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The novel coronavirus infection (COVID-19), which quickly became a pandemic in 2020, has presented new challenges for healthcare system. COVID-19, being a contagious infectious disease predominantly affects respiratory system, causes cardiovascular, neurocognitive, renal, gastrointestinal, hepatic, metabolic and mental damages, which is in fact a multisystem disease. Patients with COVID-19, primarily with moderate and severe forms, need appropriate rehabilitation. This article establishes need of development of rehabilitation programs for COVID-19 patients, identifies their problems that leads to restrictions on everyday life, self-service, mobility, communication, interpersonal relationships, and professional activities. Goals and general principles of medical rehabilitation in context of a pandemic at all three stages are presented. Features of rehabilitation approaches are highlighted and important components of individual rehabilitation program for COVID-19 patients are highlighted.

The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.

Cardiovascular disease (CVD) is the leading cause of death in the Russian Federation, as in many other countries. Taking into consideration the observed increase in the spread of risk factors, modern demographic trends (an increase in the proportion of elderly people), and a high economic burden of circulatory system diseases, the search for new forms and effective strategies of prevention is becoming relevant. OBJECTIVE: To provide the data available in the scientific literature on the effectiveness of the measures to modify risk factors and lifestyle, which are implemented during balneotherapy under both resort and in non-resort conditions, and to define areas for further investigators in this field. Investigations evaluating the effectiveness of these measures were sought in the Embase, PubMed, PEDro, Web of Science, eLIBRARY databases in January 2012 to August 2018. The analysis included seven trials that showed an improvement of estimated endpoints (blood pressure, body mass index, lipid profile, physical activity, and morbidity and mortality rates). The generalization of results of the analyzed trials was limited by the high heterogeneity of their protocols and methodological quality, which does not allow for a final conclusion on the effectiveness of preventive measures implemented during balneotherapy. Future research should provide more evidence of the benefits of this approach. The analysis will be able to take into account the existing experience and to develop a strategy to enhance the effectiveness of cardiovascular disease prevention programs based on high-quality randomized clinical trials.В России, как и во многих странах мира, сердечно-сосудистые заболевания занимают ведущее место среди причин смертности населения. Учитывая наблюдаемый рост распространения факторов риска, современные демографические тенденции (увеличение доли людей пожилого возраста), высокое экономическое бремя болезней системы кровообращения, становится актуальным поиск новых форм и эффективных стратегий профилактики. Цель исследования - представить имеющиеся в научной литературе данные об эффективности мероприятий по коррекции факторов риска и изменению образа жизни, проводимых на фоне бальнеотерапии как на курорте, так и во внекурортных условиях, и определить направления дальнейших исследований в этой области. Поиск исследований, изучающих эффективность таких мероприятий, проведен в базах данных Embase, PubMed, PEDro, Web of Sience, eLIBRARY за период с января 2012 г. по август 2018 г. В анализ было включено 7 исследований. В них показано улучшение по оцениваемым конечным точкам (уровень артериального давления, индекс массы тела, липидный профиль, уровень физической активности, заболеваемость и смертность). Обобщаемость результатов анализируемых исследований ограничивается большой гетерогенностью их протоколов и методологического качества, что не позволяет сделать окончательный вывод об эффективности применения проводимых на фоне бальнеотерапии профилактических мероприятий. Будущие исследования должны представить больше доказательств преимущества такого подхода. Проведенный анализ позволит учесть имеющийся опыт и разработать стратегию повышения эффективности программ профилактики сердечно-сосудистых заболеваний на основе проведения качественных рандомизированных клинических исследований.

Six-minute walk test (6MWT) is a simple and safe tool for assessing exercise tolerance in various categories of patients. Currently, 6MWT is used to assess the functional status of a patient and determine the strategy of increasing physical activity, primarily in patients with reduced exercise tolerance and contraindications for cardiopulmonary exercise test. The basic requirements for the 6MWT are presented, taking into account the factors affecting its informativeness and accuracy, as well as the interpretation of results. The diagnostic and prognostic value of 6MWT in different categories of patients are discussed. The prospects for 6MWT use in cardiac rehabilitation for planning rehabilitation program, prescribing exercises, determining the risk of complications, and evaluating the effectiveness are considered. The limitations of 6MWT and ways to overcome it, as well as directions for further research are presented.