Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Cardiorehabilitation is a fundamental component of the secondary prevention of cardiovascular disease in patients with acute cardiovascular disease. The article considers the main goals, components, rules of selection and control of intensity and safety of physical training programs during ambulatory cardiorehabilitation.

No abstract

Coronavirus infection causes lung damage and leads to the development of disabling conditions. The development of the Covid-19 pandemic leads to a one-stage increase in the number of patients who need assistance not only from infectious disease specialists and intensive care specialists, but also from rehabilitation specialists. However, patients suffering from other non-infectious conditions need rehabilitation despite the pandemic. Thus, rehabilitation specialists are faced with new tasks to organize rehabilitation in the epidemic for both patients with Covid-19 and patients at high risk of infection, but without coronavirus infection, to develop specific programs for pulmonary rehabilitation, data collection on the nature of disability, organization of outpatient programs and telerehabilitation.

Aim. To investigate exercise tolerance in patients undergoing acute coronary syndrome with outcome in myocardial infarction, dependingon physical activity tolerance. Material and methods. We studied 80 patients aged from 40 to 75 years old who were admitted from primary vascular centers for athree-week rehabilitation course to the department of medical rehabilitation for patients with somatic diseases of the clinic of the IvanovoState Medical University of the Ministry of Health of Russia, of which 61 were men (76,3%) and 19 women (23,7%). In accordancewith the aim of the study, a 6-minute walk test was performed in all patients before and after the completion of the rehabilitationcourse. Based on the test results, physical exercise tolerance was assessed and the functional class (FC) of coronary heart disease (CHD) was determined. The patients with I class coronary heart disease (CHD) in the number of 20 patients (25%) made up the 1st group, 21patients (26,3%) with II class – the 2nd group, 21 patients (26,3%) with III class – the 3rd group, and 18 patients (22,5%) with IV class– the 4th group. Results. Every third patient who was admitted to a 3-week cardiac rehabilitation course had short-term adverse reactionson loading during physical training on simulators. Most cases of inadequate reactions were noted in patients with III and IV IHDclass III (according to the 6-minute walk test) having, according to the International Classification of Functioning, Disability and Health(ICF), moderate and pronounced reduction of exercise tolerance function. Patients often had tachycardic and hypertensive reactionsin the porcess of prysical training on stimulators and some patients (more often those with the pronounced decrease in exercise tolerancefunction) had hypotensive reaction which is the most unfavorable type of response to the load. In the vast majority of patientswith I and II CHF with no impairment or mild decrease in exercise tolerance according to ICF, an adequate response of hemodynamicparameters to exercise was determined. Adverse reactions were observed only in every fifth-seventh patient and were manifested onlyin the form of tachycardic and hypertensive reactions to exercise. The study analyzed the effectiveness of rehabilitation measures inthe groups of patients with different levels of tolerance to physical activity. It was found out that all the patients with myocardial infarction,regardless of the initial level, had increased exercise tolerance after cardiac rehabilitation. Conclusion. The 6-minute walk test is insufficiently informative for patients with markedly reduced tolerance to physical activity. The«gold standard» of qualitative and quantitative assessment of reactions and interaction between cardiovascular and respiratory systems,as well as metabolic response of the body during physical activity for these patients is the spiroergometric study.