井澤 和大 | |
イザワ カズヒロ | |
大学院保健学研究科 保健学専攻 | |
准教授 | |
保健その他 |
2023年02月 第8回日本心臓リハビリテーション学会近畿支部地方会, 最優秀演題賞, 慢性心不全患者に対する生活行動記録に基づくセルフモニタリング支援の効果
2022年08月 Asia PRevent, JACR2022 (Japanese Association of Cardiac Rehabilitation) Annual Meeting in Okinawa: International Session, 2022年 AsiaPRevent優秀賞, Difference in peak VO2 between HFimpEF and HFuncEF in HFpEF patients
2022年08月 Asia PRevent, JACR2022 (Japanese Association of Cardiac Rehabilitation) Annual Meeting in Okinawa: International Session, 2022年 AsiaPRevent優秀賞, Physical and mental functions of cardiovascular disease patients decrease during the state of emergency initiated by the COVID-19 pandemic in Japan
2022年07月 第28回日本心臓リハビリテーション学会学術集会, 優秀賞, 心不全患者における入院による日常生活の困難度の悪化は退院後QOL低下の規定因子の一つである
2022年07月 第28回日本心臓リハビリテーション学会学術集会, 優秀賞, Short physical performance battery はTAVI患者の自宅退院の可否を最も予測するフレイル指標である
2022年04月 Asia PRevent, JACR2021 (Japanese Association of Cardiac Rehabilitation) Annual Meeting in Chiba: International Session, 2021年 AsiaPRevent優秀賞, Physical and Psychological States of Outpatients Receiving Rehabilitation at a Geriatric Health Services Facility during the State of Emergency Caused by the COVID-19 Pandemic
2022年04月 Asia PRevent, JACR2021 (Japanese Association of Cardiac Rehabilitation) Annual Meeting in Chiba: International Session, 2021年 AsiaPRevent優秀賞, Pinch strength is associated with the prevalence of mild cognitive impairment in patients with cardiovascular disease
2022年04月 Asia PRevent, JACR2021 (Japanese Association of Cardiac Rehabilitation) Annual Meeting in Chiba: International Session, 2021年 AsiaPRevent優秀賞, The Effect of Early Mobilization on Physical Function in Patients After Cardiac Surgery : systematic review and meta-analysis
2022年02月 第6回日本栄養・嚥下理学療法研究会学術大会, 優秀賞, 心臓手術前のフレイルと術後嚥下障害との関連性の検討
2021年06月 一般社団法人 日本腎臓学会 (第64回日本腎臓学会学術総会), ベストサイテーション賞, Decreased physical function in pre-dialysis patients with chronic kidney disease
2019年07月 第25回日本心臓リハビリテーション学会学術集会, 優秀演題賞, 心不全患者の機能的制限は退院時QOLの規定因子である
日本国国内外の国際的学術賞
2019年07月 The 25 Annual Meeting Japanese Association of Cardiac Rehabili, AsiaPRevent, International Session Award, Self-Monitoring to Increase Physical Activity in Patients with Cardiovascular Disease: systematic review and meta-analysis
日本国国内外の国際的学術賞
2019年07月 The 25 Annual Meeting Japanese Association of Cardiac Rehabilitation, AsiaPRevent, International Session Award, Influence of mild cognitive impairment on activities of daily living in patients with cardiovascular disease
日本国国内外の国際的学術賞
2019年02月 日本心臓リハビリテーション学会 第4回近畿地方会, 優秀演題賞, 心臓外科術後患者における年齢層別の最長発声持続時間の継時的推移
日本国国内学会・会議・シンポジウム等の賞
2018年07月 The 24th Annual Meeting of the Japanese Association of Cardiac Rehabilitation, AsiaPRevent, International Session Award, Impact of Delirium on Postoperative Frailty and Cardiovascular Events after Cardiac Surgery
日本国国内外の国際的学術賞
2017年10月 第21回日本心不全学会学術集会, Young Investigator Award 優秀賞, The Effects of Dietary Intake and Sarcopenia on Functional Recovery Undergoing Cardiac Surgery
日本国国内学会・会議・シンポジウム等の賞
2017年07月 The 23rd Annual Meeting of the Japanese Association of Cardiac Rehabilitation, International Session Award, Effect of cardiac rehabilitation combined with a directed self-monitoring approach on physical activity in hospitalized patients with mild ischemic stroke: a randomized, controlled study.
日本国国内学会・会議・シンポジウム等の賞
2017年03月 第 2 回日本予防理学療法学会サテライト集会, 第 2 回日本予防理学療法学会サテライト集会 優秀賞, 軽症脳梗塞患者に対する再発予防に向けた身体活動促進の取り組み
日本国国内学会・会議・シンポジウム等の賞
2017年02月 第7回日本腎臓リハビリテーション学会学術集会, 副大会長賞, 保存期慢性腎臓病患者における栄養障害と身体活動量との関連
日本国国内学会・会議・シンポジウム等の賞
2016年07月 The 22th Annual Meeting of the Japanese Association of Cardiac Rehabilitation., International Session Award, Gait speed is a predictor of postoperative delirium in elderly cardiac surgery patients
日本国国内外の国際的学術賞
2016年05月 公益社団法人 日本理学療法士協会, 第7回学術誌優秀賞, 高齢入院患者におけるTwo-Square Step TestとADLおよび歩行自立度との関連
日本国学会誌・学術雑誌による顕彰
2016年 第91回神奈川腎研究会, 優秀演題賞, 高齢保存期慢性腎臓病患者における軽度認知障害有病率とその関連要因
日本国国内学会・会議・シンポジウム等の賞
2015年07月 The 21st Japanese Association of Cardiac Rehabilitation, International Session Award, Differences in maximum phonation time based on body mass index in chronic heart failure patients
日本国国内学会・会議・シンポジウム等の賞
2015年03月 第5回日本腎臓リハビリテーション学会学術集会, Young Investigator Award, 保存期慢性腎臓病患者の上下肢筋力水準-健常者平均値との比較ー
日本国国内学会・会議・シンポジウム等の賞
2014年07月 The 20th Annual Meeting of the Japanese Association of Cardiac Rehabilitation., International Session Award, Sleep quality, exercise capacity, and nutritional status in relation to physical function and physical activity in cardiac patients
日本国国内外の国際的学術賞
2013年05月 第47回日本理学療法学術大会, 優秀賞, •膝伸展筋力と推算糸球体濾過量から慢性心不全患者の運動耐容能は予測可能か
日本国国内学会・会議・シンポジウム等の賞
2013年05月 日本理学療法士協会, 第4 回表彰論文, 糖尿病を合併した急性心筋梗塞患者における運動療法の効果-外来での回復期運動 療法実施の有無による比較-理学療法学 39, 1-6, 2012
日本国学会誌・学術雑誌による顕彰
2012年11月 学校法人聖マリアンナ医科大学, 前田賞, Research on Leisure Time Physical Activity and Upper and Lower Extremity Muscle Strength Levels Associated with an Exercise Capacity of 5 Metabolic Equivalents in Chronic Heart Failure Patients
日本国その他の賞
2012年07月 第18回日本心臓リハビリテーション学会学術集会, 優秀ポスター賞, 慢性心不全患者における精神的健康度と身体活動の関連-SF36での検討-
日本国国内学会・会議・シンポジウム等の賞
2012年05月 第46回日本理学療法学術大会, 学会奨励賞, 慢性高齢心不全患者における腎機能および下肢筋力指標
日本国国内学会・会議・シンポジウム等の賞
2012年03月 第3回日本腎臓リハビリテーション学会学術集会, 最優秀演題賞, 保存期慢性腎臓病患者の膝伸展筋力と腎機能の関係 歩行自立に必要な筋力閾値との検討
日本国国内学会・会議・シンポジウム等の賞
2010年09月 第29回 関東甲信越ブロック理学療法士学会, 学会奨励賞, Hand Held Dynamometerで測定した 膝伸展筋力値から1RMを予測することは可能か?―1RM法の再現性および等尺性膝伸展筋力と1RMの関連-
日本国国内学会・会議・シンポジウム等の賞
2010年07月 第16回日本心臓リハビリテーション学会学術集会, Young Investigator Award, 大宮一人: 入院期心疾患患者における疾患別の身体活動量と筋力との関係. 心臓リハビリテーション 15: 155-159, 2010.
日本国学会誌・学術雑誌による顕彰
2010年05月 第44回日本理学療法学術大会, 第44回日本理学療法学術大会学会奨励賞, 入院高齢患者における前方リーチ距離, 片脚立位時間と歩行自立度との関連
日本国国内学会・会議・シンポジウム等の賞
2009年07月 第15回日本心臓リハビリテーション学会学術集会, ザ・ベストオブ心臓リハビリテーション指導士賞, ザ・ベストオブ心臓リハビリテーション指導士
日本国その他の賞
2008年07月 第14回日本心臓リハビリテーション学会学術集会, 優秀演題賞, 心疾患患者における不安・抑うつおよび睡眠時間に対する年齢の影響
日本国国内学会・会議・シンポジウム等の賞
2007年07月 第13回日本心臓リハビリテーション学会学術集会, Young Investigator Award, Influence of autonomic nervous dysfunction characterizing effect of diabetes mellitus on heart rate response and exercise capacity in patients undergoing cardiac rehabilitation for acute myocardial infarction. Circulation Journal. 2006, 70:1017-1025.
日本国学会誌・学術雑誌による顕彰
2007年05月 第42回日本理学療法学術大会, 第42回日本理学療法学術大会優秀賞, 心筋梗塞患者における退院時の下肢筋力水準が回復期運動耐容能改善に及ぼす影響
日本国国内学会・会議・シンポジウム等の賞
2004年09月 第10回日本心臓リハビリテーション学会学術集会, Young Investigator Award, Improvement in physiological outcomes and health-related quality of life following cardiac rehabilitation in patients with acute myocardial infarction.Circulation Journal. 2004;68:315-20.
日本国学会誌・学術雑誌による顕彰
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BACKGROUND: The impact of body mass index (BMI) on hospital mortality in patients with acute heart failure has been well documented in Asian populations. However, the relationship between BMI, hospital-associated disability (HAD), and hospitalization costs in patients with heart failure is poorly understood. This study aimed to explore the impact of BMI on HAD and hospitalization costs for acute heart failure in Japan. METHODS: From April 2012 to March 2020, the Japanese Registry of All Cardiac and Vascular Disease Diagnosis Procedure Combination (JROAD-DPC) database was used to identify patients with acute heart failure. All patients were categorized into five groups according to the World Health Organization Asian BMI criteria. The hospitalization costs and HAD were evaluated. RESULTS: Among the 238,160 eligible patients, 15.7% were underweight, 42.2% were normal, 16.7% were overweight, 19.3% were obese I, and 6.0% were obese II, according to BMI. The prevalence of HAD was 7.43% in the total cohort, and the risk of HAD increased with a lower BMI. Restricted cubic spline analysis showed a U-shaped relationship between BMI and hospitalization costs for all ages. Furthermore, developing HAD was associated with greater costs compared with non-HAD, regardless of BMI category. CONCLUSIONS: We found that the lower the BMI, the higher the incidence of HAD. A U-shaped association was confirmed between BMI and hospitalization costs, indicating that hospitalization costs increased for both lower and higher BMI regardless of age. BMI could be an important and informative risk stratification tool for functional outcomes and economic burdens.
2022年, International Journal of Cardiology, in press, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
BACKGROUND: As a result of the increase in older people covered by long-term care insurance (LTCI), prevention of sarcopenia and maintenance and improvement of health-related quality of life (HRQOL) have become important themes. This study aimed to clarify both the differences in HRQOL in older people with and without sarcopenia covered by LTCI and the correlation between HRQOL and physical function. METHODS: Participants were 101 older people with LTCI at a daycare center in Japan. We investigated clinical factors using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). Analysis was by unpaired t-test, Mann-Whitney U test, chi-square test, analysis of covariance, Pearson's correlation coefficient, and Spearman's rank correlation coefficient. RESULTS: Compared to the no sarcopenia group (n = 40), the sarcopenia group (n = 24) had significantly lower body mass index, skeletal muscle mass index, gait speed, EQ-5D-3L, and adjusted EQ-5D-3L (p < 0.05). The EQ-5D-3L showed a significant correlation with handgrip strength in the sarcopenia group (p = 0.02) and significant correlations with gait speed and one-leg standing time (both, p = 0.01) in the no sarcopenia group. CONCLUSION: We clarified differences in HRQOL in older people with and without sarcopenia covered by LTCI. This information on the interrelationship between HRQOL and physical function may help maintain and improve HRQOL in these people.
2022年, European Journal of Investigation in Health, Psychology and Education, 12 (6), 536 - 548, 英語, 国際誌[査読有り]
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The relationship between low physical function (LPF) at discharge and food intake percentage (FIP) during hospitalization is unclear. We aimed to clarify the relationship between LPF at discharge and FIP and the change in nutritional status during hospitalization in elderly patients with heart failure (HF), and determine cutoff values for FIP and change in nutritional status during hospitalization. We included 431 consecutive patients aged ≥ 65 years who were hospitalized for HF and underwent cardiac rehabilitation (CR) from 2017 to 2019. Physical function at discharge was classified into two groups according to the Short Performance Physical Battery (SPPB): low physical function (LPF) (SPPB ≤ 9) and high physical function (HPF) (SPPB > 9). We compared background, clinical parameters, pre-hospital walking level, CR progress, nutritional factors during hospitalization including FIP of the main dish and side dish, and changes in nutritional status using the Geriatric Nutritional Risk Index (ΔGNRI) at admission and discharge. Multiple logistic regression analysis was also performed. The final analysis included 213 patients (age, 81.6 years) divided into the LPF (n = 136) and HPF groups (n = 77). The LPF group showed low FIP and a high ΔGNRI value. Multivariate analysis showed FIP main dish, ΔGNRI, worsening renal function, pre-hospital walking level, and days to start of walking to be factors influencing LPF at discharge. Respective cutoff values for FIP main dish and ΔGNRI predicting LPF at discharge were 82.2% and 4.24. FIP main dish during hospitalization and ΔGNRI were associated with LPF at discharge.
2022年, Heart and Vessels, in press, 英語, 国内誌[査読有り]
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BACKGROUND: Lower leg strength at hospital discharge is strongly associated with poor prognosis in older patients with acute decompensated heart failure (ADHF). Improving leg strength is important in acute-phase cardiac rehabilitation (CR). AIMS: This study aimed to clarify whether a change in leg strength occurs during hospitalization of older ADHF patients receiving CR and whether it affects leg strength at discharge. METHODS AND RESULTS: We enrolled 247 ADHF patients who underwent CR during hospitalization. They were divided into the non-older patient group (<75 years; n = 142) and older patient group (≥75 years; n = 105). Quadriceps isometric strength (QIS), body mass-corrected QIS (%BM QIS), and change in QIS during hospitalization (QIS ratio) were evaluated in all patients. Physical function in the stable phase was measured by the Performance Measure for Activities of Daily Living-8 (PMADL-8). The QIS value increased during hospitalization in the non-older patient group (30.0 ± 11.1 vs. 31.6 ± 10.9 kgf, P < 0.001) but did not increase in the older patient group (19.1 ± 6.3 vs. 19.5 ± 6.1 kgf, P = 0.275). Multiple regression analysis revealed that PMADL-8 significantly predicted %BM QIS at discharge in the non-older patient group (β = -0.254, P = 0.004), whereas in the older patient group, QIS ratio and PMADL-8 significantly predicted %BM QIS at discharge (β = 0.264, P = 0.008 for QIS ratio and β = -0.307, P = 0.003 for PMADL-8). CONCLUSIONS: Leg strength was not improved in older ADHF patients during hospitalization even if they received CR, and this affected leg strength at discharge, suggesting that careful skeletal muscle intervention should be provided during hospitalization, and patients need to continue exercise after discharge.
2022年, European Journal of Cardiovascular Nursing, in press, 英語, 国際誌[査読有り]
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AIMS: To investigate the effect of mild cognitive impairment (MCI) on unplanned readmission in patients with coronary artery disease (CAD). METHODS AND RESULTS: From 2132 CAD patients, MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J) in 243 non-dementia patients who met the study criteria. The primary outcome was unplanned hospital readmission after discharge. The incidence of MCI in this cohort was 33.3%, and 51 patients (21.0%) had unplanned readmission during a mean follow-up period of 418.6 ± 203.5 days. After adjusting for the covariates, MCI (hazard ratio, 2.28; 95% confidence interval: 1.09-4.76; P = 0.03) was independently associated with unplanned readmission in the multivariable Cox proportional hazard regression analysis. In the Kaplan-Meier analysis, the cumulative incidence of unplanned readmission for the MCI group was significantly higher than that for the non-MCI group (log-rank test, P < 0.001). Even after exclusion of the patients readmitted within 30 days of discharge, the main results did not change (log-rank test, P < 0.001). CONCLUSION: Mild cognitive impairment was independently associated with unplanned readmission after adjustment for many independent variables in CAD patients. In addition to its short-term effects, the adverse effects of MCI had a persistent, long-term impact on CAD patients. Assessment of cognitive function should be conducted by health professionals prior to hospital discharge and during follow-up. To prevent readmission of CAD patients, it will be necessary to support solutions to the problems that inhibit secondary prevention behaviours based on the assessment of the patients' cognitive function.
2022年, The European Journal of Cardiovascular Nursing, 21 (4), 348 - 355, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
This study aimed to clarify the effects of gardening on hemodynamic response, rating of perceived exertion (RPE) during exercise, and body weight in patients in whom phase 2 cardiac rehabilitation (CR) was interrupted due to the Coronavirus disease 2019 (COVID-19) pandemic. Among 76 outpatients participating in consecutive phase 2 CR in both periods from March to April and June to July 2020, which were before and after CR interruption, respectively, at Sanda City Hospital were enrolled. The inclusion criterion was outpatients whose CR was interrupted due to COVID-19. Patients under the age of 65 were excluded. We compared the data of hemodynamic response and RPE during exercise on the last day before interruption and the first day after interruption when aerobic exercise was performed at the same exercise intensity in the gardener group and the non-gardener group. Forty-one patients were enrolled in the final analysis. After CR interruption, the gardener group did not show any significant difference in all items, whereas the non-gardener group experienced significant increase in HR (Peak) (p = 0.004) and worsening of the Borg scale scores for both dyspnea and lower extremity fatigue (p = 0.039 and p = 0.009, respectively). Older phase 2 CR patients engaged in gardening did not show any deterioration in hemodynamic response or RPE during exercise, despite CR interruption and refraining from going outside. Gardening may be recommended as one of the activities that can maintain or improve physical function in older phase 2 CR patients during the COVID-19 pandemic.
2022年, Heart and Vessels, 37 (1), 77 - 82, 英語, 国内誌[査読有り]
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PURPOSE: It is recommended that patients with myocardial infarction (MI) be prescribed exercise by target heart rate (HR) at the anaerobic threshold (AT) via cardiopulmonary exercise testing (CPX). Although percent HR reserve using predicted HRmax (%HRRpred) is used to prescribe exercise if CPX or an exercise test cannot be performed, %HRRpred is especially difficult to use when patients take β-blockers. We devised a new formula to predict HR at AT (HRAT) that considers β-blocker effects in MI patients and validated its accuracy. METHODS: The new formula was created using the data of 196 MI patients in our hospital (derivation sample), and its accuracy was assessed using the data of 71 MI patients in other hospitals (validation sample). All patients underwent CPX 1 mo after MI onset, and resting HR, resting systolic blood pressure (SBP), and HRAT were measured during CPX. RESULTS: The results of multiple regression analysis in the derivation sample gave the following formula (R2 = 0.605, P < .001): predicted HRAT = 2.035 × (≥65 yr:-1, <65 yr:1) + 3.648 × (body mass index <18.5 kg/m2:-1, body mass index ≥18.5 kg/m2:1) + 4.284 × (β1-blocker(+):-1, β1-blocker(-):1) + 0.734 × (HRrest) + 0.078 × (SBPrest) + 36.812. This formula consists entirely of predictors that can be obtained at rest. HRAT and predicted HRAT with the new formula were not significantly different in the validation sample (mean absolute error: 5.5 ± 4.1 bpm). CONCLUSIONS: The accuracy of the new formula appeared to be favorable. This new formula may be a practical method for exercise prescription in MI patients, regardless of their β-blocker treatment status, if CPX is unavailable.
2022年, Journal of Cardiopulmonary Rehabilitation and Prevention, 42, E1 - E6, 英語, 国際誌[査読有り]
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Objectives: The provision of inpatient programs that reduce the incidence of readmission after cardiac surgery remains challenging. Investigators have focused on multidisciplinary cardiac rehabilitation (CR) because it reduces the postoperative readmission rate; however, most previous studies used outpatient models (phase II CR). We retrospectively investigated the effect of comprehensive multidisciplinary interventions in the acute inpatient phase (phase I CR) on unplanned hospital readmission. Methods: In a retrospective cohort study, we compared consecutive patients after cardiac surgery. We divided them into the multidisciplinary CR (multi-CR) group or conventional exercise-based CR (conv-CR) group according to their postoperative intervention during phase I CR. Multi-CR included psychological and educational intervention and individualized counseling in addition to conv-CR. The primary outcome was unplanned readmission rates between the groups. A propensity score–matching analysis was performed to minimize selection biases and the differences in clinical characteristics. Results: In our cohort (n = 341), 56 (18.3%) patients had unplanned readmission during the follow-up period (median, 419 days). Compared with the conv-CR group, the multi-CR group had a significantly lower unplanned readmission rate (multivariable regression analysis; hazard ratio, 0.520; 95% confidence interval, 0.28-0.95; P = .024). A Kaplan–Meier analysis of our propensity score–matched cohort showed that, compared with the conv-CR group, the multi-CR group had a significantly lower incidence of readmission (stratified log-rank test, P = .041). Conclusions: In phase I, compared to conv-CR alone, multi-CR reduced the incidence of unplanned readmission. Early multidisciplinary CR can reduce hospitalizations and improve long-term prognosis after cardiac surgery.
2021年, The Journal of Thoracic and Cardiovascular Surgery., 161 (5), 1853 - 1860, 英語[査読有り]
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The present study aimed to clarify the difference in physical activity (PA) due to sarcopenia in community-dwelling older adults with long-term care insurance (LTCI). This was a cross-sectional study that investigated data of 97 consecutive community-dwelling older Japanese adults with LTCI who underwent rehabilitation at one day care center in Japan from November 2018 to May 2019. Sarcopenia was determined according to criteria of the Asian Working Group for Sarcopenia. Unpaired t-test, Mann-Whitney U test, chi-square test and analysis of covariance were used to compare participant characteristics and clinical parameters between the older adults with and without sarcopenia. A receiver operating characteristic (ROC) curve was constructed to determine the cut-off value of PA for sarcopenia. The sarcopenia group (n = 20) had significantly lower body mass index (BMI), skeletal muscle mass index, gait speed, and PA than those in the no sarcopenia group (n = 28) (p < 0.05). After adjustment for BMI and sex, the sarcopenia group showed significantly lower PA than the no sarcopenia group. Findings showed that the cut-off value of PA indicating sarcopenia by ROC curve analysis was 1494.4 steps/day (p < 0.05); this value may aid in identifying sarcopenia in older adults with LTCI.
2021年, European Journal of Investigation in Health, Psychology and Education, 11 (4), 1610 - 1618, 英語, 国際誌[査読有り]
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研究論文(学術雑誌)
Background: The COVID-19 pandemic has challenged healthcare systems, at times overwhelming intensive care units (ICUs). We aimed to describe the length and rate of ICU admission, and explore the clinical variables influencing ICU use, for COVID-19 patients with known cardiovascular diseases or their risk factors (CVDRF). Methods and Results: A post hoc analysis was performed of 693 Japanese COVID-19 patients with CVDRF enrolled in the nationwide CLAVIS-COVID registration system between January and May 2020 (mean [±SD] age 68.3±14.9 years; 35% female); 199 patients (28.7%) required ICU management. The mean (±SD) ICU length of stay (LOS) was 19.3±18.5 days, and the rate of in-hospital death and hospital LOS were significantly higher (P<0.001) and longer (P<0.001), respectively, in the ICU than non-ICU group. Logistic regression analysis revealed that clinical variables reflecting impaired general condition (e.g., high C-reactive protein, low Glasgow Coma Scale score, SpO2, albumin level), male sex, and previous use of β-blockers) were associated with ICU admission (all P<0.001). Notably, age was inversely associated with ICU admission, and this was particularly prominent among elderly patients (OR 0.97, 95% confidence interval 0.95-0.99; P=0.0018). Conclusions: One-third of COVID patients with CVDRF required ICU care during the first phase of the pandemic in Japan. Other than anticipated clinical variables, such as hypoxia and altered mental status, age was inversely associated with the use of the ICU, warranting further investigation.
2021年, Circulation Reports, 3 (7), 375 - 380, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
The anaerobic threshold (AT), obtained during cardiopulmonary exercise testing (CPET), is an important prognostic measure and can be used to develop an exercise prescription in patients after a myocardial infarction (post-MI). The purpose of this study was to examine the central and peripheral determinants of AT in post-MI patients end-tidal oxygen partial pressure (PETO2) measures. We performed cardiopulmonary exercise testing (CPET) on 148 consecutively enrolled post-MI patients to determine PETO2 measured at the AT (AT PETO2) and ΔPETO2 (difference between resting PETO2 and AT PETO2). We subsequently investigated the relationship between these measures of PETO2 and the individual AT for each patient. Multivariate linear regression analysis indicated that AT PETO2 and ΔPETO2 were independently and significantly associated with the AT (β = -0.344, p < 0.001 and β = 0.228, p < 0.001, respectively). Furthermore, the independent factors of AT PETO2 were left ventricular ejection fraction (p = 0.005), resting ventilatory equivalent for carbon dioxide (p = 0.002), and resting dead-space gas volume to tidal volume ratio (p < 0.001). However, the independent factors for ΔPETO2 were history of diabetes (p = 0.047), estimated glomerular filtration rate (p = 0.001), and resting systolic blood pressure (p = 0.017). These findings suggested that AT PETO2 was associated with central determinants; whereas, and ΔPETO2 was associated with peripheral determinants, The AT PETO2 and ΔPETO2 provide variable insight regarding the cause of exercise intolerance and can be used to determine appropriate therapies.
2021年, Heart and Vessels, 36 (12), 1811 - 1817, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
BACKGROUND AND OBJECTIVE: We aimed to examine the differences in life-space mobility and quality of life (QoL) of patients with cardiovascular disease (CVD) between the pre- and postnationwide state of emergency initiated by the Coronavirus disease 2019 (COVID-19) pandemic in Japan and to show the factors associated with the decrease in life-space mobility and QoL in these patients. METHODS: We undertook a longitudinal study of 20 out of 51 consecutive CVD patients with coronary artery disease (CAD) who met the study criteria. We used the Life-Space Assessment (LSA) tool to evaluate Life-space mobility and assessed QoL with the five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L) in Japanese. RESULTS: The LSA scores and EQ-5D-5L QoL score decreased significantly from the pre- to postnationwide state of emergency in Japan (p < 0.01). ΔLSA was significantly positively associated with body mass index and significantly negatively associated with knee extensor muscle strength and pre-LSA score (p < 0.05). There were no significant relationships between ΔLSA and ΔEQ- 5D-5L QoL scores and between ΔEQ-5D-5L QoL scores and patient characteristics. CONCLUSION: The policies promoted to address the state of emergency in Japan might affect life-space mobility and QoL of CAD patients. Moreover, CAD patients in Japan who were not obese and maintained their physical function and activity tended to refrain from activity during the period between the pre- and post-nationwide state of emergency. Clarification of the effects of the COVID-19 pandemic on the relationship between living space motility and QoL in CAD patients will require further study.
2021年, Reviews on Recent Clinical Trials, 16 (3), 316 - 321, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
AIM: Worsening renal function (WRF) induced by acute myocardial infarction (AMI) is a strong predictor of cardiovascular events and mortality. Peak oxygen uptake may contribute to prognosis in AMI patients with WRF, however, the impact of WRF on peak oxygen uptake is unclear. METHODS: Among 154 patients with AMI who underwent emergency percutaneous coronary intervention and participated in phase II cardiac rehabilitation, those who underwent cardiopulmonary exercise testing were consecutively enrolled. WRF was defined as a ≥20% decrease in estimated glomerular filtration rate (eGFR [ml/min/1.73 m2 ]) from admission to that at cardiopulmonary exercise testing. The association of WRF with peak oxygen uptake was evaluated by multivariate regression analysis. The non-WRF group was divided into two subgroups according to eGFR <60/≥60 at cardiopulmonary exercise testing, and eGFR at cardiopulmonary exercise testing and peak oxygen uptake of all three groups were compared. RESULTS: Ninety-four patients were enrolled in the final analysis. Multiple linear regression analysis showed that WRF was associated with peak oxygen uptake (p = .003). Comparing the non-WRF group with eGFR at cardiopulmonary exercise testing <60 and the WRF group, although eGFR at cardiopulmonary exercise testing was similar (p = 1.000), peak oxygen uptake in the WRF group was significantly lower (p = .026). CONCLUSION: WRF, not eGFR at cardiopulmonary exercise testing was significantly associated with peak oxygen uptake in patients with AMI. This result suggests that when considering the relationship between renal function and peak oxygen uptake, WRF must be taken into account.
2021年, Nephrology, 26 (6), 506 - 512, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Assessment of frailty is important for risk stratification among the elderly with severe aortic stenosis (AS) when considering interventions such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). However, evidence of the impact of preoperative frailty on short-term postoperative outcomes or functional recovery is limited. This retrospective study included 234 consecutive patients with severe AS who underwent SAVR or TAVR at Kobe University Hospital between Dec 2013 and Dec 2019. Primary outcomes were postoperative complications, postoperative 6-min walking distance (6MWD), and home discharge rates. The mean age was 82 ± 6.6 years. There were 169 (SAVR: 80, TAVR: 89) and 65 (SAVR: 20, TAVR: 45) patients in the non-frail and frail groups, respectively (p = 0.02). The postoperative complication rates in the frail group were significantly higher than those in the non-frail group [30.8% (SAVR: 35.0%, TAVR: 28.9%) vs. 10.7% (SAVR: 15.0%, TAVR: 6.7%), p < 0.001]. The home discharge rate in the non-frail group was significantly higher than that in the frail group [85.2% (SAVR: 81.2%, TAVR: 88.8%) vs. 49.2% (SAVR: 55.0%, TAVR: 46.7%), p < 0.001]. The postoperative 6MWD in the non-frail group was significantly longer than that in the frail group [299.3 ± 87.8 m (SAVR: 321.9 ± 90.8 m, TAVR: 281.1 ± 81.3 m) vs. 141.9 ± 92.4 m (SAVR: 167.8 ± 92.5 m, TAVR: 131.6 ± 91.3 m), p < 0.001]. The TAVR group did not show a decrease in the 6MWD after intervention, regardless of frailty. We report for the first time that preoperative frailty was strongly associated with postoperative complications, 6MWD, and home discharge rates following both SAVR and TAVR. Preoperative frailty assessment may provide useful indications for planning better individualized therapeutic interventions and supporting comprehensive intensive care before and after interventions.
2021年, Heart and Vessels, 36 (8), 1234 - 1245, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
This study aimed to clarify the effects of the interruption of cardiac rehabilitation (CR) and refraining from going outside due to the COVID-19 pandemic on hemodynamic response and rating of perceived exertion (RPE) during exercise including differences by age in phase 2 CR outpatients. Among 76 outpatients participating in consecutive phase 2 CR in both periods from March to April and June to July 2020, which were before and after CR interruption, respectively, at Sanda City Hospital were enrolled. The inclusion criterion was outpatients whose CR was interrupted due to COVID-19. We compared the data of hemodynamic response and RPE during exercise on the last day before interruption and the first day after interruption when aerobic exercise was performed at the same exercise intensity in the < 75 years group and ≥ 75 years group. Fifty-three patients were enrolled in the final analysis. Post-CR interruption, peak heart rate increased significantly (p = 0.009) in the < 75 years group, whereas in the ≥ 75 years group, weight and body mass index decreased significantly (p = 0.009, 0.011, respectively) and Borg scale scores for both dyspnea and lower extremities fatigue worsened significantly (both, p < 0.001). CR interruption and refraining from going outside due to the COVID-19 pandemic affected the hemodynamic response, RPE during exercise and body weight in phase 2 CR outpatients. In particular, patients aged ≥ 75 years appeared to be placed at an increased risk of frailty.
2021年, Heart and Vessels, 36 (8), 1184 - 1189, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5 days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.
2021年, Heart and Vessels, 36 (4), 509 - 517, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
Background: Poor oral health status can lead to a deteriorated level of general health and is common among patients undergoing cardiovascular surgery. However, the effect of oral health status on postoperative outcomes in cardiovascular surgery patients remains unclear. Thus, we investigated the effect of preoperative oral health status on postoperative complications and functional recovery after cardiovascular surgery. Methods: This single-centre retrospective cohort study included 884 inpatients undergoing elective cardiovascular surgery. Oral health status was assessed based on the number of remaining teeth, use of dentures, occlusal support, and periodontal status. We investigated postoperative complications related to surgery and postoperative functional recovery by measuring the reacquisition of walking ability, activities of daily living, and length of postoperative hospital stay. Results: In this cohort (age 66.9 ± 13.4 years), the mean number of remaining teeth was 18.7 ± 9.4. Patients were grouped based on tertiles of the data distribution of remaining teeth: ≥ 20 teeth (470 patients); 10-19 teeth (137 patients); < 10 teeth (185 patients). The number of missing teeth was associated with age (P < 0.001). The prevalence of postoperative pneumonia and reintubation after surgery was 3.2% and 2.5%, respectively, which was significantly higher in patients with severe tooth loss (P < 0.05 for both). After adjusting for age and other confounding factors, the number of remaining teeth was a statistically significant predictor of functional recovery (P < 0.05). Conclusions: Preoperative oral health status was related to postoperative respiratory complications and independently associated with functional recovery. Preoperative oral intervention may improve functional recovery after cardiovascular surgery.
2020年, Canadian Journal of Cardiology Open, 3 (3), 276 - 284, 英語[査読有り]
研究論文(学術雑誌)
The objective effects of early mobilization on physical function in patients after cardiac surgery remain unknown. The purpose of the present study was to clarify the effects of early mobilization on physical function in patients after cardiac surgery through meta-analysis. Four electronic databases were searched on 2 August 2019. We used search keywords related to "early mobilization", "cardiac surgery", and "randomized controlled trials". All randomized controlled trials conducting early mobilization after cardiac surgery were included. We defined early mobilization as the application of physical activity within the first five postoperative days. Citations and data extraction were independently screened in duplicate by two authors. The meta-analysis was conducted using random-effects modeling with EZR software. The primary outcome was the distance walked during the six-minute walking test at hospital discharge. Six randomized controlled trials comprising 391 patients were included following screening of 591 studies. All studies included coronary artery bypass grafting as the cardiac surgery conducted. Early mobilization started on postoperative days 1-2 and was conducting twice daily. Early mobilization showed a trend of being combined with respiratory exercise or psychoeducation. The meta-analysis showed that the distance walked during the 6-min walking test improved by 54 m (95% confidence interval, 31.1-76.9; I-2 = 52%) at hospital discharge. The present study suggested that early mobilization after cardiac surgery may improve physical function at discharge.
MDPI, 2020年, International Journal of Environmental Research and Public Health, 17 (19), 7091, 英語[査読有り]
研究論文(学術雑誌)
OBJECTIVE: Frailty is a major problem in super-aged societies. Because frailty assessments are largely unstudied in acute stroke settings, few reports have evaluated the association between pre-stroke frailty and stroke severity. The aim of this study was to determine the association between pre-stroke frailty and stroke severity in elderly patients with acute stroke. MATERIALS AND METHODS: This cross-sectional study enrolled consecutive elderly patients with acute stroke. We assessed stroke severity with the National Institutes of Stroke Scale (NIHSS), and pre-stroke frailty with a Frailty Screening Index in elderly patients with acute stroke. Patients were divided according to their Frailty Screening Index: the robust group, pre-frailty group, and frailty group. Multiple linear regression analysis was used to determine whether pre-stroke frailty was independently associated with NIHSS score. RESULTS: In total, 234 elderly patients with acute stroke (age: 75.7 years; 149 men, 85 women) were enrolled in this study. Of these, the robust group comprised 76 patients, the pre-frailty group comprised 129 patients, and the frailty group comprised 29 patients. The prevalence of pre-stroke frailty was 12.4%. Multiple linear regression analysis showed that pre-stroke pre-frailty and frailty were significantly associated with NIHSS score (pre-frailty; β = 1.191, P = .005, frailty; β = 1.708, P = .009). CONCLUSIONS: The present study indicated that the pre-stroke frailty was significantly associated with stroke severity in elderly patients with acute stroke. Additional study is needed to clarify the association between pre-stroke frailty and post-stroke prognosis.
2020年, Journal of Stroke and Cerebrovascular Diseases, 29 (12), 105346 - 105346, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
We investigated the accessibility of height- and weight-measurement tools and the awareness of one's own height and weight in a specific population in West New Britain Province (WNBP), Papua New Guinea, where obesity is prevalent. Of 558 participants (mean age 34.8 ± 14.0 years, 48.2% women, average body mass index =25.1 ± 4.83 kg/m2), >70% had limited access to measurement scales and 97.5% lacked accurate knowledge of their own height and weight. Our findings imply that increased access to measurement tools and awareness of personal height and weight is necessary to improve the feasibility and effectiveness of weight-management interventions in areas such as WNBP.
SAGE Publications, 2020年, Tropical Doctor, 50 (4), 337 - 339, 英語[査読有り]
研究論文(学術雑誌)
【目的】我々は、腹部大動脈瘤破裂術後に腹部コンパートメント症候群(abdominal compartment syndrome:以下、ACS)を合併し、術後経過が重症化した症例に対して、理学療法を施行した。その後、良好な転帰を得たため報告する。【症例紹介】症例は、腹部大動脈瘤破裂術後にACSを発症した60歳代後半の患者である。術後経過において、ACSによる循環不全や呼吸不全、多臓器不全が認められ、長期集中治療管理と入院加療が必要であった。我々は、ACSの病態や術後経過に応じて、呼吸理学療法や離床、運動療法を展開した。その結果、症例は人工呼吸器の離脱が可能であった。また、身体機能と運動耐容能は向上し、自宅退院が可能であった。【結論】腹部大動脈瘤破裂術後にACSを合併した症例に対しても、病態に応じた慎重な理学療法は実施可能であり、早期の運動機能と基本動作能力の獲得に貢献できる可能性がある。(著者抄録)
(公社)日本理学療法士協会, 2020年, 理学療法学, 47 (5), 474 - 482, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Active vitamin D (calcitriol, or 1.25 (OH) 2 D) is associated with muscle weakness, falls, and fracture in community-dwelling older people. This study aimed to investigate the relationship between a serum active vitamin D level and lower extremity muscle strength in elderly patients with pre-dialysis chronic kidney disease (CKD). This cross-sectional study included 231 patients with CKD treated conservatively as outpatients. We analyzed patient background factors, including age, sex, body mass index (BMI), intact parathyroid hormone (PTH), phosphorus, calcium, albumin, serum calcitriol level as an indicator of active vitamin D, and estimated glomerular filtration rate (eGFR) collected from medical records. As an index of lower extremity muscle strength, the isometric knee extension muscle strength-to-weight ratio (kgf/kg) was calculated. The mean patient age was 75.9 ± 6.1 years (68.8% male), and the BMI was 24.1 ± 3.8 kg/m2. A significant correlation was observed between knee extensor muscle strength and serum calcitriol level (r = 0.32, p < 0.01), age (r = -0.30, p < 0.01), BMI (r = -0.31, p < 0.01), intact PTH (r = -0.22, p < 0.01), phosphorus (r = -0.29, p < 0.01), albumin (r = -0.28, p < 0.01), and eGFR (r = 0.25, p < 0.01). Multiple regression analysis showed calcitriol to be significantly associated with knee extensor muscle strength (β: 0.14, 95% confidence interval: 0-0.002, p = 0.04) after adjustment for covariates. These results suggest that the serum active vitamin D level is associated with lower extremity muscle strength in older adults with pre-dialysis CKD. It is necessary to verify whether vitamin D supplementation increases lower extremity muscle strength in pre-dialysis CKD patients.
2020年, International Journal of Environmental Research and Public Health, 17 (4), E1433, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
BACKGROUND: Although intervention with early cardiac rehabilitation (CR) is recommended for elderly patients treated for acute heart failure (HF), there are patients in whom the progress of early CR will be delayed. The aim of this study was to clarify factors related to the progress of early CR. METHODS: We enrolled 180 Japanese inpatients aged ≥ 65 years with HF in the present retrospective cohort study. We set a short-term goal of 30 m of walking at 1 week after the start of early CR. We divided the patients into two groups according to whether this goal was achieved (Achievement group, n = 124) or not (Non-achievement group, n = 56) and compared patients' characteristics and clinical parameters. RESULTS: There was a significant difference (p < 0.05) between the groups for age, length of hospital stay, Functional Independence Measure at discharge, walking level before hospitalization, rate of co-existence of diabetes mellitus, chronic renal failure, orthopedic disease, use of diuretics, creatinine, Prognostic Nutritional Index, hemoglobin, C-reactive protein, and estimated glomerular filtration rate (eGFR). Furthermore, logistic regression analysis showed that walking level before hospitalization (odds ratio [OR]: 3.144, p = 0.0001) and eGFR (OR: 0.971, p = 0.009) were factors related to the inability to achieve the short-term goal. CONCLUSION: Our findings suggest that walking level before hospitalization and renal function on admission are factors related to delayed progress in early CR of elderly Japanese patients with HF.
2020年, Aging Clinical Experimental Research, 32 (3), 399 - 406, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
サルコペニアを有する心不全患者の身体活動量と健康関連QOLの特性について検討した。心不全検査目的に当院に入院した65歳以上の高齢者234名を対象とした。サルコペニアは59例(25.2%)に認められ、サルコペニア群は非サルコペニア群と比し、有意に高齢でBrain Natriuretic Peptide値が高く、BMI、アルブミン値、ヘモグロビン値は低値であった。交絡因子を調整後もInternational Physical Activity Questionnaireはサルコペニア群で有意に低値であった。健康関連QOLの比較では、身体的サマリースコアはサルコペニア群で有意に低値を示し、精神的サマリースコアもサルコペニア群で有意に低値を示したが、役割・社会的サマリースコアには両群間で有意な差はみられなかった。高齢心不全患者において、サルコペニアは高率で発生し、サルコペニア患者は身体活動量が有意に低下していた。
国立大学リハビリテーション療法士協議会, 2020年, 国立大学リハビリテーション療法士学術大会誌, 41, 30 - 35, 日本語[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
Purpose: This investigation aimed to examine the relationship among activities of daily living (ADL), nutritional status and 90-day hospital readmission in elderly heart failure (HF) patients. Methods: Participants were selected from 634 HF patients consecutively hospitalized at one institution. We investigated patient characteristics, ADL (motor and cognitive items of Functional Independence Measure (FIM)) and nutritional status (Geriatric Nutritional Risk Index (GNRI)). Data were analyzed using unpaired t-test, χ2 test, Cox proportional hazard model, and Kaplan-Meier method. Results: The 169 participants that met inclusion criteria were divided into two groups based on hospital readmission within 90 days of discharge. Body mass index (BMI) (p = 0.03), hemoglobin (p = 0.047), GNRI (p = 0.02) and motor-FIM (p = 0.007) were significantly different between the readmission (n = 31) and non-readmission (n = 138) groups. After Cox proportional hazard model analysis, GNRI (HR: 0.96; p = 0.048) and motor-FIM (HR: 0.97; p = 0.03) scores remained statistically significant. Participants were then classified into four groups based on a previous study’s cut-off values of prognosis for GNRI and motor-FIM. Readmission avoidance rate was significantly lower (p = 0.002) in the group with GNRI <92 and motor FIM <75. Conclusions: This study showed that motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days of discharge.
MDPI AG, 2019年12月12日, International Journal of Environmental Research and Public Health, 16 (24), 5068 - 5068, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
There is little evidence on how perceptions of the built environment may influence physical activity among post-stroke patients. This study aimed to explore the associations between perceived built environment attributes and objectively measured physical activity outcomes in community-dwelling ambulatory patients with stroke. This cross-sectional study recruited patients who could walk outside without assistance. We assessed both objectively measured physical activity outcomes such as number of steps and duration of moderate-to-vigorous physical activity (MVPA) with an accelerometer and the patients' perceived surrounding built environment with the International Physical Activity Questionnaire Environmental Module. Sixty-one patients (67.0 years old) were included. The multiple linear regression analysis showed significant associations of the presence of sidewalks (β = 0.274, p = 0.016) and access to recreational facilities (β = 0.284, p = 0.010) with the number of steps taken (adjusted R2 = 0.33). In contrast, no significant associations were found between perceived built environment attributes and MVPA. These findings may help to suggest an approach to promote appropriate physical activity in patients with stroke depending on their surrounding built environment.
2019年10月15日, International journal of environmental research and public health, 16 (20), E3908, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
BACKGROUND: Elderly patients undergoing cardiac surgery often show poor nutritional status, muscle wasting, and sarcopenia, which are reported to affect postoperative functional recovery and incidence of complications. Amino acids are essential in maintaining nutritional status, synthesizing muscle protein, and promoting beneficial energy balance of the heart muscle. β-Hydroxy β-methylbutyric acid (HMB) is a leucine metabolite known to increase muscle protein synthesis and inhibit protein catabolism; it has been used to more effectively support patients with muscle wasting due to wearing diseases. However, the efficacy of amino acid administration comprising HMB in patients undergoing open heart surgery remains unclear. This study aims to examine whether preoperative short-term aggressive amino acid administration helps support postoperative recovery of physical function and prevent complications. METHODS: This is a single-center prospective randomized controlled trial (UMIN000030490). Patients aged ≥65 years who will be hospitalized for medical examination before cardiac surgery will be recruited. The participants will be randomly assigned to the experimental or control group. The experimental group will be administered with an amino acid supplement with HMB 1200mg, l-glutamine 7000mg, and l-arginine 7000mg once or twice per day depending on the degree of renal dysfunction, for 14-28 days preoperatively. The control group will not receive any nutritional intervention. The main outcome will be a change in the 6-min walking test distance pre- and postoperatively as a sign of functional recovery. Secondary outcomes such as the incidence of complications; physical, nutritional, and psychological states; mortality; and length of hospital stay will also be evaluated. CONCLUSION: This clinical study will determine the effects of preoperative short-term oral amino acid supplementation with HMB, l-glutamine, and l-arginine on postoperative physical function in elderly patients undergoing cardiac surgery.
2019年10月, Journal of cardiology, 74 (4), 360 - 365, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
OBJECTIVE: Grip strength is a well-characterised measure of weakness and of poor muscle performance, but there is a lack of consensus on its prognostic implications in terms of cardiac adverse events in patients with cardiac disorders. METHODS: Articles were searched in PubMed, Cochrane Library, BioMed Central and EMBASE. The main inclusion criteria were patients with cardiac disorders (ischaemic heart disease, heart failure (HF), cardiomyopathies, valvulopathies, arrhythmias); evaluation of grip strength by handheld dynamometer; and relation between grip strength and outcomes. The endpoints of the study were cardiac death, all-cause mortality, hospital admission for HF, cerebrovascular accident (CVA) and myocardial infarction (MI). Data of interest were retrieved from the articles and after contact with authors, and then pooled in an individual patient meta-analysis. Univariate and multivariate logistic regression was performed to define predictors of outcomes. RESULTS: Overall, 23 480 patients were included from 7 studies. The mean age was 62.3±6.9 years and 70% were male. The mean follow-up was 2.82±1.7 years. After multivariate analysis grip strength (difference of 5 kg, 5× kg) emerged as an independent predictor of cardiac death (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001), all-cause death (OR 0.87, 95% CI 0.85 to 0.89, p<0.0001) and hospital admission for HF (OR 0.88, 95% CI 0.84 to 0.92, p<0.0001). On the contrary, we did not find any relationship between grip strength and occurrence of MI or CVA. CONCLUSION: In patients with cardiac disorders, grip strength predicted cardiac death, all-cause death and hospital admission for HF. TRIAL REGISTRATION NUMBER: CRD42015025280.
2019年06月, Heart (British Cardiac Society), 105 (11), 834 - 841, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
BACKGROUND: Although there are reports on the promotion of physical activity during hospitalization, there is no evidence that promoting in-hospital physical activity continues over time after discharge. The purpose of this study was to evaluate the long-term effect of promoting in-hospital physical activity on postdischarge physical activity and self-efficacy for physical activity in patients with mild ischemic stroke. METHODS: This was a cross-sectional study of a post hoc analysis of a previous randomized controlled trial. Patients with mild ischemic stroke were divided into the intervention group (in which physical activity was promoted during hospitalization) and a control group. To promote in-hospital physical activity, patients in the intervention group were instructed in the self-monitoring approach. After discharge, we measured physical activity and self-efficacy for physical activity by mailing a questionnaire to the patients. The average number of steps taken was used the index of postdischarge physical activity. RESULTS: The study sample comprised 30 patients, with 13 patients in the intervention group and 17 patients in the control group. There were no significant differences in physical activity values (6176.8 versus 6112.8 steps/day, P = .932) and self-efficacy for physical activity score (66.0 versus 76.0 points, P = .801) between the 2 groups. CONCLUSIONS: This study showed that the promotion of in-hospital physical activity did not appear to increase physical activity and self-efficacy for physical activity in patients with mild ischemic stroke after discharge. Additional study is needed to establish a more specific approach to promote physical activity during hospitalization that will carry over during long-term follow-up.
2019年04月, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 28 (4), 1048 - 1055, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Compared with elderly people who have not experienced falls, those who have were reported to have a shortened step length, large fluctuations in their pace, and a slow walking speed. The purpose of this study was to elucidate the step length required to maintain a walking speed of 1.0 m/s in patients aged 75 years or older. We measured the 10 m maximum walking speed in patients aged 75 years or older and divided them into the following two groups: Those who could walk 1.0 m/s or faster (fast group) and those who could not (slow group). Step length was determined from the number of steps taken during the 10 m-maximum walking speed test, and the step length-to-height ratio was calculated. Isometric knee extension muscle force (kgf), modified functional reach (cm), and one-leg standing time (s) were also measured. We included 261 patients (average age: 82.1 years, 50.6% men) in this study. The fast group included 119 participants, and the slow group included 142 participants. In a regression logistic analysis, knee extension muscle force (p = 0.03) and step length-to-height ratio (p < 0.01) were determined as factors significantly related to the fast group. As a result of ROC curve analysis, a step length-to-height ratio of 31.0% could discriminate between the two walking speed groups. The results suggest that the step length-to-height ratio required to maintain a walking speed of 1.0 m/s is 31.0% in patients aged 75 years or older.
2019年02月02日, Diseases (Basel, Switzerland), 7 (1), E17, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
The purpose of this study was to examine the factors affecting the discharge to home of medical patients treated in an intensive care unit, including elements of in-hospital rehabilitation and prehospital movement ability. The participants of this retrospective cohort study were medical patients treated in an intensive care unit (ICU) and who began rehabilitation in ICU. We assessed the participants in the ICU and analyzed data on patient background, hospitalization, and rehabilitation status. There were 155 ICU patients available for analysis. A multivariable logistic regression model identified the four variables of age (OR 1.06, 95% CI 1.02-1.09), APACHE II score (OR 1.12, 95% CI 1.04-1.24), independence in home life before admission (OR 7.10, 95% CI 1.65-30.44), and standing within 5 days of admission (OR 6.58, 95% CI 2.60-16.61) as factors significantly related to discharge from hospital to home. Independence of home life before admission and early start of standing were identified as factors strongly related to discharge to home. The degree of independence in living before hospital admission and progress toward early mobilization are helpful when considering an ICU patient's discharge destination.
MDPI, 2019年, International Journal of Environmental Research and Public Health, 16 (22), E4324, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
【目的】訪問リハビリテーション(以下、訪問リハ)従事者に対して、病状変化の気づきに関連するアセスメント能力の向上を図るための介入を行い、その長期的効果について明らかにする。【方法】訪問リハ従事者33名に対し、「内科系疾患の病状理解と全身管理」および「基本的生命活動所見(以下、SPE)の評価と解釈」に関する介入を実施した。介入効果の検討には、自己研鑽時間などの変化、アセスメントの知識や実施の改善度、病状変化の気づき経験、SPE項目の選択や実施などに関する主観的評価を用い、介入前、介入後6ヵ月、介入後1年の時期に評価した。【結果】介入後6ヵ月、介入後1年での自己研鑽時間、SPE項目の知識の程度や実施の頻度は改善した。また、利用者の病状変化の気づき経験は増加し、主観的評価も改善した。【結論】本研究の介入は、対象者の自己研鑽時間やアセスメント能力の向上、利用者の病状変化の気づき経験の増加などに寄与し、長期的な効果をもたらす。(著者抄録)
(公社)日本理学療法士協会, 2019年, 理学療法学, 46 (5), 297 - 307, 日本語[査読有り]
研究論文(学術雑誌)
目的:高齢心血管疾患患者における再入院に関わる身体運動機能指標を明らかにすることである。方法:対象は入院期心臓リハビリテーションプログラムを施行し、自宅退院した65歳以上の高齢心疾患患者で435例である。対象を男性群308例と、女性群127例に分類し、さらに再入院群と非再入院群に分けて調査した。調査方法は後ろ向きコホート研究とし、退院時の患者背景因子、および身体運動機能指標{握力、等尺性膝伸展筋力、片脚立位時間、Modified Functional Reach(M-FR)、最大歩行速度}を調査した。観察期間は退院日から1年間とした。結果:男性における再入院に関わる因子は年齢が抽出され、そのカットオフ値は75歳であった。一方、女性群では、M-FRと歩行速度が再入院に関わる因子として抽出され、それぞれのカットオフ値は28.5cm、1.31m/秒であった。結論:高齢心疾患患者において、これらの指標は、再入院を予測するための指標になり得る。(著者抄録)
専門リハビリテーション研究会, 2019年, 専門リハビリテーション, 18, 19 - 24, 日本語[査読有り]
研究論文(学術雑誌)
BACKGROUND: No longitudinal study has investigated the impact of combination of kidney function (KF) and physical function (PF) on cognitive decline in these patients. METHODS: We conducted a 2-year prospective cohort study enrolling 131 patients ≥ 65 years with pre-dialysis chronic kidney disease (CKD). We assessed cognitive function with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). We calculated %MoCA-J based on the rate of change between baseline and follow-up MoCA-J scores, and defined cognitive decline over 2 years as a %MoCA-J of less than the first quartile value. We defined eGFR ≥ 30 as mild-to-moderate and eGFR < 30 mL/min per 1.73 m2 as severe. In addition, low PF was defined as low handgrip strength (< 26 for men and < 18 kgf for women) and/or low gait speed (< 0.8 m/s). Patients were classified into four groups: group 1, patients with mild-to-moderate impairment in KF and high PF; group 2, with mild-to-moderate impairment in KF and low PF; group 3, with severe impairment in KF and high PF; and group 4, with severe impairment in KF and low PF. RESULTS: Eighty-four patients completed follow-up assessment. Multivariate logistic regression analysis showed that the combination of severe impairment in KF and low PF was significantly associated with cognitive decline (odds ratio 5.73). However, no significant cognitive decline was observed in patients with either severe impairment in KF or low PF alone. CONCLUSIONS: We may need to focus on maintaining PF in older patients with advanced CKD may help to prevent cognitive decline.
2019年, Clin Exp Nephrol, 23 (6), 756 - 762., 英語, 国内誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
AIM: Chronic kidney disease (CKD) is a risk factor for declining cognitive and physical function. However, the prevalence of mild cognitive impairment (MCI) and its relationship with physical function is not clear. Therefore, our aim was to evaluate the prevalence of MCI and the relationship between MCI and physical function among older adults with pre-dialysis CKD. METHODS: We conducted a cross-sectional study of 120 patients, aged ≥65 years (mean age, 77.3 years), with pre-dialysis CKD but without probable dementia (Mini Mental State Examination <24). MCI was evaluated using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). For analysis, patients were classified into two cognitive function groups: normal (MoCA-J ≥ 26) and MCI (MoCA-J < 26). Physical, clinical, and biochemical parameters were compared between the groups. Logistic and linear regression analyses were used to evaluate the specific association between cognitive and physical function. RESULTS: Seventy-five (62.5%) patients belonged to the MCI group. Significant differences between the two groups were identified for gait speed, balance, age, and haemoglobin concentration. After adjustment for covariates, only gait speed was significantly associated with MCI (odds ratio, 0.06; 95% confidence interval, 0.009-0,411). CONCLUSION: The prevalence of MCI among older adults with pre-dialysis CKD was as high as 62.5%. The association between MCI and reduced gait speed supports the possible interaction between physical and cognitive functions and the need for early screening.
2019年, Nephrology, 24 (1), 50 - 55, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Handgrip strength (HS) and knee extensor muscle strength (KEMS) showed a negative correlation with the Disabilities of the Arm, Shoulder, and Hand (DASH) score at one month following cardiac surgery. We performed a longitudinal study to examine changes in HS/KEMS and DASH score during phase II cardiac rehabilitation (CR) in patients after cardiac surgery. We measured and assessed HS, KEMS, and DASH score in 41 consecutive patients at one and three months following cardiac surgery and examined the relation between these factors at three months following cardiac surgery. Wilcoxon signed-rank test and Spearman correlation coefficients were used to analyze the results. Finally, 26 patients (63.2 years, 73.1% male) were analyzed. There were significant differences from one month to three months following cardiac surgery in HS (26.78 ± 8.26 to 31.35 ± 9.41 kgf, p < 0.001), KEMS (1.53 ± 0.42 to 1.72 ± 0.46 Nm/kg, p = 0.001), and DASH score (14.76 ± 12.58 to 7.62 ± 9.29, p < 0.001). DASH score correlated negatively with HS (r = -0.41, p = 0.01) but not with KEMS (r = -0.32, p = 0.09) after three months of phase II CR. Although HS, KEMS, and DASH scores changed significantly from one to three months following cardiac surgery during phase II CR, only HS correlated negatively with DASH score at three months following cardiac surgery.
2019年, Diseases, 7 (1), E32, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
A simplified substitute for heart rate (HR) at the anaerobic threshold (AT), i.e., resting HR plus 30 beats per minute or a percentage of predicted maximum HR, is used as a way to determine exercise intensity without cardiopulmonary exercise testing (CPX) data. However, difficulties arise when using this method in subacute myocardial infarction (MI) patients undergoing beta-blocker therapy. This study compared the effects of αβ-blocker and β1-blocker treatment to clarify how different beta blockers affect HR response during incremental exercise. MI patients were divided into αβ-blocker (n = 67), β1-blocker (n = 17), and no-β-blocker (n = 47) groups. All patients underwent CPX one month after MI onset. The metabolic chronotropic relationship (MCR) was calculated as an indicator of HR response from the ratio of estimated HR to measured HR at AT (MCR-AT) and peak exercise (MCR-peak). MCR-AT and MCR-peak were significantly higher in the αβ-blocker group than in the β1-blocker group (p < 0.001, respectively). Multiple regression analysis revealed that β1-blocker but not αβ-blocker treatment significantly predicted lower MCR-AT and MCR-peak (β = -0.432, p < 0.001; β = -0.473, p < 0.001, respectively). Based on these results, when using the simplified method, exercise intensity should be prescribed according to the type of beta blocker used.
2019年, International Journal of Environmental Research and Public Health, 16 (16), E2838, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Resting heart rate (HR) plus 20 or 30 beats per minute (bpm), i.e., a simplified substitute for HR at the anaerobic threshold (AT), is used as a tool for exercise prescription without cardiopulmonary exercise testing data. While resting HR plus 20 bpm is recommended for patients undergoing beta-blocker therapy, the effects of specific beta blockers on HR response to exercise up to the AT (ΔAT HR) in patients with subacute myocardial infarction (MI) are unclear. This study examined whether carvedilol treatment affects ΔAT HR in subacute MI patients. MI patients were divided into two age- and sex-matched groups [carvedilol (+), n = 66; carvedilol (-), n = 66]. All patients underwent cardiopulmonary exercise testing at 1 month after MI onset. ΔAT HR was calculated by subtracting resting HR from HR at AT. ΔAT HR did not differ significantly between the carvedilol (+) and carvedilol (-) groups (35.64 ± 9.65 vs. 34.67 ± 11.68, P = 0.604). Multiple regression analysis revealed that old age and heart failure after MI were significant predictors of lower ΔAT HR (P = 0.039 and P = 0.013, respectively), but not carvedilol treatment. Our results indicate that carvedilol treatment does not affect ΔAT HR in subacute MI patients. Therefore, exercise prescription based on HR plus 30 bpm may be feasible in this patient population, regardless of carvedilol use, without gas-exchange analysis data.
2019年, Heart and Vessels, 34 (6), 957 - 964, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
Background: While hemodynamics and exercise capacity in patients with chronic thromboembolic pulmonary hypertension (CTEPH) can be improved by invasive therapy such as pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA), there has been little data on the health-related quality of life (HRQOL) in such patients. Methods and Results: This single-center and observational study compared the impact of invasive therapy on HRQOL. We utilized the Medical Outcome Study 36-Item Short Health Survey (SF-36) to measure HRQOL and compared HRQOL changes after PEA and BPA. A total of 48 patients were diagnosed with CTEPH. Of these, 39 patients completed questionnaires before and after invasive therapy. The PEA group (n=15) and the BPA group (n=24) had similar improvements in clinical parameters. With regard to HRQOL score, both groups had fairly low scores in physical functioning (PF), role physical (RP), general health (GH), social functioning (SF), role emotional (RE), and physical component summary (PCS) at baseline. PF, GH, vitality (VT), mental health (MH), and PCS had significant improvements in the PEA group while PCS and all subscales except for bodily pain (BP) had significant improvements in the BPA group. Furthermore, changes between baseline and follow-up were not significantly different between the 2 groups. Conclusions: BPA for patients who are ineligible for PEA can recover HRQOL to a similar level to that achieved by PEA.
2019年, Circulation Reports, 1 (5), 228 - 234, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
本稿では,先ず海外の脳卒中患者における身体活動量研究の動向を病期別に紹介した。次に,我が国における身体活動量研究について現状と今後の課題について概説した。 脳卒中を発症しやすい集団は,発症前から不活動になりやすい。また,発症後のあらゆる病期においても同様に不活動に陥りやすい。更に,身体活動量や活動強度の目標値が示されているものの,脳卒中患者の多くはこれらを満たしていない。これらの対策として,身体活動促進や座位行動減少に焦点を当てたさまざまな介入研究が実施されている。主な介入方策としては,セルフ・モニタリングの指導,目標設定,言語的説得・奨励などの行動変容技法が用いられている。また,近年では,ウェアラブル端末等を利用した遠隔指導も注目されている。 我が国における脳卒中患者の身体活動量研究は,増加傾向にある。しかし,介入研究や長期的なフォローアップに関する研究は極めて少ない。したがって,今後は,脳卒中治療ガイドラインにおいても身体活動の重要性が提示されるべく,より質の高い介入研究が待たれる。
日本運動疫学会, 2019年, 運動疫学研究, 21 (2), 91 - 103, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Chronic-phase worsening renal function (WRF) in patients with acute myocardial infarction (AMI) has been associated with poor prognosis. However, there is no consensus on either the method of prevention or the cause. The aim of this study was to determine factors predictive of chronic-phase WRF from the viewpoint of circulatory dynamics response to exercise during hospitalization of AMI patients without renal dysfunction on admission. We studied 186 consecutively AMI patients who underwent the 200-m walk test. Chronic-phase WRF was defined as a 20% decrease in estimated glomerular filtration rate (eGFR) from baseline to 8-10 months after AMI onset. Heart rate (HR) and systolic blood pressure recorded during the 200-m walk test were evaluated as circulatory dynamics responses. In total, 94 patients were enrolled. Multiple linear regression analysis showed that ΔHR (peak-rest) associated significantly with ΔeGFR (β = 0.427, p = 0.018). The receiver operating characteristic curve of ΔHR to predict chronic-phase WRF showed an area under the curve of 0.77, with a cut-off value of 22.0 bpm having a 95% sensitivity and 55% specificity. Among circulatory dynamics responses during exercise in the acute phase after AMI, ΔHR was an independent predictor of chronic-phase WRF.
2019年, International Journal of Environmental Research and Public Health, 16 (23), E4785, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
OBJECTIVE: To evaluate the effect of accelerometer-based feedback on physical activity in hospitalized patients with ischemic stroke. DESIGN: Randomized controlled trial. SETTING: Acute care hospital. SUBJECTS: A total of 55 patients with ischemic stroke who could walk without assistance were randomly assigned to the intervention group ( n = 27) or the control group ( n = 28). INTERVENTIONS: At the baseline measurement, patients did not receive accelerometer-based feedback. At follow-up, a physical therapist provided instruction on accelerometer-based feedback, discussed physical activity targets and encouraged the patients to walk more until discharge. MAIN MEASURES: The average daily number of steps taken was used as the index of daily hospitalized physical activity. RESULTS: The study sample consisted of 48 patients, of whom 23 patients comprised the intervention group and 25 patients comprised the control group. Although there were no significant differences in physical activity values between the two groups at the baseline measurement, the values in the intervention group at follow-up were significantly higher than those in the control group (5180.5 ± 2314.9 vs. 3113.6 ± 1150.9 steps/day, P = 0.0003). The effect size of physical activity values (Cohen's d = 1.15) at follow-up was large between the two groups. CONCLUSION: Exercise training combined with accelerometer-based feedback effectively increased physical activity in hospitalized patients with ischemic stroke.
2018年08月, Clinical rehabilitation, 32 (8), 1047 - 1056, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
目的:握力計のない環境下でも握力の推定ができれば、スクリーニングとして役立つ。本研究の目的はペットボトル開栓に必要な握力値について明らかにすることである。方法:対象は高齢入院患者257例である。ペットボトル開栓の判定について我々は、口頭でペットボトルの開栓の可否を「開けられる」(Y群)、「開けられる時と、開けられない時がある」(DS群)、「開けられない」(N群)の3件法で聴取した。次に、我々は未開封のペットボトルを実際に開栓させ、開栓可能群と不可能群に選別した。握力値は左右の平均値[kgf]が用いられた。結果:開栓可能群と不可能群の握力値は、各々21.4±5.9kgf、9.4±3.9kgfで、差を認めた(p<0.01)。ペットボトル開栓に必要な握力の閾値は15.0kgf(感度:87.9%、特異度:94.0%、正診率:95.0%)であった。DS群とN群の握力は全例で20kgfを下回った。結論:ペットボトル開栓の可否は、握力値のスクリーニングになり得る。(著者抄録)
専門リハビリテーション研究会, 2018年03月, 専門リハビリテーション, 17, 30 - 35, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Background and Purpose: The Functional Independence and Difficulty Scale (FIDS), a newly developed basic activities of daily living (BADL) assessment tool, assesses both independence and subjective difficulty of BADL performance. This patient-reported outcome measure has been shown to have acceptable internal consistency, concurrent validity, and reliability. However, little is known about the relationship between FIDS and objective measures of physical function among older Japanese adults using long-term care insurance services. This study aimed to reveal the relationship between FIDS and physical functions and to examine the concurrent validity of FIDS against physical functions. Methods: Participants of this cross-sectional, correlational research study included community-dwelling Japanese adults aged 65 years or older and certified as long-term care insurance service users with musculoskeletal disease, internal disease, cerebrovascular diseases without observable motor paralysis, and others. Data on physical functions, including muscle strength (grip strength and isometric knee extension muscle strength [IKEMS]), flexibility (range of motion [ROM] of hip flexion and knee flexion), balance (Modified Functional Reach Test [M-FRT]) and gait performance (timed 2.4-m walk), and BADL performance assessed by FIDS, were obtained. Associations between FIDS scores and physical functions were determined by Spearman correlation coefficient and partial correlations after controlling for subject age and sex. Results: Data were collected on 53 participants (mean age = 81.9 years 62.3% women). Spearman partial correlation coefficients controlled for sex and age between FIDS score and grip strength, IKEMS, ROM of hip flexion, ROM of knee flexion, M-FRT, and timed 2.4-m walk were 0.47 (P =.001), 0.44 (P =.001), 0.29 (P =.04), -0.05 (P =.73), 0.51 (P < .001), and -0.64 (P < .001), respectively. The strength of association was moderate for the M-FRT and 2.4-m walk and was low for grip strength and IKEMS. However, ROM of the knee showed no significant association and hip flexion had negligible association with FIDS. Conclusions: The FIDS, a patient-reported BADL assessment tool, mainly reflected balance and gait performance and had concurrent validity as an objective measure of balance and gait performance.
Lippincott Williams and Wilkins, 2018年, Journal of Geriatric Physical Therapy, 41 (1), 28 - 34, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
The present study aimed to investigate the relationship between the occurrence of ventilator-associated events (VAE) in the intensive care unit and the timing of rehabilitation intervention. We included subjects who underwent emergency tracheal intubation and received rehabilitation. We performed rehabilitation according to our hospital's protocol. We assessed the mechanical ventilation parameters of inspired oxygen fraction and positive-end expiratory pressure, and a VAE was identified if these parameters stabilized or decreased for ≥2 days and then had to be increased for ≥2 days. We defined time in hours from tracheal intubation to the first rehabilitation intervention as Timing 1 and that to first sitting on the edge of the bed as Timing 2. Data were analyzed by the t-test and χ² tests. We finally analyzed 294 subjects. VAE occurred in 9.9% and high mortality at 48.3%. Median values of Timing 1 and Timing 2 in the non-VAE and VAE groups were 30.3 ± 24.0 and 30.0 ± 20.7 h, and 125.7 ± 136.6 and 127.9 ± 111.4 h, respectively, and the differences were not significant (p = 0.95 and p = 0.93, respectively). We found no significant relationship between the occurrence of VAE leading to high mortality and timing of rehabilitation intervention.
2018年, International Journal of Environmental Research and Public Health, 15 (12), 2892, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Background Daytime sleepiness can be assessed by the Epworth Sleepiness Scale (ESS), which is widely used in the field of sleep medicine as a subjective measure of a patient's sleepiness. Also, health utility assessed by the mean Short-Form Six-Dimension (SF-6D) score, one of several preference-based utility measures, is an important measure in health care. We aimed to examine age-related differences in daytime sleepiness and health utility and their relationship in patients 5 months after cardiac surgery. Methods; This cross-sectional study assessed 51 consecutive cardiac surgery patients who were divided into a middle-aged (<65 years, n = 29) and older-age group (≥65 years, n = 22). The mean ESS and SF-6D utility scores were measured at 5 months after cardiac surgery and compared. In addition, the relationship between ESS and SF-6D utility scores were assessed. Results; There were no significant differences between the middle-aged and older-aged groups in either the mean ESS (5.14 ± 2.96 vs. 4.05 ± 3.23, p = 0.22) or SF-6D utility (0.72 ± 0.14 vs. 0.71 ± 0.10, p = 0.76) scores. However, there was a negative correlation between both values in all of the patients after cardiac surgery (r = -0.41, p = 0.003). Conclusions; Although there were no age-related differences in the ESS and SF-6D utility values between the two groups, there was a negative correlation between these values in all patients at 5 months after cardiac surgery. This suggested that sleepiness is associated with decreased utility scores in patients at 5 months after cardiac surgery.
2018年, International Journal of Environmental Research and Public Health, 15 (2), E2716, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
BACKGROUND: Postoperative delirium (POD) is a critical complication that is closely associated with mortality and major morbidity in elective cardiac surgery. The identification of patients at risk for POD is crucial but has not been fully explored. AIMS: The aim of this study was to determine the predictive value of the assessment of preoperative exercise capacity for POD. METHODS: We enrolled 313 consecutive patients (mean age, 68.6 ± 14.8 years) undergoing elective cardiac surgery. We measured physical functions such as the 6-minute walking distance (6MWD) and Timed Up-and-Go test (TUG) before surgery. The assessment of delirium was conducted every 8 h from the day of surgery to 5 days after surgery using the Intensive Care Delirium Screening Checklist. RESULTS: POD occurred in 46 patients (14.6%). Age, 6MWD, TUG, serum hemoglobin, estimated glomerular filtration rate, and length of intensive care unit stay were significantly different based on the presence or absence of POD (p < 0.05 for each). After multivariate analysis, 6MWD remained a statistically significant indicator for developing POD (OR 0.98; p = 0.02). The cut-off value of 6MWD for predicting POD was 345 m (AUC = 0.75; p = 0.001). CONCLUSIONS: Poor exercise capacity was found to be an independent predictor of POD following elective cardiac surgery. This finding suggests the importance of preoperative functional evaluation in the prevention and management of POD in cardiac surgery patients.
2018年01月, Aging clinical and experimental research, 30 (1), 27 - 34, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Background: Renal function (RF) and activities of daily living (ADL) are risk factors for heart failure (HF) patients. Aims: We evaluated differences in motor and cognitive ADL in relation to RF in elderly hospitalized HF patients. Methods: Participants were selected from 414 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics including Functional Independence Measure (FIM) and estimated glomerular filtration rate (eGFR). Subjects were divided into three groups by RF level and analyzed with one-way ANOVA and Chi-square tests and two-way ANCOVA and multiple comparison tests. Results: Of the 414 patients, 165 met the inclusion criteria (high RF: 41, moderate RF: 84, low RF: 40). There were significant differences between the three groups in age, eGFR, hemoglobin level, mobility, cognitive function, and length of hospital stay (p < 0.05). Motor FIM showed an interaction between term and group, and cognitive FIM showed a main effect on the group (p < 0.05). In the multiple comparisons, motor FIM of all groups indicated significant recovery, but it was significantly lower after 1 week in the low RF versus moderate/high RF groups (p < 0.05). Cognitive FIM showed no significant recovery in the low RF group the FIM score after 2 weeks was significantly lower than that in the moderate/high RF groups (p < 0.05). Conclusions: In elderly hospitalized HF patients, the motor ADL recovery process in the low RF group was delayed compared to the high RF group. Cognitive ADL in hospitalized HF patients is difficult to recover, especially in those with low RF.
Springer International Publishing, 2018年01月01日, Aging Clinical and Experimental Research, 30 (1), 45 - 51, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Background Postoperative delirium (POD) is a common and critical complication after cardiac surgery. However, the relationship between POD and postoperative physical frailty and the effect of both on long-term clinical outcomes have not been fully explored. Objective We aimed to examine the associations among POD, postoperative frailty, and major adverse cardiac events (MACE). Design This was a prospective cohort study. Methods We studied 329 consecutive patients undergoing elective cardiac surgery. The intensive care delirium screening checklist was used to assess POD. Postoperative frailty was defined by handgrip strength and walking speed. Patients were subsequently followed-up to detect MACE. Results POD was present in 13.2%, while the incidence of postoperative frailty was 27.0%. POD was independently associated with development of postoperative frailty (adjusted odds ratio = 2.98). During follow-up, MACE occurred in 14.1% of all participants. On multivariate Cox proportional hazard analysis, POD (adjusted hazard ratio (HR) = 3.36), postoperative frailty (HR = 2.21), postoperative complications (HR = 1.54), and left ventricular ejection fraction (HR = 0.95) were independently associated with increased risk of MACE. Limitations It is a single-center study with a risk of bias. We did not investigate follow up cognitive function. Conclusions POD was a predictor of postoperative frailty after cardiac surgery. Both postoperative frailty and POD were associated with the incidence of MACE, while POD was the stronger predictor of MACE. Thus, POD and frailty play critical roles in the risk stratification of patients undergoing cardiac surgery.
Public Library of Science, 2017年12月01日, PLoS ONE, 12 (12), e0190359., 英語[査読有り]
研究論文(学術雑誌)
Background and aims The aim of the present study was to examine the approximate value of maximum phonation time in community-dwelling Japanese people and to set the range of error after ascertaining relative and absolute reliability. Methods Participants in the present study were adults living in Kobe and Himeji City, Hyogo Prefecture, Japan. Participants were seated in the upright sitting position and were asked to produce an/a/ sound at their normal speaking volume for as long as they possibly could. The examiner measured the time until the sound became inaudible. Two trials were performed. Results The subjects in the final analysis comprised 380 adults (246 women, 134 men; age, 72.7 +/- 5.9 years). The values of trial 1 and trial 2 were analyzed with intraclass correlation coefficient (ICC(1,1)), and Bland-Altman plot. Average values of the women, men, and both sexes combined were 16.1, 18.7, and 17.0 s, respectively. Average values of age groups 60-69, 70-79, and 80-89 years were 17.9, 16.8, and 15.9 s, respectively. The ICC(1,1) was 0.87 (P < 0.001). Both fixed bias and proportional bias existed. Limits of agreement (LOA) were -5.0 to 7.7 and % change ranged from -27.1 to 41.8 %. Conclusions These normative data indicated that sufficiently reliable values could be measured in two trials. LOA showed that the second value tended to be higher. In determining the effect of treatment, one must consider that the value will be slightly higher at re-test.
SPRINGER, 2017年08月, AGING CLINICAL AND EXPERIMENTAL RESEARCH, 29 (4), 781 - 786, 英語[査読有り]
研究論文(学術雑誌)
Background The newly developed Functional Independence and Difficulty Scale is a tool for assessing the performance of basic activities of daily living in terms of both independence and difficulty. The reliability of this new scale has not been assessed. Aims The aim of this study was to examine the relative reliability and absolute reliability of the newly developed scale in community-dwelling frail elderly people in Japan. Methods Participants were 47 community-dwelling elderly subjects (22 for assessing test-retest reliability and 25 for assessing inter-rater reliability). As relative reliability indices, intra-class correlation coefficients were used. From an absolute reliability perspective, we conducted Bland-Altman analysis and calculated the limit of agreement or minimal detectable change to determine the acceptable range of error. Results Intra-class correlation coefficients for test-retest and inter-rater reliability were 0.90 (P < 0.001) and 0.97 (P < 0.001), respectively. The limit of agreement for test-retest reliability was -5.2 to 1.8, representing an increase of over six points for improvement and a decrease of over two points for decline of basic activities of daily living ability. The minimal detectable change for inter-rater reliability was 3.7, indicating that a three-point difference might be existed between difference raters. The results of this study demonstrated that the FIDS appeared to be a reliable instrument for use in Japanese community-dwelling frail elderly people. Conclusions While further research using a large and more diverse sample of participants is needed, our findings support the use of FIDS in clinical practice or clinical research targeting frail elderly Japanese people.
SPRINGER, 2017年06月, AGING CLINICAL AND EXPERIMENTAL RESEARCH, 29 (3), 549 - 556, 英語[査読有り]
研究論文(学術雑誌)
Background: Only a few research is available on the effects of home-based exercise training on pre-dialysis chronic kidney disease (CKD) patients. Therefore, we aimed to elucidate the effect of home-based exercise therapy on kidney function and arm and leg muscle strength in pre-dialysis CKD patients. Methods: Thirty-six male stage 3-4 pre-dialysis CKD patients (age, 68.7 +/- 6.8 years; estimated glomerular filtration rate (eGFR), 39.0 +/- 11.6 ml/min/1.73 m(2)) who were being treated as outpatients were included. The subjects were randomly assigned to an exercise intervention group (Ex group: 18) and a control group (C group: 18). The Ex group wore accelerometer pedometers and were instructed to perform home-based aerobic and resistance exercises, such as brisk walking for 30 min per day, for 12 months. The C group subjects wore accelerometer pedometers but received no exercise therapy guidance; the number of steps covered during normal daily activities was recorded for the C group. The outcome measures were changes in kidney function and handgrip and knee extension muscle strength. Values at the baseline (T1) and 12 months later (T2) were compared. Results: There were no significant differences in baseline characteristics between the two groups; however, the C group was more physically active than the Ex group. Eight subjects dropped out, and 28 subjects (14 in each group) were included in the final analysis. Physical activity increased significantly only in the Ex group. Grip strength (F = 7.0, p = 0.01) and knee extension muscle strength (F = 14.3, p < 0.01) were found to improve only in the Ex group. Further, the changes in eGFR were not significantly different between the two groups (F = 0.01, p = 0.93). Conclusions: Home-based exercise therapy for pre-dialysis CKD patients was feasible and improved arm and leg muscle strength without affecting kidney function.
BIOMED CENTRAL LTD, 2017年06月, BMC NEPHROLOGY, 18 (1), 198, 英語[査読有り]
研究論文(学術雑誌)
Background Physical activity and physical performance relate to quality of life, mortality, and morbidity in elderly people. However, little is known about differences in physical performance related to low-intensity light physical activity (LLPA), high-intensity light physical activity (HLPA), and moderate-intensity physical activity (MPA) and how they are separated by sex in elderly populations. Aims This study aimed to determine differences in LLPA, HLPA, MPA, and physical performance, and associations between these measures in community-dwelling elderly men and women. Methods Physical activity and physical performance such as timed-up-and-go test, one-leg standing time, and maximum gait speed were measured in 181 community-dwelling elderly men (mean age, 75.1 +/- 5.3 years) and 109 women (mean age, 73.4 +/- 4.8 years) in 2013. Physical activity was classified as LLPA (1.6 +/- 1.9 METs of physical activity), HLPA (2.0 similar to 2.9 METs of physical activity), and MPA (over 3 METs of physical activity). The association between the values of these three intensities of physical activity in the participants was assessed by Pearson's correlation coefficients. Multiple linear regression analyses were used to assess the association of physical performance values with the three groups defined by accelerometer- measured physical activity intensity adjusted for sociographic, behavioral, and multiple diseases in the participants. Results MPA was beneficially associated with all physical performance indicators in the men (all P < 0.05) and women (all P < 0.05). Only HLPA showed significant associations with the timed-up-and-go test (P = 0.001) and maximum gait speed (P = 0.006) in women. Discussion These results may support the notion that not only HLPA in women but MPA in both sexes appears to improve physical performance in elderly populations. Conclusion The present study findings provide novel epidemiological evidence for the potential benefits of HLPA in women and also reinforce the potential benefits of MPA in both sexes, which is the mainstay of public health recommendations.
PUBLIC LIBRARY SCIENCE, 2017年06月, PLOS ONE, 12 (6), e0178654, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Background Preoperative nutritional status and physical function are important predictors of mortality and morbidity after cardiac surgery. However, the influence of nutritional status before cardiac surgery on physical function and the progress of postoperative rehabilitation requires clarification. Aims To determine the effect of preoperative nutritional status on preoperative physical function and progress of rehabilitation after elective cardiac surgery. Methods We enrolled 131 elderly patients with mean age of 73.7 +/- 5.8 years undergoing cardiac surgery. We divided them into two groups by nutritional status as measured by the Geriatric Nutritional Risk Index (GNRI): high GNRI group (GNRI >= 92, n = 106) and low GNRI group (GNRI < 92, n = 25). Physical function was estimated by handgrip strength, knee extensor muscle strength (KEMS), the Short Physical Performance Battery (SPPB), and 6-minute walk test (6MWT). Progress of postoperative rehabilitation was evaluated by the number of days to independent walking after surgery, length of stay in the ICU, and length of hospital stay. Results After adjusting for potential confounding factors, preoperative handgrip strength (P = 0.034), KEMS (P = 0.009), SPPB (P < 0.0001), and 6MWT (P = 0.012) were all significantly better in the high GNRI group. Multiple regression analysis revealed that a low GNRI was an independent predictor of the retardation of postoperative rehabilitation. Conclusions Preoperative nutritional status as assessed by the GNRI could reflect perioperative physical function. Preoperative poor nutritional status may be an independent predictor of the retardation of postoperative rehabilitation in patients undergoing elective cardiac surgery.
SPRINGER, 2017年04月, AGING CLINICAL AND EXPERIMENTAL RESEARCH, 29 (2), 283 - 290, 英語[査読有り]
研究論文(学術雑誌)
Background The new Functional Independence and Difficulty Scale (FIDS) is a tool for assessing the performance of basic activities of daily living (BADL). Because many BADL measures already exist, it is important to know whether FIDS can offer added benefit over the existing measures. Aims This study compared measurement properties between the FIDS and a representative BADL assessment tool, the Barthel Index (BI). Methods Recruitment of the participants was done on the basis of convenience sampling. Participants were community- dwelling elderly Japanese subjects (n = 314; age >= 65 years) divided into a healthy elderly group [ n = 225; subjects not using long-term care insurance (LTCI) services] and frail elderly group (n = 89; subjects using LTCI services). For each group, ceiling effect (percent participation with the maximum score) was calculated, and it was compared between the two scales. Associations between the FIDS, BI and Medical Outcomes Study Short Form 8 Health Survey (SF-8) were evaluated by Spearman correlation coefficient and partial correlations. Partial correlations coefficients to SF-8 were compared between the two scales. Results FIDS showed a relatively small ceiling effect compared to the BI. Compared to the BI, FIDS showed a significant positive partial correlation with the broader aspect of the SF-8 subscales, but the strength of correlation between FIDS and SF-8 was weak to negligible. Conclusions The FIDS might be less affected by ceiling effect than the BI. Additional studies using a sufficient number of probability samples are needed to clarify whether FIDS has any benefit over BI in terms of correlations with the SF-8.
SPRINGER, 2017年04月, AGING CLINICAL AND EXPERIMENTAL RESEARCH, 29 (2), 273 - 281, 英語[査読有り]
研究論文(学術雑誌)
【目的】保存期 (ND), 腹膜透析 (PD), 血液透析 (HD) など異なる治療段階が混在する末期腎不全 (ESKD) 患者を対象に, その治療法別の身体機能の差異を明らかにする. 【方法】対象は外来通院中のESKD患者93例 (平均年齢66.1歳, 男性55例) である. 対象者は治療法別にND群 (36例), PD群 (26例), HD群 (31例) の3群に選別した. 患者背景および身体機能指標 (膝伸展筋力, 握力, 片脚立位時間, 歩行速度) を横断的に調査し, 各指標を3群間で比較した. 【結果】ND群, PD群, HD群の順に, 膝伸展筋力は0.51±0.10, 0.46±0.11, 0.43±0.12kgf/kg, 片脚立位時間は40.7±21.0, 47.8±18.1, 27.8±22.6秒, 歩行速度は1.85±0.28, 1.81±0.37, 1.57±0.34m/sであり, 3群間に主効果を認めた. さらにHD群は他の群と比し, これら指標が有意に低値を示した (p<0.05). 一方握力は, 3群間に有意差を認めなかった (p=0.62). 【結語】ESKD患者では, HD患者において身体機能が有意に低下していた.
一般社団法人 日本透析医学会, 2017年, 日本透析医学会雑誌, 50 (4), 241 - 245, 日本語[査読有り]
研究論文(学術雑誌)
【目的】訪問リハビリテーション(訪問リハ)従事者を対象とし、利用者の病状変化の気づきに関連するアセスメント能力の向上を図るための単発的な介入を行い、その短期効果について検証する。【方法】我々は、訪問リハ従事者35名に対し、「内部障害系の全身管理」および「基本的生命活動所見のアセスメント」に関する講義および実技、グループワークなどの介入を実施した。その介入効果の検討には筆記テスト、主観的アセスメント評価を用い、介入前、介入直後の時期に評価した。【結果】筆記テストでは、介入直後の得点は介入前のそれと比較し、有意に高い値を示した。また、主観的アセスメント評価は、8つの項目すべてにおいて、介入直後の長さは介入前のそれと比較し、有意に長い値を示した。【結語】本研究における単発的な介入は、対象者のアセスメントに関する知識や対象者個人の主観的評価を向上させることが明らかとなった。(著者抄録)
日本保健科学学会, 2017年, The Journal of Japan Academy of Health Sciences, 20 (3), 118 - 125, 日本語[査読有り]
研究論文(学術雑誌)
【目的】保存期CKD 患者は腎機能低下に伴い筋力も低下しているが,健常者と比較しどの程度低下しているかは明らかでない。保存期CKD 患者の筋力年齢予測比を明らかにする。【方法】保存期CKD 患者291 例を対象に筋力(握力,膝伸展筋力)を測定し,健常者平均値から筋力年齢予測比を算出した。さらに男女別,年代別の筋力値の比較を行った。【結果】CKD ステージG3a,3b,4,5 の順に,握力年齢予測比は84.4%,85.5%,78.6%,72.3%,膝伸展筋力年齢予測比は104.6%,95.9%,88.3%,84.2% であった。男女別,年代別の筋力値は,高齢女性で低下が顕著であった。【結論】CKD ステージG4,5 の保存期CKD 患者において,握力は健常者平均値の70 ~80%,膝伸展筋力は85 ~90% 程度の低下を示す可能性が示唆された。
日本理学療法士学会, 2017年, 理学療法学, 44 (6), 401 - 407, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
【目的】高齢心血管疾患患者において、日常生活活動(ADL)の自立を判別する運動耐容能を、身体運動機能で予測できるか明らかにすること。【方法】65歳以上の心血管疾患患者553例を対象とした。身体運動機能(下肢筋力、握力、片脚立位時間、歩行速度、前方リーチ距離)を評価し、運動耐容能と患者背景はカルテより調査した。ADLの自立する運動耐容能を4METsとし、身体運動機能と運動耐容能の関係を分析した。【結果】身体運動機能の中でも歩行速度と下肢筋力は、運動耐容能と有意な正の相関関係を認めた(r=0.424、p<0.001、r=0.440、p<0.001)。歩行速度(cut off値1.77m/sec)は感度82%、特異度72%、下肢筋力(cut off値0.51kgf/kg)は感度78%、特異度56%で、4METsの運動耐容能が予測可能であった。【結論】高齢心血管疾患患者において、ADLの自立を判別する運動耐容能4MTEsを、身体運動機能で予測することが可能であると考えられた。(著者抄録)
(NPO)日本心臓リハビリテーション学会, 2017年, 心臓リハビリテーション, 22 (2・3), 161 - 166, 日本語[査読有り]
研究論文(学術雑誌)
Aims. To examine the relationship between activities of daily living (ADL) and readmission within 90 days and assess the cutoff value of ADL to predict readmission in hospitalized elderly patients with heart failure (HF). Methods. This cohort study comprised 589 consecutive patients with HF aged >= 65 years, who underwent cardiac rehabilitation from May 2012 to May 2016 and were discharged home. We investigated patients' characteristics, basic attributes, and ADL (motor and cognitive Functional Independence Measure [FIM]). We analyzed the data using the unpaired t-test, chi(2) test, Cox proportional hazard model, receiver operating characteristic (ROC) curve, andKaplan-Meiermethod. Results. Of 589 patients, 113 met the criteria, and they were divided into the nonreadmission (p = 90) and readmission groups (n = 23). Age, body mass index, New York Heart Association class, hemoglobin level, and motor FIM score were significantly different between the two groups (p < 0.05). The body mass index (hazard ratio [HR]: 0.87; p < 0.05) and motor FIM score (HR: 0.94; p < 0.01) remained statistically significant. The cutoff value for the motor FIM score determined by ROC curve analysis was 74.5 points (area under the curve = 0.78; p < 0.001). Conclusion. The motor FIM score in elderly patients with HF was an independent predictor of rehospitalization within 90 days.
HINDAWI LTD, 2017年, BIOMED RESEARCH INTERNATIONAL, 2017:7420738, 英語[査読有り]
研究論文(学術雑誌)
Background: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m²; left ventricular ejection fraction: 53.5 ± 13.7%). Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength (r = -0.38, p = 0.01) and with knee extensor muscle strength (r = -0.32, p = 0.04). Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation.
2017年, Diseases, 5 (4), 31, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Background: Patients with acute stroke spend most of their hospital day inactive. However, a method to promote physical activity (PA) in stroke has not been established. Objective: To evaluate the effectiveness of promoting PA by enhancing self-efficacy in hospitalized patients with mild ischemic stroke. Design: Pre-post interventional study. Methods: Hospitalized patients with mild ischemic stroke who could walk without assistance were recruited. We measured the daily number of steps taken as the index of daily hospitalized PA using an accelerometer. At the baseline measurement, patients did not receive accelerometer-based feedback. To promote hospitalized PA, a physical therapist provided instruction on the self-monitoring approach and discussed PA targets, encouraged the patients to walk more, and instructed them on the importance of PA after stroke. We also measured self-efficacy for PA using an assessment tool at the baseline and during the intervention. Results: Twenty-two patients (62.5 years old, 68.2% men) were included. PA during the intervention was higher than that at the baseline measurement (5709.4 +/- 2236.1 vs. 2813.9 +/- 1511.9 steps/day, p < 0.001). Self-efficacy for PA during the intervention was also higher than that at the baseline measurement (76.4 +/- 18.8 vs. 58.9 +/- 29.0 points, p < 0.001). Conclusions: Promoting PA by enhancing self-efficacy may increase PA and self-efficacy for PA in hospitalized patients with mild ischemic stroke. The present results might provide new strategies of PA promotion in these hospitalized patients.
TAYLOR & FRANCIS LTD, 2017年, TOPICS IN STROKE REHABILITATION, 24 (4), 256 - 261, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
To determine differences in physiological outcome (PO) based on the Geriatric Nutritional Risk Index (GNRI) and cut-off values for PO according to the GNRI in elderly post-cardiac surgery patients complicated by diabetes mellitus (DM). Thirty-five patients (72.9 years) were enrolled and divided by GNRI. Patient characteristics and PO of handgrip strength (HG), knee extensor muscle strength (KEMS), maximum gait speed (GS), and one-leg standing time (OLST) were compared between the groups, and cut-off values for PO were determined. These POs were significantly lower in the low-GNRI group (< 92 points) than in the high-GNRI (aeyen92 points) group. The cut-off values for PO were HG, 22.7 kgf; KEMS, 41.5 %BW; GS, 1.2 m/sec; and OLST, 6.7 s. Nutritional status might influence PO following cardiac surgery. The cut-off values of PO reported here might be indicative of the need to improve patient nutritional status.
SPRINGER, 2016年12月, AGING CLINICAL AND EXPERIMENTAL RESEARCH, 28 (6), 1267 - 1271, 英語[査読有り]
研究論文(学術雑誌)
Little information exists on the relation between respiratory muscle strength such as maximum inspiratory muscle pressure (MIP) and sarcopenia in elderly cardiac patients. The present study aimed to determine the differences in MIP, and cutoff values for MIP according to sarcopenia in elderly cardiac patients. We enrolled 63 consecutive elderly male patients aged aeyen65 years with cardiac disease in this cross-sectional study. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People algorithm, and, accordingly, the patients were divided into two groups: the sarcopenia group (n = 24) and non-sarcopenia group (n = 39). The prevalence of sarcopenia in cardiac patients and MIP in the patients with and without sarcopenia were assessed to determine cutoff values of MIP. After adjustment for body mass index, the MIP in the sarcopenia group was significantly lower than that in the non-sarcopenia group (54.7 +/- A 36.8 cmH(2)O; 95 % CI 42.5-72.6 vs. 80.7 +/- A 34.7 cmH(2)O; 95 % CI 69.5-92.0; F = 4.89, p = 0.029). A receiver-operating characteristic curve analysis of patients with and without sarcopenia identified a cutoff value for MIP of 55.6 cmH(2)O, with a sensitivity of 0.76, 1-specificity of 0.37, and AUC of 0.70 (95 % CI 0.56-0.83; p = 0.01) in the study patients. Compared with elderly cardiac patients without sarcopenia, MIP in those with sarcopenia may be negatively affected. The MIP cutoff value reported here may be a useful minimum target value for identifying elderly male cardiac patients with sarcopenia.
SPRINGER, 2016年12月, AGING CLINICAL AND EXPERIMENTAL RESEARCH, 28 (6), 1143 - 1148, 英語[査読有り]
研究論文(学術雑誌)
Background: There is little information on the association of sarcopenia with physical activity in elderly cardiac patients. This study determined differences in physical activity and cutoff values for physical activity according to the presence or absence of sarcopenia in elderly male cardiac patients. Methods and results: Sixty-seven consecutive men aged >= 65 years with cardiac disease were enrolled. We defined sarcopenia using the European Working Group on Sarcopenia in Older People algorithm. Patients were divided into the sarcopenia group (n = 25) and the non-sarcopenia group (n = 42). In the patients with and without sarcopenia of physical activities were evaluated to determine cutoff values of physical activity. Results: After adjusting for patient characteristics, both the average daily number of steps (3361.43 +/- 793.23 vs. 5991.55 +/- 583.57 steps, P = 0.021) and the average daily energy expenditure of physical activity (71.84 +/- 22.19 vs. 154.57 +/- 16.18 kcal, P = 0.009) were significantly lower in the sarcopenia versus non-sarcopenia group. Receiver-operating characteristic analysis identified a cutoff value for steps of physical activity of 3551.80 steps/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.44 and a cutoff value for energy expenditure of physical activity of 85.17 kcal/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.27. Conclusions: Physical activity in the male cardiac patients with sarcopenia was significantly lower than that in those without sarcopenia. The cutoff values reported here may be useful values to aid in the identification of elderly male cardiac patients with sarcopenia. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
ELSEVIER IRELAND LTD, 2016年11月, INTERNATIONAL JOURNAL OF CARDIOLOGY, 222, 457 - 461, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
AimsTo validate the Functional Independence and Difficulty Scale, a new instrument that assesses both independence and difficulty in carrying out basic activities of daily living. MethodsFirst, we developed an item list for our construct through a literature review. Second, an expert panel evaluated the item list using the modified Delphi method. Third, to evaluate psychometric properties, a random sample of 593 community-dwelling older adults aged65 years from Shiki City, Japan, was surveyed by mail. ResultsWe developed an instrument comprising 14 items: getting up from bed, standing up from a chair, standing up from the floor, dressing, putting on pants, eating, cleaning after toileting, washing, brushing teeth, opening a PET bottle, cutting toenails, walking inside, walking outside and going up or down four to six steps. Function scores for basic activities of daily living ranged from 14-42, with higher scores representing better function. Internal consistency was acceptable (Cronbach's alpha=0.92). Spearman's partial correlation coefficients controlled for sex and age between the new assessment tool, and the Katz Index and Tokyo Metropolitan Institute of Gerontology Index of Competence were 0.81 (P<0.01) and 0.63 (P<0.01), respectively. ConclusionsThis new tool for assessment of the basic activities of daily living showed good internal consistency and validity. This assessment tool might be applicable in research and clinical practice to evaluate the basic activities of daily living of community-dwelling elderly Japanese people. Geriatr Gerontol Int 2016; 16: 1127-1137.
WILEY, 2016年10月, GERIATRICS & GERONTOLOGY INTERNATIONAL, 16 (10), 1127 - 1137, 英語[査読有り]
研究論文(学術雑誌)
【目的】高齢入院患者のトイレ動作について、手すり設置が有効となる工程および身体機能指標の閾値を明らかにする。【方法】高齢入院患者100例を対象に、トイレ動作能力と身体機能指標を調査した。トイレ動作能力は、10項目に細分された工程における遂行の可否を、手すりの有無で評価した。身体機能指標は、握力、膝伸展筋力、足関節背屈可動域、前方リーチ距離、片脚立位時間を評価した。【結果】手すりが有ることで遂行可能例が有意に増加した工程は、立ち上がり、転回、着座であった。立ち上がりに必要な閾値は、握力15.1kgf、膝伸展筋力0.25kgf/kg、足関節背屈可動域14.8度、前方リーチ距離22.3cmであった。転回では、前方リーチ距離23.8cm、片脚立位時間0.3秒、着座では、握力15.1kgf、膝伸展筋力0.25kgf/kg、足関節背屈可動域14.3度、前方リーチ距離22.3cmが閾値であった。【結論】トイレ動作について、手すり設置が有効となる工程は、立ち上がり、転回、着座であり、その遂行に必要な身体機能指標の閾値が示された。(著者抄録)
(公社)神奈川県理学療法士会, 2016年02月, 理学療法: 技術と研究, (44), 34 - 40, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[目的]訪問リハビリテーション(訪問リハ)従事者が経験したリハビリテーションが中止に至った疾患(中止疾患)と病状変化の気づきについて明らかにする。[対象]全国の訪問リハ従事者323名とした。[方法]540施設に質問紙を郵送し、中止疾患および病状変化の気づきの有無とその影響要因について検討した。[結果]中止疾患は脳血管疾患や整形外科疾患に加え、呼吸器疾患や悪性腫瘍が多かった。また、病状変化の気づき経験者は全体の約4割で、気づきには年齢や臨床経験年数、訪問リハ経験年数が影響していた。[結語]訪問リハ介入時は運動機能向上のみならず、利用者の病状把握にも努め、病状変化の気づき能力を高める必要がある。(著者抄録)
(一社)日本在宅医学会, 2016年, 日本在宅医学会学会雑誌, 17 (2), 145 - 150, 日本語[査読有り]
研究論文(学術雑誌)
【目的】保存期慢性腎臓病(以下,CKD)患者の運動機能低下の要因として,糖尿病(以下,DM)および糖尿病多発神経障害(以下,DP)合併の影響について明らかにする。【方法】CKDステージ2–5の保存期CKD男性患者193例[非DM群121例,DM群72例(DP非合併群25例,DP合併群47例)]。調査項目は,基本属性,臨床検査値,運動機能(握力,膝伸展筋力,片脚立位時間,歩行速度)である。【結果】DM群の運動機能は非DM群と比較し低下していた。また,DM群をDP合併の有無で再検討したところ,非DM群とDP非合併群の運動機能に差はなく,DP合併群のみ低値を示した。さらに,DM群の運動機能低下に関与する要因を重回帰分析で検討した結果,年齢や腎機能に関連する臨床検査値以外に,DPが関与していた。【結論】保存期CKD患者の運動機能は,DPの合併症が出現していない時期では低下せず,病期が進行しDPが出現しているDM患者において低下する。
日本理学療法士学会, 2016年, 理学療法学, 43 (1), 56 - 63, 日本語[査読有り]
研究論文(学術雑誌)
〔目的〕急性期非心原性脳梗塞患者における病型による自律神経系活動の差異について明らかにする.〔対象〕対象は,急性期非心原性脳梗塞患者33名(年齢71.5歳,男性23名,女性10名)である.〔方法〕心電図は,安静,離床,回復の3条件で測定した.自律神経系活動指標(副交感神経系活動:lnHF,交感神経系活動:LF/HF)は,心拍変動解析により算出した.ラクナ梗塞患者とアテローム血栓性脳梗塞患者での自律神経系活動の比較を行った.〔結果〕ラクナ梗塞患者はアテローム血栓性脳梗塞患者に比べ,安静時のlnHFは低下(5.1 vs. 6.1),離床時のLF/HFは亢進していた(3.0 vs. 1.4).〔結語〕急性期では,ラクナ梗塞患者は,アテローム血栓性脳梗塞患者に比し,自律神経系活動が低下する可能性がある.
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研究論文(学術雑誌)
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研究論文(学術雑誌)
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研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
【目的】本研究の目的は、Two-Square Step Test(以下、TSST)の再現性、妥当性、ADL、歩行自立度との関連、および歩行自立のカットオフ値を明らかにすることである。【方法】対象は、65歳以上の高齢入院患者である。まず、TSSTの検者内、検者間再現性の検討と、Four-Square Step Test(以下、FSST)との関連を検討した。次に、TSSTとFIM運動項目、歩行自立度との関連を検討し、歩行自立のカットオフ値を算出した。【結果】TSSTのICCは、0.98であった。またTSSTは、FSST(rs=-0.82)、FIM運動項目(rs=0.73)と有意な相関を認めた。歩行自立のカットオフ値は、25.5点であった。【結論】TSSTは、再現性、妥当性ともに良好であり、歩行自立度との関連、歩行自立のカットオフ値も明らかになったことから、臨床に応用することが可能と考えられた。(著者抄録)
(公社)日本理学療法士協会, 2015年10月, 理学療法学, 42 (6), 480 - 486, 日本語[査読有り]
研究論文(学術雑誌)
[Purpose] To evaluate the relationship between the timed 2.4 meter walk result (2.4T) and physical function and ability to perform basic activities of daily living (BADL) in elderly persons covered by Japanese long-term care insurance. [Subjects and Methods] Physical functions and BADL of 51 elderly people were investigated. We evaluated the 2.4T and physical functions such as knee extensor muscle strength (KEMS) and the Modified Functional Reach Test (M-FRT). The Functional Independence Measure (FIM) was also used to assess BADL. Spearman's correlation and multiple regression analyses were performed to determine relations between 2.4T and physical function and FIM scores. [Results] There were significant negative correlations between 2.4T and the KEMS, M-FRT, and FIM. Multiple regression analysis showed that KEMS and M-FRT were significant and independent predictors of 2.4T. [Conclusion] 2.4T is associated with physical functions and BADL, confirming the test’s usefulness as a measure of home-based rehabilitation covered by Japanese long-term care insurance.
Society of Physical Therapy Science (Rigaku Ryoho Kagakugakkai), 2015年09月03日, 理学療法科学, 30 (4), 619 - 625, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Background Little is known about differences in the risk of poor nutritional status as assessed by the Geriatric Nutritional Risk Index (GNRI) in relation to physical performance in elderly female cardiac inpatients. The present study aimed to determine both differences in physical performance based on the GNRI and physical performance cut-off values according to the GNRI in elderly female cardiac inpatients. Methods We enrolled 105 consecutive female Japanese inpatients aged a parts per thousand yen65 years (mean age, 74.6 years) with cardiac disease in this cross-sectional study. We divided the patients into two groups according to GNRI: high-GNRI group (a parts per thousand yen92 points) (n = 71) and low-GNRI group (< 92 points) (n = 34). Handgrip strength (HG), knee extensor muscle strength (KEMS), gait speed (GS), and one-leg standing time (OLST) were assessed as indices of hospital physical performance and compared between the two groups to determine cut-off values of physical performance. Results After adjustment for age and left ventricular ejection fraction, HG, KEMS, GS, and OLST were significantly lower in the low-GNRI versus high-GNRI group. Cut-off values by ROC curve analysis were 16.2 kgf (AUC = 0.66; p < 0.001) for HG, 34.3 % of body weight (AUC = 0.62; p = 0.04) for KEMS, 1.24 m/s (AUC = 0.72; p < 0.01) for GS, and 8.28 s (AUC = 0.62; p = 0.04) for OLST. Conclusions The risk of poor nutrition, as indicated by a low GNRI, might be a predictor of lower physical performance. Cut-off values determined in this study might be minimum target goals for physical performance that can be attained by elderly female cardiac inpatients.
SPRINGER, 2015年04月, AGING CLINICAL AND EXPERIMENTAL RESEARCH, 27 (2), 195 - 200, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Maximum gait speed and physical activity (PA) relate to mortality and morbidity, but little is known about gender-related differences in these factors in elderly hospitalized cardiac inpatients. This study aimed to determine differences in maximum gait speed and daily measured PA based on sex and the relationship between these measures in elderly cardiac inpatients. A consecutive 268 elderly Japanese cardiac inpatients (mean age, 73.3 years) were enrolled and divided by sex into female (n = 75,28%) and male (n = 193, 72%) groups. Patient characteristics and maximum gait speed, average step count, and PA energy expenditure (PAEE) in kilocalorie per day for 2 days assessed by accelerometer were compared between groups. Gait speed correlated positively with in-hospital PA measured by average daily step count (r = 0.46, P<0.001) and average daily PAEE (r = 0.47, P<0.001) in all patients. After adjustment for left ventricular ejection fraction, step counts and PAEE were significantly lower in females than males (2651.35 +/- 1889.92 vs 4037.33 +/- 1866.81 steps, P<0.001; 52.74 +/- 51.98 vs 99.33 +/- 51.40 kcal, P<0.001), respectively. Maximum gait speed was slower and PA lower in elderly female versus male inpatients. Minimum gait speed and step count values in this study might be minimum target values for elderly male and female Japanese cardiac inpatients.
LIPPINCOTT WILLIAMS & WILKINS, 2015年03月, MEDICINE, 94 (11), e623., 英語[査読有り]
研究論文(学術雑誌)
AimNutrition is the focus of a new treatment target in older hospitalized cardiac patients. However, little is known about the differences in nutritional status in relation to physical performance in these inpatients. We determined the differences in physical performance based on the Geriatric Nutritional Risk Index (GNRI) and physical performance cut-off values according to the GNRI in older male cardiac inpatients. MethodsWe enrolled 251 Japanese male inpatients aged 65 years (mean age 74.7 years) with cardiac disease in the present cross-sectional study. We divided the patients into two groups according to GNRI: high-GNRI group (92 points; n=178) and low-GNRI group (<92 points; n=73). In-hospital physical performance as measured by handgrip strength (HG), knee extensor muscle strength (KEMS), gait speed (GS), and one-leg standing time (OLST) was assessed and compared between the two groups to determine cut-off values of physical performance. ResultsAfter adjustment for age, HG, KEMS, GS and OLST were significantly lower in the low-GNRI versus high-GNRI group. Cut-off values by receiver operating characteristic curve analysis were 25.75kgf (area under the curve [AUC]=0.740; P<0.001) for HG strength, 46.1% for bodyweight (AUC=0.742; P<0.01) for KEMS, 1.45m/s (AUC=0.782; P<0.01) for GS and 11.32s (AUC=0.705; P<0.01) for OLST. ConclusionThe risk of poor nutrition, as shown by a low GNRI, could be a useful predictor of physical performance. The cut-off values determined in the present study might be expected minimum target values that can be attained by Japanese older male cardiac inpatients. Geriatr Gerontol Int 2015; 15 189-195.
WILEY-BLACKWELL, 2015年02月, GERIATRICS & GERONTOLOGY INTERNATIONAL, 15 (2), 189 - 195, 英語[査読有り]
研究論文(学術雑誌)
【目的】Power Plate(Performance Health System社製)の加速度トレーニングは3次元の振動により25〜50回/秒の頻度で全身の筋肉が収縮し、活性化され、効果を上げるトレーニング理論である。本研究では、慢性心不全維持期における加速度トレーニングの有用性と安全性について検討した。【方法】慢性心不全維持期の13名(71.3±5.6歳)に対し、加速度トレーニングを週1回、12週間実施し、トレーニング開始前と12週間後で等尺性膝伸展筋力測定、10m歩行テスト、心肺運動負荷試験を施行した。【結果】等尺性膝伸展筋力は41±6%から49±11%(p=0.004)まで有意に改善し、10m歩行時間も6.9±1.4secから5.9±0.8sec(p=0.04)まで有意に改善したが、最高酸素摂取量は11.7±3.3ml/min/kgから12.4±3.4ml/min/kg(p=0.15)と改善傾向を認めたが、有意な上昇には至らなかった。振動による誤作動等のデバイスのトラブルは認めなかった。【結論】慢性心不全維持期患者に対して加速度トレーニングは下肢筋力、歩行速度の改善に有用であり、また安全に使用できた。(著者抄録)
(NPO)日本心臓リハビリテーション学会, 2015年, 心臓リハビリテーション, 20 (2), 350 - 355, 日本語[査読有り]
研究論文(学術雑誌)
【目的】訪問リハビリテーション(訪問リハ)従事者が経験した利用者の病状変化の気づきに影響する要因について検討する。【方法】訪問リハ従事者334名の質問紙調査結果を用い、病状変化の気づきの有無による2群で回答者特性およびアセスメント実施度の因子得点を比較し、多変量解析を行った。【結果】2群間の比較では、気づきあり群は気づきなし群に比し、高年齢、訪問リハ経験年数長期、呼吸器疾患経験多数であった。また、気づきあり群は気づきなし群に比し、第2、第3、第4因子得点が有意に低値を示した。ロジスティック分析結果では、年齢、訪問リハ経験年数、呼吸器疾患経験、第3因子(基本的生命活動所見)得点が独立した因子であった。【結語】病状変化の気づきには、訪問リハ経験を長く積むことや呼吸器疾患症例を多く経験することに加え、バイタルサインや意識レベル、視診や呼吸音聴診など基本的生命活動所見のアセスメント実施が影響する。(著者抄録)
日本保健科学学会, 2015年, The Journal of Japan Academy of Health Sciences, 18 (3), 127 - 137, 日本語[査読有り]
研究論文(学術雑誌)
[目的]訪問リハビリテーション(訪問リハ)従事者が利用者の病状把握に用いる重要なアセスメントを明らかにする。[対象]全国の訪問リハ従事者335名とした。[方法]540施設に質問紙を郵送し、その回答結果を職種別、経験年数別に検討した。[結果]訪問リハの実践においてバイタルサインや転倒、意識レベルなどは重要とされていた。しかし、腹部聴診、心尖拍動触診、心電図変化などは重要とされていないアセスメントであった。また、職種や経験年数の違いによる影響も認められた。[結語]訪問リハ従事者は、内部障害を有する利用者を経験しているにもかかわらず、内部障害系のアセスメントの知識や実施経験に乏しい現状がある。(著者抄録)
(一社)理学療法科学学会, 2015年, 理学療法科学, 30 (4), 569 - 576, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Background: Insulin resistance (IR) is characterized as a metabolic disorder syndrome that is upstream of hypertension, dyslipidemia, and diabetes mellitus (DM). This study investigated exercise training effects on the exercise tolerance and heart rate dynamics in patients with IR or pancreatic beta-cell dysfunction. Methods: Seventy patients (mean age, 60.1 years) with myocardial infarction (MI) participating in a phase II cardiac rehabilitation program were studied. Patients diagnosed with DM were excluded. Homeostasis model-assessment indices were used to divide patients into three groups - A: IR; B: normal; and C: beta-cell dysfunction. A cardiopulmonary exercise test (CPX) was performed and peak oxygen uptake ((V) over dot O-2) was measured. After baseline testing, subjects participated in a supervised, combined aerobic and resistance exercise program. Results: Peak (V) over dot O-2 at baseline was comparable among the three groups, and it improved after training in all groups (p < 0.05). However, both the increase and percentage increase in peak (V) over dot O-2 were smaller in Group C than in Group A (p <0.05). Heart rate (HR) reserve (peak HR-rest HR), and HR recovery immediately 1 mm after exercise during CPX were calculated in 45 patients who were not taking negative chronotropic agents. Group C alone did not show any significant increase in HR reserve. HR reserve at both baseline and after training had significant positive correlations with peak (V) over dot O-2. HR recovery was 1.9 beats/min lower in group C than group A, but this was not significant. HR recovery in group C did not increase after cardiac rehabilitation. Conclusion: Impaired HR reserve increase after training in patients with pancreatic beta-cell dysfunction attenuates exercise training effects on functional capacity. Comprehensive treatment including vigorous exercise training will be needed in such prediabetic patients. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
ELSEVIER SCIENCE BV, 2015年01月, Journal of Cardiology, 65 (1-2), 128 - 133, 英語[査読有り]
研究論文(学術雑誌)
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[査読有り]
研究論文(学術雑誌)
This study aimed to determine the relation between the regression slope relating minute ventilation to carbon dioxide output ((V) over dotE/(V) over dotCO2 slope) and maximum phonation time (MPT), and the MPT required to attain a threshold value for (V) over dotE/(V) over dotCO2 slope of <= 34 in chronic heart failure (CHF) patients. This cross-sectional study enrolled 115 CHF patients (mean age, 54.5 years; men, 84.9%). (V) over dotE/(V) over dotCO2 slope was assessed during cardiopulmonary exercise testing (CPX). Thereafter, patients were divided into 2 groups according to exercise capacity: (V) over dotE/(V) over dotCO2 slope <= 34 ((V) over dotE/(V) over dotCO2 <= 34 group, n = 81) and (V) over dotE/(V) over dotCO2 slope >34 ((V) over dotE/(V) over dotCO2 >34 group, n = 34). For MPT measurements, all patients produced a sustained vowel/a:/for as long as possible during respiratory effort from the seated position. All subjects showed significant negative correlation between (V) over dotE/(V) over dotCO2 slope and MPT (r = -0.51, P < 0.001). After adjustment for clinical characteristics, MPT was significantly higher in the (V) over dotE/(V) over dotCO2 <= 34 group vs (V) over dotE/(V) over dotCO2 >34 group (21.4 +/- 6.4 vs 17.4 +/- 4.3 s, F = 7.4, P = 0.007). The appropriate MPT cut-off value for identifying a (V) over dotE/(V) over dotCO2 slope <= 34 was 18.12 seconds. An MPT value of 18.12 seconds may be a useful target value for identifying CHF patients with a (V) over dotE/(V) over dotCO2 slope <= 34 and for risk management in these patients.
LIPPINCOTT WILLIAMS & WILKINS, 2014年12月, MEDICINE, 93 (29), e306, 英語[査読有り]
研究論文(学術雑誌)
Background Little is known about the differences in the geriatric nutritional risk index (GNRI) status in older patients and their relationship to accelerometer-derived measures of physical activity (PA) levels. We determined both differences in daily measured PA based on the GNRI and related cut-off values for PA in elderly cardiac inpatients. Methods We divided 235 consecutive elderly cardiac inpatients (mean age 73.6 years, men 70.6 %) into four groups by age and GNRI: older-high group, 65-74 years with high GNRI (>= 92 points) (n = 111); older-low group, low GNRI (< 92 points) (n = 30); very old-high group, >= 75 years with high GNRI (n = 55); and very old-low group with low GNRI (n = 39). Average step count and physical activity energy expenditure (PAEE in kcal) per day for 2 days of these inpatients were assessed by accelerometer and compared between the four groups to determine cut-off values of PA. Results Step counts and PAEE were significantly lower in the low-GNRI versus high-GNRI groups in the older (2,742.1 vs. 4,198.1 steps, 55.4 vs. 101.3 kcal, P < 0.001), and very old (2,469.6 vs. 3,423.7 steps, 54.5 vs. 79.1 kcal, P < 0.001) cardiac inpatients. Respective cut-off values for step counts and PAEE were 3,017.6 steps/day and 69.4 kcal (P < 0.01) in the older and 2,579.4 steps/day and 58.8 kcal in the very old cardiac inpatients (P < 0.01). Conclusion Poor nutritional status, as indicated by a low GNRI, may be a useful predictor of step counts and PAEE. The cut-off values determined in this study might be target values to be attained by older cardiac inpatients.
SPRINGER, 2014年12月, AGING CLINICAL AND EXPERIMENTAL RESEARCH, 26 (6), 599 - 605, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
The goal of the present study was to determine knee extensor muscle strength (KEMS) and degree of renal dysfunction associated with an exercise capacity of a parts per thousand yen5 metabolic equivalents (METs) in male chronic heart failure (CHF) patients with chronic kidney disease (CKD). In this cross-sectional study of 75 male CHF patients with CKD (65.3 +/- A 11.6 years), we measured clinical characteristics, peak , estimated glomerular filtration rate (eGFR), and KEMS. Patients were divided into two groups by exercise capacity: a parts per thousand yen5 METs group (n = 41) and < 5 METs group (n = 34). Cutoff values for KEMS and eGFR resulting in an exercise capacity of a parts per thousand yen5 METs were selected with ROC curves. Patients were divided into four groups according to cutoff values, and numbers of patients attaining an exercise capacity of a parts per thousand yen5 METs were compared between groups. Age was significantly higher although eGFR, Hb, and KEMS were lower in the < 5 METs versus a parts per thousand yen5 METs group (P < 0.001). Multiple logistic regression analysis revealed a positive significant relation between KEMS and eGFR and exercise capacity of a parts per thousand yen5 METs. Exercise capacity of a parts per thousand yen5 METs was associated with KEMS of approximately 1.69 Nm/kg and an eGFR of 45.7 mL/min/1.73 m(2). The number of patients attaining an exercise capacity of a parts per thousand yen5 METs in the patients who did not reach both cutoff values was significantly lower than that in any other patients (P < 0.001). KEMS and eGFR may be useful indices for predicting attainment of exercise capacity of a parts per thousand yen5 METs in male CHF patients with CKD.
SPRINGER, 2014年04月, CLINICAL AND EXPERIMENTAL NEPHROLOGY, 18 (2), 313 - 319, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Purpose: Poor mental health (MH) is common in chronic heart failure (CHF) patients. No studies have reported a relation between MH status and objectively measured physical activity (PA) in CHF patients. The study aim was to determine self-reported MH-related differences associated with PA and target values of PA for improved MH in CHF outpatients. Methods: We divided 243 CHF outpatients (mean age 57.1 years) into two groups according to MH assessed by Short Form-36 score: high-MH (>= 68 points) group (n = 148) and poor-MH (<68 points) group (n = 95). Average step count (steps) and energy expenditure on PA (EE) (kcal) per day for 1 week of PA were assessed by an accelerometer and compared between groups. PA resulting in high MH was determined by the receiver-operating characteristic (ROC) analysis. Results: PA correlated positively with MH in all patients (steps: r = 0.46, p<0.001; EE: r = 0.43, p<0.001). After adjusting for patient characteristics, steps and EE were significantly lower in the poor-MH versus high-MH group (5020.1 +/- 280.7 versus 7174.1 +/- 221.5 steps, p<0.001; 133.9 +/- 10.8 versus 215.9 +/- 8.4 kcal, p<0.001). Cut-off values of 5590.8 steps and 141.1 kcal were determined as PA target values associated with improved MH. Conclusions: Poor MH status may reduce PA. Attaining PA target values may improve MH status of CHF outpatients.
TAYLOR & FRANCIS LTD, 2014年, DISABILITY AND REHABILITATION, 36 (3), 250 - 254, 英語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
The purpose of this study was to determine both an association between mortality and physical activity (PA) objectively measured by accelerometer and cutoff values for PA in Japanese outpatients with heart failure (HF). This prospective observational study comprised 170 HF outpatients (mean age, 65.2 years; 77% men). Peak oxygen uptake (VO2) and the relation between ventilation and carbon dioxide production (VE/VCO2 slope) as indices of exercise capacity were measured during cardiopulmonary exercise testing with a cycle ergometer. PA was assessed by accelerometer-measured average step count (steps) per day for 1 week. Study endpoint was cardiovascular-related death. Over an average follow-up of 1,377.1 (median, 1,335) days, 31 cardiovascular-related deaths occurred. Patients were then divided into survivor (n = 139) and nonsurvivor (n = 31) groups. Brain natriuretic peptide level was significantly different between groups. Peak VO2 and steps were also significantly lower and VE/VCO2 slope higher in the nonsurvivors versus survivors. Univariate Cox proportional hazards analysis showed brain natriuretic peptide, peak VO2, VE/VCO2 slope, and steps to be significant prognostic indicators of survival. Multivariate analysis showed PA of <= 4,889.4 steps/day to be a strong and independent predictor of prognosis (hazard ratio: 2.28, 95% confidence interval: 1.31-6.30; p = 0.008). Kaplan-Meier curves after log-rank test showed significant prognostic difference between PA of <= 4,889.4 and >4,889.4 steps/day in the 2 groups (log-rank: 12.19; p = 0.0005). In conclusion, step count as objectively measured by accelerometer may be a prognostic indicator of mortality in Japanese outpatients with HF. (C) 2013 Elsevier Inc. All rights reserved.
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, 2013年06月, AMERICAN JOURNAL OF CARDIOLOGY, 111 (12), 1767 - 1771, 英語[査読有り]
研究論文(学術雑誌)
BackgroundThe aim of this study was to determine whether a single moderate-intensity exercise session induces renal injury based on various parameters that reflect kidney dysfunction, including urinary L-type fatty acid-binding protein (L-FABP). MethodsAdult outpatients (n = 31) with chronic kidney disease (CKD) not receiving renal replacement therapy participated in this study. Urine was collected before and after a single 20-min moderate-intensity exercise session. Urinary levels of L-FABP, albumin, N-acetyl--d-glucosaminidase (NAG), and 1-microglobrin (1MG) were measured. In addition, 12 patients with estimated glomerular filtration fraction less than 30 ml/min/1.73 ml(2) were selected from all patients and evaluated using the same analysis. ResultsUrinary values of L-FABP, albumin, NAG, and 1MG did not increase significantly after exercise compared with before exercise (urinary L-FABP, from 8.3 to 9.4 g/g of creatinine; urinary albumin, from 293.1 to 333.7 mg/g of creatinine; urinary NAG, from 9.2 to 8.2 U/g of creatinine; urinary 1MG, from 11.4 to 9.8 mg/g of creatinine, not significant). Similar findings were seen in all patients, regardless of degree of renal dysfunction. ConclusionsA single session of moderate-intensity exercise was not associated with an increase in renal parameters used to assess renal damage. (C) 2013 Wiley Periodicals, Inc.
JOHN WILEY & SONS INC, 2013年05月, JOURNAL OF CLINICAL LABORATORY ANALYSIS, 27 (3), 177 - 180, 英語[査読有り]
研究論文(学術雑誌)
Patients undergoing dialysis experience decreases in physical function; however, few data exist on physical function in pre-dialysis patients with chronic kidney disease (CKD). The primary objective of this study was to clarify physical function in pre-dialysis patients according to CKD stage. This was a cross-sectional study of 120 ambulant pre-dialysis CKD stage 2 or higher patients (85 male, 35 female; mean age 66.5 years) who visited St. Marianna University School of Medicine Hospital. Participants were grouped according to CKD stage as follows: stage 2 (n = 17), stage 3 (n = 55), stage 4 (n = 25), and stage 5 (n = 23). Handgrip strength, knee extensor muscle strength, single-leg stance time, and maximum gait speed were used to assess physical function. Clinical laboratory tests were also examined at the same time as physical function measurements. All indices of physical function decreased according to the progression of CKD. Each physical function index was significantly lower in CKD stage 4 or 5 patients than CKD stage 2 or 3 patients. All physical function indices showed a positive correlation with estimated glomerular filtration rate (eGFR), blood hemoglobin level, and serum albumin level, and a negative correlation with urinary protein levels. In multiple regression analysis, age, female sex, body mass index, eGFR and urinary protein were significantly correlated with indices of physical function. Physical function in pre-dialysis CKD patients decreased as the disease progressed according to stage. Early intervention in CKD patients might delay the loss of physical function.
SPRINGER, 2013年04月, CLINICAL AND EXPERIMENTAL NEPHROLOGY, 17 (2), 225 - 231, 英語[査読有り]
研究論文(学術雑誌)
【目的】腹膜透析(PD)患者の身体活動(PA)の実態をあきらかにすること。【方法】外来通院中のPD患者30例を対象とした。PAの測定は,加速度つきの歩数計を用い,平均歩数,平均活動時間,平均運動量を評価した。また,低強度(<3METs),中等強度(3〜6METs),高強度(>6METs)の3群による運動強度別の運動時間を比較した。さらに,対象者を5,000歩/日未満(A群),5,000〜7,499歩/日(B群),7,500〜9,999歩/日(C群),10,000歩/日以上(D群)の4群に選別し,歩数別の人数の割合を比較した。【結果】PD患者の平均歩数は4,864.3±3,365.7歩/日,平均活動時間は53.6±34.4分/日,平均運動量は135.6±122.2kcal/日であった。運動強度別の運動時間は,低強度37.0分,中等強度10.6分,高強度1.8分であった。PD患者の歩数別の人数の割合は,A群18例,B群7例,C群3例,D群2例であり,各群の割合には有意な偏りがあった(p<0.01)。【結語】PD患者のPAは,低強度の活動が中心で,5,000歩/日未満の低活動者が有意に多いことがあきらかとなった。
日本理学療法士学会, 2013年, 理学療法学, 40 (7), 473 - 479, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
Background. Patients with chronic heart failure (CHF) commonly fatigue easily due to low peak oxygen uptake (peak VO2), an important index of exercise capacity. Maximum phonation time (MPT) is widely used to evaluate maximum vocal capabilities because it is non-invasive, quick, and inexpensive. Aim. The aim of this study was to determine the relation between MPT and exercise capacity, and MPT required to attain an exercise capacity of metabolic equivalents (METs) in CHF outpatients. Design. Cross-sectional study. Setting. Outpatient cardiac rehabilitation unit. Population. We enrolled 111 CHF outpatients (mean age 54.2 +/- 10.1 years). Methods. Peak VO2 was assessed during cardiopulmonary exercise testing (CPX) as the index of exercise capacity. After CPX, we divided the patients into two groups according to exercise capacity: METs group (N.=68) and <5 METs group (N.=43). Measurements of MPT were taken in the seated position. All patients were asked to produce a sustained vowel /a:/ for as long as possible and were verbally encouraged during respiratory effort. Results. After adjustment for patient clinical characteristics, MPT in the CHF patients was found to be significantly higher in the METs group than in the >= 5 METs group (22.1 +/- 8.4 vs. 17.0 +/- 11.6 s, F=13.5, P<0.001). Receiver-operating characteristic curve analysis of exercise capacity of >= 5 METs extracted a cutoff value for MPT of 18.27 s, with a sensitivity of 0.76, 1-specificity of 0.33, and AUC value of 0.81 (95% CI: 0.70-0.87, P<0.001). Conclusion. There were differences in MPT in relation to an exercise capacity threshold of METs in CHF outpatients. A MPT of 18.27 sec may be the best cutoff value to identify people with or without exercise capacity of METs. Clinical rehabilitation impact. Measurement of MPT may be a useful method for estimating exercise capacity in CHF outpatients.
EDIZIONI MINERVA MEDICA, 2012年12月, EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE, 48 (4), 593 - 599, 英語[査読有り]
研究論文(学術雑誌)
Objective: To investigate the effect of the self-monitoring of physical activity by hospitalized cardiac patients attending phase I cardiac rehabilitation (CR). Design: Randomized controlled trial. Setting: University hospital CR program. Participants: CR patients (N=126) with a mean age of 59.1 years. Interventions: Patients were randomly assigned to the selfmonitoring group (group A, n=63) or the control group (group B, n=63). Along with CR, group A patients performed selfmonitoring of their physical activity at the beginning of a phase I CR program (acute in-hospital phase for inpatients) and ending just before they began a phase 11 CR program (postdischarge recovery phase for outpatients). Main Outcome Measures: Physical activity (averages of daily number of steps taken and daily energy expenditure for lwk) as measured by accelerometer was assessed in both groups at baseline (t1) and before the beginning of phase II CR (t2). Results: Although there were no significant differences in physical activity values between groups A and B at t1, values of group A at t2 were significantly higher than those of group B (8609.6 vs 5512.9 steps, P<.001; 242.6 vs 155.9kcal, P<.001). Conclusions: Self-monitoring of patient physical activity from phase II CR might effectively increase the physical activity level in preparation for entering a phase IT CR program. Results of the present study could contribute to the development of new strategies for the promotion of physical activity in cardiac patients.
W B SAUNDERS CO-ELSEVIER INC, 2012年11月, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, 93 (11), 1896 - 1902, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
PURPOSE: Exercise capacity of fewer than 5 metabolic equivalents (METs) has been associated with high risk of death and poor physical functioning in male patients with heart failure (HF). Therefore, we aimed to determine upper and lower extremity muscle strength levels required to attain an exercise capacity of 5 or more METs in male outpatients with HF. METHODS: We enrolled 148 male HF patients (age 60.1 +/- 1.0 years). Peak oxygen uptake (peak (over dot)VO2) was assessed by cardiopulmonary exer cise testing (CPX). After CPX, we further divided the patients into groups according to exercise capacity: 5 or more METs (group A, n = 85) and fewer than 5 METs (group B, n = 63). Handgrip strength and knee extensor and flexor muscle strengths were assessed as indices of upper and lower extremity muscle strength, respectively. Receiver operating characteristic curves were used to select cutoff values for upper and lower extremity muscle strength resulting in an exercise capacity of 5 or more METs in these patients. RESULTS: Exercise capacity of 5 or more METs in male HF patients was equivalent to approximately 35.2 kgf of handgrip strength and 1.70 Nm/kg of knee extensor and 0.90 Nm/kg of knee flexor muscle strengths. CONCLUSIONS: These upper and lower extremity muscle strength values may be useful target goals for improvement of exercise capacity, risk management, and activities of daily living in male HF patients.
LIPPINCOTT WILLIAMS & WILKINS, 2012年03月, JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION, 32 (2), 85 - 91, 英語[査読有り]
研究論文(学術雑誌)
【目的】糖尿病(DM)を合併した急性心筋梗塞(AMI)患者における運動耐容能の改善に対する膝伸展筋力および自律神経指標の関与について回復期運動療法実施の有無によりあきらかにすること。【方法】本研究は後方視研究である。対象はDMを合併したAMI男性患者連続41例(運動群24例,対照群17例)で,運動群は8週間の回復期運動療法を実施した。発症1ヵ月後(T1)および3ヵ月後(T2)の最高酸素摂取量(Peak VO_2).膝伸展筋力,自律神経指標であるΔHR(安静時心拍数と最大運動時の心拍数の差)の変化を比較検討した。【結果】運動群は対照群に比しPeak VO_2(26.1→29.4 vs 23.5→24.4ml/kg/min, F=7.5, p< 0.01),膝伸展筋力(1.7→1.9 vs 1.7→1.7 Nm/kg, F=5.1, p=0.02),ΔHR (71.3→77.2 vs 63.5→62.5 bpm, F=5.5, p=0.02)は T1からT2にかけて有意に改善した。【結論】DMを合併したAMI患者では,回復期運動療法を実施した群のみPeak VO_2,膝伸展筋力およびΔHRが有意に改善を示した。したがって,DMを合併したAMI患者の運動耐容能改善の背景には,膝伸展筋力とΔHRの改善が寄与しているものと考えられた。
公益社団法人日本理学療法士協会, 2012年, 理学療法学, 39 (1), 1 - 6, 日本語[査読有り]
研究論文(学術雑誌)
Purpose: Patients with exercise capacity of <5 metabolic equivalents (METs) are considered to have a high risk of death. The aim of this study was to determine age-related differences in physical activity associated with an exercise capacity of >= 5 METs in chronic heart failure (CHF) outpatients. Methods: We enrolled 157 stable CHF patients (79.6% men, age 60.3 +/- 11.5 years). Patients were divided into two age-based groups (middle-aged, <65 years, n = 97) and (older-aged, >= 65 years, n = 60). Peak oxygen uptake (peak VO2) was assessed by cardiopulmonary exercise testing. We further divided patients into groups according to exercise capacity: >= 5 METs and <5 METs. Physical activity was assessed by measuring the average number of steps/day for 1 week with an electronic pedometer. Results: Receiver-operating characteristic curves were used to select cutoff values for steps associated with an exercise capacity of >= 5 METs in the middle- and older-aged patients. Cutoff values of 6045 steps in the middle-aged and 6070 steps in the older-aged patients were determined. Conclusions: Both middle-and older-aged CHF patients with exercise capacity of >= 5 METs completed approximately 6000 steps/day. This could become a target amount for minimal physical activity that could contribute to increased exercise capacity in CHF patients.
INFORMA HEALTHCARE, 2012年, Disability & Rehabilitation, 34 (23), 2018 - 2024, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
To determine self-reported sleep quality-related differences in physical activity (PA) and health-related quality of life (HRQOL) and target values of PA for high-quality sleep in chronic heart failure (CHF) outpatients, 149 CHF outpatients (mean age 58 years) were divided into two groups by sleep-quality level determined via self-reported questionnaire: shallow sleep (SS) group (n = 77) and deep sleep (DS) group (n = 72). Steps were assessed by electronic pedometer, HRQOL was assessed with the Short Form 36 (SF-36) survey, and data were compared between groups. PA resulting in high-quality sleep was determined by receiver-operating characteristics curves. All SF-36 subscale scores except that of bodily pain were significantly decreased in the SS versus DS group. A cutoff value of 5723.6 steps/day and 156.4 Kcal/day for 1 week were determined as target values for PA. Sleep quality may affect PA and HRQOL, and attaining target values of PA may improve sleep quality and HRQOL of CHF outpatients. Patents relevant to heart failure are also discussed in this article. © 2011 Bentham Science Publishers.
2011年09月, Recent Patents on Cardiovascular Drug Discovery, 6 (3), 161 - 167, 英語[査読有り]
研究論文(学術雑誌)
To examine differences in objective and subjective outcomes in outpatients undergoing percutaneous coronary intervention (PCI) performed for acute myocardial infarction versus cardiac surgery (CS) following a phase II cardiac rehabilitation (CR). Longitudinal observational study of 437 consecutive cardiac outpatients after 8 weeks of phase II CR. Patients were divided into the PCI group (n = 281) and CS group (n = 156). Handgrip and knee extensor muscle strength, peak oxygen uptake (VO2), upper- and lower-body self-efficacy for physical activity (SEPA), and physical component summary (PCS) and mental component summary (MCS) scores as assessed by Short Form-36 were measured at 1 and 3 months after PCI or CS. All outcomes increased significantly between months 1 and 3 in both groups. However, increases were greater in the CS versus PCI group in handgrip strength (+12.3 % vs. +8.1%, P < 0.01), knee extensor muscle strength (+19.3% vs. +17.5%, P = 0.008), peak VO2 (+20.9% vs. +16.9%, P < 0.01), upper-body SEPA (+27.7% vs. +9.2%, P = 0.001), and PCS score (+6.5% vs. +4.1%, P = 0.001). Although this relatively short-term phase II CR increased all outcomes for both groups, outcomes showed the recovery process was different between the PCI and CS groups, slightly favoring CS patients. Furthermore, patents in the field of CR are presented. © 2011 Bentham Science Publishers.
2011年05月, Recent Patents on Cardiovascular Drug Discovery, 6 (2), 133 - 139, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
【目的】本研究の目的は,慢性心不全(CHF)患者の運動耐容能を腎機能別に調査し,慢性腎臓病(CKD)合併CHF患者の運動耐容能関連要因について明らかにすることである。【方法】男性CHF患者119例を対象に推算糸球体濾過量(eGFR)を基に,A群(eGFR60以上),B群(eGFR30以上60未満),C群(eGFR30未満)の3群に選別し,運動耐容能および上下肢筋力を比較した。さらにB・C群(CKD群)の運動耐容能関連要因を検討した。【結果】腎機能別の3群間の比較では,運動耐容能,膝伸展筋力,握力は,eGFRが低い群で有意に低値を示した。さらに,CKD群の運動耐容能関連要因を重回帰分析にて検討した結果,膝伸展筋力とeGFR(R=0.68,R^2=0.44,p<0.001)が抽出された。【結語】CHF患者では,腎機能低下にともない運動耐容能は低下した。また,CKD合併CHF患者の運動耐容能関連要因に,膝伸展筋力とともにeGFRが抽出された。
公益社団法人日本理学療法士協会, 2011年, 理学療法学, 38 (6), 436 - 441, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
【目的】糖尿病(DM)を合併した急性心筋梗塞(AMI)患者における運動耐容能低下への身体機能の関与の有無を明らかにする。【方法】対象はAMI男性患者190例(DM群47例,非DM群143例)。最高酸素摂取量(Peak VO_2),身体機能指標(膝伸展筋力,握力,片脚立位時間,前方リーチ距離,体脂肪率,筋肉量),自律神経指標(%HRR,ΔHR)を測定した。【結果】DM群は非DM群に比しPeak VO_2 24.3,27.1ml/kg/min(p<0.01),膝伸展筋力1.75,1.93Nm/kg(p<0.01),握力38.1,41.3kgf(p=0.02),片脚立位時間22.2,28.5秒(p<0.01),%HRR79.1,85.6%(p=0.04),ΔHR66.0,75.4bpm(p<0.01)と低値を示した。DM群のPeak VO_2の関連要因を検討した結果,膝伸展筋力とΔHRが抽出された(r=0.58,R^2=0.301,p<0.01)。【結論】DM群の運動耐容能低下には,膝伸展筋力の低下と自律神経指標(ΔHR)が関与することが明らかとなった。
公益社団法人日本理学療法士協会, 2011年, 理学療法学, 38 (5), 343 - 350, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
【目的】大動脈解離および大動脈瘤の急性期リハビリテーションプログラムを,残存解離のない例(真性群),血栓閉塞型解離例(閉塞群),Ulcer-Like Projectionを認める例(ULP群),血栓開存型解離例(開存群)の4群に分類して実施しその有用性を検討した。【方法】大動脈解離および大動脈瘤症例172例(男性131例女性41例)を対象とし,各症例の急性期治療と急性期リハビリテーションプログラム進行状況,および逸脱理由を診療録より後方視的に調査した。急性期リハビリテーションプログラム進行状況はADLが許可されるまでの日数を算出し,完遂率や逸脱率およびその理由を検討した。【結果】離床までの期間は真性群2.9±2.0日,閉塞群4.7±3.0日,ULP群4.5±1.7日,開存群8.8±4.2日であった。トイレ歩行までの期間は真性群4.9±1.5日,閉塞群6.8±3.2日,ULP群9.8±4.0日,開存群13.7±4.2日であった。退院までのリハビリ実施期間は真性群12.8±4.5日,閉塞群15.2±5.9日,ULP群17.3±3.8日,開存群27.2±7.7日であった。各群のプログラム完遂率/逸脱率は真性群86%/14%,閉塞群68%/32%,ULP群71%/29%,開存群52%/48%であった。再解離を認めた症例は真性群0%,閉塞群2%,ULP群7%,開存群11%であった。【結論】プログラムの進行状況は概ね予定通りであり,急性期リハビリテーションプログラムは有用と思われた。
公益社団法人日本理学療法士協会, 2010年, 理学療法学, 37 (1), 52 - 56, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Objective: To examine differences in physiologic and psychosocial outcomes between age groups after an exercise-based supervised-recovery phase 11 cardiac rehabilitation outpatient program. Design: This is a longitudinal observational study. The study assessed 442 consecutive cardiac patients. Patients were divided into the middle-aged group (<65 yrs, n = 242) and older-age group (>= 65 yrs, n = 200). Peak oxygen uptake, handgrip and knee extensor muscle strength, upper- and lower-body self-efficacy for physical activity, and physical component summary and mental component summary scores as assessed by SF-36 were measured at 1 and 3 mos after the onset of acute myocardial infarction or cardiac surgery and were compared. Results: All physiologic and psychosocial outcomes increased significantly between months 1 and 3 in both groups. However, increases were greater in the middle-aged vs. older-aged group in peak oxygen uptake (+13.1% vs. +8.7%, P < 0.01), knee extensor muscle strength (+17.6% vs. +13.3%, P = 0.01), lower-body self-efficacy for physical activity (+17.3% vs. +12.7%, P = 0.02), and physical component summary score (+5.4% vs. +2.7%, P = 0.02). Conclusions: Age-related differences in various physiologic and psychosocial measures indicated greater improvement from an exercise-based supervised recovery-phase II cardiac rehabilitation outpatient program in middle-aged vs. older-aged patients. Older adults may derive equal mental or emotional benefit from such a cardiac rehabilitation program but do not experience as much improvement in physiologic outcomes as middle-aged adults.
LIPPINCOTT WILLIAMS & WILKINS, 2010年01月, AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 89 (1), 24 - 33, 英語[査読有り]
研究論文(学術雑誌)
Background: Recently, sleep disordered breathing (SDB) has gained attention in the field of cardiology. Until now, no study describing the relationship between acute coronary syndrome (ACS) and SDB has been carried out in Japan. Methods: Among ACS patients admitted to our hospital, 44 patients (mean age 60.6 +/- 13.5 years) who received a portable polysomnography to measure apnea hypopnea index (AHI) were selected for this study. The circadian pattern of ACS onset was studied in 6-h intervals. In addition, all subjects were divided into three groups according to AHI severity (AHI < 5, 5 < AHI < 15, and 15 < AHI). Then, a comparative study between peak time of ACS and AHI severity was conducted for each group. Results: In the AHI < 5 group, 66.0% patients suffered from ACS between 12:00 h and 18:00 h and 17.0% between 18:00h and 24:00h, and a total of 83.0% patients had ACS between 12:00 h and 24:00 h. In the 5 < AHI < 15 group, 49.9% patients had ACS between 24:00 h and 06:00 h, 16.7% patients between 06:00 h and 12:00 h. 12:00-18:00 h and 18:00-24:00 h showed no significant difference. All 22 patients in the 15 < AHI group suffered from ACS between 24:00 h and 12:00 h. Conclusion: The results of this study suggest a possible relationship between SDB and the onset of ACS between midnight to morning. (C) 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.
ELSEVIER IRELAND LTD, 2009年04月, JOURNAL OF CARDIOLOGY, 53 (2), 164 - 170, 英語[査読有り]
研究論文(学術雑誌)
Background Whether upper-extremity and lower-extremity muscle strength can predict a prognosis of congestive heart failure (CHF) patients is unclear. This study evaluated the impact of muscle strength on long-term mortality in patients with CHF. Design Prospective observational study of male Japanese CHF patients. Methods Clinical characteristics (age, body mass index, left ventricular ejection fraction, heart failure etiology, and medications) were obtained from hospital records of 148 male outpatients with stable CHF. Brain natriuretic peptide was determined as an index of disease severity. Peak oxygen uptake (V) over dot(O2), handgrip, and knee extensor muscle strength were also determined. Results After 1331.9 +/- 700.3 days of follow-up, 13 cardiovascular-related deaths occurred, and the patients were divided into two groups: survival (n = 135) and nonsurvival (n = 13). No significant differences were found between the groups in clinical characteristics, brain natriuretic peptide levels, and knee extensor muscle strength. Peak (V) over dot(O2) (P= 0.011) and handgrip strength (P=0.008) were significantly lower in the (V) over dot(O2) nonsurvival versus survival group. Left ventricular ejection fraction, peak , and handgrip strength were found by univariate Cox proportional hazards analysis to be significant prognostic indexes of survival. Multivariate analysis, however, revealed handgrip strength to be an independent predictor of prognosis. A handgrip strength cutoff value of 32.2 kgf was determined by the analysis of receiver-operating characteristics and was assessed. Kaplan-Meier survival curves after log-rank test showed significant prognostic difference between the two groups (P=0.008). Conclusion Handgrip strength may be useful for forecasting prognosis in patients with CHF. Eur J Cardiovasc Prev Rehabil 16:21-27 (C) 2009 The European Society of Cardiology
LIPPINCOTT WILLIAMS & WILKINS, 2009年02月, EUROPEAN JOURNAL OF CARDIOVASCULAR PREVENTION & REHABILITATION, 16 (1), 21 - 27, 英語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
【目的】回復期冠動脈疾患患者の身体活動量(PA)の実態とその関連要因を明らかにすること。【方法】対象は,急性心筋梗塞発症および冠動脈バイパス術後1か月時点の冠動脈疾患外来患者50例である。基礎疾患および属性,PA,最高酸素摂取量(peak VO_2),下肢筋力(膝伸展筋力)を調査,測定した。【結果】各指標の平均値±標準偏差は,PA:7893.3±2914.5歩/日,peak VO_2:24.8±5.9ml/kg/min,下肢筋力:1.7±0.4Nm/kgであった。PAとpeak VO_2間にr=0.32(p=0.02),PAと下肢筋力の間にr=0.41(p=0.03)の相関関係を認めた。重回帰分析の結果,PAの関連要因として下肢筋力が抽出された(r=0.48,R^2=0.23,p=0.02)。【結論】回復期冠動脈疾患患者のPAは7893歩で,その関連要因として下肢筋力が示された。
公益社団法人日本理学療法士協会, 2009年, 理学療法学, 36 (3), 109 - 113, 日本語[査読有り]
研究論文(学術雑誌)
Sleep-disordered breathing (SDB) is frequently observed in patients with congestive heart failure. Recent studies have shown that SDB negatively affects the onset of congestive heart failure; however, no studies have addressed the relationship between the level of SDB and the onset time of acute dyspnea. We hypothesized that SDB affects the acute onset time of dyspnea (AOT) and investigated the relationship between SDB and AOT. We examined 80 patients (mean age, 61.6 years) with congestive heart failure in a clinically stable condition, AOT was divided into 5 time periods (0:00 - 6:00. 6:00 12:00, 12:00 - 18:00, 18:00 - 24:00, and unknown). The apnea-hypopnea index (AHI) was obtained based on the results of polysomnography (PSG) to evaluate the severity of SDB. Acute dyspnea occurred in 59 (73.7%) of the 80 patients. When we divided the patients into an AHI < 5 group and all AHI >= 5 group, there was no significant difference in the AOT,- however, a significant difference was observed in those divided into AHI < 20 and AHI >= 20 groups (P < 0.001). The patients with AHI >= 20 had more acute dyspnea between 18:00 - 24:00 and between 0:00 - 6:00 than those with AHI < 20 (32% and 19%, and 4.1% and 4.1%, respectively). Severe SDB patients tended to have acute dyspnea between midnight and dawn. The results suggest SDB might be one of the risk factors of heart failure. (Int Heart J 2008; 49: 471-480)
SPRINGER, 2008年07月, INTERNATIONAL HEART JOURNAL, 49 (4), 471 - 480, 英語[査読有り]
研究論文(学術雑誌)
Objective: To examine gender differences in clinical characteristics and physiological and psychosocial outcomes at entry into phase II cardiac rehabilitation. Design: Cross-sectional study. Subjects: The study comprised 442 consecutive patients with cardiac diseases assessed at entry into a phase II cardiac rehabilitation programme. Methods: Clinical characteristics of the patients, such as age, education, marital status, employment and body mass index, were obtained from hospital records. Oxygen uptake, handgrip and knee extensor muscle strength were measured to assess physiological outcomes. Self-efficacy for physical activity, hospital anxiety depression scale and health-related quality of life assessed by Short Form-36 were evaluated to assess psychosocial outcomes. Results: The number of married women and their levels of education, employment and body mass index were significantly lower, and their ages higher, than those of the men. Measures of physiological outcome in women were significantly lower than those in men. Measures of self-efficacy for physical activity and Short Form-36 physical and emotional subscale scores were lower and anxiety levels higher in women than in men. Conclusion: Cardiac rehabilitation programmes exclusively for women focusing on physiological outcomes, group counselling, and training to enhance physical and emotional domains may encourage increased participation by women in cardiac rehabilitation.
TAYLOR & FRANCIS AS, 2008年03月, JOURNAL OF REHABILITATION MEDICINE, 40 (3), 225 - 230, 英語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
Objective: Indices of exercise capacity such as peak oxygen uptake (VO2peak) and muscle strength are important In association with reduced mortality. The present study compared differences in V02peak and muscle strength indices (grip strength and knee extensor and flexor muscle strength) with disease severity and investigated the relation of these variables in congestive heart failure (CHF) patients. Design: The study comprised 102 patients with stable CHIF (93 men, age 61.4 +/- 10.2 yrs) with left ventricular ejection fraction (LVEF) <40% by echocardiography. We used New York Heart Association (NYHA) functional class to index disease severity. VO2peak, grip strength, knee extensor, and flexor muscle strength were determined. Patients were divided into three groups by NYHA class: class I (n = 39), class 11 (n 49), and class III (n = 14). Results: Age, sex, and LVEF did not differ according to NYHA class. VO2peak and all muscle strength indices decreased with increases in NYHA class (P < 0.05). VO2peak correlated positively with all muscle strengths (P < 0.05). Stepwise linear regression analysis revealed that grip and knee extensor strength were important in predicting VO2peak center dot Conclusions: Exercise capacity and disease severity in CHIF patients may be influenced not only by lower-limb but also upper-limb muscle strength.
LIPPINCOTT WILLIAMS & WILKINS, 2007年11月, AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 86 (11), 893 - 900, 英語[査読有り]
研究論文(学術雑誌)
慢性心不全患者のBMIによる下肢筋力、骨格筋肉量、運動耐容能の関係に相違があると仮定し、それらについて検討した。通院中の、安定している慢性心不全患者148例を対象とした。下肢筋力の指標として最高膝伸展筋力を測定し、下肢筋肉量に関してはインピーダンス方式により測定し、運動耐容能との関連についてBMIの大小で群分けして検討した。慢性心不全患者の運動耐容能と下肢筋肉量、下肢筋力と下肢筋肉量の関係は、ともにBMIにより異なった。BMIの大きい症例の運動耐容能は下肢筋肉量よりも下肢筋力が規定した。BMIの小さい症例の運動耐容能は下肢筋肉量に依存した。BMIを考慮することで、慢性心不全患者の心臓リハビリテーションにおける最も適切な運動療法の内容が選択されうることが示唆された。
ライフサイエンス出版(株), 2007年, Therapeutic Research, 28 (7), 1296 - 1301, 日本語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
We conducted a randomized, controlled trial to evaluate the effect of self-monitoring approach (SMA) on exercise maintenance, self-efficacy for physical activity (SEPA), and objective physical activity (OPA) over the long-term after supervised cardiac rehabilitation (CR). Forty-five myocardial infarction (MI) patients (mean age 64.2 years) were recruited following completion of an acute-phase exercise-based CR program. Patients were randomly assigned to a SMA or control group. Along with CR, the SMA group performed self-monitoring of their weight and OPA for 6-months; the control group participated in CR only. Twelve months after MI onset, exercise maintenance, SEPA scores, and OPA as a caloric expenditure were assessed. More patients maintained their exercise routine in the SMA than the control group. Mean SEPA score and mean OPA after CR were significantly higher in the SMA than control group. SMA during CR may effectively increase exercise maintenance, SEPA, and OPA over a I-year after MI.
JAPANESE SOC PHYSICAL FITNESS SPORTS MEDICINE, 2006年10月, JAPANESE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE, 55, 113 - 118, 英語[査読有り]
研究論文(学術雑誌)
Background The aim of this study was to clarify the influence of sympathetic and parasympathetic nerve (SN and PN) dysfunction on the heart rate (HR) response to exercise and the exercise capacity of patients with acute myocardial infarction (AMI) and diabetes mellitus (DM). Methods and Results Fifty-two male patients who underwent cardiopulmonary exercise testing (CPX) 1 month after onset of AMI were divided into 2 groups: (DM (+) group, n=20; DM (-) group, n=32). HR, peak oxygen uptake (VO2peak), and plasma norepinephrine (NE) levels were measured during CPX. The high-frequency power (HF) was analyzed by HR variability. The Delta HR/log Delta NE obtained from changes of HR and NE from rest to peak exercise and HR change from baseline to the minimum HF (Delta HRHF) were calculated as parameters of HR response derived from SN and PN activities, respectively. Delta HR, VO2peak, Delta HR/log Delta NE, and Delta HRHF were signifiantly lower in the DM (+) group than in the DM (-) group, and both of them showed positive correlations with VO2peak. Conclusion An inadequate HR response to exercise is a major factor causing a decline of exercise capacity, which is derived from both of SN and PN dysfunction, in AMI patients with DM.
JAPANESE CIRCULATION SOCIETY, 2006年08月, CIRCULATION JOURNAL, 70 (8), 1017 - 1025, 英語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
学位論文(博士)
Exercise maintenance after supervised cardiac rehabilitation is important in maintaining both physical activity and physiological factors, such as peak VO2 and muscle strength (MS), associated with reduced mortality. However, there is no evidence of the effects of unsupervised exercise training and MS training on physical activity and physiological factors after supervised cardiac rehabilitation of Japanese cardiac patients. We conducted a randomized, controlled trial to evaluate the effect of unsupervised exercise training on physical activity and selected physiological factors after supervised cardiac rehabilitation. Eighteen myocardial infarction (MI) patients (16 men, 2 women; mean age 66.3 years) were recruited following completion of a supervised recovery-phase cardiac rehabilitation program. Patients were randomly assigned to a MS training (n=10) or control group (n=8). Baseline measurements of physical activity, peak VO2, and MS were performed at the end of supervised recovery-phase cardiac rehabilitation (6 months after the onset of MI: T1). Six months later, after going through an unsupervised exercise program (12 months after the onset of MI: T2) exercise maintenance, peak VO2, MS, and physical activity were remeasured. The MS training group performed low-intensity MS training and walking over the second 6-month period; the control group performed walking exercise only. All patients maintained their exercise training. At T2, there were no significant differences in peak VO2 values between the MS training and control groups. There was also no significant difference in physical activity (mean number of steps per week) between the MS training and control groups. However, MS was significantly higher in the MS training group than in the control group. We concluded that unsupervised exercise training and low-level MS training performed after supervised cardiac rehabilitation may effectively maintain not only physical activity and peak VO2 but increase MS.
JAPANESE PHYSICAL THERAPY ASSOCIATION, 2006年, Journal of the Japanese Physical Therapy Association, 9 (1), 1 - 8, 英語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
Objective: To evaluate the effect of the self-monitoring approach (SMA) on self-efficacy for physical activity (SEPA), exercise maintenance, and objective physical activity level over a 6-mo period after a supervised 6-mo cardiac rehabilitation (CR) program. Objective: To evaluate the effect of the self-monitoring approach (SMA) on self-efficacy for physical activity (SEPA), exercise maintenance, and objective physical activity level over a 6-mo period after a supervised 6-mo cardiac rehabilitation (CR) program. Design: We conducted a randomized, controlled trial with 45 myocardial infarction patients (38 men, seven women; mean age, 64.2 yrs) recruited after completion of an acute-phase, exercise-based CR program. Patients were randomly assigned to an SMA group (n = 24) or control group (n = 2 1). Along with CR, the subjects in the SMA group self-monitored their weight and physical activity for 6 mos. The SMA used in this study was based on Bandura's self-efficacy theory and was designed to enhance confidence for exercise maintenance. The control group participated in CR only. All patients were evaluated with the SEPA assessment tool. Exercise maintenance, SEPA scores, and objective physical activity (average steps per week) as a caloric expenditure were assessed at baseline and during a 6-mo period after the supervised CR program. Results: Mean period from myocardial infarction onset did not differ significantly between the SMA and control groups (12.1 +/- 1.3 vs. 12.2 +/- 1.2 mos, P = 0.692). All patients maintained their exercise routine in the SMA group. Mean SEPA score (90.5 vs. 72.7 points, P < 0.001) and mean objective physical activity (10,458.7 vs. 6922.5 steps/wk, P < 0.001) at 12 mos after myocardial infarction onset were significantly higher in the SMA than control group. SEPA showed significant positive correlation with objective physical activity (r = 0.642, P < 0.001). Conclusions: SMA during supervised CR may effectively increase exercise maintenance, SEPA, and objective physical activity at 12 mos after myocardial infarction onset.
LIPPINCOTT WILLIAMS & WILKINS, 2005年05月, AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 84 (5), 313 - 321, 英語[査読有り]
研究論文(学術雑誌)
急性心筋梗塞患者を対象とし,短期間の運動療法を主体とした心臓リハビリテーション(心リハ)が身体活動セルフ・エフィカシーに及ぼす影響について検討した.急性期心リハを終了し,かつ心肺運動負荷試験を施行した115例を対象とした.心肺運動負荷試験終了後,運動療法を主体とした回復期心リハ参加群(n=77)と非参加群(n=38)の二群に選別した.心リハ参加群は,非参加群に比し,歩行に関する身体活動セルフ・エフィカシーはT1からT2にかけて有意に向上した.階段昇降に関する身体活動セルフ・エフィカシーは,T1からT2にかけて向上する傾向にあった.8週間の回復期心リハは,身体活動に対するセルフ・エフィカシーのうち,特に歩行の向上に影響する可能性が示唆された
(NPO)日本心臓リハビリテーション学会, 2005年03月, 心臓リハビリテーション, 10 (1), 79 - 82, 日本語糖尿病(DM)を合併した急性心筋梗塞(AMI)患者の運動時の副交感神経活動(PA)と嫌気性代謝閾値(AT)との関連を検討した.DMを合併したAMI患者13例とDM非合併AMI患者43例を対象とし,AMI発症から1ヵ月の時点で心肺運動負荷試験(CPX)を施行した.DMを合併するAMI患者は,DM非合併AMI患者に比較してPAが低値を示し,心拍上昇反応が減弱した.DM合併AMI患者では,PAが消失する時の心拍数はAT時の心拍数より低値を示した
(NPO)日本心臓リハビリテーション学会, 2005年, 心臓リハビリテーション, 10 (1), 54 - 57, 日本語[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
We investigated the changes of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQL) in Japanese cardiac surgery patients. Subjects were 47 consecutive outpatients (32 men, 15 women mean age 59.4 ± 12.6 years) recovering from cardiac surgery. Patients performed both aerobic exercise on a treadmill at anaerobic threshold intensity and moderate resistance training 2 days per week, 60 min per session, from 1 to 3 months after cardiac surgery. Differences in the eight SF-36 subscale scores and physiological outcomes within the patient group at 1 month and at 3 months after cardiac surgery were analyzed. Peak oxygen uptake, handgrip strength, and knee extension strength were used as physiological outcome measures. HRQL was assessed with the Japanese version Medical Outcome Study Short Form 36 (SF-36). Significant change in overall physiological outcome from 1 month to 3 months was observed. There was also significant change in seven of the eight SF-36 health status subscale scores (physical functioning, role-physical, bodily pain, general health, vitality, role-emotional, and mental health). However, with the exception of physical functioning and mental health scores, values did not reach those of the average healthy Japanese. In conclusion, we found that CR exercise training for Japanese cardiac surgery patients during the recovery phase changes not only physiological outcomes but also HRQL as assessed by the SF-36.
2005年, Journal of the Japanese Physical Therapy Association, 8 (1), 21 - 28, 英語[査読有り]
研究論文(学術雑誌)
The purpose of the present study was to compare differences in physiological outcomes and health-related quality of life (HRQOL) in relation to degree of illness in patients with chronic heart failure (CHF) and to compare HRQOL in CHF patients with that of a normal Japanese population. One hundred and twenty-five patients with stable CHF (93 men, 32 women, mean age 63.3 ± 12.4 years) with left ventricular ejection fraction (LVEF) of less than 40% were enrolled in the present study. We used New York Heart Association (NYHA) functional class as an index of degree of illness. In 64 of the 125 patients, physiological outcome measures included peak oxygen uptake (peak V̇O 2) and V̇E/V̇CO2 slope. HRQOL was assessed with the medical outcome study short form-36 (SF-36) Japanese version. In addition, SF-36 scores of CHF patients were compared against Japanese standard values. Age and LVEF did not differ according to NYHA functional class. The eight SF-36 subscale scores and peak V̇O2 decreased with increases in the NYHA functional classes, whereas V̇E/ V̇CO2 slope increased with increases in NYHA functional class (p< 0.05). Of the 8 SF-36 subscales measured in CHF patients, only the bodily pain score attained that of the normal Japanese population. These findings suggest that HRQOL decreases as NYHA functional class increases and other physiological measures worsen. In addition, HRQOL values of CHF patients were low in comparison with standard values of a normal Japanese population.
2005年, Journal of the Japanese Physical Therapy Association, 8 (1), 39 - 45, 英語[査読有り]
研究論文(学術雑誌)
Objective: The purpose of this study was to determine exercise maintenance rate, leisure-time objective physical activity level, and health-related quality of life in relation to exercise maintenance over the 6-mo period after a supervised 5-mo recovery-phase cardiac rehabilitation program in acute myocardial infarction patients. The study also investigated whether exercise maintenance resulted in reproducible health-related quality-of-life outcomes comparable with those of the Japanese normal population. Design: This observational study comprised 109 acute myocardial infarction patients (89 men, 20 women; mean age, 63.5 +/- 10.1 yrs). Physiologic outcomes (peak oxygen uptake, handgrip, and knee-extension strength) measured at 1 and 6 mos after acute myocardial infarction onset were compared. Completed exercise maintenance and health-related quality-of-life questionnaires and results of electronic pedometer recordings to evaluate leisure-time objective physical activity level were assessed 6 mos after cardiac rehabilitation. Results: The mean period from acute myocardial infarction to evaluation of outcomes was 18.8 +/- 3.4 mos. Ninety of 109 patients (82.6%) continued exercise for >6 mos after cardiac rehabilitation (exercise group); 19 patients (17.4%) quit exercise after cardiac rehabilitation (nonexercise group). Improvement in physiologic outcomes was noted at 6 mos vs. those at 1 mo, but outcomes were not significantly different between groups. The exercise group performed significantly better than the nonexercise group for leisure-time objective physical activity level and scored significantly higher than the nonexercise group for seven of eight health-related quality of life measures, attaining scores similar to those of the Japanese normal population. Conclusions: At >18 mos after acute myocardial infarction, the exercise maintenance rate in our patients remains high, and exercise maintenance may be one of the factors contributing to improvement of health-related quality of life and leisure-time objective physical activity level.
LIPPINCOTT WILLIAMS & WILKINS, 2004年12月, AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 83 (12), 884 - 892, 英語[査読有り]
研究論文(学術雑誌)
Background The present study examined the impact of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQOL) of patients with acute myocardial infarction (AMI). Methods and Results A total of 124 consecutive AMI patients were divided into a supervised outpatient CR group (n=82) and a non-CR group as a control (n=42). Peak oxygen uptake, handgrip strength, and knee extension muscular strength were used as physiological outcome measures. HRQOL outcomes were assessed by the Medical Outcome Study Short Form 36 (SF-36). CR group patients performed both aerobic exercise and moderate resistance training from 1 month (T1) to 3 months (T2) after AMI onset. Age, sex, body mass index, medications, and ejection fraction were similar in both groups. Significantly greater increases in overall physiological outcomes from T1 to T2 were measured in the CR group compared with those of the non-CR group. There were also significantly greater improvements in 4 of the 8 SF-36 health status subscales (physical functioning, role-physical, general health, and vitality) in the CR group compared with the non-CR group. Conclusions Eight weeks of exercise training have specific effects on improvement in HRQOL and physiological outcomes in Japanese patients.
JAPANESE CIRCULATION SOC, 2004年04月, CIRCULATION JOURNAL, 68 (4), 315 - 320, 英語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
急性心筋梗塞(AMI)86例を対象とし,AMI発症後1,6ヵ月時点およびAMI発症12ヵ月以上経過後に健康関連QOL調査を施行した.また,重症度別に健康関連QOLを層別した.健康関連QOLには,SF-36日本語版を用いた.SF-36の8つの下位尺度(身体機能,体の痛み,全体的健康観,活力,心の健康,役割機能-身体,社会生活機能,役割機能精神)は,AMI発症後19ヵ月までには,日本人の国民標準値に到達した.重症度別に層別したところ,中等度群は53例,軽度群は33例,高度群は0例であった.AMI発症後1,6,19ヵ月におけるSF-36の8つの下位尺度を従属変数,群間を独立変数とする二元配置分散分析で,1,6,19ヵ月におけるSF-36のすべての8つの下位尺度は,中等度群と軽度群において交互作用は認められなかった
(NPO)日本心臓リハビリテーション学会, 2004年, 心臓リハビリテーション, 9 (1), 181 - 185, 日本語[査読有り][招待有り]
研究論文(学術雑誌)
This study was undertaken in acute myocardial infarction (AMI) patients with noninsulin-dependent diabetes mellitus (type 2 DM) to investigate their impaired chronotropic response to exercise. Seventy-one AMI subjects entered the study, 30 with type 2 DM and 41 age- and body mass index-matched non-DM (control) patients. One month after the onset of AMI, these patients underwent cardiopulmonary exercise testing on a treadmill under a ramp protocol. Anaerobic threshold (AT) and peak oxygen uptake (peak VO2) were determined as indicators of exercise capacity. Plasma norepinephrine (NE) concentration was measured in blood samples obtained at 2 time points: during pre-exercise rest and immediately after peak exercise. The change in NE concentration during exercise, as an index of sympathetic nervous activity, was calculated as a percentage: DeltaNE = [(NE during exercise)-(resting value)]/(resting value) x 100. The change in heart rate (HR) during exercise was calculated as a simple difference: DeltaHR =[(peak HR)-(rest HR)]. Index of chronotropic response to exercise was then quantified as the DeltaHR/DeltaNE during exercise. No significant intergroup differences in ejection fraction at rest or HR at peak exercise were observed. However, VO2 at AT, peak VO2, DeltaHR, and DeltaHR/DeltaNE were significantly lower in the type 2 DM group than in the non-DM group. DeltaHR correlated with VO2 at AT (r= 0,49, P<0.001) and with peak VO2 (r= 0.53, P<0.001) in all subjects. Also, DeltaHR/DeltaNE correlated with VO2 at AT (r=0.42, P<0.001) and with peak VO2 (r=0.44, P<0.001) in all subjects. AMI patients with type 2 DM had impaired cardiopulmonary responses to maximal and submaximal exercise testing and impaired chronotropic response to exercise, even though their cardiac function at rest was similar to that of non-DM AMI patients. The data suggest that one mechanism of impaired cardiopulmonary response to exercise in AMI patients with type 2 DM groups is an impaired chronotropic response. (Jpn Heart J 2003; 44: 187-199).
JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED, 2003年03月, JAPANESE HEART JOURNAL, 44 (2), 187 - 199, 英語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
学位論文(修士)
[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
This study was conducted to investigate the effects of stride walking on cardiovascular and electromyographical responses on a treadmill in healthy young female (mean age of 23.0 yrs, height of 156.2 cm and weight of 50.6 kg). The subjects performed initial 6 minutes walking based on a heart rate of anaerobic threshold minus 10 beats per minute under two conditions of treadmill walking, on increased velocity with horizontal inclination (A) and on a constant velocity (2.0 mph) with increased grade (B). Consequently, the subjects performed stride walking which was made by 10% reduction of steps under each condition. The results were as follows: 1) Under A condition, the values of leg fatigue by Borg's 20 numeric scale in stride walking was significantly higher than in non-stride walking, while no difference under B condition. 2) Under A condition, the mean values in oxygen uptake and heart rate during stride walking were significantly higher than during non-stride walking, while no difference under B condition. 3) Under A condition, total amount of integrated electromyogram in gastrocnemius, vastus medialis and tibialis anterior were higher during stride walking than during non-stride walking. Under B condition, gastrocnemius and gluteus maximus showed higher values during stride walking than in non-stride walking. These findings suggest that stride walking manipulated on a high velocity tends to alter cardiovascular and electromyographical parameters than on a lower velocity with higher inclination on treadmill walking in healthy young adults.
Japanese Physical Therapy Association, 2000年, Journal of the Japanese Physical Therapy Association, 3 (1), 27 - 32, 英語[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
退院早期に自動車運転を希望した急性心筋梗塞(AMI)患者26名を対象に自動車運転時心血管反応を検討した。発症後4〜5週間目に心電図伝送システムを用い, 2回における運転中の心電図, 心拍数を常時監視し, 16名に携帯型自動血圧計にて血圧を測定した。1)運転時心電図変化をHolter心電図, 心肺運動負荷試験および嫌気性代謝閾値(AT)レベル運動療法中の心電図変化と比較検討した。2)16例について, 運転中の収縮期血圧, 心拍数および二重積の最高値を初回, 2回目運転時, および運動療法中と比較検討した。その結果, 1)運転時と運動療法中, 運動負荷試験およびHolter心電図からみた心電図の検討では不整脈, 虚血性変化の発現頻度はいずれも差を認めなかった。2)初回運転時の心拍数は2回目に比較し差がなかったが, 初回運転時の収縮期血圧は有意な高値を示した。また, 二重積は高値傾向を示したが有意ではなかった。3)運転時の心拍数, 二重積は運動療法中に比べ有意な低値を示した。以上のことから二重積より見た心負荷は初回運転時は2回目に比較し高値傾向を示すが, 運動療法中の心負荷値より低くHolter心電図, 運動負荷試験, 運動療法中において異常心血管反応を認めない症例に対しての早期運転は許可出来ると考えられた。
公益社団法人日本理学療法士協会, 1999年, 理学療法学, 26 (1), 9 - 13, 日本語[査読有り]
研究論文(学術雑誌)
The purpose of this study was to evaluate cardiopulmonary responses during submaximal cycle exercise at various angles of backrest inclination. Ten healthy Japanese men of mean age 25.9 yrs, height 170.6 cm, and body mass 66.1 kg, performed cycle exercises at a constant workload which reached the anaerobic threshold, at 20 degrees, 40 degrees, and 60 degrees of backrest inclination from the vertical plane, but the angle between the seat and back rest was kept at 110 degrees. The results were as follows: 1) Both cardiac output and stroke volume showed a higher value at the resting control state and during exercise as the backrest angle increased. 2) Oxygen consumption, carbon dioxide output, heart rate, gas exchange ratio, and oxygen pulse were not affected by the angle of backrest inclination. 3) Tidal volume at 20 degrees of backrest inclination was higher than at 60 degrees. 4) No significant differences were found in minute ventilation between each backrest angle. These findings suggest that changes in the backrest angle significantly alter cardiopulmonary parameters at rest and during exercise in particular, an angle difference of 40 degrees may be enough to alter tidal volume, cardiac output and stroke volume, but not the minute ventilation.
Japanese Physical Therapy Association, 1999年, Journal of the Japanese Physical Therapy Association, 2 (1), 31 - 36, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り][招待有り]
研究論文(学術雑誌)
[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
[査読有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(大学・研究所紀要)
[招待有り]
速報,短報,研究ノート等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
BACKGROUND: Oral health is important for maintaining general health and is associated with components of physical frailty among the elderly. Oral health problems are common in hospitalized patients; however, no reports on oral health problems pertain to patients with cardiovascular diseases (CVD). The present study aimed to evaluate the association between oral health and physical frailty in these patients. METHODS: In this retrospective cohort study, we included consecutive patients admitted for CVD to our hospital between May 2014 and December 2018. Physical frailty was assessed using the Short Physical Performance Battery (SPPB). Oral health characteristics, such as the number of remaining teeth, denture use, occlusal support, and periodontal status, were assessed. RESULTS: In our cohort (n = 457), 111 (24.3%) patients had physical frailty. Univariate linear regression showed that the number of teeth present and the prevalence of occlusal support were significantly lower in patients with than without physical frailty. Pearson correlation indicated that the number of teeth significantly correlated with the nutritional status (r = 0.27) and SPPB score (r = 0.24), grip strength (r = 0.33), and 6-minute walking distance (r = 0.26). Multiple linear regression analysis showed that the number of teeth was independently associated with physical frailty after adjusting for confounders. CONCLUSIONS: Oral health was closely associated with physical frailty, and nutritional status in patients with CVD; thus, it could be an important screening marker for early frailty symptoms and a predictor of future malnutrition risk.
2021年, Journal of cardiology, 77 (2), 320 - 321, 英語, 国際誌[査読有り]
速報,短報,研究ノート等(学術雑誌)
超高齢社会に伴い、高齢心疾患患者は急増している。それは、身体機能や身体活動の低下のみならず、認知機能障害もきたす。ひいては、日常生活の制限を余儀なくされ、要介護状態にも陥りやすくなる。本稿では、フレイルと認知機能障害について、主に高齢心疾患患者に焦点を定め述べる。(著者抄録)
(株)北隆館, 2020年, BIO Clinica, 35 (10), 982 - 984, 日本語[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[査読有り]
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
その他
心疾患は、整形外科、脳血管、代謝性疾患などの重複障害を呈する例も存在する。それらは、重複障害に起因する諸々の機能低下などから日常生活の制限を余儀なくされ、要介護状態に陥りやすくなる。これらのことから、臨床においては循環器系のスペシャリストとしての視点だけではなく、地域在宅を見据え、他職種との連携を踏まえたジェネラリストとしての視点を含んだ"みる"というスキルが重要となる。"みる"という言葉は、評価や治療という意味だけではなく、対象者の生活や人生にも携わることを含み、客観的な根拠の下に成り立つものと我々は考える。そのためには、循環器系のみならず、重複障害に関連する要因や地域在宅での自己管理、活動と参加などのエビデンスの蓄積や医療従事者の教育が急務である。(著者抄録)
(一社)京都府理学療法士会, 2018年, 理学療法京都, (47), 49 - 53, 日本語[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
書評論文,書評,文献紹介等
1.心不全は特別な病気ではない。2.再入院予防には、多職種による疾病管理を主とした包括的アプローチが必須である。3.理学療法士は、「活動(運動)する」ことを前提とした在宅生活に対する指導・支援を行う。4.高齢心不全患者への介入においては、特に地域包括ケアシステム(住まい、医療、介護、予防、生活支援)の目的やサービス内容、多職種連携などについて周知するべきである。5.疾病管理を踏まえた循環器理学療法を実施できる理学療法士の育成が急務である。(著者抄録)
(株)メディカルプレス, 2016年, 理学療法, 33 (4), 341 - 348, 日本語[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
[招待有り]
速報,短報,研究ノート等(大学,研究機関紀要)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
速報,短報,研究ノート等(大学,研究機関紀要)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
[招待有り]
その他
[招待有り]
記事・総説・解説・論説等(学術雑誌)
【はじめに、目的】 慢性腎臓病(CKD)は末期腎不全や心血管疾患(CVD)の危険因子である。本邦のCKD患者数は成人人口の約13%の1330万人にのぼり,総合的なCKD対策が必要とされている。CKDガイドラインでは,CKD患者の肥満の是正,糖尿病新規発症,高血圧,CVD予防などの観点から,身体活動度の維持が求められている。CKD患者の身体活動(PA)に関するこれまでの報告では,森ら(2001)が血液透析患者の平均歩数を3266歩/日(平均年齢65歳)と報告し,我々は腹膜透析患者の平均歩数を4864歩/日(平均年齢63歳)と報告した。しかし,保存期CKD患者を対象とした報告は極めて少ない。本研究の目的は,保存期CKD患者のPAの実態を明らかにすることである。【方法】 対象は,当院腎臓・高血圧内科外来通院中の保存期CKDstage2-5患者70例(平均年齢67.5歳,男性75.7%)である。我々は対象者を,CKDのstage分類を用いて, stage2(A群), stage3(B群), stage4,5(C群)の3群に選別した。除外基準は,中枢性および運動器疾患を有する患者とした。患者背景として,我々は年齢,性別,Body Mass Index,運動習慣の有無,血液生化学検査値よりヘモグロビン(Hb),血清アルブミン(Alb),C反応性蛋白(CRP)を診療記録より後方視的に調査した。PAの測定には,加速度付きの生活習慣記録機(ライフコーダ®)を用いた。対象者は,本記録機を入浴,就寝時間を除く連続9日間装着し,装着期間中は普段通りの生活を送るよう指示された。PAの指標として,我々は初日と最終日を除いた7日間の1日当たりの平均歩数(歩/日),平均活動時間(分/日),平均運動量(kcal/日)を用い,各群におけるこれらの平均値を算出した。また,先行研究に基づき,活動時間(分/日)を,低強度(<3Mets),中等強度(3-6Mets),高強度(>6Mets)別に算出した。統計解析は,χ二乗検定,一元配置の分散分析を,また多重比較にTukey法を用いた。なお危険率5%を有意水準とした。【倫理的配慮、説明と同意】 本研究は,当大学生命倫理委員会の承認を得て,対象には説明の後に文書による同意を取得して実施した(承認番号:第1624号)。【結果】 各群の症例数はA群12例, B群41例, C群17例であった。患者背景は年齢,性別, BMI, Alb, CRPに差は認めなかった。運動習慣の有るものの割合はA群, B群, C群の順に 83.3%, 36.6%, 47.1%であり, A群が他の2群に比し有意に高値であった(p=0.02)。Hbは同様に13.3±1.9, 13.1±1.7, 11.4±1.7 g/dlであり,C群が他の2群に比し有意に低値であった(p<0.01)。 保存期CKD患者のPAは,A群, B群, C群の順に, 平均歩数 8878.0±2184.3, 6411.2±2650.5, 5870.7±2439.0歩/日 (p<0.01), 平均活動時間 89.3±29.2, 66.7±27.0, 62.7±25.4分/日 (p=0.02), 平均運動量 264.1±72.1, 176.7±93.5, 132.2±61.8kcal/日 (p<0.01)であり,全ての指標でA群が他の2群に比し有意に高値であった。運動強度別の活動時間は同様に,低強度 58.5±29.2, 48.7±19.9, 48.8±21.8分/日 (p=0.38), 中等強度 31.5±14.5, 17.8±14.2, 12.4±8.1分/日 (p<0.01), 高強度 0.7±0.7, 0.9±1.4, 0.6±1.9分/日 (p=0.70)であり,中等強度の活動時間のみA群が他の2群に比し有意に高値であった。【考察】 保存期CKD患者のPAはstage進行に伴い低下し,stage3以降でその低下は顕著であることが示された。運動強度別の活動時間では,中等強度の活動がstage3以降で有意に低値であり,運動の質も低下していた。この背景として,運動習慣の有るものはstage3以降で有意に少なかった。また,Hbはstage4,5で有意に低く,腎性貧血に伴う易疲労の可能性も示唆される。そして,CKD患者では腎機能の低下に伴い運動機能が低下していることが報告されている。これら運動が習慣化されていないこと,易疲労や運動機能の低下がCKD患者の不活動を引き起こし,PAの低下に関与しているものと推察された。さらに,本結果を「健康日本21」にて,生活習慣病予防や死亡率低下の目標値とされる一日の平均歩数,男性9200歩,女性8300歩と比較した。各群で,対象各々を比較した結果,目標値以上であったものの割合はA群41.7%, B群17.1%, C群5.8%と,stage2が最も高値であった。保存期CKD患者において,生活習慣病予防のため,PAの管理が重要とされている。しかし,目標値に達しているものは全ての群で半数以下であり,特にstage3以降ではごく少数であった。以上より,CKD患者に対するCVD予防など生活習慣病管理の観点から,早期からPA向上に向けた介入が重要であると考える。しかし,本研究は横断研究でありPA向上とCKD進行や,CVD発症との関連性については未だ不明である。【理学療法学研究としての意義】 本研究は保存期CKD患者におけるPAの実態について示した。本結果は,保存期CKD患者に対するPA向上のための,運動指導方策の一助となる可能性がある。
公益社団法人 日本理学療法士協会, 2013年05月, 理学療法学Supplement, 2012 (0), 48100214 - 48100214, 日本語[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
【はじめに、目的】 本邦の末期腎不全患者における透析患者数は約30万人と急増し、そのうち、腹膜透析(PD)患者数は約3%を占める。PDは、血液透析(HD)に比較して、残存腎機能の保護効果やライフスタイルの維持という観点より、高いQOLが保たれるなどの利点がある。その利点を生かすため、残存腎機能を有する慢性腎臓病(CKD)患者は、PD導入を優先的に考慮するよう推奨されている。残存腎機能の維持には、肥満、血圧、血糖、脂質異常の管理が重要であり、身体活動(PA)の向上は、これらを是正させることが知られている。しかし、末期CKD患者のPAに関しては、HD患者の報告は見られるが、PD患者の報告はきわめて少ない。本研究では、PD患者のPAの実態を明らかにすることを目的とした。【方法】 対象は、当院腎臓・高血圧内科外来通院中のPD患者30例(男性16例、平均年齢63.2±11.5歳)である。除外基準は、中枢性および運動器疾患を有する者とした。患者背景として、Body Mass Index(BMI)、PD期間、血液生化学検査からヘモグロビン(Hb)、血清アルブミン(Alb)、C反応性蛋白(CRP)を診療記録より後方視的に調査した。PAの測定には、加速度付きの生活習慣記録機(ライフコーダ®)を用いた。対象者に本記録機を入浴、就寝時間を除く連続9日間装着した。PAの指標として、初日と最終日を除いた7日間の1日当たりの平均歩数(歩/日)、平均運動時間(分/日)、平均運動量(kcal/日)を求め、PD患者全体でのPAの平均値を算出した。続いて、PD患者における歩数別の割合を比較するために、Hatanoら(1993)の報告に基づき、対象者を次の4群に選別した(A群:5000歩/日未満、B群:5000-7499歩/日、C群:7500-9999歩/日、D群:10000歩/日以上)。さらに、運動強度別の運動時間は、Kumaharaら(2004)の報告に基づき、低強度(<3Mets)、中等強度(3-6Mets)、高強度(>6Mets)の3群に選別し、算出した。統計解析は、歩数別の割合の比較にはカイ二乗適合度検定を、運動強度別の運動時間にはKruskal Wallis検定を用い,危険率5%を有意水準とした。【倫理的配慮、説明と同意】 本研究は、当大学生命倫理委員会の承認を得て、対象には説明の後に文書による同意を取得して実施した(承認番号:第1965号)。【結果】 患者背景は、BMI 23.4kg/m<sup>2</sup>、PD期間 21.0か月、Hb 10.8g/dl、Alb 3.77g/dl、CRP 0.29mg/dlであった。PD患者のPAは、平均歩数4864.3±3365.7歩/日、平均活動時間53.6±34.4分/日、平均運動量135.6±122.2kcal/日であった。PD患者の歩数別の割合は、A群18例、B群7例、C群3例、D群2例であり、各群の割合には有意な偏りがあった(p<0.01)。運動強度別の運動時間の中央値は、低強度33.3分、中等強度7.3分、高強度0分であり、3群間で主効果を認めた(p<0.01)。【考察】 本研究結果より、歩数別の割合は5000歩/日未満の低活動者が、運動強度は低強度の運動時間がそれぞれ有意に多いことが示された。本結果を健常者の平均歩数と厚生労働省の「平成21年度 国民健康・栄養調査」を参考に比較した。その結果、PD患者は、同性、同年代の健常者の平均歩数の75.6%と低値であった。これは、CKDに伴う腎性貧血、低栄養、運動機能低下といった要因がPA低下に関与している可能性がある。また、PD患者では腹腔内に透析液を貯留しておく必要があり、腹部膨満感を訴えることがある点もPA低下の要因として推察された。次に、PD患者と森ら(2001)のHD患者の平均歩数を比較した。その結果、PD患者は、HD患者(平均年齢65±12.8歳)の平均歩数3266歩/日に比較し、約1600歩高値であった。PDでは日中の透析による拘束時間が短縮され、ライフスタイルが保たれること、透析後の倦怠感が少ないことなどより、HD患者と比較してPAが保たれていた可能性がある。一般にPA向上は、生活習慣病予防や総死亡率の低下に寄与するとされる。そのため、PD患者のPA向上は、QOL維持のみならず、残存腎機能保護、合併症予防、予後改善の観点からも重要である。また、運動強度について、脂肪燃焼や糖代謝などには中等強度での運動が有効とされ、CKDガイドライン上でも、中等強度までの運動で腎機能は悪化しないとされている。よって、PA向上のための介入において、運動強度にも着目する必要がある。【理学療法学研究としての意義】 本研究はPD患者におけるPAの実態について歩数別、また強度別に示した。本研究結果は、PD患者に対するPA向上のための、運動指導方策の一助となる。
公益社団法人 日本理学療法士協会, 2012年04月, 理学療法学Supplement, 2011 (0), Da0321 - Da0321, 日本語【はじめに、目的】 透析導入の原疾患の第1位は糖尿病腎症で,その約半数を占めている.また,糖尿病(DM)の身体的特徴として,筋力やバランスなどの運動機能が低下していることが報告されている. 透析を導入していない保存期の慢性腎臓病(CKD)患者を対象とした先行研究において我々は,腎機能の低下に伴い運動機能も低下していることを報告した.しかし,CKDの原疾患や併発症として多いDMの有無による運動機能の比較検討はできていない. 本研究の目的は,CKD患者の運動機能について,DM合併の有無と運動機能の関係について明らかにすることである.【方法】 対象は,当院腎臓・高血圧内科外来通院中のCKDステージ 1を除いたCKD患者145例である[男性102例,平均年齢66.5歳].除外基準は,透析患者,中枢および運動器疾患を有する者とした.なお,CKDステージ1の患者は年齢が若く,症例も少ないことが予想されたため除外した.対象をDM合併の有無によりDM群51例,非DM群94例に選別した.さらに,DM群のみを対象として糖尿病多発神経障害(DP)の合併の有無によりDP群26例,非DP群25例に分けた. 患者背景として年齢,性別,Body Mass Index(BMI),運動習慣の有無,CKDステージ分類を診療記録より後方視的に調査した. 運動機能指標は,握力,等尺性膝伸展筋力,片脚立位時間,最大歩行速度を採用した.握力は左右2回測定し,その最高値の左右の平均値(kgf)を算出した.等尺性膝伸展筋力は左右の最大値の平均を体重で除した値(kgf/kg)を膝伸展筋力として算出した.片脚立位時間は上肢の支持なく60秒を上限に,開眼にてそれぞれ2回ずつ測定し,最高値(秒)を採用した.歩行速度は10m歩行路の最速歩行時間を2回測定し,時間の短い記録を採用し,最大歩行速度(m/秒)を算出した. DM群に対するDP合併の有無は,「糖尿病多発神経障害の簡易診断基準」を用いて,自覚症状,アキレス腱反射,振動覚より判定した. 以上の方法より,CKD患者の運動機能指標をDMおよびDP合併の有無により比較検討した.統計解析はχ2乗検定,対応のないt検定,Mann-WhitneyのU検定を用い,危険率5%を有意水準とした.【倫理的配慮、説明と同意】 本研究は,当大学生命倫理委員会の承認を得て実施した(承認番号:第1624号).本研究に際し,事前に患者に研究の趣旨,内容および調査結果の取り扱い等に関して説明し文書にて同意を得た.【結果】 運動機能指標は,DM群と非DM群の順に,握力27.5 vs 29.8kgf (p=0.22),膝伸展筋力0.52 vs 0.61kgf/kg (p=0.01),片脚立位時間30.0 vs 60.0秒 (p<0.01),歩行速度1.8 vs 2.0m/秒 (p=0.02)で,握力以外のすべての指標でDM群が低値を示した.DM患者のみを対象とした検討では,DP群と非DP群の順に,握力23.5 vs 31.6kgf (p<0.01),膝伸展筋力0.45 vs 0.59 kgf/kg (p<0.01),片脚立位時間24.3 vs 60.0秒 (p<0.01),歩行速度1.8 vs 2.0m/秒 (p=0.02)であり,すべての運動機能指標でDP群は有意に低値を示した.なお,いずれの検討においても患者背景である年齢,性別,BMI,運動習慣の有無,CKDステージ分類には両群で有意差はなかった.【考察】 先行研究において,DM患者の運動機能は低下しているという報告は散見される.しかし,CKD患者の運動機能をDMおよびDP合併の有無により差異があるのかを検討したものはきわめて少ない.本研究では,CKD患者の運動機能はDMの合併の有無により差異があり,DM群は握力以外の指標ですべて有意に低値を示した.さらに,DM症例のみをDPの合併の有無で選別し比較した結果,DP群は非DP群に比して,すべての運動機能指標において有意に低下していることが明らかとなった.以上より,DMを合併したCKD患者の運動機能低下の要因には,DPが関与している可能性が示された.なお, いずれの検討においても患者背景の指標に両群で有意差はなく,それらの影響は少ないものと考えられた. ただし,今回は神経伝導速度やDPの重症度などは検討できていない.【理学療法学研究としての意義】 保存期CKD患者の運動機能に関する報告は少ないため,本研究結果はその参考値になるものと考えられた.また,CKD患者への介入時には,運動機能評価に加え,DM合併の有無や簡易に測定可能なDP検査についても参考にすべきと考えられた.
公益社団法人 日本理学療法士協会, 2012年04月, 理学療法学Supplement, 2011 (0), De0040 - De0040, 日本語[招待有り]
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平成18年度以降の診療報酬改定によって、リハビリテーション(リハ)医療は臓器別あるいは疾患別に大別され、理学療法士(PT)はこれらの各領域において、PTの専門性を活した関わりと人材育成が求められている。日本理学療法士協会における職能活動と医療現場の現状から、心大血管等リハにおけるPTの位置づけを改めて討議した結果、心血管疾患に対する専門的知識と技術に加えて、併存する疾患に対する医学的管理と、他の疾患を併存することによるリハ進行への影響ならびに生活能力(ADL)の障害に直接つながる運動能力を的確に捉える専門的技術の重要性が再確認された。(著者抄録)
(NPO)日本心臓リハビリテーション学会, 2010年, 心臓リハビリテーション, 15 (1), 78 - 80, 日本語[招待有り]
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学術書
学術書
学術書
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学術書
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学術書
口頭発表(一般)
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(一般)
口頭発表(一般)
[招待有り]
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
ポスター発表
ポスター発表
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
その他
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
その他
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
シンポジウム・ワークショップパネル(指名)
ポスター発表
ポスター発表
口頭発表(一般)
ポスター発表
ポスター発表
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
ポスター発表
口頭発表(一般)
ポスター発表
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
シンポジウム・ワークショップパネル(公募)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
ポスター発表
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
口頭発表(一般)
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
ポスター発表
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
シンポジウム・ワークショップパネル(指名)
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
ポスター発表
口頭発表(一般)
口頭発表(一般)
ポスター発表
ポスター発表
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
ポスター発表
ポスター発表
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
[招待有り]
口頭発表(招待・特別)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
口頭発表(招待・特別)
[招待有り]
シンポジウム・ワークショップパネル(指名)
ポスター発表
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
ポスター発表
ポスター発表
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
ポスター発表
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
ポスター発表
ポスター発表
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
ポスター発表
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
ポスター発表
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
ポスター発表
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
[招待有り]
口頭発表(招待・特別)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
シンポジウム・ワークショップパネル(指名)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
ポスター発表
シンポジウム・ワークショップパネル(公募)
ポスター発表
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
シンポジウム・ワークショップパネル(指名)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
シンポジウム・ワークショップパネル(公募)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
ポスター発表
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
その他
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
シンポジウム・ワークショップパネル(指名)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
ポスター発表
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
ポスター発表
ポスター発表
ポスター発表
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
ポスター発表
ポスター発表
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
競争的資金
競争的資金
競争的資金
競争的資金
競争的資金
競争的資金
競争的資金
競争的資金
競争的資金
競争的資金
競争的資金