The epidemic of overweight and obesity, which has reached the proportions of a total crisis in health care in recent years, affects more than 1 billion people worldwide, of whom 2.8 million die annually. The polymodal nature of the pathogenesis of obesity, manifested by the participation of multiple pathological processes, allows us to consider the complex use of physiotherapeutic effects as the most effective therapeutic strategy, the implementation of which allows us to achieve a high clinical result due to the synergistic interaction of therapeutic physical factors.
OBJECTIVE
Development and evaluation of the effectiveness of preventive and personalized technologies based on the predominant use of therapeutic physical factors that have a pathogenetic effect on key patterns of metabolically unhealthy obesity.
MATERIAL AND METHODS:
The studies were conducted at the Scientific and Clinical Center 1 of the Russian Scientific Center of Surgery named after academician B.V. Petrovsky with the participation of 157 patients (89 men and 68 women) aged 30 to 70 years. A prospective, controlled, comparative, randomized study was performed. Using the simple fixed randomization method, all patients were divided into 2 groups: control (77 patients) and experimental (80 patients). In the main group, patients received a course of complex exposure to therapeutic physical factors aimed at correcting their metabolic profile (thermotherapy, oxygen and aromatherapy, vibration massage of the back and lower extremities, relaxation music therapy, pressotherapy, dry carbon dioxide baths and general air cryotherapy). The course of complex physiotherapeutic exposure was carried out twice with an interval of 6—8 months. Patients in the control group did not undergo correction of the metabolic profile. The design of the study provided for a three-fold examination of patients in the main and control groups: before the complex program of physiotherapeutic correction of the metabolic profile, after the first and second courses.
RESULTS
Conducting a complex course of physiotherapy had a reliable corrective effect on the parameters of the metabolic profile of patients with obesity, including a reliable decrease in anthropometric indices, improvement of the lipid spectrum of the blood, a decrease in insulin resistance, a decrease in the level of leptin and the severity of sluggish systemic inflammation. Conducting a comparative assessment of the effectiveness of a course of complex physiotherapeutic intervention in the main group compared to the control group, performed using the correlation adaptometry algorithm, made it possible to establish a reliable decrease in the weight of the correlation graph in the main group, which indicates an increase in functional reserves. To implement a personalized approach to the use of a complex of physiotherapeutic interventions, an algorithm for identifying predictor biomarkers that allow predicting the expected clinical effectiveness was used. As a result, informative indicators were identified for predicting the effectiveness of using the developed physiotherapeutic complex to reduce body mass index and insulin resistance.
CONCLUSION
Using the correlation adaptometry method, the effectiveness of using the developed technologies based on the complex use of therapeutic physical factors affecting the main clinical and metabolic manifestations of obesity was proven. The identified predictors of the effectiveness of physiotherapeutic correction of obesity have criterion significance for forming a prognosis of the expected clinical effect at the initial stage (before the start of therapy).
