Physical exercise for pupils with deviations in health status
(special medical group)

It is important to identify children having deviations in health status that have not yet irreversible, but reduce physical performance, delay the development of the body. This contributes to early detection of pathological conditions, systematic monitoring of sick children and children at risk.

To assess the health of children and adolescents there are four criteria: the presence or absence of chronic diseases; the level of functioning of basic body systems; degree of resilience to the adverse effects; the level of physical development and the degree of its harmony.

Very large impact on children and adolescents social environment. This and health of the parents, and peculiarities of mother's pregnancy, childbirth, and early child development, home conditions, microclimate in the family, organization of physical education, recreation, sanitary-hygienic conditions at school, vocational school, preschools, etc.

Today in schools, gymnasiums and lyceums of the large percentage of children have deviations in health status. It is ORVI, quinsy, chronic tonsillitis, allergic diseases, disturbances of vision, functions of musculoskeletal, gastrointestinal diseases, neuritis, diseases of the cardiovascular system, etc.

The nature of pathology depends on the age of the children. In children 2-4 years of age is mainly revealed reversible changes of the functional nature.

Chronic diseases are formed at older ages (mostly high school years), but they often arise at the age of 4-7 years (diseases of the nasopharynx, disorders of posture, disorders of the skin, gastrointestinal tract, etc.). The first place belongs to diseases of the nasopharynx, followed by myopia, impaired posture, flat feet, diseases of the digestive system, respiratory, neuro-psychiatric disorders.

There are the following health groups: group I — healthy, not having a chronic disease, with an age-appropriate physical development. Rarely get sick; group II — healthy, with morphological and functional deviations without any chronic diseases, but having deviations in physical development; group III — patients with chronic diseases in stage of compensation; rarely suffer acute illnesses, feel good, have high performance; group IV — patients with chronic diseases in stage of subcompensation, sickly, with reduced working capacity; group V patients with chronic diseases in stage of decompensation. Usually with this kind of pathology children do not attend school, they are in special hospitals.

A comprehensive assessment of the health status yields a pediatrician preschools and schools. Children and adolescents that belong to different groups require a differentiated approach in physical education or physical therapy.

For the first group of health, educational, employment and sports activities will be organized without any restrictions in accordance with the programs.

Children of the second group of health need increased attention from doctors as a risk group. They need to carry out hardening, exercise, diet therapy, to adhere to the rational mode of the day.

Children of third, fourth and fifth groups of health should be under constant medical supervision. Their motor mode is limited, extended duration of rest and sleep for the night.

Modalities of physical activity with children

1. Conducting morning exercises or walking.

2. Conducting fitness breaks between classes, on break, etc.

3. Stay on air for at least 3.5 hours.

4. 5-6 meals a day, fortified with vitamins, twice a year (November-December, January-February) with a total UV irradiation in an accelerated method with an additional intake of ascorbic acid.

5. Tempering procedure (wiping, pouring, showers, baths, sauna, etc.).

Organization of physical education students with impaired health

The correct distribution of children on medical groups for physical exercise is an important part of a doctor-pediatrician and physical education teacher.

The distribution of students by health groups produces a pediatrician on the basis of "Regulations on medical control for physical education of the population of the USSR" Order No. 826 of 9.XI.1966". This allows the correct dosage of the physical load in accordance with the state of health of schoolchildren.

All students engaged in physical activity for government programs, based on data about their health, physical development and physical preparedness are divided into three groups: basic, preparatory, special.

For core group includes students without disabilities in the state of health, as well as having a slight deviation with sufficient physical development.

For preparatory group includes students without disabilities in the state of health, and also with minor deviations, at insufficient physical development.

For special medical group includes students with a deviation in the health status of permanent or temporary nature which require limitation of physical activity.

For students of preparatory and special medical groups provides for limitation of the amount of exercise. The limit load depends on the state of health of each student, his illness, and other indicators.

Physical education students of special medical groups is carried out according to specially developed program.

General recommendations for the physical education of schoolchildren

The main group. 1. The classes of physical education in full. 2. Surrender any standards. 3. A lesson in one of sports clubs, participation in competitions.

The preparatory group. 1. The classes of physical education, provided a more gradual its passage with a delivery delay of control tests (standards) and regulations for a period of up to one year. 2. Classes in the section for General physical training.

Special medical group. 1. Classes for a special program or separate state programs, the period of training lengthened, and regulations reduced. 2. Physical therapy exercises.

It should be noted that a transfer from one group to another is carried out during the annual medical examination of schoolchildren. The transition from special medical group in the preparatory is possible under condition of positive results of treatment and success in physical education, the hardening, that is, the presence of positive dynamics.

Organisation of regular physical exercise requires a number of practical activities. First, PE teachers need to have a complete understanding about the illness of the student, to know its functionality, physical development and preparedness in order to equip the group to choose the right exercises and correctly measure the load. Secondly, carry out with these children in regular classes and constantly instill in them a love of physical education and sport.Thirdly, to observe the reaction, shifts and changes that occur in the body of each student under the influence of physical exercise. Fourth, to teach children simple techniques of self-control and to prepare them for self-employment at home.

Of the disease and the timing of the resumption of the exercise

Special medical groups are formed from students for whom physical activity derived physical education classes, is contraindicated or requires a significant limitation (children who have certain additional severe abnormalities in the cardiovascular system: primary or secondary, on the basis of one or another chronic disease or residual phenomena after the transferred sharp diseases). This group includes students, patients with rheumatism in remission if after another attack took place 6-12 months at normal blood picture and good objective data;children after myocarditis in connection with the transferred acute infectious diseases; children with congenital and acquired heart diseases; children with high blood pressure.

In special medical group also includes students suffering from other diseases, which at this time must significantly limit physical stress (after suffering tuberculosis, with a significant lag in physical development and the absence of physical training; acute gastro-intestinal diseases with symptoms of exhaustion, after 5-6 months after gepatoholetsistitah and viral hepatitis).

For this group includes students for whom physical activity is not dangerous, but they can't do on the overall program because of defects of the musculoskeletal system, ankylosis, contractures, severe muscle atrophy, trauma, chronic infectious arthritis, accompanied by restriction of mobility of joints; those with residual effects of poliomyelitis and expressed deformation of the spine II—III degree.

For group with deviations in health status include students with chronic diseases (focal infection of the oral cavity, nasopharynx, paranasal sinuses, etc.). Especially prevalent in chronic tonsillitis (20-40% of students), dental caries is almost 90%. it is Known that chronic inflammation in the nasopharynx and oral cavity changes in the overall reactivity of the organism, reduce its protective function, natural resistance to infection.Children often get sick during the rise of acute respiratory viral infections (ORVI) and flu, they have frequent exacerbations of chronic tonsillitis, otitis, sinusitis.

The source of infection in the nasopharynx can cause bronchitis, pneumonia, transition them into the chronic form.

Chronic tonsillitis affects the health of students during training sessions, since intoxication leads to a decrease in the functionality of such body systems as cardiovascular and sympatho-adrenal, and blood, kidneys, liver, etc. Children with chronic foci of infection create a "contingent risk" in relation to the development of rheumatic fever, kidney damage, gastrointestinal tract and many chronic diseases.

In the formation of special medical groups should be guided by the table of sample readings to determine the medical group.

Exemplary indications for determining medical group
while some deviations in health status in children and adolescents

The disease, its forms and phases
Medical group
Physical therapy sessions
The main Preparatory Special
The defeat of the myocardium:        
a) convalescence after suffering revm. myocarditis In good condition 2 years after attack Not earlier than in a year, in the absence of clinical signs of the disease Not earlier than 8-10 months after the attack Assigned in the acute period and in the first months after acute attack
b) myocardiodystrophy In good condition 1 year after disease Not earlier than 6 months, in the absence of the wedge. signs disease Since the beginning of school attendance In the hospital, at home
Congenital heart diseases without cyanosis In the absence of hemodynamic disorders In the early stages
Postoperative period If successful, the exercise therapy class during the year Before and after surgery
Chronic pneumonia In remission more than 1 year In 1-2 months after treatment 1-2 months after the exacerbation Within 1-2 months after the disease
Bronchial asthma 2 years after the last attack with good condition No sooner than a year after the attack If seizures 1-2 times a year With frequent attacks
Operations on the lungs A year after the surgery during the normal course postoperative period 4-6 months after surgery in the normal course postoperative period In the early postoperative period
Pulmonary tuberculosis In the absence of respiratory insufficiency, intoxication When auspicious the disease When auspicious for in the respiratory insufficiency I extent Individually
Chronic gastritis, colitis In overall good condition In the absence of exacerbations in the past 6 months When mild severe intoxication and symptoms exhaustion
Peptic ulcer and 12 duodenal ulcer Not earlier than one year after the end of treatment Without exacerbation in the absence of bleeding, pain
Hemophilia, idiopathic thrombocytopenic purpura disease Can be assigned to ocenet easy form
Chronic pyelonephritis Outside the period of exacerbation and in the absence of changes in heart At compensated renal insufficiency
Endocrine diseases (diabetes, obesity) Appointed in the lungs and minor violations When moderately expressed violations, when there is insufficient body weight Severe violations from the first day
Underdevelopment When the growth rate and body weight are below the age standards When growth and body weight significantly below age standards In the early stages
Hernia inguinal, femoral, appendicitis Not earlier than six months after treatment Within six months after the resumption of classes Within six months after the operation In the early postoperative period
Bone fractures Not earlier than six months Six months after surgery Within six months after the operation From the first days after surgery (overlay plaster bandage)
Scoliosis and posture disorders When violations posture Scoliosis
Congenital and acquired deformations ODE In the absence of violations of motor functions When mild severe motor disorders, not earlier than after a year of classes in the special group Individually When significant violations of motor functions
Paralysis, paresis, cerebral palsy, polio Solved individually in connection with the clinic and the nature of the changes muscle system Recommended from first days
Chronic breathing ailments In the absence of significant violations of nasal breathing At moderate violations of nasal breathing With frequent exacerbations of chronic diseases In the hospital
Chronic otitis media with perforation of the tympanic membrane Counter-indicative swimming, diving In the absence of dysfunction of the hearing Purulent processes After surgery
Myopia At least +3 or -3 without vision correction At least +3 or -3 with vision correction +7 or more

Teaching load, especially physical activity, cause significantly larger changes in the health of pupils with deviations in health status than healthy children. For example, children, patients with rheumatism, and 2 times more likely to miss classes because of sickness, headaches, pain in the heart in acute rheumatic fever. Therefore, children with chronic diseases in secondary school it is necessary to introduce elements of Wellness regimen: reduction in teaching load, physical therapy in a special program.For this group of pupils require a mandatory daily morning exercises, walking before and after school, the tempering procedure. Between lessons should be 2-5 min fitness breaks, walking in the fresh air during the lunch break and walking if the child is in group of the prolonged day, — the organization of outdoor games.

As a therapeutic factor 5-6 meals a day for students and dismissal from extracurricular activities. Students in this category are exempt from examinations, according to the Ministry of health and education of the Russian Federation No. 120/813 from 3.08.1981 year.

Acquisition of special medical groups is carried out as a pediatrician. The basis for inclusion in special medical group is a particular disease, usually chronic, physical fitness level, chronic infections and other criteria. Special medical group are completed according to the nature of the disease:

diseases of cardiovascular system;

diseases of the respiratory system;

diseases of the digestive, endocrine and metabolic disorders;

diseases and injuries of the spine and musculoskeletal system;

diseases of the organs of sight and hearing;

diseases of the urinary system;

diseases of Central nervous system and peripheral nervous system (cerebral palsy, polio, etc.).

Some schools organize joint classes, pupils with deviations in health status, with students the main and preparatory groups. These lessons are ineffective, because unhealthy children are sedentary, do not hesitate to perform a number of exercises, too shy, etc.

There are schools where such children attend physical education lessons. This is unacceptable. Classes with special medical group should be conducted separately, in order to spare the psyche of children and to avoid undue stress.

Special medical groups for physical education classes completed, taking into account age and health status, regardless of the disease.

In single-shift schools, classes in special medical groups are scheduled after school and in two working shifts — between shifts. Group size to 15 people. Classes are held two times (but physiologically justified daily sessions of 35-45 minutes, or 3-5 times a week).

In the determination of students in special medical group pediatrician informs the physical education teacher about the faults in the physical development and health of the student, and recommends what types of exercise and at what does it will be useful and necessary. In this approach, the number of children in special medical group in each school will be negligible.

Full exemption of students from physical education classes may wear only temporary. Released can the children not attending school due to a significant pathological deviations in health, home educated.

Temporary release from employment, restrictions, or limitations are necessary after the transfer of acute and exacerbation of chronic diseases.

The timing of the resumption of exercise in these cases are determined strictly individually, taking into account the health status and functional state of body systems student. In the practice of medical control in determining the timing of the resumption of exercise after acute and infectious diseases are the indicative scheme (table. The approximate timing of the resumption of exercise).

The approximate timing of the resumption of exercise after illness

Disease Have passed since the beginning of attending school after an illness Note
Angina 2—4 weeks In the subsequent period to avoid cooling (swimming, skiing, etc.)
Bronchitis, ORVI 1—3 —»—  
Acute otitis 2—4 —»—  
Pneumonia 1—2 months  
Pleurisy 1—2 —»—  
Grippe 2—4 weeks  
Acute infectious diseases 1—2 months With the satisfactory results of functional tests of the heart
Acute pyelonephritis 2 —»— To avoid hypothermia (swimming etc.)
Hepatitis viral 8—12 —»—  
Appendicitis (after operation) 1—2 —»—  
Fracture 1—3 —»—  
Concussion 2 months or more  

V.I. Dubrovsky,
Academician of the Russian Academy of Natural Sciences,
IANPO and the New York Academy of Sciences,
Doctor of Medical Sciences, Professor,
A.V. Dubrovskaya, pediatrician

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