Development and feasibility assessment of a virtual reality-based aerobic exercise program with real-time pulse rate monitoring on hemodynamic and arterial stiffness in healthy people: a pilot study.

Introduction: Virtual reality (VR) exercises are reportedly beneficial as a physical activity tool for health promotion and rehabilitation, and can also help individuals exercise under professional supervision. We developed and investigated the potential feasibility of a VR-based aerobic exercise program using the XBOX ONE console and Kinect sensor with real-time pulse rate monitoring. The VR setting consisted of two-dimensional (2D) environments via computer, laptop, or television screens. In addition, the study investigated the potential feasibility of the VR-based exercise program on hemodynamic response and arterial stiffness in healthy participants of various ages. Methods: Healthy participants (n = 30) aged > 18 years were enrolled in the VR exercise-based program. All participants were required to wear a polar heart rate (HR) monitor set for moderate-intensity exercise, targeting 40%-59% of their HR reserve. Hemodynamic and arterial stiffness (pulse wave velocity) were noninvasively measured. The Borg scale rate of perceived exertion (RPE) was also assessed. Results: Following a VR-guided exercise routine, all participants performed moderate-intensity exercise with no adverse health outcomes during or after the exercise. The effects of VR-based aerobic exercise extended beyond enhanced central hemodynamic and arterial stiffness. However, neither hemodynamic nor arterial stiffness showed significant differences before and after the VR exercise, except for a higher RPE response following the exercise program. Conclusion: VR-based aerobic exercise with pulse rate monitoring is a promising physical activity tool to induce physiological changes and impact dyspnea scales and is also feasible for administration to healthy populations.

Acute cardiac autonomic and hemodynamic responses to resistive breathing: Effect of loading type and intensity.

OBJECTIVES: This study aimed to assess the acute impact of distinct loading breathing types and intensities on cardiac autonomic function and hemodynamic responses in healthy young adults. METHODS: A randomized, crossover trial involved 28 participants who underwent inspiratory resistive breathing, expiratory resistive breathing (ERB) and combined resistive breathing, each at 30% and 60% of maximal respiratory pressures. Data on heart rate variability (HRV) and hemodynamic parameters were collected during each trial. RESULTS: The study revealed significant main and interaction effects for both the performed task and the intensity across all measured variables (all p < 0.001). ERB at 60% load demonstrated significantly higher HRV values in the standard deviation of normal-to-normal RR intervals, the square root of the mean squared difference of successive normal-to-normal RR intervals and high-frequency power, as well as significantly lower values in heart rate, stroke volume, stroke volume index, cardiac output, cardiac index, end-diastolic volume and end-diastolic volume index, compared to other loaded protocols (all p < 0.001). CONCLUSION: These findings highlight the acute effect of type-specific and load-dependent resistive breathing on cardiac autonomic and hemodynamic functions, where ERB at 60% intensity showed the most significant cardiovagal modulation while causing the least hemodynamic alterations.

Effects of slow breathing training on hemodynamic changes, cardiac autonomic function and neuroendocrine response in people with high blood pressure: A randomized control trial.

BACKGROUND: High blood pressure (BP) is a non-communicable disease that is a risk factor for cardiovascular disease and is the leading cause of mortality and morbidity worldwide. High BP can be managed by both pharmacological and non-pharmacological interventions. Non-pharmacological treatment, such as slow-breathing training (SBT), has been shown to reduce BP. However, there are few studies on the effect of SBT on both cardiac activation and oxidative stress in people with high BP. OBJECTIVES: To explore the effect of SBT on cardiac autonomic function (i.e., heart rate variability: HRV) and neuroendocrine response (i.e., salivary cortisol). METHODS: One hundred people (including 89 women) with high BP were randomly assigned to either a control (n = 50) or intervention group (n = 50). The intervention program was conducted for 30 min per day, for 5 days per week, for 4 weeks, with a total of 20 sessions of the SBT at the rate of 10 times per minute, whereas the control group was required to continue with their daily routine. HRV, BP, and salivary cortisol were measured before and after the intervention program. A two-way mixed ANOVA was performed for within-group and between-group comparisons over time. RESULTS: Of the 100 participants, 71 individuals completed the study. The participants in the intervention group had a lower BP and salivary cortisol levels compared to those in the control group (p < .05). Further, those participants showed an increase in the standard deviation of normal R-R intervals after the 4-week intervention program (p < .05). CONCLUSION: This study provided evidence demonstrating the effect of SBT on cardiac autonomic and stress reactivity, which has important implications for health promotion in people with high BP. CLINICAL TRIAL REGISTRATION NUMBER: TCTR20180302008.

Neural respiratory drive assessment and its correlation with inspiratory muscle strength in patients undergoing open-heart surgery: A cross-sectional study.

BACKGROUND AND PURPOSE: Pulmonary dysfunction and inspiratory muscle weakness are frequently observed after cardiac surgery. Understanding the load on and capacity of respiratory muscles can provide valuable insights into the overall respiratory mechanics and neural regulation of breathing. This study aimed to assess the extent of neural respiratory drive (NRD) and determine whether admission-to-discharge differences in NRD were associated with inspiratory muscle strength changes among patients undergoing open-heart surgery. METHODS: This cross-sectional study was conducted on 45 patients scheduled for coronary artery bypass graft or heart valve surgery. NRD was measured using a surface parasternal intercostal electromyogram during resting breathing (sEMGpara tidal) and maximal inspiratory effort (sEMGpara max). Maximal inspiratory pressure (MIP) was used to determine inspiratory muscle strength. Evaluations were performed on the day of admission and discharge. RESULTS: There was a significant increase in sEMGpara tidal (6.9 ± 3.6 µV, p < 0.001), sEMGpara %max (13.7 ± 11.2%, p = 0.008), and neural respiratory drive index (NRDI, the product of EMGpara %max and respiratory rate) (337.7 ± 286.8%.breaths/min, p < 0.001), while sEMGpara max (-43.6 ± 20.4 µV, p < 0.01) and MIP (-24.4 ± 10.7, p < 0.001) significantly decreased during the discharge period. Differences in sEMGpara tidal (r = -0.369, p = 0.045), sEMGpara %max (r = -0.646, p = 0.001), and NRDI (r = -0.639, p = 0.001) were significantly associated with a reduction in MIP. DISCUSSION: The findings indicate that NRD increases after open-heart surgery, which corresponds to a decrease in inspiratory muscle strength.

Effects of virtual exercise on cardio-pulmonary performance and depression in cardiac rehabilitation phase I: A randomized control trial.

BACKGROUND: Cardiac rehabilitation is recommended for patients undergoing open-heart surgery (OHS). During the hospital admission, these patients suffer from reduced cardiopulmonary performance and decreased psychological health, leading to poor physical function, depression, and morbidity. To prevent post-operative pulmonary complications, a pre and post-operative physical therapy intervention is recommended for patients undergoing heart surgery. Virtual reality (VR) promotes the health status of healthy individuals and those with health conditions. However, few studies have reported the beneficial effects of VR exercise programs on the pulmonary performance and mental health status of patients undergoing OHS. OBJECTIVES: To determine whether by using training enhanced by VR, patients who have undergone OHS can more effectively attain cardiopulmonary performance and improve depression than through conventional physical therapy. METHOD: 60 participants were randomly assigned to a conventional physical therapy and VR exercise program. Each session was conducted once daily until discharge from the hospital. Cardiorespiratory performance and depression were evaluated before surgery and at the time of discharge from the hospital. A two-way mixed ANOVA was performed to compare within (i.e., pre and post-operation) and between (i.e., VR and conventional physical therapy) groups. RESULTS: No significant cardiopulmonary performance gains were detected in patients receiving the VR exercise program when compared with those who participated in conventional physical therapy prior to post-operative OHS (p > 0.05). However, the conventional physical therapy group showed significantly higher depression scores than the VR group (∆4.00 ± 0.98 vs. ∆1.68 ± 0.92). However, cardiopulmonary performance did not differ in both VR exercise and conventional physical therapy.

Concurrent validity and reliability of new application for 6-min walk test in healthy adults.

Background: Evaluation assessments for physical performance, such as walking tests, are important for measuring a person's well-being. As of current, medical technology is primarily used to administer these assessments. However, medical devices are not easily accessible and are intended for research purposes only, and hence inconvenient for clinical use. Therefore, we aimed to develop a prototype physical performance assessor device with a mobile application and explored concurrent validity and reliability between the standard 6-min walk test (6MWT) and wearable sensor 6MWT using 6-min walk distance in healthy adults. Methods: Sixty healthy males and females, above 18 years of age, were required to attach a sensor to their dominant ankle while the standard protocol for 6MWT was performed. After completing the walking test, the distance from the wearable sensor 6MWT with a mobile application and the standard 6MWT were recorded and compared. Results: There was no significant difference between the distance between the standard 6MWT (410.12 ± 74.03 m) and the distance obtained with the wearable sensor. Concurrent validity was found to be moderate, and Cronbach's alpha was 0.79, which indicated good internal consistency. Conclusion: The innovative prototype wearable walking sensor with a mobile application can effectively evaluate physical performance in healthy individuals.Clinical trial registration number: TCTR20220801002.

A Prospective Study of 73 Patients to Compare Forward Head Angle, Forward Shoulder Angle, Maximal Inspiratory Pressure, and Self-Reported Breathing-Related Symptoms Before and After Open-Heart Surgery.

BACKGROUND Patients who undergo open-heart surgery often experience widespread musculoskeletal and pulmonary complications. These can interfere with their functioning, resulting in soft tissue changes, worsening postural changes, and poor respiratory performance. Therefore, the prospective study aimed to compare forward head angle (FHA) and forward shoulder angle (FSA), maximal inspiratory pressure (MIP), and self-reported breathing dysfunction before and after open-heart surgery. MATERIAL AND METHODS In a prospective observational study of 106 patients, men and women scheduled for open-heart surgery were enrolled. Prior to surgery and before discharge from the hospital, all patients were required to assess FHA and FSA using 2-dimensional motion analysis software, MIP using a respiratory pressure meter, and breathing dysfunction using the 25-item Self Evaluation of Breathing Questionnaire (SEBQ). Paired t test was used to compare differences between before and after surgery. To evaluate associations, logistic regression analysis was performed. RESULTS Of the 106 patients recruited, 73 completed the study. FHA (-Δ6.55±4.77, P.

Effects of a Pedometer-Based Walking Home Program Plus Resistance Training on Inflammatory Cytokines and Depression in Thai Older People with Sarcopenia: A Three-Arm Randomized Controlled Trial.

OBJECTIVE: To examine the effects of daily walking steps plus resistive exercise on chronic inflammatory markers and depressive symptoms in older adults with sarcopenia. METHODS: Ninety men and women aged over 60 years were enrolled and divided into 60 and 30 adults with and without sarcopenia, respectively. Older individuals were screened for sarcopenia using the Asian Working Group for Sarcopenia in 2019. A simple random sample was conducted to divide the older adults with sarcopenia into two groups: control and intervention. Thirty older adults with sarcopenia were assigned to perform 12 weeks of step walking (>7500 steps) daily for 5 days/week plus resistance exercise with an elastic band twice/week; the control groups (i.e., no sarcopenia and sarcopenia) performed routine daily life Changes in depression and expression of the pro-inflammatory cytokines tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) were measured before and after the 12-week intervention program. Two-way mixed ANOVA models were computed for group and interaction effects for each variable. RESULTS: Changes in depressive symptom scores (Δ2.86 ± 0.92) and TNF-α levels (Δ22.16 ± 2.30) were observed in the intervention group after the 12-week program. In addition, an interaction effect between the intervention (Δ4.04 ± 3.10) and control groups (Δ8.10 ± 4.88) was found for the symptoms of depression. CONCLUSION: Older people with sarcopenia who accumulated >7,500 steps/day, 5 days/week plus resistive elastic band twice /week show improvements in inflammation and depressive symptoms. CLINICAL IMPLICATIONS: Encourage physical activity had a positive effect on reducing inflammation and depression among older people with sarcopenia.

Beneficial effects of walking-based home program for improving cardio-respiratory performance and physical activity in sarcopenic older people: a randomized controlled trial.

BACKGROUND: Sarcopenia is an age-related loss of muscle mass, decline in physical performance, and/or loss of muscle strength. Improving physical activity (PA) is associated with a reduced risk of sarcopenia. Additionally, the World Health Organization 2020 guidelines recommend 150 minutes/week of moderate-intensity or 75 minutes/week of vigorous PA plus resistance exercise twice a week. An increase in walking steps/day also enhances PA. AIM: The study explored the benefits of a pedometer-based walking program plus a resistance exercise program in older adults with sarcopenia. DESIGN: A randomized control trial. SETTING: In community dwelling. POPULATION: Older individuals with sarcopenia. METHODS: Screening for sarcopenia was defined according to the Asian Working Group of Sarcopenia criteria in 2019, which is composed of the skeletal muscle mass index (SMI), muscle strength, and physical performance. Bioimpedance analysis, handgrip strength, and gait speed were measured for the SMI, muscle strength, and physical performance, respectively. to explore the effectiveness of a pedometer-based walking program plus TheraBand resistance exercise over 12 weeks. The intervention group was required to wear a pedometer and walk 7 500 steps/day for 5 days/week and perform the TheraBand resistance exercise twice a week, while the control group continued their routine daily activities. Respiratory muscle strength, functional capacity (i.e., 6-minute walk test), and PA were assessed before and after the 12-week program. To evaluate the benefits of the home-based walking program plus resistance exercise, two-way mixed ANOVAs were performed. RESULTS: Sixty older individuals with sarcopenia aged ≥60 years were enrolled; however, a total of 57 older adults (28 in the invention group and 29 in the control group) completed the study. Inspiratory muscle strength, functional capacity, and PA increased between and within groups after the 12-week program (all P<0.05). Furthermore, muscle strength and physical performance improved in the intervention group after the 12-week program but not in the control group. CONCLUSIONS: A pedometer-based intervention program with TheraBand resistance exercise could improve cardio-respiratory performance and PA among older Thai individuals with sarcopenia. Further study needs to consider type of exercise and dietary supplements. CLINICAL REHABILITATION IMPACT: Increasing the number of steps walked per day may reduce the risk of developing sarcopenia in older people.

Systemic Inflammation in Sarcopenia Alter Functional Capacity in Thai Community-dwelling Older People: A Preliminary Observational Study.

BACKGROUND: Sarcopenia is linked to the loss of muscle mass in older adults, leading to impaired functional capacity and quality of life. In addition, this finding was recognized as an agerelated chronic inflammatory process. We aimed to determine the relationship between sarcopenia, functional capacity, and inflammatory biomarkers and subsequent prediction of inflammatory biomarkers in older adults. METHODS: A total of 126 women and men aged ≥ 60 years were enrolled. Participants were required to complete a handgrip dynamometer, 6-meter walk test, and bioimpedance analysis. Diagnosis was based on the definition of sarcopenia from the Asian Working Group for Sarcopenia 2019. Prior to performing a 6-minute walking test (i.e., functional capacity testing), blood samples were drawn for a C-reactive protein (CRP) test. RESULTS: A total of 12.70% were categorized as having sarcopenia. Significant differences in CRP and functional capacity between the sarcopenia and non-sarcopenia groups were found (p <.05). Older people with high CRP levels had significantly reduced functional capacity and slow gait speed. CONCLUSIONS: Poor functional capacity was associated with increased CRP levels, which might be due to the development of age-related inflammation. Older patients with sarcopenia may be at higher risk for functional decline.

Prevalence and incidence of sarcopenia and low physical activity among community-dwelling older Thai people: a preliminary prospective cohort study 2-year follow-up.

Background: Sarcopenia, defined as a loss of muscle mass, has become a major health problem in older people. Few prospective studies report the incidence and risk of sarcopenia. Therefore, this study aimed to explore the prevalence of sarcopenia at the baseline and follow-up after 2 years in community-dwelling older Thai individuals. Methods: In 2019, 330 older people were recruited from a community-dwelling population, and these participants were requested to present again in 2021. Sarcopenia was diagnosed using the criteria for the Asia Working Group for Sarcopenia (AWGS). All participants were asked to perform a 6-meter walk test, handgrip strength test, and bioelectric impedance assessment, and complete the Global Physical Activity Questionnaire. Results: The study found that the prevalence of sarcopenia was 65 (19.70%) in 330 older people in 2019, and 44 of 205 participants (21.46%) were reported to have sarcopenia after 2 years. The incidence of sarcopenia was noted to be 2.44% in 2021. Analysis with ANOVA and pairwise comparisons showed that the reversibility of sarcopenia was attributed to high level of physical activity in the 2-year follow-up group (p = 0.014, 95% CI [-1753.25--195.49]). Further, participants with moderate and high physical activity had a reduced incidence of sarcopenia (odds ratio = 9.00 and 14.47, respectively). Therefore, low physical activity in older people led to the development of sarcopenia from the baseline to the 2-year follow-up, indicating that increased physical activity may be useful in reversing sarcopenia, as suggested in the 2-year follow-up study. Low physical activity could be a risk factor for the incidence of sarcopenia. Hence, the prevention of sarcopenia could promote health improvement through moderate to high physical activity.

Type 2 Diabetes Mellitus Related to Decreased Peripheral and Respiratory Muscle Strength in Sarcopenic Thai Elderly.

BACKGROUND: Age is related to a decline in muscle mass and physical function in both respiratory and peripheral muscle strength, which could lead to mobility and mortality. In addition, older people have suffered from one or multiple chronic conditions in particular in type 2 Diabetes Mellitus (type 2 DM). However, a few studies have reported the relationship between sarcopenic elderly and respiratory and peripheral muscle strengths in type 2DM. OBJECTIVE: To explore the prevalence of sarcopenia in type 2 DM elderly people among community- dwelling patients and the relationships with peripheral and respiratory muscle loss in sarcopenic type 2 DM older patients. METHODS: A total of 330 older individuals were recruited from community-dwelling centers. Respiratory muscle and quadriceps muscle were assessed. According to the defined criteria for sarcopenia (defined by Asian Working Group for Sarcopenia), muscle mass, gait speed (six-meter walk test), and handgrip strength were examined. RESULTS: Of 330 elderly people, 82 volunteers had a history of type 2 DM. Participants with type 2DM had a risk for sarcopenia (odds ratio= 2.324, 95% CI=1.251-4.317). The prevalence of sarcopenia was 25.61% among older participants with type 2 DM. In addition, decreased respiratory muscle strength and quadriceps muscle strength were observed in type 2 DM with sarcopenia compared to type 2 DM with non-sarcopenia. These relationships also remained after controlling for age and sex. CONCLUSION: Sarcopenia in type 2 DM leads to a decrease in respiratory muscle and peripheral muscle strength.

Depression and low physical activity are related to sarcopenia in hemodialysis: a single-center study.

BACKGROUND: The number of patients who suffer from chronic renal failure (CRF) has widely increased worldwide. Patients with advanced stages of CRF experience a gradual and progressive loss of muscle and fat mass leading to decreased physical activity and mental health problems. The loss of muscle mass in CRF might contribute to the development of sarcopenia. Therefore, this study aimed to explore the prevalence of sarcopenia and to determine the relationship of physical activity and mental state of depression with sarcopenia in hemodialysis patients. METHODS: A cross-sectional study was designed with a total of 104 male and female with a minimum age of 35 years. Based on the guidelines of the Asian Working Group for Sarcopenia in 2019, gait speed, muscle mass, and handgrip were used to define sarcopenia. In addition, participants were requested to perform a set of questionnaires to evaluate their physical activity and state of depression. Logistic regression analyses were used to explore the risk factors of sarcopenia. RESULTS: Thirty-four (32.69%) of 104 participants had sarcopenia. Compared to the 70 individuals without sarcopenia, they had a low physical activity and a high depression score (ps < .05). Furthermore, low physical activity and high depression scores in combination with sarcopenia were associated with an increased mortality risk. Low physical activity and high depression scores were also independently associated with sarcopenia in hemodialysis patients after controlling for age (odds ratio = 3.23, and 4.92, respectively).

Beneficial Effect of Water-Based Exercise Training on Exercise Capacity in COPD Patients-a Pilot Study.

Background: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable condition, characterized by persistent airflow limitation. Exercise training is a core component of pulmonary rehabilitation in people with COPD. Water-based exercise has been studied, but it remains unclear whether water-based exercise program leads to the improvement in respiratory function, muscle strength, balance ability, and exercise capacity. We aim to study the effect of an 8-week water-based exercise program on respiratory function, muscle strength, balance ability, and exercise capacity in people with COPD. Methods: Fourteen stable COPD participants (FEV1 56.8 ± 24.6%pred) were recruited and randomized into a water-based exercise or a land-based exercise group. Both groups were trained for 8 weeks, two sessions per week. Pulmonary function, respiratory muscle strength, peripheral muscle strength, balance ability, exercise capacity [6-min walking test (6MWT), incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT)] were assessed at baseline and at the end of the program. ANCOVA was used to conduct between-group comparisons of outcomes after adjusting for pre-intervention values. Results: Baseline characteristics of participants were not significantly different between the two groups (p ≥ 0.05). After the 8-week training program, participants in the intervention group achieved larger gains in ESWT (Δ663.4 ± 279.5 vs. Δ45.4 ± 93.2 s, p = 0.001). In addition, maximal inspiratory pressure (MIP) was significantly increased more in the intervention group (Δ11.1 ± 7.8 vs. Δ1.1 ± 5.7 cmH2O, p = 0.026). However, no significant differences in pulmonary function, peripheral muscle strength, balance ability variables, 6MWD (p = 0.248), and ISWT (p = 0.506) were observed between the two groups. Conclusions: The water-based exercise program could be recommended to the COPD rehabilitation program for improving the endurance exercise capacity and inspiratory muscle strength. Clinical Trial Registration: www.thaiclinicaltrials.org, identifier: TCTR20210125005.

Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: A randomized control trial.

BACKGROUND: People with chronic renal failure (CRF) show decreased respiratory fitness and poor quality of life (QOL). Exercise during hemodialysis has been suggested to improve the cardio-respiratory fitness. However, results of effects of respiratory muscle (RM) training on respiratory fitness and QOL are inconsistent. In addition, very few studies explored the association between inspiratory muscle (IM) training and sensation of breathlessness. OBJECTIVES: To examine the effects of IM training in hemodialysis patients on respiratory fitness QOL and breathlessness. METHOD: A randomized control trial with 50 CRF, who underwent hemodialysis (25 individuals in each group; IM training and sham group) was designed. Pulmonary function, RM strength, QOL (measured by Kidney Disease Quality of Life-36), and sensation of breathlessness were measured before and after an 8-week intervention. RESULTS: Compared to the sham group, the IM strength increased in the intervention group after an 8-week program (Δ25.92 ± 8.73 cmH2 O, p = 0.005). Significantly increased IM and forced vital capacity values in training groups was observed after an 8-week intervention (Δ12.44 ± 3.07 cmH2 O and Δ0.097 ± 0.046 L, respectively), but not the sham group. Neither, the training group, nor the sham group were significantly different in the QOL. However, feeling of shortness of breath improved after the training program among inspiratory muscle training group, but not the sham group. CONCLUSION: IM training during hemodialysis could lead to an improvement of respiratory fitness and reduce breathlessness in people with CRF who are receiving hemodialysis. However, QOL was not different after the training program. The study suggests that after 8-week intervention program, IM training (loading exercise) could improve IM strength, pulmonary function without any complications during the intervention program within 1-2 h.

Anxiety and Depression Symptomatology Related to Inspiratory Muscle Strength and Functional Capacity in Preoperative Cardiac Surgery Patients: A Preliminary Cross-sectional Study.

BACKGROUND: Poor psychological health and cardiorespiratory fitness prior to open heart surgery (OHS) might be predictors of postoperative pulmonary complications that lead to morbidity and mortality. Assessment of physical and psychological conditions should be considered for patients receiving OHS, to possibly prevent these complications. This study investigates how inspiratory muscle strength (IMS) and functional capacity (FC) relate to the psychological health of preoperative cardiac surgery patients. METHOD: A cross-sectional study was designed before OHS; the 6-minute walk test and IMS were performed on patients who were admitted for OHS. All participants were requested to complete Hospital Anxiety and Depression Scale. Pearson correlation and hierarchal regression analysis were performed to determine the relationships between IMS and FC and psychological conditions (anxiety and depression). RESULTS: Overall, 36 males and 28 females aged 56.89±10.23 years were recruited. Significant relationships were observed between IMS and anxiety and depression symptoms (r = -0.33 and r = -0.27, respectively). Anxiety was negatively related to FC (r = -0.25). These relationships remained significant after adjustment for age, sex, and body mass index (BMI) (∆R 2 = 0.11 and ∆R 2 = 0.09). In addition, anxiety was also related to FC after controlling for age, sex, and BMI (∆R 2 = 0.09). CONCLUSION: Among patients undergoing OHS, those with a higher level of depression or anxiety had a lower cardiorespiratory fitness than those with a low level of depression or anxiety.

Sarcopenia in open heart surgery patients: A cohort study.

BACKGROUND: Sarcopenia is a condition characterized by loss of muscle mass, muscle strength, or physical performance. It has been reported that cardiac surgery causes systemic inflammatory response, which leads to sarcopenia. In addition, open-heart surgery (OHS) has been associated with length of hospital stay, prolonged mechanical ventilation, and postoperative pulmonary complications. However, very few studies have explored the association of sarcopenia with OHS. Thus, this study explores the prevalence of sarcopenia in OHS patients as well as their relationship. METHODS: This cohort study included 160 patients; it was designed to assess sarcopenia during preoperative OHS and before patient discharge from the hospital. Sarcopenia was defined according to Asian Working Group for Sarcopenia (AWGS) criteria as low muscle mass plus low muscle strength and/or slow gait speed. Participants were requested to perform exercises to test their handgrip strength, gait speed, and bioelectrical impedance. In addition, their medical history (e.g., duration of hospitalization and mechanical ventilation) was recorded. RESULTS: The prevalence of sarcopenia during preoperative OHS was 26.9%, with affected men comprising 11.9% and affected women comprising 15% of the total sample. Participants with sarcopenia had a significantly lower body mass index (BMI) than those without. Further, patients who had longer stays in the hospital and prolonged mechanical ventilation time showed significantly higher rates of developing sarcopenia. During postoperative OHS, the incidence of sarcopenia rose by 20.92%, increasing the total prevalence of sarcopenia to 46.41%. Moreover, advanced age emerged as one of the most significant risk factors of sarcopenia. Participants in the age group >55 years had an increased risk of sarcopenia (odds ratio [OR]: 3.90). It was also found that patients with a low BMI (<23 kg∗m-2) and a history of diabetes mellitus (DM) had an increased risk of sarcopenia (ORs: 2.11 and 1.47, respectively). Moreover, longer hospital stays and mechanical ventilation times were important risk factors (ORs: 1.58 and 2.07, respectively). CONCLUSION: The prevalence of sarcopenia was observed to be high during postoperative OHS. Participants with sarcopenia who underwent OHS had a history of DM, longer length of hospital stays, and prolonged mechanical ventilation times, compared with patients without sarcopenia. CLINICAL TRIAL REGISTRATION NUMBER: TCTR20190509003.

Duration of hemodialysis associated with cardio-respiratory dysfunction and breathlessness: a multicenter study.

BACKGROUND: Patients with hemodialysis suffer with protein-energy wasting and uremic myopathy lead to lack of physical activity and poor functional performance. However, ventilation abnormality in patients undergone hemodialysis remains controversial regarding the respiratory impairment. Therefore, the study aimed to determine the effect of duration of dialysis on respiratory function. METHODS: A multicenter study with cross-sectional study was designed in four hemodialysis outpatient clinics. Respiratory muscle strength (i.e., maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)) pulmonary function test (i.e., forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC ratio), functional capacity (6-minute walk test) and sensation of breathlessness were assessed prior to dialysis. RESULTS: A total of 100 hemodialysis patients were recruited with 38 females and 62 males. An average of duration of hemodialysis was 5.93± 4.96 years. Decreased MIP values, FEV1 values, FVC values, %FEV1 and %FVC were noted in patients with long duration of dialysis (defined as ≥ 5 years of dialysis) compared to those with short duration of dialysis (ps < .05). In addition, increased sensation of breathlessness was observed in patients with long duration of dialysis (p < .05). Furthermore, participants with long duration of dialysis had an increased risk of ventilatory restriction (OR 6.093, p = .007).

Sarcopenia and Its Relationships with Depression, Cognition, and Physical Activity in Thai Community-Dwelling Older Adults.

BACKGROUND: Age-related sarcopenia is associated with physical decline, including poor functional capacity, lack of physical activity, problems with activities of daily living, and disability. However, little is known about the association between mental health problems and cognitive function in older adults with sarcopenia. Therefore, this study explored community-dwelling older adults' sarcopenia prevalence and related associations with depression, cognitive performance, and physical activity. METHODS: This cross-sectional study included 330 community-dwelling older adults (66.85 ± 5.54 years, 76.06% female). Based on the Asian Working Group for Sarcopenia guidelines, gait speed, muscle mass, and handgrip were assessed. All participants responded to a set of questionnaires (e.g., Global Physical Activity Questionnaire, cognitive assessment, and depression scale). Logistic regression analysis and multivariate logistic regression were used to determine independent predictors for sarcopenia. RESULTS: Overall, 16.1% of the participants were identified as having sarcopenia. Further, advanced age (i.e., mean age ≥ 70 years; odds ratio: 4.67), high depression scores (odds ratio: 2.09), mild cognitive impairment (odds ratio: 0.22), and low physical activity levels (odds ratio: 1.96) were significant associated risk factors for sarcopenia after adjusting for age, sex, and educational level. CONCLUSIONS: Sarcopenia can lead to adverse health outcomes (i.e., depressive symptoms, cognitive decline, and low physical activity) in older adults.

CXCL12 G801A polymorphism is associated with significant liver fibrosis in HIV-infected Thais: a cross-sectional study.

BACKGROUND: Previous studies indicate high prevalence of liver diseases in HIV-infected patients, and their genetic risk factors are still unclear. The chemokine CXCL12 plays important roles in development of chronic liver injury and a single nucleotide polymorphism (SNP) G to A change at position 801 in CXCL12 gene has been demonstrated to affect CXCL12 production levels. OBJECTIVE: This study aimed to analyze the association of CXCL12 G801A SNP with liver complication in HIV-infected Thais. METHODS: A cross-sectional study was conducted in 164 patients who were evaluated for transaminitis and significant liver fibrosis, defined by fibrosis-4 (FIB-4) score and AST to platelet ratio index (APRI), and genotyped for the SNP using tetra-primer PCR-SSP. RESULTS: There were high rates of patients with transaminits (28.0%), and significant liver fibrosis by FIB-4 score (18.9%) and by APRI (14.0%). The CXCL12 G801A AA/GA genotypes were significantly associated with transaminitis (p = 0.014) and significant fibrosis by APRI (p = 0.020). Univariate and multivariate analyses identified the AA/GA genotypes as predictive factors for significant fibrosis (OR 6.8, 95%CI 1.7-28.2, p = 0.008), together with age older than 40 years, CD4+ cell count < 350 cells/µl and hepatitis B and/or C virus coinfection. The significantly higher medians of APRI and FIB-4 score, in patients with AA/GA than those with GG genotypes (p < 0.05) were observed in the ART-naïve, but not ART-experienced groups. CONCLUSION: The CXCL12 G801A AA/GA genotypes are significant predictive factors for hepatic fibrosis potentially in the ART-naïve HIV-infected Thais.