Feasibility of Seated Stepping and Handshaking as a Cardiopulmonary Exercise Testing: A Pilot Study.

Cardiopulmonary function is usually assessed by cardiopulmonary exercise testing (CPX) using a cycle ergometer (CE-CPX) or a treadmill, which is difficult in patients with lower extremity motor dysfunction. A stepping and handshaking (SHS) exercise has been developed that can be performed safely and easily while sitting on a chair. This study compared peak oxygen uptake (peak V.O2) between CE-CPX and SHS-CPX in healthy adults and investigated the safety and validity of SHS-CPX. Twenty young adults (mean age 27.8 ± 4.4 years) were randomly assigned to perform CE-CPX or SHS-CPX, with the other test to follow 1-2 weeks later. The peak V.O2, respiratory exchange ratio (RER), peak heart rate, blood pressure, and test completion time were compared between CE-CPX and SHS-CPX. All subjects completed the examination and met the criteria for peak V.O2. SHS-CPX and CE-CPX showed a strong correlation with peak V.O2 (r = 0.85, p < 0.0001). The peak V.O2 (40.4 ± 11.3 mL/min/kg vs. 28.9 ± 8.0 mL/min/kg), peak heart rate (190.6 ± 8.9 bpm vs. 172.1 ± 12.6 bpm), and test completion time (1052.8 ± 143.7 s vs. 609.1 ± 96.2 s) were significantly lower in the SHS-CPX (p < 0.0001). There were no adverse events. The peak V.O2 with SHS-CPX was equivalent to about 70% of that with CE-CPX despite the exercise being performed in a sitting position, suggesting its suitability as a submaximal exercise test.

Comparative Study of Muscle Hardness during Water-Walking and Land-Walking Using Ultrasound Real-Time Tissue Elastography in Healthy Young People.

Compared with land-walking, water-walking is considered to be beneficial as a whole-body exercise because of the characteristics of water (buoyancy, viscosity, hydrostatic pressure, and water temperature). However, there are few reports on the effects of exercise in water on muscles, and there is no standard qualitative assessment method for muscle flexibility. Therefore, we used ultrasound real-time tissue elastography (RTE) to compare muscle hardness after water-walking and land-walking. Participants were 15 healthy young adult males (24.8 ± 2.3 years). The method consisted of land-walking and water-walking for 20 min on separate days. The strain ratio of the rectus femoris (RF) and medial head of gastrocnemius (MHGM) muscles were measured before and immediately after walking using RTE to evaluate muscle hardness. In water-walking, the strain ratio significantly decreased immediately after water-walking, with p < 0.01 for RF and p < 0.05 for MHGM, indicating a significant decrease in muscle hardness after water-walking. On the other hand, land-walking did not produce significant differences in RF and MHGM. Muscle hardness after aerobic exercise, as assessed by RTE, was not changed by land walking but was significantly decreased by water walking. The decrease in muscle hardness induced by water-walking was thought to be caused by the edema reduction effect produced by buoyancy and hydrostatic pressure.

[Evaluation of supplemental and oral deglutition foods in bedridden elderly patients receiving parenteral nutrition].

BACKGROUND AND AIM: We examined oral dyskinesia (OD), wearing artificial tooth, food test findings and conducted a video - fluoroscopic swallowing study (VFSS) in bedridden elderly patients before they were received parenteral nutrition once daily. However, the validity and properties of these deglutition foods have not been evaluated. Therefore, in this study, we clarified four deglutition foods as four aspects. METHOD: Forty-five patients (23 males, mean age: 82.5 years) receiving deglutition foods were evaluated. The OD and food tests were performed at the bedside. The VFSS (dynamics of swallowing, oropharyngeal transit time, distance of hyoid bone displacement and difference in the oropharyngeal transit time) was conducted via X-rayunder administration of contrast medium mixed with food. Additionally, the physical properties of the deglutition foods were evaluated in accordance with thestandard methods for patients with dysphagia by the Ministry of Health, and Labour, Welfare and Consumer Affairs Agency. RESULTS: The mean duration receiving deglutition foods was 8 months. Although OD and wearing artificial tooth were observed in 42% of the patients, the rate of OD was significantly higher in patients receiving thick than in patients receiving jelly. The deglutition foods were classified into four types based on their physical properties (thick 1, n=18; thick 2, n=10; jelly 1, n=10; and jelly 2, n=7). The food test scores markedly differ among the four types of deglutition food. The mean score for swallowing dynamics was significantly different among the four types. Although the oropharyngeal transit time was similar for each type, the thick 1 group was divided into fast and slow transitors. The distance of hyoid bone displacement was significantly different among the four types. The oropharyngeal transit time was significantly correlated with the number of teaspoons ingested at a time. In the physical properties test, all four deglutition foods showed appropriate results; thick 1 and 2 were within the standardII category, while jelly 1 and 2 were within the standardIII category. CONCLUSION: The results of swallowing tests suggest that these four deglutition foods may be safe and reasonable for administration to bedridden elderly patients receiving parenteral nutrition.

Chronic expanding hematoma in the stumps of persons following transfemoral amputation: A report of two cases.

BACKGROUND: Two persons presented with severe stump pain following transfemoral amputation. CASE DESCRIPTION AND METHODS: A 21-year-old female and a 31-year-old male with transfemoral amputation were ambulatory with prostheses and suffered from severe stump pain caused by the presence of masses around the tip of the bone stump. From the clinical courses, imaging studies, and the intraoperative findings, the masses were diagnosed as a relatively rare condition known as chronic expanding hematoma. FINDINGS AND OUTCOME: The two patients were treated successfully with surgical resection. The hematomas were soft cystic masses with a thick capsule containing old blood clots and serous fluid. There were no pathological signs of malignancy. After surgical treatment, the patients achieved walking without stump pain. CONCLUSION: Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain. CLINICAL RELEVANCE: Stump pain is caused by many conditions. Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain.

Relation between 24-h heart rate variability and blood pressure fluctuation during exercise in stroke patients.

BACKGROUND: In some stroke patients blood pressure (BP) fluctuates extensively during medical rehabilitation, so the present study investigated the influence of autonomic nervous dysfunction on the change in BP during exercise. METHODS AND RESULTS: The subjects consisted of 55 stroke inpatients (males, 29; mean age, 58.8 years old; ischemic/hemorrhagic etiology, 30/25) who were admitted to the Stroke Center within 2 weeks of their first stroke. The control group consisted of 15 age-matched healthy volunteers. The 24-h heart rate (HR) variability (HRV) and BP variability (BPV) were examined, and then the increase and recovery of BP and HR were measured during bicycle ergometer exercise at 4 METs. Components of 24-h HRV (low-frequency power (LF), high-frequency power (HF), LF/HF, and asleep-awake ratio of LF/HF (LF/HF(d-n)) were lower (p < 0.01) and BPV was greater in the stroke group (p < 0.05) than in the control group. There was a negative correlation between BP change during exercise and LF/HF or LF/HF(d-n) (r = -0.43 or r = -0.58, p < 0.01), and a greater increase in systolic BP (102 +/-9.8 mmHg, n = 7) during exercise was observed in stroke patients with lower LF/HF(d-n) (< or = 1.0). CONCLUSIONS: Lower HRV in stroke patients may relate to an increase in BP during exercise. HRV is useful for estimating the risk during medical rehabilitation.