nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2018-22-4-102-107nefr-547Research ArticleПРОГРАММА НЕПРЕРЫВНОГО ПОСЛЕДИПЛОМНОГО ОБРАЗОВАНИЯ ПО НЕФРОЛОГИИPROGRAM ON CONTINUOUS POSTGRADUATE EDUCATION ON NEPHROLOGYОБЩИЕ ПРИНЦИПЫ ПРИМЕНЕНИЯ ДОЗИРОВАННЫХ ФИЗИЧЕСКИХ НАГРУЗОК У БОЛЬНЫХ НА ГЕМОДИАЛИЗЕGENERAL PRINCIPLES OF USE OF DOSED PHYSICAL EXERCISE IN PATIENTS WITH HEMODIALYSISВишневскийК. А.VishnevskyK. A.

198205, Россия, Санкт-Петербург, ул. Авангардная, д. 4

Вишневский Константин Александрович, канд. мед. наук, заведующий отделением хронического гемодиализа. Тел.: (812) 736-93-42

198205, Russian Federation, St.-Petersburg, Avangardnaya str. 4

Konstantin A. Vishnevskii, PhD, head of hemodialysis unit; Phone: (812) 736-93-42

hd15gb@mail.ruРумянцевА. Ш.RumyantsevA. Sh.

Россия, 199106, Санкт-Петербург, 21-я линия В.О., д. 8а

Проф. Румянцев Александр Шаликович, кафедра пропедевтики внутренних болезней. Тел.: +7 (812) 326-03-26

Russia, 199106, Saint Petersburg, V.O., 21 line 8a

Prof. Alexandr Sh.Rumyantsev MD, PhD, DMedSci, Department of propedeutic of internal diseases. Phone: +7(812)326-03-26

rash.56@mail.ruКоростелеваН. Ю.KorostelevaN. Yu.

197022, Россия, Санкт-Петербург, ул. Л. Толстого, д. 17, корп. 54

Коростелева Наталья Юрьевна, канд. мед. наук, лаборатория почечной недостаточности. Тел.: (812) 338-69-14

197022, Russia, St-Petersburg, L. Tolstoy st., 17, build. 54

Natalya Yu. Korosteleva, MD, PhD, Laboratory of Renal Insufficiency. Phone: (812) 338-69-14

Городская больница №15РоссияSaint Petersburg City hospital №15Russian FederationСанкт-Петербургский государственный университет Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссияSaint Petersburg State University Pavlov First Saint Petersburg State Medical UniversityRussian FederationНаучно-исследовательский институт нефрологии Научно-клинического исследовательского центра Первого Санкт-Петербургского государственного медицинского университета им. акад. И.П. ПавловаРоссияNephrology research institute of scientific clinical research centre, Pavlov First Saint Petersburg State Medical UniversityRussian Federation201821072018224102107Copyright © Вишневский К.А., Румянцев А.Ш., Коростелева Н.Ю., 20182018Вишневский К.А., Румянцев А.Ш., Коростелева Н.Ю.Vishnevsky K.A., Rumyantsev A.S., Korosteleva N.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/547

В статье отражены современные представления о причинах и механизмах нарушения физического функционирования больных с хронической болезнью почек, получающих  лечение программным гемодиализом. Рассмотрены различные виды физических нагрузок и  приведено обоснование целесообразности их использования у диализных пациентов. Представлены возможности диагностики основных вариантов белково- энергетической недостаточности. Намечены возможные направления их коррекции.  Детально освещены возможности и методики регулярных физических тренировок в столь  сложной когорте пациентов, имеющих изменения практически всех основных систем  организма. Для больных, которые не могут выполнять физические нагрузки в тренирующем  режиме, специально разработана, опробована на репрезентативной выборке, обоснована и  подробно рассмотрена новая реабилитационная методика, не применявшаяся ранее в  нефрологии – накожная билатеральная электростимуляция мышц нижних конечностей. Приведены собственные данные длительного наблюдения за больными, которые  подтверждают возможности представленных методик не только в плане улучшения физической работоспособности, но и в отношении улучшения адекватности диализа и качества жизни.

The article reflects modern ideas about the causes and mechanisms of the physical functioning disorders in patients with chronic kidney  disease receiving program hemodialysis. Various types of physical  activity are considered and the rationale for their use in dialysis  patients is justified. The diagnostics possibilities of the protein- energy deficiency main variants are presented. Possible directions  for their correction are outlined. The possibilities and methods of  regular physical training in such a complex cohort of patients with  changes in almost all the basic systems of the body are described in  detail. For patients who cannot perform physical exercises in a  training mode, a new rehabilitation technique was developed and  tested on a representative sample, and a new rehabilitation  technique that was not previously used in nephrology – a cutaneous  bilateral electrostimulation of the muscles of the lower extremities –  was justified and considered in detail. The authors give their own data on long-term follow-up of patients, which confirm the  possibilities of the presented methods not only in terms of improving physical performance, but also in improving the adequacy  of dialysis and the quality of life.

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The authors declare that there are no conflicts of interest present.