ABSTRACT 【Background and purpose】The effect of prolonged obesity history on muscle loss remains unknown; thus, it is necessary to investigate the influence of a prolonged obesity history on skeletal muscle before the onset of age-related muscle loss. The aim of the study was to investigate the influence of prolonged obesity history on skeletal muscle before the onset of age-related muscle loss. 【Methods】Young Sprague-Dawley rats were randomly divided into two groups: fed a normal diet (ND) or a high-fat diet (HFD). 【Results】The body weight was significantly higher in the HFD group than in the ND group at 11 weeks old. At 50 weeks old, the mean body weight of the HFD group was 1.3-fold higher than that of the ND group. There were no significant differences in the fasting glucose levels between the two groups. However, glucose levels after glucose administration were significantly higher in the HFD group than in the ND group after 32 and 49 weeks old, suggesting that prolonged obesity in young adults results in mild glucose intolerance in middle-aged rats. At 50 weeks old, histologically, many larger adipocytes were observed in the HFD group. However, indicators of chronic inflammation were not observed in the HFD group. Although absolute muscle loss was not observed in the HFD group, low relative muscle mass was detected with downregulation of interleukin 6, muscle RING finger protein 1, and atrogin-1 in the skeletal muscle. 【Discussion】Downregulation of these factors before the onset of age-related muscle loss could be an indicator of muscle loss in older adults with a history of prolonged obesity.

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【Purpose】Using classification of “the Medical Care System for Older Senior Citizens”, we clarified the incidence of locomotive syndrome (LS) in patients with diabetes by age group and examined the factors affecting the occurrence of complications of LS. 【Methods】We enrolled 80 older patients with type 2 diabetes and classified them by age into two groups: senior group, with age of 65–74 years (n = 53), and grand senior group, with age of 75 years and older (n = 27). The 25-question Geriatric Locomotive Function Scale (GLFS-25) was used to determine the presence/absence and stage of LS. General characteristics, diabetes control index, diabetic complications, knee extension force (KEF), and exercise habits were investigated and compared by the LS stage. In addition, a multivariate analysis was performed for factors affecting LS using the presence/absence of LS as the objective variable. 【Results】The incidence of LS was 52% in the senior group and 66% in the grand senior group, showing no significant difference by age group. In both senior and grand senior groups, KEF was significantly lower in those with LS than in those without LS, and the proportion of those with LS who had an exercise habit was lower. In the multivariate analysis, exercise habits were selected as a factor influencing LS in both the senior and grand senior groups. KEF was selected as a factor influencing LS in the grand senior groups. 【Discussion】The incidence of LS in the general Japanese population aged ≥60 years as assessed by GLFS-25 was approximately 30%. The prevalence rates of LS in both senior and grand senior groups were approximately twice those of the general population, and older patients with diabetes seemed to require more long-term care. The results of this study suggest that to prevent the onset of LS in older patients with diabetes, maintaining high muscle strength in the lower limbs and exercise habits are effective, and detection and management of the onset of LS should be timely.

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【Background and purpose】Long-term childhood exercise prevents obesity not only during exercise period but also during adulthood after detraining period. However, it is unclear why the effects of childhood exercise persist into adulthood. The purpose of this study was to clarify why obesity was controlled after quitting exercise, focusing on mitochondrial metabolism in the skeletal muscle. 【Methods】Four-week-old male Otsuka Long-Evans Tokushima Fatty (OLETF) rats were randomly divided into a sedentary group (OLETF Sed) and an exercise group (OLETF Ex); they exercised from 4- to 12-week-old and detrained from 12- to 20-week-old. Citrate synthase (CS) and 3-hydroxyacyl-CoA dehydrogenase (β-HAD) activities were measured as enzymatic activity analysis for mitochondrial metabolism in the soleus muscle. Succinate dehydrogenase (SDH) activity was also observed for the histological analysis of the skeletal muscles. 【Results】CS activity in the soleus muscle was significantly higher in the OLETF Ex group than in the OLETF Sed group at 12-week-old; however, there were no significant differences at 20-week-old. There were no significant differences in β-HAD activity between the OLETF Ex and OLETF Sed groups at 12- and 20-week-old. In the OLETF Ex group, many muscle fibers were densely stained with SDH staining at 12-week-old; however, at 20-week-old, there were both densely and lightly stained muscle fibers. 【Discussion】Childhood exercise enhanced enzyme activity related to mitochondrial metabolism in the skeletal muscle; however, this adaptation disappeared in adulthood after the detraining period. Increased mitochondrial metabolism in the skeletal muscle due to childhood exercise may contribute little to preventing obesity in adulthood.

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【Background/Aim】Functional decline in external anal sphincter (EAS) muscle might occur due to diabetic neuropathy (DN), which could result in various dysfunctions such as anal incontinence. Hyperglycemia has been reported to inhibit EAS function and decrease rectal compliance. However, there is no information on how diabetes affects EAS motoneurons and muscle. Therefore, we examined anatomical alterations in EAS motoneurons and muscle. 【Method】Type 1 diabetes was induced in 21 animals by administering streptozotocin (STZ). Twenty-two age-matched control animals were injected with saline. EAS motoneurons were retrogradely labeled using dextran-fluorescein, and the number and size of cell bodies were examined. EAS muscle fibers were stained using hematoxylin-eosin, and the myocyte sizes were determined. 【Results】No differences were observed in total number and size of EAS motoneurons, or diameter of EAS muscle fibers between the two groups. 【Discussion】The present study suggests that EAS motoneurons and their muscle are highly resistant to diabetes. However, it is unclear why these elements are resistant to diabetic changes. EAS motor nucleus consists only of alpha motoneurons, which are known to be highly resistant to diabetes among hindlimb motoneurons. Additionally, EAS muscle is in a state of constant weak contraction, except during defecation when relaxed and strongly contracted when cutting stool. This is unlike any other body part muscle. We considered that these characteristic activities, which differ from those of limb muscles, might contribute to maintenance of EAS motoneurons and their muscle. Future research to identify factors that affect tolerance to diabetes may reveal information that could be useful in preventing movement disorders caused by diabetes.

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【Background】The intervention was conducted in a 50-year-old patient with type 2 diabetes visiting a diabetology clinic under exercise guidance by a physical therapist and using a pedometer application. 【Methods】Aerobic exercise using equipment was performed in the exercise therapy room of our clinic thrice a week for 30 min on each occasion. Three exercise modalities, a bicycle ergometer, treadmill, and cross trainer, were used for 10 min each. The intervals and cool-downs were approximately 1 min for each machine. A goal of at least 5,000 steps per day was set on the pedometer application, and its completion was checked by the physical therapist. The pedometer application also enables one to visualize changes in their daily step count on a graph and has a function that allows one to earn points on reaching their goal. 【Results】As a result of continuing these measures for 6 months, the body mass index improved from 27.0 kg/m2 to 25.5 kg/m2, and the glycosylated hemoglobin improved from 8.3% to 7.0%. Biochemical tests showed an improvement in the Aspartate aminotransferase level from 44.0 IU/L to 19.0 IU/L, Alanine transaminase level from 65.0 IU/L to 29.0 IU/L, and triglyceride level from 552.0 mg/dL to 364.0 mg/dL. Bone mineral density went from 86.77 mmAI to 89.04 mmAI, and the results of the pulse wave conduction velocity test and Diabetic peripheral neuropathy test were in the normal range before and after the test. 【Conclusions】In this study, in addition to exercise guidance by a physical therapist, the use of a pedometer application may have contributed to the promotion of healthy behavior.

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【Background/Objective】Exercise therapy for hospitalized dialysis patients should be provided as regularly as possible during the post-dialysis period in addition to the sessions conducted on non-dialysis days. However, physical performance, vital sign, muscle oxygen saturation (SmO2) during exercises performed post-dialysis remain unclear. This case study aimed to show descriptive SmO2, vital sign, and physical performance assessment on non-dialysis and post-dialysis days in hospitalized patients. 【Method】An 80s man who underwent hemodialysis. The patient underwent Near-infrared spectroscopy (NIRS) measurements at during the same passive cycling exercise on non-dialysis and post-dialysis. SmO2 and total hemoglobin (THb) were measured by NIRS during non-dialysis, and post dialysis, and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and Rating of Perceived Exertion (RPE) were measured during exercise. Short physical performance battery (SPPB), maximal isometric knee extension strength and the 10-m walking test were also measured on non-dialysis days and post-dialysis period. 【Results】SmO2 during exercise was lower post-dialysis compared to non-dialysis. SBP, DBP, and HR during exercise showed minimal increase during post-dialysis compared to during non-dialysis days. RPE was higher post-dialysis. SPPB (12 and 10 points) and maximal isometric knee extension strength (31.5 and 26.5 kgf) and 10-m walking test (1.2 and 1.1 m/s) were lower during the post-dialysis period. 【Discussion】In the post-dialysis period, less elevation of the circulation response and high deoxygenation in muscle tissue was observed. The exercise load during post-dialysis exercise may need to be decreased, depending on the physician’s judgment.

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【Objective】This case study aimed to evaluate the effect of exercise therapy on a physical function in an elderly patient undergoing outpatient maintenance hemodialysis over a 20-months period, including the period of outpatient dialysis visits and hospitalization due to the 12th thoracic vertebra. 【Case Presentation / Methods of Intervention】A woman in her eighties undergoing dialysis for chronic renal failure caused by chronic glomerulonephritis began exercise therapy during dialysis approximately 1.5 months after induction. Exercise therapy consisted of stretching and resistance training, with exercise intensity ranging from 11 to 13 on the Borg scale. During hospitalization due to the fracture, rehabilitation was provided on dialysis and non-dialysis days with the goal of discharge home was implemented. After discharge from the hospital, the patient continued the exercise therapy during dialysis. Grip strength, isometric knee extension strength, 10 m walking speed, short physical performance battery, and EuroQol-5D were used to assess the physical function and quality of life, respectively. 【Results】Seven assessments of physical function were conducted over a 20-month period, including hospitalization, and all the evaluations showed improvement three months after the initiation of exercise, a slight decline six months later, and no significant change after that. Rehabilitation was provided during hospitalization for the fracture event, and physical function was maintained during discharge. 【Discussion】This case report suggests that continuous exercise therapy and rehabilitation are important for maintaining physical function in both outpatient and inpatient settings. Maintaining and improving physical function requires seamless intervention by setting the exercise according to the exercise duration while assessing physical function.

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【緒言】糖尿病患者には下肢筋力の低下やバランス障害などの運動障害が生じ，その原因として糖尿病性末梢神経障害や筋実質の障害がよく知られている．しかし，近年，末梢神経障害や筋障害だけでなく身体運動を制御する中枢神経系もまた糖尿病の影響を受け，それらの異常が運動障害の原因となる可能性が明らかになってきた．本総説では特に糖尿病に関連して生じる大脳皮質運動野や皮質脊髄路などの随意運動の制御に関わる中枢神経の異常に着目し，最新の知見をまとめる． 【糖尿病患者を対象とした研究】糖尿病患者を対象にした研究はMRIや電気生理学的手法を用いて行われ，大脳皮質運動野や皮質脊髄路の体積減少や微細構造の変化と，運動野の興奮性低下，可塑性の減少，皮質脊髄路の神経伝導速度低下などが生じることが明らかにされた． 【糖尿病モデル動物を対象とした研究】糖尿病モデル動物を用いた基礎研究では，腰髄以下に投射する皮質脊髄路に優位な軸索変性と興奮伝導障害，運動野後肢領域を中心とした運動野面積の減少が生じることが知られている． 【結論】糖尿病によって生じる随意運動を制御する中枢神経系の障害は糖尿病患者に生じる運動障害の原因を理解する上で新しい視点を与えるものであり，運動障害との関連について今後の研究が望まれる．

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糖尿病性末梢神経障害（diabetic peripheral neuropathy：DPN）は糖尿病に合併する最も頻度の高い合併症である．DPNは感覚運動神経障害を基盤として下肢機能障害や動作障害へと発展し，生活の質（Quality of Life：QOL）の低下を招く．運動療法はDPNに対する非薬物療法の1つとして期待が高まっており，様々な効果について報告されてきている．有酸素運動は神経の構造と機能を改善し，神経障害の兆候と症状を改善する．また，有酸素運動は神経機能だけではなく心肺機能，代謝機能の改善が見込め，日常的な身体活動への参加が促進し血糖コントロールの向上につながる．レジスタンス運動は，筋力や関節トルクを向上させ，動作機能を改善する可能性がある．有酸素運動とレジスタンス運動，バランス運動，運動感覚トレーニングなどを組み合わせた複合運動は，血糖コントロールや神経機能，静的動的バランス機能，動作機能，QOLなどの向上が期待できる．DPNに対する運動療法のエビデンスが徐々に蓄積されてきており，理学療法士が積極的に関わり，適切な運動療法が提供されることを期待したい．

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【背景】糖尿病足病変発症予防期における理学療法介入の医学的根拠は乏しい．本研究では，理学療法士が治療手段として一般的に用いることができる自作インソールと足関節背屈運動が胼胝部足底圧に与える影響を明らかにすることを目的とした． 【方法】前足部および母趾に胼胝を有する糖尿病患者22名を対象に通常の歩行，自作インソールでの歩行，足関節背屈可動域運動後の歩行の3試行で胼胝部の足底圧，足圧中心（center of pressure： COP）を測定した．また足関節可動域運動後に関節可動域（Range of motion： ROM）が改善する群，しない群に分け足底圧の変化量を比較した． 【結果】通常歩行と比較して自作インソール（p ＜ 0.01），足関節背屈運動後（p = 0.03）ともに有意に胼胝部足底圧が軽減した．足関節背屈運動後のROM改善の有無による足底圧の変化量は，両群間に有意差を認めなかった．また通常歩行と比較し，足関節背屈運動後のCOP最大前方移動量は有意に増加した（p = 0.017）． 【考察】自作インソールにおける除圧効果は構造的に圧分散を可能にしたものと考える．足関節背屈運動は関節構成体の硬さではなく歩行中の足関節運動を改善させ，COPをより前方へ移動させることで除圧効果を得たと考える．

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【緒言】近年，腎臓リハビリテーション（腎リハ）の重要性が認識され，血液透析（Hemo Dialysis：HD）患者の下肢筋力低下に対する有効性が報告されている．HD患者では糖尿病（Diabetes Mellitus：DM）を合併している割合が多く，DMは下肢筋力の低下と密接に関連している．よって，DMを合併したHD患者では，下肢の筋力低下がより進行していることが考えられることから，腎リハの効果はDMを合併していないHD患者とは異なる可能性があるが，そのような研究は報告されていない．本研究の目的は，DMの有無によって下肢筋力低下に対する腎リハの効果に違いがあるのかを明らかにすることである． 【方法】外来通院中のHD患者22名を対象とし，DMの有無で2群に分類した．両群とも同一の腎リハプログラムを1年間実施した．筋力評価は握力，膝伸展筋力，足趾筋力とし，研究開始時と1年後に測定した．統計解析として，各群での筋力の変化と2群間での筋力の変化率を比較した．有意水準は5%とした． 【結果】1年間の経過では，握力で非DM群，DM群ともに有意な改善は認めなかったが，膝伸展筋力と足趾筋力は両群ともに有意に改善した．各筋力の変化率を2群間で比較した結果，握力は有意差を認めなかったが，膝伸展筋力と足趾筋力は，非DM群の方がDM群よりも有意に改善した． 【結語】DM患者で，腎リハを実施しても膝伸展筋力と足趾筋力で改善効果が乏しくなる可能性が示唆された．

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