Exercise intensity of real-time remotely delivered yoga via videoconferencing: Comparison with in-person yoga.

BACKGROUND AND PURPOSE: Yoga has been studied as a rehabilitation option, but barriers to attendance remain. Videoconferencing, where participants can receive online, real-time instruction and supervision, may reduce the barriers. However, whether exercise intensity is equivalent to that of in-person yoga, and the relationship between proficiency and intensity remain unclear. The present study aimed to investigate whether the intensity of exercise is different between real-time remotely-delivered yoga via videoconferencing (RDY) and in-person yoga (IPY) and its relationship to proficiency. MATERIALS AND METHODS: Healthy yoga beginners (n = 11) and yoga practitioners (n = 11) performed yoga (Sun Salutation) consisting of 12 physical postures in real-time remotely delivered via videoconferencing and in-person (RDY, IPY, respectively), each for 10 min on different days, in random order, using an expiratory gas analyzer. Oxygen consumption was collected, metabolic equivalents (METs) were calculated based on the data, exercise intensity was compared between RDY and IPY, and differences of METs between beginners and practitioners in both interventions were also assessed. RESULTS: Twenty-two participants (mean age ± standard deviation, 47.2 ± 10.8 years) completed the study. There were no significant differences in METs between RDY and IPY (5.0 ± 0.5, 5.0 ± 0.7, respectively, P = 0.92), and no difference by proficiency level in both RDY (beginners: 5.0 ± 0.4, practitioners: 5.0 ± 0.6, P = 0.77) and IPY (beginners: 5.0 ± 0.7, practitioners: 5.0 ± 0.7, P = 0.91). No serious adverse events occurred in both interventions. CONCLUSION: The exercise intensity of RDY is equivalent to IPY regardless of proficiency with no adverse events in RDY occurring in this study.

L-menthol administration facilitates breathing comfort during exhaustive endurance running and improves running capacity in well-trained runners: A randomized crossover study.

ABSTRACTThis study aimed to clarify the contribution of L-menthol administration to endurande exercise capacity. Thirteen male runners (age, 35.8 ± 7.8 years; peak oxygen uptake, 62.7 ± 6.8 mL kg-1 min-1) ran on treadmills at fixed intensities of their anaerobic thresholds to exhaustion. All participants underwent three trials-water ingestion (W-IG), L-menthol mouth rinsing (M-MR), and L-menthol ingestion (M-IG)- in a random order every 5 min while running. Breathing comfort (BC) was measured immediately after fluid intake. Dyspnea threshold against external inspiratory resistance was examined before and after the running test. The running time with M-IG (1683.9 ± 520.3 s) was longer than that with W-IG (1410.2 ± 465.9 s, effect size [ES] = 0.55). BC with M-IG (2.00 ± 0.74) was higher than that with W-IG (0.42 ± 0.79) at exhaustion (ES > 2.00). The dyspnea threshold after running decreased to 19.2 ± 7.6 cm H2O L-1 s-1 with W-IG, whereas that with M-MR (26.2 ± 6.5 cm H2O L-1 s-1) and M-IG (29.2 ± 2.8 cm H2O L-1 s-1) remained high (p for interaction < 0.001). M-IG facilitated BC during running, improved endurance capacity, and prevented decreases in the dyspnea threshold against external inspiratory resistance after exhaustive running.HighlightsL-menthol ingestion facilitated breathing comfort during high intensity endurance running and improved exhaustive endurance running capacity.Even after exhaustion, L-menthol solution relieved dyspnea sensitivity against external inspiratory resistance.L-menthol ingestion might help athletes improve their endurance running capacity.

Role of physical therapists and aromatherapy for fall prevention in older people: A narrative review.

Falls among older people are usually the result of several causes combined. Identifying all the fall-related factors that apply to a particular individual and providing comprehensive multifactorial intervention is recommended for the prevention of falls among older people. However, the overall net benefit of multifactorial intervention in preventing falls is small, and it does not appear to improve fall-related outcomes, such as the number of fall-related injuries. Therefore, we might require new perspectives to overcome this situation. Here, we raise two novel strategies for fall prevention among older people. One is using physical therapists more actively. The other is using aromatherapy for stabilization of older people. Physical therapists should carry out detailed gait assessment and caregiver education. Aromatherapy is effective in improving balance and mental stability in older people. To overcome refractory geriatric syndrome, there is no choice but to eliminate all preconceived ideas before choosing the best fall prevention strategies. Geriatr Gerontol Int 2021; 21: 445-450.

Medical aromatherapy in geriatric syndrome.

Geriatric syndromes are symptoms and signs, such as falls, incontinence, delirium, pressure ulcers, dysphagia and so on, that often threaten the independence of older adults, rather than the disease itself. Although the syndromes are very common in older people, it is difficult to treat those by modern medicine due to their complexity. To mitigate the intractable geriatric symptoms, we review the efficacy of aromatherapy, especially for dysphagia, dyspnea, cognitive dysfunction and falls in geriatric syndrome. Olfactory stimulation using a volatile black pepper oil on institutional residents improved the swallowing reflex, which is a crucial risk factor of aspiration pneumonia. Brain imaging study showed that olfactory stimulation using volatile black pepper oil activated cerebral regions of the anterior cingulate and the insular cortex, which play a role in controlling appetite and swallowing. Also, aromatherapy with volatile l-menthol decreased the sense of dyspnea and improved the efficacy of exercise therapy. The fragrance of the combination of rosemary and lemon oils in the morning, and the combination of lavender and orange oils in the night-time were reported to improve cognition and behavioural and psychological symptoms of dementia, respectively. Also, the combination of lavender and lemon balm oils was reported to be effective for irritability-related agitation in older adults. Furthermore, aromatherapy with lavender fragrance could improve both static and dynamic balance, resulting in a reduction in the number of fallers and the incidence rate in older people. Thus, aromatherapy is a promising remedy for geriatric syndrome. Geriatr Gerontol Int 2021; 21: 377-385.

Appendicular Skeletal Muscle Mass Correlates with Patient-Reported Outcomes and Physical Performance in Patients with Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF), an incurable lung disease of unknown cause, often presents with losses of skeletal muscle mass. IPF requires comprehensive care, but it has not been investigated which skeletal muscle mass index reflects holistic management factors: pulmonary function, patient-reported outcomes (PROs), and physical performance. We compared three representative indices of skeletal muscle mass with holistic management factors in IPF patients. Twenty-seven mild to severe IPF patients (21 male) with the mean age of 76.1 ± 5.9 years were enrolled. The three indices were appendicular skeletal muscle mass index (ASMI), cross-sectional area of pectoralis major (PMCSA), and cross-sectional area of erector spinae muscles (ESMCSA). ASMI is considered as a gold standard for sarcopenia assessment, while PMCSA and ESMCSA are frequently used in IPF. As PROs, we assessed breathlessness with the modified Medical Research Council dyspnea scale (mMRC), symptoms with the chronic obstructive pulmonary disease assessment test (CAT), and health-related quality of life with St. George's Respiratory Questionnaire (SGRQ). For physical performance, peripheral muscle strength and 6-min walk distance (6MWD) were investigated. In this cross-sectional study, ASMI showed the greatest number of significantly correlated indices, such as pulmonary function, peripheral muscle strength, 6MWD, mMRC, and SGRQ. PMCSA showed the next greatest number of correlations, with peripheral muscle strength, 6MWD, and mMRC, whereas ESMCSA showed no significant correlations with any index. Thus, ASMI correlated with both PROs and physical performance, and PMCSA correlated mainly with physical performance. In conclusion, assessing ASMI is helpful for the comprehensive care of patients with IPF.

Alleviation of Dyspnea Sensation by Phototherapy in Healthy Adults.

BACKGROUND: Because both dyspnea and pain have common features from a clinical and physiologic point of view, we hypothesized that stellate ganglion irradiation by using a linear polarized near-infrared ray device, which is often used for pain management, might be applicable for dyspnea relief. To evaluate the use of stellate ganglion irradiation as a novel noninvasive treatment for dyspnea, we investigated the influence of stellate ganglion irradiation on dyspnea. METHODS: Perceptions of dyspnea were examined with or without stellate ganglion irradiation in 28 healthy adults. The sensation of breathing difficulty was induced by a two-way non-rebreathing valves with linear inspiratory resistance (R) of 0, 10, 20, and 30 cm H2O/L/s. Dyspnea was evaluated with the modified Borg scale to determine subjects' discomfort level. Stellate ganglion irradiation was performed by intermittent irradiation near the bilateral stellate ganglion by using a linear polarized near-infrared ray device. RESULTS: There were significant changes from baseline at R = 10 cm H2O/L/s (P = .007), R = 20 cm H2O/L/s (P = .005), and R = 30 cm H2O/L/s (P = .009). For each resistive load, the mean dyspnea sensation score was lower with stellate ganglion irradiation compared with sham irradiation, with significant differences (P = .003 at R = 0 cm H2O/L/s; P < .001 at R = 10, 20, 30 cm H2O/L/s). There was a significantly lower slope of the dyspnea response for the linear regression of the loads and Borg scores in the stellate ganglion irradiation versus sham treatment (P = .003). CONCLUSIONS: Stellate ganglion irradiation significantly alleviated dyspnea induced by an external inspiratory load in healthy adults. Stellate ganglion irradiation might be an option to treat dyspnea in some cases. Further studies in individuals with diverse types of dyspnea and clinical settings are warranted.

Development of the Dementia Assessment Sheet for Community-based Integrated Care System 8-items, a short version of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items, for the assessment of cognitive and daily functions.

AIM: The present study aimed to: (i) examine the reliability and validity of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items for classifying patients to the appropriate categories for glycemic targets in older patients; and (ii) develop a short version of the tool and examine its reliability and validity. METHODS: A total of 410 older individuals were recruited for this multicenter cross-sectional study. We classified them into three categories used for determining the glycemic target in older patients in Japan based on cognitive functions and activities of daily living. Exploratory factor analyses were used to select the eight items of the shorter version. The reliability and validity of the assessment tools were assessed using Cronbach's alpha coefficients and receiver operating characteristic analyses, respectively. RESULTS: The Dementia Assessment Sheet for Community-based Integrated Care System 21-items had three latent factors: cognitive function, instrumental activities of daily living and basic activities of daily living. The Dementia Assessment Sheet for Community-based Integrated Care System 8-items was developed based on each factor load quantity and was confirmed to have a strong correlation with the original version (r = 0.965, P < 0.001). Both tools significantly discriminated older adults belonging to category I from those belonging to category II or III, and category III from category I or II. CONCLUSIONS: Both tools had sufficient internal consistency and validity to classify older patients into the categories for determining the glycemic target in this population based on cognitive and daily functions. Geriatr Gerontol Int 2018; 18: 1458-1462.

Long-acting muscarinic antagonist and long-acting ß2-agonist therapy to optimize chronic obstructive pulmonary disease prior to lung cancer surgery.

Bronchodilators are essential for the perioperative management of patients with chronic obstructive pulmonary disease (COPD) undergoing surgery for lung cancer. The objective of the present study was to examine whether the usage of a long-acting ß2-agonist (LABA) with a long-acting muscarinic antagonist (LAMA) could optimize preoperative lung function and reduce the risk for postoperative pulmonary complications. Thirty-two consecutive patients with moderate-to-severe COPD who underwent a lobectomy for lung cancer and received preoperative LAMA (n=19) or LAMA/LABA (n=13) therapy between January 2005 and December 2015 were enrolled in this retrospective study. The improvement of preoperative pulmonary function and the postoperative morbidity were compared between the patients with preoperative LAMA, and LAMA/LABA therapy. Increases in the forced expiratory volume in one second (FEV1) were significantly larger in the LAMA/LABA group than in the LAMA group (0.26±0.05 l vs. 0.07±0.05 l; P=0.0145). More patients in the LAMA/LABA group than in the LAMA group showed a marked improvement of >10% in %FEV1 after bronchodilators (85 vs. 32%; P=0.0046). The incidence of postoperative pneumonia was significantly lower in the LAMA/LABA group than in the LAMA group (0 vs. 26%; P=0.044). In conclusion, the present study showed that preoperative LAMA/LABA therapy was associated with larger improvements in preoperative pulmonary function and less postoperative pneumonia than LAMA therapy. These results may lead to greater improvements in FEV1 and less postoperative pneumonia by encouraging preoperative LAMA/LABA therapy in this patient population.

Effect of olfactory stimulation with essential oils on cardiovascular reactivity during the moving beans task in stroke patients with anxiety.

OBJECTIVE: To investigate the effect of olfactory stimulation with essential oils on cardiovascular reactivity during the "moving beans" rehabilitation task in stroke patients with anxiety. METHODS: Twenty-eight stroke patients participated in this study. Blood pressure and heart rate were measured before and after finger movement tasks (e.g., moving beans and the Purdue pegboard test). Olfactory stimulation with lavender oil, grapefruit oil, and distilled water were conducted during finger tasks. Anxiety was assessed using the State Trait Anxiety Inventory (STAI)-Y2 before the finger movement tasks. RESULTS: There were no significant changes in blood pressure or heart rate activity in both finger movement tasks when stimulation of lavender oil, grapefruit oil, and distilled water was applied. However, the change values of Δ diastolic blood pressure (DBP) associated with the moving beans task indicated a significant interaction between olfactory stimulations and the groups of STAI-Y2 scores (high vs low) (p=0.03), without main effects in the olfactory stimulations and the groups of STAI-Y2 scores. CONCLUSION: Olfactory stimulation with lavender and grapefruit oil may repress the exaggerated DBP response during the moving beans task in stroke patients with higher levels of trait anxiety symptoms.

Royal jelly prevents the progression of sarcopenia in aged mice in vivo and in vitro.

Sarcopenia is characterized by the age-related loss of muscle mass and strength. One of the mechanisms of sarcopenia is the loss in the function and number of muscle satellite cells. Royal jelly (RJ) is a health food used worldwide. To obtain better digestion and absorption than RJ, protease-treated RJ (pRJ) has been developed. RJ and pRJ have been suggested to have potential pharmacological benefits such as prolonging the life span and reducing fatigue. Because these effects may improve sarcopenia and the functions of satellite cells, we examined the effects of RJ or pRJ treatment on the skeletal muscles in an animal model using aged mice. In vivo, RJ/pRJ treatment attenuated the decrease in the muscle weight and grip strength and increased the regenerating capacity of injured muscles and the serum insulin-like growth factor-1 levels compared with controls. In vitro, using isolated satellite cells from aged mice, pRJ treatment increased the cell proliferation rate, promoted cell differentiation, and activated Akt intracellular signaling pathway compared with controls. These findings suggest that RJ/pRJ treatment had a beneficial effect on age-related sarcopenia.

C-reactive protein (CRP) is a predictor of high medical-care expenditures in a community-based elderly population aged 70 years and over: the Tsurugaya project.

Because CRP is a strong independent predictor of various diseases, it was hypothesized that CRP may be a useful predictor or treatment target for medical-care expenditures. The aim of this study was to investigate the relationship between CRP and medical-care expenditures in a community-dwelling elderly population. This prospective cohort study was conducted including 925 Japanese subjects aged ≥70 years. A high-sensitivity CRP assay was used by applying the nephelometric method. Hospitalizations, outpatient visits, and expenditures were ascertained through computerized linkage with claims lodged between August 2002 and March 2008 with the Miyagi National Health Insurance (NHI) Association. Since medical-care expenditures were not normally distributed, the category of high medical-care expenditures (>75th percentile of medical-care expenditures: inpatient expenditures >$494/month; outpatient expenditure >$522/month; total expenditures >$1103/month) was used to examine the relation of CRP levels with medical-care expenditures. Multiple logistic regression analysis was used to examine the relationship between CRP cutoff points (low concentrations: <1.0mg/L; intermediate concentrations: 1.0-3.0mg/L; or high concentrations: ≥3.0 mg/L) and medical-care expenditures during 6 year-follow up period. After adjustment for potential confounding factors, a positive association of CRP with hospitalization, and total expenditures (p for trend=0.03 and 0.02, respectively) was found. An elevated baseline CRP level is an independent predictor of increases in prospective medical-care expenditures among community-dwelling elderly. Further study is required to clarify whether reducing CRP by intervention is a cost-effective measure.

Sensory stimulation to improve swallowing reflex and prevent aspiration pneumonia in elderly dysphagic people.

Morbidity and mortality from aspiration pneumonia continues to be a major health problem in the elderly. A swallowing disorder, such as a delayed triggering of the swallowing reflex, exists in patients with aspiration pneumonia. We found that the swallowing reflex in elderly people was temperature-sensitive. The swallowing reflex was delayed when the temperature of the food was close to body temperature. The actual swallowing time shortened when the temperature difference increases. The improvement of swallowing reflex by temperature stimuli could be mediated by the temperature-sensitive transient receptor potential (TRP) channel. The administration of a pastille with capsaicin as an agonist stimulus of TRPV1, a warm-temperature receptor, decreased the delay in swallowing reflex. Food with menthol, an agonist of TRPM8, a cold-temperature receptor, also decreased the delay in swallowing reflex. Olfactory stimulation such as black pepper was useful to improve the swallowing reflex for people with low activity of daily living (ADL) levels or with decreased consciousness. Oral care also shortened the latent time of swallowing reflex presumably due to stimulating the nociception of the oral cavity. A combination of these sensory stimuli may improve the swallowing disorders and prevent aspiration pneumonia.

Green tea consumption is associated with depressive symptoms in the elderly.

BACKGROUND: Green tea is reported to have various beneficial effects (eg, anti-stress response and antiinflammatory effects) on human health. Although these functions might be associated with the development and progression of depressive symptoms, no studies have investigated the relation between green tea consumption and depressive symptoms in a community-dwelling population. OBJECTIVE: The aim of this study was to investigate the relations between green tea consumption and depressive symptoms in elderly Japanese subjects who widely consumed green tea. DESIGN: We conducted a cross-sectional study in 1058 community-dwelling elderly Japanese individuals aged >or=70 y. Green tea consumption was assessed by using a self-administered questionnaire, and depressive symptoms were evaluated by using the 30-item Geriatric Depression Scale with 2 cutoffs: 11 (mild and severe depressive symptoms) and 14 (severe depressive symptoms). If a participant was consuming antidepressants, he or she was considered to have depressive symptoms. RESULTS: The prevalence of mild and severe and severe depressive symptoms was 34.1% and 20.2%, respectively. After adjustment for confounding factors, the odds ratios (95% CI) for mild and severe depressive symptoms when higher green tea consumption was compared with green tea consumption of or=4 cups green tea/d (0.56; 95% CI: 0.39, 0.81) (P for trend: 0.001). Similar relations were also observed in the case of severe depressive symptoms. CONCLUSION: A more frequent consumption of green tea was associated with a lower prevalence of depressive symptoms in the community-dwelling older population.

Dietary intakes and plasma 8-iso-prostaglandin F2alpha concentrations in community-dwelling elderly Japanese: the Tsurugaya project.

We examined the association between dietary intakes and oxidative stress status in elderly Japanese. We analyzed cross-sectional data from a community-based Comprehensive Geriatric Assessment conducted in 2002. The subjects included 961 Japanese subjects aged 70 years or older who were non-daily antioxidant supplements users. We measured plasma total 8-iso-prostaglandin (PG)F(2alpha) concentrations, a measurable lipid peroxidation biomarker, using a specific enzyme immunoassay kit. Dietary intakes were assessed through a food frequency questionnaire. Subjects were divided into three groups according to their dietary intake frequencies. Logistic regression was applied to calculate the odds ratios (ORs) for being in the highest tertile of plasma 8-iso-PGF(2alpha) concentration. Frequent intake of orange or other citrus fruits, or persimmon, strawberry, or kiwi fruit was associated with lower plasma 8-iso-PGF(2alpha) concentrations, respectively. After adjustment for potential confounders, the ORs and 95% confidence intervals (CIs) for orange or other citrus fruits were 1.00 (reference), 0.66 (0.47, 0.92), and 0.58 (0.39, 0.87) (p for trend, 0.009). Intake of persimmon, strawberry, or kiwi fruit showed similar results. These associations were partly explained by vitamin C intake. Other dietary intakes had no association. Intake of fruits may have a beneficial effect against oxidative stress in elderly Japanese.

Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project 1.

BACKGROUND: Although considerable experimental and animal evidence shows that green tea may possess potent activities of neuroprotection, neurorescue, and amyloid precursor protein processing that may lead to cognitive enhancement, no human data are available. OBJECTIVE: The objective was to examine the association between green tea consumption and cognitive function in humans. DESIGN: We analyzed cross-sectional data from a community-based Comprehensive Geriatric Assessment (CGA) conducted in 2002. The subjects were 1003 Japanese subjects aged > or =70 y. They completed a self-administered questionnaire that included questions about the frequency of green tea consumption. We evaluated cognitive function by using the Mini-Mental State Examination with cutoffs of <28, <26, and <24 and calculated multivariate-adjusted odds ratios (ORs) of cognitive impairment. RESULTS: Higher consumption of green tea was associated with a lower prevalence of cognitive impairment. At the <26 cutoff, after adjustment for potential confounders, the ORs for the cognitive impairment associated with different frequencies of green tea consumption were 1.00 (reference) for < or =3 cups/wk, 0.62 (95% CI: 0.33, 1.19) for 4-6 cups/wk or 1 cup/d, and 0.46 (95% CI: 0.30, 0.72) for > or =2 cups/d (P for trend = 0.0006). Corresponding ORs were 1.00 (reference), 0.60 (95% CI: 0.35, 1.02), and 0.87 (95% CI: 0.55, 1.38) (P for trend = 0.33) for black or oolong tea and 1.00 (reference), 1.16 (95% CI: 0.78, 1.73), and 1.03 (95% CI: 0.59, 1.80) (P for trend = 0.70) for coffee. The results were essentially the same at cutoffs of <28 and <24. CONCLUSION: A higher consumption of green tea is associated with a lower prevalence of cognitive impairment in humans.

Increased plasma 8-isoprostane levels in hypertensive subjects: the Tsurugaya Project.

To examine the relationship between 8-isoprostane and blood pressure, we measured plasma 8-isoprostane concentration and home blood pressure levels in an elderly Japanese population. Our study population comprised 569 subjects aged 70 years and over who were not receiving antihypertensive medication. On the basis of their blood pressure values, the participants were classified into three groups: normotensive (home blood pressure <135/85 mmHg), hypertensive (home blood pressure 135/85-160/90 mmHg), and severely hypertensive (home blood pressure > or =160/90 mmHg). The mean plasma 8-isoprostane level in the severely hypertensive group (21.1+/-5.2 pg/ml) was significantly higher than that in the normotensive (20.2+/-4.9 pg/ml) or hypertensive (19.7+/-5.1 pg/ml) group, and this result was unchanged when we adjusted for possible confounding factors such as age, sex, use of vitamin A, C or E supplements, smoking status, drinking status, body mass index, use of non-steroidal anti-inflammatory drugs, history of diabetes, hypercholesterolemia, home heart rate and serum creatinine level. Thus, the level of plasma 8-isoprostane appears to be elevated in older subjects with severe hypertension.