Вплив важкості ожиріння на структуру добового профілю артеріального тиску та ефективність його корекції засобами фізичної терапії на фоні різного рівня терапевтичного альянсу

Abstract

In recent years, obesity has become one of the most common non-communicable diseases, affecting the population around the world, regardless of age, gender, social status. Weight gain is associated with an increased risk of death from any cause, primarily from cardiovascular disease. The main clinical complication of obesity is arterial hypertension. Purpose: to determine the effect of the severity of obesity on the structure of the daily blood pressure profile and the effectiveness of its correction by means of physical therapy against the background of different levels of therapeutic alliance. Materials and methods. The study involved 213 people with obesity of I-III degree, diagnosed by body mass index. According to the results of the definition of the therapeutic alliance, they were divided into two groups. The comparison group consisted of individuals with a low level of therapeutic alliance who refused to actively participate in the program of weight loss. The main group consisted of patients with a high level of therapeutic alliance, they underwent a correction program using dietary and lifestyle modifications, therapeutic exercises, massage, acupuncture, psychocorrection lasting one year. The control group consisted of 32 people with normal body weight. Daily monitoring of blood pressure was carried out to determine its profile by the types "diрper", "non-dipper", "over-dipper", "night-peaker". Results. In patients with grade I-III obesity, changes in the structure of the daily profile of systolic and diastolic blood pressure were revealed: a decrease in the number of individuals with an optimal "diрper" profile, an increase - with unfavorable profiles "non-dipper", "over-dipper", "night-peaker" ", the number of which increased in direct proportion to the degree of obesity. The use of kinesiоtherapy against the background of a decrease in body weight as part of a physical therapy program allows to normalize the daily blood pressure profile. A low level of therapeutic alliance leads to unsatisfactory fulfillment or non-fulfillment of the recommendations provided (aimed at reducing body weight and increasing physical activity) in obese patients, which is associated with a lack of improvement in the functioning of the cardiovascular system in the context of normalizing the daily blood pressure profile. Conclusions. It is advisable to prescribe physical therapy means to correct the indicators of the daily blood pressure profile in patients with obesity of I-III severity, which will prognostically reduce the risk of cardiovascular accidents in them