Effects of physical activity counselling in women with systemic lupus erythematosus: A randomized controlled trial.

BACKGROUND: Low physical activity is common in systemic lupus erythematosus populations. AIM: To evaluate the effect of physical activity counselling on physical activity and the association between physical activity changes and changes in fatigue, quality of sleep, and quality of life in women with systemic lupus erythematosus. METHODS: A randomized, controlled, single-blind trial was conducted from March 2015 to August 2016. Seventy-six women with systemic lupus erythematosus were randomly assigned to the intervention or control groups. The intervention group received three sessions of physical activity counselling at 1, 4, and 8 weeks and three telephone follow-ups over 13 weeks. Outcome measures, which include daily steps, fatigue, quality of sleep, and the quality of life, were collected at baseline and 8 and 12 weeks. RESULTS: The study showed that daily steps, quality of sleep, and vitality in the intervention group were significantly improved compared with those in the control group at weeks 8 and 12. Mental health was significantly improved only at week 8 in the counselling group. A positive correlation between physical activity changes and changes in vitality and mental health was observed. CONCLUSIONS: Physical activity counselling can improve physical activity. As physical activity increases, systemic lupus erythematosus women feel more energetic and happier.

Effects of 100-km ultramarathon on acute kidney injury.

OBJECTIVE: To evaluate the prevalence and characteristics of acute kidney injury (AKI) in 100-km ultramarathon runners. DESIGN: Prospective observational study. SETTING: The 2011 Soochow University ultramarathon, in which each athlete ran for 100 km. PARTICIPANTS: All Taiwanese entrants who participated in the 100-km race and lived in the northern part of Taiwan were invited to participate in the study. MAIN OUTCOME MEASURES: Acute kidney injury was defined using the Acute Kidney Injury Network criteria. Blood and urine samples were collected 1 week before, immediately after, and 1 day after the race. RESULTS: Immediately after the race, 85% (22) of the 26 subjects were diagnosed with AKI, 65% (16) with moderate dehydration, 23% (6) with muscle cramps, and 12% (3) with hematuria. Body weight was significantly decreased from prerace to all postrace measurements. Plasma levels of potassium ion, creatinine, renin, and aldosterone were significantly elevated immediately after the race and then significantly reduced 1 day after the race. Changes in plasma levels of sodium, creatine kinase, and creatine kinase-MB, as well as urine potassium and creatinine, were indicative of AKI. CONCLUSIONS: Transient AKI and muscle cramps are very common in 100-km ultramarathon runners. All transient ultra-runners who developed AKI in this study recovered their renal function 1 day later. CLINICAL RELEVANCE: Ultramarathon running is associated with a wide range of significant changes in hematological parameters, several of which can be associated with potentially serious renal and physiological abnormalities.

Collaborative evaluation and management of students' health-related physical fitness: applications of cluster analysis and the classification tree.

Health-related physical fitness has decreased with age; this is od immense concern to adolescents. School-based health intervention programs can be classified as either population-wide or high-risk approach. Although the population-wide and risk-based approaches adopt different healthcare angles, they all need to focus resources on risk evaluation. In this paper, we describe an exploratory application of cluster analysis and the tree model to collaborative evaluation of students' health- related physical fitness from a high school sample in Taiwan (n=742). Cluster analysis show that physical fitness can be divided into relatively good, moderate and poor subgroups. There are significant differences in biochemical measurements among these three groups. For the tree model, we used 2004 school-year students as an experimental group and 2005 school-year students as a validation group. The results indicate that if sit-and-reach is shorter than 33 cm, BMI is >25.46 kg/m2, and 1600 m run/walk is >534 s, the predicted probability for the number of metabolic risk factors ≥2 is 100% and the population is 41, both results are the highest. From the risk-based healthcare viewpoint, the cluster analysis can sort out students' physical fitness data in a short time and then narrow down the scope to recognize the subgroups. A classification tree model specifically shows the discrimination paths between the measurements of physical fitness for metabolic risk and would be helpful for self-management or proper healthcare education targeting different groups. Applying both methods to specific adolescents' health issues could provide different angles in planning health promotion projects.

High-altitude retinopathy after climbing Mount Aconcagua in a group of experienced climbers.

BACKGROUND: Visual disturbances after high-altitude exposure were first reported in 1969. Manifestations may include retinal hemorrhage, papilledema, and vitreous hemorrhage. METHODS: We observed a group of 6 experienced climbers who ascended Mt Aconcagua to an altitude of 6,962 m in February 2007. Visual acuity study, intraocular pressure study, visual field study, nerve fiber layer analysis, eye Doppler, laboratory studies, fundus photography, and intravenous fluorescein angiography were performed on the climbers before and after their exposures to high altitude. RESULTS: In all six study subjects, retinal vascular engorgement and tortuosity were present in varying degrees in both eyes. One of the climbers had both retinal hemorrhage and pulmonary edema. Of the two subjects who had visual field defects, one had severe nerve fiber layer defects of both eyes. Furthermore, laboratory studies of this climber showed a high level of antiphospholipid antibody. Significant reduction of the left ocular blood flow was also noted on this subject's eye Doppler examination after the Mt Aconcagua expedition. CONCLUSION: Various high-altitude retinopathies were observed in the experienced climbers of this study. As high-altitude pursuits become more popular, attention should be paid to the increasing prevalence of high-altitude retinopathy.

Efficacy of Tai Chi-Style Multi-Component Exercise on Frontal-Related Cognition and Physical Health in Elderly With Amnestic Mild Cognitive Impairment.

Early prevention from accelerated neurocognitive declines with advanced aging and the delay of the onset of dementia have became paramount for the achievement of active aging. The present study examined whether the proposed non-pharmaceutical, multi-component exercise training which combined Tai-Chi exercise, Aerobic fitness, and thera-band therapy protects against age-related neurocognitive and physical deterioration in the older participants with amnestic mild cognitive impairment (aMCI). Participants with aMCI in the quasi-experimental design were assigned to the multi-component exercise group or care control group. Evaluations of neuropsychological function and functional fitness were performed before and after 12-weeks intervention, and after 24-weeks follow-up. Our results showed that the multi-component intervention significantly improved various domains of neurocognitive function, particularly in memory- and frontal-related cognition, and better performance on functional fitness, including muscle strength, cardiopulmonary endurance, and agility. Furthermore, such beneficial effects were preserved after 24 weeks. The findings provide supportive evidence that non-pharmaceutically multi-component intervention with Tai-Chi style practice as a core exercise may protect against age-related neurocognitive and physical deficits and lay the path on developing age-friendly intervention programs to delay, or even reverse, the progression of MCI to dementia.

Urine output and performance of runners in a 12-hour ultramarathon.

OBJECTIVE: To understand the urination pattern and to determine the relationships between urine output and performance of ultramarathon runners. DESIGN: Prospective observational study. SETTING: The 2005 Soochow University international ultramarathon, in which each athlete ran for 12 hours. PARTICIPANTS: All entrants in the 12-hour race were invited to participate in the study. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Athletes were weighed immediately before and after the race. Urine samples were collected during the race and immediately after the race. RESULTS: There was a trend toward better performance of the group with less urination (LU), although the difference was not statistically significant. Further analysis of hourly running distances between groups showed better performance in the group with LU during the first 11 hours of the competition. Comparison of athletes in 3 levels of running distance (tertiles) showed statistically significant differences between groups in total urine output. The fastest tertile had lower prerace body weight and greater body weight change than the slowest and intermediate tertiles, but the differences were not statistically significant. Linear regression analysis using the stepwise method showed that total urine output and prerace body weight were negatively associated with performance. CONCLUSIONS: Runners with LU had better performance during the first 11 hours of the competition. Linear regression analysis showed that total urine output and prerace body weight were negatively associated with performance.

Short-term altitude mountain living improves glycemic control.

The aim of this study was to investigate the effect of mountain living conditions and high altitude hiking activities on glucose tolerance. In study I, we performed an oral glucose tolerance test on nine untrained subjects before and after 3 days of mountain living. In study II, the same measurement was used to determine the effect of high altitude hiking in two distinct geographic environments; participants included 19 professionally trained mountaineers. We found that trained mountaineers displayed significantly better sea-level glucose tolerance than sedentary subjects of a similar age (p < 0.05). This result suggests that mountaineering training could produce a beneficial effect on glucose tolerance. More importantly, in study I we demonstrated that 3 days of high altitude living (altitude approximately 2400 m) was sufficient to improve glucose tolerance. Furthermore, hiking in a relatively flat plateau area (Pamirs highland area, China, altitude approximately 4000 m) generated significantly better improvement in glucose tolerance than hiking in a mountain that contained many rough hills at a similar altitude (Mountain Snow, Taiwan, altitude approximately 3800 m). In conclusion, we found that living at a high altitude for the short term can significantly improve glucose tolerance. Additionally, the improving effect of hiking at high altitudes on glucose tolerance appears to be influenced by the geographic environment. These preliminary results suggest that high altitude living conditions and activities may possibly be developed as potential natural medicines for the prevention and treatment of type II diabetes in the future.

Impact of Center-of-Mass Acceleration on the Performance of Ultramarathon Runners.

Ultramarathon races are rapidly gaining popularity in several countries, raising interest for the improvement of training programs. The aim of this study was to use a triaxial accelerometer to compare the three-dimensional center-of-mass accelerations of two groups of ultramarathon runners with distinct performances during different running speeds and distances. Ten runners who participated in the 12-h Taipei International Ultramarathon Race underwent laboratory treadmill testing one month later. They were divided into an elite group (EG; n = 5) and a sub-elite group (SG; n = 5). The triaxial center-of-mass acceleration recorded during a level-surface progressive intensity running protocol (3, 6, 8, 9, 10, and 12 km/h; 5 min each) was used for correlation analyses with running distance during the ultramarathon. The EG showed negative correlations between mediolateral (ML) acceleration (r = -0.83 to -0.93, p < 0.05), and between anterior-posterior (AP) acceleration and running distance (r = -0.8953 to -0.9653, p < 0.05), but not for vertical control of the center of mass. This study suggests that runners reduce stride length to minimize mediolateral sway and the effects of braking on the trunk; moreover, cadence must be increased to reduce braking effects and enhance impetus. Consequently, the competition level of ultramarathons can be elevated.

A course to teach students to learn mobile health by serving the elderly.

We designed a special course based on Service Learning theory to train the undergraduate students to teach the elderly people in community college to learn using smartphones for health. A 2-credit course was designed, composed of lecture & discussion and community service. 20 undergrduate stundents from university and 26 seniors from community college registered at this course. The results show very postitive impacts in both groups. The students felt doing something meaningful and learning helping the elder when the elderly felt very appreciated by being served and taught by students about the smartphones. The elderly wished us to go back in the future.

Readmission, mortality, and first-year medical costs after stroke.

BACKGROUND: Stroke is the leading cause of adult disability and mortality in Taiwan, resulting in a tremendous burden on the healthcare system. The purpose of this study was to characterize disease burden by evaluating readmissions, mortality, and medical cost during the first year after acute stroke under the National Health Insurance (NHI) program. METHODS: This retrospective cohort study extracted information about patients hospitalized with acute stroke from claims data of 200,000 randomly sampled NHI enrollees in Taiwan, with a 1-year follow-up duration. The incidence of the first-year adverse events (AEs) indicated by readmissions or mortality, and the amount of the first-year medical cost (FYMC) were assessed with predictive factors explored. Additionally, we also estimated the cost per life and life-year saved. RESULTS: There were 2368 first-ever stroke patients in our study, including those with subarachnoid hemorrhage (SAH) 3.3%, intracerebral hemorrhage (ICH) 17.9%, ischemic stroke (IS) 49.8%, and transient ischemic attack/other ill-defined cerebrovascular diseases (TIA/unspecified) 29.0%; each stroke type was identified with an all-cause AE of 59.0%, 63.0%, 48.6%, and 46.8%, respectively. Readmissions were mainly because of acute recurrent stroke or the late effects of previous stroke, respiratory disease/infections, heart/circulatory disease, and diseases of the digestive system. Advanced age, hemorrhagic stroke type, respiratory distress/infections, and greater comorbidities were predictive of increased AE risk. Admission to neurology/rehabilitation wards, undertaking neurosurgery, or use of inpatient/outpatient rehabilitation was less likely to incur AEs. Initial hospitalization, readmission, and ambulatory care constituted 44%, 29%, and 27%, respectively, of FYMC with the initial length of stay being the most reliable predictor. The FYMCs were NT $217,959, $246,358, $168,003, and $122,084 for SAH, ICH, IS, and TIA/unspecified, respectively. The cost per life saved were estimated to be NT $435,919, $384,028, $196,281, and $138,888, whereas cost per life-year saved were estimated to be NT$43,926, $48,019, $97,830, and $188,770 for SAH, ICH, IS, and TIA/unspecified, respectively. CONCLUSION: Half of the patients encountered readmission or death during the first year after stroke. Patients with advanced age, more complications, or comorbidities during initial stay tended to be highly vulnerable to AE occurrence, whereas TIA/unspecified stroke carried no less risk for AEs. FYMC or estimated cost per life saved for IS or TIA/unspecified was lower relative to SAH or ICH; however, their estimated cost per life-year saved became higher because of reduced life expectancy.

Real-time electrocardiogram transmission from Mount Everest during continued ascent.

The feasibility of a real-time electrocardiogram (ECG) transmission via satellite phone from Mount Everest to determine a climber's suitability for continued ascent was examined. Four Taiwanese climbers were enrolled in the 2009 Mount Everest summit program. Physiological measurements were taken at base camp (5300 m), camp 2 (6400 m), camp 3 (7100 m), and camp 4 (7950 m) 1 hour after arrival and following a 10 minute rest period. A total of 3 out of 4 climbers were able to summit Mount Everest successfully. Overall, ECG and global positioning system (GPS) coordinates of climbers were transmitted in real-time via satellite phone successfully from base camp, camp 2, camp 3, and camp 4. At each camp, Resting Heart Rate (RHR) was transmitted and recorded: base camp (54-113 bpm), camp 2 (94-130 bpm), camp 3 (98-115 bpm), and camp 4 (93-111 bpm). Real-time ECG and GPS coordinate transmission via satellite phone is feasible for climbers on Mount Everest. Real-time RHR data can be used to evaluate a climber's physiological capacity to continue an ascent and to summit.

The effect of virtual reality-enhanced driving protocol in patients following spinal cord injury.

BACKGROUND: Ability to drive was an important factor of quality of life for subjects with spinal cord injuries (SCI). However, the effect of virtual reality (VR) environment on driving ability and simulation-based driving training of people with SCI has not yet been investigated in any systematic, objective study. The purpose of this study was to examine the effect of the virtual reality created by a driving simulator, and determine the number of simulator sessions necessary for patients with spinal cord injuries to reach maximum driving competence. METHODS: This was a longitudinal, prospective before-after trial. It was comprised of 12 spinal cord injury patients who attended driving rehabilitation between July and December 2005. At their initial and subsequent evaluations, the participants' driving skills were measured as they drove along a simulated 6 km two- and three-lane urban road with traffic signals, overpass, underpass, obstacles, and a number of straight and curved stretches of road. The primary outcome measures consisted of total driving time, average speed, center-line violation, stop-line violation, collisions, and steering/braking stability, with a sampling rate of 16 Hz. Each training session lasted for 30 minutes and was carried out twice a week for about 1.5 months. RESULTS: After 5 sessions of simulator driving training, there was a significant increase in the average speed and/or total driving time. The participants could stop their cars more precisely at the stop-line in traffic signal testing, and there was significantly less speed variation and center line violation in overpass testing. CONCLUSION: This study shows the significant effect of a virtual environment on the progress of driving rehabilitation, and suggests that incorporating virtual reality into rehabilitation programs will accelerate the maximal recovery of the patient's driving competence.

Cost-effectiveness analysis of stroke management under a universal health insurance system.

OBJECTIVE: Cost-effectiveness analysis (CEA) of stroke management was evaluated in three care models: Neurology/Rehabilitation wards (NW), Neurosurgery wards (NS), and General/miscellaneous wards (GW) under a universal health insurance system. METHODS: From 1997 to 2002, subjects with first-ever acute stroke were sampled from claims data of a nationally representative cohort in Taiwan, categorized as hemorrhage stroke (HS) including subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH); or, ischemic stroke (IS), including cerebral infarction (CI), transient ischemic attack/ unspecified stroke (TIA/unspecified); with mild-moderate and severe severity. All-cause readmissions or mortality (AE) and direct medical cost during first-year (FYMC) after stroke were explored. CEA was performed by incremental cost-effectiveness ratios. RESULTS: 2368 first-ever stroke subjects including SAH 3.3%, ICH 17.9%, CI 49.8%, and TIA/unspecified 29.0% were identified with AE 59.0%, 63.0%, 48.6%, 46.8%, respectively. There were 50.8%, 13.5%, 35.6% of stroke patients served by NW, NS and GW with AE 44.9%, 60.6%, 56.0%, and medical costs of US$ 5,031, US$ 8,235, US$ 4,350, respectively. NW was cost-effective for both mild-moderate and severe IS. NS was the dominant care model in mild-moderate HS, while NW appeared to be a cost-minimization model for severe HS. CONCLUSIONS: TIA/unspecified stroke carried substantial risk of AE. NS performed better in serving mild-moderate HS, whereas NW was the optimal care model in management of IS.

Inpatient rehabilitation utilization for acute stroke under a universal health insurance system.

OBJECTIVE: To explore the population-level utilization and factors associated with the use of inpatient stroke rehabilitation services under a single-payer government-based National Health Insurance (NHI) program in Taiwan. STUDY DESIGN: Retrospective cohort study based on claims data. METHODS: Inpatients with stroke were sampled from a nationally representative cohort of 200,000 NHI program enrollees. Multiple inpatient claims for individuals were merged to create a patient-level file; the first-ever admission was considered the index stroke. Proxy indicators to represent stroke severity, comorbidity, and complications were constructed. Predisposing, need, and enabling characteristics associated with rehabilitation use were explored. RESULTS: Among 2639 identified patients with stroke from January 1, 1997, to December 31, 2002, the overall inpatient rehabilitation utilization was 34.0% (33.0% for physical therapy, 19.6% for occupational therapy, and 5.3% for speech therapy). Stroke type and stroke severity were immediate causes of rehabilitation use. Except in neurology wards, rehabilitation use was unaffected by physician or facility characteristics. Among 898 patients receiving rehabilitation services, the median number of treatment sessions was 8 (interquartile range, 4-19), and the total rehabilitation costs were US $114.00 (interquartile range, $47.80-$258.30), with a mean (SD) length of stay of 22.2 (21.8) days. CONCLUSIONS: In a setting in which ability to pay is neutralized, inpatient stroke rehabilitation service in this universal NHI program was equitable but inadequate relative to use elsewhere or estimated need. Less severe case mix and financial or human resources constraints might partially account for the low utilization. Further studies measuring stroke severity and functional status are needed to clarify the actual utilization, requirements, and cost-effectiveness of inpatient stroke rehabilitation services.

Effect of aging on treadmill exercise induced theta power in the rat.

The effects of aging on the electroencephalogram (EEG) power spectra of 8- and 60-week-old Wistar-Kyoto rats were examined during the waking baseline and treadmill exercise. Using continuous and simultaneous recordings of EEG and electromyogram signals, this study demonstrated that the alpha (10-13 Hz), theta (6-10 Hz), and delta (0.5-4 Hz) powers of the EEG were significantly lower in older rats as compared with young rats during the waking baseline. In the young rats, treadmill exercise resulted promptly in a higher alpha power, higher theta power, and higher theta power percentage as compared with the waking baseline. In the aged rats, treadmill exercise only resulted in a higher theta power and higher theta power percentage. During the treadmill exercise, however, the aged rats still showed a significantly lower exercise-evoked theta power change than the young rats. These results suggested that aging is accompanied by lower EEG activities during waking and this also is accompanied by an attenuated response of the brain to exercise in the rat.

Athletic performance and serial weight changes during 12- and 24-hour ultra-marathons.

OBJECTIVE: The principal objective of this study was to evaluate serial weight changes in athletes during 12- and 24-hour ultra-marathons and to correlate these changes with athletic performance, namely the distance covered. DESIGN: This was a prospective study. SETTING: The 2003 Soochow University international ultra-marathon. PARTICIPANTS: Fifty-two race participants. INTERVENTIONS: 12- or 24-hour ultra-marathon. MAIN OUTCOME MEASUREMENTS: Body weight changes were measured before, at 4-hour intervals during, and immediately after the 12- and 24-hour races. RESULTS: Significant overall decreases in body weight were apparent at the conclusion of both races. The mean relative body weight change after the 12-hour race was -2.89 +/- 1.56%, ranging from 0 to 6.5%. The mean relative body weight change after the 24-hour race was -5.05 +/- 2.28%, ranging from -0.77% to -11.40%. Of runners in the 24-hour race, 26% lost greater than 7% of baseline body weight during the race. During both the 12- and 24-hour races, the greatest weight change (decrease) occurred during the first 4 hours. Weight remained relatively stable after 8 hours, although a further decrease was apparent between 16 and 20 hours in the 24-hour participants. Weight change had no bearing on performance in the 12-hour race, whereas weight loss was positively associated with performance in the 24-hour race. CONCLUSIONS: Our findings demonstrate that the majority of weight decrease/dehydration in both the 12- and 24-hour races occurred during the first 8 hours. Hence, to maintain body weight, fluid intake should be optimized in the first 8 hours for both 12- and 24-hour runners and in 16 to 20 hours for 24-hour marathon runners.

Effects of hiking at altitude on body composition and insulin sensitivity in recovering drug addicts.

In the current study individuals with a history of drug abuse (users of heroin, cocaine, or amphetamine) displayed a 13-100% increase in body weight (self-reported) and exhibited a trend toward insulin resistance. Therefore, we investigated the effects of long-term altitude hiking on insulin sensitivity in this special population. Nine males recovering from drug addiction (ex-addicts) (age 28.7 +/- 1.3 years) and 17 control subjects (age 29 +/- 1.1 years) voluntarily participated in a 25-day hiking activity (altitude 2200-3800 M). On the 25th day of hiking, oral glucose tolerance test (OGTT), insulin response, lean body mass, fat mass, and waist-to-hip ratio (WHR) were measured in all subjects. After the altitude expedition, insulin levels during the OGTT in ex-addicts were similar to controls, suggesting that insulin sensitivity in this special population was normalized by long-term altitude activity. Along with improvements in insulin sensitivity, a significant reduction in WHR, but small increase in lean body mass, was observed. Twenty-five days of altitude activity significantly reverses hyperinsulinemia in the ex-addicts and this improvement appears to be partially associated with the reduction in central fatness.