Dosed physical load – based rehabilitation of children with exogenous constitutional
Currently worldwide, there are also increasing numbers of children with
obesity. According to the International working group on obesity, presents the who, every tenth child of school age in the world has a weight problem. And worldwide the number of people with excess weight more than the hungry [1,6]. With the increase in obese patients is associated a significant increase in the prevalence of diabetes, cardiovascularand other diseases .
In the treatment of obesity there are two main steps: initiation loss of body weight and maintain the achieved effect. The cornerstone of treatment is to modify eating behavior and increase physical activity [4,5].
Unfortunately, so far in outpatient Pediatrics practically there is no universally accepted system for assessing the effectiveness of courses of rehabilitation therapy for children with obesity .
The aim of this work was to develop and test the methods formal assessment of the effectiveness of rehabilitation of children with obesity in the Department of rehabilitation (owl) the children’s clinic.
Materials and methods
Rehabilitation therapy in owl children’s clinic Yaroslavl got 22 children with a diagnosis of constitutional-exogenous obesity, attending the city’s summer camp. 5 children had grade I obesity (mean excess body weight 17,2%), 14 grade II (average excess body weight 31,3%) and in 3 persons was grade III (mean excess body weight – 82,0%). The children had complications of the basic disease. As comorbidity is most often diagnosed: chronic gastroduodenitis, incorrect posture, flat feet, urinary tract infection, myopia, diffuse endemic arteriotony the goiter of I degree, etc.
The basis of the rehabilitation program was based on the principle of regular physical exertion in the reduction of calorie intake in the body: children in the classroom in the swimming pool and gym.
Examination before the beginning of rehabilitation therapy was performed in a volume of quality standards (ECG, blood pressure monitoring, glucose levels in the blood, ultrasound of the thyroid gland). Along with the usual anthropometry for an objective assessment of lipid balance in the body of the child was used to determine the percentage mass fraction of fat in the body with the use of electronic scales “Tanita”, the measurement of the thickness of the fat fold in five areas: biceps, triceps, shoulder, waist, thigh with the use of spring-loaded caliper.
For all children with the participation of specialists (pediatrician, endocrinologist, physiotherapist, physiotherapist) was a rehabilitation programme tailored to the individual characteristics of each patient.
Child nutrition was based on a school camp (Breakfast, lunch, afternoon snack). Dinner the kids got home. From the diet were completely excluded high-calorie foods (pastries, cakes, muffins, pancakes) at full replacement of them (in money equivalent) vegetables, fruits and juices. Thus, the caloric value of food received by children with obesity, was 360 kcal lower than for children without obesity.
In addition to dietary restrictions, the rehabilitation program included physical therapy and training in the gym every day 2 times a day, hydro-Kinesis therapy (exercises in the pool 3 times a week), herbal tea, oxygen cocktails, aromatherapy. The dosing of physical load was carried out based on the severity of the disease and the initial level of physical health and functional capacity of the organism of the child. It should be noted that twice a day the children came from school to the clinic for treatments, we have additional 40-45 minutes.
The basis of the rehabilitation program was based on the principle of regular physical exertion in the reduction of calorie intake in the body. In addition, our task was to convince parents and children that a low-calorie diet and adequate physical activity ultimately lead not only to reduction of body weight, but also increase the child’s self-esteem, improving the quality of life. Rehabilitation was conducted within 24 calendar days.
To monitor the effectiveness of the rehabilitation process, we developed a map of formalised assessment of the health status of the patient, which consisted of several fragments of the ball and provided an assessment of clinical symptoms, complaints, blood pressure, level of physical and functional capacity of the organism (sample Rufe, the strength of the muscles of the back and abdomen) and self-esteem well-being of the patient (table 1).