Orthostatic test evaluates. Definition and assessment of the functional state

It gives an idea of the sympathetic division of the autonomic nervous system, it is often used in the study of the cardiovascular system of an athlete, as it allows one to judge the regulation of vascular tone. An orthostatic test consists in transferring 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 with a decrease in the adaptive capacity of the circulatory apparatus: the blood supply to the brain can significantly suffer, which is expressed in the development of the so-called orthostatic collapse. Orthostatic test as a method of functional diagnostics is often used in clinical practice. It is carried out in the examination of working capacity, in the diagnosis of hypotonic conditions and in other cases. It has found wide application in the examination of pilots and astronauts. A very promising orthostatic test, carried out in various versions, turned out to be in the examination of 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 of the cerebral cortex has been revealed (if its functional state is disturbed, for example, in neurosis, these regulatory effects are disturbed) and humoral factors, among which catecholamines have the main effect on vascular tone. Decrease in venous tone, observed in overwork, overtraining, disease state, is associated with discoordination of the links that provide both its regulation and the activity of the heart. At the same time, 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 fainting can be observed.

When the skeletal muscles contract, the 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 that prevent its stagnation in the limbs. Among other factors, one should point out the influence of the residual energy of the heart impulse, negative pressure in the chest cavity, and, to some extent, arteriovenous shunts, which make direct connections between small arteries and veins, are important for the movement of blood through the veins.

It is known that deep veins are surrounded by muscles, and even in a calm state there is some contraction of them, exerting pressure on the veins, sufficient to push blood through the venous valves in the direction of 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 dramatically. The blood flow to the heart also increases with the contraction of the abdominal muscles (blood is forced out of the vessels of the liver, spleen, intestines).

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

Orthostatic test according to Schellong 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. Stoida (1974) suggested changing the vertical position of the subject to another one, in which his legs are at a distance of one foot from the wall, and the subject himself leans on it with his back, a roller with a diameter of 12 cm is placed under the sacrum. With this position, a more pronounced relaxation of the muscles is achieved. The angle of inclination of the body relative to the horizontal plane is about 75°.

For a passive orthostatic test, a turntable 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 interruption of the subject in a vertical position up to 20 minutes. When conducting an orthostatic test, heart rate (HR) and blood pressure (BP) are usually recorded, however, if the appropriate equipment is available, the study can be supplemented, for example, by recording a polycardiogram and a plethysmogram.

On the basis of numerous data from the study 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 value of heart rate in supine position), the transient 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., every minute fluctuation in the value of heart rate does not exceed 5%), the 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 transient process for heart rate ends in men no later than the 5th minute, and in women - the 7th minute of the orthostatic position. Pulse pressure decreases by 36-60% (in relation to the lying position), the state of health is 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, pallor of the face, dizziness. The development of orthostatic collapse is evidence of a particularly adverse reaction to the test (to prevent it, the test should be stopped if you feel worse and dizzy).

Numerous studies suggest that an increase in heart rate 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, dizziness. If at the same time the test is not stopped, then orthostatic collapse develops. We noted such reactions during forced training (especially those carried out in the middle mountains), in a state of overstrain, overtraining, and also during the period of recovery after an illness.

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

A.F. Sinyakov proposes the following method for conducting an orthostatic test. The subject rests in the supine position for 10 minutes. At the 11th minute, the pulse is calculated for 20 seconds, converted to 1 minute. Then stand up, lean against the wall with your back, so that your legs are one foot away from the wall. In this position, you need to be 10 minutes, counting the pulse every minute and noting how you feel. The data is recorded in protocol format.

The test can be simplified by adjusting immediately after getting up, that is, at 1 minute of the vertical position, then at 5 and 10 minutes.

According to the author, with good orthostatic stability, the pulse at 10 minutes of the orthostatic position increases by no more than 20 beats per minute for men and 25 beats for women compared to the pulse in the prone position, and 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, feeling unwell, the face turns pale, and fainting may even develop. Therefore, if you feel worse, in order to avoid orthostatic collapse, the test should be canceled.

Deterioration of orthostatic stability can be observed with overwork, overtraining, after illnesses, with vegetovascular dystonia, etc.

Clinical orthostatic test . This test is carried out in reverse order. The subject after 10 minutes of standing again lie down. Immediately after the transition to a horizontal position, and then 3-5 minutes, the 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 rises by 5-10 mmHg. In the clinical-orthostatic test, the changes are opposite.

The main role in the reaction of the heart when changing the position of the body is played by the so-called Starling mechanism (“the law of the heart”). An increase in venous blood flow to the heart in the supine position and upside down leads to a “ventricular volume load”, increasing the force of cardiac contraction. In the standing position, venous return (blood flow) decreases, "ventricular volume underload" develops, accompanied by phase signs of hypodynamia.

Rufier test is a fairly significant burden. The athlete in a sitting position (after a 5-minute rest) measures the pulse (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 in 15 second intervals. The value of the Rufier sample index is calculated by the formula

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

If the index value is less than 0, the adaptability to the 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 control.

The test is designed to assess the adaptation of the human body to high-speed work and endurance. The test consists of three loads: the first is 20 squats performed in 30 seconds; the second is a 15 second run in place at a 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 subject recorded the recovery of heart rate and blood pressure. These data are recorded throughout the rest period between loads.

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

In healthy and physically trained people, the normotonic type of reaction to the test is most often noted. 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.

Reaction types

With a normotonic type of reaction to all types of loads, the maximum blood pressure increases and the minimum blood pressure decreases. These changes in response to 20 squats are small, and in response to 15-second and 3-minute runs are quite pronounced. So, at the 1st minute of the recovery period, the maximum blood pressure rises to 160-210 mm Hg. Art. An important criterion for a normotonic reaction is the rapid recovery of heart rate and blood pressure to a resting level.
Other types of reactions to the sample of S.P. Letunov are designated as atypical. Some may experience the so-called hypertonic 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 hypertonic 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 on the 2nd and 3rd load (up to 170-190 beats / min). Recovery of heart rate and blood pressure is slowed down. This type of reaction is considered unfavorable.
Dystonic type of reaction 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 current”). Systolic blood pressure in these cases rises to 180-200 mm Hg.

With the deterioration of the functional state of the body, a reaction with a stepwise rise in systemic blood pressure can 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 (KV). Grade HF is based on the analysis of heart rate, systolic and diastolic pressure and is calculated from Kwasi formula:

Remember, - Pulse BP = systolic BP – diastolic BP.
Normally, the value of CV 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 coefficient of efficiency of blood circulation (CEC) , which characterizes 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.).
KEK\u003d BP pulse * HR

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

Kerdo index: BP minimum: heart rate

In healthy people, the Kerdo index is 1. If the nervous regulation of the cardiovascular system is disturbed, the Kerdo index becomes either greater than 1 or less than 1.

The simplest, most accessible, and at the same time indicative, is the so-called Harvard step test allows you to objectively assess physical performance (step test is climbing stairs and descending from it.). The essence of this method is that the ascent to and descent from 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 1 minute. Each cycle consists of 4 steps: put one foot on the step, substitute the second; lower one leg, put the other.

After performing the test in 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 has external signs of excessive fatigue: pale face, stumbling, etc., then the test should be stopped.

The result of this test is quantified 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 heartbeats in the first 30 seconds in the second, third and fourth minutes of recovery, respectively.

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

IGST = ; where the designations are the same

Physical performance is assessed as weak if 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 overcome (run or walk) as much distance as possible (you can not overexert and prevent shortness of breath).

Only qualified people can take the test. 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, with a sharp change in body position, from dizziness, lowering blood pressure and even fainting. The orthostatic test is designed to fix these sensations according to physiological characteristics.

Methods

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 conduct tests for several days, then you need to conduct them 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 active orthostatic testing.

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 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 position of the body,
(2) when standing up or moving the table to a vertical position,
(3) three minutes after going upright.

Evaluation of results

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

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

If, after rising to a vertical position, your heart rate increased by 1 beats per minute or even less, and then after three minutes of standing it stabilized to + 0-10 beats from the initial (measured lying down), then your orthostatic test readings are normal. In addition, it speaks of good fitness.
A greater change in heart rate (up to +25 beats per minute) indicates poor body fitness - you should spend more time exercising and eating healthy.
An increase in heart rate by 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 the body is raised to a vertical position. The principle of this oblique test is aimed at establishing dysfunctions in the activity of the three divisions 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 an incorrect 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 contributes to a decrease in venous return to the heart, which in turn provides a minute volume of blood circulation.

Orthostatic dysfunctions of blood flow

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

orthostatic hypotension. It is characterized by impaired blood supply to the brain. Since the head is the extreme point on top of the body, when hemodynamic processes are disturbed, 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. During standing up, the intensity of blood flow decreases, thereby reducing the volume of liquid mobile connective tissue that goes directly to the heart.

Orthostatic test: classification, basic concepts and types of loads

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

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 the gravitational change in the position of the body. This results in increased blood pressure and an increased heart rate.
Hyposympathicotonic type. Accompanied by a rapid decrease in blood pressure, in 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 assumes 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 on a special device, which ensures the exclusion of the contribution of skeletal muscle contractions. With this examination, the patient can be connected to ECG and plethysmography sensors. This approach allows a more thorough study of the activity of the heart and the dynamics of blood filling of individual organs.

Orthostatic blood flow disorders are also diagnosed using a pharmacological method. It consists in taking adrenomimetics 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 to diagnose:

Dysfunctions of the activity of the autonomic nervous system.
Hypertension.
Ischemic heart disease.

Also, this examination helps to establish control over the state of health during drug therapy, which can cause orthostatic blood flow disorders.

In the life of every person, there have repeatedly been cases of weakness or dizziness with a sharp adoption of 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, it is recommended to carry out orthostatic tests.

The results of this examination are established on the basis of heart rate and their difference in the horizontal and vertical position of the body. A normal indicator is an increase in heart rate by no more than 20 beats in 60 seconds. The doctor provides the final conclusion only after a full 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 the functional state

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 prone 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. The subject is then asked to stand up slowly. The 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. It is possible to make an assessment even only on heart rate indicators.

Orthostatic test evaluation

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, and diastolic blood pressure may remain elevated.

Thus, the results of the orthostatic test make it possible to easily and quickly assess the regulation of the 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.

Definition and evaluation of the functional state. Tests with a change in body position in space

Orthostatic test

1. Evaluation of changes in heart rate and blood pressure or only heart rate for the first seconds after the transition to a vertical position;

2. Evaluation of changes in heart rate and blood pressure or only heart rate after 1 minute of being in a vertical position;

3. Evaluation of changes in heart rate and blood pressure or only heart rate for the first seconds after the transition to a vertical position, and then after 3 minutes of being in a vertical position.

A normal reaction to the test is an increase in heart rate per beat for 1 minute immediately after lifting. 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 the 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 minute;

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

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

Orthostatic test and other health monitoring methods

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 organism 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, striving for activity (study, work, sports), high working capacity.

For self-control, the duration of the working day is noted (divided into industrial and domestic employment) and a separate assessment of working capacity is given.

Sleep is considered normal, coming soon after a person has gone to bed, strong enough, with awakening, giving a feeling of cheerfulness and rest. Poor sleep is characterized by a long period of falling asleep or early awakening, awakening in the middle of the night. After such a dream, there is no feeling of cheerfulness and freshness.

Physical exercise and the right regimen contribute to better sleep. An hour of sleep during the day has a good effect on the body, it is especially good for the elderly and old people. The duration of sleep, its quality is recorded: disturbances, falling asleep, awakening, insomnia, dreams, intermittent or restless sleep.

Very subtly characterizes the state of the body. A good, normal, reduced, increased appetite or its absence is fixed. There are other signs of indigestion, if any, as well as increased thirst.

Objective control method

The weight of an adult is calculated according to Brock's criterion - the number 100 for men and 105 for women (with growth up to 175 cm) is subtracted from the body height (in cm); number 110 (with growth over 175 cm). Body weight can change during the day, so you need 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 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 point of attachment of the 4th rib to the sternum in women). Measured either with a deep breath, or a deep breath, 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 - Adam's apple. Shoulder dimensions 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 crease and around the largest volume of the lower leg.

The size of the body in the abdomen 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 on the outside above the radius or on the basis of the temporal bones. Usually, the pulse is counted for 6 or 10 seconds and multiplied by 10 and 6, respectively (a count 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 appropriate limitations in frequency.

Immediately after physical activity, the pulse can double in comparison with the state of 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, one must simultaneously pay attention to its rhythm, any doubts about this should be resolved with the attending physician.

In trained people at rest, the pulse is less frequent than in people who do not engage in physical culture, including sports.

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

It is convenient to count the respiratory rate by placing a hand on the chest. Count for 30 seconds and multiply by two. Normally, in a calm state, the respiratory rate in an untrained person is equal to inhalations and exhalations per minute. 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 is taken. The VC value 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, VC 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 with subsequent analysis of the results of measurements of the parameters and characteristics of the state of the body (for example, pulse rate, respiration, etc.) immediately before and after the test. As a result of comparison with the standard norms of changes, they judge the degree of fitness, adaptability to this factor.

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

When the body position changes from horizontal to vertical, blood is redistributed. This causes a reflex reaction in the circulatory system, which ensures 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 positions of the body are small. But if the mechanism of regulation of peripheral circulation is disturbed, fluctuations in pulse and blood pressure (blood pressure) during the transition from a horizontal position to a vertical position are more pronounced. With vegetovascular dystonia, orthostatic collapse (fainting) is possible.

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

These measurements are necessary to evaluate the speed of recovery of the heart rate. Usually, the pulse reaches its original value (the frequency that was in the standing position before the test). Tolerability of the test is considered good with an increase in heart rate of no more than 11 beats, satisfactory - for beats and unsatisfactory - for 19 beats or more.

Squat test (Martinet test).

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

Sample evaluation. The state of the cardiovascular system is assessed as good with an increase in heart rate 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 Nmm Hg. Art., and diastolic (lower) or remains at the same level, or slightly (by 5-10 mm Hg. Art.) decreases. Recovery of the pulse 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). According to the level of load that causes shortness of breath, a person's physical performance is judged.

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 and difficulties, you have a good working capacity.

If the rise is accompanied by shortness of breath - rise, controlling your pulse. After rising 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 fitness is almost completely absent.

Consider tests for psychological stability (volitional preparedness) of the state of the respiratory and cardiovascular systems.

Breath holding test.

Standing, count the pulse for one minute. Then, after inhaling, exhale the air, pinch your nostrils with your fingers and hold your breath for as long as you can. This is breath-holding - apnea. Record your heart rate and apnea data (in seconds) as a fraction: pulse/apnea.

Test with breath holding and squats.

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

Yes, I answered my wards to the question of the need to keep a scrupulous, "accounting" record of indicators in the self-control diary. It's not about form, it's about substance.

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

Self-control is also self-discipline, strong-willed hardening, comprehension of one's way of life. All this can be seen by looking at the approximate diary diagram given here. As for the content of the records, health, working capacity, appetite, heart rate, etc. are assessed daily. Functional tests are the object of monthly observations, and weekly assessments of well-being for a week (general), body weight can be recommended.

An example of a self-control diary entry

Orthostatic test, methods of conducting, evaluation of results

Tests with a change in body position in space include orthostatic (straight, vertical) and clinostatic (inclined). In both tests, we are talking about a change in the position of the body relative to the gravitational 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 ortho test: a person stands up by himself with the help of his kinesthetic analyzer, he himself maintains an upright posture. Passive orthotest: transfer to a vertical state is carried out using special turntables, when the participation of skeletal muscles in changing the position of the body is excluded.

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

The International Biological Program (IBP) for the study of human adaptability recommends using information on the value of aerobic productivity, an indicator of which is the MPC (maximum oxygen consumption), to judge physical performance. The value of the IPC very reliably characterizes the physical performance of an athlete, or, more precisely, the so-called aerobic performance. The study 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, the method of direct determination of the IPC has been adopted.

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

Sample PWC170. This submaximal functional test is recommended for in-depth medical and biological examination of qualified athletes. The subjects performed 6 sequentially stepwise 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 his own limit of max heart rate, in many respects it is determined by age.

The PWC170 test is a functional test to determine the physical performance, measured by the power of the slave, which the 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 (artistic 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 an indispensable 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 ejection decreases (by 20-30%). Compensation for this adverse effect is carried out mainly by increasing the heart rate. An important role belongs to changes in vascular tone. If it is reduced, then the decrease in venous return can be so significant that when moving to a vertical position, fainting may develop due to a sharp deterioration in the blood supply to the brain.

In athletes, orthostatic instability associated with a decrease in venous tone develops extremely rarely. However, when conducting 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 the pulse in response to a change in body position during the transition from horizontal to vertical. Pulse indicators are determined in the supine position and at the end of 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 division 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 actively performs the transition from a horizontal to a vertical position, standing up. The reaction to standing up is studied according to changes in heart rate and blood pressure (BP). These indicators are measured in the supine position, and then for 10 minutes in a standing position.

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

Modified orthostatic test according to Yu.M. When conducting an active orthostatic test, the reaction of the cardiovascular system is to a certain extent associated with muscle tension during a 10-minute 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 back against it, a roller 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 the body with respect 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 the most accurate determination of orthostatic stability. Changing the position of the body occurs with the help of a turntable. The subject is fixed 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 reaction from the side of the pulse 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. Exceeding the pulse of more than 95 beats / min is a sign of low orthostatic stability, in which orthostatic collapse may develop.

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

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

2) satisfactory - the pulse increases by the 10th minute of the vertical position up to 30 beats / min in men and 40 beats / min in women. The transient process for the pulse ends no later than the 5th minute for men and the 7th minute for women. Pulse pressure decreases by %, health is 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: there is dizziness, pallor.

Vegetative Kerdo 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 divisions.

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

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

Orthostatic test evaluation

The test can be simplified by adjusting immediately after getting up, that is, at 1 minute of the vertical position, then at 5 and 10 minutes.

According to the author, with good orthostatic stability, the pulse at 10 minutes of the orthostatic position increases by no more than 20 beats per minute for men and 25 beats for women compared to the pulse in the prone position, and 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, feeling unwell, the face turns pale, and fainting may even develop. Therefore, if you feel worse, in order to avoid orthostatic collapse, the test should be canceled.

Deterioration of orthostatic stability can be observed with overwork, overtraining, after illnesses, with vegetovascular dystonia, etc.

Clinical orthostatic test. This test is carried out in reverse order. The subject after 10 minutes of standing again lie down. Immediately after the transition to a horizontal position, and then 3-5 minutes, the 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 rises by 5-10 mmHg. In the clinical-orthostatic test, the changes are opposite.

Rufier test is a fairly significant burden. The athlete in a sitting position (after a 5-minute rest) measures the pulse (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 in 15 second intervals. The value of the Rufier sample index is calculated by the formula

If the index value is less than 0, adaptability to the 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 control.

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

Other types of reactions to the sample of S.P. Letunov are designated as atypical. Some may experience the so-called hypertonic type of reaction: a sharp increase in systolic blood pressure domm Hg. Art., and diastolic blood pressure either does not change or increases. The hypertonic 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 on the 2nd and 3rd load (doud/min). Recovery of heart rate and blood pressure is slowed down. This type of reaction is considered unfavorable.

Dystonic type of reaction 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 current”). Systolic blood pressure in these cases increases domm Hg.

An indicator of the activity of the cardiovascular system is endurance coefficient (KV). Grade HF is based on the analysis of heart rate, systolic and diastolic pressure and is calculated from Kwasi formula:

Remember, - Pulse BP = systolic BP – diastolic BP.

Normally, the value of CV 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 coefficient of efficiency of blood circulation (CEC), which characterizes 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.).

KEK\u003d BP pulse * HR

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

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

In healthy people, the Kerdo index is 1. If the nervous regulation of the cardiovascular system is disturbed, the Kerdo index becomes either greater 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 summer 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 1 minute. Each cycle consists of 4 steps: put one foot on the step, substitute the second; lower one leg, put the other.

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

The result of this test is quantified 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 heartbeats in the first 30 seconds in the second, third and fourth minutes of recovery, respectively.

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

IGST = ; where the designations are the same

Physical performance is assessed as weak if 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 overcome (run or walk) as much distance as possible (you can not overexert and prevent shortness of breath).

Only qualified people can take the test. 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

In the vertical position of the body, the blood falls down according to the law of gravity, 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 region of the celiac nerve, blood is mobilized from the depot and brought to the heart; at the same time, a normal pulse volume is maintained and arterial blood supply is provided, 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 technique. In the supine position, the patient is repeatedly measured with minute intervals systolic and diastolic pressure (auscultatory method on the right hand) and count the pulse.

Then the patient gets up and stands for 10 minutes without any tension. Immediately upon getting up and then at the end of each minute, check blood pressure and pulse. In conclusion, 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 device for measuring blood pressure during the study remains on the arm; The cuff must be completely deflated with each measurement.

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

Physiological limits of fluctuations: for the 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 equalization 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 the absolute figures.

Orthostatic test as a functional test for varicose veins. Varicose veins develop mainly on the lower extremities, which are particularly susceptible to hydrostatic pressure, and occur due to damage to the vascular walls (disappearance of the muscle layer), and vein dilation with the appearance of insufficiency of venous valves. When standing in the areas of varicose veins, a significant amount of blood is retained, which is therefore turned off from the general circulation. As a result, blood pressure drops significantly. The patient, when working in a standing position, has signs of brain hypoxia (feeling tired, dizzy, blurred vision). An idea of the retention of blood in varicose veins can be obtained using an orthostatic test.

Execution technique. With a horizontal position of the body, the legs are bandaged with an elastic bandage from the bottom up and the pulse and blood pressure are repeatedly determined. After that, the patient gets up, and all measurements are taken from him, as in the Schellong 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 when they want to find out the role of relaxation of the abdominal muscles in a hypotonic symptom complex.

To do this, the torso is tightly bandaged, starting from below, with a wide strip of matter, and then further research 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, a correctly applied bandage).

Problems with the cardiovascular system are a mandatory reason for seeking 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 start 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 done in a variety of 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 small change in pressure, as well as due to physical activity. With insufficiency of the cardiovascular system, there is an increase (less often - a decrease) in the difference between blood pressure and heart rate before and after the test.

Methods for conducting an orthostatic test

Depending on the type of orthostatic test, the methods of conducting are somewhat different 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 with a change in body position occur in each person, there are average indicators. Deviation from the norm in the direction of increasing and decreasing heart rate and blood pressure indicates a violation of the cardiovascular or nervous system. When the patient is lying 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. With stagnation of blood in the lower extremities or the abdominal cavity, the indicators of the orthostatic test differ from normal. This indicates the presence of the disease.

Orthostatic test: norm and pathology

When evaluating the results, attention is paid 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 of the nervous system. Slight sweating and a constant state of pressure before and after the study are allowed. An increase in heart rate by 12-18 beats / min is considered satisfactory. An orthostatic test with a large increase in heart rate and diastolic pressure, severe sweating and tinnitus, and a decrease in systolic blood pressure indicate serious hemodynamic disorders.

Study of primary indicators.

– Pulse count;
– Measurement of blood pressure: diastolic, systolic, pulse, mean dynamic, minute blood volume, peripheral resistance;

Study of initial and final indicators during test impacts:

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

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

DESCRIPTION OF METHODS

RESEARCH OF PRIMARY INDICATORS.
Assessment of the degree of tension of regulatory mechanisms:
– Pulse count;
– Measurement of blood pressure: diastolic, systolic, pulse, mean dynamic, minute blood volume, peripheral resistance;
Pulse count. Norm indicator: 60 - 80 beats. in min.
diastolic or minimum pressure (DD).
Its height is mainly determined by the degree of patency of the precapillaries, the heart rate and the degree of elasticity of the blood vessels. DD is higher, the greater the resistance of precapillaries, the lower the elastic resistance of large vessels and the greater the heart rate. Normally, in a healthy person, DD is 60-80 mm Hg. Art. After loads and various kinds 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, on the contrary, its increase and a slow (more than 2 minutes) return to the initial values is regarded as an unfavorable symptom. Norm indicator: 60 - 89 mm. rt. Art.
Systolic, or maximum pressure (BP).
This is the entire supply of energy that the blood stream actually possesses in a given section of the vascular bed. The lability of systolic pressure depends on the contractile function of the myocardium, systolic volume of the heart, the state of elasticity of the vascular wall, hemodynamic stroke and heart rate. Normally, in a healthy person, DM ranges from 100 to 120 mm Hg. Art. Under load, SD increases by 20-80 mm Hg. Art., and after its termination returns to the initial level within 2-3 minutes. The slow recovery of the initial values of DM is considered as evidence of insufficiency of the cardiovascular system. Norm indicator: 110-139 mm. rt. Art.
When assessing changes in systolic pressure under the influence of the load, the obtained shifts in maximum pressure and heart rate are compared with the same indicators at rest:
(1)

SD		SDR - SDP		100%
		sdp

heart rate		Czechoslovakia - ChSSp		100%
		HRsp

where SDr, HR is systolic pressure and heart rate during work;
ADP, HRSp - the same indicators at rest.
This comparison makes it possible to characterize the state of cardiovascular regulation. Normally, it is carried out due to changes in pressure (1 more than 2), with heart failure, regulation occurs due to an increase in heart rate (2 more than 1).
Pulse pressure (PP).
Normally, in a healthy person, it is about 25-30% of the minimum pressure value. Mechanocardiography allows you to determine the true value of PP, equal to the difference between the lateral and minimum pressure. When determining PD 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 - DD).
Average dynamic pressure (SDD).
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, DDS can be calculated using the formulas:
(1)

DDS		PD		DD

SDD \u003d DD + 0.42 x PD.
The value of SDD, calculated by formula (2), is somewhat higher. Norm indicator: 75-85 mm. rt. st.
Minute volume of blood (MO).
This is the amount of blood pumped by the heart per minute. According to MO, the mechanical function of the myocardium is judged, which reflects the state of the circulatory system. The value of MO depends on age, gender, body weight, ambient temperature, intensity of physical activity. Norm indicator: 3.5 - 5.0 l.
The norm of MO for the state of rest has a fairly wide range and significantly depends on the method of determination:
The simplest way to determine MO, which allows you to roughly determine its value, is to determine MO using the Starr formula:
CO \u003d 90.97 + 0.54 x PD - 0.57 x DD - 0.61V;
MO = SO-HR
where CO is the systolic blood volume, Ml; PD - 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, the SDD is first determined by the formula:

hence MO = RAD x heart rate.
In order to perhaps more objectively assess the observed changes in MO, you can also calculate the proper minute volume: DMV \u003d 2.2 x S,
where 2.2 - cardiac index, l;
S - the surface of the body of the subject, determined by the Dubois formula:
S = 71.84 M ° 425 R 0725
where M - body weight, kg; P - height, cm;
or

DMO		preschool

where DOO is the proper basal metabolic rate, calculated in accordance with the age, height and body weight data according to the Harris-Benedict tables.
Comparison of MO and DMO allows more accurate characterization of the specifics of functional changes in the cardiovascular system due to the influence of various factors.
Peripheral resistance (PS).
It determines the constancy of the average dynamic pressure (or its deviation from the norm). Calculated according to the formulas:

where CI - cardiac index, equal to an average of 2.2 ± 0.3 l / min-m 2.
Peripheral resistance is expressed either in arbitrary units or in dynes. Norm indicator: 30 - 50 arb. units The change in PS during work reflects the reaction of the precapillary bed, which depends 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. loads;
- Test with squats - a characteristic of the functional usefulness of the cardiovascular system;
- Flack's test - allows you to evaluate the function of the heart muscle;
- Rufier's test - dynamic load tolerance; endurance coefficient;
1. Martinet test(simplified method) is used in mass studies, allows you to evaluate the ability of the cardiovascular system to recover after exercise. As a load, depending on the contingent of the examined, 20 squats for 30С and squats at the same pace for 2 minutes can be used. In the first case, the period lasts 3 minutes, in the second - 5. Before the load and 3 (or 5) minutes after it ends, the subject's heart rate, systolic and diastolic pressure are measured. The evaluation of the sample is carried out by the magnitude of the difference between the studied parameters before and after the load:
with a difference of no more than 5 - "good";
with a difference from 5 to 10 - "satisfactory";
with a difference of more than 10 - "unsatisfactory".
2. Squat test. It serves to characterize the functional usefulness of the cardiovascular system. Methodology: in a person before the load, the heart rate and blood pressure are calculated twice. 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. With good physical preparation of the subject, the test at the same pace can be extended up to 2 minutes. To evaluate the sample, the reaction quality indicator is used:

RCC		PD2 - PD1
		P2-P1

where PD2 and PD1) - 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 carried out after a forced breath with a pinched nose. During its implementation, every 5C, the heart rate is determined. The evaluation criterion is the degree of increased heart rate in relation to the initial one and the duration of pressure maintenance, which in trained people does not exceed 40-50C. According to the degree of increased heart rate for 5C, the following reactions differ: no more than 7 beats. - good; up to 9 bpm - satisfactory; up to 10 beats - unsatisfactory.
Before and after the test, the subject's blood pressure is measured. Violation of the functions of the cardiovascular system leads to a decrease in blood pressure, sometimes by 20 M; M Hg. Art. and more. The sample is evaluated according to the quality of the reaction:

Pkr		SD1 - SD2
		SD1

where SD 1 and SD2 - systolic pressure initial and after the test.
When the cardiovascular system is overloaded, the RCC value exceeds 0.10-0.25 rel. units
systems.
4. Rufier test (dynamic load tolerance)
The subject is in a standing position for 5 minutes. For 15 seconds, the pulse / Pa / is calculated, after which physical activity is performed / 30 squats per minute /. The pulse is recalculated for the first /Pb/ and the last /Pv/ 15 seconds of the first minute of recovery. When counting the pulse, the subject must stand. The calculated indicator of cardiac activity /PSD/ is a criterion for the optimality of the vegetative provision of the cardiovascular system when performing low-power physical activity

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

Sample interpretation: with PDS less than 5, the test was performed as "excellent";
when the PSD is less than 10, the test is performed as "good";
with PDS less than 15 - "satisfactory";
with PSD more than 15 - "bad".
Our studies allow us to assume that in healthy subjects PSD does not exceed 12, and patients with neurocircular dystonia syndrome, as a rule, have PSD over 15.
Thus, the periodic monitoring of PDM gives the doctor a fairly informative criterion for assessing the adaptive potential of the cardiovascular system.
5. Endurance coefficient. 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 - heart rate, bpm;
PD - pulse pressure, mm Hg. Art.
Norm indicator: 12-15 arb. units (according to some authors 16)
An increase in CV associated with a decrease in PP is an indicator of the detraining of the cardiovascular system, a decrease in fatigue.

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

VI=	1 –	DD
		heart rate

DD - diastolic pressure, mm Hg;
heart rate - heart rate, beats/min.

Norm 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 (the level of vegetative-vascular resistance)
The test is one of the functional stress tests, allows you to evaluate the functionality of the cardiovascular system, as well as the state of the central nervous system. A decrease in the tolerance of orthostatic tests (activity and passive) is often observed in hypotonic conditions in diseases accompanied by vegetative-vascular instability, in asthenic conditions and overwork.
The test should be carried out immediately after a night's sleep. Prior to the start of the test, the subject must lie quietly on his back for 10 minutes, without a high pillow. After 10 minutes, the subject in the supine position counts the pulse rate three times (counting for 15 s) and determines the value of blood pressure: maximum and minimum.
After receiving the background values, the subject quickly gets up, assumes a vertical position and stands for 5 minutes. At the same time, every minute (in the second half of each minute) the frequency is calculated and blood pressure is measured.
Orthostatic test (OI "- orthostatic index) is estimated according to the formula proposed by Burkhard-Kirhoff.

Sample interpretation: Normally, the orthostatic index is 1.0 - 1.6 relative units. With chronic fatigue, RI=1.7-1.9, with overwork, RI=2 or more.
3. Orthostatic test. Serves to characterize the functional usefulness of the reflex mechanisms of regulation of hemodynamics and assess the excitability of the centers of sympathetic innervation.
After a 5-minute stay in the prone position, the subject's heart rate is recorded. Then, on command, the subject calmly (without jerks) takes a standing position. The pulse is counted at the 1st and 3rd minutes of being in a vertical position, blood pressure is determined at the 3rd and 5th minutes. The evaluation of the sample can be carried out only by pulse or by pulse and blood pressure.

Gradeorthostatic test
Indicators	Sample tolerance
Indicators	good	satisfactory	unsatisfactory
Frequency cardiac cuts	The increase is not more than 11 beats.	Increase in 12-18 beats.	Increase in 19 beats. and more
systolic pressure	rises	Does not change	Decreases within 5-10 mmHg Art.
diastolic pressure	rises	Does not change or slightly increases	rises
Pulse pressure	rises	Doesn't change	Decreases
Vegetative reactions	Missing	sweating	Sweating, tinnitus

The excitability of the centers of sympathetic innervation is determined by the degree of heart rate increase (SUP), and the usefulness of autonomic regulation 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 the sympathetic links according to the SJS index are presented in the table.

4. Oculocardial test. It is used to determine the excitability of parasympathetic centers for the regulation of heart rate. It is carried out against the background of continuous ECG recording, during which the eyeballs of the subject are pressed 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. The increase in rhythm is interpreted as a perversion of the reflex, which proceeds according to the sympathicotonic type. You can control the 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. in min - sharply enhanced;
no slowdown - areactive;
there is no increase - perverted.

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

Excitability	Deceleration ratepulse with a wedge-shaped sample,%
Normal:
weak	Up to 6.1
average	6,2 - 12,3
live	12,4 - 18,5
Increased:
weak	18,6 - 24,6
conspicuous	24,7 - 30,8
significant	30,9 - 37,0
sharp	37,1 - 43,1
very sharp	43.2 and more

CALCULATED INDEX OF ADAPTATION POTENTIAL OF THE CARDIOVASCULAR SYSTEM.
1. Estimated 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 clinic. In order to make this experience available to a wide range of doctors, a number of formulas have been developed that allow calculating the adaptive potential of the circulatory system for 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, 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, state of emergency- pulse rate (bpm); GARDEN And DBP- systolic and diastolic blood pressure (mm Hg); R- height (cm); MT- body weight (kg); IN- age (years).
According to the values of the adaptive potential, the functional state of the patient 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 above - failure of adaptation.
A decrease in the adaptive potential is accompanied by some shift in the indicators of myocardial-hemodynamic homeostasis within their so-called normal values, the tension of regulatory systems increases, and the "payment for adaptation" increases. Disruption of adaptation as a result of overstrain and depletion of regulatory mechanisms in older people is characterized by a sharp drop in the reserve capacity of the heart, while at a young age even an increase in the level of functioning of the circulatory system is observed.

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, an increase in functional reserves.