PURPOSEFULNESS OF EARLY APPLICATION OF PHYSICAL REHABILITATION MEANS FOR IMPROVEMENT OF EXTERNAL RESPIRATION SYSTEM FUNCTIONAL STATE OF WOMEN WITH POST MASTECTOMIES

Purpose: to determine purposefulness of early application of physical rehabilitation means for improvement of external respiration system functional state of women with post mastectomies syndrome. Material: in the research 135 women with post mastectomies syndrome, who endured radical mastectomy by Madden, participated. Women of main groups were trained in compliance with appropriate programs during one year. Effectiveness of trainings was controlled after half of year. Admission to trainings was given by oncologist. Patients of these groups belonged to third clinical group. At the beginning of dispensary period the groups were equal by all indicators of external system function. Results: it was found that early rehabilitation is more effective exclusively for indicators of bronchial patency. Complex, personality oriented program included: aqua-fitness; conditional swimming; health related aerobic and Pilates. It was found that after half year training advantages of early physical rehabilitation were noticed only in indicators of forced exhale volume at first second. Conclusions: we stated importance of early rehabilitation trainings of women with post mastectomies syndrome.

Introduction 1  Modern tendency of breast cancer dynamic witnesses about rising importance of this malignant tumor's localization for women [7,8,16,20].Constant perfection of breast cancer treatment facilitates prolongation of women's life span.However, it does not exclude side effects of therapy [5,13,14,15,19].
Advanced researches prove purposefulness of early diagnosis and correction of complications from side of muscular skeletal apparatus, cardio-vascular and nervous systems for their removal in due time and improvement of women's life quality [11,12,17,18].However, prevailing orientation on medical component of rehabilitation, development of modern schemas of medical provisioning, implementation of reconstructive-plastic operations do not pay sufficient attention to physical rehabilitation of patients with post mastectomies syndrome (in particular to improvement of external respiration system's functioning).
The above said undoubtedly witnesses about importance of working out, conduct and determination of usefulness of timely rehabilitation measures.The purpose of the mentioned measures is improvement of external respiration system indicators in women with post mastectomies syndrome.

Purpose, tasks of the work, material and methods
The purpose of the research is to determine purposefulness of early application of physical rehabilitation means for improvement of external respiration system functional state of women with post mastectomies syndrome.
The researches were conducted on the base of Zaporozhye regional oncology dispenser.In the research 135 women with post mastectomies syndrome participated (50 patients were on inpatient and dispensary rehabilitation stages, 85 -only on dispensary).Average age of the tested was 60.27±0.79years.At inpatient stage women were divided into two groups: main group (n=25) and comparison group (n=25).At dispensary stage they were divided into first main group (n=45) and second main group (n=40).The groups were completed in compliance with wishes of the patients and their motivations for training by personality oriented physical rehabilitation program.Before dividing into groups all women were consulted about specificities of training in every group.
The first complex, personality oriented program [4] included: aqua-fitness (aqua-motion), aqua building, aqua stretching), conditional swimming; health related aerobic (first main group and main group); conditional swimming and pilates (group [3] -second main group and comparison group).
Women of main groups trained as per appropriate programs during one year.Effectiveness of trainings was controlled after every half of year.Admission to trainings was given by oncologist.Patients of these groups belonged to third clinical group.At the beginning of trainings all groups were equal by all indicators of external respiration system functioning.
Independent indicators of FVC (after one year's training) were normal in 80% of MG patients, in 88% -of MG1, in 78% -of MG2 and in 32% of CG, conventionally normal -in 20, 18, 22 and 44% of women accordingly.Detail analysis of PVQ showed that in 44% of MG women it was normal, in 52% -conventionally normal; in CG patients it was accordingly 20 and 16%.After half year's trainings advantages of early rehabilitation trainings (see table 1) were registered only by indicators of forced exhale volume in first second.This indicators was by 140 ml (р<0.05)higher in women of MG1, comparing with women of MG.At the same time, after one year trainings confident differences between these groups were observed by indicators of forced vital capacity of lungs, volume of forced exhale in first second, instant volume quickness at level of 50% FVC, reserve exhale volume, minute breathing volume in favor of MG.By indicators of reserve inhale volume and maximal lungs' ventilation confident differences were in favor of MG1.After 6 months' trainings of physical rehabilitation in MG2 patients the following indicators were confidently better (comparing with CG): forced vital capacity of lungs (by 0.16 l, р<0.01), minute breathing volume (by 1.81 l/min, р<0.01) and reserve volume of inhale (by 0.38 l, р<0.001).At the same time in CG the following indicators were better confidently: peak, instant and volume quickness at level of 25 and 50% of FVC.After one year only actual indicator of instant volume quickness at level of 50% of FVC was higher by 0.47 l/sec (р<0.05) in CG patients.At the same time in MG2 women relative indicator of forced vital capacity was higher (by 6.46%, р<0.05) than in CG.
Thus, the problem of determination of lasting results of the worked out personality-oriented physical rehabilitation programs for women with post mastectomies syndrome is rather important.

Conclusions
The worked out and tested personality-oriented physical rehabilitation programs for women with post mastectomies syndrome facilitate improvement of functional state of external respiration system.As per results of year control it was registered that early rehabilitation is most effective exclusively for improvement of bronchial patency indicators: in MG forced vital capacity of lungs improved as well as forced exhale per one second and instant volume quickness of reserve and minute breathing volume in comparison with MG1.Reserve volume of inhale and maximal lungs' ventilation were confidently better in MG1.In CG indicators of instant volume quickness at level of FVCL 50% was higher by 0.47 l/sec (р<0.05)comparing with MG2.
The prospects of further researches imply determination of purposefulness of early personality-oriented physical rehabilitation programs directed on improvement of cardio-vascular system of women with post mastectomies syndrome.

Table 1 .
Comparison of indicators of women with post mastectomies syndrome at dispensary stage of rehabilitation and CG.VCL -vital capacity of lungs; FVCL -forced vital capacity of lungs; FVE 1 -volume of forced exhale per 1 second; PVQ -peak volume quickness; IVQ 25 instant volume quickness at exhale with IVQ 25%; IVQ 50 instant volume quickness at exhale with IVQ 50%; MVL -maximal ventilation of lungs; MVB -minute volume of breathing; RV inh -reserve volume of inhale; RV exh -reserve volume of exhale.A -actual; B -% from proper value.