We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. We prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass.

Objective: Open thoracic esophagectomy for patients with esophageal cancer is highly invasive and is reportedly associated with delayed postoperative mobilization. Our hospital introduced an early mobilization protocol from April 2019 to standardize early mobilization in the intensive care unit. This study aimed to evaluate the effects of the early mobilization protocol on postoperative mobilization, respiratory complications, and physical function at hospital discharge in patients after open thoracic esophagectomy.

Methods: Thirty-nine patients who underwent open thoracic esophagectomy were included in this study. The patients were divided into two groups: the early mobilization protocol group (patients operated after the introduction of the early mobilization protocol) and the conventional group (patients operated before the introduction of the early mobilization protocol). The patients’ background, postoperative course, and physical function at hospital discharge were compared between both groups.

Results: The early mobilization protocol group had a shorter duration of ventilator use [49.0 (40.3-63.7) vs. 73.8 (51.2-75.9) hours], and the commencement of sitting [2 (1.5-3) vs. 4 (3-5)days], standing [3 (1.5-3) vs. 5 (3.3-6.0) days], and walking [4 (2-5) vs. 6 (5-7) days] were significantly reduced compared with those of the conventional group.

Conclusion: After open thoracic esophagectomy for esophageal cancer, the early mobilization protocol may reduce the number of days before mobilization and the duration of ventilator use after surgery.

Introduction: The current status of pulmonary rehabilitation in the Saga Prefecture and Chikugo District of Fukuoka Prefecture (Chikugo District) and dependence of pulmonary rehabilitation on therapists with respiration-related professional qualifications (qualified therapists) remains unknown.

Methods: Questionnaires were sent to facilities in the Saga Prefecture and Chikugo District that had submitted pulmonary rehabilitation fee applications, regarding methods of providing pulmonary rehabilitation, patient assessment, program components, and quality assurance. Comparisons were made between facilities with and without qualified therapists.

Results: Our data showed a trend toward low implementation rates of assessments on physical activity, patient knowledge, disease-specific activities of daily living, frailty, health-related quality of life, and measurement of lower-extremity muscle strength using equipment. In addition, implementation of self-management education tended to be low. Facilities with qualified therapists were significantly more likely to implement only exercise tolerance testing (p＝0.024).

Conclusion: The prevalence of self-management education needs to be increased. The association between the presence of qualified therapists and the quality of pulmonary rehabilitation is limited.

Introduction: Patients with severe COVID-19 infection require intensive care management such as ventilatory support. Their activities of daily living (ADL) and motor functions can be significantly impaired. Therefore, motor function recovery is invariably inadequate, and it is challenging to provide optimal discharge support during the acute phase of hospitalization.

Case: We describe three patients admitted to a rehabilitation ward following severe COVID-19 infection that necessitated ventilatory management. All three patients showed various complications, including post-intensive care syndrome.

Results: The evaluation of these cases indicated that Medical Research Council total scores improved from 44 to 60 for Case 1, 42 to 48 for Case 2, and 46 to 60 for Case 3. The Functional Independence Measure improved from 76 to 116 points for Case 1, 77 to 122 points for Case 2, and 77 to 123 points for Case 3.

Conclusion: Intensive rehabilitation in the recovery phase rehabilitation ward was associated with good recovery of ADL and motor function in patients with severe COVID-19 infection that had required ventilatory management.

Although pulmonary telerehabilitation (PTR) is a potential alternative to conventional pulmonary rehabilitation, there have been no practices and reports in Japan. In this case report, we describe the clinical course of a chronic obstructive pulmonary disease (COPD) patient who received our PTR system. A male in his 70s with COPD was lent a tablet installed with the telemedicine system and received the PTR program, which included respiratory conditioning, resistance training, endurance training using a cycle ergometer, and promotion of physical activity twice a week for eight weeks. In the results, reduced dyspnea during stair climbing was observed, and significant improvements in exercise capacity and health-related quality of life over the minimum clinically important differences were obtained. The PTR enabled a remote and direct exercise program in his home, which may have contributed to the behavioral change. PTR can be an effective means of addressing the limitations in access and opportunities for providing pulmonary rehabilitation, which have been a major issue.

Purpose: While survival rates have improved with advances in intensive care, there have been many reports of complications and other problems. We report a case of intensive care unit-acquired weakness (ICU-AW) after severe pneumonia in which physical function and activities of daily living (ADL) had been improved by intensive rehabilitation in a convalescent rehabilitation ward.

Case: The patient developed ICU-AW after severe pneumonia at the referring hospital and was transferred to convalescent rehabilitation ward of our hospital on the 97th day. The patient had significant impairment of physical function and ADL, but was treated with in progressive exercise therapy.

Results: The Medical Research Council sum score improved from 30 to 54 points, and the Functional Independence Scale improved from 39 to 100 points shown in the order of initial to final evaluation.

Conclusion: Intensive convalescent rehabilitation improved physical function and ADL in a patient who presented with ICU-AW after severe pneumonia.

Introduction: We report a case of a patient with severe hypoxemia after exacerbation of interstitial lung disease (ILD), whose activities of daily living improved with the use of neuromuscular electrical stimulation (NMES).

Case presentation: The patient, a 70-year-old male, was hospitalized for exacerbation of ILD, and physical therapy was started on the 15th day of hospitalization. Transferring was possible with light assistance, but walking was difficult. He was independent in eating and used a urinal and a bedpan for defecation. Transcutaneous arterial blood oxygen saturation decreased from 95% to 89% during sitting and standing motions while inhaling 6 L/min of oxygen. Since high-intensity exercise therapy was difficult, NMES was started on the 36th day of hospitalization, taking hypoxemia into consideration.

Results: Isometric knee extension muscle strength improved by 4.3-6.2 kgf and continuous walking distance improved to 40 m. The patient became independent in activities of daily living and was discharged home.

Conclusion: For patients following an exacerbation of ILD, the combined use of NMES, considering exertional hypoxemia, may help improve physical function and activities of daily living.

Introduction: While numerous studies have investigated the benefits of preoperative physical therapy (RPT) for patients undergoing lung resection surgery, most have focused on those between 50 and 75 years of age. This case report reveals the impact of unsupervised preoperative RPT on an 87-year-old patient who demonstrated marked improvement in exercise capacity, physical function, and pulmonary function.

Case: An 87-year-old woman diagnosed with lung cancer participated in a 7-week home-based RPT program involving endurance, resistance, and respiratory training. Substantial improvements were observed in her 6-minute walking distance (45 meters), Short Physical Performance Battery score (1 point), forced vital capacity (16%), and forced expiratory volume in 1 second (14%). Following RPT, the patient underwent video-assisted thoracic surgery for lung cancer resection. Remarkably, no postoperative pulmonary complications were reported. Although the patient experienced hypoxemia during a 6-minute walking test on postoperative day 5, she was discharged without the need for home oxygen therapy on the postoperative day 6.

Conclusion: This case suggests that unsupervised preoperative RPT can yield substantial benefits for older patients undergoing lung resection surgery, including improvements in exercise capacity, physical function, and pulmonary function.

With globalization, ways of obtaining information about studying abroad have increased, and it is gradually becoming easier to study overseas. However, although international activities are being promoted, it is still challenging to study abroad as a professional in the field of physical therapy. Few physical therapists have managed to study abroad. Fortunately, I had the opportunity to research abroad under Professor Darlene Reid at the Department of Physiotherapy, University of Toronto in Canada, as a postdoctoral researcher for one year. This activity report covers my experiences of research in Canada as a physical therapist, including processes leading there, the flight to Canada, differences in research and in the educational systems of Canada and Japan, as well as benefits of research abroad. I hope that this report will help physical therapists who are considering studying abroad, by providing pertinent information focusing on my actual experience.

Purpose: The aim of this study was to consider the relationship between respiratory function and activities of daily living (ADLs) in clients with cerebrovascular disease.

Methods: The subjects were 23 clients admitted to the convalescent rehabilitation wards and were in charge of the author over a seven-year period from 2016. ADLs ability was assessed using the functional independence measure (FIM) and basic movement ability (ABMS-II). Physical function was assessed with the Trunk Control Test, grip strength. We examined the association between ADLs ability, physical function, and respiratory function test results.

Results: Percentage of predicted forced vital capacity at admission was significantly correlated with FIM, ABMS-II, and physical function at discharge.

Conclusion: Forced vital capacity in clients with cerebrovascular disease was associated with respiratory muscle strength and trunk function. The postural control function of the trunk, which is the non-respiratory activity of the respiratory muscles, affects basic movements and FIM，and forced vital capacity, which reflects respiratory muscle strength and trunk function, was considered to be positively correlated with FIM. We thought that the pulmonary function test could be used as a comprehensive evaluation of respiratory muscle strength and trunk function.