Dr.Hab., Professor A.V. Leyfa¹
Dr.Hab., Professor Yu.D. Zheleznyak²
Dr.Med., Professor Yu.M. Perelman³
PhD, Associate Professor K.N. Sizonenko^1
1Amur State University, Blagoveshchensk
²Moscow State Regional University, Moscow
³Far Eastern Scientific Center of Physiology and Pathology of Respiration, Blagoveshchensk

Keywords: students, health, respiratory diseases, physical rehabilitation, quality of life.

Introduction. Russian society has entered the period of progressive development, which determines the socioeconomic and political changes aiming at promotion of humanistic values and raising people’s quality of life. In this process, of great importance are the problems connected with the quality of life of people, their health and healthy lifestyle.

L.I. Lubysheva and A.I. Zagrevskaya believe the traditional views on the arrangement of the training process need to be reviewed. It can be based on kinesiology (metasubject knowledge about human movement and physical activity) [1]. Physical activity of moderate and high intensity contribute to health protection and promotion both directly and indirectly [2, 3, 5, 6, 7 et al.]. Yet, only 20-30% of Russian students practice physical activities on a regular basis, unlike 40-60% in the economically developed countries of the world [4]. The number of students who, according to their health status, are assigned to a special health group (SHG) keeps steadily growing. In the morbidity pattern, respiratory diseases are uppermost – 57.8-72%. In the morbidity pattern of the population of the Far East, respiratory diseases are on the first place. First of all, it occurs due to the environmental and climatic conditions of living in the Far East. Russian Far East is divided into several climatic zones: the North-East zone with subarctic climate (Magadan Oblast, Chukotka, the north of Khabarovsk Krai, Amur Oblast and Kamchatka Krai); the extreme continental climate zone (the main territory of Amur Oblast, Khabarovsk Krai); the monsoon climate zone (Primorsky Krai, Sakhalin Oblast, south of Kamchatka Krai). Physical activity of pupils and university students is getting lower, while their nervous and emotional tension is rising, which damages their health and quality of life.

The situation can be resolved only when providing a comprehensive solution of the tasks of physical, moral and mental education of students of special health groups (SHG). It should efficiently incorporate new approaches to the teaching process of Physical Education and innovative technologies of physical activity and health protection.

Thus, objective of the research was to show the feasibility of modern methods of physical activity of SHG students diagnosed with respiratory diseases and to study their impact on the students’ quality of life.

Research methods and structure. The target goal was reached with the combination of the following informative, reliable and mutually complementary research methods: analysis of scientific literature; study of documents and best practices; lesson observation; conversation, interview and questionnaire; expert evaluation; testing of physical development, motor fitness, physical work capacity, external respiration characteristics; educational experiment; mathematical methods of statistics. To measure SHG students’ performance and their cardiorespiratory fitness under maximal exercise, we used cycle ergometer ER2 (Erich Jaeger, Germany) with the automatic power dissipation regardless of pedaling rate. The cycle ergometer was used to estimate power of work performed, duration of work, recovery time and heart rate. Measured were the functions of external respiration (forced expiratory volume in 1 second – FEV1, forced vital capacity – FVC, forced expiratory flow at the level of 25%, 50%, 75% of VC – FEF 25, FEF 50, FEF 75, peak expiratory flow – PEF, maximum oxygen consumption – VO₂ max), with Ultrascreen (Erich Jaeger, Germany) applied.

To estimate the tolerance of the body to physical exercise, a graded exercise intensity was applied. It started with a 3-minute free pedaling without resistance (0 Wt) with the speed of 40 rpm, followed by graded growth of estimated efficiency by 10% every minute. The optimal cadence is 60 rpm. To study the quality of life, the Russian version of the MOS SF-36 survey (J.E.Ware,1992) was used. The abovementioned research methods were realized during the education and training process with the students of Moscow Region State University, Amur State University, and Blagoveschensk State Pedagogical University diagnosed with respiratory diseases, with the total of 250 students taking part in the educational experiment.

Main stages of the study. The research was arranged at three stages during 2001-2015. The first stage (2001-2003) – literature searching and theorizing stage – included analyzing the scientific and methodical sources on the problem, defining the research apparatus, and selecting the research methods, whose reliability and validity were checked. The second stage (2003–2008) was experimental and included specification and generalization of general hypotheses and theoretical concepts. Methods of forming physical activity of SHG students (case study of respiratory diseases) and techniques of their realization in higher education were elaborated and approbated. The third stage (2008-2015) was the summarizing one and included systematization, generalization and theoretical analysis of the results of the practical and experimental work, formulating the implications, and creating research-findings-based practical guidelines.

Results and discussion. The analysis of the previous methods of physical rehabilitation of students diagnosed with respiratory diseases showed that all of them were based on the load reduction during physical exercises. Together with the specialists of Far Eastern Scientific Center of Physiology and Pathology of Respiration of the Siberian Branch of the Russian Academy of Medical Sciences, we elaborated the approaches to arrange high-intensity physical exercises for students diagnosed with respiratory diseases. The main feature of the technology is the students’ physical activity with graded exercise intensity, which is of training and restoration effect. To get this effect we suggest applying submaximal intensity exercise.

The process of physical rehabilitation of the students diagnosed with respiratory diseases included three stages:

1. Preparatory stage was five weeks long and was geared to adequately adjust the body to the forthcoming training exercise. The exercise performance during this period (as well as during the others) depends largely on the combination of the in-class activities with some other forms and means of physical education: open air classes, walks, hikes, self-training, morning exercises etc.
2. Training stage included planning means of physical education and selecting teaching techniques aimed at physical development of the students, mastering movement techniques, health promotion, and raising exercise intensity. In this period students improved and trained their respiratory system, physical fitness, and strengthened their motor skills. Of particular importance was self-training, right regimen to cultivate the need for physical training and healthy lifestyle.
3. Supporting stage included stabilization of physical functions, physical work capacity and improving practical professional physical training on this basis. The main purpose of the third stage was to help students keep attained health level and high work capacity as long as possible (Table 1).

The intensity of physical exercise was assigned on the basis of the data of medical supervision and self-check, in the course of lesson observation and medical monitoring: stage, current, and operative ones. Type of physical exercises, their quality, tempo, rhythm and amplitude, as well as class intensity and duration, and other factors determined the level of physical exercise.

During the classes with SHG students diagnosed with respiratory diseases, conditioning exercises and special exercises were applied. Conditioning exercises improved the performance of all organs and systems of the body, and activated respiration. To stimulate the functions of the respiratory system we used high-intensity exercises which strengthen the breathing muscles, improve the thoracic and diaphragmatic mobility, facilitate stretching of pleural adhesions and expectoration, reduce lung congestion, improve the respiratory mechanism and the coordination of respiration and movements.

Table 1. Exercise norms during classes with SHG students diagnosed with respiratory diseases

The respiration exercises were intended to increase lung ventilation and oxygen consumption. While using the respiration exercises it was taken into account that: usually inhalation is performed with relaxed breathing muscles, under the gravity of the chest; slow exhalation happens with a dynamic inferior work of the muscles.

In both cases the air goes out of the lungs due to the elasticity of pulmonary tissue. While selecting the exercises, we focused on their simplicity and ease. The initial position was varied. The tempo, rhythm and amplitude of movements were set according to the stage of development and the pedagogical tasks of the lesson, with the preferred moderate tempo and rhythm, and gradually increasing amplitude.

The set of physical exercises was compiled with a view of strengthening the breathing muscles, developing the functionally weaker muscles and systems. During the lessons, each exercise was demonstrated and physiologically characterized.

The physiological curve of physical exercise according to the heart rate during the SHG classes was gradually stepped up and reached its maximum by the middle or the second third of the lesson time, and then gradually lowered. The heart rate did not exceed 105-170 bpm, i.e. it had a health-improving effect. To keep the gradual growth of the physiological curve, the lessons started from easier exercises involving minor and medium sized groups of muscles, and then gradually switched to the exercises for medium and largest muscle groups. The most difficult exercises were performed in the middle and at the end of the main part of lesson, when the body is warmed-up. A set included 20-30 exercises, alternating with walking and running. The play lessons included less physical exercises, while the open air classes had more of them.

The intensity of lessons increased with the growth of fitness: at the first stage it amounted to 40-50%, at the second – 55-70%, at the third – 70-80%. Depending on the stage, essence and methods applied in the lesson were changed.

The regulation of power, duration and rate of exercise was based on the results of the maximal work capacity tests on a cycle ergometer in compliance with the cardiorespiratory system performance and the general requirements for organizing training classes. Submaximal intensity is taken as a standard exercise because, on the one hand, it is characterized by minimal signs of respiration performance disturbance, and, on the other hand, it supports the aerobic-anaerobic regime with the domination of aerobic process, which is believed to contribute more to the maximal effect than what the purely aerobic training regime does. The recommended training exercise intensity on the submaximal level is physically safe, if it does not last long. Also, the suggested regime of the main part of the lesson promotes the stable performance of the autonomic systems of the body for 15-20 minutes. The optimal combination of the exercise intensity and the duration of the work in the elaborated and described mode were studied for all the periods of physical rehabilitation. For this purpose, operative monitoring of cardiorespiratory system performance was conducted using the functional methods of evaluating immediate training effects, i.e. changes in the body during the exercises and the immediate recovery period. Subjective evidence, visual control, pulse curve in class, spirometry data, stage cycle ergometric examination together enable us to estimate to what extent the current stage tasks of physical rehabilitation are completed.

The dynamic monitoring registered a positive growth in the amount of work completed on a cycle ergometer (from 129,1± 8,0 to 156,6±7,3 W) and the performance duration (from 9,1±0,5 to 10,9±0,4); the heart rate increased significantly during the maximal exercise (from 161,8±3,1 to 172,2±2,1 bpm) and the recovery period became shorter (from 9,2±0,6 to 5,5±0,4 min). The heart rate one minute after exercise decreased from 139,8±3,7 to 131,4±2,5 bpm. (Table 2)

Table 2. Changes in physical work capacity among special health group students during the experiment (respiratory diseases case study)

All the parameters showed a positive increase of bronchial permeability except PEF: VC – from 3,95±0,21 to 4,23±0,22 liters; FVC – from 6,95±0,42 to 7,55±0,45 liters; FEV₁ – from 3,37±0,13 to 3,61±0,17 liters; FEV₁/VC – from 80,35±2,23 to 83,06±2,07 %; FEF₂₅ – from 5,93±0,28 to 6,79±0,92 liters per second; FEF₅₀ – from 3.90±0,34 to 4,49±0,49 liters per second;  FEF₇₅ – from 2,06±0,21 to 2,27±0,27 liters per second. (Table 3).

Table 3. Changes in the ventilation parameters of the lung function in special health group students during the experiment (respiratory diseases case study)

The resulting changes in the level of quality of life of the study group students prove the positive growth in their physical and mental health (Table 4).

The low values of physical health in the students diagnosed with respiratory diseases in the beginning of the experiment represent to what extent their physical fitness limits exercise performance and physical activity, which impacts their health status. The low values of mental health indicate depressive and anxious feelings and mental ill-being. At the end of the experiment, the study group students show high values of the quality of life (89±7,4) (р<0,05). The students of this group are well-adapted to the university environment and have a high level of physical activity and vitality, and a low level of anxiety.

Table 4. Changes in the quality of life of students (study group)

Conclusions:

1. The results of the present paper prove that ordinary classes with SHG students diagnosed with respiratory diseases did not have any significant positive effect on their physical fitness, efficiency, or pulmonary ventilation, and, consequently, did not solve the tasks of physical activity.

2. For SHG students diagnosed with respiratory diseases, the usage of submaximal exercise during the classes in cooperation with the out-of-class activities produces most positive changes in their physical fitness, physical work capacity, pulmonary ventilation and raised quality of life.

3. The elaborated method of development of physical activity in students diagnosed with respiratory diseases, integrated into the university education, can be viewed as an effective health promotion technology.

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Corresponding author: Aleifa@mail.ru

Abstract. The article represents the overall results of a long-term research on the feasibility of the physical activity of students diagnosed with respiratory diseases. Methods of organisation of physi-cal activity of students diagnosed with respiratory diseases are based on the idea of applying physi-cal exercises of submaximal intensity. Basic approaches to organizing the physical activity of such university students have been set out and approbated. The presented research results show the rela-tion between the physical activity of students diagnosed with respiratory diseases and their health status and quality of life.