VRAChEBNYY CONTROL in physical culture and sport

From Big Medical Encyclopedia

MEDICAL CONTROL in physical culture and sport — the system of medical observation in the USSR of the persons playing physical culture and sport directed to effective use of means and methods physical. education, on strengthening of health, improvement physical. development and physical. readiness of the population. Century to. is one of sections sports medicine (see). Founder of the ideas of scientific justification physical. education P. F is. Lesgaft; his pupil V. V. Gorinevsky possesses a merit of development of bases of V. to. as systems of medical service of athletes and athletes.

To increase in a role of V. to. resolutions of party and the government on development of physical culture and sport, in particular the resolution SNK RSFSR of 1928, the resolution of the Central Election Commission of the USSR of 1930 and the Central Committee of the All-Union Communist Party (bolsheviks) of 1932, the resolution of the All-Union Communist Party (bolsheviks) of the Central Committee of 1948, resolutions of the Central Committee of the CPSU and Council of ministers of the USSR of 1966 about measures for further development of physical culture and of 1972 about introduction of the new All-Union sports complex «It Is Ready to Work and Defense of the USSR» (GTO) promoted. Creation in 1950 of network specialized to lay down. - professional, institutions — medical and sports clinics (see the Clinic, medical and sports) — promoted the organization B. to. and development of its methods. Century to. as the system of medical providing playing physical culture and sports is carried out by medical and sports clinics (republican, regional, city, regional), and also offices of medical control in policlinics, higher education institutions, volunteer sports societies, nurseries and junior sports schools. A relevant provision about V. to. participation of doctors of the general is provided to lay down. - professional, networks in monitoring procedure for the persons playing physical culture and sports. The general management of medical and sports service is performed to lay down. - professional, management of the Ministry of Health of the USSR. In Committee on physical culture and sport at Council of ministers of the USSR there is a special medicobiological department organizing together with bodies of health care of V. to. over groups of the leading athletes of the country.

Century to. in physical training and sport consists of a number of sections: 1) medical surveys of the persons playing physical culture and sports; 2) medical and pedagogical observations directly in the course of the occupations; 3) medical sportivioy consultations; 4) dignity. - a gigabyte. supervision of places of occupations and competitions; 5) dignity. - a gleam, works; 6) medical and sanitary providing sports competitions and mass sports and recreational actions.

At medical survey methods of clinical inspection and functional diagnosis, and also the special, developed in sports medicine receptions are used. Frequency, volume and content of medical inspection are defined by the contingent of engaged — their age, sex, character of occupations, sports qualification according to what survey is carried out by a short or profound technique.

To inspection by a short technique (in a form 227) for the solution of questions of the admission to occupations, checks of their impact on the state of health and physical development are exposed persons of the following categories: engaged according to the obligatory program physical. education in educational institutions; preparing for hitting qualifying standards of GTO; physical which are engaged in groups of the general. preparation, in sports staff of the industrial enterprises, institutions, collective farms, state farms, etc. By a short technique of medical inspection physical examination, the main anthropometrical measurements (determination of weight, growth, an animal force, etc.), clinical analyses of urine and blood is conducted. If necessary the therapist conducting examination involves specialists doctors of other profile. These examinations by doctors of district clinics, first-aid posts of stadiums, pools and other sports constructions, doctors of health centers of the industrial enterprises, and also doctors of average and higher educational institutions are conducted. This work is carried out under the general organizational and methodical management of medical and sports clinics. Inspection of pupils of high schools, technical training college, technical schools and higher education institutions is dated for the beginning of academic year. Proceeding from the state of health, physical. development and physical. readiness, pupils are distributed on three medical groups for exercises (the main, preparatory and special).

Enlist the persons which do not have deviations in the state of health or having minor changes at sufficient physical in the basic medical group. readiness. Classes in training programs in full, delivery of control standards of GTO, sports, participation in competitions are shown them.

In preparatory medical group carry the persons having insignificant deviations in the state of health, but which insufficiently are physically prepared in this connection restriction and gradualness of increase of loadings, an exception (sometimes temporary) competitions is required a nek-swarm. Enlist persons with diseases in special medical group, at to-rykh group occupations can be carried out only according to special programs; according to indications — occupations of LFK in policlinic or in a medical and sports clinic. At the same time consider the nature of a disease, level physical. readiness, etc. Medical inspection of the contingents of middle and advanced age, in particular before transfer in groups of the general physical. preparation, by preparation for delivery of standards of the V step of the GTO complex «Cheerfulness and health», in addition include an electrocardiographic research. Besides, for definition of extent of age changes of cardiovascular system or identification of signs it is hidden the proceeding pathology apply the modified step-test — rise and descent on a two-level ladder with the general height of 40 cm (height of a step of 20 cm). Duration of test is 2 — 3 min. (depending on physical. readiness of inspected) at constant speed — 20 transitions in 1 min.; it is possible to use also other options of ladder test. Before test count pulse, measure arterial pressure, register the electrocardiogram.

At the solution of a question of the admission to occupations physical culture and hitting qualifying standards of GTO the doctor considers also data on negotiability for the medical help on the basis of represented inspected extracts from the out-patient card of policlinic.

Examination by a profound technique is conducted in the course of dispensary observation for highly skilled athletes (in a form 227a). Medical examination is based on the principles of a complex research of the main fiziol, systems of an organism, functional orientation of methods of a research, the differentiated approach depending on sports specialization of inspected; individual assessment of results of inspection, dynamic nature of medical observations. Highly skilled athletes are exposed to profound medical inspection.

Medical examination of athletes by a profound technique is conducted by medical and sports clinics and doctors of volunteer sports societies. The research is conducted by the therapist — V. specialist to., in necessary cases involve the neuropathologist, the oculist, the surgeon, the stomatologist, the gynecologist, etc. Collect the detailed general and sports anamnesis, conduct physical examination, clinical analyses of urine and blood, use necessary tool methods (including surely radiological and electrocardiographic inspections), carry out special functional trials.

Special significance is attached to V. to. over athletes of high categories, participants of city, republican, all-Union and international competitions, including Olympic Games.

The program of profound medical inspection includes the inspections at the main stages of a year training cycle dated for the preparatory and competitive periods of a training (2 — 3 times a year), and additional inspections according to indications. The main objectives of profound medical inspection are: a) assessment of efficiency of the applied modes and a technique of a training; check of impact of a systematic training on the state of health, physical development and sports working capacity; b) definition of readiness for the forthcoming competitions (assessment of «sportswear») for the purpose of recommendations about selection in structure of national teams; c) purpose of effective methods and means of recovery and maintenance of high performance (vitamin, fortifying means, etc.), prevention of a condition of an overtraining (decrease in volume and intensity of loading, its character, in case of need purpose of medical actions).

Definition of impact of a systematic training on physical. development is established by external examination and anthropometrical measurements of growth, weight, a circle of a thorax, vital capacity of lungs, stanovy force, force of a brush, diameters and perimeters of various parts of a body, etc. Assessment physical. development it is carried out on five-point system (low, below an average, an average, above an average, high) on the basis of local standards physical. development or special tables of correlation (see. Physical development ).

At inspection of teenagers define also degree of puberty; at the same time consider development of secondary sexual characteristics (by a technique Aron and Stavitskoy) — degree of pilosis of a pubis, axillary hollows, development of mammary glands, time of emergence of periods, etc. Proportions of a body for the characteristic like a constitution are defined (one of criteria of sports selection, see below the section of Vrachebnosportivnaya consultation). Research physical. development allows to estimate correctly individual data of the athlete, to track dynamics physical. development in the course of regular trainings by sport, influence of this or that sport on physical improvement.

A profound technique of V. to. gives the chance to reveal the nek-ry morphological and functional changes of an organism arising in the course of the regular trainings and also the disturbances connected with an overtraining and an overstrain. Indicators of a research of cardiovascular system are for this purpose very important. So, typical result of repeated trainings with big loadings, especially in the sports developing endurance is physiological increase in heart at athletes at the expense of tonogenny dilatation of his cavities and a hypertrophy of a myocardium.

Moderate expansion of cardial cavities physiologically comes down to increase in residual (reserve) intra ventricular volume of blood during rest thanks to what at hard muscular work cordial emission can significantly increase.

Changes of the main functions of heart (automatism, excitability and conductivity), to-rye can arise in connection with a systematic training, receive reflection on the electrocardiogram. At the trained athletes at rest the expressed sinus bradycardia (40 — 60 reductions in 1 min.) with a moderate sinus arrhythmia and signs of a hypertrophy of a myocardium often is observed (see. Bradycardia , Heart , heart and sport).

Expression of the fitness of an economical form of action of the heart developing with growth at rest is, in addition to an urezheniye of a rhythm, also reduction of initial velocity of increase of chamber pressure, shock and minute volumes of blood.

In case of existence of the centers hron, infections, and also at considerable perenapryazheniyakh in connection with excessive loadings can develop changes on the ECGs reflecting changes of metabolism of a myocardium: disturbance of intra ventricular conductivity, lengthening of atrioventricular conductivity, electrical systole of heart; disturbances of a rhythm, two-staging or inversion of teeth T, shift of a segment of RS — T from top to bottom from the isoline, increase in a corner of QRS — T over 60 ° and more.

For assessment of operability of heart in necessary cases use methods polycardiography (see), determination of shock and minute volumes of blood — gas-analytical, cultivations of dye (Stewart's method — Hamiltona), etc. At hard muscular work the minute volume of blood at athletes reaches 30 l/min and more. At a number of athletes the so-called syndrome of an adjustable hypodynamia of a myocardium is observed (V. L. Kariman, 1959). In these cases the structure of a cycle of cordial reduction changes. So, on the polycardiogram to increase in duration of a cardial cycle, phase of asynchronous and isometric reductions there is a reduction of relative duration of a sphygmic interval and duration of a mechanical systole. These changes cause increase of potentialitys of the trained heart. The strengthened muscular work causes transition of a condition of an adjustable hypodynamia of a myocardium to a condition of a giperdinamiya. At the same time the postsphygmic period and exiles is shortened, the intra systolic indicator increases, i.e. the most part of energy of cordial reduction is spent for exile of blood. These changes cause increase of potentialitys of the trained heart.

For check of system arterial pressure (maximum, minimum and average), rates of propagation of pulse wave, degree of compliance of peripheric resistance to the minute volume of blood and other indicators of a hemodynamics use methods sfigmografiya (see) and takhoostsillografiya (see. Oscillography ). Use of venous occlusal pletizmografiya (see) gives the chance of quantitative definition of a condition of a muscular blood-groove and its changes in connection with increase of fitness. The tendency to nek-rum to a lowering of arterial pressure in a condition of muscular rest decides on growth of fitness.

At a research of respiratory system W use clinical and tool methods of a research. h determination of respiratory volumes (frequency, depth and respiratory rhythm, minute volume of breath, vital capacity of lungs, maximal voluntary lung ventilation, force of respiratory muscles, etc.). Assessment of respiratory volumes and their changes under the influence of physical. loadings and in the course of increase in fitness it is carried out by comparison of the actual sizes with «due» on special formulas and tables (A. G. Dembo, etc., 1939). With growth of fitness in a condition of muscular rest more economical type of breath is observed: its frequency urezhatsya, and depth increases. The largest sizes of vital capacity of lungs (to 6 — 7 l) and the maximal voluntary ventilation of lungs (to 100 — 200 l) are defined at the athletes doing sports developing endurance — at oarsmen, swimmers, skiers, etc.

Researches of a nervous system include definition of function of cherepnomozgovy nerves, the motive and sensitive sphere, studying vegetative reflexes (see). Orthostatic, klinoortostatichesky tests are used (see. Orthostatic tests), are investigated oculocardiac reflex (see) and dermographism (see). Special tests for definition of stage of latency of motor reaction, coordination of movements, etc. are carried out. According to indications (effects of craniocereberal injuries, repeated knockouts, the residual phenomena of neuroinfection, etc.) apply electroencephalography (see), electromyography (see) and other special methods. On the basis of data of inspection the psychological status of the athlete is defined; possible deviations are fixed.

For data acquisition about a functional state cardiovascular and other main fiziol, systems of an organism of the athlete, identification of precursory symptoms of disturbance of sports working capacity in the course of profound medical inspection apply functional trials with dosed physical. loadings. So-called dynamic functional trials allow to watch fitness of the athlete and adaptation of an organism to the raised loadings.

Tests with a dynamic muscular exercise, in particular the combined three-moment functional trial on the speed and endurance have the most wide spread occurance (20 squats during 30 sec., 15-second bystry running on the spot and 3-minute running on the spot on average speed — 180 steps in 1 min. with use of a metronome). In the course of the research after each loading within 3 — 4 min. pulse rate and level of arterial pressure is registered. Assessment of results of test is carried out on change of these indicators in absolute values and as a percentage to basic data thanks to what the nature of reaction to loading and time of recovery of the studied functions after it is defined. At the same time five types of reactions are established. I. The normotonic reaction which is characterized by moderate increase of pulse (60 — 100% of initial) and increase in arterial pressure (maximum shall not increase more than for 20 — 40%, and minimum to decrease more than by 10 — 35%), and also short (1 — 3 min.) the period of recovery (return to basic data). Usually this reaction is defined at athletes in a condition of good fitness. II. Asthenic (hypotonic), with considerable increase of pulse (120 — 150% of initial) at slight increase of maximal pressure and lengthening of the period of recovery. It is observed at not enough trained athletes or in a condition of exhaustion. III. Hypertensive, with considerable increase of maximal pressure (to 200 — 220 mm of mercury.) and considerable increase of pulse, and also nek-eye increase in minimal pressure. It is found more often in persons with hypertensia or initial stages of an idiopathic hypertensia. IV. With «step» rise in the maximal arterial pressure when directly after loading level is lower than it, than on the 2nd, and sometimes even in the 3rd minute of the period of recovery. It is observed at bad adaptability of an organism to physical. to loading, in particular at overfatigue, including after the previous considerable physical. loadings. V. Dystonic, at a cut minimal pressure is not defined because of sounding of «infinite tone» (see. Blood pressure ), and maximal pressure increases considerably (sometimes over 200 mm of mercury.). If «infinite tone» keeps after a usual functional trial no more than 1 — 2 min., it can be considered physiological. Longer preservation of «infinite tone» demands medical inspection for identification of the reasons of its emergence. The expressed increase of pulse is observed, the period of recovery is slowed down. Dystonic reaction is caused by increase in true pulse amplitude, a motive energy of blood at a systole and change of elastic properties of vessels that is confirmed by increase in rate of volume flow of cordial emission, rate of propagation of pulse wave and other indicators of a vascular tone. Dystonic reaction most often is defined at young people (15 — 24 years) and is not regarded as pathological reaction. However it can arise also in a condition of exhaustion after the previous considerable physical. tension or as one of symptoms of vascular and vegetative dystonia (along with other displays of this disease).

Normotonic reaction is optimum type of adaptation of the device of blood circulation to loadings of a functional trial.

For the purpose of definition of physical effeciency of rated sportsmen the functional trial — the PWC170 test is used (test is recommended to WHO); PWC — the first letters of the words Physical Working Capacity — physical effeciency. Use of the test is based on the provision that heart rate 170 ud. in 1 min. corresponds to optimal conditions of functioning of cardiovascular system in the conditions of big sports loadings and that linear relation between the heart rate and power of work remains in frequency limits to 160 ud. in 1 min. Test is that the athlete carries out on the stationary bicycle two loadings, each of to-rykh duration of 5 min., with rest between them 3 min., the frequency of rotation of pedals 60 — 80 in 1 min. Having determined pulse rate during the last 30 sec. of first (f1) and second (f2) of loadings by the formula developed by V. L. Karpman with sotr., calculate physical effeciency for this athlete:

PWC 170 = N 1 + (N 2 - N 1 ) (170-f 1 ) / (f 2 - f 1 ),

where N1 and N2 — the power of work (in watts), f1 and f2 — pulse rate respectively at the end of the first and second loadings. The size PWC170 depends on age, sex, physical fitness, sport, the Crimea is engaged inspected. Determine an estimated value of the maximum oxygen consumption by a special formula.

Physical readiness of athletes of high categories, participants of responsible competitions (including the Olympic Games, etc.), especially in the sports developing endurance is checked by means of different models of loadings (on the stationary bicycle, the tretbena) with in steps increasing power of work «to the full». Duration of loading at each step from 3 to 6 min., an increase of power each 1 — 2 min. — 200 — 250 whom. Testing stops at emergence of the expressed external signs of exhaustion, impossibility to maintain the set rate of rotation of pedals, the increase of pulse exceeding 200 — 210 ud. in 1 min. at a simultaneous lowering of arterial pressure, stabilization or decrease in an oxygen utilization quotient, increase in a respiratory coefficient. Besides, for definition of a functional condition of an organism of athletes it is possible to use the Harvard step test, to-ry consists in rises on a bench (height of 50,8 cm — for adults, 40 — 45 cm — for teenagers and young men) within 5 min. On duration of the executed loading and by quantity of ictuses calculate an index of results of test on a special formula. Average working capacity is estimated at the size of an index equal 50 — 80, high — more than 80, low — less than 50.

During execution of functional trials and in the recovery period determine indicators of gas exchange (oxygen consumption, release of carbonic acid) by Haldane's device or others gas analyzers (cm.). According to indications use also other methods of a research. Use of a spiroergometriya allows to define important indicators of a condition of fitness: a limit of possible increase in oxygen consumption at the increasing power of muscular work that characterizes the aerobic productivity of an organism, i.e. ability to the maximum oxygen consumption by an organism at hard muscular work (at outstanding athletes the maximum oxygen consumption reaches 80 — 85 ml/min. and more on 1 kg of body weight), profitability of work on oxygen consumption on unit of the performed work. With age the maximum oxygen consumption decreases, at women it is 20 — 25% lower, than at men.

In special inspections of nek-ry groups of athletes for determination of anaerobic productivity of an organism, i.e. ability to perform work in the conditions of deficit of oxygen (a motive anoxemia) when biochemical transformations take place with dominance of glycoclastic processes, in vitro use model of veloergometrichesky loading in the form of repeated «arrivals» with intensity of 90% of the maximum speed of rotation of pedals determined at inspected during 20 sec. before experience; duration of each repetition — 30 sec. with an interval for rest 10 sec. Loading repeats several times before preservation of the set rate of rotation of pedals. In the course of work and 10-second intervals for rest, and also within 30 min. recovery after all loading range of speeds of pedals, oxygen absorption, release of carbonic acid, a rhythm of cordial reductions is registered (according to an ECG). The general request of oxygen, oxygen debt as a percentage to the general request is calculated.

Aerobic productivity and resistance to deficit of oxygen are determined by the size of an oxygen debt and increase in contents milk to - you in blood. To loading on the stationary bicycle, right after it and in the 30th minute of the recovery period investigate biochemical indicators: a) stability carbohydrate energeti ches whom exchange (milk and Pyroracemic acids, inorganic phosphorus, «true» glucose, the general activity of a lactate dehydrogenase in blood and creatinine in urine); b) reactivity of blood: quantity of leukocytes (phase of a leukocytosis), hemoglobin content and quantity of erythrocytes (calculation of a color indicator, average gemoglobinization of erythrocytes, calculation of content of the general hemoglobin for formulas).

At V. to. behind nek-ry groups of athletes — weight-lifters, gymnasts, throwers, participants of competitions in figure skating, a car - and motorcycle racers, etc. — for researches of a functional condition of the neuromuscular device exerting considerable impact on special working capacity in high-speed and power and difficult and technical sports use different options of an electromyography.

On the basis of profound medical inspection the general conclusion is drawn, it is provided in Krom: assessment of the state of health, physical. development, functional state; the recommendation of the training mode (according to the general plan or individual); are in case of need recommended to lay down. - professional, actions and recovery therapy; purpose of additional functional and diagnostic inspections and terms of repeated medical surveys.

Contraindications to sports activities

in the presence of deviations in the state of health necessary restrictions in sports activities are set. A number of diseases is a contraindication to sports activities.

As for exercises and to lay down. gymnastics, the issue is resolved in each case individually taking into account character and the clinical course of a disease, physical. readiness of the inspected, its age, sex, etc. (see. «It is ready to work and defense», Physiotherapy exercises ).

The persons suffering from the effects of injuries of a head and spinal cord which are followed by frustration in motive and sensitive spheres are not allowed to sports activities; organic diseases of c. N of page; mental diseases, persistent diseases of a vestibular mechanism; diseases of peripheral nerves in the presence of disorders of the movements or a resistant pain syndrome.

As a contraindication to sports activities serves tuberculosis in an active form; at a healed tuberculosis and nonspecific diseases of lungs of an absolute contraindication existence respiratory or a pulmonary heart is.

Sports activities are excluded at the acquired and inborn defects of valves of heart. Contraindication is the idiopathic hypertensia of II and III stages; in IA (tranzitorny) stage in the absence of tendency to hypertensive crises under medical observation it is possible to resolve trainings (the boxing, weightlifting, fight, fencing, acrobatics, soccer, hockey, scuba diving, slalom, ski jumping, technical sports are excluded). Sports activities are contraindicated also at symptomatic forms of arterial hypertension. Neurocirculatory dystonia on hypertensive type and a so-called juvenile hypertension do not serve as a contraindication to trainings, but at the same time especially strict medical observation is required. In the presence of a cardiosclerosis of various etiology or a myocardial dystrophy atherosclerotic and infectious and allergic an origin a .snyatiya are prohibited by sport. Obliterating diseases of arterial vessels cause the necessity to stop sports activities in connection with the functional disturbances caused by deterioration in blood supply of extremities. Hron. diseases of kidneys and urinary tract, and also hron. diseases of the digestive system are a contraindication to sports activities. In a phase of permanent long remission trainings under careful medical observation are possible (excepting the vaults, bicycle sport, aquatics, equestrian sport, cross-country skiing and other sports connected with possible overcooling and severe concussion). Diseases of joints exchange, allergic, infectious and endocrine an origin are incompatible with systematic entertaining sport. The same treats diseases of a backbone with restriction of function and a pain syndrome. In the presence of osteochondrosis the issue of the admission to sports activities is resolved individually. Endocrine diseases (a diabetes mellitus, gout with tendency to attacks, disturbance of a lipometabolism of the II—III degree, a thyrotoxicosis) interfere with sports activities. At obesity of the I degree and a struma of the I degree without the phenomena of a thyrotoxicosis it is possible to resolve trainings.

As a contraindication to sports activities serve also diseases of system of blood, hron, diseases of ENT organs and upper respiratory tracts in the presence of frequent aggravations and at functional disturbances. At an otosclerosis and various forms of the progressing relative deafness occupations are inexpedient conducted - and motorcycle sport, firing, game sports. The persons suffering from a surdomutism are engaged according to special programs in the groups organized for them.

The women suffering hron, inflammatory diseases of generative organs with frequent aggravations cannot play sports. In the period of long remission resuming of trainings is possible. Omission of female generative organs of II and III degrees with the phenomena of a dysuria interferes with sports activities, at the I degree of occupation are resolved, but jumps and gymnastics are excluded.

The anomalies of development of a musculoskeletal system in children and teenagers which are followed by lag physical. development, disturbance of a bearing, the deformation of feet causing functional frustration serves as a contraindication to sports activities. In these cases the physiotherapy exercises are recommended.

At small degree of short-sightedness of sports it is possible to resolve without correction; at average degree (from — 3,0 to — 5,0 dptr) or far-sightednesses (from +3,0 to +5,0 dptr) during the trainings and competitions glasses wearing is allowed. More expressed degree of short-sightedness if it progresses or korrigirutsya badly by points or is followed by changes of an optic disk, is a contraindication to occupations the majority of sports.

At skin infectious and parasitic diseases group occupations are prohibited before full treatment.

If the diseases which are not distinguished at the admission to occupations are found in systematically training athletes, there are temporary contraindications to occupations both sport, and physical culture.

At acute infectious diseases and injuries there are temporary contraindications to occupations physical. culture and sport. After recovery the admission to occupations is possible only on permission of the doctor. Terms of resuming of occupations are established individually depending on character and weight of the postponed disease or an injury, the existence of complications, a functional state inspected.

Terms of the admission to competitions, and also to delivery of standards (educational, GTO) are defined, in addition to the listed factors, also duration rummaged in regular trainings.

In the presence of contraindications to sports activities or restrictions to them it is necessary to consider: a) features of a clinical course of a disease in each case; b) character of the given classes (according to obligatory programs, the general physical. preparation, sports trainings and competitions), and also specific sports specialization; c) physical. readiness, fitness: d) sex, age, profession of inspected.

The overtraining and various manifestations of an overstrain demand recovery treatment with the subsequent gradual inclusion in training process according to the individual plan under observation of the doctor. *

Control over the implementation of medical recommendations is exercised by the trainer (teacher) and the doctor during additional and repeated inspections, and also in the course of medical and pedagogical observations.

The listed above contraindications are only the main, but in practice of V. to. also other deviations which are subject to the account for the decision on the admission to exercises and sport can be revealed.

The important section B. to. are medical and pedagogical observations, carried out directly in the course of the training occupations and competitions. These observations in the greatest measure help to study adaptation of an organism of the athlete to specific conditions of trainings, to define fitness, and also to study the level of requirements imposed on an organism by the appropriate program of occupations physical culture and sport. During medical and pedagogical observations direct acquaintance with contents, the organization and a technique of training is carried out. The timing allows to determine density of occupations, i.e. time which is actually spent directly for performance of exercises. Duration of each of exercises and duration of pauses between them is fixed; data of timing are entered in the protocol. For the characteristic of intensity physical. loadings «the physiological curve» on pulse is investigated (its frequency is defined just before the beginning and immediately after the main stages or series of the main exercises throughout all occupation).

Medical and pedagogical observations are made by means of a complex technique, the program a cut is defined by an objective, character of occupations and the contingent of inspected. At the same time definition of degree of the exhaustion caused by occupation on external signs (perspiration, decolourization of face skin, deterioration in coordination of movements etc.) is obligatory and on reaction of cardiovascular and respiratory systems (a research of pulse rate, breath, level of arterial pressure, vital capacity of lungs) at the separate moments of occupations.

At assessment of influence considerable on the volume and intensity of the training loads used in a technique of training of athletes of high categories in addition apply tool researches (a teleelectrocardiography, an electromyography and some other), and also a complex of biochemical tests. For assessment of reaction of an organism of the training occupation inspected on loading or competitions the method of «additional» loading directly in the course of the training gives important additional data, in quality the cut is applied running on the spot at the maximum speed during 15 sec. or three-minute run at rate of 180 steps in 1 min., loading on the stationary bicycle (dosed or before achievement of pulse 170 ud. in 1 min.). More complete data can be obtained during the use of specific loading (e.g., for swimmers — a proplyvaniye of a 50-meter distance at rate of 90% from maximum, for runners — probegany distances of 60 — 100 m, etc.). The athlete is offered to execute this loading prior to occupation (the first loading), in 10 — 15 min. after completion of occupation (the second loading), and also in the recovery period — in the morning next day. Change of reaction to the second (and a third) additional loading comes to light by comparison of data of pulse, arterial pressure, a respiration rate to results of a research after the first additional loading. At the same time changes of indicators physical are considered. working capacity and sports and technical results. The revealed shifts reflect degree of exhaustion after major activity.

The most important problem of medical and pedagogical observations is definition of a condition of special fitness (for each sport).

In usual conditions of a sports training medical and pedagogical observations are made by tests of two types. The test of the first look — with continuous operation, maximum for this distance, or with the set intensity, at the same time is defined the possible duration of maintenance of work. After performance of exercises shifts according to pulse, breath, arterial pressure, and also an electrocardiography and to other tool techniques are defined caused by them fiziol. The first test helps to establish the level of development of qualities of speed, the general or special (depending on sport) to endurance in specific sports with a ring structure of movements. Tests of the second look are constructed by the principle of the repeated loadings (divided by short intervals), each of to-rykh is carried out with a competitive speed or close to it. During the definition of fitness in sports with acyclic structure of movements the athlete carries out specially picked up exercises (e.g., repeated presses, a raising of a bar for weight-lifters, etc.). In intervals between loadings functional shifts are defined, to-rye are compared with indicators of working capacity (effectiveness of performance of loadings).

Results of medical and pedagogical observations form a basis for management of training process according to the state of health and functional readiness of an organism of the athlete, and also for holding actions for maintenance or increase it.

Medical-sporting consultation on the questions connected with occupations physical. exercises and sport, it is given by the doctor — V. specialist to. to the teacher, the trainer, the athlete and the persons wishing to start a regular training (group or individual, by preparation for hitting qualifying standards of GTO, etc.). Consultation is carried out on the basis of the given medical survey and medical and pedagogical observations.

For beginners medical-sporting consultation helps to make a rational choice physical. exercises or sport, the most corresponding to the state of health, physical. development and to level physical. readiness. Medical-sporting consultation is given to trainers and athletes concerning the mode, volume and character of training loads, sports selection and orientation.

Sports selection and orientation of gifted youth are carried out on the basis of a number of criteria. The following indicators are considered: 1) the state of health — lack of deviations and tendency to the diseases limiting use of modern methods of a training; 2) features fiziol, the impact made by the chosen sport on an organism; 3) the physiological and psychological features favoring to achievement of good results in specific sport (constitutional features, rates biol, maturing, personal qualities, etc.); 4) level and rates of development of adaptation changes fiziol, the systems which are carrying out power ensuring muscular activity (aerobic and anaerobic productivity); 5) tension of process of adaptation to considerable training loads (according to medical and pedagogical observations); 6) degree of resistance to the increased psychoemotional influences.

Sanitary and hygienic supervision of places and conditions of training by physical culture and sport includes precautionary supervision at design and construction of sports constructions (see) or allocation of rooms for exercises and sport (the representative of SES of the area together with the doctor of a medical and sports clinic, health center of the enterprise, etc.), and also the current supervision of performance established a dignity. rules of maintenance of places of occupations (it is carried out by the doctor of the relevant sports organization of the station). Are subject to check: compliance to the established requirements of a condition of cleaning and ventilation of the enclosed space, their lighting and heating, the maintenance of the equipment and stock; timeliness of carrying out cleaning and disinfecting of water in pools, etc. It is also necessary to consider epidemiol, a situation and in the necessary cases to hold the relevant preventive activities.

Sanitary and educational work aims at promotion among the population of recreational value of physical culture and sport (charging, production gymnastics, occupations in groups of health, development of standards of GTO, etc.); explanation of a role of the correct work-rest schedule, use of natural factors of the nature for a hardening, values of medical control and self-checking of the athlete (see) for successful sports preparation. Direct participation of the doctor in teaching preparation of different age groups of the population for delivery of the section of «requirements» of GTO for development of skills of personal and public hygiene is provided.

At medical and sanitary providing sports competitions and mass forms of recreational and sports work (a sports contest, hitting qualifying standards of GTO, etc.) it is provided: 1) verification of medical documentation on the admission to participation in competitions; 2) organization of rendering the first medical aid; 3) carrying out the medical commission for examination of athletes (the individual conclusion about the admission to trainings and to participation in sports competitions etc.); 4) check gigabyte. conditions of venues of competitions, observance of the meteorological and other standards caused by rules of competitions.

In medical - a dignity. providing all-Union and international competitions, including and Olympic Games, special sections B. are provided, besides, to. — anti-doping control and control on a sex for women. The necessity of the organization of anti-doping control is caused by the fact that use just before competitions or during competitions of the pharmacological drugs promoting artificial increase in sports results due to stimulation nek-ry fiziol, processes (see. Dopes ), involves danger of causing damage to health of the athlete and creates unequal conditions of wrestling. At the international competitions anti-doping control is carried out by the international medical commissions of the international federations on sports by means of doctors — specialists in anti-doping control of the country organizer. At the Olympic Games (see. Olympic Games ) anti-doping control is carried out by medical commission of the International Olympic Committee (IOC). Anti-doping control at sports competitions is provided by position of Committee on physical culture and sport at Council of ministers of the USSR of 1971 in the USSR. Anti-doping control is based on use of methods qualitative and quantification in biol, liquids (hl. obr. in urine) contents of the doping drugs belonging to various classes of chemical connections (drugs, sympathomimetic amines, antidepressants, stimulators of c. N of page, analeptics, anabolic steroid hormones, etc.). The analysis biol, liquids is carried out at the encoded number without indication of a surname of the athlete and the name of the country. The conclusion according to the analysis is approved at a meeting of the commission and reported to a judiciary board, and in case of detection of dope — to the representative of team, to a cut the athlete belongs.

Sanctions against athletes, to-rye applied dope, are accepted. heads of the all-Union or international sports organization (depending on the scale of a competition).

The special resolution of the IOC established obligatory monitoring procedure of a floor before all large international competitions. Single passing of such control remains for life acting (in the presence of the corresponding documentation).

The purpose of control on a sex is check at athletes of compliance of a genetic floor passport. At nek-ry forms of anomaly of the sexual device at women, most often option of a false men's hermaphroditism (see. Hermaphroditism ), the system of gonosomes does not correspond to external bases of sex. Psychophysiological features of an organism of the sportswoman with a false hermaphroditism provide it advantages in sport in comparison with the women having normal development of the sexual device. It breaks the important principle of sports competitions — equality of participants on them fiziol. to features. At control on a sex a number of express methods of definition of a sex chromatin is used (by Sanderson's methods — Stewart and Kasperson). Cells of an epithelium of a mucous membrane of a vagina, a mucous membrane of a cheek (are exposed to a research at mass inspections) or a hair bulb. At assessment of maintenance of a sex chromatin consider days of a menstrual cycle (in 3 — 7 days after periods its level decreases), age inspected (the lowest contents in 13 — 14 years). Researches should be conducted to physical. loadings. According to results of express methods in each explicit and suspicious case on anomaly the integrated chromosomal analysis of culture of leukocytes of peripheral blood using differential coloring of chromosomes is carried out. Discrepancy of a genetic floor to passport excludes a possibility of participation in competitions among women.

The doctor, organizing medical - a dignity. providing sports competitions, is a part of a judiciary board and also the dignity is the deputy chief judge for all questions of medicine. - a gigabyte. providing competitions. All conclusions of the doctor are obligatory for representatives of the participating teams, judges at competitions, administration of stadium and other sports constructions.

See also Sports medicine , Training .

Bibliography: Grayevskaya N. D. Influence of sport on cardiovascular system, M., 1975, bibliogr.; D e of m about A. G. and Levin M. Ya. Hypotonic states at athletes, L., 1969, bibliogr.; Ivanov S. M. Medical control and physiotherapy exercises, M., 1970, bibliogr.; Karpman V. L., Bila Tserkva 3. B. and Beeps of I. A. Issledovaniye of physical effeciency at athletes, M., 1974, bibliogr.; To at-kolevsky G. M. Medical overseeing by athletes, M., 1975; Flyers S.P., Motylyanskayar.E. and Grayevsky N. D. Metodika of medical and pedagogical overseeing by athletes, M., 1962; Nalbandyanm. And. V. V izot. Cytogenetic researches in sports medicine, Teor. and prakt. physical. cult., No. 6, page 26, 1974; Problems of sports medicine, under the editorship of S. P. Letunov, etc., t. 1, M., 1974; Heart and sport, under the editorship of V. L. Karp-mana and G. M. Kukolevsky, M., 1968, bibliogr.; Sports medicine, under the editorship of. And. G. Dembo, M., 1975.

S. Letunov, R. E. Motylyanskaya.