КОМПЛЕКСНА ПРОГРАМА ФІЗИЧНОЇ ТЕРАПІЇ В АМБУЛАТОРНІЙ РЕАБІЛІТАЦІЇ ПАЦІЄНТІВ ПОХИЛОГО ВІКУ З ХРОНІЧНОЮ СЕРЦЕВОЮ НЕДОСТАТНІСТЮ

Introduction. To improve the effectiveness of rehabilitation in elderly patients with chronic heart failure (CHF) of functional class (FC) II by developing and clinically validating a comprehensive physical therapy program in an outpatient setting. Materials and Methods. The study included 42 patients (25 men and 17 women) aged 61-73 years with CHF stage IIA and FC II (NYHA). Patients were randomized into a main group (MG, n=21) that received a comprehensive physical therapy program (controlled treadmill aerobic training, resistance exercises, inspiratory muscle training, general strengthening and coordination exercises) and a control group (CG, n=21) that received a standard program (prescribed walking, breathing exercises, general gymnastics). The course lasted 8 weeks. Effectiveness was assessed using the 6-minute walk test (6MWT), heart rate and blood pressure monitoring, pulse oximetry, handgrip dynamometry, and the Borg scale. Results. After the 8-week physical therapy course, patients in the main group (MG) demonstrated a marked regression of the main clinical symptoms: the frequency of dyspnea, rapid fatigability, and lower limb edema decreased by an average of 50–70%, which significantly exceeded the corresponding changes in the control group (CG). The increase in the 6-minute walk test (6MWT) distance in the MG averaged 54,8 m (p < 0,001) compared with 22,8 m in the CG (p < 0,01). Resting heart rate in the MG decreased by an average of 8,3 bpm (p < 0,001), indicating improved cardiac efficiency. Blood oxygen saturation (SpO₂) increased by an average of 1,5% (p < 0,01). Subjective perception of dyspnea on the modified Borg scale (0–10) decreased by an average of 1,7 points (p < 0,001), corresponding to a transition from “somewhat strong” to “moderate” dyspnea. Handgrip strength increased in the MG by 17,2% in men and 17,6% in women (p < 0,001), whereas the increase in the CG was only 5,1% and 6,0%, respectively. Intergroup differences between the MG and CG at the end of the study were statistically significant for all primary parameters (p < 0,05–0,001), indicating the higher effectiveness of the developed comprehensive physical therapy program. The 8-week physical therapy program for MG patients with CHF of functional class II proved to be safe: all patients completed the course without the need for premature termination of sessions. Conclusions. The comprehensive physical therapy program developed for patients with CHF of functional class II (NYHA) is safe and significantly more effective than standard approaches. It improves exercise tolerance, muscle strength, and hemodynamic parameters in elderly patients with CHF FC II and can be recommended for implementation in outpatient practice.