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1.
PLoS One ; 16(7): e0254128, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34214129

RESUMO

BACKGROUND: Limitation of instrumental activity of daily living (IADL) is independently associated with an adverse prognosis in older heart failure (HF) patients. AIMS: This multicenter study aims to examine the relationship between average daily rehabilitation time (ADRT) and risk of IADL decline during acute hospitalization in older patients with HF. METHODS: Four hundred eleven older patients who were hospitalized due to acute HF and underwent rehabilitation were divided into three groups based on the tertile of the ADRT: short, intermediate, and long groups. IADL was assessed by the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL) scale. Change in NCGG-ADL (Δ NCGG-ADL) was calculated by subtracting the pre-hospitalization score from the at-discharge score and IADL decline was defined as Δ NCGG-ADL < = -1 point. Logistic regression analysis was carried out examining the association between ADRT and occurrence of IADL decline. RESULTS: The ADRT was 23.9, 32.0, and 38.6 minutes in short, intermediate, and long group, respectively. The proportion of patients with IADL decline during hospitalization was 21% among all subjects and short group had the highest proportion of IADL decline (33%) and long group had the lowest proportion (14%). The long group had significantly lower odds of IADL decline compared with the short group (OR:0.475, 95% CI:0.231-0.975, P = 0.042). Among the items of NCGG-ADL scale, significant decreases in the "go out by oneself", "travel using a bus or train", "shop for necessities", "vacuum", and "manage medication" were observed at discharge compared to pre-hospitalization in the short group (p<0.01, p<0.01, p<0.01, p<0.05, and p<0.05). CONCLUSIONS: The present study demonstrated that short of ADRT may be associated with the risk of IADL decline during hospitalization in older patients with HF.


Assuntos
Terapia por Exercício/estatística & dados numéricos , Insuficiência Cardíaca/fisiopatologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Vida Independente/estatística & dados numéricos , Masculino , Estudos Prospectivos , Fatores de Risco
2.
Int J Rehabil Res ; 44(3): 200-204, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34034289

RESUMO

During the nationwide state of emergency, many hospitals could not provide outpatient cardiac rehabilitation for cardiac disease patients in order to minimize coronavirus disease 2019 (COVID-19) incidence. The purpose of this study was to examine the trajectories of frailty, physical function and physical activity levels due to interruption and resumption of outpatient cardiac rehabilitation by COVID-19 in elderly heart failure patients. Fifteen patients who did not attend outpatient cardiac rehabilitation during the state of emergency but resumed it after the state of emergency were included. Frailty, physical function and physical activity levels were assessed with the Kihon checklist (KCL), various tests including short physical performance battery (SPPB), and life space assessment (LSA), respectively. Objective parameters were measured at three points; before and after the nationwide state of emergency in Japan and 3 months after resuming outpatient cardiac rehabilitation. The post-state of emergency KCL score was significantly higher than the pre-state of emergency score (P = 0.03), whereas there was no significant difference in KCL between post-state of emergency and 3 months after cardiac rehabilitation resumption. SPPB and LSA scores did not change significantly between pre- and post-state of emergency. The changes in LSA from post-state of emergency to 3 months after cardiac rehabilitation resumption tended to correlate with changes in KCL (r = -0.71, P = 0.11). We demonstrated that frailty status deteriorated significantly in elderly heart failure patients whose outpatient cardiac rehabilitation was interrupted due to COVID-19. In addition, the frailty status showed no significant improvement after 3 months of resuming cardiac rehabilitation.


Assuntos
COVID-19 , Reabilitação Cardíaca , Exercício Físico , Fragilidade/complicações , Insuficiência Cardíaca/reabilitação , Retenção nos Cuidados , Idoso , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Insuficiência Cardíaca/complicações , Humanos , Pacientes Ambulatoriais , SARS-CoV-2 , Volume Sistólico
3.
Injury ; 52(7): 1978-1984, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34030864

RESUMO

INTRODUCTION: Only a few reports have described calcaneal insufficiency fractures (IFs) following total knee arthroplasty (TKA). Herein, we describe nine cases of calcaneal IFs following ipsilateral TKA. The purpose of this study was to investigate the incidence of calcaneal fractures following TKA and determine the characteristics of patients with IFs. PATIENTS AND METHODS: We retrospectively investigated cases of calcaneal IF that occurred following TKA. We collected and analyzed radiographic and magnetic resonance imaging (MRI) findings as well as patient demographic data. We compared the demographic data, bone mineral density (BMD), and preoperative hip-knee-ankle angle (HKA) between cases with a calcaneal fracture following TKA and 100 cases without a fracture following TKA. RESULTS: We performed a total of 1548 knee arthroplasties at our clinic from 2011 to 2020. Nine calcaneal IFs in eight patients were diagnosed following ipsilateral TKA. All patients were women with varus knee osteoarthritis (mean age, 71.8 years). The average change in the alignment angle was 14.7° ± 5.4°. In eight cases, dysfunction was observed in the opposite lower limb. The postoperative onset of hindfoot pain started at an average of 5.6 months. In seven patients, calcaneal fractures occurred idiopathically, but in one patient, two fractures occurred after long-distance walking. No abnormal findings on a calcaneus radiograph were seen for six fractures. MRI demonstrated a definite fracture line and bone marrow edema in all patients. All patients, except one with type 2 diabetes mellitus (T2DM), had osteoporosis. Fractures healed without complications in eight patients; however, the calcaneal anterior facet fracture became displaced and caused a flat foot in one case. The calcaneal IF rate was 0.58% among all cases. Besides one case with T2DM, significant differences were observed in preoperative HKA and BMD between cases with a calcaneal fracture following TKA and those without a fracture. CONCLUSIONS: A change in the load on the calcaneus due to changes in the alignment of the lower extremities after TKA may cause calcaneal IFs. Orthopedic surgeons should be aware of the possible occurrence of calcaneal IFs following TKA, especially in women with osteoporosis and severe varus knee.


Assuntos
Artroplastia do Joelho , Calcâneo , Diabetes Mellitus Tipo 2 , Fraturas de Estresse , Osteoartrite do Joelho , Idoso , Artroplastia do Joelho/efeitos adversos , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Feminino , Fraturas de Estresse/diagnóstico por imagem , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/etiologia , Humanos , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos
4.
Phys Ther Res ; 24(1): 52-68, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33981528

RESUMO

OBJECTIVE: Early mobilization and rehabilitation has become common and expectations for physical therapists working in intensive care units have increased in Japan. The objective of this study was to establish consensus-based minimum clinical practice standards for physical therapists working in intensive care units in Japan. It also aimed to make an international comparison of minimum clinical practice standards in this area. METHODS: In total, 54 experienced physical therapists gave informed consent and participated in this study. A modified Delphi method with questionnaires was used over three rounds. Participants rated 272 items as "essential/unknown/non-essential". Consensus was considered to be reached on items that over 70% of physical therapists rated as "essential" to clinical practice in the intensive care unit. RESULTS: Of the 272 items in the first round, 188 were deemed essential. In round 2, 11 of the 62 items that failed to reach consensus in round 1 were additionally deemed essential. No item was added to the "essential" consensus in round 3. In total, 199 items were therefore deemed essential as a minimum standard of clinical practice. Participants agreed that 42 items were not essential and failed to reach agreement on 31 others. Identified 199 items were different from those in the UK and Australia due to national laws, cultural and historical backgrounds. CONCLUSIONS: This is the first study to develop a consensus-based minimum clinical practice standard for physical therapists working in intensive care units in Japan.

5.
Artigo em Inglês | MEDLINE | ID: mdl-32764418

RESUMO

BACKGROUND: Aerobic exercise is known to reduce arterial stiffness; however, high-intensity resistance exercise is associated with increased arterial stiffness. Stretching exercises are another exercise modality, and their effect on arterial stiffness remains unclear. The purpose of this study was to determine whether stretching exercises reduce arterial stiffness in middle-aged and older adults, performing the first meta-analysis of currently available studies. METHODS: We searched the literature for randomized controlled trials (RCTs) and non-RCTs published up to January 2020 describing middle-aged and older adults who participated in a stretching intervention vs. controls without exercise training. The primary and secondary outcomes were changes in arterial stiffness and vascular endothelial function and hemodynamic status. Pooled mean differences (MDs) and standard MDs (SMDs) with 95% confidence intervals (CIs) between the intervention and control groups were calculated using a random effects model. RESULTS: We identified 69 trials and, after an assessment of relevance, eight trials, including a combined total of 213 subjects, were analyzed. Muscle stretching exercises were shown to significantly reduce arterial stiffness and improve vascular endothelial function (SMD: -1.00, 95% CI: -1.57 to -0.44, p = 0.0004; SMD: 1.15, 95% CI: 0.26 to 2.03, p = 0.01, respectively). Resting heart rate (HR) and diastolic blood pressure (DBP) decreased significantly after stretching exercise intervention (MD: -0.95 beats/min, 95% CI: -1.67 to -0.23 beats/min, p = 0.009; MD: -2.72 mm Hg, 95% CI: -4.01 to -1.43 mm Hg, p < 0.0001, respectively) Conclusions: Our analyses suggest that stretching exercises reduce arterial stiffness, HR, and DBP, and improve vascular endothelial function in middle-aged and older adults.


Assuntos
Exercício Físico , Rigidez Vascular , Idoso , Pressão Sanguínea , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
J Cardiol ; 75(6): 600-605, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32098749

RESUMO

BACKGROUND: To determine whether baseline gait speed predicts mortality after transcatheter aortic valve implantation (TAVI), a meta-analysis of currently available studies was performed. METHODS: To identify all studies researching the impact of preprocedural gait speed on mortality after TAVI, PubMed and Web of Science were searched through May 2019. Adjusted (if unavailable, unadjusted) hazard/odds ratios (ORs/HRs) with their confidence interval of mortality for slow (if available, the slowest) versus fast (if available, the fastest) gait speed (with cut-off values defined in each study) and those for unable to walk versus walker (if available, with the fastest gait speed) were extracted from each study, and then separately pooled by means of inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. RESULTS: Twelve eligible studies (7 and 5 based on the distance-limited and time-limited walk test, respectively) were identified and integrated in the present meta-analysis. The pooled analysis of all ORs/HRs demonstrated that slow walkers (primary meta-analysis; OR/HR, 2.38; p < 0.00001) and unable to walk (OR/HR, 1.75; p = 0.01) were significantly associated with increased mortality. The subgroup analysis for the primary meta-analysis indicated no significant subgroup difference between studies utilizing the 4-m/5-m/15-foot walk test and those applying the 6-min walk test (p = 0.45). Combining studies with 1-year follow-up did not alter the primary result (p < 0.0001). Pooling studies with adjusted ORs/HRs did not change the principal result (p = 0.0002). No funnel plot asymmetry for the primary meta-analysis was identified. CONCLUSIONS: Slow baseline gait speed (and unable to walk) is associated with increased mortality after TAVI.


Assuntos
Marcha , Substituição da Valva Aórtica Transcateter/mortalidade , Humanos
7.
Gen Thorac Cardiovasc Surg ; 68(9): 914-921, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31865600

RESUMO

OBJECTS: The aim of this study was to determine the association between underweight or obese status and hospital- acquired functional decline (HAFD) following cardiovascular surgery. METHODS: We performed a retrospective, observational, multicenter cohort study of cardiovascular surgery patients between April, 2010, and June, 2017. Body mass index (BMI) was categorized into four classes: underweight group (< 18.5 kg/m2), normal weight group (18.5 to < 25 kg/m2), overweight group (25 to < 30 kg/m2), and obese group (≥ 30 kg/m2). HAFD was defined as a decrease of at least one point on the short physical performance battery score at discharge, compared with the preoperative score. RESULTS: A total of 3,850 adult patients were included in the analysis data set (median age 72 years, 35% female). A total of 811 (21.0%) patients demonstrated HAFD: 27.2% in the underweight group, 21.3% in the normal weight group, 18.8% in the overweight group, and 19.3% in the obese group. The relative risk for HAFD was 1.381 (95% CI 1.052-1.814) for the underweight group versus the normal weight group, although that is comparable to the obese group after adjustment by confounding factors. Analyses of subgroup interactions showed that the relative risk of HAFD in the obese group compared with the normal group was higher in patients with muscle wasting (p < 0.05). CONCLUSION: HAFD was significantly worse for underweight patients following cardiovascular surgery. In contrast, obese status was not associated with HAFD, exclusive of the obese patients with muscle wasting.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares , Obesidade/fisiopatologia , Desempenho Físico Funcional , Magreza/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Fatores de Risco , Magreza/complicações
8.
Phys Ther Res ; 22(1): 1-8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31289706

RESUMO

OBJECTIVE: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The aim of this multicenter study was to determine the relationship between POAF and patients' progress in early rehabilitation after heart valve surgery. METHODS: We enrolled 302 patients (mean age, 69±10 years) who had undergone heart valve surgery. POAF was monitored using continuous electrocardiogram telemetry, and the Short Physical Performance Battery (SPPB) was used to assess lower-extremity function before surgery and at the time of discharge. Progress in early rehabilitation was evaluated by the duration from the surgery to independent walking. We determined factors associated delayed early rehabilitation and evaluated the interplay of POAF and delayed early rehabilitation in increasing the risk of decline in lower-extremity function from preoperatively to hospital discharge. RESULTS: Multivariate analysis determined POAF to be independent predictors of delayed early rehabilitation after heart valve surgery (OR: 3.906, P = .01). The association between delayed early rehabilitation and decline in lower extremity function was stronger in patients with POAF (OR: 2.73, P = .041) than in those without (OR: 2.22, P = .052). CONCLUSIONS: POAF was clinical predictors of delayed early rehabilitation in patients undergoing heart valve surgery. The combination of POAF with delayed early rehabilitation conferred a high risk of decline in lower-extremity function during hospitalization.

9.
Eur J Prev Cardiol ; 26(18): 1931-1940, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31272205

RESUMO

AIMS: The efficacy and safety of cardiac rehabilitation for patients with persistent atrial fibrillation who restored sinus rhythm after catheter ablation remains unclear. The aim of the present study was to evaluate the effects of cardiac rehabilitation on exercise capacity, inflammatory status, cardiac function, and safety in patients with persistent atrial fibrillation who had catheter ablation. METHODS: In this randomized controlled study, 61 patients treated with catheter ablation for persistent atrial fibrillation (male, 80%; mean age, 66 ± 9 years) were analyzed. Thirty patients underwent cardiac rehabilitation (rehabilitation group), whereas the remaining 31 patients received usual care (usual care group). The rehabilitation group underwent endurance and resistance training with moderate intensity, at least three times per week for six months. Six-minute walk distance, muscle strength, serum high-sensitivity C-reactive protein, plasma pentraxin 3, left ventricular ejection fraction and atrial fibrillation recurrence were assessed at baseline and at six-month follow-up. RESULTS: In the rehabilitation group, significant increases in the six-minute walk distance, handgrip strength, leg strength and left ventricular ejection fraction and significant decreases in high-sensitivity C-reactive protein and plasma pentraxin 3 concentrations were observed at six-month follow-up compared with baseline (all p < 0.05). No significant changes were observed in the usual care group. During the six-month follow-up period, the number of patients with atrial fibrillation recurrence was six (21.4%) in the rehabilitation group and eight (25.8%) in the usual care group (risk ratio, 0.83; 95% confidence interval, 0.33 to 2.10). CONCLUSIONS: Cardiac rehabilitation improved exercise capacity without increasing the risk for atrial fibrillation recurrence. It may also be effective in managing systemic inflammatory status and systolic left ventricular function in patients with persistent atrial fibrillation treated with catheter ablation.


Assuntos
Fibrilação Atrial/terapia , Reabilitação Cardíaca/métodos , Ablação por Cateter , Terapia por Exercício/métodos , Idoso , Fibrilação Atrial/fisiopatologia , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Resultado do Tratamento
10.
J Cardiol ; 74(3): 279-283, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31230900

RESUMO

BACKGROUND: As few studies have examined physical functioning changes after cardiac surgery, the factors related to the decline in physical functioning remain unclear. This study aimed to investigate the factors related to physical functioning decline after cardiac surgery in older patients. METHODS: The final study sample consisted of 523 older (≥65 years) patients (age 74.2±6.1 years, 66% male) who underwent cardiac surgery at 8 Japanese institutions. We excluded patients who were unable to walk independently or had a slow gait speed (<0.8m/s) before surgery, and those who were unable to regain independent walking after surgery. We divided the patients into two groups, a decline-in-gait-speed group and a non-decline-in-gait-speed group, according to whether their gait speed was less than 0.8m/s at discharge. We analyzed patients' clinical characteristics to identify the factors that predicted the postoperative decline in gait speed. RESULTS: Eighty-nine patients (17.0%) showed a postoperative decline in gait speed. Multivariate logistic regression analysis showed that the following factors predicted a postoperative decline in gait speed: age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.02-1.11]; estimated glomerular filtration rate (OR 0.98, CI 0.96-0.99); preoperative gait speed (OR 0.01, CI 0.00-0.08); and the postoperative day on which the patient could walk independently (OR 1.08, CI 1.02-1.14). CONCLUSIONS: Physical functioning declined in 17% of patients after surgery. The decline could be predicted by several clinical factors, including some that are modifiable. These results suggest that further interventional research on rehabilitation before and after cardiac surgery for older patients might help overcome the decline in physical functioning.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Desempenho Físico Funcional , Velocidade de Caminhada , Caminhada , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Avaliação Geriátrica , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Período Pós-Operatório , Estudos Retrospectivos
11.
J Phys Ther Sci ; 31(4): 318-325, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31037002

RESUMO

[Purpose] Considering that respiratory muscle fatigue is a cause of respiratory failure, we aimed to clarify the characteristics of respiratory muscle fatigue under inhalation load and investigate its impact on individual respiratory muscles. [Participants and Methods] The study included 14 healthy adult male volunteers. Maximal inspiratory and expiratory mouth pressures were measured under inhalation load and while at rest. The statuses of the trapezius, sternocleidomastoid, pectoralis major, diaphragm, rectus abdominis, and external and internal abdominal oblique muscles were also assessed using electromyographic frequency analysis. [Results] The maximal inspiratory and expiratory mouth pressures decreased over time and recovered after rest. The median power frequency decreased significantly in the sternocleidomastoid and rectus abdominis muscles at maximal inspiratory and expiratory mouth pressures, respectively, under inhalation load. [Conclusion] As a characteristic of respiratory muscle fatigue, there is a possibility that decreases in maximal inspiratory and expiratory mouth pressures as a result of the inhalation load affect muscle fatigue in the sternocleidomastoid and rectus abdominis muscles.

12.
Arch Gerontol Geriatr ; 83: 204-210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31082565

RESUMO

BACKGROUND: This study aimed to examine the relationship between preoperative frailty and the reacquisition of walking ability in patients after cardiac surgery. METHODS: 450 patients who underwent cardiac surgery were included as subjects. We implemented the Short Physical Performance Battery (SPPB) before surgery and classified subjects into three groups according to the SPPB score: SPPB 10-12, SPPB 7-9, and SPPB 0-6. We examined the postoperative day and the rate of the reacquisition of walking ability after surgery, and compared them among three groups. In addition, we calculated the cutoff value for the SPPB score to regain walking ability by performing a receiver operating characteristic curve analysis. RESULTS: The postoperative day of the reacquisition of walking ability in SPPB 10-12 was earlier than other groups (SPPB 10-12: 4.0 days, SPPB 7-9: 4.5 days, SPPB 0-6: 6.0 days, p < 0.01), and SPPB 0-6 was lower than other groups in the rate of the reacquisition of walking ability (SPPB 10-12: 98.8%, SPPB 7-9: 96.4%, SPPB 0-6: 76.2%, p < 0.01). The cutoff value for SPPB was ≧9(Area under the curve: 0.85, sensitivity: 0.82, specificity: 0.71, p < 0.001). CONCLUSION: Preoperative frailty affected the day of the reacquisition of walking ability in patients after cardiac surgery. The preoperative SPPB cutoff value which indicates the feasibility of reacquisition walking ability after surgery was ≧ 9.


Assuntos
Procedimentos Cirúrgicos Cardíacos/reabilitação , Fragilidade , Caminhada , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino
14.
J Vasc Surg ; 69(3): 933-943, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30578072

RESUMO

OBJECTIVE: Low exercise capacity preoperatively leads to increased postoperative complications, perioperative mortality, length of stay, and inpatient costs among patients going through elective abdominal aortic aneurysm (AAA) surgery. Therefore, exercise training may be extremely important for reducing perioperative adverse events in AAA patients. This paper aimed to perform a meta-analysis of randomized controlled trials to evaluate the safety of exercise training and its effects on exercise capacity in AAA patients. METHODS: We searched for randomized controlled trials published up to December 2017 that compared exercise training vs usual care without exercise training in AAA patients. The primary outcome was safety, specifically the occurrence of cardiovascular adverse events during the study. Secondary outcomes were changes in AAA diameter, inflammation markers, and exercise capacity based on peak oxygen consumption (peak V˙o2) and anaerobic threshold (AT). RESULTS: We identified 341 trials, and after an assessment of relevance, 7 trials with a combined total of 489 participants were analyzed. There were a total of two cardiovascular adverse events during the exercise test and training, and the cardiovascular event rate and its 95% confidence interval (CI) were 0.8% and 0.2% to 3.1%. Exercise training did not tend to increase AAA diameter, and it also tended to decrease high-sensitivity C-reactive protein level in patients with AAA. All studies that evaluated the changes in AAA diameter or high-sensitivity C-reactive protein level involved patients with AAA diameter <55 mm at baseline; there was no study involving participants with AAA diameter ≥55 mm at baseline. Exercise training significantly increased peak V˙o2 (pooled mean difference, 1.67 mL/kg/min; 95% CI, 0.69-2.65; P < .001) and AT (pooled mean difference, 1.98 mL/kg/min; 95% CI, 0.77-3.19; P < .001) in AAA patients. The result of meta-regression suggested that the effects of exercise training on peak V˙o2 and AT were not modulated by the exercise duration. CONCLUSIONS: Our analyses suggested that exercise training among AAA patients is generally safe, although future research should be carried out to further clarify the safety among patients with large AAAs. Exercise training improved peak V˙o2 and AT in AAA patients. More data are required to identify the optimal exercise duration for improving exercise capacity in patients with AAA.


Assuntos
Aneurisma da Aorta Abdominal/terapia , Terapia por Exercício , Tolerância ao Exercício , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
15.
J Phys Ther Sci ; 30(3): 413-418, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29581662

RESUMO

. [Purpose] This study aimed to evaluate the relationship between advanced glycation end-product accumulation and pulmonary function in a general population with normal spirometry results. [Subjects and Methods] A total of 201 subjects (mean age, 56 ± 11 years; males, 58%) enrolled in this study. Subjects were classified into two groups (younger group [<65 years old] and elderly group [≥65 years old]). Skin autofluorescence was assessed as an estimate of advanced glycation end-product. Forced vital capacity and forced expiratory volume in one second were measured using a spirometer, and the forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC) was calculated. [Results] Skin autofluorescence was not an independent factor associated with FEV1/FVC in the younger group, but both skin autofluorescence and pack-years of smoking were significant independent factors associated with FEV1/FVC in the elderly group. [Conclusion] Advanced glycation end-product accumulation, assessed by skin autofluorescence, is an independent factor negatively associated with FEV1/FVC in elderly people with normal spirometry results.

16.
Int J Rehabil Res ; 40(3): 193-201, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28796004

RESUMO

Exercise training has become part of the standard care for patients with cardiovascular disease. We investigated the effects of exercise training on exercise capacity, cardiac function, BMI, and quality of life in patients with atrial fibrillation (AF). We searched for randomized-controlled trials of supervised exercise training versus care without exercise training (the control) in patients with permanent or nonpermanent AF published up to November 2016. Standard mean differences (SMD) or mean differences (MD), and 95% confidence intervals (CIs) were calculated using random-effect models. We identified 259 trials, and after an assessment of relevance, five trials with a combined total of 379 participants were analyzed. In AF patients, exercise training significantly improved exercise capacity and left ventricular ejection fraction compared with the control (SMD: 0.91, 95% CI: 0.70 to 1.12; MD: 4.8%, 95% CIs: 1.56 to 8.03, respectively). Compared with the control, exercise training also significantly reduced BMI (MD: -0.47 kg/m, 95% CIs: -0.89 to -0.06) and significantly improved scores in the 'general health' and 'vitality' sections of the 36-item Short Form Health Status Survey (SMD: 0.71, 95% CIs: 0.30 to 1.12; SMD: 0.81, 95% CIs: 0.40 to 1.23, respectively). Exercise training improved exercise capacity, left ventricular ejection fraction, and some the 36-item Short Form Health Status Survey scores, and reduced BMI in AF patients.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/reabilitação , Índice de Massa Corporal , Teste de Esforço , Exercício Físico/fisiologia , Condicionamento Físico Humano/fisiologia , Qualidade de Vida/psicologia , Função Ventricular Esquerda/fisiologia , Idoso , Fibrilação Atrial/psicologia , Fibrilação Atrial/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Cardiopulm Rehabil Prev ; 37(2): 130-138, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28225475

RESUMO

PURPOSE: Endurance training improves oxidative stress and vascular endothelial dysfunction in patients with chronic heart failure (CHF). However, patients with CHF and an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) often avoid endurance training for fear of ICD shock. Recent studies have reported that stretching exercises enhance antioxidant activity and improve vascular responses. Therefore, we aimed to assess the effects of 4 weeks of stretching exercises on oxidative stress and vascular endothelial function in patients with CHF with an ICD or CRT-D. METHODS: Fifty sedentary patients with CHF (78% males; mean age = 70 ± 9 years; left ventricular ejection fraction = 26% ± 8%) with an ICD or CRT-D were randomly divided into a group that performed 4 weeks of stretching exercises (stretching group) and a group that continued a sedentary lifestyle (control group). We compared the reactive hyperemia peripheral arterial tonometry (RH-PAT) index and blood parameters, such as von Willebrand factor (vWF), malondialdehyde-modified low-density lipoprotein cholesterol (MDA-LDL), reactive oxygen species (ROS), high-sensitivity C-reactive protein, pentraxin 3, and fibrinogen between the 2 groups before and after the 4-week study period. RESULTS: In the stretching group, a significant increase in the RH-PAT index and significant decreases in vWF, MDA-LDL, ROS, and fibrinogen concentrations were observed after the study compared with before (all P < .05). No significant changes were observed in the control group. CONCLUSION: Four weeks of stretching exercises improved vascular endothelial dysfunction through attenuation of oxidative stress in sedentary patients with CHF with an ICD or CRT-D.


Assuntos
Desfibriladores Implantáveis , Endotélio Vascular/fisiopatologia , Insuficiência Cardíaca/terapia , Exercícios de Alongamento Muscular/métodos , Estresse Oxidativo/fisiologia , Disfunção Ventricular Esquerda/terapia , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia
18.
Geriatr Gerontol Int ; 17(5): 785-790, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27119258

RESUMO

AIM: The present study aimed to investigate the relationship between advanced glycation end-product accumulation and skeletal muscle mass among middle-aged and older Japanese men and women. METHODS: A total of 132 participants enrolled in this cross-sectional study. Skin autofluorescence was assessed as a measure of advanced glycation-end products. Appendicular skeletal muscle mass was measured using dual-energy X-ray absorptiometry, and skeletal muscle index was calculated by dividing appendicular skeletal muscle mass by height squared. Participants were divided into two groups (low skeletal muscle index and normal skeletal muscle index) using the Asian Working Group for Sarcopenia's skeletal muscle index criteria for diagnosing sarcopenia. Multivariate logistic regression analysis and the area under the receiver operating characteristic curve were used to determine significant factors associated with low skeletal muscle index. RESULTS: Participants consisted of 70 men (mean age 57 ± 10 years) and 62 women (mean age 60 ± 11 years). There were 31 and 101 participants in the low and normal skeletal muscle index groups, respectively. Skin autofluorescence was significantly higher in the low skeletal muscle index group compared with the normal skeletal muscle index group (P < 0.01). Skin autofluorescence was a significant independent factor associated with low skeletal muscle index based on multivariate logistic regression analysis (odds ratio 15.7, 95% confidence interval 1.85-133.01; P = 0.012). The cut-off for skin autofluorescence was 2.45 arbitrary units, with a sensitivity of 0.75 and specificity of 0.91. CONCLUSIONS: Skin autofluorescence was an independent factor associated with low skeletal muscle index among middle-aged and older Japanese men and women. Geriatr Gerontol Int 2017; 17: 785-790.


Assuntos
Produtos Finais de Glicação Avançada/metabolismo , Músculo Esquelético/metabolismo , Sarcopenia/metabolismo , Absorciometria de Fóton , Idoso , Biomarcadores/sangue , Biomarcadores/urina , Índice de Massa Corporal , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/epidemiologia
19.
J Phys Ther Sci ; 28(2): 621-5, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27065553

RESUMO

[Purpose] This study aimed to elucidate characteristics of postoperative physical functional recovery in octogenarians undergoing coronary artery bypass graft surgery. [Subjects and Methods] This was a multi-center, retrospective study. Nine hundred and twenty-seven elective isolated coronary artery bypass graft surgeries were evaluated (746 males and 181 females, mean age: 68.6 years, range: 31-86 years). Participants were stratified according to age < 80 years (n = 840; mean age, 67.1; range, 31-79) or > 80 years (n = 87; mean age, 82.2; range, 80-86). Patient characteristics and postoperative physical functional recovery outcomes were compared between groups. [Results] There was no significant difference between groups when considering the postoperative day at which patients could sit on the edge of the bed, stand at bedside, or walk around the bed. The postoperative day at which patients could walk 100 m independently was later in octogenarians, when compared with non-octogenarians (6.1 ± 3.2 days vs. 4.9 ± 3.9 days). In octogenarians, the percentage of patients who could walk 100 m independently within 8 days after surgery was 79.5%. [Conclusion] A postoperative target time in octogenarians for independent walking, following coronary artery bypass grafting, can be set at approximately 6 days.

20.
Eur J Appl Physiol ; 116(4): 749-57, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26822582

RESUMO

PURPOSE: The present study aimed to investigate the effects of low-intensity resistance training with blood flow restriction (BFR resistance training) on vascular endothelial function and peripheral blood circulation. METHODS: Forty healthy elderly volunteers aged 71 ± 4 years were divided into two training groups. Twenty subjects performed BFR resistance training (BFR group), and the remaining 20 performed ordinary resistance training without BFR. Resistance training was performed at 20 % of each estimated one-repetition maximum for 4 weeks. We measured lactate (Lac), norepinephrine (NE), vascular endothelial growth factor (VEGF) and growth hormone (GH) before and after the initial resistance training. The reactive hyperemia index (RHI), von Willebrand factor (vWF) and transcutaneous oxygen pressure in the foot (Foot-tcPO2) were assessed before and after the 4-week resistance training period. RESULTS: Lac, NE, VEGF and GH increased significantly from 8.2 ± 3.6 mg/dL, 619.5 ± 243.7 pg/mL, 43.3 ± 15.9 pg/mL and 0.9 ± 0.7 ng/mL to 49.2 ± 16.1 mg/dL, 960.2 ± 373.7 pg/mL, 61.6 ± 19.5 pg/mL and 3.1 ± 1.3 ng/mL, respectively, in the BFR group (each P < 0.01). RHI and Foot-tcPO2 increased significantly from 1.8 ± 0.2 and 62.4 ± 5.3 mmHg to 2.1 ± 0.3 and 68.9 ± 5.8 mmHg, respectively, in the BFR group (each P < 0.01). VWF decreased significantly from 175.7 ± 20.3 to 156.3 ± 38.1 % in the BFR group (P < 0.05). CONCLUSIONS: BFR resistance training improved vascular endothelial function and peripheral blood circulation in healthy elderly people.


Assuntos
Endotélio Vascular/fisiologia , Fluxo Sanguíneo Regional , Treinamento de Força/métodos , Idoso , Idoso de 80 Anos ou mais , Endotélio Vascular/crescimento & desenvolvimento , Feminino , Hormônio do Crescimento/sangue , Hemodinâmica , Humanos , Ácido Láctico/sangue , Masculino , Norepinefrina/sangue , Treinamento de Força/efeitos adversos , Fator A de Crescimento do Endotélio Vascular/sangue
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