We investigated the changes in exercise tolerance before and after coronary artery bypass graft surgery (CABG) in patients with angina pectoris (AP). Subjects were consecutive 33 patients with AP who had undergone CABG. The exercise capacity of all patients were assessed before and after surgery by cardiopulmonary exercise test (CPX). All patients were under the management to start the daily exercise training (Treadmill or bicycle ergometer) at 1 week after surgery. Hemoglobin (Hb) was measured in all patients at the time of CPX. Exercise capacity was reduced at the early phase (within 7 days before training) after surgery, but it recovered to the baseline 20 days after surgery (after 2 weeks training). The changes in exercise capacity were correlated with the changes in ventilatory efficiency, the maximal O₂pulse and the Hb. The improvement of exercise capacity after exercise had a tendency to reflect the changes in maximal O₂pulse. In conclusion, the present study indicate that exercise capacity at the early phase after CABG is reduced from the level before surgery, but return to the baseline rapidly. Because the duration of exercise training after surgery was short (10-14 days) in this study, the effect of exercise training in improvement of exercise tolerance is not clear. These results suggest that further exercise training may have the potential to improve exercise tolerance of the patients after CABG.

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Lansbury's activity index is one of the assessments of disease activity in rheumatology widely used, and one necessary element of this index is a test for erythrocyte sedimentation rate. In physical therapy, on the other hand, little has been reported about the index for assessing the disease activity by a physical therapist. In 1992, Mason et al, drew up a simple table for assessing the disease activity in rheumatology. The table has six questions that the patients answer by themselves. The first question is based on three visual analogue scales and Mason's score can be completed in 10 minutes by the patient. The purposes of the study were to investigate the correlation between the Mason's score and both activities of daily living (ADL) and Lansbury's activity index. We found that both correlations were significant. Mason's score correlated negatively with ADL (r = -0.64) and positively with Lansbury's activity index (r = 0.89). These results suggest that Mason's score is useful for the physical therapist to assess the disease activity in rheumatology.

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In our hospital, various attempts have been made to enrich team approach treatments of patients. As one of them, a new house-staff system for rehabilitation staffs was introduced in 1996. The purpose of this study was to evaluate the validity of this house-staff system. The clinical recordings of 238 and 125 cases before and after the introduction of the system respectively, were investigated to compare their clinical courses. It was concluded that the house-staff system was effective to shorten the period of admission from 100 days to 68 days in average without changing the rate of home-to-return and ADL after discharge.

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The muscle activities of knee extensors (musculus rectus femoris, and vastus lateralis and medialis) during 1-km walking were measured to investigate the effects of long-distance walking on these extensors in 12 healthy persons. Compared with the muscle activities at the start of walking, those at the end of 1-km walking were increased in the rectus femoris and decreased in the vastus lateralis. The activities of these muscles were not significantly different between both sexes. The activity of rectus femoris was increased especially in the early-middle stance phase of gait and that of vastus lateralis was decreased in the middle swing phase of gait. There was no difference in the muscle activities at the respective maximum actions between the start and the end of 1-km walking. With regard to the knee extensors, it was suggested that the muscle endurance of rectus femoris should be taken into consideration to complete a long-distance walking satisfactorily.

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The intensity of exercise in the therapy of diabetics is usually moderate, but from the viewpoints of ease of education and establishment of safety we are experimenting with low intensity exercise (50% anaerobic threshold: 50% AT). The purpose of this study was to investigate whether or not body fat reduction leading to improvement in insulin resistance could be realized by continuance of low intensity exercise among non-insulin-dependent diabetes mellitus (NIDDM) patients. The subjects were seven NIDDM patients. At the start of exercise an exercise tolerance test was performed on a bicycle ergometer, and after the AT value was found, a load of 50% of the AT value was computed. Then, the heart rate of steady state of 50% AT intensity exercise was found and this value was used as an intensity index in the exercise prescription. The heart rate of the subjects in 50% AT exercise was 97.9 ± 11.6 bpm. Exercise was performed twice daily at 50% AT intensity for 30 minutes, at a frequency of 5 days a week, and was continued for 4 months. In examinations before and after the 4 months exercise period %Fat and lean body mass (LBM) were measured by dual energy X-ray absorptiometry, and at the same time fasting plasma glucose, glycohemoglobinA_1C (HbA_1C), and serum lipids were also measured. As a result, after exercise the %Fat of whole body, and that of the separate regions, upper, lower extremity and trunk, were all significantly lowered in comparison with before exercise, but no significant changes in LBM were found. Fasting plasma glucose, HbA_1C and plasma free fatty acid were significantly reduced, and a significant rise in HDL-cholesterol was observed. It is thought that these facts suggest plasma glucose control was improved through insulin resistance being relieved. We have shown that low intensity exercise preserves LBM, and has the effect of reducing body fat in NIDDM patients, and have confirmed its very high effectiveness in improving insulin resistance.

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