Stroke is a leading cause of serious long-term physical disability due to insufficient neurorepair mechanisms. In general, physical activity is an important modifiable risk factor, particularly for stroke and cardiovascular diseases. Physical exercise has shown to be neuroprotective in both animal experiments and clinical settings. Exercise can be considered a mild stressor and follows the prototypical preconditioning stimulus. It has beneficial effects on brain health and cognitive function. Preconditioning exercise, which is prophylactic exercise prior to ischemia, can protect the brain from subsequent serious injury through promotion of angiogenesis, mediation of inflammatory responses, inhibition of glutamate over-activation, protection of the blood-brain barrier, and inhibition of apoptosis. Preconditioning exercise appears to induce brain ischemic tolerance and it has been shown to exert beneficial effects. It is clinically safe and feasible and represents an exciting new paradigm in endogenous neuroprotection for patients with acute stroke. In this review, we describe the neuroprotective potential of preconditioning exercise and clinical applications in patients with acute ischemic stroke.

The aim of this systematic review and meta-analyses was to calculate the pooled prevalence of sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) criteria among Japanese community-dwelling older adults. Data from 8 studies were used to determine the prevalence of sarcopenia in the overall population and in men; data from 9 studies were used to determine that of women. The pooled prevalence rates of sarcopenia using random-effects models were 9.9% (95% confidence interval [CI], 6.2%-15.4%) overall; 9.8% (95% CI, 6.2%-15.2%) among men; and 10.1% (95% CI, 6.4%-15.5%) among women. These findings would be useful to inform community-based strategies and advanced research addressing sarcopenia prevention.

Purpose: Mechanically assisted coughing (MAC) is an airway clearance method in which the thorax/abdomen is compressed in synchronization with mechanical insufflation-exsufflation (MI-E). MAC can be performed with manual assistance at the upper thorax (MAC-UT), lower thorax (MAC-LT), and upper thorax + abdomen (MAC-UT/A). This study aimed to determine the most effective approach under different conditions (air stacking or tracheostomy) in patients with neuromuscular disorders (NMDs). Methods: The study included 34 patients with NMDs. The patients were categorized into air stacking group (n=15), no air stacking group (n=9), and tracheostomy/tracheostomy positive-pressure ventilation (TPPV) group (n=10). Results: In each group, the cough peak flow (CPF) at 75% of the forced vital capacity (V75), V50, V25, and V10 were investigated during the approaches. In the air stacking group, the CPF was higher with MAC-UT, MAC-LT, and MAC-UT/A than with MI-E (p < 0.05). Additionally, V75 was higher with MAC-LT and MAC-UT/A than with MI-E (p < 0.05 and p < 0.01, respectively). In the no air stacking group, V75 was higher with MAC-UT/A than with MI-E (p < 0.05). In the tracheotomy/TPPV group, there were no significant differences. Conclusions: MAC approaches, especially MAC-LT and MAC-UT/A, are preferred in air stacking patients. However, in tracheostomy/TPPV patients, the CPF might not increase with MAC.

Background: Sedentary behavior increases the risks of obesity and cardiovascular disease in adults, but these relationships are uncertain in elementary and junior high school students. We investigated whether sedentary behavior is related to overweight status and obesity in high-risk children with lifestyle diseases. Method: A cross-sectional study was performed in 115 children and primary caregivers who attended a lecture for preventing child lifestyle diseases in Ibaraki prefecture, Japan. The main outcome measure was excess weight (percent overweight). Factors associated with excess weight in children were evaluated using multiple regression analysis. Basic physical and demographic characteristics, biochemical data (total cholesterol [TC], low and high density lipoprotein cholesterol [LDL-C and HDL-C], alanine aminotransferase [ALT]), blood pressure, child and parental sedentary time, parental BMI, and family environment were evaluated. Results: In total, 107 children were eligible for participation in the study. Excess weight in these children was 28.6 ± 18.4. Sedentary time was 337.2 ± 122.5 min/day in children and 347.0 ± 196.2 min/day in parents. Multiple regression analysis revealed that children's sedentary behavior (β = 0.02, (95%CI: 0.00 to 0.04) ) and HDL-C (β = −0.59, (95%CI: −0.81 to −0.38) ) as independent predictors of children's excess weight. Conclusion: Study findings suggest that decreasing children's sedentary behavior in addition to greater physical activity is important for the prevention of overweight status and obesity in high-risk children with lifestyle diseases. Reduction of sedentary time, and engaging in regular exercise are all important for proper weight maintenance in children.

Objective: This study aimed to clarify the levels of physical activity of elderly pneumonia patients. Method: This is a prospective observational study among pneumonia patients who were hospitalized in a clinic within a general and respiratory medicine hospital department, and community-dwelling elderly. Activity levels of 29 elderly patients with pneumonia who were aged >75 years (PP group), and 15 community-dwelling healthy elderly (CD group) were measured. Triaxial accelerometers were attached to the patients' left chest regions from 48 h until 7 days after hospitalization. Results: The time spent in the upright position was 320.0 min/day in the PP group and 729.0 min/day in the CD group. The time spent walking was 3.8 min/day in the PP group, and 71.0 min/day in the CD group. In the PP group, the times spent in the upright position and walking did not increase during the period studied, that is, from 48 h until 7 days after hospitalization. Conclusion: The time spent in the upright position and walking among elderly patients with pneumonia did not increase, despite gradual improvement of the disease.

Purpose: The purpose of this study was to clarify the influence of complications of diabetes on the exercise tolerance of patients with heart failure. Methods: The subjects of this study were 69 patients (44 men; mean age: 62.2 ± 13.4 years) who were hospitalized and diagnosed with heart failure between November 2016 and November 2017. The subjects all took part in a cardiopulmonary exercise test. The patients' medical background, indexes obtained from lower-limb muscle strength and the cardiopulmonary exercise test, heart rate response indexes [Δ heart rate (ΔHR)], and autonomic nervous activities were measured, and these individual indexes were compared between the diabetic group and the non-diabetic group. Results: Compared with the non-diabetic group, the peak oxygen uptake (peak VO₂) and ΔHR in the diabetic group were significantly lower (13.0 ± 2.2 vs. 14.9 ± 4.4 ml/kg/min and 27.2 ± 11.7 vs. 36.7 ± 14.7 bpm, respectively) (p<0.05). Regarding the autonomic nervous activity during the cardiopulmonary exercise test in the diabetic group, there was a significant decrease of parasympathetic nerve activity and a significant lack of increase in sympathetic nerve activity (p<0.05). Conclusions: Patients with heart failure and diabetes had lower levels of exercise tolerance, as compared with patients without complications. It was suggested that the decrease in heart rate response was due to the decrease of autonomic nervous activity and that this may play a role in reduced exercise tolerance.