Etiology and pathogenesis Diseases of the digestive system are very diverse, the leading ones being disorders of the nervous system, local effects on the gastrointestinal tract of possible exogenous factors and circulatory disorders in the abdominal area.

Disturbances in the activity of individual parts of the gastrointestinal tract are usually functional and reversible at first. As the disease progresses, functional disorders are accompanied by morphological changes, which subsequently become irreversible. Morphological changes, in turn, become a source of pathological impulses into the central nervous system and disrupt its corrective effect on the digestive organs and other organs and systems. As a result, organic damage to any part of the gastrointestinal tract is often combined with functional disorders of its other parts, as well as with a disorder in the activity of other systems.

Treatment of diseases of the digestive system is both etiological and pathogenetic, and exercise therapy takes a significant place in this complex therapy.

Therapeutic effect physical exercise is primarily due to its strengthening and normalizing effect on the nervous system. When the reactivity of the nervous system is impaired, physical exercise leads to the normalization of its activity, balancing the process of excitation and inhibition in the cerebral cortex and improving the activity of the autonomic parts, and as a result, normalizing the functions of the digestive organs. Improving the function of the digestive organs with the help of physical exercises and massage is due to motor-visceral reflexes. It has been established that the receptors of muscles, tendons and joints serve not only to carry out movements, but also to regulate the most important autonomic functions, including the activity of the gastrointestinal tract.

Physical exercise activate tissue metabolism. Thanks to this, the nutrition of tissues and organs improves, the general tone of the body and the performance of patients increase. Under the influence of special exercises, blood circulation in the abdominal organs improves and the amount of deposited blood decreases. This helps to subside inflammatory processes in the organs of the gastrointestinal tract and accelerate regeneration processes in them (for example, scarring of ulcers). Blood circulation improves at the same time in the pelvic organs. Exercises for the pelvic floor muscles, preventing blood stagnation in the rectum and hemorrhoidal veins, have a beneficial effect on pathological processes in this area.

By providing a general tonic effect on the body and improving the condition of the central nervous system and blood circulation, exercise therapy strengthens the abdominal muscles, promotes increased intestinal peristalsis and outflow of bile and gallbladder. The abdominal muscles play a significant role in fixing the abdominal organs, and when they are weakened, the internal organs move downwards (the so-called splanchnoptosis). An effective means of preventing and treating splanchnoptosis are special exercises in combination with massage aimed at strengthening the abdominal muscles.

Local the effect of exercise to the colon caused by changes in intra-abdominal pressure during contraction and relaxation of the abdominal muscles and breathing. When the abdominal muscles contract, intra-abdominal pressure increases and has a pressor effect on the colon; when the abdominal muscles relax, intra-abdominal pressure returns to its original level. Periodic changes in increasing and decreasing intra-abdominal pressure have a “massaging” effect on the large intestine and improve its functional state. Periodic changes in intra-abdominal pressure are also facilitated by deep breathing, during which the diaphragm contracts and thereby the volume of the abdominal cavity decreases; As a result, intra-abdominal pressure increases; when exhaling, the diaphragm relaxes, and therefore the volume of the abdominal cavity increases again and intra-abdominal pressure weakens. Combining breathing exercises with abdominal exercises provides a stronger effect on the colon.

Exercise therapy has a significant effect on the motor and secretory functions of the gastrointestinal tract. Large loads inhibit motility and secretion, moderates normalize them. Physical exercises during which pressure changes occur in the abdominal cavity (full deep breathing, bending the torso, bending the legs at the hip joints, etc.) help improve the outflow of bile from the gallbladder, which is extremely important for diseases of the liver and biliary tract and gallbladder.

Physical exercise remains the simplest means of increasing gallbladder drainage.

A decrease in general nutrition (hypotrophy) often complicates diseases of the digestive system. The main causes of malnutrition in these diseases are impaired digestion of food and absorption in the intestine due to morphological changes in the mucous membrane and malnutrition, when patients themselves limit it. The therapeutic effect of exercise therapy against the background of a balanced diet is determined by its stimulating effect on metabolism. The unconditional and conditioned reflex increase in metabolism is explained by the corrective influence of the nervous system on tissue trophism.

Exercise therapy technique

Contraindications To prescription of exercise therapy: period of exacerbation of the disease - severe pain, severe dyspeptic disorders; general contraindications.

Motor mode represents the use and rational distribution of various types of physical activity of the patient throughout the day, in a certain combination and sequence in relation to other factors of complex treatment.

Morning hygienic exercises pursues the goals of general development and strengthening of health, increasing efficiency. It helps hardening, promotes a more complete transition from an inhibited state to an alert state, and eliminates stagnation in various departments.

In morning hygienic exercises, a small (8-10) number of exercises are used, covering the main muscle groups; physical exercise should be simple.

Therapeutic gymnastics is one of the main forms of exercise therapy.

The basis of the private method of therapeutic gymnastics, as well as the general one, is systematicity, regularity, duration of classes, increased physical activity during classes, individualization, and the use of special and breathing exercises.

In addition to general developmental exercises, special exercises are used for the abdominal and pelvic floor muscles, breathing exercises (static and dynamic), and voluntary muscle relaxation exercises.

Attention! Exercises for the abdominal muscles are excluded in the subacute period of the disease.

Exercises in voluntary muscle relaxation reduce excitatory processes in the central nervous system, help accelerate the recovery processes of working muscles, reduce the tone of not only the muscles involved in relaxation, but (reflexively) also the smooth muscles of the internal organs of the stomach and intestines, relieve spasms of the intestines, pylorus and sphincters.

The therapeutic effect of therapeutic exercises will be significantly higher if special physical exercises are performed by muscle groups that receive innervation from the same segments of the spinal cord as the diseased organ (stomach C 3 -C 4 (cervical segments 3 to 4); liver, gallbladder C 3 -C 4, Th 6 -Th l0 (from 3 to 4 cervical and 6 to 10 thoracic segments), pancreas C 3 -C 4, Th 7 -Th 9 (from 3 to 4 cervical and from 7 9 thoracic segments each) These are exercises involving the muscles of the neck, trapezius, muscles that lift the scapulae, rhomboid major and minor, diaphragm, intercostal muscles, anterior abdominal wall, iliopsoas, obturator, muscles of the foot and lower leg.

For diseases of the digestive system, the effectiveness of therapeutic exercises largely depends on the choice of starting positions that allow differentiated regulation of intra-abdominal pressure.

The most commonly used starting position is lying with legs bent (on the left or right side, on the back); standing, kneeling, on all fours, standing and sitting.

The starting position lying down is recommended during an exacerbation and immediately after an exacerbation of the disease as the most gentle, promoting the least functional changes, providing the best conditions for performing breathing exercises (lying on your back with bent legs), and voluntary muscle relaxation. These starting positions are convenient for performing exercises for the abdominal muscles and pelvic floor.

The anatomical and topographic relationships of the gallbladder, common bile duct and duodenum allow us to recommend the initial position lying on the left side, standing on all fours, in which the outflow of bile towards the neck of the bladder and ampulla is carried out under the influence of hydrostatic pressure. Additionally, the outflow of bile in these initial positions is accelerated by an increase in intra-abdominal pressure during full breathing with an emphasis on the diaphragm and some participation of the abdominal muscles.

The initial kneeling position (on all fours) is used if necessary to limit the impact on the abdominal muscles, to cause mechanical movement of the stomach and intestinal loops; the initial standing and sitting positions are used for the greatest impact on the digestive organs.

Physiotherapy in the aquatic environment carried out in pools with fresh or mineral water. Exercises are performed from a starting position lying down with floating devices or at the handrail, sitting on a hanging chair, standing and in motion.

Lesson duration is from 20 to 40 minutes. Water temperature 24-26 °C. There are 12-15 procedures per course of treatment. Classes are conducted individually or in a small group.

health path in the fresh air it trains and strengthens the body, normalizes the psycho-emotional sphere. This is a natural physical exercise - walking.

Physical activity can be dosed by changing the distance, the angle of elevation (route number), the pace of walking (covering a given distance in a certain period of time), the number of stops for rest and their duration, the use of breathing exercises during the period of walking and rest, the prescription 1-2 or 3 walks a day, alternating training days with rest days.

Sport games from a physiological point of view, they represent complex forms of acyclic muscle activity, which significantly complicates their dosage. This deficiency is compensated by their high emotionality.

Gaming activity allows you to include and use large reserve capabilities of the cardiovascular system.

The listed forms of exercise therapy, sports exercises and massage can be included in the motor regimen of patients.

Approximate schemes of motor modes.

Low mode physicalwhat activity (gentle) adaptation restorations to extended mode loads are applied; stimulation of metabolic processes; combating congestion in the abdominal cavity; normalization of regenerative processes; a positive effect on the psycho-emotional sphere of patients and a moderate increase in the adaptation of the cardiovascular system to increasing physical stress. With a gentle regime, periods of rest prevail over periods of stress.

Contents of the regime: include balneo- and physiotherapeutic procedures. Morning hygienic gymnastics using a small group method with low load, duration 10-15 minutes, therapeutic gymnastics class density 40-50 %, LH in a small group method or individually, duration 20-25 minutes, lesson density 40-50%, dosed walks on flat terrain with a length of 0.5-1.5 km 1-2 times a day with a rest interval of at least 1 -2 hours, at a pace characteristic of the patient’s dynamic stereotype. Independent physical exercises 1-2 times a day, 6-8 special exercises. Sedentary games (croquet, bowling) up to 30 min.

Indications for the regimen: diseases of the gastrointestinal tract in the stage of fading exacerbation, organic damage to the cardiovascular system with symptoms of circulatory failure, a tendency to vascular crises, poor general condition (severe weakness, fatigue).

Mode with average physical activity (gentle training). Goal: restoration of adaptation to training loads. Regulation of excitation and inhibition processes in the central nervous system, normalization of autonomic functions. Stimulation of metabolic processes, fight against congestion in the abdominal cavity, improvement of regenerative processes.

Contents of the regime: include balneo- and physiotherapeutic procedures. Morning hygienic gymnastics using the group method with low load (duration 12-15 minutes, motor density 50-60%), therapeutic exercises with medium load (duration 25-30 minutes, 3-4 sessions per day for 5-10 minutes ). Dosed walks at a slow and medium pace with a length of up to 6 km and an elevation angle of up to 10° 1-2 times a day. It is allowed to play croquet, bowling, gorodki, table tennis, badminton according to simplified rules with a low load, on average up to 40-60 minutes. Sports exercises (water and winter sports) with low impact, dosed rowing, horseback riding, skiing.

Indications for prescribing the regimen: chronic diseases of the gastrointestinal tract in the phase of complete remission, 1-3 years after cholecystectomy and gastrectomy, initial phenomena of organic damage to the cardiovascular system with compensation of blood circulation and the absence of heart rhythm disturbances. The regimen is also indicated for patients transferred from a gentle regimen.

Mode with high physical activity (training). Goal: maintaining performance at the highest possible level.

Mode content: The daily routine includes balneo- and physiotherapeutic procedures. Morning hygienic gymnastics in a group method with an average load (15-20 minutes, motor density 60-70%), therapeutic exercises with a heavy load using a special method (30-45 minutes, motor density 60-70%). Self-training of patients with special exercises 3-4 times a day. Measured walks at a slow pace along routes ranging from 10 to 20 km with an elevation angle of up to 20°. Participation in competitions according to simplified rules is allowed. Sports exercises (water and winter sports) with an average load. Physical activity takes precedence over rest and relaxation.

Indications for the regimen: chronic diseases of the gastrointestinal tract in the phase of stable remission with stable compensation of functions. The regimen is also prescribed to patients transferred from the gentle training regimen to the second half of the course of treatment, subject to positive dynamics. The duration of a patient’s stay in one or another mode of movement is not determined by a certain number of days. The attending physician transfers the patient from one mode to another based on favorable changes in his clinical condition with adaptation of the cardiovascular system and the body as a whole to the previous mode of movement. It is not necessary to prescribe all forms of exercise therapy in a new regime: a training effect can be achieved by increasing the load in only one form of exercise therapy.

Introduction

1. Literature review

1.1 The influence of physical exercise on the functioning of the digestive organs

1.2 Features of the method of therapeutic physical culture for chronic gastritis

1.3 Features of the method of therapeutic physical culture for gastric ulcer

1.4 Therapeutic physical training for biliary dyskinesias

2. Experimental part

2.1 Purpose, objectives and methodology of experimental work

3. Research results

4. Research results

List of used literature

Introduction

The health status of schoolchildren is one of the most pressing problems of modern healthcare, the solution of which is unthinkable by doctors alone without the involvement of teachers, students and their parents.

Scientific research in medicine can be divided into two areas: the study of diseases and the treatment of these diseases, that is, the study of diseases, and research in the field of disease prevention, that is, the study of health. Today, it is obvious that curative medicine is not able to resolve all health-related problems, since despite great achievements in scientific research and improvement of the technological medical base, successful disease outcomes are disproportionate to these achievements, and from an economic point of view, the increase in costs in medical treatment medicine does not lead to an increase in positive results. In this regard, interest in preventive medicine has increased again in recent decades. At the same time, the inconsistency of these studies in terminological, methodological and other aspects also emerged.

A child's body is special. The morphological and functional rearrangements occurring in it implement a certain genetic program aimed at the formation of a healthy individual. Environmental conditions can significantly change the implementation of the genetic program both in the direction of ensuring optimal development conditions and in the direction of the formation of the pathological process.

Strengthening the health of the younger generation, optimizing the process of forming a healthy, harmoniously developed personality, mobilizing efforts to overcome the influence of negative socio-economic phenomena in society are the most important tasks of physical education of schoolchildren.

Their importance is increasing due to the deterioration of health, the increase in manifestations of social maladjustment and neuropsychic disorders in the structure of morbidity in children and adolescents.

Over the past 10 years, there has been a decrease in the number of healthy children by 4-5 times and a deterioration in the health of schoolchildren by 47%. Due to poor health, about 1 million school-age children are completely exempt from physical education.

In this regard, it is necessary to more fully use the health-improving opportunities of physical education in order to preserve and correct the health of schoolchildren in the educational process, increase the level of their physical development and physical fitness, form a healthy lifestyle for them through the use of new forms of organizing physical exercises, the use of modern physical education - health technologies.

In our opinion, insufficient attention has been paid to the organization of differentiated physical education of schoolchildren with different levels of health, the rational combination of basic and variable components of the physical education curriculum, and the inclusion of health-improving and rehabilitation-oriented means into the content of physical education lessons. Such works are isolated and fragmentary in nature.

The contradictions between the need to improve physical education and the lack of scientifically based approaches in the field of individualization and differentiation of physical education of schoolchildren have determined the relevance of the scientific problem, which is to determine how the educational process in physical education at school should be optimized when using technologies of differentiated physical education.

digestion physical exercise therapeutic

The purpose of the thesis: to provide a physiological justification for the need to use therapeutic physical culture for diseases of the digestive system in children.

According to this goal, the thesis set the following tasks:

Studying the effect of physical exercise on the functioning of the digestive organs;

Consider the features of the method of therapeutic physical culture for chronic gastritis;

Describe the features of the method of therapeutic physical culture for gastric ulcer;

Conduct experimental work on the use of therapeutic physical culture for diseases of the digestive system.

Object of study: the influence of physical therapy on the health of children with diseases of the digestive system.

Subject of research: the use of therapeutic physical culture for diseases of the digestive system.

Hypothesis: if a correctional and health-improving complex of physical exercises is used in a secondary school, this will help improve the health of children with diseases of the digestive system.

The experimental base for the study was Zatobolsk Secondary School No. 2.

1. Literature review

1.1 The influence of physical exercise on the functioning of the digestive organs

Physical exercises for the purpose of treatment and prevention were used in ancient times, 2 thousand years BC in China and India. In Ancient Rome and Ancient Greece, physical exercise and massage were integral in everyday life, military affairs, and treatment. Hippocrates (460-370 BC) described the use of physical exercises and massage for diseases of the heart, lungs, metabolic disorders, etc. Ibn Sina (Avicenna, 980-1037) highlighted in his works the method of using physical exercises for sick and healthy, dividing loads into small and large, strong and weak, fast and slow. During the Renaissance (XIV-XVI centuries), physical exercise was promoted as a means to achieve harmonious development.

In Russia, outstanding clinicians such as M.Ya. Mudrov (1776-1831), N.I. Pirogov (1810-1881), S.P. Botkin (1831-1889), G.A. Zakharyin (1829-1897), A.A. Ostroumov (1844-1908), attached great importance to the use of physical exercises in treatment practice.

Works of P.F. Lesgaft (1837-1909), V.V. Gorinevsky (1857-1937) contributed to the understanding of the unity of mental and physical education for more perfect human development.

Discoveries of great physiologists - I.M. Sechenov (1829-1922), Nobel Prize laureate I.P. Pavlova (1849-1936), N.E. Vvedensky (1852-1922), who substantiated the importance of the central nervous system for the life of the body, influenced the development of a new approach to a comprehensive assessment of a sick person. Treatment of diseases gives way to treatment of the patient. In this regard, the ideas of functional therapy and exercise therapy are beginning to spread more widely in the clinic, being such a method, it has found recognition and wide application.

For the first time in the period 1923-1924. Exercise therapy was introduced in sanatoriums and resorts. In 1926, I.M. Sarkizov-Serazini (1887-1964) headed the first department of exercise therapy at the Moscow Institute of Physical Culture, where the future first doctors and candidates of science (V.N. Moshkov, V.K. Dobrovolsky, D.A. Vinokurov, K.N.) received training. Pribilov and others).

Therapeutic physical education (physical therapy) is an independent scientific discipline. In medicine, this is a treatment method that uses physical education for prevention, treatment, rehabilitation and supportive care. Exercise therapy forms in a person a conscious attitude towards physical exercise and, in this sense, has educational value; develops strength, endurance, coordination of movements, instills hygiene skills, hardening the body with natural factors. Exercise therapy is based on modern scientific data in the field of medicine, biology, and physical education.

The main means of exercise therapy are physical exercises, used in accordance with the objectives of treatment, taking into account the etiology, pathogenesis, clinical features, functional state of the body, and the degree of general physical performance.

Physiotherapy:

A natural biological method, as it uses the body’s inherent function of movement;

A method of nonspecific therapy, but at the same time, certain types of exercises can affect certain functions of the body;

A method of pathogenetic therapy, due to the ability of physical exercise to influence the reactivity of the body;

A method of active functional therapy, as it adapts the patient’s body to increasing physical activity;

Method of maintenance therapy at the stages of medical rehabilitation in elderly people;

Method of rehabilitation therapy in complex treatment of patients.

Objectives of exercise therapy for diseases of the digestive system:

Promote strengthening and healing of the body;

Affect the neurohumoral regulation of digestion;

Stimulate blood circulation in the abdominal cavity and pelvis;

Strengthen the abdominal muscles;

Contribute to the normalization of secretory, motor and absorption functions;

Prevent congestion in the abdominal cavity;

Promote the development of full breathing function;

The ability to use the benefits of diaphragmatic breathing in this pathology;

Have a positive impact on the psycho-emotional sphere.

A characteristic feature of exercise therapy is the process of training patients with physical exercises.

There are general and special training:

General training is aimed at improving health and strengthening the patient’s body with the help of general strengthening exercises;

Special training is carried out with exercises that specifically target the affected organ, the area of ​​injury.

Massage is a method of treatment, prevention, rehabilitation after illness and recovery, which is a set of techniques of mechanical, dosed influence on various areas of the surface of the human body, performed by the hands of a massage therapist or special devices. To achieve a positive result when using massage, it is necessary to differentiate its technique depending on the etiology, pathogenesis, clinical features, functional state of the central and nervous system (CNS), and the nature of the influence of various techniques on the body.

Exercise therapy and massage are widely used in combination with other methods for diseases and injuries, and can also be independent methods of treating many chronic diseases and the consequences of injuries: for paralysis, paresis, spinal curvature, emphysema, consequences of bone fractures, etc.

The effect of physical exercise on the body. Physical exercises are natural and specially selected movements used in exercise therapy and physical education. Their difference from ordinary movements is that they have a target orientation and are specially organized to improve health and restore impaired functions.

The effects of physical exercise are closely related to the physiological properties of muscles. Each striated muscle consists of many fibers. The muscle fiber has the ability to respond to stimulation of the muscle itself or the corresponding motor nerve, i.e. excitability. Excitation is carried out along the muscle fiber - this property is referred to as conductivity. A muscle is capable of changing its length when excited, which is defined as contractility. The contraction of a single muscle fiber goes through two phases: contraction - with the expenditure of energy and relaxation - with the restoration of energy.

During work, complex biochemical processes occur in muscle fibers with the participation of oxygen (aerobic metabolism) or without it (anaerobic metabolism). Aerobic metabolism dominates during short-term intense muscular work, and anaerobic metabolism provides moderate physical activity for a long time. Oxygen and substances that ensure muscle function come from the blood, and metabolism is regulated by the nervous system. Muscular activity is connected with all organs and systems according to the principles of motor-visceral reflexes; physical exercise causes an increase in their activity. Muscle contractions occur under the influence of impulses from the central nervous system.

The central nervous system regulates movements by receiving impulses from proprioceptors, which are located in muscles, tendons, ligaments, joint capsules, and periosteum. The motor response of a muscle to stimulation is called a reflex. The path of excitation transmission from the proprioceptor to the central nervous system and the muscle response constitute a reflex arc.

Physical exercise stimulates physiological processes in the body through nervous and humoral mechanisms. Muscular activity increases the tone of the central nervous system, changes the function of internal organs and especially the circulatory and respiratory systems through the mechanism of motor-visceral reflexes. The effects on the heart muscle, vascular system and extracardiac circulatory factors are enhanced; the regulatory influence of the cortical and subcortical centers on the vascular system is enhanced. Physical exercise provides better pulmonary ventilation and constant carbon dioxide tension in the arterial blood.

Physical exercises are carried out with the simultaneous participation of both the mental and physical spheres of a person. The basis of the physical therapy method is the process of dosed training, which develops the body's adaptive abilities.

Under the influence of physical exercise, the state of basic nervous processes is normalized - excitability increases with increased inhibition processes, inhibitory reactions develop with pathologically expressed increased excitability. Physical exercises form a new, dynamic stereotype, which helps to reduce or disappear pathological manifestations.

Products of the activity of the endocrine glands (hormones) and products of muscle activity entering the blood cause changes in the humoral environment of the body. The humoral mechanism in the influence of physical exercise is secondary and is carried out under the control of the nervous system.

Physical exercise:

Stimulate metabolism, tissue metabolism, endocrine system;

By increasing immunobiological properties and enzymatic activity, they contribute to the body’s resistance to diseases;

Positively affect the psycho-emotional sphere;

Improving mood;

They have a tonic, trophic, normalizing effect on the body and form compensatory functions.

This action is based on the generally accepted principle of neurophysiology about the neuro-reflex mechanism.

Physical exercise causes nonspecific physiological reactions in the patient’s body, stimulating the activity of all systems and the body as a whole.

The specificity of the influence of exercise therapy is that when using physical exercises, training is carried out, which helps to increase motor activity and physical performance.

The pathogenetic effect of exercise therapy is due to the fact that physical exercises are aimed at improving the functions of affected systems and organs, as well as at the pathogenetic links of diseases.

Exercise therapy is a biological stimulant, enhancing the body's protective and adaptive reactions. In their development, a large role belongs to the adaptation-trophic function of the sympathetic nervous system. The stimulating effect is manifested by increased proprioceptive afferentation, increased central nervous system tone, activation of all physiological functions of bioenergy, metabolism, and increased functional capabilities of the body.

The compensatory effect is due to the active mobilization of all its mechanisms, the formation of stable compensation for the affected system or organ, and the compensatory replacement of the lost function.

The trophic effect consists of activating the trophic function of the nervous system, improving enzymatic oxidation processes, stimulating immune systems, mobilizing plastic processes and tissue regeneration, and normalizing impaired metabolism.

As a result of all these processes, psycho-emotional unloading and switching occurs, adaptation to household and work physical stress, increased resistance to unfavorable factors of the external and internal environment, secondary prevention of chronic diseases and disability, and increased physical performance.

Diseases and injuries are accompanied by limitation of motor activity and force the patient to absolute or relative rest. This hypokinesia leads to a deterioration in the functions of all body systems, and not just the motor system. Exercise therapy reduces the harmful effects of hypokinesia and is the prevention and elimination of hypokinetic disorders.

The effect of exercise therapy on a patient depends on the strength and nature of the physical exercise and the body’s response to this exercise. The response also depends on the severity of the disease, the patient’s age, individual response characteristics, physical fitness, and psychological mood. Therefore, the dosage of exercise should be prescribed taking these factors into account.

Muscular work influences various functions of the digestive system according to the principle of motor-visceral reflexes. The changes that occur as a result of physical activity are different. Intense muscular work sharply inhibits motor, secretory and absorption functions, and moderate loads stimulate the activity of the digestive system.

In turn, physical activity, through afferent, proprioceptive impulses from working muscles, influences the central mechanisms of regulation of digestion in the brain. Special physical exercises for the abdominal muscles have a direct effect on intra-abdominal pressure; diaphragmatic breathing exercises change the position of the diaphragm, putting pressure on the liver and gall bladder. The combination of all these factors determines the positive role of the use of exercise therapy in the complex treatment of patients with diseases of the digestive system.

1.2 Features of the method of therapeutic physical culture for chronic gastritis

Gastritis is inflammatory or inflammatory-dystrophic changes in the gastric mucosa.

Gastritis can be primary and develop as an independent disease or secondary, accompanying a number of infectious and non-infectious diseases and intoxications.

Gastritis is divided into acute and chronic. In acute gastritis, the development of inflammatory changes in the stomach occurs quickly - within several hours and even minutes.

However, the most common is chronic gastritis, a characteristic feature of which is the gradual development of the inflammatory process, leading to changes in the mucous membrane, disruption of motor and secretory functions.

With this form of gastritis, other digestive organs are often affected: the liver, gallbladder, pancreas, as well as the nervous and endocrine systems.

Chronic gastritis is a polyetiological disease, the main causes of which are:

Long-term violation of diet;

Eating foods that irritate the gastric mucosa;

Addiction to too hot or spicy foods;

Poor chewing of food;

Dry food;

Frequent consumption of alcoholic beverages;

Poor nutrition (especially lack of protein, vitamins and iron).

Other diseases of the digestive system (appendicitis, colitis, cholecystitis, etc.) can also contribute to the development of chronic gastritis. Disturbances in the activity of the endocrine glands and the autonomic nervous system can affect the secretory and other functions of the stomach.

Chronic gastritis is a gradually progressive disease: periods of exacerbation are followed by periods of remission.

For diseases of the digestive system, therapeutic exercises play an important role in the complex of therapeutic agents.

Physical exercise affects the digestive system through the type of motor-visceral reflexes. Short-term muscle loads of low and medium intensity increase the excitability of the cerebral cortex, including the food center, which, in turn, activates autonomic functions and improves digestion. The abdominal muscles and diaphragm, as if massaging the abdominal organs, activate the functions of the digestive tract.

Intense physical activity has a depressing effect on digestion. At the same time, the secretion of gastric juice decreases and acidity decreases.

The inhibitory effect of physical exercise is more pronounced immediately after eating, so the training load during this period can cause not only functional, but also organic disorders in the digestive system.

1-2 hours after eating, physical activity even above average intensity has a positive effect. By this time, the activity of the vagus nerve, which provides the motor and secretory functions of the gastrointestinal tract, decreases.

Consequently, knowing the nature of the violation of secretory or motor function and taking into account the phase of digestion, it is possible through differentiated administration of physical activity of varying intensity to achieve normal functioning of the digestive organs.

Under the influence of physical exercise, the trophic processes of the digestive organs are improved - the blood supply to the abdominal organs is activated and the amount of deposited blood is reduced, which helps to attenuate inflammatory processes and accelerate regeneration processes.

Physical exercises have a tonic and normalizing effect on the body, helping to normalize motor-visceral reflexes.

Thus, the mechanisms of the therapeutic effect of physical exercise on the digestive organs come down to changes in the functional state of the cerebral cortex and the tone of the autonomic nervous system.

With the help of therapeutic physical culture, the following problems are solved for diseases of the digestive system, in particular gastritis:

Providing a positive effect on the neuropsychic and emotional spheres (since digestion processes in the body are regulated by the central nervous system);

Development and improvement of external and especially diaphragmatic breathing;

Impact on the secretory and motor functions of the stomach, as well as on the neurohumoral regulation of digestive processes;

Improving the trophism of the gastric mucosa;

Improving blood circulation in the abdominal cavity and creating favorable conditions for regenerative processes.

Therapeutic physical culture is used in the attenuation phase of exacerbation and the remission phase. In the acute phase and in case of complications, physical therapy exercises should be stopped.

The method of therapeutic physical culture involves a combination of general developmental and special exercises. General developmental exercises have a tonic effect on the central nervous system and improve the function of the digestive organs. As special exercises, exercises are used for the muscles surrounding the abdominal cavity.

Exercises for the abdominal muscles are prescribed taking into account the phase of the disease. They are indicated if necessary to enhance peristalsis, gastric secretory function and bile outflow. In the acute and subacute phases they are excluded.

Diaphragmatic breathing exercises have a massaging effect on the stomach.

The choice of initial exercises depends on the nature of the exercises performed and the phase of the disease. For muscle relaxation exercises, as well as after an exacerbation of the disease, the most favorable starting position is lying down. In a sitting position, exercises are performed on bed or semi-bed rest. For the purpose of mechanical movement of the stomach, as well as to limit the impact on the abdominal muscles, the starting positions are used, kneeling and standing.

Depending on the phase of the disease, the pace and rhythm of physical exercises are determined. In the subacute phase, a slow pace and monotonous rhythm are used, and in complete remission, any rhythm and change of rhythms are recommended.

The main purpose of physical exercise is general health improvement, normalization of the secretory-motor function of the digestive tract.

Treatment and rehabilitation for chronic gastritis are complex and include the following measures.

Drug treatment aimed at eliminating the inflammatory process and influencing the mechanisms of development of the pathological process;

Exercise therapy classes (therapeutic gymnastics, health path, outdoor games, elements of sports games);

Diet (therapeutic nutrition and dietary adherence);

Elimination of professional and bad habits;

Physiotherapy;

Local effect on the gastric mucosa (rosehip or sea buckthorn oil, mineral water).

For gastritis with secretory insufficiency, a moderate effect of physical activity on the entire body is indicated. In accordance with the treatment period and motor regimen, general developmental exercises are used, at a slow pace, with limited amplitude and a small number of repetitions; special exercises for the abdominal muscles with a gradual increase in load, static and dynamic breathing exercises, as well as slow walking for up to 30 minutes.

In the first period, corresponding to the acute and subacute phases of the disease, therapeutic exercises are carried out 2 hours before meals and 20-40 minutes before drinking mineral water to improve blood circulation in the stomach. Starting positions - lying on your back, on your side, reclining; then sitting and lying down. Lesson duration - 20-25 minutes.

No earlier than 1.5-2 hours after eating, walking is used to improve the evacuation function of the stomach. The walking pace is slow, with a gradual increase in walking duration - up to 30 minutes. During the period of remission, it is allowed to perform exercises to increase intra-abdominal pressure in the initial position lying on the stomach. In combination with therapeutic exercises, it is recommended to massage the anterior abdominal wall.

For gastritis with increased secretion, therapeutic physical culture is carried out before meals with increasing load. The patient must be sufficiently physically prepared to perform exercises for medium and large muscles, with a large number of repetitions, swing movements, exercises with apparatus, which serve to reduce gastric secretion.

In the second period, in addition to general strengthening exercises, classes include special exercises with an emphasis on diaphragmatic breathing and relaxation. Segmental massage has a good effect in relaxing the stomach muscles.

In the third period, the means of therapeutic physical culture are expanded: walking, outdoor and sports games (volleyball, badminton, tennis), skiing, skating, swimming, rowing, close hiking, dosed running, and health paths are used. Therapeutic exercises are carried out between drinking mineral water and lunch, since mineral water inhibits gastric secretion.

The influence of the nature of physical activity on various gastric functions is given in Table 1.

Table 1

The influence of the nature of physical activity on various functions of the stomach

The dosage of physical activity is carried out in accordance with the physical fitness of patients, the functional state of the cardiorespiratory system, as well as depending on concomitant diseases that limit physical performance.

With hypocidal gastritis, atony of the stomach and intestines, moderate physical activity that does not cause fatigue increases metabolism, improves blood circulation and stimulates the activity of all organs secreting digestive juices.

For patients suffering from low and zero acidity of gastric juice, in order to normalize the acidity of the stomach and improve the functioning of the digestive organs, a set of eighteen simple physical exercises is proposed below, which should be performed, gradually increasing the pace towards the middle of the complex, and then gradually towards the end of the session reduce it.

To perform exercises 1 to 5, the starting position is standing.

Exercise 1. Putting your right leg back, raise your arms up - inhale, return to the starting position - exhale. The same for the left leg. The pace is slow. Perform 3-4 times.

Exercise 2. Torso turns. Hands to the sides - inhale, turn 90° to the right - exhale, return to the original position - inhale.

Turn 90° to the left - exhale, return to the starting position - inhale. The pace is slow. Perform 3-4 times in each direction.

Exercise 3. Bends to the side. Bend to the right - exhale, straighten - inhale; bend to the left - exhale, straighten - inhale. Breathing is uniform. The pace is slow. Perform 3-4 times.

Exercise 4. “Lumberjack” exercise. Leaning forward - exhale, returning to the original position - inhale. The exercise simulates chopping wood. The pace is fast. Perform 3-4 times.

Exercise 5. Full breathing. The pace is slow. Perform 3-4 times.

Exercise 6. Starting position - sitting. Legs straight, arms supported behind. Bend over - inhale, return to the starting position - exhale. The pace is slow. Perform 4-6 times.

To perform exercises 7 to 9, the starting position is lying on your back.

Exercise 7. Alternately raising the right and left straight legs. Raising your leg - exhale, lowering - inhale. The pace is slow. Perform 4-6 times.

Exercise 8. Exercise "bicycle". Breathing is uniform. The pace is average. Perform for 15-25 seconds.

Exercise 9. Full deep breathing - 3-4 times. The pace is slow.

Exercise 10. Starting position - lying on your stomach. Bend your arms while standing. While doing push-ups from the floor, exhale, returning to the starting position - inhale. The pace is average. Perform 5-10 times.

To perform exercises 11 and 12, the starting position is standing.

Exercise 11. Squats. Squatting, exhale, returning to the starting position - inhale. The pace is average. Perform 5-15 times.

Exercise 12. Raise your right leg straight - exhale, take it back - inhale. The pace is average. Perform 4-6 times. The same for the left leg.

To perform exercises 13 and 14, the starting position is sitting.

Exercise 13. Find a footrest. Bend back - inhale, return to the starting position - exhale. The pace is slow. Perform 3-5 times.

Exercise 14. Starting position - sitting. Full slow breathing under hand control. Place your right hand on your chest, your left hand on your stomach.

On the count of one or two, we begin to take a slow diaphragmatic breath, the diaphragm goes down, and the stomach protrudes. This movement is recorded by the left hand. On the count of three or four, we continue to take a full breath, but this time through the chest. This is fixed by the right hand. At the same time, the chest rises, the shoulders turn, and the head leans back a little. At the count of five or six, we begin to exhale slowly diaphragmatically, the diaphragm goes up, and the stomach retracts. This movement is recorded by the left hand. At the count of seven or eight, we continue to exhale completely, but this time through the chest. This is fixed by the right hand. At the same time, the chest drops, the shoulders come together, the head drops to the chest. On the count of nine to ten, try to hold your breath while exhaling completely. (In the future, you should try to gradually increase the time you hold your breath while fully exhaling, but do not do it forcefully.) Repeat the exercise 3-5 times.

Exercise 15. Starting position - on all fours. Synchronized arm and leg raise. Raise your right arm and right leg - inhale, lower - exhale; Raise your left arm and left leg - inhale, lower - exhale. The pace is average. Perform 3-8 times.

To perform exercises 16 to 18, the starting position is standing.

Exercise 16. Jumping. Breathing is uniform. Perform 15-60 times, then start walking.

Exercise 17. Walking in place for 1.5 minutes.

Exercise 18. Full breathing - 1.5-2 minutes. The pace is slow.

In addition to therapeutic exercises and walking, patients with hypocidal gastritis are recommended to engage in swimming (especially with prolapse of the stomach and intestines), rowing, volleyball, tennis, weekend tourism, skiing and skating. It is very good for such patients, along with exercises for all muscle groups, to perform exercises with a load on the abdominal muscles.

For constipation, which very often accompanies atony, you should perform additional exercises associated with shaking the body (running, jumping rope, horse riding, sports games, skiing and rowing).

Thus, thanks to the integrated use of therapeutic exercises, anti-inflammatory and reparative therapy, hygienic procedures and diet therapy in combination with medical therapy, it becomes possible to solve the global problem of normalizing the functioning of the gastrointestinal tract at the stage of preparing the body for cleansing the large intestine.

1.3 Features of the method of therapeutic physical culture for gastric ulcer

Peptic ulcer is a chronic, cyclical disease with a varied clinical picture and ulceration of the gastric or duodenal mucosa during periods of exacerbation.

The leading symptom in the clinical picture of peptic ulcer disease is pain. Its distinctive features should be considered periodicity (alternating periods of exacerbations and remissions), rhythm (the connection of pain with food intake), seasonality (exacerbation in spring and autumn, and in some patients - in winter and summer), the increasing nature of pain as the disease develops, changes and disappearance of pain after eating, antacids; use of heat, anticholinergics, after vomiting.

According to the time of onset of pain after eating, they are divided into early, occurring soon after eating, late (after 1.5 - 2 hours) and night. Early pain is characteristic of ulcers located in the upper part of the stomach. Ulcers of the antrum and duodenal ulcers are characterized by late and night pain, which can also be “hungry”, as it decreases or stops after eating.

Pain in peptic ulcers reaches its maximum intensity at the height of digestion and only “hunger” pains disappear after eating. In the presence of perigastritis or periduodenitis, the pain intensifies with physical stress. Reduction or cessation of pain after accidental vomiting leads to the fact that patients, when pain appears, induce vomiting artificially. No less typical for peptic ulcer disease is the lightning cessation of pain after taking alkalis.

Vomiting during a peptic ulcer occurs without previous nausea, at the height of pain in the midst of digestion, and with different localization of the ulcerative process, its frequency varies. The release of active gastric juice on an empty stomach is often accompanied by vomiting. Frequent morning vomiting with the remains of food eaten the day before indicates a violation of the evacuation function of the stomach.

Of the dyspeptic phenomena in peptic ulcers, heartburn occurs most often (in 60-80% of all patients with peptic ulcers). From a diagnostic point of view, it is important that it is noted not only during periods of exacerbations, but can precede them for a number of years and has the same typical features as pain (frequency, seasonality). Heartburn is associated with impaired motor function of the esophagus and stomach, and not with secretory function, as previously thought. When inflating the esophagus, stomach, or duodenum with a rubber balloon, you can cause a burning sensation of varying degrees, up to the sensation of a “burning cramp.”

Appetite in case of peptic ulcer is not only preserved, but sometimes even sharply increased. Since pain is usually associated with eating, sometimes patients develop a fear of food. Some people suffering from peptic ulcer periodically experience increased salivation, which is preceded by nausea. There is often a feeling of heavy pressure in the epigastric region. These phenomena are characterized by the same patterns as pain.

Constipation is often observed during an exacerbation. They are caused by the nature of the patients’ diet, bed rest and mainly by neuromuscular dystonia of the colon of vagal origin. The general nutrition of patients with peptic ulcer is not affected. Weight loss can be observed during an exacerbation of the disease, when the patient limits food intake due to fear of pain. With superficial palpation of the abdomen, tension in the right rectus muscle can be detected, which decreases as the pathological process subsides.

According to the clinical course, acute, chronic and atypical ulcers are distinguished. Not every acute ulcer is a sign of peptic ulcer disease.

The typical chronic form of peptic ulcer disease is characterized by a gradual onset, an increase in symptoms and a periodic (cyclical) course.

The first stage is the prelude of an ulcer, characterized by pronounced disturbances in the activity of the autonomic nervous system and functional disorders of the stomach and duodenum, the second by the appearance of organic changes initially in the form of a structural restructuring of the mucous membrane with the development of gastroduodenitis, the third by the formation of an ulcerative defect in the stomach or duodenum, the fourth - development of complications.

The duration of periods of remission for peptic ulcer disease ranges from several months to many years. Relapse of the disease can be caused by mental and physical stress, infection, vaccination, trauma, taking medications (salicylates, corticosteroids, etc.), and insolation.

Causes of occurrence: damage to the nervous system (acute psychological trauma, physical and mental fatigue, nervous diseases), hormonal factor (impaired production of digestive hormones - gastrin, secretin, etc., impaired histamine and serotonin metabolism, under the influence of which the activity of the acid-peptic factor increases) .

Impulses from the receptors of internal organs enter the central nervous system, signaling the intensity of functioning and the condition of the organs. When the disease occurs, reflex regulation is disrupted, pathological dominants and vicious (pathological) reflexes arise, distorting the course of normal processes in the human body.

It is already known that performing dosed physical exercises, accompanied by positive changes in the functional state of the centers of the subcutaneous region and an increase in the level of basic life processes, causes positive emotions (the so-called psychogenic and conditioned reflex influence). This is especially applicable in case of peptic ulcer disease, when the neuropsychic state of patients leaves much to be desired (normalization of the symptoms of dystonia expressed in patients from the nervous system). It should be noted the impact of physical activity on the nervous regulation of the digestive apparatus.

Depending on the clinical nature of the disease and the functionality of the patient, various forms and means are used.

Contraindications to classes include:

Fresh ulcer in the acute period;

Ulcer complicated by bleeding;

Preperforative state;

An ulcer complicated by stenosis in the stage of decompensation;

Fresh massive paraprocesses during penetration;

Severe dyspeptic disorders;

Severe pain;

General contraindications;

Regulation of excitation and inhibition processes in the central nervous system;

Normalization of the patient’s neuropsychological tone;

Improving respiratory function, blood circulation and digestion, redox processes;

Normalization of muscle tone (which is a powerful regulator of internal organs), increased muscle strength, proprioceptive sensitivity;

Development of the necessary motor qualities, skills and abilities (breathing, muscle relaxation, elements of autogenic training, coordination of movements, etc.).

Morning hygienic gymnastics pursues the goals of general development and strengthening of health, increasing efficiency, and helps hardening, promotes a more complete transition from an inhibited state to an alert state. Morning hygienic exercises use a small (8-10) number of exercises covering the main muscle groups; physical exercise should be simple.

The therapeutic effect of LH will be significantly higher if special physical exercises are performed by muscle groups that receive innervation from the same segments of the spinal cord as the affected organ. These are exercises involving the muscles of the neck, trapezius, levator scapulae, rhomboid major and minor, diaphragm, intercostal muscles, anterior abdominal wall, iliopsoas, obturator, foot and calf muscles.

In diseases of the digestive organs, the effectiveness of LH largely depends on the choice of starting positions that allow differentiated regulation of intra-abdominal pressure.

The most commonly used position is lying down with bent legs (on the left or right side, on the back); standing, kneeling, on all fours, standing and sitting.

The lying position is recommended during an exacerbation and immediately after an exacerbation of the disease as the most gentle, promoting the least functional changes, providing the best conditions for performing breathing exercises (lying on your back with bent legs), and voluntary muscle relaxation. These starting positions are convenient for performing exercises for the abdominal muscles and pelvic floor.

The anatomical and topographic relationships of the gallbladder, common bile duct and duodenum make it possible to recommend a position lying on the left side, standing on all fours, in which the outflow of bile towards the neck of the bladder and ampulla is carried out under the influence of hydrostatic pressure. Additionally, the outflow of bile in these initial positions is accelerated by an increase in intra-abdominal pressure during full breathing with an emphasis on the diaphragm and some participation of the abdominal muscles.

The kneeling position (on all fours) is used if necessary to limit the impact on the abdominal muscles, cause mechanical movement of the stomach and intestinal loops; standing and sitting positions are used for the greatest impact on the digestive organs.

LH in an aquatic environment is carried out in pools with fresh or mineral water. Exercises are performed from a lying position with floating devices or at the handrail, sitting on a hanging chair, standing and in motion. Lesson duration is from 20 to 40 minutes. Water temperature 24-26°C. There are 12-15 procedures per course of treatment. Classes are conducted individually or in a small group.

LH is used after the acute period of the disease. Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective condition and the ulcer can progress with subjective well-being (disappearance of pain, etc.). In this regard, when treating patients, one should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient's motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing exercises and exercises for the abdominal muscles.

LH classes are first carried out in relation to bed rest. In the first lessons, it is necessary to teach the patient abdominal breathing with a small amplitude of vibrations of the abdominal wall. These exercises, causing minor changes in intra-abdominal pressure, help improve blood circulation and gentle massage of the abdominal organs, reduce spastic phenomena and normalize peristalsis. Movements in large joints of the limbs are performed first with a shortened lever and a small amplitude. You can use exercises in static tension of the muscles of the upper limbs, abdominals and lower limbs. It is necessary to turn over in bed and move to a sitting position calmly, without significant tension. The duration of LG classes is 8-12 minutes.

With a noticeable subsidence of pain and other exacerbation phenomena, the disappearance or reduction of rigidity of the abdominal wall, a decrease in pain and an improvement in general condition, a ward regime is prescribed (approximately 2 weeks after admission to the hospital). Exercises from a lying, sitting, standing, kneeling position are performed with gradually increasing effort for all muscle groups (except for the abdominal muscles), with incomplete amplitude, at a slow and medium pace. Short-term moderate tension of the abdominal muscles while lying on your back is allowed. Diaphragmatic breathing gradually deepens. Duration of LG classes is 15-18 minutes.

After the disappearance of pain and other signs of exacerbation, in the absence of complaints and general satisfactory condition, a free regimen is prescribed. In LH classes, exercises are used for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various starting positions. Include exercises with dumbbells (0.5-2 kg), medicine balls (up to 2 kg), exercises on a gymnastic wall and bench. Diaphragmatic breathing is carried out with maximum depth. Walking is up to 2-3 km per day, walking up stairs - up to 4-6 floors, outdoor walks are desirable. The duration of the LG session is 20-25 minutes.

In the conditions of sanatoriums and resorts, where patients undergo treatment during remission, the volume and intensity of PH exercises increase: general strengthening, breathing exercises, exercises for coordination of movements are widely used, outdoor and some sports games (badminton, table tennis), and relay races are allowed. A health path, walking, and in winter skiing should be recommended (the route should exclude ascents and descents with a steepness exceeding 15-20°; an alternating walking style is indicated). In the LH procedure, strength, speed-strength exercises, static efforts and tensions, jumps and leaps, and performing exercises at a fast pace are excluded.

Approximate schemes of motor modes:

A mode with low physical activity (gentle) is used to restore adaptation to the loads of an extended mode; stimulation of metabolic processes; combating congestion in the abdominal cavity; normalization of regenerative processes; a positive effect on the psycho-emotional sphere of patients and a moderate increase in the adaptation of the cardiovascular system to increasing physical activity. With a gentle regime, periods of rest prevail over periods of stress.

Contents of the regime: include balneo- and physiotherapeutic procedures. Morning hygienic gymnastics is carried out in a small group method with a low load, lasting 10-15 minutes, the density of the exercise is 40-50%. LH is carried out in a small group method or individually, duration is 20-25 minutes, class density is 50%. Dosed walks on flat terrain with a length of 0.5-1.5 km 1-2 times a day with a rest interval of at least 1-2 hours, at a pace characteristic of the patient’s dynamic stereotype. Independent physical exercises 1-2 times a day, 6-8 special exercises. Sedentary games (croquet, bowling) up to 30 minutes. Indications for prescribing the regimen: diseases of the gastrointestinal tract in the stage of fading exacerbation, poor general condition (severe weakness, fatigue).

Mode with average physical activity (gentle training).

Goal: restoration of adaptation to training loads. Regulation of excitation and inhibition processes in the central nervous system, normalization of autonomic functions. Stimulation of metabolic processes, combating congestion in the abdominal cavity, improving regenerative processes.

Contents of the regime: include balneo- and physiotherapeutic procedures. Morning hygienic gymnastics in a group method with low load (duration 12-15 minutes, motor density 50-60%). LH with an average load (duration 25-30 minutes, 3-4 sessions per day for 5-10 minutes). Dosed walks at a slow and medium pace with a length of 6 km and an elevation angle of up to 10° 1-2 times a day. It is allowed to play croquet, bowling, gorodki, table tennis, badminton according to simplified rules with a low load, on average up to 40-60 minutes. Sports exercises (water and winter sports) with low impact, dosed rowing, horse riding, skiing.

Contents of the regimen: the daily regimen includes balneo- and physiotherapeutic procedures. Morning hygienic gymnastics in a group method with an average load (15-20 minutes, motor density 60-70%). LH with a heavy load using a special technique (30-45 minutes, motor density 60-70%). Self-training of patients with special exercises 3-4 times a day. Measured walks at a slow pace along routes ranging from 10 to 20 km with an elevation angle of up to 20°. Participation in competitions according to simplified rules is allowed. Sports exercises (water and winter sports) with medium load. Physical activity takes precedence over rest and relaxation.

Indications for the regimen: chronic diseases of the gastrointestinal tract in the phase of stable remission with stable compensation of functions. The regimen is also prescribed to patients transferred from the gentle training regimen to the second half of the course of treatment, subject to positive dynamics. The duration of a patient's stay in one or another mode of movement is not determined by a certain number of days. The attending physician transfers the patient from one mode to another based on favorable changes in his clinical condition with adaptation of the cardiovascular system and the body as a whole to the previous mode of movement. It is not necessary to prescribe all forms of exercise therapy in a new regime: a training effect can be achieved by increasing the load in only one form of exercise therapy.

Goal setting: restoration of the patient’s adaptation to the loads of the extended regime. Increasing stimulation of metabolic processes, impact on the regulation of excitation and inhibition processes in the cerebral cortex, impact on the normalization of autonomic functions. Combating congestion in the abdominal cavity. Promoting regenerative processes in the gastrointestinal tract.

The intensity of performing resistance exercises for the muscles of the shoulder girdle and intercostal muscles gradually increases (up to approximately 40-50%) with the aim of a reflex effect on the digestive organs. You can use dumbbells weighing up to 2-4 kg, medicine balls weighing no more than 2-3 kg, exercises on sports equipment. To combat congestion, a good effect is achieved by diaphragmatic breathing from various starting positions, which is brought to great depth, alternating with chest and full breathing; A more frequent change of starting positions, exercises, games and loads as they become more difficult also helps. Gradually, increasingly complex attention exercises are included in the classes. The density of classes remains no higher than average.

Walking is increased to 4-5 km per day. With general good health and absence of pain, ball games (volleyball, etc.) are allowed, taking into account individual reactions, lasting no more than 25-35 minutes. Including various types of games in the course helps maintain interest and increases the production of positive emotions during general physical activity.

During the entire course, the patient should be pointed out to the positive changes achieved in his condition and physical development, and should be taught that gastric disorders are insignificant and easily correctable (psychological impact).

Exercise therapy is effective only if long-term, systematic classes are carried out with a gradual increase in load both in each of them and throughout the course. Below is a table (Table 2) of an approximate structure of a lesson for the remission stage of the ulcerative process.

Strict consistency in increasing the load and its individualization are the main conditions for conducting all classes. In this case, the condition, reaction of the students, features of the clinical course, concomitant diseases and physical fitness of the students should be taken into account.

Another thing is also important: by doing physical exercises, the patient himself actively participates in the healing process, and this has a beneficial effect on his psycho-emotional sphere.

table 2

Scheme of the LH procedure for patients with duodenal ulcer in remission

The classes also have an educational value: patients get used to systematically performing physical exercises, this becomes their daily habit. Exercise therapy classes turn into general physical education classes and become a human need even after recovery.

1.4 Therapeutic physical training for biliary dyskinesias

Biliary dyskinesia is a functional disorder of the motor function of the gallbladder and extrahepatic bile ducts. According to statistics, women are more likely to suffer from biliary dyskinesia. Increased contractile activity of the biliary tract (hyperkinetic dyskinesia) is more common at a young age, weakening (hypokinetic dyskinesia) occurs in people with an unstable psyche over 40 years of age.

For the most part, biliary dyskinesias are secondary and arise as a result of disturbances in the neurohumoral regulation of bile secretion, pathological impulses from other digestive organs, kidneys and genitals. A long-term diet with the exclusion of natural choleretic agents, toxic damage to smooth muscles and nerve ganglia of the biliary system, and acute hepatitis are important. In the occurrence of dyskinesia, great importance is attached to immune mechanisms. With severe asthenia, a sedentary lifestyle, poor nutrition with very long intervals between meals, a hypokinetic form of dyskinesia (reduced contractile activity) is relatively often detected. In addition to psychogenic disorders, food allergies are also called etiological factors. And also, dyskinesia can be associated with cholecystitis and cholelithiasis. The hyperkinetic form (increased contractile activity) occurs reflexively with peptic ulcers, colitis, appendicitis, and some other diseases.

The first signs of the disease appear in preschool and school age, the peak incidence occurs at 7-9 years. Patients with ADHD are more often found in families where there are conflict situations that lead to the development of neurosis in children. The importance of hereditary factors in the occurrence of ADHD has not been directly proven, but it must be borne in mind that the child’s body may have a hereditary predisposition to the weakness of adaptation mechanisms, manifested by frequent colds, allergic reactions, and neurological disorders.

Therapeutic exercise is used for all chronic diseases of the biliary tract in children, which are accompanied by disorders of the general metabolism of the digestive function, congestion in the liver and disorders of the motor functions of the gallbladder.

Objectives of therapeutic physical culture for diseases of the liver and biliary tract:

Improving metabolism, healing and strengthening the body;

Reducing congestion in the liver and gall bladder;

Relieving spasmodic phenomena in the gallbladder and ducts;

Increased mobility of the diaphragm - the main regulator of intra-abdominal pressure;

Improving blood circulation in the liver and other abdominal organs;

Promoting the flow of bile in the gallbladder;

Strengthening the abdominal press in order to keep the abdominal organs in a normal position, as well as regulate the functions of the stomach and intestines;

Replenishment of the deficiency of muscle activity (the main stimulator of the function of internal organs) caused by the disease.

Therapeutic physical education classes are indicated during hospitalizations in the absence of frequent attacks and exacerbations. However, it is not contraindicated:

Presence of low-grade body temperature;

The presence of pain on palpation in the gallbladder area, a slight enlargement of the liver, and mild pain in the liver area;

Minor jaundice, sometimes occurring in patients with angio-cholecystitis as a result of a delay in the outflow of bile from the gallbladder, because exercises for the abdominal muscles and breathing exercises help improve bile secretion and quickly eliminate jaundice;

Exercise therapy is completely contraindicated in the acute period of the disease with high body temperature, ROE and severe pain;

After discharge from the hospital, exercise therapy is not only indicated, but also necessary, since in most cases patients leave the hospital with residual symptoms of the disease. It is during this period that systematic exercise therapy can significantly improve the patient's health.

Gymnastic exercises effectively affect the body, normalizing or improving neurotrophic processes and metabolism. A correctly selected set of exercises allows you to have a versatile impact on various muscle groups, the respiratory and circulatory systems, and influence the functional functions of internal organs. Under the influence of regularly performed physical exercises, the conditioned reflex activity of the body is strengthened and metabolic processes are improved. Exercise therapy complexes are applied in a certain sequence. The load increases as training increases.

Factors affecting blood flow to the liver are:

Intra-abdominal pressure;

Activity of digestive processes;

Intestinal peristalsis.

The outflow of blood from the liver is affected by:

Periodic increase in intra-abdominal pressure;

Position and movement of the diaphragm;

Full function of the right heart;

Body position (lying down).

The best effect of physical therapy for liver diseases, in particular for the outflow of bile, is undoubtedly achieved in the initial lying position, and of the 4 possible positions, each has its own characteristics (lying on the back, stomach, right side, left side).

The location of the biliary system in the abdominal cavity determines the best starting position, lying on the left side. This ensures the free movement of bile in the gallbladder to its neck along the cystic duct. At the same time, this provision sharply limits the use of a variety of exercises necessary to improve the functioning of other body functions.

The starting position lying on your back allows you to significantly expand the range of exercises for the abdominals, limbs and diaphragmatic breathing. However, the effectiveness of using exercises in this initial position for the outflow of bile is somewhat lower than in the first option.

The starting position lying on your stomach increases abdominal pressure. Due to the formation of so-called pressor pressure on the gallbladder, an additional effect occurs, promoting its emptying.

The initial position lying on the right side is unfavorable for the outflow of bile, since its entry into the neck of the gallbladder is difficult. However, in this position it is recommended to use a number of exercises for diaphragmatic breathing. In this initial position, the excursion of the right dome of the diaphragm is significantly improved, which leads to an increase in blood circulation in the liver.

In the initial standing position, it is possible to use a wide range of gymnastic exercises. This position is less favorable for the outflow of bile, but it expands the area of ​​motor, breathing and play exercises. The latter is especially important when working with children.

The complex should include, in a certain sequence, gymnastic exercises from various starting positions, affecting different departments of the human body. In this case, special attention should be paid to exercises of a specific nature, necessary specifically for this disease.

There cannot be any general recommendations regarding dosage. It must be carried out on a case-by-case basis.

Auxiliary physical training activities are of great importance as general strengtheners, increasing the vitality of the body, strengthening the nervous system and promoting recovery. These include exercises with long-term moderate physical activity (walking on flat terrain, health path, walking excursions, short-range tourism). In certain conditions, it is advisable to use swimming, skiing and skating, playing volleyball, and tennis. Occupational therapy exercises in the fresh air - gardening, gardening, snow removal and others - have a good effect.

Along with a set of gymnastic exercises, massage of the abdomen and intestines is of no small importance.

Regular use of physical exercises has not only therapeutic, but also important preventive value.

Below is a list of sample exercises.

Lying on your back

Raising a straight leg forward;

Alternately pulling the knee to the stomach;

Taking the leg to the side;

Raising both straight legs forward;

Bending both legs, pulling the knees towards the stomach;

Leg movements reproducing the movements of riding a bicycle;

Breathing with the stomach (diaphragmatic), lying on your side;

Raising your leg to the side;

Taking the leg back - bending forward, pulling the knee towards the stomach;

Counter swinging movements of the arm and leg while sitting on a chair;

Turning the torso to the sides;

Bends the torso to the sides;

Hands on the belt, move your elbows back - inhale, bend forward - exhale;

Alternately bending and pulling the leg towards the stomach;

Pulling both legs towards the stomach;

Belly breathing (diaphragmatic);

Full breath while standing;

Walking. Walking with high knees;

Standing at a support, swing your legs forward, backward, to the sides;

Breathing belly and full;

Turn the torso to the sides with abduction of the arm in the same direction;

Tilts of the torso to the side, forward and bending from various starting positions for the legs, with additional movement of the arms;

Squat;

Torso rotation.

A set of exercises is compiled taking into account the disease, the individual characteristics of the patient, and the principles of using physical exercises for therapeutic purposes. Special exercises are performed in combination with general developmental and breathing exercises from various starting positions.

It must be remembered that the positive effect of physical therapy is achieved through systematic and regular exercise over a long period of time under supervision.

2. Experimental part

2.1 Purpose, objectives and methodology of experimental work

Based on theoretical principles, we conducted an experiment, the purpose of which was to test the effect of the use of therapeutic physical training for diseases of the digestive system

The purpose of the experimental work is to identify the significance of using physical therapy methods for diseases of the digestive system in children aged 5-7 years.

Objectives of the experimental work:

Develop exercises aimed at improving the health status of children with diseases of the digestive system;

To test in practice the effectiveness of physical therapy methods in children with diseases of the digestive system.

The experimental part of our study took place in Zatobolsk School No. 2. Two groups aged 7 years took part in the experiment: an experimental group (10 people) and a control group (10 people).

The modern school education system in our country is undergoing great changes, which significantly increases the importance of the problem of preserving and strengthening the health of schoolchildren.

The school is a place of active activity for children for 9-11 (12) years. Staying at school takes up a significant share of students' time budget, which increases from elementary to high school.

It becomes obvious that there is a need to strengthen the health of schoolchildren within an educational institution with the active participation of teachers, medical workers, parents and the children themselves.

From a modern point of view, the formation of the health of children of organized groups is based on the complex impact of measures for the primary prevention of diseases, correction of risk states (i.e., such recommendations on lifestyle, nutrition, physical education, educational activities that minimize the likelihood of a risk state transitioning into disease), as well as preventing relapses and complications of chronic pathology.

The medical service of Zatobolsk School No. 2 is an integral part of the education system designed to preserve and strengthen the health of students. The work is based on strict adherence to orders, instructions, and methodological recommendations.

The ill health of schoolchildren, especially the presence of long-term pathological conditions, congenital morphological disorders, and the consequences of injuries, lead to a limitation of life and social functions characteristic of their age, which can manifest itself in limited physical independence and mobility, the ability to engage in normal activities, reduced opportunities for education, and integration into society, towards future professional activity and economic independence. Modern innovative pedagogical technologies are aimed at significantly improving the quality of education and are accompanied by a pronounced intensification of the educational process and an increase in the length of stay of children in an educational institution. In parallel to this, there is a process of deterioration in the health of children and adolescents.

Therefore, the search for new organizational forms of prevention and health promotion directly in the conditions of an educational institution, with the active participation of teachers, parents and children themselves, becomes relevant. One of the ways to solve this problem is to organize a correction room at Zatobolskaya school No. 2.

Organizing a school health and rehabilitation center in an educational institution allows you to:

Carry out activities to improve the health of children directly at the place of their education as part of the educational process;

Along with improving the health of students, solve rehabilitation problems aimed at minimizing the consequences of chronic diseases and improving the quality of life of children;

Ensure access to health care services for all students;

It is more effective to solve the problems of health improvement, prevention and rehabilitation through the introduction of the principles of unified planning of medical, psychological, pedagogical and social activities and joint activities of participants in the educational process (medical workers, teachers, students, parents).

The basis of the activities of the correction office of Zatobolsk school No. 2 is organizational and methodological support for the health-preserving activities of the educational institution. For this purpose, interaction between doctors, teachers, psychologists, and social educators is organized. Parents are actively involved in the work, and, if necessary, specialists from other institutions and departments.

The purpose of the correction room at Zatobolskaya school No. 2 is to carry out preventive and rehabilitation medical, pedagogical and social activities aimed at improving the level of health of students and teachers.

Prevention of morbidity based on the implementation of the “Program of general strengthening measures and reduction of morbidity among schoolchildren,” which provides for the phased implementation of measures to prevent the unfavorable course of adaptation, fatigue, increased incidence of ARVI and influenza, digestive organs, etc.;

Restorative treatment of children with chronic diseases of the respiratory system, digestion, kidneys, cardiovascular system, dental system, according to the recommendations of the pediatrician and specialists;

Corrective and recreational activities for schoolchildren with disorders of the gastrointestinal tract and respiratory system, based on current recommendations for exercise therapy;

Promotion of healthy lifestyle skills among students and parents, formation of parents' responsibility for maintaining the health of the child. Use of scientific and methodological materials (lectures, memos, health information sheets), holding sports events, Health Days, etc.

The experiment took place in three stages:

At the first stage of our experiment, we identified the level of health in children with digestive diseases.

At the second stage, we worked on the development and experimental testing of a system of physical exercises aimed at improving the condition of children with diseases of the digestive system.

The third stage is a repeated examination on the problem of using therapeutic physical culture for diseases of the digestive system in children.

At the ascertaining stage, we used the following methodology for constructing health-improving activities:

Health-improving physical exercises are conducted in the form of microcycles, which are divided into two periods: introductory (or preparatory) and main.

In the introductory (preparatory) period, the main task is to overcome reduced adaptation to physical activity, restore motor skills and physical performance (usually lagging behind age standards), and achieve the desire to actively and systematically engage in physical exercise.

The main period is intended for the tasks of further restoration and promotion of health. Physical exercises are aimed at maintaining the achieved rehabilitation results and achieving full recovery.

During the introductory period, exercises are used for all muscle groups, at a calm pace. Rhythmically, always in combination with breathing exercises and relaxation exercises. The load on the abdominal muscles should be limited.

In the main period, with systematic exercise, the total volume, amplitude and intensity of physical exercises gradually increases, exercises with weights, for coordination of movements, with partner resistance, in balance, etc. are introduced.

The principle of combination: tension - relaxation - breathing exercises must be observed.

In choosing starting positions (IP) for gastrointestinal diseases, preference is given to: lying on your back, on the right or left side, resting, kneeling.

Diaphragmatic breathing is performed in all of the listed starting positions. The number of exercises in the complex and the number of repetitions of each depends on the characteristics of the disease and physical fitness.

Scheme of health-improving gymnastics classes. Introductory part: counting heart rate, breathing exercises, exercises to correct posture.. Preparatory part: general developmental exercises for all muscle groups, recreational walking, running, walking with a high hip lift, “overlapping” the shin, walking on toes, heels, external and internal side of the foot, rolling from heel to toe, cross step, etc.; walking in combination with breathing exercises.. The main part is a set of special exercises, selected taking into account the form of the disease, physical fitness.. The final part: exercises for stretching working muscles, breathing exercises, exercises for relaxing muscle groups. Heart rate calculation.

The lesson includes 75% special exercises and 25% general developmental and breathing exercises. The physiological load curve is multi-vertex. The starting positions in the exercises are different. The pace of the exercises is slow (TM), medium (TC), fast (TB). The ratio of breathing exercises to general developmental and special ones is 1: 3.

3. Research results

3.1 Contents of experimental work on the use of therapeutic physical culture for diseases of the digestive system

During the experiment, at the ascertaining stage, we were faced with the task of identifying the health status of children with diseases of the digestive system. When there is a disease of the digestive organs, reflex regulation is disrupted, pathological dominants and vicious (pathological) reflexes arise, distorting the course of normal processes in the human body.

The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. Therefore, physical therapy is a very important element in the treatment of ulcerative processes.

It is already known that performing dosed physical exercises, accompanied by positive changes in the functional state of the centers of the subcutaneous region and an increase in the level of basic life processes, causes positive emotions (the so-called psychogenic and conditioned reflex influence). This is especially applicable in case of peptic ulcer disease, when the neuropsychic state of patients leaves much to be desired (normalization of the symptoms of dystonia expressed in patients from the nervous system). It should be noted the impact of physical activity on the nervous regulation of the digestive apparatus.

With regular exercise, as in the process of physical training, energy reserves gradually increase, the formation of buffer compounds increases, and the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This leads to the activation of redox processes and to an increase in the stability of acid-base balance, which in turn has a beneficial effect on the scarring of the ulcerative defect (impact on the trophic and regenerative potency of the gastrointestinal tract tissues).

The effect of physical exercise is determined by its intensity and time of use. Small and moderate muscle tensions stimulate the basic functions of the gastrointestinal tract, while intense ones depress them. There is a beneficial effect of exercise therapy on blood circulation and breathing, which also expands the functional capabilities of the body and increases its reactivity.

The main objectives of exercise therapy are:

Regulation of excitation and inhibition processes in the central nervous system;

Normalization of the patient’s neuropsychological tone;

Improving respiratory function, blood circulation and digestion, redox processes;

Counteraction to various complications accompanying peptic ulcer (adhesions, congestion, etc.);

Normalization of muscle tone (which is a powerful regulator of internal organs), increased muscle strength, proprioceptive sensitivity;

Development of the necessary motor qualities, skills and abilities (breathing, muscle relaxation, elements of autogenic training, coordination of movements, etc.).

Therapeutic gymnastics (TG) is one of the main forms of exercise therapy. In addition to general developmental exercises, special exercises are used for the abdominal and pelvic floor muscles, breathing exercises (static and dynamic), and voluntary muscle relaxation exercises (exercises for the abdominal muscles in the subacute period of the disease are excluded). Exercises in voluntary muscle relaxation reduce excitatory processes in the central nervous system, help accelerate the recovery processes of working muscles, reduce the tone of not only the muscles involved in relaxation, but (reflexively) also the smooth muscles of internal organs, including the stomach and intestines, relieve spasms of the intestines and pylorus stomach and other sphincters.

The therapeutic effect of LH will be significantly higher if special physical exercises are performed by muscle groups that receive innervation from the same segments of the spinal cord as the affected organ. These are exercises involving the muscles of the neck, trapezius, levator scapulae, rhomboid major and minor, diaphragm, intercostal muscles, anterior abdominal wall, iliopsoas, obturator, foot and calf muscles. In diseases of the digestive organs, the effectiveness of LH largely depends on the choice of starting positions that allow differentiated regulation of intra-abdominal pressure.

In order to determine the condition of children with diseases of the digestive system, we conducted a set of exercises in the experimental and control groups; a total of 20 people participated in the experiment.

Exercise 1. for diaphragmatic breathing

I. p. - lying on your back, legs straight, arms along the body.

Calm breathing of mixed type with a slightly extended exhalation phase 5-7 times. Clenching and unclenching your fingers into a fist. 10-12 times.

Flexion and extension of the legs at the ankle joints. 10-12 times.

Bend your legs at the hip and knee joints; put your feet on the bed. Breathing is diaphragmatic. 5-7 times (Fig. 1). Alternately pulling your legs along the bed, bending them at the knee and hip joints (feet slide along the bed). 4-5 times with each leg. Flexion and extension of the arms at the elbow joints. 6-8 times. Hands to shoulders; raising the elbows - inhale; return to i. p. - exhale. 4-5 times.

Rice. 1. Diaphragmatic breathing exercise.

Exercise 2. to activate intestinal motility

To activate intestinal motility and prevent adhesions, bend the legs at the knee and hip joints, swing them to the sides, and turn them on their sides.

I. p. - lying on your back. Medium depth breathing - calm inhalation, slightly extended exhalation, 4-6 times.

Clenching and unclenching your fingers at a slow pace; when unclenching, relax your hand muscles, 8 to 10 times.

Flexion and extension at the ankle joints of the right and left legs simultaneously. 10-12 times.

Alternate flexion and extension of the arms at the elbow joints of the right and left hands, 6-8 times each.

Left hand on the stomach, right hand on the chest - deep breathing of the chest type, 6-7 times.

Circular movements in the ankle joints alternately with the right and left foot. 8-9 times.

Raising the shoulders, trying to connect the shoulder blades, inhale, relax the muscles, exhale, 5-6 times.

Legs are bent, feet are on the floor. A slight sway of the joined legs to the right and left. 5-6 times in each direction.

Turn your hands palms up, slightly spreading your shoulders, inhale; return to i. p., relaxing the muscles of the arms, exhale. 6-7 times.

A set of exercises in diaphragmatic breathing for the abdominal muscles

I. p. - lying on your back, hands on your stomach, elbows apart. Pressing your hands on your stomach while exhaling deeply, return to i. p. - inhale 4 - 6 times. The pace is slow.

I. p. - lying on your back, arms along the body, legs together; simultaneous bending of the legs while pulling them towards the stomach. When pulling your legs up, exhale; when straightening, inhale. 4-6 times. The pace is slow.

I. p. - lying on your back, hands above your head, legs bent, feet on the bed. Bent legs bend to the sides. Breathing is voluntary. 5-7 times. The pace is average.

I. p. - lying on your back, arms along the body, legs together. Raise up (up to 90°) the straightened legs alternately, then together. When raising your legs, exhale, when lowering, inhale. 4-6 times. The pace is slow.

I. p. - lying on your back, hands on your belt, legs together. Transition from a lying position to a sitting position. When moving to a sitting position, exhale, when lowering to a lying position, inhale. 4-6 times. The pace is slow.

For patients suffering from high acidity of gastric juice, in order to normalize stomach acidity and improve the functioning of the digestive system, we conducted a set of thirteen simple physical exercises given below, which should be performed at a calm, smooth and leisurely pace.

To perform exercises 1 to 7, you should take the starting position - sitting.

Exercise I. Torso turns. Hands to the sides - inhale, turn 90° to the right - exhale, return to the starting position - inhale; turn 90° to the left - exhale, return to the starting position - inhale. The pace is slow. Repeat in each direction 3-6 times.

Exercise 2. Clenching and unclenching the hands and flexing and extending the feet. Execute synchronously. The pace is average. Repeat 10-40 times. Breathing is uniform.

Exercise 3. Alternately raising and lowering the right and left legs. Raising a straight leg - exhale, lowering - inhale. The pace is slow. Repeat 3-6 times with each leg.

Exercise 4. Bend the body towards the right and left legs alternately. Tilt to the right - exhale, straighten - inhale; tilt to the left - exhale, straighten - inhale. The pace is slow. Repeat 3-6 times in each direction.

Exercise 5. Raise your right knee to your chest, arms to your shoulders - exhale, lower your knee and arms - inhale; raise your left knee to your chest, arms to your shoulders - exhale, lower - inhale. The pace is slow. Repeat 3-6 times for each side of the body.

Exercise 6. Squats. Sit down (back straight) - exhale, sit on a chair - inhale. The pace is slow. Repeat 4-12 times.

Exercise 7. Alternately relaxing the muscles of the lower leg and foot of either the right or left leg. Breathing is uniform. Repeat 3-6 times.

To perform exercises 8 to 10, the starting position is lying on your back.

Exercise 8. Raising your Hands, clasp your fingers and turn your palms up. Pull yourself up - and at the same time straighten your legs without lifting them off the floor - inhale. Return to the starting position - exhale. The pace is slow. Repeat 4-6 times.

Exercise 9. Turn on your right side. Raising your arm and moving your leg back, bend over - inhale and return to the starting position - exhale. The pace is slow. Repeat 3-8 times. The same on the left side.

Exercise 10. Alternately abducting the right and left straight legs upward to the side. As you move your leg away, you exhale, and when you lower it, inhale. The pace is average. Repeat 3-8 times for each leg.

Exercise 11. Starting position - rest on your knees. Raising your arms and legs at the same time. Raise your right arm and right leg - inhale, lower - exhale; Raise your left arm and left leg - inhale, lower - exhale. The pace is slow. Repeat 3-8 times for the left and right sides of the body.

Exercise 12. Starting position - standing. Walking with a gradual slowdown. Breathing is uniform.

Exercise 13. Starting position - sitting. Full slow breathing under hand control. Place your right hand on your chest, your left hand on your stomach. On the count of one or two, we begin to take a slow diaphragmatic breath, the diaphragm goes down, and the stomach protrudes. This movement is recorded by the left hand. On the count of three or four, we continue to take a full breath, but this time through the chest. This is fixed by the right hand. The chest rises, the shoulders turn, and the head leans back a little. At the count of five or six, we begin to exhale slowly diaphragmatically, the diaphragm goes up, and the stomach retracts. This movement is recorded by the left hand. At the count of seven or eight, we continue to exhale completely, but this time through the chest. This is fixed by the right hand. The chest drops, the shoulders come together, the head drops to the chest. On the count of nine to ten, try to hold your breath while exhaling completely. (In the future, you should try to gradually increase the breath-holding while exhaling completely, but do not force it.) Repeat the exercise 3-5 times.

If you are feeling well and have no stomach pain, we recommend that patients suffering from hyperacid gastritis take walks, play volleyball and gorodki, go boating and cycling (on a flat road). Shaking and sudden movements of the body should be avoided.

You should also not engage in heavy physical work that causes a sharp increase in intra-abdominal pressure, as this can lead to an exacerbation of gastritis.

4. Research results

The data obtained during the examination of children at the ascertaining stage made it possible to assess the level of condition of children with diseases of the digestive organs of the experimental and control groups. The results are presented in Table 3.

Table 3

Health status of students in the control group before the experiment

Table 4

Health status of students in the experimental group before the experiment

Diagram 1

Health status of students in the control group before the experiment

Diagram 2

Health status of students in the experimental group before the experiment

Analyzing the results of the first stage of the experiment, we found that the health status of children in both the experimental and control groups was at a low level. Based on the results of the analysis, it can be noted that good health in both the experimental and control groups averaged 30%, which is a very low figure. To improve the health of children with diseases of the digestive system, it is necessary to introduce corrective additional physical exercises.

The formative stage was of a correctional and health-improving nature. At this stage, we organized a correctional and health complex of breathing exercises according to the method of A.N. Strelnikova, also performed therapeutic exercises in the pool and in the fresh air.

Correctional and health work with pupils of the experimental group at the second stage of the experiment is aimed at improving the health status of children with diseases of the digestive system.

Methodology A.N. Strelnikova found the most optimal option for a full breath, thus solving the key issue of healthy breathing, which helps get rid of many diseases.

The first clinical studies of the effectiveness of A.N.’s technique Strelnikova demonstrated that even in a completely unprepared person, after just a few minutes of exercise, the vital capacity of the lungs increases by 10-15%. Of course, longer systematic exercises bring even more tangible positive results.

Gymnastics A.N. Strelnikova is also called “inhalation gymnastics.” To train the respiratory muscles that inhale, it is proposed to create a certain resistance, which is achieved by compressing the chest with your hands during inhalation.

You should do this type of breathing exercises twice a day, morning and evening, making one thousand two hundred breaths and movements in one session. According to Alexandra Nikolaevna herself, after a short time a positive result is observed.

When performing a complex of breathing exercises A.N. Strelnikova must comply with a number of conditions and rules.

During exercises, you need to think only about inhalation and monitor the synchronization of inhalation and movement, the correct rhythm (inhale every second). You need to inhale as much air as you inhale naturally.

You should only think about inhaling through your nose.

This means that you only need to train your inhalation, which should be short, sharp and noisy - like clapping your hands.

Exhalation should be done after each inhalation independently and preferably through the mouth. Exhalation should not be held or “pushed out”. Inhalation should be done as actively as possible and exclusively through the nose.

Exhalation must be done passively through the mouth, so that “the exhalation is neither seen nor heard.”

It is necessary to firmly understand that noisy exhalation is unacceptable with this technique.

Inhalation should be done simultaneously with the movements. Alexandra Nikolaevna herself says that in her gymnastics there is no inhalation without movement and no movement without inhalation.

All inhalation movements must be performed at the tempo and rhythm of the marching step.

Counting in gymnastics A.N. Strelnikova is carried out only on 8 (the so-called “eight”). Of course, you need to count not out loud, but mentally, to yourself.

The exercises can be performed while standing, sitting or lying down.

Exercise 1. "Palms"

The exercise is performed in a standing position. It can also be performed sitting or lying down. In the basic version, you should stand up straight, bend your elbows - while your elbows are lowered down. At the same time, you seem to be showing your palms to someone who is standing in front of you. This body position is also sometimes called the “psychic pose.”

Take noisy, short and rhythmic (all three conditions must be met!) inhales through your nose, while clenching your palms into fists, i.e. making "grasping" movements.

It is necessary to take 4 sharp and rhythmic breaths in a row through your nose, in other words, “sniff” your nose 4 times. After this, lower your hands and take a break for 3-4 seconds. Then, after a pause, take 4 short, noisy breaths again; then again a pause of 3-4 seconds. You need to “sniff” your nose 24 times, 4 breaths each.

It should be borne in mind that during the first classes, slight dizziness may occur, which, however, passes quite quickly and does not pose a danger to health and well-being. If the dizziness turns out to be more severe, then the proposed exercise must be performed in a sitting position. In this case, pauses should follow after every 4 inhalations-movements, and the duration of pauses can reach 5 - 10 seconds.

Exercise 2. "Epaulettes"

In the basic version, the exercise is performed in a standing position. It can also be performed sitting or lying down. Your hands should be clenched into fists and pressed to your stomach at waist level. At the moment of inhalation, sharply push your fists down, as if “doing push-ups from the floor.” In this case, your shoulders should be tense, your arms straight and reaching towards the floor.

Then the hands return to their original position, at waist level. The shoulders are relaxed, the exhalation has gone away.

You should not raise your arms above your waist. Do not 4 inhalation movements in a row, but 8. Then there is a pause of 3-4 seconds, after which again do 8 inhalation movements. In total, you need to do 12 times of 8 breaths-movements.

Exercise 3. "Pump"

Basic starting position: stand straight, feet slightly narrower than shoulder-width apart, arms along your torso. Make a slight bow, i.e. stretch your hands towards the floor without touching it, and at the same time take a short and noisy breath through your nose - in the second half of the bow. The inhalation should end with the bow.

Then rise slightly (without straightening), and bow again and take a short, noisy breath “from the floor.”

After this, pick up a stick (or, for example, a rolled-up newspaper) and imagine that you are inflating a bicycle or car tire with a pump.

Bends forward should be performed rhythmically and easily, without straining or bending too low - a “bow at the waist” will be enough. The back should maintain a rounded (not straight!) shape, the head should be lowered.

It is necessary to “inflate the tire” at the pace of a marching step, 12 times with 8 breaths-movements. This exercise can be performed not only standing, but also sitting.

The bends should be done barely noticeably, but always with a short and noisy inhalation through the nose. You should exhale after each inhalation independently, without straining (i.e. passively) through your mouth, without opening it wide.

Exercise 4. “Cat” (squat with rotation)

Stand straight with your feet slightly wider than shoulder-width apart; During the exercise, the feet should not lift off the floor. Do a dance squat and at the same time turn your torso to the right - a short, sharp breath.

This is followed by the same squat with a turn to the left, also accompanied by a noisy and short inhalation through the nose. Right left; inhale on the right - inhale on the left. Exhalations occur between inhalations independently, involuntarily.

The knees should be slightly bent and straightened; the squat should be light and springy; There is no need to squat deeply. At the same time, perform grasping movements with your hands on the right and left at waist level. The back should be completely straight; rotation occurs only at the waist. It is necessary to perform 12 times of 8 breaths-movements.

This exercise can also be done while sitting in a chair or lying in bed. It all depends on the patient's health condition.

Exercise 5. “Hug your shoulders” (inhale while compressing the chest)

Stand straight, arms bent at elbows and raised at shoulder level. Sharply move your hands towards each other to the point of failure, as if hugging yourself by the shoulders. And at the same time, with each “hug”, sharply “sniff” your nose. Hands at the moment of “hug” go parallel to each other, and not crosswise; Do not change them under any circumstances (it doesn’t matter which hand is on top - right or left). Do not spread your arms wide to the sides or strain them.

Having mastered this exercise, you can slightly tilt your head back at the moment of counter movement of your arms - “inhale from the ceiling.” You should perform 12 times of 8 breaths-movements. The “Hug Your Shoulders” exercise can also be done while sitting or lying down.

If your health condition does not allow you to perform this exercise in full, then you can do not 8 breath-movements in a row, but 4 breath-movements or even 2, then a pause of 3-5 seconds, and again 2 or 4 breaths. movements.

The starting position lying down is recommended during an exacerbation and immediately after an exacerbation of the disease as the most gentle, promoting the least functional changes, providing the best conditions for performing breathing exercises (lying on your back with bent legs), and voluntary muscle relaxation. These starting positions are convenient for performing exercises for the abdominal muscles and pelvic floor.

The anatomical and topographic relationships of the gallbladder, common bile duct and duodenum allow us to recommend and. n. lying on the left side, standing on all fours, in which the outflow of bile towards the neck of the bladder and ampulla is carried out under the influence of hydrostatic pressure. Additionally, the outflow of bile in these initial positions is accelerated by an increase in intra-abdominal pressure during full breathing with an emphasis on the diaphragm and some participation of the abdominal muscles.

I. p. while kneeling (on all fours) are used if necessary to limit the impact on the abdominal muscles, cause mechanical movement of the stomach and intestinal loops; And. standing and sitting are used for the greatest impact on the digestive organs.

LH in an aquatic environment is carried out in pools with fresh or mineral water. Exercises are performed from and. etc. lying down with floatation devices or at the handrail, sitting on a hanging chair, standing and in motion. Lesson duration is from 20 to 40 minutes. Water temperature 24-26°C. There are 12-15 procedures per course of treatment. Classes are conducted individually or in a small group.

A health path in the fresh air trains and strengthens the body, normalizes the psycho-emotional sphere. This natural physical exercise is walking. Physical activity can be dosed by changing the distance, angle of elevation, walking pace (walking a given distance in a certain period of time), the number of rest stops and their duration, using breathing exercises during walking and rest, prescribing 1-2 or 3 walks a day, alternating days of training with days of rest.

Sports games, from a physiological point of view, are complex forms of acyclic muscle activity, which makes their dosage significantly more difficult. This deficiency is compensated by their high emotionality. Gaming activity allows you to include and use the large reserve capabilities of the cardiovascular system.

LH is used after the acute period of the disease. Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective condition, and the ulcer can progress with subjective well-being (disappearance of pain, etc.). In this regard, when treating patients, one should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient's motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing exercises and exercises for the abdominal muscles.

LH classes are first carried out in relation to bed rest. In the first lessons, it is necessary to teach the patient abdominal breathing with a small amplitude of vibrations of the abdominal wall. These exercises, causing minor changes in intra-abdominal pressure, help improve blood circulation and gentle massage of the abdominal organs, reduce spastic phenomena and normalize peristalsis. Movements in large joints of the limbs are performed first with a shortened lever and a small amplitude. You can use exercises in static tension of the muscles of the upper limbs, abdominals and lower limbs. It is necessary to turn over in bed and move to a sitting position calmly, without significant tension.

Duration of LG classes is 8-12 minutes.

When pain and other exacerbation phenomena noticeably subside, abdominal wall rigidity disappears or decreases, pain decreases and general condition improves, exercises from and are prescribed. lying, sitting, standing, kneeling position are performed with gradually increasing effort for all muscle groups (except for the abdominal muscles), with incomplete amplitude, at a slow and medium pace. Short-term moderate tension of the abdominal muscles while lying on your back is allowed. Diaphragmatic breathing gradually deepens.

The duration of LG classes is 15-18 minutes.

After the disappearance of pain and other signs of exacerbation, in the absence of complaints and general satisfactory condition, a free regimen is prescribed. In LH classes, exercises are used for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various starting positions. Include exercises with dumbbells (0.5-2 kg), medicine balls (up to 2 kg), exercises on a gymnastic wall and bench. Diaphragmatic breathing is carried out with maximum depth. Walking is up to 2-3 km per day, walking up stairs - up to 4-6 floors, outdoor walks are desirable. The duration of the LG session is 20-25 minutes.

In the conditions of the correctional room at Zatobolskaya school No. 2, where patients in remission are treated, the volume and intensity of physical therapy exercises increase: general strengthening, breathing exercises, exercises for coordination of movements are widely used, outdoor and some sports games (badminton, table tennis) are allowed, relay races In the LH procedure, we exclude strength, speed-strength exercises, static efforts and tensions, jumping and skipping, and performing exercises at a fast pace.

With the children of the experimental group, we carried out exercises according to the following scheme of motor modes:

Mode with low physical activity (gentle).

A mode with low physical activity (gentle) is used to restore adaptation to the loads of an extended mode; stimulation of metabolic processes; combating congestion in the abdominal cavity; normalization of regenerative processes; a positive effect on the psycho-emotional sphere of patients and a moderate increase in the adaptation of the cardiovascular system to increasing physical activity. With a gentle regime, periods of rest prevail over periods of stress.

Contents of the regime: include balneo- and physiotherapeutic procedures. Morning hygienic gymnastics is carried out in a small group method with a low load, lasting 10-15 minutes, the density of the exercise is 40-50%. LH is carried out in a small group method or individually, duration is 20-25 minutes, class density is 50%. Dosed walks on flat terrain with a length of 0.5-1.5 km 1-2 times a day with a rest interval of at least 1-2 hours, at a pace characteristic of the patient’s dynamic stereotype. Independent physical exercises 1-2 times a day, 6-8 special exercises. Sedentary games (croquet, bowling) up to 30 minutes. Indications for prescribing the regimen: diseases of the gastrointestinal tract in the stage of fading exacerbation, poor general condition (severe weakness, fatigue).

Mode with average physical activity (gentle training).

Goal: restoration of adaptation to training loads.

Dosed walks at a slow and medium pace with a length of 6 km and an elevation angle of up to 10° 1-2 times a day. It is allowed to play croquet, bowling, gorodki, table tennis, badminton according to simplified rules with a low load, on average up to 40-60 minutes. Sports exercises (water and winter sports) with low impact, dosed rowing, horse riding, skiing.

Indications for the regimen: chronic diseases of the gastrointestinal tract in the phase of complete remission, 1-3 years after gastrectomy. The regimen is also indicated for patients transferred from a gentle regimen.

Mode with high physical activity (training).

Goal: maintaining performance at the highest possible level.

Contents of the regimen: the daily regimen includes balneo- and physiotherapeutic procedures. Morning hygienic gymnastics in a group method with an average load (15-20 minutes, motor density 60-70%). LH with a heavy load using a special technique (30-45 minutes, motor density 60-70%). Self-training of patients with special exercises 3-4 times a day. Measured walks at a slow pace along routes ranging from 10 to 20 km with an elevation angle of up to 20°. Participation in competitions according to simplified rules is allowed. Sports exercises (water and winter sports) with medium load. Physical activity takes precedence over rest and relaxation.

Indications for the regimen: chronic diseases of the gastrointestinal tract in the phase of stable remission with stable compensation of functions. The regimen is also prescribed to patients transferred from the gentle training regimen to the second half of the course of treatment, subject to positive dynamics. The duration of a patient's stay in one or another mode of movement is not determined by a certain number of days. The attending physician transfers the patient from one mode to another based on favorable changes in his clinical condition with adaptation of the cardiovascular system and the body as a whole to the previous mode of movement. It is not necessary to prescribe all forms of exercise therapy in a new regime: a training effect can be achieved by increasing the load in only one form of exercise therapy.

General tonic training regimen of exercises.

Prescribed after the disappearance of pain and exacerbation in the absence of complaints about the main signs of the disease with a general improvement in condition. Appointment dates are in 20-26 days.

Goal setting: restoration of the patient’s adaptation to the loads of the extended regime. Increasing stimulation of metabolic processes, impact on the regulation of excitation and inhibition processes in the cerebral cortex, impact on the normalization of autonomic functions. Combating congestion in the abdominal cavity. Promoting regenerative processes in the gastrointestinal tract.

Characteristics of the physical exercises used. From the initial positions lying down, on the side, etc., the movements are gradually expanded to full amplitude for large joints at a slow and medium pace. Includes exercises for all abdominal muscles, performed at a slow pace with limited amplitude and the exclusion of sudden movements.

The intensity of performing resistance exercises for the muscles of the shoulder girdle and intercostal muscles gradually increases (to approximately 40-50% of max.) with the aim of a reflex effect on the digestive organs. To combat congestion, a good effect is achieved by diaphragmatic breathing from various starting positions, which is brought to great depth, alternating with chest and full breathing; Changing it more frequently also helps. etc., exercises, games and loads when they become more complex. Gradually, increasingly complex attention exercises are included in the classes. The density of classes remains no higher than average. Walking is increased to 4-5 km per day. With general good health and absence of pain, ball games (volleyball, etc.) are allowed, taking into account individual reactions, lasting no more than 25-35 minutes. Including various types of games in the course helps maintain interest and increases the production of positive emotions during general physical activity.

Throughout the course, we point out to the patient the positive changes achieved in his condition and physical development, instill in him that gastric disorders are insignificant and easily correctable (psychological impact). Exercise therapy is effective only if long-term, systematic classes are carried out with a gradual increase in load both in each of them and throughout the course. Strict consistency in increasing the load and its individualization are the main conditions for conducting all classes. In this case, the condition, reaction of the students, features of the clinical course, concomitant diseases and physical fitness of the students should be taken into account. Another thing is also important: by doing physical exercises, the patient himself actively participates in the healing process, and this has a beneficial effect on his psycho-emotional sphere.

Control stage. At this stage, we summarized our entire study. Children in the experimental and control groups were re-examined. The results of the study are shown in tables (3,4,).

Table 5

The health status of students in the control group after the experiment

Table 6

The health status of students in the experimental group after the experiment

Diagram 3

The health status of students in the control group after the experiment

Diagram 4

The health status of students in the experimental group after the experiment

From the analysis of the control study, we see a significant difference between the experimental and control groups. In the control group, the results of the health status of children remained at the same level, and in the experimental group, the well-being of children improved by almost 40%, their performance increased, their psycho-emotional state improved by 20%, sleep returned to normal - 100%. In general, the health status of children in the experimental group improved by 30-40%.

Thus, we can conclude that the introduction of a correctional and health complex of breathing exercises, exercises in the fresh air and in the pool into therapeutic physical culture helps to improve the health of children with digestive diseases. Breathing exercises for gastrointestinal diseases have a local effect on the abdominal organs by changing the position of the diaphragm - during inhalation (the diaphragm lowers) and exhalation (it rises). This causes an increase and decrease in intra-abdominal pressure, which improves digestion and increases intestinal motility - as a result, the movement of feces accelerates. In addition, breathing exercises enrich the blood with oxygen, favorably influencing the redox processes in the digestive organs, and promote rapid healing of ulcers (stomach, duodenum) and erosions. Our experimental research confirms the hypothesis we put forward: the use of a correctional and health-improving set of exercises in physical education helps to improve the health of children with diseases of the digestive system.

conclusions

Today, it is becoming obvious that there is a need to improve the health of schoolchildren within an educational institution with the active participation of teachers, medical workers, parents and the children themselves.

From a modern point of view, the formation of the health of children of organized groups is based on the complex impact of measures for the primary prevention of diseases, correction of risk states (i.e., such recommendations on lifestyle, nutrition, physical education, educational activities that minimize the likelihood of a risk state transitioning into disease), as well as preventing relapses and complications of chronic pathology.

The medical service at school is an integral part of the education system, designed to preserve and strengthen the health of students.

The medical service at the school provides:

Phased implementation of measures to prevent the unfavorable course of adaptation, fatigue, and increased morbidity among students;

Restorative treatment of children with chronic diseases of the respiratory system, digestion, kidneys, cardiovascular system, dental system, according to the recommendations of the pediatrician and specialists.

Corrective and health activities for schoolchildren with disorders of the musculoskeletal system, gastrointestinal tract, respiratory system, and myopia based on current recommendations for exercise therapy.

Therapeutic physical education is an integral part of general physical education and one of the most important methods of complex treatment of diseases of the gastrointestinal tract, as well as an effective means of preventing exacerbations with the correct structure of exercises and the entire complex. The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. Therefore, exercise therapy is a very important element in the treatment of diseases of the gastrointestinal tract.

With regular exercise, energy reserves gradually increase, the formation of buffer compounds increases, and the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This leads to activation of redox processes and increased stability of acid-base balance.

The use of therapeutic physical culture for diseases of the digestive system is justified by experimental research data on the reflex effect of physical activity on secretion, gastric motility and the activity of the salivary glands.

Normalization of the secretory and motor functions of the stomach and intestines in children is possible with dosing of physical activity, taking into account the nature of the disorders of secretion and peristalsis. Moderate physical activity (calm walking, light gymnastic exercises, etc.) increases the excitability of the cerebral cortex, the tonic activity of the sympathetic nervous system and the motor-evacuatory function of the stomach. Intense physical activity (strength exercises, long running, etc.) inhibits gastric secretion and motor function of the stomach and intestines. Walking for 30 minutes immediately after eating stimulates acidity and increases pain. In the phase of complete remission, patients with peptic ulcer disease, like healthy individuals, react to the same physical activity by inhibiting the acid-forming function of the stomach.

The purpose of using physical exercises is to improve the neuropsychic state of patients, normalize the function of the autonomic nervous system, and improve intestinal motor function. It is advisable to include abdominal breathing with active movement of the diaphragm, flexion, extension, bending and turning of the torso in the set of exercises; flexion of the hip and knee joints with external rotation of the hips; flexion, extension, pronation and supination of the feet; movements of fingers moaning. The optimal starting positions are lying on your back, on your stomach, on your side, knee-wrist, knee-elbow. Exercises are performed without tension or with weak effort, rhythmically, at an average and slow pace, 8-15 times.

The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. Therefore, exercise therapy is a very important element in the treatment of ulcerative processes.

It is already known that performing dosed physical exercises, accompanied by positive changes in the functional state of the centers of the subcutaneous region and an increase in the level of basic life processes, causes positive emotions (the so-called psychogenic and conditioned reflex influence). This is especially applicable in case of peptic ulcer disease, when the neuropsychic state of patients leaves much to be desired (normalization of dystonia expressed in patients from the nervous system. It should be noted the impact of physical activity on the nervous regulation of the digestive apparatus.

With regular exercise, as in the process of physical training, energy reserves gradually increase, the formation of buffer compounds increases, and the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This leads to the activation of redox processes and to an increase in the stability of acid-base balance, which in turn has a beneficial effect on the scarring of the ulcerative defect (impact on the trophic and regenerative potency of the gastrointestinal tract tissues).

The effect of physical exercise is determined by its intensity and time of use. Small and moderate muscle tensions stimulate the basic functions of the gastrointestinal tract, while intense ones depress them.

There is a beneficial effect of exercise therapy on blood circulation and breathing, which also expands the functional capabilities of the body and increases its reactivity.

In the prevention and complex treatment of diseases of the gastrointestinal tract, physical therapy occupies an important place - it has a strengthening and regulating effect on the nervous system and the functions of the digestive organs. In addition, exercise therapy locally affects the abdominal press and intra-abdominal organs: stomach, intestines, liver, spleen, kidneys. The result of the impact of physical exercise depends on its type, dosage, rhythm and tempo of execution, the stage of its application, the duration of the course, as well as on its combination with diet and other therapeutic agents.

Thus, exercise therapy has a positive effect on the abdominal organs and stimulates the regulatory mechanisms of the digestive system.

List of used literature

1. Therapeutic physical culture: textbook. for students higher textbook head - 3rd edition, rev. and additional, - M.: Humanit. ed. VLADOS center, 2004

2. Milyukova I.V., Evdokimova T.A. Physiotherapy. The newest reference book / Under the general editorship. prof. T.A. Evdokimova. - St. Petersburg: Owl; M.: Eksmo Publishing House, 2006. - 862 p., ill.

Kornienko, E.A. Abdominal pain in children. Differential diagnosis and treatment algorithms / E. A.

Korobeinikov N.K. Physical education. M.: Higher. school, 2006, 245 p.

Korotkevich, A.G. Operative endoscopy for gastrointestinal diseases method. recommendations / A.G. Korotkevich, V.F. Menshikov, Yu.M. Krylov. - Leninsk-Kuznetsky, 2003. - 12 p.

Tranquillitati A.N. Restore health. - M.: Figure and Sports, 2002. - 304 p.

Physical rehabilitation: Textbook for academies and institutes of physical culture / Under the general editorship. prof. S.N. Popova. - Rostov n / D: publishing house "Phoenix", 2005. - 608 p.

Belov, V.I. Psychology of health. St. Petersburg: Respex, 2004.272 p.

Epifanov V.A. Therapeutic physical education: Handbook/Ed. Prof. V.A. Epifanova. - 2nd ed., Medicine, 2003. - 592 p.

Therapeutic physical culture: textbook. for students higher textbook manager / S.N. Popov, N.M. Valeev, T.S. Garaseva and others; Ed. S.N. Popova-M.: Publishing house. Center "Academy", 2004

Kudryavtsev V.T., Egorov B.B. Developmental pedagogy of health improvement: Program and methodological manual. M., 2006.

Practitioner's Handbook; edited by A.I. Vorobyova.2nd ed., M.: Medicine, 2006.656 p.

Student physical culture. / Textbook; edited by V.I. Ilyinich. M.: Gardariki, 2005.448 p.

Milyukova, I.V. Complete encyclopedia of therapeutic gymnastics / I.V. Milyukova, T.A. Evdokimova; under general editorship prof. T.A. Evdokimova; St. Petersburg: Owl; M.: Eksmo, 2003.512 p.

Therapeutic physical education: Handbook / Edited by V.A. Epifanova - M.: Medicine, 2008.

Smirnov N.K. Health-saving educational technologies in a modern school. Moscow 2005

Textbook for physical institutes. culture; edited by V.P. Pravosudova; M.: Physical culture and sport, 2004.415 p.

Diagnosis and treatment of chronic diseases of the digestive system. - M.: Medicine, 2008.

Healthy preschooler: Social and health technology of the 21st century /Auth. - comp. Yu.E. Antonov, M.N. Kuznetsova, T.F. Saulina. - M., 2006.

Ibragimova A.G. Physical factors in the treatment and rehabilitation of patients with diseases of internal organs. - Kazan, 2005. - 77 p.

Therapeutic physical culture: textbook. for physical inst. kutt. /Ed. S.N. Popova - M.: Physical culture and sport, 2007

Therapeutic exercise in the system of medical rehabilitation / Ed. A.F. Kaptelina, I.P. Lebedeva. - M.: Medicine, 2005.

Moshkov, V.N. Therapeutic physical culture in the clinic of internal diseases. 3rd ed.; M.; Medicine, 1977.375 p.

Pimanov, S.I. Esophagitis, gastritis, peptic ulcer. M.: Medical book, 2007.377 p.

Belov, V.I. Encyclopedia of health. Youth up to 100 years. M.: Chemistry, 2003.400 p.

Elizavetina G.A. Carrying out rehabilitation treatment for patients with diseases of the digestive system. - M., 205.

Derekleeva N.I. Motor games, training and health lessons. Moscow "VAKO" 2004

Landa, B.H. Methodology for a comprehensive assessment of physical development and physical fitness: textbook / B.Kh. Landa. - M.: Soviet sport, 2004. - 192 p.

Travis, S.P. Gastroentorology / S.P. Travis, R.H. Taylor, D.D. Misevich. Per. from English; edited by Prof. S.I. Pimanova. M.: Medical literature. 2005.627 p.

Kholodov, Zh.Kh. Theory and methodology of physical education and sports: textbook. aid for students Universities / Zh.Kh. Kholodov, V.S. Kuznetsov. - 3rd ed. - M.: Academy, 2007. - 479 p.

Physical therapy and medical supervision: A textbook for medical students. Institutes / Edited by V.A. Epifanova, G.A. Apanasenko. - M.: Medicine, 2007.

Physical rehabilitation: a textbook for university students / ed. S.N. Popova - Rostov-n/Don: Phoenix, 2004. - 603 p.

Belov, V.I. Life without drugs. St. Petersburg: Respex, 2006.494 p.

Vasilenko V.Kh., Grebnev A.L. Diseases of the stomach and duodenum. - M.: Medicine, 2008.

Dubrovsky V.I. Therapeutic physical education - M.: VLADOS, 2005. - 608 p.

Efimov.O.I. School problems. Moscow - St. Petersburg "Dilya" 2004

Korkin M.A., Rabinovich I.M. Therapeutic exercise at home. - L.: Lenizdat, 2000. - 142 p.

Kornienko // Russian Medical Journal. - 2005. - T.13, No. 18. - P.1197-1201.

Korkhin, M.A. Therapeutic exercise at home.M. A.

Koteshova I.A. Treatment and prevention of respiratory diseases. M.: Eksmo, 2003.352 p.

Therapeutic physical culture: under the general editorship of Professor V.E. Vasilyeva - M.: Physical culture and sport, 2009

Loveiko I.D., Fonarev M.I. Therapeutic physical training for spinal diseases in children. Medicine 2005

Shevrygin B.V. If the baby is often sick. Moscow "Enlightenment" 2005

Performing dosed physical exercises, accompanied by positive changes in the functional state and an increase in the level of basic life processes, evokes positive emotions. This is especially applicable in case of peptic ulcer disease, when the neuropsychic state of patients leaves much to be desired (normalization of the symptoms of dystonia expressed in patients from the nervous system). It should be noted the impact of physical activity on the nervous regulation of the digestive system.

With regular exercise, as in the process of physical training, energy reserves gradually increase, the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This has a beneficial effect on the scarring of the ulcerative defect (impact on the trophic and regenerative potency of the tissues of the gastrointestinal tract).

Complex treatment of diseases of the stomach and duodenum must necessarily include means that help improve blood circulation both in the abdominal cavity and in the body in general. This allows you to more effectively combat the manifestations of the inflammatory process and, in addition, contribute to the normalization of metabolic processes in tissues, without which it is impossible to achieve rapid scarring of the ulcer and improvement of impaired stomach functions.

An equally important task is the selection of means to normalize the impaired nervous regulation of the functions of these organs. One of the multifaceted and effective methods of treating diseases of the stomach and duodenum is physical therapy with all its arsenal that affects the body, and in particular, therapeutic exercises.

Numerous studies show that physical exercise for diseases of the stomach and duodenum helps to normalize the nervous regulation of stomach functions, primarily motor and evacuation, as well as acid-forming and enzymatic, improves blood circulation, helps normalize intra-abdominal pressure, and all together improves tissue nutrition and metabolism in them , which helps reduce the inflammatory process, accelerate ulcer scarring, and normalize the functioning of the stomach and duodenum.

The effect of physical exercise is determined by its intensity and time of use. Small and moderate muscle tensions stimulate the basic functions of the gastrointestinal tract, while intense ones depress them.

There is a beneficial effect of exercise therapy on blood circulation and breathing, which also expands the functional capabilities of the body and increases its reactivity.

Depending on the clinical nature of the disease and the functionality of the patient, various forms and means are used.

Contraindications to classes include:

· Fresh ulcer in the acute period.

· Ulcer complicated by bleeding.

· Preperforative state.

· Ulcer complicated by stenosis in the stage of decompensation.

· Fresh massive paraprocesses during penetration.

· Severe dyspeptic disorders.

· Severe pain.

· General contraindications.

The principle of individualization when applying physical therapy for this disease is mandatory.

Therapeutic exercises for prolapse of abdominal organs are aimed at general strengthening of the body, normalization of intra-abdominal pressure, stimulation of the motor and secretory functions of the stomach and intestines. And most importantly, regular and dosed training with special physical exercises in combination with subsequent hydrotherapeutic procedures (rubbing, showering) strengthens the muscles of the abdominal press, pelvic floor, and back, which gradually helps to establish the abdominal organs in a normal anatomical position. It must be said that this method is one of the most effective means of helping patients with prolapse of the abdominal organs.

Students with chronic diseases need to introduce elements of a health regime: reducing the academic load, exercise therapy according to a special program, compulsory daily morning exercises, walks before and after classes. As a therapeutic and health factor - 5-6 meals a day. In a comprehensive plan for the rehabilitation of patients with diseases of the digestive system at all stages, the differentiated, pathogenetically substantiated use of physical therapy ensures an increase in the effectiveness of treatment, helps restore performance and maintain it at the required level. Exercise affects digestive functions through the central nervous system.

Morning hygienic gymnastics pursues the goals of general development and strengthening of health, increasing efficiency, and helps hardening, promotes a more complete transition from an inhibited state to an alert state. Morning hygienic exercises use a small (8-10) number of exercises covering the main muscle groups; physical exercise should be simple.

Objectives of exercise therapy:

· General improvement and strengthening of the patient’s body.

· Impact on the neurohumoral regulation of digestive processes.

· Improving blood circulation in the abdominal cavity and pelvis, preventing adhesions and congestion.

· Strengthening the abdominal muscles and stimulating the motor function of the digestive system.

· Improved breathing function.

· Increased emotional tone.

Morning hygienic gymnastics, therapeutic exercises, walks, health path, outdoor games, elements of sports and applied exercises, cycling, swimming, rowing, skiing, ray therapy. In addition, massage and self-massage of the abdomen are used.

Therapeutic gymnastics (TG) is one of the main forms of exercise therapy.

The therapeutic effect of LH will be significantly higher if special physical exercises are performed by muscle groups that receive innervation from the same segments of the spinal cord as the affected organ. These are exercises involving the muscles of the neck, trapezius, levator scapulae, rhomboid major and minor, diaphragm, intercostal muscles, anterior abdominal wall, iliopsoas, obturator, foot and calf muscles.

In diseases of the digestive organs, the effectiveness of LH largely depends on the choice of starting positions that allow differentiated regulation of intra-abdominal pressure.

Special exercises include:

· breathing exercises, especially diaphragmatic breathing, which, rhythmically changing intra-abdominal pressure, has a massaging effect on the liver, stomach, and intestines. As a result, bile secretion, peristalsis of the stomach and intestines increase, venous outflow improves, and congestion in the digestive organs decreases.

· relaxation exercises: reduce the increased tone of the central nervous system, reflexively lower the tone of the muscles of the stomach and intestines, and are effective for relieving spasms of the pylorus and sphincters.

· exercises for the abdominal muscles.

· exercises for the pelvic floor muscles. When the abdominal muscles relax and contract, the pressure in the abdominal cavity either increases or decreases, exerting a massaging effect on the internal organs. Actively acting muscles of the abdominal press, back and pelvis increase blood flow to the abdominal organs, and this helps eliminate inflammatory processes, normalize blood circulation in the liver, kidneys, eliminate stagnation of venous blood in the pelvic area, and also increases oxidative processes and metabolism substances. Strengthening the abdominal muscles and pelvic floor helps normalize the position of the digestive organs, especially when the internal organs prolapse.

· exercises that promote the flow of bile from the gallbladder. Various starting positions are used: standing, kneeling, sitting, lying, knee-elbow, knee-wrist. Lying on your back with bent legs and on all fours achieves the best relaxation of the abdominal organs. To improve the outflow of bile, the best starting position is lying on the left side (the movement of bile is facilitated by the contraction of the walls of the gallbladder, the gravity of the bile), as well as on all fours. Lying on the right side improves blood supply to the liver and provides liver massage by increasing the excursion of the right dome of the diaphragm. Starting position: lying on your back with the foot end of the couch raised, as well as the knee-elbow position are used for splanchnoptosis. In various starting positions, movements of the torso and legs are performed with a large amplitude in combination with breathing.

Indications for prescribing exercise therapy:

· chronic gastritis with normal, increased and decreased secretion;

· peptic ulcer of the stomach and duodenum;

· biliary dyskinesia and chronic cholecystitis;

· chronic hepatitis;

· chronic colitis, mainly with a tendency to constipation;

hiatal hernia;

· splanchnoptosis (prolapse of internal organs).

Contraindications for prescribing exercise therapy:

· period of exacerbation of the disease with severe pain, repeated vomiting and nausea;

· complicated course of the disease: bleeding due to gastric and duodenal ulcers, ulcerative colitis, perforation of the ulcer, acute perivisceritis (perigastritis, periduodenitis).

The classes also have an educational value: patients get used to systematically performing physical exercises, this becomes their daily habit. Exercise therapy classes turn into general physical education classes and become a human need even after recovery.

Thus, we found out that the state educational program involves physical education classes for students with diseases of the gastrointestinal tract and digestive system in a special group. In this work, we focused our attention on subgroup “B”, which is recommended for students who have significant deviations in their health status caused by serious chronic diseases. Such students are admitted to theoretical classes and classes on the rehabilitation of their own health.

In our work, we considered the limitations of physical activity of students with diagnoses such as celiac disease, peptic ulcer, splanchnoptosis, GERD, gastroduodenitis. Until recently, adolescents with similar diagnoses were completely exempt from sports; exercise therapy was not developed for them.

Due to the fact that in recent decades there has been a significant increase in gastrointestinal diseases, the amount of popular medical literature and scientific works on such rare diseases as celiac disease, GERD has increased, and exercise therapy programs are widely represented.

In our work, we presented an approximate complex of exercise therapy, presented in the work of V.N. Moshkov. During the study, we were able to find out that for some diseases of the gastrointestinal tract, fitness classes, dancing, swimming, and cycling are acceptable.