The influence of low-intensity resistance training combined with neuromuscular electrical stimulation on autonomic activity in healthy adults: A randomized controlled cross-over trial.

BACKGROUND: Low-intensity resistance training (RT) combined with neuromuscular electrical stimulation (NMES) is one method of exercise to improve the deterioration of physical function. However, it is unclear whether low-intensity RT combined with NMES (RT + NMES) can be safely implemented. OBJECTIVE: This study aimed to examine the influence of low-intensity RT + NMES on autonomic activity and cardiovascular responses in healthy adults. METHODS: This study was an open-label, randomized controlled cross-over trial. The exercise intensity of isometric knee extension RT was set to 40% of the maximum voluntary contraction (peak torque). NMES was adjusted to a biphasic asymmetrical waveform with the frequency maintained at 50 Hz and a phase duration of 300 µ s. The difference in the change in autonomic activity and cardiovascular responses was compared by assessing heart rate variability, blood pressure, and heart rate during RT and RT + NMES . RESULTS: Twenty healthy male college students (mean age 21 . 0 ± 0 . 6 years) participated in this study. The ratio of low- and high-frequency components of heart rate variability, systolic blood pressure, and heart rate increased during exercise in the RT and RT + NMES sessions ( P < 0.05). There were no significant differences in autonomic activity and cardiovascular responses throughout the sessions during RT and RT + NMES . CONCLUSION: In conclusion, our results demonstrated that low-intensity RT + NMES was safe and did not induce excessive autonomic and cardiovascular responses in healthy adults.

The effect of short-term health promotion intervention on motor function in community-dwelling older adults.

BACKGROUND: Slow walking speed as one indicator of physical frailty has been found to be associated with deterioration of the health status. Although many reports have shown that exercise training improves motor function, it is unclear whether a group-based and short-term health promotion intervention will improve motor function in older adults. AIMS: This study aimed to examine the effectiveness of a short-term health promotion intervention on motor function in community-dwelling older adults. METHODS: A 6-month middle-term and moderate-intensity programme (MTMIP) and a 6-week short-term high-intensity programme (STHIP) were conducted. There were 28 and 29 subjects selected for the MTMIP and STHIP, respectively. The difference in motor function test outcomes was compared by assessment of comfortable walking speed, maximal walking speed, a sit-to-stand test (STS), and a timed up-and-go test (TUG). RESULTS: Comfortable walking speed, maximum walking speed, STS and TUG were significantly improved at end of the programme in the STHIP group (p = 0.02, p = 0.03, p < 0.001 and p = 0.002). Multiple regression analysis revealed that implementation of STHIP had a significant effect on end-of-programme comfortable walking speed (ß = 0.19, p = 0.006, 95% CI 0.06 to 0.32). DISCUSSION: It was assumed that the training content of the STHIP, with its emphasis on high intensity and physical performance, was the main factor in improved walking speed. CONCLUSIONS: Our results demonstrated the effectiveness of STHIP on motor function. These findings could help support development of more effective intervention methods in community-dwelling older adults.

Endothelial Dysfunction Is Associated with Cognitive Impairment of Elderly Cardiovascular Disease Patients.

Cognitive impairment is frequently represented in elderly patients with cardiovascular disease (CVD); yet, the mechanism is uncertain. Recent studies have suggested the association between the vascular endothelial dysfunction and cognitive impairment. The aim of this study was to clarify the association between endothelial dysfunction and cognitive impairment in elderly patients with CVD.A total of 80 elderly patients (> 70 years old) with CVD were included. Patients who had already pharmacologically intervened for cognitive impairment were excluded. The endothelial dysfunction was assessed by the reactive hyperemia-peripheral arterial tonometry (RH-PAT). Cognitive impairment was diagnosed by the Mini-mental state examination.The RH-PAT index was significantly lower in cognitive impairment (median 1.60 [interquartile range (IQR) 1.34 to 1.89], n = 51) as compared with non-cognitive impairment (median 1.75 [IQR 1.55 to 2.30], n = 29, P = 0.005). By a multivariate analysis, the RH-PAT index was independently associated with cognitive impairment (odds ratio: 0.89; 95% confidence interval: 0.81 to 0.97; per 0.1, P = 0.044). In the receiver-operating characteristic analysis, the best cut-off of the RH-PAT index to identify cognitive impairment was 1.65 (area under the curve 0.67; P = 0.011) with limited the sensitivity (63%) and specificity (66%).A lower RH-PAT index was significantly associated with the presence of cognitive impairment in elderly CVD patients. Further studies are required to clarify the mechanism and the causal relationship between the endothelial dysfunction and cognitive impairment in patients with CVD.

Difference between tablet methods and paper questionnaire methods of conducting a survey with community-dwelling elderly.

[Purpose] This study aimed to develop a tablet app that emulates paper questionnaires used in clinical care, and to verify the difference between the utility of tablet survey methods and paper questionnaire methods with elderly people. [Subjects and Methods] A tablet app was developed in the Java language. A questionnaire was provided to 30 community-dwelling elderly people. The subjects were randomly allocated to the group responding on the tablet (tablet group) or that responding to a paper-based questionnaire (questionnaire group). Assessed items included response time to questions, whether or not they had queries regarding the survey, and data input time. For the tablet group, a questionnaire was conducted regarding the operability of the tablet. [Results] There was no difference in response time between the two groups. Significantly more people in the tablet group had queries regarding the survey. Data input time was 426 seconds for the tablet group and 1268 seconds for the questionnaire group. In the survey regarding tablet operability, there were no negative opinions about the visibility of the screen. [Conclusion] Tablets can be used with elderly people to shorten the data input time. The present findings suggested that tablet surveys could be effective for a large-scale investigation.

Association of habitual physical activity measured by an accelerometer with high-density lipoprotein cholesterol levels in maintenance hemodialysis patients.

After confirming the relationship between high-density lipoprotein cholesterol (HDL-C) levels and mortality in hemodialysis patients for study 1, we investigated the effect of physical activity on their HDL-C levels for study 2. In study 1, 266 hemodialysis patients were monitored prospectively for five years, and Cox proportional hazard regression confirmed the contribution of HDL-C to mortality. In study 2, 116 patients were recruited after excluding those with severe comorbidities or requiring assistance from another person to walk. Baseline characteristics, such as demographic factors, physical constitution, primary kidney disease, comorbid conditions, smoking habits, drug use, and laboratory parameters, were collected from patient hospital records. An accelerometer measured physical activity as the number of steps per day over five consecutive days, and multiple regression evaluated the association between physical activity and HDL-C levels. Seventy-seven patients died during the follow-up period. In study 1, we confirmed that HDL-C level was a significant predictor of mortality (P = 0.03). After adjusting for patient characteristics in study 2, physical activity was independently associated with HDL-C levels (adjusted R (2) = 0.255; P = 0.005). In conclusion, physical inactivity was strongly associated with decreased HDL-C levels in hemodialysis patients.

The relationship between spatiotemporal gait parameters and cognitive function in healthy adults: protocol for a cross-sectional study.

BACKGROUND: Motor dysfunctions, such as slower walking speed, precede the occurrence of dementia and mild cognitive impairment, suggesting that walking parameters are effective biomarkers for detecting early sub-clinical cognitive risk. It is often also concurrent with self-complained cognitive dysfunction, called motoric cognitive risk (MCR) syndrome. Our preliminary study found several walking parameters, obtained by a three-dimensional motion capture system, to be correlated with computer-based assessments of various cognitive function modalities, although the sample size was small. The Cognitive-Gait (CoGait) Database Project, described in the current protocol, aims to establish a database of multi-dimensional walking and cognitive performance data, collected from a large sample of healthy participants, crucial for detecting early sub-clinical cognitive risk. METHODS: We will recruit healthy volunteers, 20 years or older, without any neurological musculoskeletal or psychiatric disorders. The estimated sample size is 450 participants, including a 10% attrition rate. Using computer-based cognitive assessments, participants will perform six tasks: (i) the simple reaction time task, (ii) Go/No-Go task, (iii) Stroop Color-Word Test, (iv) N-back test, (v) Trail Making Test, and (vi) digit span test. We will also conduct paper-based cognitive assessments such as the Mini-Mental State Examination, Montreal Cognitive Assessment, and the Geriatric Depression Scale-15 for assessing MCR. Gait will be measured through joint kinematics and global positioning in participants' lower legs while walking at a comfortable and faster pace, using pants with an inertial measurement unit-based three-dimensional motion capture system. Finally, we will establish a prediction model for various cognitive performance modalities based on walking performance. DISCUSSION: This will be the first study to reveal the relationship between walking and cognitive performance using multi-dimensional data collected from a large sample of healthy adults, from the general population. Despite certain methodological limitations such as the accuracy of measurements, the CoGait database is expected to be the standard value for both walking and cognitive functions, supporting the evaluation of psychomotor function in early sub-clinical cognitive risk identification, including motoric-cognitive risk syndrome.

Spinal movement variability associated with low back pain: A scoping review.

OBJECTIVE: To identify suggestions for future research on spinal movement variability (SMV) in individuals with low back pain (LBP) by investigating (1) the methodologies and statistical tools used to assess SMV; (2) characteristics that influence the direction of change in SMV; (3) the methodological quality and potential biases in the published studies; and (4) strategies for optimizing SMV in LBP patients. METHODS: We searched literature databases (CENTRAL, Medline, PubMed, Embase, and CINAHL) and comprehensively reviewed the relevant papers up to 5 May 2020. Eligibility criteria included studies investigating SMV in LBP subjects by measuring trunk angle using motion capture devices during voluntary repeated trunk movements in any plane. The Newcastle-Ottawa risk of bias tool was used for data quality assessment. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS: Eighteen studies were included: 14 cross-sectional and 4 prospective studies. Seven linear and non-linear statistical tools were used. Common movement tasks included trunk forward bending and backward return, and object lifting. Study results on SMV changes associated with LBP were inconsistent. Two of the three interventional studies reported changes in SMV, one of which was a randomized controlled trial (RCT) involving neuromuscular exercise interventions. Many studies did not account for the potential risk of selection bias in the LBP population. CONCLUSION: Designers of future studies should recognize that each of the two types of statistical tools assesses functionally different aspects of SMV. Future studies should also consider dividing participants into subgroups according to LBP characteristics, as three potential subgroups with different SMV characteristics were proposed in our study. Different task demands also produced different effects. We found preliminary evidence in a RCT that neuromuscular exercises could modify SMV, suggesting a rationale for well-designed RCTs involving neuromuscular exercise interventions in future studies.

Perceived difficulty in activities of daily living and survival in patients receiving maintenance hemodialysis.

PURPOSE: Most patients receiving hemodialysis have perceived difficulty in mobility tasks, such as basic activities of daily living (ADL), ambulation, and walking up or down stairs, even if they can ambulate independently. Perceived difficulty in performing ADL (ADL difficulty) is reportedly a useful predictor of mortality in older community-dwelling people. However, very few studies have examined the association of ADL difficulty with clinical outcomes in patients receiving hemodialysis. This study aimed to identify the association between ADL difficulty related to mobility tasks of lower limbs and all-cause mortality in patients receiving hemodialysis who are able to ambulate independently. METHODS: This retrospective study analyzed 300 clinically stable outpatients (median age, 65.0 years) receiving hemodialysis. ADL difficulty was evaluated at baseline with a novel questionnaire developed for patients receiving hemodialysis. Lower scores indicated lower ADL, i.e., greater ADL difficulty. The patients were divided into two groups by the median ADL score: a higher ADL group and a lower ADL group. The association between ADL difficulty and all-cause mortality was estimated by Cox regression analyses. RESULTS: Median follow-up duration was 58 months. The incident rates were 0.02 per person-year in the higher ADL group and 0.06 per person-year in the lower ADL group (P < 0.001). After adjusting for the effects of clinical characteristics, the hazard ratio for all-cause mortality in the lower ADL group was 2.70 (95% confidence interval 1.57-4.64) compared with that in the higher ADL group. CONCLUSIONS: Perceived difficulty in mobility tasks was independently associated with all-cause mortality among ambulatory patients receiving hemodialysis.

Effect of cardiac rehabilitation on cognitive function in elderly patients with cardiovascular diseases.

BACKGROUND: Cognitive function is an important factor for secondary prevention in elderly patients with cardiovascular diseases. The objective of this study was to evaluate the impact of cardiac rehabilitation (CR) on the improvement of cognitive function. METHODS: A total of 66 consecutive elderly patients (≥70 years old) with cardiovascular diseases were prospectively enrolled. The change in cognitive function during 6 months was compared between the patients with monthly CR (at least once per month; n = 27) and those without monthly CR (n = 39). Cognitive function was evaluated using the Mini-mental State Examination (MMSE) and Frontal Assessment Battery (FAB). RESULTS: There was no significant difference in baseline characteristics between the 2 groups. The change in the MMSE score was significantly greater in patients with monthly CR than in those without monthly CR (2.3 ± 0.4 vs. -0.1 ± 0.3 points; p <0.001). Among the MMSE items, the change in temporal orientation and attention and calculation was significantly greater in the monthly CR group than in the non-monthly CR group (0.8 ± 0.7 vs. -0.1 ± 0.8 points [p <0.001] and 1.0 ± 1.5 vs. -0.1 ± 0.1 points [p <0.001], respectively). The general linear model revealed that monthly CR (effect estimate, 1.455; 95% confidence interval, 0.747-2.163; p <0.001) was independently associated with the change in the MMSE score. CONCLUSIONS: Cognitive function may improve with regular CR. These results might partly explain the efficacy of CR for secondary prevention.

Determinants of Slow Walking Speed in Ambulatory Patients Undergoing Maintenance Hemodialysis.

Walking ability is significantly lower in hemodialysis patients compared to healthy people. Decreased walking ability characterized by slow walking speed is associated with adverse clinical events, but determinants of decreased walking speed in hemodialysis patients are unknown. The purpose of this study was to identify factors associated with slow walking speed in ambulatory hemodialysis patients. Subjects were 122 outpatients (64 men, 58 women; mean age, 68 years) undergoing hemodialysis. Clinical characteristics including comorbidities, motor function (strength, flexibility, and balance), and maximum walking speed (MWS) were measured and compared across sex-specific tertiles of MWS. Univariate and multivariate logistic regression analyses were performed to examine whether clinical characteristics and motor function could discriminate between the lowest, middle, and highest tertiles of MWS. Significant and common factors that discriminated the lowest and highest tertiles of MWS from other categories were presence of cardiac disease (lowest: odds ratio [OR] = 3.33, 95% confidence interval [CI] = 1.26-8.83, P<0.05; highest: OR = 2.84, 95% CI = 1.18-6.84, P<0.05), leg strength (OR = 0.62, 95% CI = 0.40-0.95, P<0.05; OR = 0.57, 95% CI = 0.39-0.82, P<0.01), and standing balance (OR = 0.76, 95% CI = 0.63-0.92, P<0.01; OR = 0.81, 95% CI = 0.68-0.97, P<0.05). History of fracture (OR = 3.35, 95% CI = 1.08-10.38; P<0.05) was a significant factor only in the lowest tertile. Cardiac disease, history of fracture, decreased leg strength, and poor standing balance were independently associated with slow walking speed in ambulatory hemodialysis patients. These findings provide useful data for planning effective therapeutic regimens to prevent decreases in walking ability in ambulatory hemodialysis patients.

Relationship between lower extremity muscle strength and all-cause mortality in Japanese patients undergoing dialysis.

BACKGROUND: Skeletal muscle wasting is common and insidious in patients who are undergoing hemodialysis. However, the association between lower extremity muscle strength and all-cause mortality remains unclear in this population. OBJECTIVE: The purpose of this study was to investigate the prognostic significance of lower extremity muscle strength on 7-year survival in a cohort of patients who were clinically stable and undergoing hemodialysis. DESIGN: A prospective cohort study was conducted. METHODS: A total of 190 Japanese outpatients who were undergoing maintenance hemodialysis 3 times per week at a hemodialysis center were followed for up to 7 years. Lower extremity muscle strength was evaluated using a handheld dynamometer at the time of patient enrollment in the study. Muscle strength data were divided by dry weight and expressed as a percentage. A Cox proportional hazards regression model was used to assess the contribution of lower extremity muscle strength to all-cause mortality. RESULTS: The median age (25th and 75th percentiles) of this study population was 64 years (57 and 72 years), 53.2% of the patients were women, and the time on hemodialysis was 39.0 months (15.9 and 110.5 months) at baseline. During a median follow-up of 36.0 months, there were 30 deaths. With a multivariate Cox model, the hazard ratio in the group with a knee extensor strength of <40% was 2.73 (95% confidence interval=1.14-6.52) compared with that in the ≥40% group. LIMITATIONS: This was a small-scale observational study, and the mechanisms underlying the higher mortality risk in patients with poor muscle strength undergoing hemodialysis than in other patients undergoing hemodialysis remain to be elucidated. CONCLUSIONS: Decreased lower extremity muscle strength was strongly associated with increased mortality risk in patients undergoing hemodialysis.

Excessive fall of blood pressure during maintenance hemodialysis in patients with chronic renal failure is induced by vascular malfunction and imbalance of autonomic nervous activity.

Acute hypotension during maintenance hemodialysis (HD) is not only a critical complication, but also an independent risk factor for mortality in patients with chronic renal failure (CRF). This study was designed to clarify the mechanisms underlying excessive fall of blood pressure during HD. Fifty-six CRF patients with HD thrice a week were divided into two groups according to the intradialytic hypotension episodes after 4 weeks of the observation period; the hypotension group, showing four or more episodes of intradialytic hypotension, and the non-hypotension group, showing three episodes of intradialytic hypotension or less. The intradialytic hypotension was defined as a fall of ≥30 mm Hg in the systolic blood pressure during HD. The brachial-ankle pulse wave velocity (ba-PWV), serum high-sensitivity (hs)-CRP, reactive oxygen species (ROS) generation, and serum malondialdehyde-modified LDL (MDA-LDL) were measured before HD. The high- frequency (HF) and low-frequency components (LF) of the heart rate variability and entropy were analyzed by the maximal entropy method. The ba-PWV, hs-CRP, ROS generation, and MDA-LDL were significantly higher in the hypotension group than in the non-hypotension group. HF, LF/HF, and entropy during HD increased significantly in the non-hypotension group, while entropy during HD decreased significantly in the hypotension group as compared with the baseline. LF/HF and entropy during HD were significantly lower in the hypotension group than in the non-hypotension group. These findings suggest that the major factors causing excessive fall of blood pressure during HD in patients with CRF might be vascular malfunction and imbalance of autonomic nervous activity.

Habitual physical activity measured by accelerometer and survival in maintenance hemodialysis patients.

BACKGROUND AND OBJECTIVES: The association between mortality and physical activity based on self-report questionnaire in hemodialysis patients has been reported previously. However, because self-report is a subjective assessment, evaluating true physical activity is difficult. This study investigated the prognostic significance of habitual physical activity on 7-year survival in a cohort of clinically stable and adequately dialyzed patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 202 Japanese outpatients who were undergoing maintenance hemodialysis three times per week at the hemodialysis center of Sagami Junkanki Clinic (Japan) from October 2002 to February 2012 were followed for up to 7 years. Physical activity was evaluated using an accelerometer at study entry and is expressed as the amount of time a patient engaged in physical activity on nondialysis days. Cox proportional hazard regression was used to assess the contribution of habitual physical activity to all-cause mortality. RESULTS: The median patient age was 64 (25th, 75th percentiles, 57, 72) years, 52.0% of the patients were women, and the median time on hemodialysis was 40.0 (25th, 75th percentiles, 16.8, 119.3) months at baseline. During a median follow-up of 45 months, 34 patients died. On multivariable analysis, the hazard ratio for all-cause mortality per 10 min/d increase in physical activity was 0.78 (95% confidence interval, 0.66-0.92; P=0.002). CONCLUSIONS: Engaging in habitual physical activity among outpatients undergoing maintenance hemodialysis was associated with decreased mortality risk.

Effects of prolonged expiration breathing on cardiopulmonary responses during incremental exercise.

This study was designed to clarify the effects of breathing with prolonged expiration on cardiopulmonary responses and autonomic nervous activity during incremental exercise. Eleven healthy men were randomly assigned to breathing mode: a prolonged expiration breathing with a 2-s inspired time and 4-s expired time and a spontaneous breathing without any constraints. Oxygen uptake (V(O2)), ventilation efficiency (V(E)/V(CO2)) and rate pressure product were measured. Low- (LF) and high-frequency (HF) components of blood pressure and heart rate variability were analyzed to assess sympathetic and parasympathetic nervous activities, respectively. V(E)/V(CO2), rate pressure product and LF were significantly lower, and [Formula: see text] and HF were significantly higher during exercise with prolonged expiration than with spontaneous breathing. Striking effects of prolonged expiration breathing included the improvement of ventilation efficiency, the suppression of sympathetic nervous activity and the activation of parasympathetic one during incremental exercise. Furthermore, prolonged expiration breathing may have suppressed the exercise-induced increase in myocardial V(O2).

Beneficial effects of L- and N-type calcium channel blocker on glucose and lipid metabolism and renal function in patients with hypertension and type II diabetes mellitus.

It has been proved that cilnidipine has N-type calcium channels inhibitory activity as well as L-type calcium channels and inhibits excessive release of norepinephrine from the sympathetic nerve ending. This study was undertaken to compare the efficacy of amlodipine (an inhibitor of L-type calcium channels) and cilnidipine (an inhibitor of both L-type and N-type calcium channels) in patients with hypertension and type II diabetes mellitus. Seventy-seven hypertensive patients were divided into two groups according to presence/absence of type II diabetes mellitus. In these two groups of patients, the effects of amlodipine and cilnidipine on glucose and lipid metabolism and renal function were compared. As for glucose and lipid metabolism, homeostasis model assessment insulin resistance (HOMA-R) level in the non-diabetic group and triglyceride in the diabetes group were significantly lower with cilnidipine than with amlodipine. As regards renal function in the diabetic group, estimated glomerular filtration rate (eGFR) was significantly higher and urinary albumin/creatinine ratio was significantly lower with cilnidipine than with amlodipine. Cilnidipine which inhibits N-type calcium channels is more useful for patients with hypertension and diabetes mellitus from its effects on glucose and lipid metabolism and renal function.

Development of a novel questionnaire evaluating disability in activities of daily living in the upper extremities of patients undergoing maintenance hemodialysis.

The aim of the present study was to develop a novel questionnaire evaluating disability in the activities of daily living in the upper extremities of hemodialysis (HD) patients (QDUE-HD). We recruited 83 patients (40 males and 43 females) aged 66 ± 8 years, and measured their muscle strength and range of motion in the upper extremities. Moreover, 14 patients performed a six-week exercise training regimen (the exercise group) and were compared with 15 patients not performing such training (the control group). In an initial questionnaire consisting of 37 items, 30 were taken from the Disabilities of the Arm, Shoulder and Hand questionnaire and the Activities of Daily Living Test, and the remaining seven were selected from activities that HD patients perceived as impossible or extremely difficult to perform. The principal factor analysis focused on 11 items, as 26 showing floor and ceiling effects were excluded. These 11 items were divided into two categories consisting of six items termed "light work" and five termed "holding activities". The scores for light work and holding activities correlated significantly and positively with both muscle strength and range of motion in the upper extremities. These scores increased significantly after the six-week exercise training as compared with those before training in the exercise group. We conclude that the QDUE-HD is clinically useful for evaluating disability in activities of daily living in the upper extremities of HD patients because of its high reliability, validity and responsiveness.

Physical activity is necessary to prevent deterioration of the walking ability of patients undergoing maintenance hemodialysis.

Maintenance of the walking ability is very important for smooth continuation of maintenance hemodialysis (HD). The aim of the present study was to clarify the physical activity level in daily living that HD patients should maintain to prevent deterioration of their walking ability. Outpatients undergoing maintenance HD, consisting of 65 males and 88 females with a mean age of 64 +/- 11 years, were recruited for the present study. Their physical activity level was recorded over a week with an accelerometer. The physical activity level in daily living was defined as the sum of the lengths of time for which the patients were engaged in physical activity of light or greater intensity during the day, and expressed as the average duration per day. The walking ability was assessed by the normal walking speed and maximum walking speed. Data were analyzed using the receiver operating characteristic (ROC) curve, and the cut-off point for the physical activity time was determined to predict deterioration of the walking ability. In the prediction of deterioration of the normal and maximum walking speeds, the areas under the ROC curve for the physical activity time were 0.78 (95% confidence interval, 0.69-0.87, P < 0.001) and 0.75 (95% confidence interval, 0.63-0.86, P < 0.001), respectively. Moreover, the ROC curve revealed that the cut-off point for the physical activity time to prevent deterioration of the normal and maximum walking speeds was 50 min/day. Thus, HD patients should engage in physical activity for at least 50 min/day to prevent deterioration of their walking ability.

Effects of phase II cardiac rehabilitation on job stress and health-related quality of life after return to work in middle-aged patients with acute myocardial infarction.

The aim of the present study was to clarify the effects of phase II cardiac rehabilitation (CR) on job stress and health-related quality of life (HRQOL) after return to work in middle-aged patients with acute myocardial infarction (AMI). A total of 109 middle-aged outpatients (57 +/- 7 years) who completed a phase I CR program after AMI were enrolled, 72 of whom participated in a phase II CR program for 5 months after hospital discharge (CR group) and 37 who discontinued the phase II CR program after the discharge (non-CR group). Job stress was assessed at 6 months after the AMI using a brief job stress questionnaire containing questions related to job stressors, worksite support, level of satisfaction with work or daily life, and psychological distress. HRQOL was assessed using the short-form 36-item health survey (SF-36) at hospital discharge and at 3 and 6 months after the AMI. There were no significant differences in clinical and occupational characteristics between the CR and non-CR groups. The CR group patients exhibited significantly better results for job stressors and psychological distress and higher SF-36 scores at 6 months after the AMI, as compared with those in the non-CR group. These findings suggest that discontinuing a phase II CR program induced chronic psychosocial stress after return to work in these middle-aged post-AMI patients.