difference from 5 to 10 - “satisfactory”;
if the difference is more than 10 - “unsatisfactory”.
2. Squat test. Serves to characterize the functional usefulness of the cardiovascular system. Methodology: a person’s heart rate and blood pressure are calculated twice before exercise. Then the subject performs 15 squats in 30 seconds or 60 in 2 minutes. Immediately after the end of the load, the pulse is counted and the pressure is measured. The procedure is repeated after 2 minutes. If the subject is in good physical condition, the test at the same pace can be extended to 2 minutes. To evaluate the sample, the reaction quality indicator is used:

RCC		PD2 – PD1
		P2-P1

where PD2 and PD1) are pulse pressure before and after exercise; P 2 and P1 - heart rate before and after exercise.
3. Flack test. Allows you to evaluate the function of the heart muscle. Methodology: the subject maintains a pressure of 40 mm Hg in the U-shaped tube of a mercury manometer with a diameter of 4 mm for the maximum possible time. Art. The test is performed after a forced inhalation with the nose pinched. During its implementation, the heart rate is determined every 5C. The evaluation criterion is the degree of increase in heart rate in relation to the initial one and the duration of maintaining pressure, which in trained people does not exceed 40-50C. According to the degree of heart rate increase over 5C, the following reactions differ: no more than 7 beats. - good; up to 9 beats - satisfactory; up to 10 beats - unsatisfactory.
Before and after the test, the subject's blood pressure is measured. Impaired functions of the cardiovascular system lead to a decrease in blood pressure, sometimes by 20 M;M Hg. Art. and more. The sample is assessed according to the reaction quality indicator:

Pkr		T1DM – T2DM
		T1DM

where DM 1 and DM2 are systolic pressure initially and after the test.
When the cardiovascular system is overloaded, the RCC value exceeds 0.10-0.25 rel. units
systems.
4. Ruffier's test (dynamic load tolerance)
The subject is in a standing position for 5 minutes. The pulse /Pa/ is calculated in 15 seconds, after which physical activity is performed / 30 squats per minute /. The pulse is re-calculated for the first /Рб/ and last /Рв/ 15 seconds of the first minute of recovery. When counting the pulse, the subject must stand. The calculated indicator of cardiac activity /CDA/ is a criterion for the optimal autonomic support of the cardiovascular system when performing low-power physical activity

PSD	4 x (Ra + Rb + Rv) - 200

Sample interpretation: if the PSD is less than 5, the test is performed “excellent”;
if the PSD is less than 10, the test is performed “good”;
if PSD is less than 15 – “satisfactory”;
with PSD more than 15 - "bad".
Our studies suggest that in healthy subjects the PSD does not exceed 12, and patients with neurocircular dystonia syndrome, as a rule, have a PSD of more than 15.
Thus, periodic monitoring of PSD provides the doctor with a fairly informative criterion for assessing the adaptive potential of the cardiovascular system.
5. Endurance factor. It is used to assess the degree of fitness of the cardiovascular system to perform physical activity and is determined by the formula:

HF		Heart rate x 10
		PD

where HR is heart rate, beats/min;
PP - pulse pressure, mm Hg. Art.
Norm indicator: 12-15 arb. units (according to some authors 16)
An increase in KB associated with a decrease in PP is an indicator of detraining of the cardiovascular system, a decrease in fatigue.

ASSESSMENT OF VEGETATIVE STATUS:
– Kerdo index - the degree of influence of the autonomic nervous system on the cardiovascular system;
– Active orthotest - level of vegetative-vascular stability;
– Orthostatic test - serves to characterize the functional usefulness of reflex mechanisms for regulating hemodynamics and assessing the excitability of the centers of sympathetic innervation;
– Ocular heart test - used to determine the excitability of the parasympathetic centers for regulating heart rate;
– Clinostatic test - characterizes the excitability of the centers of parasympathetic innervation.
1. Kerdo index (degree of influence on the cardiovascular system of the autonomic nervous system)

VI=	1 –	DD
		Heart rate

DD - diastolic pressure, mmHg;
Heart rate - heart rate, beats/min.

Normal indicator: from – 10 to + 10%
Sample interpretation: a positive value - the predominance of sympathetic influences, a negative value - the predominance of parasympathetic influences.
2. Active orthotest (level of vegetative-vascular resistance)
The test is one of the functional stress tests; it allows you to assess the functionality of the cardiovascular system, as well as the state of the central nervous system. A decrease in the tolerance of orthostatic tests (active and passive) is often observed in hypotonic conditions in diseases accompanied by vegetative-vascular instability, in asthenic conditions and fatigue.
The test should be carried out immediately after a night's sleep. Before starting the test, the subject must lie quietly on his back for 10 minutes, without a high pillow. After 10 minutes, the subject’s pulse rate is counted three times in a lying position (counting for 15 s) and the blood pressure is determined: maximum and minimum.
After receiving the background values, the subject quickly gets up, takes a vertical position and stands for 5 minutes. In this case, every minute (in the second half of each minute) the frequency is calculated and blood pressure is measured.
Orthostatic test (OI - orthostatic index) is assessed according to the formula proposed by Burchard-Kirhoff.

Sample interpretation: Normally, the orthostatic index is 1.0 - 1.6 relative units. For chronic fatigue, RI = 1.7-1.9, for overfatigue, RI = 2 or more.
3. Orthostatic test. Serves to characterize the functional usefulness of reflex mechanisms for regulating hemodynamics and assessing the excitability of the centers of sympathetic innervation.
After 5 minutes of lying down, the subject's heart rate is recorded. Then, on command, the subject calmly (without jerking) takes a standing position. The pulse is calculated at the 1st and 3rd minutes of being in an upright position, blood pressure is determined at the 3rd and 5th minutes. The sample can be assessed by pulse alone or by pulse and blood pressure.

Gradeorthostatic test
Indicators	Sample tolerance
Indicators	good	satisfactory	unsatisfactory
Frequency heart abbreviations	Increase in speed by no more than 11 beats.	Increase in 12-18 beats.	Increase in frequency by 19 beats. and more
Systolic pressure	Rising	Does not change	Decreases within 5-10 mm Hg. Art.
Diastolic pressure	Rising	Does not change or increases slightly	Rising
Pulse pressure	Rising	Doesn't change	Decreasing
Vegetative reactions	Missing	Sweating	Sweating, tinnitus

The excitability of the centers of sympathetic innervation is determined by the degree of heart rate increase (PS), and the usefulness of autonomic regulation is determined by the time of pulse stabilization. Normally (in young people), the pulse returns to its original values at 3 minutes. The criteria for assessing the excitability of sympathetic units according to the SUP index are presented in the table.

4. Ocular heart test. Used to determine the excitability of the parasympathetic centers for regulating heart rate. It is carried out against the background of continuous ECG recording, during which pressure is applied to the eyeballs of the subject for 15 C (in the direction of the horizontal axis of the orbits). Normally, pressure on the eyeballs causes the heart rate to slow down. Increased rhythm is interpreted as a perversion of the reflex, which occurs according to the sympathicotonic type. You can monitor your heart rate by palpation. In this case, the pulse is counted 15C before the test and during pressure.
Sample rating:
decrease in heart rate by 4 - 12 beats. in min – normal;
decrease in heart rate by 12 beats. per minute – sharply enhanced;
no reduction – areactive;
no increase in frequency – perverted.

5. Clinostatic test.
Characterizes the excitability of the centers of parasympathetic innervation.
Method of behavior: the subject smoothly moves from a standing position to a lying position. The pulse rate in vertical and horizontal positions is counted and compared. The clinostatic test is normally manifested by a slowing of the pulse by 2-8 beats.
Assessment of excitability of parasympathetic innervation centers

Excitability	Deceleration ratepulse during wedge test, %
Normal:
weak	Up to 6.1
average	6,2 - 12,3
live	12,4 - 18,5
Increased:
weak	18,6 - 24,6
noticeable	24,7 - 30,8
significant	30,9 - 37,0
sharp	37,1 - 43,1
very sharp	43.2 or more

CALCULATION INDEX OF ADAPTATION POTENTIAL OF THE CARDIOVASCULAR SYSTEM.
1. Calculated index of the adaptive potential of the cardiovascular system R.M. Baevsky et al., 1987.
Recognition of functional states based on the analysis of data on autonomic and myocardial-hemodynamic homeostasis requires certain experience and knowledge in the field of physiology and clinical practice. In order to make this experience available to a wide range of doctors, a number of formulas have been developed that make it possible to calculate the adaptive potential of the circulatory system according to a given set of indicators using multiple regression equations. One of the simplest formulas, providing a recognition accuracy of 71.8% (compared to expert estimates), is based on the use of the simplest and most commonly available research methods - measuring heart rate and blood pressure levels, height and body weight:

AP = 0.011(PR) + 0.014(SBP) + 0.008(DBP) + 0.009(BW) - 0.009(P) + 0.014(B)-0.27;

Where AP- adaptive potential of the circulatory system in points, Emergency- pulse rate (bpm); GARDEN And DBP- systolic and diastolic blood pressure (mm Hg); R- height (cm); MT- body weight (kg); IN- age (years).
Based on the values of adaptation potential, the patient’s functional state is determined:
Sample interpretation: below 2.6 - satisfactory adaptation;
2.6 - 3.09 - tension of adaptation mechanisms;
3.10 - 3.49 - unsatisfactory adaptation;
3.5 and higher - adaptation failure.
A decrease in adaptation potential is accompanied by a slight shift in the indicators of myocardial-hemodynamic homeostasis within the limits of their so-called normal values, the tension of regulatory systems increases, and the “payment for adaptation” increases. Failure of adaptation as a result of overstrain and exhaustion of regulatory mechanisms in older people is characterized by a sharp drop in the reserve capacity of the heart, while in young people there is even an increase in the level of functioning of the circulatory system.

OTHER METHODS

Determination of the type of self-regulation of blood circulation makes it possible to assess the level of tension in the regulation of the cardiovascular system. An express method for diagnosing the type of self-regulation of blood circulation (TSC) has been developed:

TSC from 90 to 110 reflects the cardiovascular type. If the index exceeds 110, then the type of self-regulation of blood circulation is vascular, if less than 90 – cardiac. The type of self-regulation of blood circulation reflects the phenotypic characteristics of the organism. A change in the regulation of blood circulation towards the predominance of the vascular component indicates its economization and an increase in functional reserves.