Lately, ischemic heart diseases became one of the most prevalent diseases with high mortality in Japan. The coronary arterial by-pass grafting (CABG) has become an essential surgical management. However, there have been few systematic and comprehensive rehabilitation programs for the patients who have undergone the coronary by-pass surgery. The purpose of this paper is to present our original rehabilitation program for the patients before and after CABG, and to investigate the advantage and the disadvantage of the program.
The program consists of preoperative exercises for prevention of complications and postoperative exercise with progressive walking on the level and climbing stairs. Physical therapisits start to involve at preoperative stage of patient management and education in this program.
Twenty-three patients who undergone CABG participated in this program. Seventeen patients out of 23 (74%) were able to complete the rehabilitation program within 10 days and to reach the final step of physical therapy (climbing the staircases : 40 steps and walking alone : 500 meters)
The patients who had failed to complete the schedule within 10 days developed latent complications such as renal dysfunction, congestive heart failure, poorly controlled diabetes mellitus. However, they eventually completed the rehabilitation program by continuing the exercise after the discharge. There were no postoperative complications during the rehabilitation.
It appears that application of physical therapy before and immediately after CABG seemed to be of advantage for prevention of the postoperative complications and for restoration of the physical activities.

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The strength of the quadriceps muscle was evaluated according to type of sports events in 343 healthy males. The types of sports events studied were : soccer, rugby, American football, judo, volleyball, sprint and long-distance.
Peak muscle torque and peak muscle torque per kilogram of body weight at angular velocities of 60°/sec and 180°/sec were measured using CybexⅡ⁺. The mean value of peak muscle torque per kilogram of body weight was obtained for each type of sports events. A regression line was obtained for each type of sports events from the body weight and peak muscle torque values. The differences among the slopes were analyzed.
The mean of peak muscle torque per kilogram of body weight was highest in American football. The value of peak muscle torque per kilogram of body weight characterized the nature of the sports events. The slope of the regression line was greatest in volleyball ; judo had the smallest slope. The differences in the slopes of the regression line between judo and the other sports events were significant. The differences in the slopes were related to the athletes' amplitude of vertical positional change of the center of gravity (magnitude of potential energy).

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Hemiparesis grade, weight bearing on the hemiparetic limb while standing, muscle strength of the affected limb, deep sensory impairment, height, body weight, period after onset, and age were evaluated in 39 stroke patients in order to determine the relationship between these factors and walking task performance (speed and level of independence). Individual relationships between these factors were also investigated. Statistical analysis for selection of the most important factor related to gait abilities was performed using stepwise multiple regression analysis. The hemiparesis grade, weight bearing rate, and muscle strength were found to correlate with both gait speed and level of independence. There were also significant individual correlation between the three factors. The most important factor affecting gait speed was the rate of weight bearing on the hemiparetic limb, and the most important factor affecting gait levels of independence was the hemiparesis grade. The results indicate that the measurement of quantitative motor function is important to project the walking task performance in stroke patients, as well as to evaluate qualitative motor function.

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With respect to changes in walking speed and gradient, the relationship between Physiological Cost Index (PCI) and METS was examined.
In 10 healthy normal male subjects, PCI was measured in 8-type flat walking of 30 m-circumference according to MacGregor et al. Also in flat walking using treadmill, gradient walking and continuous walking according to Bruce method, PCI and METS were measured, respectively for comparative examination.
The relationship between PCI and walking speed showed a significant correlation for each loading. The value of PCI for walking speed was lowest for treadmill flat walking, being high for gradient walking and continuous walking according to Bruce method in this order. The relationship between PCI and METS showed the highest correlation (r = 0.87) for gradient walking. Clinically, the simple approach of PCI enables us to indirectly presume one's energy consumption, but its application needs proper attention because of different PCIs according to exercise loading method.

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We measured sitting postural sway using force plate to investigate plane tilting responses in 10 right and 10 left hemiplegic patients. The results were as follows :
① In right hemiplegic group the body sway tilting toward the unaffected side increased significantly compared with normal group. However, we found no such tendency in left hemiplegic group.
② Right hemiplegic group tended to show greater postual sway tilting toward the unaffected side. On the contrary, left hemiplegic group showed greater postural sway tilting toward the affected side.
③ These discrepancies were thought to be related to the difference caused by the involved side in addition to normal genetic laterality of trunk function.

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The incidence of gait disorders was investigated in patients with acute myocardial infarction (AMI). The subjects were 189 AMI patients (age : 63.2 ± 12.1). The results were as follows : Gait disorder was found in 23% of cases (44/189), and its incidence was higher than the rate of abnormal cardiovascular responses (19%) during inpatient program after AMI. Gait disorders occurred frequently in elderly patients (age ≧ 70), patients with cerebrovascular accident, musculoskeletal disease, chronic phase of medical disorders, and those who had more than 20 days of immobilization period. Completion rate of the inpatient program was significantly lower in patients exhibiting gait disorders than in the other patients. However, in patients who completed the program, the program progression was slightly delayed in those with gait disorders alone (30 days). These results indicate that the occurrence of gait disorders should be recognized as a factor impeding the completion of the program in AMI patients.

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The purpose of this investigation was to evaluate the muscle strengths of shoulder rotators in the patients with shoulder instability. Subjects were 15 normal males and 10 patients with shoulder instability. Torques of internal and external shoulder rotators were measured using an isokinetic torque machine (KIN-COM 500 H). Peak torques and external/internal peak torque ratio were compared between two groups.
During both concentric and eccentric contractions, peak torques of both internal and external rotators was significantly lower in the patients than in the normal subjects. External/internal peak torque ratio of concentric contraction was also higher in the patients than in the normal subjects.
Those results may imply that the muscle exercise training for shoulder instability requires not only appropriate quantity levels such as exercise intensity but also appropriate quality ones such as the concentric and eccentric contraction mode.

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The purpose of this study was to examine the relationship between compliance behaviors of patients with low back pain in the low back pain school and their psycho-social profile or behavioral characters. The subjects were 52 patients in the low back pain school. Using six psycho-social behavior scales, i.e. ‘fragile sensation of diseases in general’, ‘preference of health behavior to living one’, ‘positive countermeasure’, ‘emotional support network’, ‘health norm’ and ‘pain sensitivity’, we examined these subjects for behavioral characters and also. using ‘compliance behavior’ scales, for compliance to the instructive contents indicated by the low back pain school. The multiple regression analysis was performed with these six psycho-social behavior scales as objective and explanatory variables, respectively. As a result, behavioral characters of patients with low back pain proved to have a strong influence on the practice of their compliance behaviors (R² = 0.82, p < 0.001). Calculation of standard partial regression coefficient revealed ‘preference of health behavior’ (β = 0.346, p < 0.01), ‘emotional support’ (β = 0.306, p < 0.01) and ‘health norm’ (β = 0.225, p < 0.001) to have positive influences on the practice of their compliance behaviors as objective variable and ‘pain sensitivity’ (β = 0.247, p < 0.001) to have negative influence thereon. The above results suggested that effective low back pain school education required having a good understanding not only about the physical profile of patients with low back pain, but also about their behavioral characters in psycho-social aspect.

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