Congress of the Japanese Physical Therapy Association
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  • Genki Kawaura, Chiharu Fujisawa, Miku Tatewaki, Shinya Mitani, Hideki ...
    Session ID: E-R-1-1
    Published: 2019
    Released: August 20, 2019
    CONFERENCE PROCEEDINGS FREE ACCESS

    [Background/Purpose]

    In this study, we attempted to determine whether an outpatient pulmonary rehabilitation program can change the muscle quality in patients with chronic obstructive pulmonary disease (COPD).

    [Methods]

    Twelve outpatients with COPD were randomized to either the intervention (INT) or the control (CON) group with a 1-week washout period between the groups. The INT group participants completed an 8-week program involving a weekly outpatient pulmonary rehabilitation program. The INT group performed 4 resistance-training sessions, with the load on the modified Borg scale being 4 ‒ 7 per set. The set or the number of repetitions was increased or the rest time between consecutive sets was decreased every week. The subjects were also instructed in self-training. The CON group maintained their routine lifestyle. The evaluations were performed once at baseline and then after the intervention. The primary outcomes were assessed by measuring the quadriceps muscle echo intensity (EI) using ultrasonography. The ultrasonography images were recorded using a personal computer and analyzed. An unpaired t-test was used to compare the results of the INT and CON groups.

    [Results]

    There were no baseline differences between the groups. After 8 weeks, the EI of the INT group was significantly lower than that of the CON group (p < 0.05). The INT group showed significant improvements in the EI (p < 0.05).

    [Discussion/Conclusion] This study demonstrated that 8-week outpatient pulmonary rehabilitation program involving weekly sessions improved the quadriceps muscle EI in COPD patients. The lower EI of quadriceps indicates that the muscle cell gap had little connective tissue, less fat, and lower extracellular fluid, associated with muscle strength and physical activity. Our study indicates that a pulmonary rehabilitation program could help improve the quadriceps muscle quality in COPD patients.

     

    [Ethical consideration]

    The study was approved by the regional ethics committee and conducted in accordance with the Declaration of Helsinki.

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  • Isato Fukushi, Yosuke Kono, Shigefumi Yokota, Kotaro Takeda, Shuntaro ...
    Session ID: E-R-1-2
    Published: 2019
    Released: August 20, 2019
    CONFERENCE PROCEEDINGS FREE ACCESS

    [Background/Purpose]

    The diencephalon is one of the brain regions where stroke occurs frequently. Because patients with stroke often present respiratory disorders and it has been suggested that the diencephalon plays a role in modulation of respiration, it would be necessary to elucidate how the diencephalon modulate respiration. Here, we aimed to address this issue.

    [Methods]

    We examined respiratory frequency in the isolated diencephalon-lower brainstem-spinal cord preparations of newborn rats (n=11, P0-P1), before and after transection of the diencephalon. Briefly, the diencephalon, lower brainstem and spinal cord were together isolated from neonatal rats under isoflurane anesthesia. The preparation was fixed in a recording chamber and continuously superfused with oxygenated (95% O2, 5% CO2) artificial cerebrospinal fluid at 26 °C ‒ 28 °C. Neural respiratory output was recorded from ventral roots of the 4th cervical spinal cord (C4). The respiratory frequency was obtained as the frequency of the C4 burst activity.

    [Results]

    Ablation of the diencephalon decreased respiratory frequency. The paired t-test was carried out to examine significant differences of the respiratory frequency. Respiratory frequency was decreased after ablation with statistical significance (p = 0.007).

    [Discussion/Conclusion]

    We conclude that the diencephalon plays an active role in facilitation of respiration. Further studies are needed to identify the diencephalic region that augments respiratory output.

     

    [Ethical consideration]

    This study was conducted with the approval of the Animal Experiment Ethics Committee of Murayama Medical Center.

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  • Chiharu Fujisawa, Genki Kawaura, Miku Tatewaki, Shinya Mitani, Hideki ...
    Session ID: E-R-1-3
    Published: 2019
    Released: August 20, 2019
    CONFERENCE PROCEEDINGS FREE ACCESS

    [Background/Purpose]

    This study investigated the effects of combined progressive resistance training (PRT) and counseling on physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD).

    [Methods]

    Eleven out-patients with COPD (mean age 71.3 ± 6.8 years, height 1.62 ± 0.1 m, body weight 65.1 ± 11.1 kg) were randomized in to the PRT group and control (CON) group with a one week washout period between groups. Participants in the PRT group completed an 8-week program involving once a week PRT and counseling. The PRT group performed four resistance training sessions, wherein the load on the modified Borg scale was 4‒7 per set; each week the set or number of repetitions was increased, or the rest time between sets was decreased. Counseling was done via pedometer feedback. The CON group maintained their usual lifestyle. The evaluations were performed at baseline and post the intervention. The primary outcomes were assessed by measuring PA using a pedometer and quadriceps muscle strength (QS) using a dynamometer. The secondary outcome, quality of life, was evaluated using COPD assessment test (CAT). An unpaired t-test was used to compare the results between the PRT group and control group.

    [Results]

    There were no baseline differences between the groups. After 8-weeks, PA and QS were significantly higher in the PRT than in the CON group (p < 0.05). The PRT group showed significant improvements in PA and QS (p < 0.05). There was no significantly difference in CAT score between the groups.

    [Discussion/Conclusion]

    The present study demonstrates that eight weeks of combined PRT and counseling performed once a week resulted in increased daily step counts and QS in patients with COPD. Our study indicates that PRT programs could be useful in improving PA in patients with COPD.

     

    [Ethical consideration]

    The study was approved by the regional ethics committee and conducted in accordance with the Declaration of Helsinki.

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  • Kazuki Hotta, Rie Shimotsu, Yutaka Kano
    Session ID: E-CV-1-4
    Published: 2019
    Released: August 20, 2019
    CONFERENCE PROCEEDINGS FREE ACCESS

    [Background/Purpose]

    Patients with diabetes mellitus (DM) have reduced skeletal muscle mass, resulting in functional incapacity. Hyperglycemia impairs vascular endothelial function of skeletal muscle. Although endothelium has a crucial role as muscle-blood barrier (MBB) through modulating microvascular permeability, there is no direct evidence showing relationship between MBB impairment and skeletal muscle atrophy. The purpose of this study is to assess microvascular permeability of diabetic skeletal muscle by a novel in vivo imaging using two-photon laser scanning microscopy (TPLSM).

    [Methods]

    Wistar male rats (10 wks old, n=10) were divided into streptozocin-induced insulin-dependent DM (n=5) and control groups (n=5). Fluorescent dye (rhodamine b dextran, 70 kDa) was intravenously infused and then 3D images of extravasation in exposed tibialis anterior (TA) muscle were obtained by TPLSM. Interstitial leakage volume of fluorescent dye was calculated by image analysis, and was compared between DM and control rats.

    [Results]

    The leakage volume was significantly higher in DM compared to control rats (11.97 ± 5.71 vs. 44.09 ± 12.19 μ m3 x min x 106, control vs. DM, P=0.04). TA weight divided by body weight (TA/BW) was significantly lower in DM compared to control rats (1.77 ± 0.06 vs. 1.57 ± 0.04 mg/g, control vs. DM, P=0.04). The TA/BW was significantly and negatively correlated with interstitial leakage volume in both groups (R2=0.44, P=0.04).

    [Discussion/Conclusion]

    These results indicate that insulin-dependent DM impairs MBB, likely resulting in rat skeletal muscle atrophy.

     

    [Ethical consideration]

    All experiments were conducted under the guidelines estab-lished by the Physiological Society of Japan and were approved by the University of Electro-Communications Institutional Animal Care and Use Committee.

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  • Nobuaki Hamazaki, Kentaro Kamiya, Ryota Matsuzawa, Kohei Nozaki, Takaf ...
    Session ID: E-CV-1-5
    Published: 2019
    Released: August 20, 2019
    CONFERENCE PROCEEDINGS FREE ACCESS

    [Background/Purpose]

    Impaired peripheral muscles and respiratory muscles reportedly deteriorate exercise intolerance in patients with chronic heart failure (CHF). Cardiac rehabilitation (CR) has been known to improve exercise tolerance and peripheral muscle function. However, the relationship between change in respiratory muscle strength and exercise tolerance is still unclear. We aimed to examine the impact of change in respiratory muscle strength following CR on exercise tolerance in CHF patients.

    [Methods]

    We studied 115 patients with compensated CHF who continued 5-month CR during hospitalization and after hospital discharge. Isometric quadriceps strength (QS) and maximal inspiratory pressure (PImax) were measured as peripheral muscle and respiratory muscle strength, respectively. We also measured peak oxygen uptake (VO2) during cardiopulmonary exercise test to assess exercise tolerance. All variables were measured at baseline and after the 5-month observation period. We compared the %changes of peak VO2 among 4 groups based on the median of %changes in QS and PImax: group A (%change QS <13.0% and %change PImax <12.6%), group B (%change QS ≥13.0% and %change PImax <12.6%), group C (%change QS <13.0% and %change PImax ≥12.6%) and group D (%change QS ≥13.0% and %change PImax ≥12.6%).

    [Results]

    In all the patients, %change peak VO2 showed significant positive correlations to %change QS (r = 0.324, P <0.001) and %change PImax (r = 0.352, P <0.001). The group D showed significantly higher %change peak VO2 as compared with group A even after adjustment for clinical confounding factors (mean difference: 10.693, 95% CI: 2.434 ‒ 18.952, P = 0.004).

    [Discussion/Conclusion]

    Increased respiratory muscle strength as well as peripheral muscle strength contributed to improvement of exercise tolerance following CR in CHF patients.

     

    [Ethical consideration]

    The study protocol was approved by the Ethics Committee of Kitasato University Hospital (KMEO B16-107).

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  • Ryosuke Matsuki, Yoshikazu Hirasawa, Hideaki Tanita, Toshihiko Ebisu, ...
    Session ID: E-DM-1-6
    Published: 2019
    Released: August 20, 2019
    CONFERENCE PROCEEDINGS FREE ACCESS

    [Background/Purpose]

    In patients with type 2 diabetes mellitus (T2DM), maximum oxygen uptake and anaerobic threshold (AT) was decreased in comparison with that of a healthy population. It was reported that Homeostasis model assessment of insulin resistance (HOMAIR) was associated with maximum oxygen uptake in patients with T2DM. However, no studies have assessed the relationship between AT and HOMAIR. The purpose of this study was to examine the characteristic differences, especially AT differences between patients with T2DM whose HOMAIR was high and those whose HOMAIR was normal.

    [Methods]

    Of the patients with T2DM who underwent CPX at our hospital, those without insulin treatment and fasting plasma glucose (FPG) ≧ 140 mg/dL were included as study subjects. AT was evaluated using the V-slope method. %AT was calculated in comparison with the standard value of the Japanese Circulation Association. High HOMAIR and normal HOMAIR groups were defined as HOMAIR is higher than 1.6 and lower than 1.6, respectively. We compared the age, BMI, diabetic complication, drug therapy, HbA1c, FPG, CPI, %AT, knee extension power, body skeletal muscle percentage (%muscle) and body fat percentage (%fat) between high HOMAIR and normal HOMAIR groups using t-test. A software package (IBM SPSS Ver. 22) was used with a significance level at <5% for statistical analysis.

    [Results]

    The following characteristics were observed in patients in the high HOMAIR(n=27) group as compared with those in the normal HOMAIR(n=16) group with statistically significant difference: higher BMI (p < 0.01), higher CPI (p < 0.05), higher %fat (p < 0.01), lower %AT (p < 0.05), lower %muscle (p < 0.05). No significant difference was observed in age, diabetic complication, drug therapy, HbA1c, FPG, knee extension power.

    [Discussion/Conclusion]

    In patients with T2DM, high HOMAIR decreased aerobic fitness.

     

    [Ethical consideration]

    This study was approved by the Study Ethical Review Board of Kansai electric power hospital under No. 28-15. All subjects gave informed consent for their participation in the study.

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