General medical examination.
The inspected belongs to a general medical examination with the use of instrumental methods of examination and laboratory diagnostics.
 At initial inspection its  tasks are: health assessment and detection of violations in comparison with the definition of physical development and functionality possibylities. It enables us to solve problems before starting  physical classes, sports orientation or selection of appropriate forms of classes  , outline plan preventive and treatment work with each examined, to determine the individual characteristics of mode and method of training. Therefore, such examination should be the most completed.
At  repeated inspection its  tasks are :to determine changes of the body that adopted under influence of training, assessing the state and development of physical training and, if necessary, making adjustments to the individual training plans. For this purpose, examination of organs and systems  is complemented by instrumental methods of examination, laboratory methods and conducting of functional tests and loading tests.
Examination of persons who are engaged in physical culture and sports of lower qualifications  conduct one doctor. He registers survey’ results in medical-control card of athlete and sportsman (Form 061 / y), if necessary consultation of relevant experts can be appointed.

Athletes of higher qualifications and members of the bits teams are putted on clinical records in the regional medical physical clinics, they are examined by all the necessary specialists: theraputist, endocrinologist, neurologist, ophthalmologist, otolaryngologist, a surgeon, traumatologist and dentist. Iecessary of  more detailed examination  a athlete is sent for consultation to specialists with more narrow specialization:: cardiologist, rehabilitologist, urologist, dietician. The results of examination are recorded in medical-control card of athlete/ Form 062.
         After examination the doctor concludes which includes: physical development, health / functional state /, group health, access to training, necessary consultations, the terms re-examination, recommendations.
Life anamnesis and sporting anamnesis plays an important role in the examination of athletes and sportsmen. “Who knows how good ask, he knows how to treat well ” (G.A. Zahar’yin). Correct patient’s anamnesis makes much easier the task of examination. Of course, it should be asked a life anamnesis and sporting anamnesis.
It should be studied the conditions for the development, welfare, housing, diet, bad habits, lifestyle, nature and frequency of meals. It is important to know the type of activity, nature of study or work, previous diseases, trauma, surgery operations, presence in a family of hereditary diseases.
 For sporting anamnesis we ask if the patients were engaged in physical culture and sports, how long, if he is engaged now, which sport category, athletic achievements, the nature and frequency of trainings , the desire to train, dynamic sports results since the last inspection.
Correct patient’s anamnesis allows to the  doctors to have a possibility of orientation in health state, degree of physical training that in future examinations will help to estimate the results which were obtained by clinical examination.
 The study of physical development, its methods are described in the theoretical material in  the first topic. Evaluation of physical development is based on external examination, anthropometry indicators and additional studies (kalipermetriya, biofotometriya, radiography, skoliozometriya, and others.)
Physical development is assessed as right or wrong / in the presence of any defects of body condition or posture.
Antropometry indexes   are compared with the typical for the age, sex, type of physical activity standards and are estimated as “average”, “below” or “above average”. You must also specify the degree of  accordance  of physical development to the selected sports specialization and the nature of activities and identified deficiencies and lagging indicators with the purpose of making  recommendations how eliminate them during future training classes or recreational sports.
  Investigation of the internal organs begins with a  study the complaints. Special
attention we should be pay to the appearance of early symptoms of diseases that often characterize unfavorable condition. Especially is needed need to pay attention on complaints that may indicate the development of overtraining syndrome (sleep disorders, poor appetite, dizziness, apathy, lower sports results).
 Examination of the internal organs is conducted by the generally accepted method. The doctor must know the basic signs of the influence of physical exertion on the body.
During examinations are used instrumental methods.
Instrumental methods
Video:  ECG + rheoencephalography
In assessing of the morphofunctional characteristics of the body of persons who are engaged in physical culture and sports, should be used the complex of instrumental methods that describe the different sides of the organs and systems. Instrumental examination is conducted during state of rest and during physical exercise.
Cardiovascular system.
Measuring blood pressure by  Korotkov method – the measurement of force, by which blood makes pressure on vascular walls.
Electrocardiography – a method of registering electric currents that arise in the myocardium during its work.

Fonocardiography – graphic registration of the acoustic manifestation (tones and noise) of cardiac activity.
Policardiography– simultaneous record sfihmohramy of carotid arteries, elektrokariography  in the second  standard abduction and fonocardiography with the purpose to determine the contractility of the myocardium, the phase structure of cardiac cycle, to conduct it in analysis phase.
Ballistocardiography – method based on registration of the body displacements which associated with heartbeats and movement of blood in major vessels that depend on the strength of heart beats, blood pumping speed and magnitude of systolic ejection, high blood pressure in the aorta and pulmonary artery ,elasticity of vessels, venous pressure, the mass of circulating blood, elastic properties of tissue.

Reography – method of study of blood circulation, which is based on registration of changes in ohmic resistance, associated with volume fluctuations of blood arterial vessels in the testing area.

Kinetocardiography – a record of  low frequency  vibrations of the chest wall in the pericardial area, which arise as result  of the heart movements during cardiac cycle and blood flow in major vessels.
Flebography – record of venosus pulse rate.
Mehanocardiography – integrated study of hemodynamics by recording of  tahoosotsylohramy and sfihmohramy of different arteries.
Biplan telerenthenocardimetry – measurements of heart volume.
Echocardiography – a method that is based on the reflection of pulsed ultrasound, which is directed through the body. When the anatomic barriers are achieved the part of the sound energy is reflected back (echo). Reflected sound is made by piezoelectric sensor and after conversion into electrical energy is registered on the oscilloscope and recorded on film. The method enables to determine the volume of certain cavities of the heart. Their dimensions during systole and diastole, the rate of construction and relaxation by myocardium of left ventricular, wall thickness of the heart and its intraventricular septum; speed and amplitude of motion of mitral valve and so on.

Using mathematical analysis of cardiac mode. Recently in many areas of physiology, clinical, sporting medicine are used methods of the mathematical analysis of heart rate which are based on the study of indexes of variability and its internal structure.

 

This method makes possible to obtain valuable information about the state of neurohormonal mechanisms of regulating cardiac activity and body as a whole.
Respiratory system.

The term – “respiratory” is relative. In a wider sense as term “breathing” we  understand not only lung function but also the processes that ensure the consumption of oxygen in the tissues of the body and the allocation of carbon dioxide. Instrumental methods of its functions are diverse.
Spirometry – definition of lung vital capacity by spirometer. We study the maximum amount of air which person can exhale after maximum inhalation.
Spirography – method of research of gas exchange by spirograph: the patients inhaled air from the machine and exhale it back again. Towards to the expired air is carbon dioxide absorber. On paper tape, which moves is recorded a respiration curve – spirohrama. As it are registered the frequency and depth of breathing, minute volume, vital capacity of lungs  and its function, oxygen consumption per unit of time, calculate the basic parameters and respiratory exchange.

Pneumography – method of study of respiratory movements of the chest.
   Pneumotaxigraphy  – method of study of power of forced expiratory inspiration for the purpose of studying of bronchial patency.
Nervous system.

Electroencephalography – the method of brain research, based on registration of electrical potentials that arise during its work. Electroencephalogram is a total registration of electrical activity of many millions of nerve cells with their spikes, placed near the outlet electrodes.

Electromyography – a method of investigation of muscles by recording their electrical potentials.
Ehoencephalography– method of study of intracranial structures by using ultrasonic signals that are reflected within environments that are differ in their physical properties (bone-scalp, brain tissue- cerebrospinal fluid, cerebral tissue -vascular formation, etc.).
Rheoencephalography – method of studying of hemodynamics in the skull cavity by recording changes of brain vessels which   arise due to  blood fluctuations .
X-ray methods include: kraniography, spondylography, contrast radiological methods.

Investigation of hearing organ.
Kamerton tests – a method of study of  time hearing sense of tuning fork by hearing analyzer.
Audiometry – a method of studying of hearing sharpness and hearing function of individual components of the auditory analyzer (defining of adaptation of hearing organ, noise audiometry, ultrasound audiometry, refleksoaudiometry, electroencephaloaudiometry etc.).

 The research function of vestibular organ .
Rotary Barani test  -a patient  in the Barani chair is rotated with head down and eyes closed  10 times for 20 sec. After that is conducted the  studying of nystagmus, somatic reactions (finger- nose test, rejecting the trunk) and autonomic reactions(Pulse, BP).
Investigation of the digestive system.
X-ray method – gives an  opportunity to explore the state of motor function, tone and peristalsis of the stomach, the ability to evacuate the contents.
Contrast X-ray examination of bowel can help to determine the tone and the ability to evacuate the contents.
Elektrogastrography– registration of  potentials of antral muscles of stomach which  enables the study of gastric motor function under the various conditions (food, physical, muscular loading, etc.)..
Gastroscopy – a review of gastric mucosa by gastroscope.
Ultrasound diagnosis – study of abdominal organs using ultrasonic signals.
In sporting  medicine the researches can be conducted in a state of rest, during physical exertion and after long physical classes.
Modern equipment not only registers the indexes we research  but also estimates and concludes  its results, which considerably makes easier the work of a doctor.

Assessment of health provides a solution of the question of admission to classes and competitions, mode and methods of training.
For athletes are important even minor rejections in the health, because under the influence of loadings they may deepen and lead to the overtraining and development of various diseases, while in usual people these rejections may not have practical value iormal conditions life. Therefore, in the slightest suspicion on  rejections in health it is needed to conduct the additional reviews.
Conclusions on the results of investigation of health. Conclusions  “healthy” can be made only in the absence of any / even minor / complaints and deviations in the state of health. Conclusions ” almost healthy” is when present deviations in health state have no danger to the health due to the use of physical activity and do not  require special correction of training mode. Thus in conclusion should be specified  the exact nature of the violations. During  repeated examination  should be drawn attention to the dynamics of these changes.
                         Study and evaluation of functional state.
     Methods of studying of the functional state are described in the subject 2 and 3. Evaluation of functional state is based on the analysis and comparison of studies which are conducted in the state of muscle rest and during functional tests. Functional state – one of the main indicators of  training state of inspected. Good functional state  reflects the compliance of the loading of the state of inspected , and lack of functional state or its violations require correction of classes mode. Dynamics of functional mode reflects the rationality of used training mode.
Functional state can be rated as good, satisfactory, or with violations (fatigue, overtraining, etc.)..

MEDICAL CONCLUSION BY THE RESULTS OF EXAMINATION
Access to trainings and competitions. On  base of the evaluation of health state, physical development and functional state a physician decides about the admission to trainings, provides recommendations for treatment, recovery, methods and mode of trainings.
       Access to trainings and competitions is based on the examination ,including indications and contraindications /even  temporary due to previous diseases or injuries / to training to those or other forms of physical culture (sport and health program , health group, classes in the regular curriculum, sport training, competition, etc.).
 In case of temporary contra indication is recorded the time of admission or length of employment with a reduced loading, the physician determines the medical group for physical classes.
Medical group for physical education. Persons who involved in physical education in schools of the compulsory curriculum and persons of middle and old age for employments in the health group should be divided into medical groups.

MEDICAL  EQUIPMENT OF HEALTH PHYSICAL   CULTURE.

 INDICATIONS AND CONTRA-INDICATIONS FOR SETTING OF HEALTH PHYSICAL CULTURE

Basic contra-indications for classes of physical education are:

1.     Acute and subacute stages of diseases.

2.     Diseases, which are accompanied with disorders of function, a pain syndrome, threat of bleeding, thromboembolic complications. 

3.     Disease of the cardiovascular system: violation of rhythm of cardiac activity, aneurysm of heart and main vessels, ischemic heart trouble with the frequent attacks of cardiac-angina, the heart attack of myocardium which was to 6 months, hypertensive illness of ІІ–ІІІ of the stage.

4.     Organic diseases of CNS and psychical diseases which complicate contact  with a patient.

5.     Malignant diseases.

In every case a contra-indication the setting of health physical education is determined by a doctor individually.

 

CLASSIFICATION OF PHYSICAL EXERCISES

All physical exercises are divided:

1. After basic motive qualities:

– on speed, on short distances    ( in track-and-field, swimming, skating sport, cycle racing);

– on endurance, on long distances (in track-and-field, swimming, dike, in skating sport, cycle racing);

– on force  (in heavy athletics, in track-and-field (throwing, pushing), in a fight, in a gymnastics sporting);

– on adroitness  (in a sporting gymnastics ,acrobatics in track-and-field (jumps), jumps from a springboard (skiers, swimmers),

slalom, figure-skating and others).

2. After the character of muscular activity:

– dynamic  (all types of exercises which are related with body moving in space);

– static (moving of body in space is absent )

3. After the  character of motive act:

– cyclic (walking, running, swimming, ski and cycle racing) which are divided into exercises with maximal intensity (short distances), submaximal intensity (middle distances), large intensity (long distances), middle intensity (overlong distances);

– acyclic (jumps, throwing, games, gymnastics and others).

4. After a power criteria:

– aerobic – the metabolism during muscular activity is conducted due to aerobic mechanisms (exercises on endurance are walking, running , swimming and in  other a moderate rate);

– anaerobic – with the mainly anaerobic mechanism of energy providing of motive act: (exercises of speed, speed-power and power character: running with maximal speed, jumps, throwing, fight and other).

A DOSAGE OF PHYSICAL LOADING DURING HEALTH TRAININGS

Dosage of the physical loading during health trainings of N.M.Amosov, Y.A.Bendat (1989), G.L.Apanasenko, V.A.Epifanov, K.D.Lobyzh (1990) should be  the after following principles:

1.  A dosage after relative power which concernes in percents to the maximally attained level of physical capacity (МСO, PWC 170 and other). A method requires the previous conduction of tests with the physical loading of submaximal or maximal power.On the basis of which the training level of loading is determined.

2. A dosage of power in accordance to the metabolic indexes. In quality of measurment unit is used a metabolic unit (a level of energy expenses in the conditions of basic metabolism). Essence of the method is in choosing of different types of muscular activity and also physical exercises which by its “energy expenses” do not exceed the individual power backlogs of organism. The proper recommendations are developed by power estimation of the professional, domestic loadings and physical exercises ( table.1).

Table 1

Energy expenses on the some types of physical activity (N.M.Amosov, Y.A.Bendet in 1989)

 

Most distribution this method got in a dosage of loading for persons with the limited motive possibilities. Information has an oriental character.

Orientaly it is possible to define the energy expenses on the different types of physical activity on the basis of information of L. Brouha (1960) in relation to energy expenses at different  heart  rate. If in state of rest the heart rate is 60-70  in 1 min,so during the physical loading it will be:

 

3. A dosage of  power due to the heart rate.

Three indexes of pulse are used: threshold, spades and middle. Threshold heart rate it is the lowest heart rate, below which training effect does not arise up. Heart rate of spades is the most frequent heart rate which caot be surpassed in the process of trainings. Middle heart rate is to accordance to the middle intensity of loading of physical class.

It is accepted that heart rate of spades:

– for persons who begin to be engaged in the health trainings

                  180 – age (years);

– for experienced athletes who have experience of regular phusical employments more than 3 years

                  170 – 0,5 age.

4. Dosage by time and by the number of reiterations of physical exercises. This method foresees a previous test on the maximal amount of reiterations of some exercise during the set time. The training size of loading is expressed in percents from individual maximum of reiterations.

5. The empiric method of dosage of power is based on the analysis of the subjective feelings of athlete and self-control.

The signs of the adequate loading are :

-absence of the unpleasant feelings, desire to continue training, absence of fatigue, pleasure from employments, “muscular gladness”;

– “colloquial rate” which characterizes a possibility during the implementation of loading (for example, running) to freely  conduct the relaxed talk;

– degree of efforts on implementation of loading must not be bigger than half-force;

– the nasal rate of breathing must be saved, at appearance of necessity to breathe by mouth (that appears at a pulse 130 and more beats for a minute and testifies the connecting of anaerobic mechanisms of energy-expenses) loading must be decreased or stopped;

– in a restoring period through 5 minutes after stopping of loading the heart rate must not be more than 120 per/min., through 10 min –100 per/min.

Breathing frequency must be restored during 10 min.

AEROBIC LOADINGS AND THEIR INFLUENCE ON ORGANISM

Physical exercises with anaerobic level at intensity of loading which exceeds a maximal necessity of oxygen are very exhausting. That is why in practice of the ordinary trainings are not used. More effective and safe in the health trainings are the aerobic loadings.

The aerobic loadings by the intensity are divided into exercises of maximal (95-100% МСO), near maximal (80-9-%), submaximal (70-80%), middle (55-60%), small (less 50%  of  МСO) aerobic power.   In the health trainings a level of loading must be submaximal, not more than 70-80 percents of maximal aerobic ability. To the persons older than 50 years due to reduce of reserved possibilities of training it is needed to conduct at lower level – with power expenses within the limits of 50% МСO. Maximally possible frequency of heart-beats at physical exercises depends on age is represented in a table 2.

Table 2

Maximally possible frequency of heart-beats at physical exercises

 

The initial level of loadings for the untrained persons must not be resulted in increasing of heart rate more than 30 beats per 1 min. , comparatively with frequency of pulse in a state of rest. Intensity of loading can be gradually multiplied in future  but so, that frequency of pulse was multiplied no more than on a 6-% difference with the frequency of pulse in state of  rest and maximally possible frequency of heart-beats.

The important factor of high efficiency and safety of the physical trainings is a gradualness of growth of loading and permanent medical control, because even loadings of middle intensity for untrained persons can be resulted in heavy complications. All of this is especially necessary for untrained persons and persons after 40 years old  who proceed to the physical trainings.

For the health aerobic loadings more frequent are used jogging, skiing, skates rolling, bicycle, swimming, diking, physical exercises (more effective in the form of rhythmic gymnastics, games with the moderate loading and other.

The aerobic loadings are conducted without pauses for rest from 5-6 min. to a few hours. During this time the consumption of oxygen is multiplied in an organism. Oxygen debt here unlike to the aerobic loadings does not grow.

The rational use of the aerobic loadings provides the improvement of hemodynamics, perfection of functional system of transport of oxygen, aerobic ability of organism  which determines a physical capacity.

Positive influence of the aerobic loadings on the function of heart shows up the increase of construction ability of myocardium, the economy of its work, positive influence on the enzymic systems and electrolyte balance of cardiac muscle.

There is rebuilding of function of the vegetative nervous system to the side of  increase the tone of  parasympathetic link which makes  coronal vessels less sensitive to spasmogenic  influences of factors of external and internal environment.

Reserved possibilities are increased in all organs and systems. The functional state of the nervous system is normalized, persons become more balanced. Development of atherosclerotic processes is slowed. A blood pressure  is normalized. Weight of body is diminished. Immunity and firmness of organism rises to the of diseases or their relapses.

PRINCIPLES AND METHODS OF HEALTH TRAININGS

Basis of the health trainings are physiology conformities which are incorporated in the row of principles.

Principle of reiteration.

The systematic use of physical exercises according to the functional possibilities of organism.

Principle of gradualness.

Consists in the changing of trainings loading according to the dynamics of the functional state of man. Essence is in the gradual increase of loading up to the proper age and sexual indexes.

Principle of individuality is the basic condition of the health trainings and consists in strict approach to every individual with the proper setting of loadings.

For the increase of aerobic ability and also for strengthening of health are used two methods of trainings. First is\ interval, second – continuous.

Interval method. Its essence is in implementation of the maximal loadings with moderate, during one training. For example, 3 – 6 minute intensive running  changes with state of rest of the same duration during which are conducted exercises with insignificant intensity.

This method should be appointed to the physically unprepared people.

Continuous method.  At achieving the certain level of trainings (for example, ability to overcome distance during certain time at admitted heart rate). It is possible to give  for a such man a equipoise loading in basic part of employment. For example, an easy run during 20 min. at frequency of pulse not higher than   120-130 per./min.

MEDICAL-PEDAGOGICAL  SUPERVISIONS  DURING  EMPLOYMENTS FROM  PHYSICAL  EDUCATION   AND SPORTING PERFECTION

Content and task  of medical-pedagogical supervisions

 Medical-pedagogical observations (LPS) are  inspections, which are conducted by a doctor together with a teacher and by a trainer during the scientifically training classes and competitions with the purpose of estimation of influence of the physical loadings on an organism of  those who practice. The most essential task of LPS is receiving a information for individualization and improvement of planning of educational–training process, and also for a choice and estimation of efficiency of the use of different restoration facilities.

 Tasks of LPS are:     

1. Estimation of organization and method of conduction according to accepted hygienical and physiology norms.

2. Study of adequacy of the physical loading according tothe age, floor, to the state  of health, level of general physical development.

3. An estimation of influence of employments, trainings, competitions on the organism of inspected. 

4. Checking of conditions of sanitary-hygienic maintenance of places for employments, equipment, sportswear and shoes of inspected.   

5. Checking of measures for prevention of traumatism, observance of rules of safety.

6. A help for a trainer in the correct planning of employments, analysis of plan of conduction of educational-trainings employments

7. Periodic comparisons of results of medical inspection with information of pedagogical supervisions.

 Methods of research during process of medical-pedagogical supervisions and estimation of results

Research methods:

1. Interview;  the visual supervision after the influence of employments.

2. Determination of closeness of employment.

3. A study of reaction on the physical loading.

4. Research of sanitary-hygienic conditions of trainings.       

5. A study of measures of prevention of traumatism.

   Determination of closeness of employment. It is the time which is  outlayed on implementation of physical exercises during all employment. The closeness of employment is determined  as a relation of time, outlayed on implementation of physical exercises, to general duration of all employment and is shown in percents.   The  qualified conducted employment has a closeness 60-70%, for beginners it is less, for the sportsmen of higher digits – more high.

  A reaction on the physical loading of athletes and sportsmen more frequent is estimated by the change of frequency of heart beats , BP, frequency of breathing, temperature and weight of body. If it is needed electro-physiology and biochemical methods  of research can be used.

         Researches are  conducted during all employment which is divided into three basic parts: preparatory, basic, final. Duration each of them depends on  the level of physical preparedness of athletes and sportsmen and period of training process. Basic part for highly skilled sportsmen makes 2/3 parts of duration of all employment, 1/3 of time is equally divided between preparatory and final parts. For novices time can be divided inversy: 1/3 – basic, 2/3 – on two other parts, gradually, in the process of trainings main part is increasing.         

         Determination of frequency of heart-beats, breathing and BP is conducted before and after employment,  after its  separate parts, after  termination of separate exercises. The count of frequency of pulse is conducted for 10 seconds, breathing frequency – for 15 seconds,  then transfer them for 1 minute. Researches must not violate natural motion of trainings.

 Determinations of frequency of pulse is  conducted on a radial or sleepy artery or on  the area of apex shove of heart. The last method is the  most comfortable at the use of the large, intensive loadings. Result of determination of pulse is recorded by a point  in the proper place of graphic arts. After termination of employment for valuation of the findings it is necessary to joint the points which are  marked on the graph. A curve has the name of PHYSIOLOGY CURVE OF PHYSICAL EMPLOYMENT. It represents the sequence of  use of loadings, its size and enables to estimate a division of loadings.

Requirement to the physiology curve of loading:  

a/ it must have a protuberant form, that gradually increases and achieving to the spade it goes down;

b/ spades loading must be on second third of basic part of employment;

c/ loading must go down to the end of employment, than lower qualification of inspected, the nearer a pulse must approach an initial level;

d/ spades loading (maximal frequency of heart-beats) must be in accordance to the age, floor, state of health, level of physical preparedness, period of training process. Frequency of pulse 180-200 per. 1 min is considered as a strong reaction which is usually observed on large loadings (maximal or submaximal intensity). If such reaction is observed on loading of less intensity, it testifies to insufficient preparedness of inspected or his fatigue. At multiplying frequency of pulse to 140-170 per. 1 min a reaction is estimated as middle, to 100-130 per. 1 min – as weak, for persons of middle and old years maximally possible frequency of pulse is concerned after a formula: 180 minus age. For example, if  inspected is 50 years old, spades heart rate of persons of basic medical group will be 130.   

 e/ indexes of frequency of pulse, breathing and BP during  the employment must change synchronously. Different changes of these indexes (symptom of “scissors”) determine the inadequacy of loading, a reaction on which was studied.      

 A rapid decrease of frequency of heart-beats  after the separate types of exercises is an important index, which enables to estimate the functional state of inspected,   define the sizes of interval of rest between exercises. A considerable acceleration of pulse and multiplying the period of renewal after the executed loading testifies to negative influence of the physical loadings on adaptation to the physical loadings. For the well trained sportsmen frequency of pulse lower from 170-190 per 1 min. to 120 per 1 min. during 60-90 seconds.

  Research of breathing frequency is conducted the same way as frequency of heart beats: before employment, after its separate parts and after separate exercises.  The received indexes registered in a table. The synchronousness of change of indexes of frequency of heart beats and breathing testify the adequacy of loading.

         Research of blood pressure  is conducted after the count of pulse and breathing. For possibility of  less interfere into a natural motion of trainings or employments it is necessary to quickly  impose a cuff and measure an АBP. On the proper graph are marked two points: maximal  and minimum BP. Changes of BP as well as the changes of pulse characterize the size of loading and its adequacy. A strong reaction (an increase of maximal ABP to 180-200 mm.Hg. and higher) is observed at implementation of exercises of maximal intensity, if such indexes  are contained during employment, it testifies to surplus loading. Multiplying a maximal BP to 140-170 mm.Hg. testifies to middle or higher middle loading, to 130 mm.Hg. – loading of small intensity. For the people of middle and old years in basic group BP must not be increased more than 40 mm.Hg.

An important value has a study of minimum (diastolic)BP, especially, pulse. The last characterizes the size of systolic range of heart. At an adequate reaction it must be multiplied.

 The “step” type of reaction can show up at the intensive inadequate loadings, when the change of BP comes later than increasing of pulse frequency. On occasion the “phenomenon of endless tone”. If it shows up no other unfavorable changes (decline of maximal pressure, deceleration of proceeding in a pulse, breathing, АBP and other), it is accepted to consider the “endless tone” as a physiology reaction. In other cases it  is as the display of inadequacy of loading, the state of fatigue, overtraining, as to the result of violation of the mode of trainings, rest and other.

 At the adequate loading there are synchronous changes of frequency of heart-beats, breathing, АBP. Violation of proportion of changes is the first sign of worsening of adaptation of organism to the loadings.

 For the sportsmen of higher digits under time LPS are conducted general for all kinds (electro-physiology, biochemical researches, determinations of vital capacity of lungs and other) and the special for the certain type of sport (co-ordination of motions, myodynamia, and other) researches.

Sanitary-hygienic control after places and conditions of employments a physical culture and sport must be based on knowledge of sanitary-hygienic rules and norms of maintenance and exploitation of places for employments, bases of hygiene of physical exercises.

 Supervisions must engulf:

1. Sanitary-hygenic estimation of places of employments, state of the inventory and instruments, conditions of weather and other .

2. Estimation of the state of clothes and shoes of inspected;

3. Study the accordance to norms an area, volume, lighting an apartment and others.

4. Study the accordance of time of employments to correct organization of the mode of day and trainings.

As a result of inspection a doctor must give conclusions in relation to the dosage of the trainings loadings, which is estimated as: physiology, witness, pathological. Except for it, a doctor estimates the observance of sanitary-hygienic norms, implementation of measures for prevention of traumatism, gives recommendations in relation to organization of training process.

Medical-pedagogical supervisions are conducted with the purpose of operative, current and stage researches.

Purpose of operative researches – to learn changes which take place in an organism during implementation of physical exercises and in a nearest period of rehabilitation.

Changes which arise up in the late phases of renewal (on the second day after competitions, in a few days) are studied in current inspections.

Changes in an organism, which arose up during the protracted period of trainings, are studied in stage researches. Its task – to estimate changes which arise up in the functional state of the separate systems of organism, general physical capacity. Stage researches are conducted each 2-3 months: in rest, before and after implementation of the physical loading (with the help of the specific for a sportsman loadings and standard tests). Teachers, doctors, psychologists, take part in an inspection.

Researches enable a trainer to correctly organize an educational-pedagogical process. Analysing research results, a doctor can help a trainer to expose functional possibilities of separate sportsmen and help a trainer to pick up the most correct and rapid ways and facilities for the increasing  of sporting technical results, to warn the origin of the prepathological states, diseases.

PHYSIOLOGY INDEXES OF TRAINING STATE

 Physical culture is part of general culture of society, one of industries of public activity, directed on strengthening of health and physical development of population. The basic mean of physical culture are physical exercises. Physical exercises – natural and specially neat motions and complexes of motions. From motions in general physical exercises are differ by having a special purpose orientation and used with the purpose of strengthening of health, physical perfection, achieving high sporting results.

A training process is in basis of the use of physical exercises. A training process is a pedagogical process at which as a result of  many, regularly repeating motions and exercises with the gradually growing physical loading come positive morpho-functional  changes for a human’s organism. For achieving a positive effect  a training process requires the certain system of employments and severe medical control after forming of changes, which arise up in the organism of athletes, sportsman or patient.

In the process of trainings are perfecting  the mechanisms of regulators, which provide integrative activity between the different links of organism. That promotes the growth of his possibilities of adaptations, both in a norm and pathologies, to the changes of conditions of external and internal environment. In the process of trainings the existent motive skills (motive dynamic stereotypes) are perfected and formed new. It is accompanied with  development and perfection of different physical  and motive qualities: speed, endurance, force, flexibility, adroitness, jumping and others. Exactly they determine the capability of organism (physically and motive condition).

For persons who are engaged in a physical culture and sport it is possible to select the rows of the states of trained: untrained (insufficient trained iovices), trained, sporting form, stove sporting form, overstrain, overtraining. Persons who are not engaged in regularly a physical culture and sport have diminished functional possibilities of organism comparatively with standards for their age  and floor and belong to untrained people.

The trained is the state which develops in the process of regular physical exercises, which predetermines the possibility of the most effective implementation of concrete muscular activity and readiness to achieving sporting results. It is accepted to name the greatest level of trained a sporting form.

For functional possibilities of the well trained organism  are characteristic:

–         rapid including in to the work, which provides even at the beginning of work rapid mobilization of the functional systems which take part in execution of this activity, at optimum for an organism conditions;

–         economization of  activity of the different functional systems in the conditions of rest and during standard (ordinary) for an organism physical work;

–         high “border” of functional possibilities of organism during maximal work in these conditions, mobilization and complete use of biopower and functional reserve;

–         an increase of firmness to the considerable (whether extreme) changes of internal and external environment;

–         rapid and complete renewal after different by a volume and intensity physical work.

All these qualites are the result of accumulation of morpho-functional changes in organism in the process of trainings. They are divided into short time which arise up directly  in the conditions of implementation of the physical loading (increase of frequency of heart bears, breathing frequency, biochemical changes and others), last not long after physical trainings and duration qualites which are formed as a result of the protracted regular employments and saved in an organism long time.

Stopping of the regular trainings results in lower and further – to disappearance of the last.

Task of doctor is to promote positive morpho-functional changes in the organism of athletes and sportsmen, that a training process would provide strengthening of health, to achieving high sporting results. For this purpose it is necessary for a doctor to correctly inspect a patient, define the health state, physical development, functional possibilities, correctly choose the mode of motive activity and constantly  control the efficiency of its use. If necessary , together with a teacher correct the methods of the use of physical exercises and their dosage, constantly control short- and longtime morpho-functional changes in an organism which arise up in the process of trainings.

Warning of sporting traumatism and morbidity

Measures on the prevention of traumatism and morbidity must be carried out in the followings forms:

1.     Control is after implementation of rules on the prevention of sporting traumatism;

2.     Systematic account and analysis of all cases of sporting traumatism and morbidity as a result of reading a physical culture and sport with taking of information to the trainers and leaders of the proper establishment

3.     Development of measures is on the prophylaxis of sporting traumatism and morbidity.

         Reasons of traumatism are various

Conclusions are as a result of medical-pedagogical supervisions.

The results of medical-pedagogical observations are entered in the proper minutes:  Act of medical-pedagogical supervisions:

ACT (chart)

medical-pedagogical supervision

after employment

 

       (type of employments: Class of physical education, sporting training, procedure of medical gymnastics)

 

                                                                                     Date

1.     Last name, qualification of trainer, teacher, instructor

 

2.     Information about employment (kind employment, its number, what period of trainings)

 

3.     Description of group (amount, age, floor, degree of preparedness, diagnosis)

 

 

 

4.     Date of the last passing of medical examination

5.     Description of the sanitary-hygenic state of place and conditions of employments: area

                                  cubic capacity                          , illumination

     ventilation                              , heating

   sanitary-hygenic state of inventory and equipment

     method and quality of cleaning up of apartment

     state of sportwear and shoes

6.     Presence in  the teacher (trainer) of plan-compendium of employment

7.     Description of organization and discipline of  employment

8.     Medical-pedagogical description of employment:

à) preparatory part                                    , basic part                                  

                                                       (duration)

     finaly                                        , general duration                               

              b) calculation of closeness of employment

              c) looking after breathing of athletes by trainer

              d) measures of education of correct posture

              e) accordance of material of employment to its purpose and tasks and plan.           

 

              f) a presence in a employment of heavy exercises for people who are training

 

              gº) a presence among people who are training the

 persons with the signs of the expressed fatigue                  

 

 

h) individualization of material                                                                                                 

 

Physiological curve of the physical loading.

 

 

i) accordance of loading to the educational material of employment, floor, age, state of health, preparation of inspected

 

9.  An estimation of measures of  insurance, helpness and prevention of sporting traumatism

 

            10.  Description of emotionality of employment

 

            11. Elements of an educate work on the employment (appearance, manners of communication, pedagogical tact and etc)

 

    12. Results and suggestions

 

 

 

 

 

 

 

Doctor:

                                     (signature)

As a result of inspection a doctor must give conclusions in relation to the dosage of the trainings loadings, which is estimated as: physiology, witness, phatology.

 Except for it, a doctor estimates the observance of sanitary-hygenic norms, implementation of measures on the prophylaxis of traumatism, gives recommendations in relation to organization of training process.

Medical-pedagogical supervisions are conducted with the purpose of operative, current and stage researches.

Purpose of operative researches – to learn changes which take place in an organism during implementation of physical exercises and in a nearest period of rehabilitation.

Changes which arise up in the late phases of renewal are studied in current inspections (on the second day after competitions, in a few days).

Changes in an organism, which arose up during the protracted period of trainings, are studied in stage researches. His task – to estimate changes which arose up in the functional state of the separate systems of organism, general physical capacity. Stage researches conduct each 2-3 months: in rest, under time and after implementation of the physical loading ( with the help of the specific for a sportsman loadings and standard tests). Teachers, doctors, psychologists, take part in an inspection.

Researches enable a trainer correctly to organize an educational-pedagogical process. Analysing research results, a doctor can help a trainer to expose functional possibilities of separate sportsmen and help a trainer to pick up the most correct and rapid ways and facilities for the increase of their sporting technical results, to warn the origin of the prepathological states, diseases and damages as a result of the inefficient trainings.

Recovery  an athlete’s organism during process of trainings and competitions
Achieving high sports results is impossible without considerable physical exertions.
Recovery in the sport – a mandatory part of training process, which is not less important than the direct impact of training on athletes.

Due to repeated heavy physical loadings  in the body can develop two opposite states:
1. Rising of  training level and increasing of physical capacity, if the processes of recovery provide recovery and accumulation of energy resources;
2. Chronic fatigue and exhaustion, if  no systematically recovery is present.
Faster recovery – a direct impact on the recovery processes – one of the important levers of management of training process.
Faster recovery can be achieved by a natural way and by a direct impact on the flow of recovery processes with purpose of their stimulation. Using an assistive technology can have positive effects only in combination with naturally accelerate recovery.

Managing of recovery processes  is important not only for high- skilled athletes who train using heavy loadings, but also for all other people who are involved in physical culture and mass sport. Because  that  promote the most pleasant feeling of influence of loadings on the body, and thus the health effect of the exercises.

To date, are developed and implemented in to practice a large number of restorative measures that can be divided into three groups:
1. pedagogical,
2. psychological,
3.medical biological.

Combination of these measures depending on the orientation of training process, task and phase of training, state and level of training, the previous mode makes the system recovery.

      The pedagogical measures include: a rational combination of measures of special and general training, the correct combination of loading and state of rest, correct division of loading into parts of training employment, using during training class  exercises on muscle relaxation, breathing exercises, self-massage, individualization of training, rational mode of training and state of rest, sufficient emotions of classes.
     Psychological measures are aimed on the rapid normalization of neuro-psychological state of athletes after intense training and competition, which creates the necessary background for the functional recovery of physiological systems and physical capacity. To them can be included psychopedagogical means (optimal moral climate, positive emotions, comfortable conditions of training and rest, etc.) and  psychohygienic means of regulation and self-regulation of mental states (continued sleep, inspired dream, psychoregulation, autogenic training, colorful and musical influences and special techniques of muscle relaxation, the use of certain medicinal remedies for balancing the nervous system).

Basic medical biological restorative measures:
1. Nutrition.
2. Physical factors.
3. Natural and pharmacological agents.
4. Rational daily mode.
5. Climate factors.

        Mechanism of action of these factors manifests itself by a non-specific (action on protective-adaptive forces of the body) and by the specific influence which are directly aimed on the fast elimination of general and local manifestations of fatigue caused by performed work. By neurohumoral mechanisms of regulation these measures affect on changed ,as a result of exercise, metabolism, temperature and blood supply of tissues, promote the restoration of spent energy and plastic resources, faster excretion of decay products, restoration of  state of nervous processes.
Rational nutrition should provide restorative processes by energy, plastics, trace elements, vitamins. Caloric content of daily ration should be in accordance to the energy costs. Rational form of food is at daily calories 4500 kcal and approximately consists of: protein 14%, 22% fats, carbohydrates 64%.
Important role is played by vitamins (B1, B6, B12, V15, C, PP, E) that are needed for an organism in relatively small quantities.

 At the same time vitamins  are necessary elements because are not synthesized or synthesized in insufficient quantities in the body. So appointment polyvitamins drugs (Tetravit, Aerovit, Dekamevit, Hlyutamevit etc.) is effective.
         Physical factors. In differentiated using their influence can be directed on the most “tired” systems or on the regulation of certain functions or on the body as a whole. Among physical factors we can distinguish natural (light, water, heat) and preformed by special apparatus physical therapy factors (impulse currents of low frequency sound, electrical, electrostimulation of muscles,

currents and fields of high voltage and high frequency (microwave), ultraviolet irradiation, electroanalgesia.
For water treatment in sporting medicine are used carbon dioxide, sodium chloride, coniferous, pearl, vibrating, dry carbon dioxide gas and  cold baths.

Sauna can be used as a Russian sauna where are supported such conditions: temperature 45 – 60°C, relative humidity 75 – 100%

and dry-air sauna (typically Finnish sauna)  where are supported such conditions: temperature 70 – 90°C, relative humidity 10 – 25%.

Massage in sporting medicine is divided into preparatory (mobilizing), restorative, preventive, rehabilitative. Opportunities of properly chosen and performed procedures of massage are very big. It can promote the mobilization of mental,emotional and functional condition ,preparation of the musculoskeletal system to physical activity, acceleration of recovery, remove fatigue, prevention and treatment of diseases and injuries.

  Pharmacological agents. The purpose of the use of pharmacological agents – creating conditions that counteract to excessive, significant shift of neurophysiological constants of homeostasis.

The main indications for the use of medications are:
1. Treatment of diseases.
2. Prevention of overexertion by the activation of recovery systems.
3. Treatment of the overstraining.

For pharmacological medications which are used in sporting practice belong drugs of general application,

 

 koferments and their precursors, drugs of the plastic action, erhotropny substances, adaptogens and antioxidants, drugs that improve the function of certain organs.

Each of the drugs should be appointed individually depending on the period of intensive training ,specific features of athlete, type of sport and others. In case of appointing new drugs we should ensure that it do not belong to the class of stimulants  which is determined by  the International Olympic Committee and approved for use by WHO.

 

In cases where due to medical indications the medication should be appointed and it belong to one of the classes of stimulants (steroid anabolics, β-blocker  or other stimulants), the physician must prohibit for  athlete to participate in activities of big sport. During this period the seize of training loading is determined by doctor.

Doping in sport. Doping control.

At the organization of medical support of official international competitions (Championship National, European, World, Olympics) is made anti-doping control.
Anti-doping control – a system of special measures which is aimed on detecting of using doping by the participants with the imposition of appropriate sanctions on these sportsmen.
Term ”doping” in sport means the injection by athletes (before or while the competition) of pharmacological substances that may artificially increase the sporting results. Doping not only creates the conditions of unfair fight in sport, breaks its moral and ethical foundations but it harms the health of athletes.

  These substances stimulate the organism, causing uneconomic activity for physical activities and development of various pre-pathological and pathological states. After increasing for some time comes the frustration and reduce of physical capacity, sometimes it results in death. Effects of doping substances on the body depend on age, health, nervous system features of the athlete.Doping is widespread in professional sport, especially boxing, football, bicycle cycling . In 1967 it was decided to ban the introduction of doping and  make doping control.
Doping control is the system of special measures for detecting possible using of doping by the participants and imposing sanctions on them. Charging the athlete in doping admission must be proved by objective methods which require presence of certain doping substances and its metabolites in the sportsmen’s urine, collected after the competition according to rules. Control is made by organization of the country in which competitions are held under the supervision of the IOC medical commission or by sports federations. This procedure is determined by special rules of the IOC and international federations. Under control are prize-participants  of competitions. Immediately after the competition an athlete, who is under control, receives a subpoena, which speaks of compulsory attendance at doping-centre on the surrender of urine samples. Test (in the presence or by the participation of an athlete and representative of the team) is divided into two equal parts – main and control. Each part of urine is poured in vials that are tightly closed and coded. Minutes is  signed by an athlete, team representative, employee of doping-centre and also by a representative of the medical commission. The main part under the code symbol (that person who is conducting the analysis would not know the name of athlete)according to safely rules to prevent a violate of the integrity of the vial or substituting of samples is directed to chemical-toxicological laboratory for analysis. The second sample is stored under seal for the control and is researched in the case if in the first sample is found doping.
           Laboratory analysis is conducted for the presence of doping by using modern methods – chemical-toxicological analysis ( spectrophotometry, spectroscopy, gas chromatography). For the detection of anabolic steroids is used radioimmune method.
          Results of the analysis under the code name are directed to the medical commission, which may identify the name of the athlete and give the medical report. Athletes who used doping are under sanctions, its decisions are be made by the IOC (at the Olympic Games) or the International Federation (at the world championships in various sports at various championships, cup competitions). Showing results by such athletes are annulled, athlete forfeits of the prize and also can be disqualified for various periods. The results of that team in which participant received the doping are withdrawn.
According to the IOC  doping include 5 groups of pharmaceutical drugs:
• psychostimulate drugs (amphetamine, phenetrazyn etc.). These substances act mainly on the mental sphere, reinforcing the processes of excitation, fatigue abcense;

  • sympatomimetychny amino-substances (ephedrine, metoksyphenamin), acting through the nerve centers on the vegetative system, increasing blood circulation, activity of respiratory system and others;
• central nervous system stimulants (nuketomid, koramin, strychnine, etc.);
• drugs and substances that relieve pain (morphine, codeine, etc.);
• anabolic steroids (nerabol, retabolil, etc.).

Pre-pathological conditions, diseases and damage due to the irrational employments of physical culture and sport, means of prevention.

Pre-pathological states and pathological changes can be developed in the body of the athlete due to inefficient sport employments under the influence of excessive short-term or long-term training loading and the loading in conditions of the competition. In the first case they are caused by acute and in the second – a chronic physical overstrain. These states are often considered as separate diseases. But better is to consider the acute and chronic physical overstraiot an independent disease but as the etiological factors that cause the body to the development of pathological conditions and pathological changes.

Acute physical overexertion is developed in athletes in cases when the training loading or loading during the competition are higher than their functionality possibilities. Similar discrepancy most often is seen in insufficiently trained athletes, although it could (rarely) develop in a well-trained people, such as in the case of their participation in the competition with more skilled athletes. APO may also occur in well-trained athletes when they train or take part in competitions in the state of disease or in a state of recovery after various diseases. Very often APO is observed in athletes with chronic infections, violations of mode of life, education, nutrition, are in a state of nervous or physical fatigue. Manifestations: cold sweats, nausea, pale skin, shortness of breath, increased heart beat. (This are expressed vegetative disorders).
APO in most cases can proceed on the type of cardiovascular failure. It is marked by the expressed pale skin, violation of coordination, dizziness, darkening before the eyes, weakness, vomiting, pain in the right area (liver) and area of heart, shortness of breath, increased heart quake.

Acute vascular insufficiency can manifest by syncope, collapse, shock.
Damage of heart, as a result of acute physical overexertion is revealed by acute heart failure and myocardial infarction.

Acute left ventricular failure is manifested by asthma, pulmonary edema, cardiac asthma, may occur a sharp pain behind the breastbone. Blood pressure decreases. In case of acute right ventricular failure occurs stagnation of blood in a large circle of blood circulation, which manifests by pain in the right part of abdomen, increased liver.
Acute physical overexertion can damage respiratory organs (develops lungs emphysema, acute spontaneous pneumothorax), kidney (renal epithelial dystrophy, myocardial kidney), blood system (significant leukocytosis). In all cases of dysfunction of the lung, kidney, liver and other organs athletes must be hospitalized.
At the beginning of the training cycle in the preparation period due to insufficient preparatory in athletes can developed APO. Prevention: correct and timely medical control of state of health,functionality possibilities, mode of life, work, training, nutrition and rest of athlete.

Chronic physical overexertion is developing due to a long physical and emotional loading that are not in accordance to the functional possibilities of the athlete.

 

 Essential in development of HPO are violation of mode of training, life, work, rest, sleep and nutrition, physical and mental traumas, poisoning of the body with chronic infections, training on the background of any disease, recovery condition after flu, sore throat , acute respiratory diseases. All these factors contribute to the development of HPO of body by reducing the tolerance to physical and emotional stress, that’s why the ordinary and competitive loadings may become excessive. Examples of similar situation, may be training in mountain location without previous acclimatization and doing unusual sports. HPO is often observed in the main period of training process, when the level of training is high enough and athletes are seeking to improve their achievements by irrational increase in training loading. The most typical manifestation of HPO is the development of neurosis. Thus appear changes of hearts, livers, kidneys and blood system. As a result there are heart rhythm disorders, increase or decrease of blood pressure, etc..

Overtraining – is pathological condition that develops in athletes due to HPO, in its clinical picture are defined functional disturbances in the central nervous system ,pathogenesis is similar to neurosis. Usually in the clinic are three stages of overtraining.

1- stage. It is characterized by the absence of complaints. Sometimes athletes complain on sleep disturbance which  results in bad falling asleep and frequent awakenings. Often is observed lack of growth, seldom – reduce of sporting achievements.

 Objective symptoms: worsening of cardiovascular system to adaptation to speed loading and violation of the thinnest motor coordination. First can be shown in appearing after speed loading (15-second running on same  place with the most fast speed) of atypical  reactions in pulse rate and blood pressure, instead of what before was normotonic  type of reaction. The second is in irregularity tapping of  fingers (some tapes are made arrhythmic and with different power). Other objective and subjective changes are abcent.

II- stage is characterized by numerous complaints, functional abnormalities in many organs and systems and lower sports results. Athletes complain of apathy, lethargy, sleepiness, increased irritability, decreased appetite, unwillingness to exercise, pain in the area of the heart. In some cases athletes complain of loss of sharpness of muscular sense, the emergence of inadequate reactions at the end of complicated exercise. Progresses a sleep disorder: sleep is surface, with dreams of horrific nature. This dream does not provide a necessary rest and recuperation.

Violations of the nervous system appears in change of daily periodicals and daily functions by the dynamic stereotype. As a result, the maximum growth of all the functional parameters are observed in the athlete not in those times when he usually trains, for example, in the afternoon but in the early morning or late at night when he doesn’t training. Cardio-vascular system dysfunctions manifest in inadequate response to the great physical effort, in prolonged restorative period after physical training, in violation of the cardiac rhythm. At state of rest in athletes may be tachycardia and high blood pressure or sudden bradycardia and hypotension. In some cases, is possible development of vegetative dystonia. It is characterized by inadequate response of vessels to temperature stimulus, unstable blood pressure, and the advantage of sympatotonia or vagotonia. In respiratory system decreases vital capacity of lungs. Decreasing of body weight is associated with enhanced dissolution of proteins in the body of the athlete. For athletes in the second stage of overtraining is observed excessive sweating. In women – menstrual disorder in men – a decrease or increase of sexual potency. Background of these changes are nervous disorders. Changes of the blood system: reducing the phagocytic capacity of neutrophils, reducing the complement of blood, reducing of defenced property of skin.

 

Stage III. It is characterized by the development of neurasthenia 1) hypersthenia or 2) a hypotonic form and the acute deterioration of sporting results. The first form is the result of the weakening of inhibitory processes and the second – overstraining  of exciting processes in the cerebral cortex. Clinically a hypersthenic form of neurasthenia is characterized by increased nervous irritability, feeling of fatigue, general weakness, insomnia. Clinically a hyposthenic form of neurasthenia is characterized by general weakness, exhaustion, tiredness, apathy and drowsiness in the day.
In heart due to chronic physical overstrain can develop myocardial degeneration. On ECG myocardial dystrophy is manifested as diffuse neuromuscular changes and ventricular overstrain.

Overtraining in first stage is eliminated without any harmful effects. Overtraining in II and especially in III stage can lead to long-term sporting disability and can have a bad result. It demands a treatment from patient.
Prevention of overtraining is based on the elimination of the causing reasons. To the competition can be allowed healthy and well-trained athletes, according to the age and level of physical preparation. Sport in painful state and in the recovery period should be prohibited. Focuses of chronic infection before the intensive training and competition should be eliminated. Athletes must adhere to the training mode, a mode of work, nutrition and rest. Physical exercises should not exceed the limits of functional possibilities.

Diseases and injuries due to irrational employment of physical culture and sport and its prevention.
Selective lesions of various organs and systems are due to acute or chronic physical overloading and are caused by complex  of congenital or acquired properties of the body. It is believed that primarily affects are on those organs and systems which have the least resistance or are the most exposed for life. Mostly are lesions of such organs and systems as: cardiovascular, nervous, musculoskeletal, digestive, endocrine, respiratory systems, urinary excretion, and throat, nose, ears and separately are liver pain syndrome and neyrocirculatory dystonia syndrome
 The most frequent are next diseases:
Cardiovascular system: myocardial dystrophy:, cardiac arrhythmia, hypertensive states, hypotonic states.

Nervous system: organic lesions, traumatic brain injury:
Diseases of peripheral nervous system, radiculitis and sciatica, a syndrome of neuro-circulatory dystonia, neuroses and neurosis-like states.
Musculoskeletal system: chronic injuries of the musculoskeletal apparatus, acute traumas.

Digestive system: biliary dyskinesia, chronic cholecystitis, gastritis, gastric ulcer and 12 peptic ulcer, colitis, enterocolitis, cholecystoholanhitis, inflammatory diseases of liver, liver pain syndrome.
Diseases of the ear, throat, nose: diseases of nasal cavity (rhinitis, haymorit), diseases of the pharynx (pharyngitis, chronic tonsillitis, pharyngo- laryngitis), middle ear disease (chronic catarrhal otitis). Acute diseases of upper respiratory tract and organ of hearing.
Endocrine system. Endocrine system diseases in athletes exists relatively rarely. On the basis of clinical symptoms of overtraining are two forms: one of which resembles the state of hyperactivity of the thyroid gland and the second – the state of adrenal cortex hypofunction.
Urinary system: acute and chronic diffuse glomerulonephritis, acute nephritis, urolithiasis, an infectious-toxic kidney.
Admittance to the physical exercises after diseases and injuries.
After diseases and injuries a person has a temporarily complete exemption from physical education.

Influence of physical exercise on the body.
Human health is ultimately determined by the number and power of its adaptation reserves. The higher is functional reserve, than lower is the “value of adaptation.” Adapting of organism to the new conditions of life with physical activities is not provided by separate organs, it is coordinated by connected in time and space specialized functional systems.
The characteristic feature of the adapted system is economy of functioning with purpose of maximum economy of resources of the body. Constant variability of the internal and external environments of the organism determines the dynamics, diversity and plasticity of adaptive processes. Its stability depends on the adaptive homeostatic mechanisms of personality, its reserve capacity, which determine the margin of force due to which the body counteracts with the extreme factors. The main component of the mechanism of general adaptation is the mobilization of energy resources, plastic reserve and all protective possibilities of the organism, directed on its energy provision and keeping of normal life.
In adaptation mechanisms has value a enhanced formation of metabolites and hormones as well as adaptative protein synthesis. Due to this the functional capacity of functioning structures of cells increases, it indicate the transition from immediate (negative) to a stable long-term adaptation. Rational is that adaptation which makes the possibility of prolonged adaptation to increasing loadings and lowers the possibility of failure of adaptation.
During systemic effects of physical exercises (certain stimulus on the body) effect of them gradually weakens due to the increased stability of the regulatory mechanisms, cellular structures, change of physical and chemical properties of cells, extension of the functional and adaptive reserve of the body.
        Adaptation to the extreme conditions is not unlimited and may lead to depletion of the functional system, which is basic in the adaptative reaction and as a result – to state of detraining and reducing of structural and functional reserve of the body.
The task of the doctor –between  all changes that occur in the body during physical exercises to identify those that promote the improvement of health, functional possibilities of the organism and achievement of high sports results by athletes, promote their development and prevention of the negative changes.
Influence of physical exercise on hemodynamics. Regular physical exercises significantly improve the function of all organs and systems that’s promote positive changes in hemodynamics.
        Oxygen, which is needed for processes of transformation of energy, is delivered to the muscles by oxygen transport system. It includes respiratory, cardiovascular systems. Physical trainings lead to increased functional capacity of each of these links.
Heart rate in trained individuals is lower than in untrained. Regular exercises give an opportunity to increase productivity of the heart work in state of rest and during exercises by lower heart rate with increased volume of the heart stroke. This increases the efficiency of myocardial contractile function due to that is relatively reduced an oxygen demand. Bradycardia is caused by increased impact of vagus nerve on the heart. It is more expressed in individuals who are engaged in cyclic sport, mainly aimed on the development of endurance. Heart rate may decrease to 40 beats per minute.
In process of intensive training in athletes in developing a working hypertrophy – widening of ventricles and atriums,thickening of the muscle fibers. Weight of heart reaches 350-500 g compared with 280-350 g in untrained persons. The degree of hypertrophy does not exceed the physiological limits.
        Working hypertrophy is accompanied by improvement of myocardium contractility and coronary circulation. It promotes the increasing of the stroke volume and less minute  volume during training and is a manifestation of increasing of the heart functional ability in well-trained individuals. Phase analysis confirms these findings: prolongation of mechanical systole is not accompanied by increased period of blood ejection from the left ventricle. Improvement of coronary blood flow, decreasing of myocardial oxygeeeds of trained individuals are the prevention measures of coronary heart disease.
         Blood pressure. It is believed that reducing of blood pressure in athletes is one of the important aspects of adaptation to regular physical activity. But not every decreasing of BP in athletes is a sign of high-training level of the body. Except of high-level of training (physiological norm) it can be other forms -hypotension from overtraining, neurocirculatory dystonia of hypotonic type,hypotension  due to chronic infection because of adverse influence of internal and external environment on the humoral control of vascular tone in athletes. Various adverse factors: excessive physical activity, frequent physical and emotional stress can cause the increase of blood pressure.
Features of electrocardiogram of athletes (by LA Butchenko, 1963): moderate or expressed bradycardia, sinus arrhythmia, reducing the voltage of R wave and increasing of T wave in the standard assignments; high voltage of QRS complex; vertical electrical heart position.
In blood in the process of training are increasing hemoglobin content and the number of red blood cells. Is increasing a oxygen content of blood (about 1-2%) and its alkaline reserve (approximately 10-20%). Is increasing a enzyme activity of blood (catalase, karboanhidrazy etc.). Sugar level becomes more stable, that is the prevention of coronary spasms.
        In trained people the oxygen use by tissues in state of rest is on a higher level and the number of hemoglobin is increasing. Considerably grow maximum oxygen consumption, maximal oxygen pulse, boundary minute volume circulation.
Blood circulation in muscles during strong rhythmic loadings increases in 15-20 times. The number of open capillaries in the working muscles may increase in 50 times.

        Respiration and gas exchange are the components of oxygen transport and are directly related to the influence  of physical exercises. During the training of respiratory mechanisms are improving. Also are increasing of the strength of respiratory muscles and mobility of the diaphragm. As a result – breathing slows down, become deeper, more efficient, the reserved air volume decreases and respiratory volume  increases due to increased pulmonary ventilation.
Is increasing of vital capacity of lungs from 3-4 l in untrained people and to 6-7 in athletes. It promotes more efficient diffusion of gases between alveolar air and blood, more complete assimilation of oxygen, better adaptation to hypoxia, increasing of physical capacity.
       Influence of regular physical exercise on the nervous system. In the central nervous system are increased the power, poise and mobility of processes of excitation and inhibition, speed and strength of created connections. The functional state of autonomic nervous system is changing towards to increasing its parasympathetic tone. Level of analyzers action is increasing: motor, vestibular, auditory, visual, tactile. Vestibular analyzer improves the coordination of movements during changing of body position in space, a hearing – the rhythm of movements, visual – spatial orientation.
Influence of physical exercise on musculoskeletal system. Under the influence of systematic physical exercises increases a blood circulation in the musculoskeletal system, which promotes the strengthen of bones, joints and muscles. Mobility in joints increases, articular cartilages become more flexible, tone of joint capsule and ligaments enhances. Mobility of the spine increases.
Alteration of microstructure of bone and muscle is performed. Growth of bones is activated. This is especially characteristic for sport connected with a pulsating loading. Muscle size is increased due to thickening and strengthening of every muscle fiber. Loading of speed character improves functioning of the muscle fibers of type II, if loading is associated with the work on endurance – type l. In the middle distance runners is observed relatively equal division of fibers type I and II.
Influence of physical exercise on the endocrine system. Physical activity and participation in competitions cause a significant functional strain of the organism that requires maximum mobilization of its reserves. To endocrine glands are high demands.

        Mobilization of energy and plastic reserves of the body is the result of a complex interaction between different functional systems, but primarily it is related with activity of the sympathoadrenal and pituitary-adrenocortical systems. Actual content of training, character of exercises and loading play a role in the activation of a certain hormonal link. It also depends on the duration and intensity of muscular work. The change of work of the adrenal cortex and pancreas is correlated with phases of athletic training.
Influence of physical exercises on the immunologic reactivity of the organism. Adequate loading during classes of physical culture and sport positively affect on the factors of nonspecific protection and immunological reactivity: increases activity of humoral and cellular parts of the immune system, increases body’s resistance to infections and other unfavorable environmental factors. During inadequate physical exercises may appear a expressed violation of homeostasis of nonspecific protection factors (skin, mucous membranes) and the immune system.

        Changes in the excretion system . Changes in kidney activity depends on the type and nature of the training period or competition. Changes in the kidney may be of different nature. They can be expressed in changing of seize and composition of urine,in the appearance of not typical components, of a considerable the secretion of substances which can be normally found. During expressed physical exertions in the urine increases the number of metabolic products. Urea, uric acid, kreatynin and other products of protein and purine metabolism can grow in urine in 8-10 times after running for marathon distance.
         During intense exertion in body dominate anaerobic glycolysis, so in blood increases content of such products: lactic, oxbutyric, acetoacetic acids and other. These substances are strenuously excreted by kidneys. Thus the concentration of lactic acid in the urine can grow to 0,22-0,24% after submaximal work intensity, while after work of  moderate intensity it does not exceed 0,05-0,06%. During great emotional loading in connection with the activation of glycogenolysis processes under the influence of increased allocation of adrenaline, which increases blood glucose, glucosuria may occur.
Appearance in the urine  increased amounts of protein and blood cells (erythrocytes, leukocytes) give a evidence of the violation of functional state of the kidneys. Organs caot provide the completed activity after made physical loading.
Influence of physical exercise on the digestive system depends on the type of loading, its duration and intensity. As a result functional state of all components of the digestive system is improved. In the mechanism of action of physical exercise plays an important part its influence on the functional state of hemispheres cortex, on sympathetic part of vegetative nervous system and digestion centers.

Directly during physical activity due to the redistribution of blood to organs the blood supply of digestion system worsens. Therefore, the digestion process slows down and the food that gets to the stomach and intestines become untouched ballast. Therefore, food caot be accepted less than 1,5-2 hours before training and competition.