Упражнения при MPA — лёгочно-почечный синдром, мониторинг фиброза, фазно-осознанные, модификатор диализа

ACR/EULAR 2022 criteria + 2021 EULAR/ERA AAV management framework. Microscopic polyangiitis (MPA) is one of the three ANCA-associated vasculitides alongside GPA and EGPA, and it is defined clinically by the pulmonary-renal syndrome: diffuse alveolar hemorrhage (DAH) + rapidly progressive glomerulonephritis (RPGN, crescentic on biopsy). MPO-ANCA is the classic serology (vs PR3-ANCA in GPA). Compared to GPA, MPA has less ENT involvement (saddle-nose deformity, chronic sinusitis are GPA features) and more renal involvement (RPGN with ESRD risk if delayed treatment). Pulmonary fibrosis affects 10-30% of MPA patients and is often PRE-vasculitic — patients may present with ILD years before the systemic vasculitic presentation. Treatment follows the AAV pattern: cyclophosphamide or rituximab for induction; methotrexate / MMF / rituximab for maintenance. Exercise programming is phase-aware: during induction with active DAH or RPGN, exercise is limited to rest + ICU-appropriate ROM (DAH is a respiratory emergency); during maintenance with stable disease, graded aerobic + light strength is appropriate. Pulmonary fibrosis monitoring (high-resolution CT + PFTs) modifies aerobic prescription — DLco decline shifts the exercise envelope. ESRD-requiring patients add dialysis modifiers (fluid restriction + sodium + potassium + phosphorus + dialysis-day fatigue + energy/protein adequacy to combat dialysis catabolism).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity work, wall-push-up for scaled upper-body strength, scapular-retraction for posture (chronic disease + steroid changes), cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic + chest-wall mobility + pulmonary mucus mobility, pursed-lip-breathing for fibrosis/DAH dyspnea management, standing-march for managed cardio (maintenance phase, post-fibrosis assessment), ankle-pump for circulation + DVT prevention. The AI coach also knows the nutrition side — Mediterranean anti-inflammatory backbone (Bichara 2024), renal modifier low-sodium + protein moderate during active disease per nephrology + phosphorus + potassium control if CKD/ESRD per renal dietitian, iron + folate + B12 check, vitamin D often low target 40-60 ng/mL, calcium 1000-1200 + vitamin D + weight-bearing (steroid osteoporosis), pulmonary fibrosis modifier omega-3 1-3 g/day + adequate calories + anti-fibrotic medication per pulm, DAH acute ICU support + post-acute nutrition resumption + iron repletion, infection prevention CRITICAL (food safety + vaccines), AVOID grapefruit + Seville orange (cyclophos/tacrolimus/cyclosporin), cyclophos bladder protection ≥3 L/day fluids (coordinate with renal if fluid restriction needed), methotrexate folic acid 1-5 mg/day, dialysis ESRD-specific fluid + electrolyte + energy + protein per renal dietitian. CRITICAL: Vasculitis Foundation + V-PPRN + ACR + rheumatology + nephrology (RPGN + dialysis if ESRD) + pulmonology (DAH + fibrosis monitoring) + ID for opportunistic infection + renal dietitian. This is NEVER a replacement for rheumatology + multispecialty care.