Objective: Lower extremity training (LET) was implemented in patients with cardiac failure (CF) during an early stable phase to investigate differences in cardiovascular response, symptomatic response, and severity according to cardiovascular indices. These were investigated using cardiac autonomic nerve activity. Methods: The study was included 20 patients with CF. After 5 minutes of LET, we measured changes in heart rate (HR), blood pressure (SBP), heart rate variability [low frequency (LF), high frequency (HF), and LF/HF], and rating of perceived exertion (RPE). The objects were classified in slight illness group and the severe ill group, and the comparison between groups was carried out. Results: In all patients, HR and RPE significantly increased after LET, and these effect were observed for up to 20 min after completion of LET. The decrease in HF was also maintained for 20 min after completion of RT. Comparison of the mild and severe CF groups revealed that HF significantly declined due to LET, and the decline was maintained for 40 min after completion of LET in the severe CF group. Evidence of significant decline in the mild CF group disappeared 10 min after completion of LET. Recovery was observed in RPE immediately after completion of LET in the mild CF group. Conclusion: In our study, parasympathetic nerve activity was reduced by LET its RPE was around 3 until 20 min after exercise in all patients. The severe CF group demonstrated strong RPE and decreases in both parasympathetic nerve activity and heart rate response. The mild CF group demonstrated prompt responses in parasympathetic nerve activity.

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Purpose: To assess the impact of left ventricular systolic dysfunction and cardio-renal anemia syndrome (CRAS) on activity of daily living (ADL) and walking ability in patients with heart failure. Methods: Two hundreds fifty-five patients (49 % of a woman, 79 ± 11 years) of decompensated heart failure were selected and divided into 2 groups depending on left ventricular ejection fraction (LVEF); 119 HFrEF groups (LVEF < 40 %) and 137 HFpEF groups (LVEF ≧40 %). Serum hemoglobin (Hb): male < 12 g/dl and female < 11 g/dl was defined as anemia, estimated glomerular ifitration rate < 60 ml/ min/1.73 m^2 was defined as chronic kidney disease (CKD), and CRAS was classified into three groups (A group: neither CKD nor anemia. B group: either CKD or anemia, C group: both CKD and anemia). We investigated the Barthel index (131) and walking ability of pre-hospital admission and at discharge. Results: BI and walking ability of pre-hospital admission and at discharge in HFpEF group were lower than those in HFrEF group, respectively (p < 0.05). There is no interaction between CRAS and BI in both HFrEF and HFpEF group. However, there was the main effect of CRAS to BI in only HFrEF group (p < 0.05). Conclusion: ADL level and walking ability in HFpEF group were lower than that in HFrEF group. On the other hand, ADL level was deteriorated depending on severity of CRAS in HFrEF group.

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Purpose: The present study was investigated to know the functional role of deep fascia enveloping thigh and fascia between muscles in vivo. Methods: We measured the length-force relationship, in vivo, in whole muscle preparations in knee extensor, triceps femoris muscle (TFM), of the frog, Rana catesbeiana. TFM consists of three muscles, Rectus femoris muscle (RFM), vastus madialis muscle (VMM) and vastus lateralis muscle (VLM). The sciatic nerve was exposed at dorsal portion of the pelvis and all the branches of sciatic nerve except for the one innervating VMM and VLM were cut. Experiments were performed on two different preparations of TFM; in one preparation, surface of TFM was totally covered with fascia (CTF), in the second one, hamstrings was removed from TFM (CRH). Results: Length-force curve located at the longer length in CRH than in CTF. Both the ascending and descending limbs in the curves were steeper in CTF than in CRH. In muscle length of TFM in the posture for Jumping, the isometric contractile force in CRH was about 10 percent lower than that in CTF. Conclusions: The results in the present study indicate that the active force development in CTF is more efficient than in CRH, suggesting that one of the functional roles of deep fascia and fascia between muscles is to produce higher active outputs by bundling each component muscle that has different contractile property, into one whole muscle.

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Purpose: The purpose of this study was to evaluate the effect of the 6-minute Pegboard and Ring Test (6PBRT) on the respiratory and cardiac response and the motor function of the upper-limb in patients with chronic obstructive pulmonary disease (COPD). Methods: We evaluated the respiratory gas, the heart rate and the blood pressure during 6PBRT and Upper-Limb Ergometer eXercise Test (ULEXT) in 10 COPD patients (mean age 76.7 yr), 12 healthy young adults (22.0 yr) and 12 healthy elderly adults (77.3 yr). Results: The values of VO2/kg increased slight rapidly up to 120-150 second, then became constant. The value of 6PBRTpeak/ULEXTpeak was 71.8 ± 37.1 (mean ± SD) %. The mean ± SD scores of 6PBRT were 279 ± 93 in COPD, 346 ± 47 in elderly adults and 416 ± 47 in young adults respectively (p <0.05). Conclusion: 6PBRT is the constant-load exercise test for the upper-limb and the high-intensity exercise test in COPD patients. The motor function of upper-limb was reduced significantly in COPD patients compared with age-matched elderly adults.

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[in Japanese]

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