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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 review discusses the preparation of patients for surgery on the heart and other organs. We considered the importance of introducing a new stage of medical and cardiology rehabilitation — prehabilitation. The results of randomized clinical trials, systematic reviews and metaanalyzes evaluating the effectiveness of respiratory techniques and physical training during the prehabilitation are presented. Particular attention is paid to the involvement of patients in prehabilitation programs before the elective coronary artery bypass grafting. Methodological problems arising in the development of prehabilitation programs are discussed.

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.

To evaluate the opportunity of Borg scale using for applying and monitoring the aerobic training intensity in the pool as well as the relationship between the Borg scale and the heart rate (HR) in the aquatic environment.The study involved 11 healthy individuals (mean age 46.4±7.5 years). After a cardiopulmonary test on a treadmill and a probation lesson the training was conducted in the pool using a set of basic aerobic exercises lasting 45 minutes. During training the subjects had to maintain a load level corresponding to 12-14 points on the Borg scale. Every 10 minutes of the main training part the heart rate was calculated and the rating of perceived exertion (RPE) was determined according to the Borg scale.The average heart rate in the main part of the training was 126.8±14.0 beats/min. The intensity of aerobic exercise was 82% of the maximum heart rate determined during the cardiopulmonary test and 68% of the reserve heart rate which corresponded to a high level of intensity. Between the heart rate and the Borg scale a significant correlation was found in the first period of training (During water aerobics training the use of the Borg scale to prescribe and maintain a level of exercise allows to achieve a sufficient intensity level which is necessary to improve cardiorespiratory fitness and physical performance in order to influence risk factors for cardiovascular disease. The Borg Scale as a stand-alone method of controlling intensity when using water-based aerobic training, especially with high-intensity training should be used with caution. Further investigation is needed to determine the relation between subjective measures of exercise intensity and HR and validity of their use during water aerobics training.Оценка возможности применения шкалы Борга для назначения и контроля интенсивности аэробной тренировки в бассейне, а также связи между количеством баллов по шкале Борга и частотой сердечных сокращений (ЧСС) в водной среде.В исследовании приняли участие 11 здоровых лиц (средний возраст 46,4±7,5 года). После кардиопульмональной пробы на тредмиле и пробного ознакомительного занятия проведена тренировка в бассейне с использованием комплекса базовых аэробных упражнений продолжительностью 45 мин. Во время тренировки испытуемые должны были поддерживать уровень нагрузки, соответствовавший 12—14 баллам по шкале Борга. Каждые 10 мин основной части тренировки проводился подсчет ЧСС и определялся уровень напряжения по шкале Борга.Средняя ЧСС в основной части тренировки составила 126,8±14,0 уд/мин. Интенсивность аэробных упражнений — 82% от максимальной ЧСС, определяемой в ходе кардиопульмональной пробы, и 68% от резерва ЧСС, что соответствовало высокому уровню интенсивности. Между ЧСС и оценкой по шкале Борга выявлена достоверная корреляционная связь средней степени выраженности в первом периоде тренировки (Во время водных аэробных тренировок использование шкалы Борга для назначения и поддержании уровня нагрузки позволяет достичь достаточного уровня интенсивности, необходимого для улучшения кардиореспираторной формы и физической работоспособности, с целью влияния на факторы риска сердечно-сосудистых заболеваний. Шкала Борга как самостоятельный метод контроля интенсивности при применении водных аэробных тренировок, особенно при высокоинтенсивных тренировках, должна использоваться с осторожностью. Необходимо дальнейшее изучение соотношения методов субъективного измерения интенсивности нагрузки с ЧСС и валидации их использования при проведении водных аэробных тренировок.

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.