[Purpose] In this study, the author investigated the kinetic loads of the lower limb joints in lunge movements with different step widths. [Subjects] Subjects were 8 healthy males. [Methods] Each subject performed the lunge movement with two different steps: the greatest step width (Long-step) and half the greatest step width (Short-step). A motion analysis system and force plate were used to collect kinematic and kinetic data of the lower limb joints, and the joint forces and torques of the hip, knee and ankle joints in the lunge movement were calculated. [Results] The ground reaction force showed a significantly larger value in the long-step. The compression and front shear forces of the hip, knee and ankle showed significantly larger values in the long-step. The joint torques of hip flexion and ankle plantar flexion showed significantly larger values in the long-step, and the knee extension torque showed a significantly larger value in the short-step. [Conclusion] The results suggest that it is important to choose an appropriate step width in therapeutic purposes for the lower limb joints when the lunge movement is adopted as a kind of physical therapy.

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[Purpose] An easy method to determine the anaerobic threshold (AT) is required. The aim of this study was to determine AT by heart rate (HR) square methods and to collect basic data. Moreover, we compared AT determined by the V-slope method and the double product break point (DPBP) method, and investigated the utility of (HR)² methods. [Subjects] The subjects were 10 healthy adult men (23.8 ± 2.5 years old). [Methods] After resting in a seated position for 5 min and 0 watt warm-up for 3 min, the subjects performed a ramped exercise load test on a bicycle ergometer starting with 30 watts and increasing by 10 watts every 2 min. [Results] There was no significant difference in VO₂ and watts when AT was determined by (HR)², DPBP and V-slope methods. [Conclusion] The results suggest that the (HR)² method is one of easiest ways to find HR and load to determine AT.

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[Purpose] We investigated the effect of exercise intervention and nutrition management on an arterial stiffness related index and physical function in stroke patients. [Subjects] Subjects were sixteen community-living stroke patients. [Methods] Exercise intervention that consisted of a two-hour program was performed twice a week for three months. Nutrition management was performed by nutrition managers during the intervention. We measured the Cardio-Ankle Vascular Index (CAVI), and the Ankle-Brachial Index (ABI) to assess the arterial function. Other measurements included gait speed, grip strength, Functional Reach Test (FRT), Timed Up and Go Test (TUG), and Sit-to-stand Test. [Results] In arterial function, CAVI of the affected side was significantly improved after intervention. There was no significant difference in ABI. In physical function, FRT and TUG were significantly improved. [Conclusion] These results suggest that an interdisciplinary intervention consisting of exercise and nutrition management was effective at not only improving physical function but also arterial function.

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[Purpose] The present study investigated whether intervention for enhancing body awareness would lead to reduced postural sway during a quiet standing task which was performed subsequent to the intervention. [Subjects] The participants were 10 healthy adults. [Methods] The 10 participants performed a quiet standing task under three different postural conditions: bipedal (easy), unipedal (moderately difficult), and unipedal on a foam surface (difficult). During the intervention the participants sat on a chair with their eyes closed and attempted to focus on the active-assistive movement among the postural conditions of the whole body. [Results] Comparison of the postural sway prior to and after the intervention showed that postural sway was significantly reduced after the intervention in the unipedal and unipedal on the foam surface conditions but not in the bipedal condition. [Conclusion] These findings suggest that an intervention that enhances body awareness, provided prior to performing a postural task, is likely to be effective at reducing the postural sway under difficult postural conditions.

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[Purpose] We carried out a prospective study of falls in community-living elderly for a year and examined the factors in their fall. [Subjects] The subjects were 133 elderly people (average age 73.9 ± 5.6 years) who didn't have severe cognitive symptoms and were receiving certified long-term care needs. Thirty-five subjects had a fall during the year (falls group) and 98 subjects did not (no-fall group). [Methods] We evaluated subjects' physical, cognitive and psychological functions for the baseline survey, and compared the results of falls group and no-fall group. [Results] In comparison of the baseline characteristics, foot-gripping strength, one-leg standing time, the TMIG index of competence scores, attention function and subjective view of health of the falls group were significantly lower than those of the no-fall group. However, in logistic regression analysis with the dependent variable as "fall experience in a year", the odds ratios of all items showed no significant difference. [Conclusion] These results suggest that specific physical, cognitive and psychological functions of community-living elderly show correlation with fall, but single factors are not determining factors of falls.

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[Purpose] The aim of this study was to reveal changes in lumbar curvature and muscle activities during the functional reach test (FRT) with both arms. [Subjects] The subjects were 20 healthy male university students who were 20 years old. [Methods] The subjects' FR distance and muscle activities of the left multifidus (MF), gluteus maximus (GM), biceps femoris long head (BF), soleus (SL) and caput medial flexor hallucis brevis (FHB) during FRT by surface electromyography were measured. We divided the FR distance into 4 parts: arm elevation, initial (1/3FR cm), middle (2/3FR cm) and last (FR cm) part, and compared muscle activities in the 4 parts. [Results] Anterior lumbar curvature of all the subjects decreased during FRT, if the lumbar curvature at rest in the standing position before arm elevation was in the neutral position of anterior-posterior curvature. SL muscle activities between arm elevation and initial reach increased significantly, but the activities between initial and middle part of reach varied very little. FHB and MF muscle activities from the middle part of reach increased markedly. [Conclusion] In this study, changes in lumbar curvature and muscle activities during FR action were found. The results suggest that the FR distance of patients with lumbar pain becomes shortened because lumbar curvature decreased and MF muscle activities increased during FRT.

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[Purpose] Using electromyography, we investigated our hypothesis that maintenance of standing on an upward sloping platform would be a mix of ankle and hip joint postural strategies. [Subjects] The subjects were 8 normal healthy adults. [Method] Electromyographic activities (EMGs) of the rectus femoris (RF), vastus medialis (VM), vastus longus (VL), semimembranosus (SM), biceps femoris (BF), gastrocnemius (medial and lateral heads: GM and GL) and tibialis anterior (TA) muscles were observed. Subjects maintained standing on upward slopes of 10 and 20 degrees for one minute, and EMGs were recorded 4 times: on the level, while standing on the upward slope, immediately after standing on the slope and 2 minutes later. [Results] Immediately and 2 min after standing on the 10-degree slope, RF, VM, VL and GM, and on the 20 degree slope, all muscles except SM, showed significant changes in each of the EMG measurements in comparison with those made at the start on the level. In standing on the 20-degree slope, TA activity showed a remarkable increase compared to on the level, and immediately after standing on the 20-degree slope GM activity increased significantly. [Conclusion] From the results, we infer that in maintenance of standing on an upward slope, the muscle activities of the whole of the lower leg are raised in which a strong contribution from the tibialis anterior is needed; on the level, after standing on the slope, the gastrocnemius functions to stabilize the center of foot pressure.

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[Purpose] The purpose of this study was to examine how changes in the visual system, which are important for posture and balance control, contribute to declining stability as people age. [Subjects and Methods] Subjects were 11 young people and 11 elderly people. Tests of the visual system were performed on the Equitest system with the use of an eye mask recorder (EMR). The visual field angle of the EMR was 92 degrees, and the calibration distance was 2 m. During sensory organization test 6, participants stood on a swinging floor with a moving wall. [Results] We observed significant differences between the young and elderly groups in postural sway (rectangular area), fixation point duration and pupil diameter. For area of eye movement a significant difference was observed only for the left eye. [Conclusion] In the elderly group, the postural sway increased and eye movements increased. These results may be associated with the body's perceived position according to visual information.

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[Purpose] The purpose of this study was to investigate the correlation between tests used as balance ability test and the star excursion balance test (SEBT) for 50- to 60-year-olds which was reported by Kinzey et al. in 1998. [Subjects] Seventeen healthy 50- to 60-year-olds (13 males and 4 females, mean age was 62.8 ± 6.2 years old) participated in this study. [Methods] We conducted balance ability tests such as 10 m walking distance, the 30-s chair-stand test (CS-30) and one-leg standing time with eyes open and closed. In addition, we performed SEBT. [Results] There was no correlation between 10 m walking distance and SEBT or between one-leg standing time with eyes open and SEBT. On the other hand, there were the significant correlations between CS-30 and all reach directions in SEBT, between one-leg standing time with eyes closed and postero-lateral (PL) in SEBT, and between posterior (PO) and postero-medial (PM) in SEBT. [Conclusion] These results suggest that it is necessary for the balance ability of 50- to 60-year-olds to assess reach distance of the lower extremity such as in the posterior, postero-lateral and postero-medial of directions.

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[Purpose] The purpose of this study was to clarify whether or not righting of the neck with the trunk laterally inclined influences swallowing movement. [Subjects] The subjects were 12 normally healthy persons (average age 21.3 years) who gave their consent to the study. [Method] For three conditions, sitting comfortably in a chair, and with the trunk laterally inclined at 30 degrees with and without neck righting, we measured the activation time of the suprahyoid muscle group (swallow time index) in swallowing 10 g of rice porridge using surface electromyograms. [Results] For the activation time of the suprahyoid muscle group, we found no significant difference between sitting comfortably and with the trunk laterally inclined at 30 degrees with the neck righted, but we found a significant prolongation when the neck was not righted. [Conclusion] Swallow time was not prolonged by lateral inclination of the trunk alone, but was affected by neck righting. Since prolongation of the swallowing time raises the risk of aspiration, the results show the importance of paying attention to the verticality of the head when preparing a feeding posture.

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[Purpose] In order to obtain basic data on nasal obstruction in patients with dysphagia, we investigated the swallowing movement under conditions of nasal obstruction utilizing time series analysis of surface electromyograms and laryngeal movement. [Subjects] The subjects were 10 normally healthy persons (average age 22.3 years) who gave their consent to the study. [Method] The subjects swallowed 10 ml of water under two conditions: with and without nasal obstruction. We measured the activation time of the suprahyoid muscle group, which is strongly influenced by volitional movement up to the start of the swallowing reflex, the time of laryngeal movement activity, which is strongly influenced by the swallowing reflex, as well as the time from the start of suprahyoid activation to the start of laryngeal movement, the interval from the start of volitional swallowing to the start of the swallowing reflex. [Results] With nasal obstruction, suprahyoid muscle group activation time as well as the time from the start of suprahyoid muscle group activation to the start of laryngeal movement were significantly lengthened, but there was no significant difference in laryngeal movement time. [Conclusion] The results show that the time of volitional movement up to the start of the swallowing reflex was lengthened by nasal obstruction, raising the risk of aspiration before swallowing.

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[Purpose] In this study, we investigated voluntary step behavior and postural sway under single- and dual-task conditions, and compared them between young subjects and older adult subjects, and between with and without a history of falls for the older adult subjects. Furthermore, we investigated the relationship between balance ability and cognitive function in the elderly. [Methods] Subjects performed the rapid voluntary stepping test in a standing position to measured dynamic balance ability, and postural sway with the eyes open was measured as static balance ability. An arithmetic task was used as the secondary cognitive task. [Results] In elderly subjects, there were significant differences between the single- and dual-task conditions in both stepping ability and postural sway. There was no significant difference in postural sway between fallers and non-fallers under both the single- and dual-task conditions. However, the stepping ability of non-fallers was significantly higher than that of fallers under both the single- and dual-task conditions. [Conclusion] These findings suggest that simple stepping ability as a dynamic balance test as well as dual task conditions, may be closely related to the incidence of falls in the elderly people.

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[Purpose] In this study we made a comparative examination of the achievement level of clinical reasoning ability of physical therapy students in a problem-based learning (PBL) tutorial, and its inter-group disparity. [Subjects and Method] Thirty-six 3rd year students at a 4-year physical therapy vocational college were given a PBL tutorial, and we performed an assessment of students' self-assessment and teachers' evaluation of each group of students with respect to the clinical reasoning achievement level from 6 items constituting it: overall understanding, use of information, interpretation and integration of assessment, identification of problem points, prognosis, and program. [Results] From both the students' self-assessments and teachers' evaluations, the items of conception of problem points and prognosis had a low assessment compared to the other items. In the teachers' evaluations, for all groups overall understanding and interpretation and integration of assessment had a comparatively high assessment, and in the students' assessments, for all groups use of information and overall understanding had a comparatively high assessment. In general assessment of clinical reasoning, significant differences were not seen among teachers' assessments for groups comprised of 7 or 8 students. [Conclusion] In group study, a comparatively high level of clinical reasoning ability was achieved. Even with minimal intervention of tutors differences in ability were not seen, and an uniform level of learning effect was achieved.

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[Purpose] The purpose of this preliminary investigation was to obtain a professional consensus regarding current high priority research questions (RQs) in the field of physical therapy. [Subjects and Methods] The Delphi method was utilized and 46 physical therapists (39 males, 7 females) who had obtained a master's degree in rehabilitation science from the University of Tsukuba were the subjects. We asked them to quickly list up to three high priority RQs in the field of physical therapy. [Results] A total of 20 questionnaires were returned, and 53 RQs were obtained in total for the study. The most common RQ was, "Is the difference between natural recovery and the effect of the treatment intervention clear?" [Conclusion] The highest ranking RQs reflected the bac kground of the promotion of evidence-based medicine in recent years.

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[Purpose] The purpose of this study was to investigate how tolerance of pain related to sensory-discriminative factors as well as emotional factors in its clinical assessment scales. [Subjects] Thirty healthy subjects participated in this study. [Methods] We used a Neurometer device to measure the non-traumatic Pain Tolerance Threshold (PTT) and painless Current Perception Threshold (CPT). Transcutaneous sine-wave stimuli at frequencies of 2000, 250 and 5 Hz delivered by the Neurometer are thought to selectively activate Aβ, Aδ and C afferent fibers respectively. PTT is the maximum amount of the electrical stimulus that a patient can tolerate, and CPT is the minimum amount of the electrical stimulus that the patient can perceive. We used PTTs, CPTs, a Visual Analogue Scale (VAS) and the McGill Pain Questionnaire (MPQ) as measurement tools for pain tolerance. [Results] There were significant correlations between PTTs and the qualitative factors in each subclass of MPQ. There were no significant correlations between PTTs and VAS, or PTTs and CPTs, but there was a significant correlation between VAS and CPTs. [Conclusion] Our results suggest that tolerance of pain correlates with emotional aspects, and that we might need to realize the influence of the qualitative factors when we measure persistent strong pain.

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[Purpose] In this study, we investigated adherence to goals of daily living and habitual exercise for healthy and active life of day-service users in the preventive approach under long-term care insurance. [Subjects] The subjects were 9 day-service users (age 83.1 ± 8.2) who were certified as having low-level care needs. [Methods] We set a goal of daily living including a symbol of life and value role, and voluntary exercise for maintaining motor ability and provided a check sheet and encouragement from day-service staff. [Results] The 7 subjects continued their voluntary exercise for one year. The average of practicing voluntary exercise was 79.6 ± 33.3% after six months, and 74.3 ± 31.3% after one year. The subjects continued their goal of daily living. In the questionnaire after one year, many subjects answered they successfully continued their voluntary exercise by their own efforts and all subjects answered they adhered to their voluntary exercise. [Conclusion] The subjects' lives became healthier and more active by adherence to the goal of daily living and the voluntary exercise.

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[Purpose] The purpose of this study was to clarify the effects of muscle strengthening of hip abductor and adductor muscles just after surgery on gait at discharge. [Subjects and Methods] Subjects were twelve patients who had open reduction and internal fixation (ORIF) for unstable unilateral fractures of the pelvis. Six patients started muscle strengthening exercises at two weeks after surgery (regular rehabilitation group, RR), and another six patients started muscle strengthening of hip abductor and adductor muscles at two or three days after surgery (early rehabilitation group, ER). All patients were assessed for free gait without a cane when they were discharged from hospital. Gait analysis was performed using the VICON 370 system with six cameras and four force plates. [Results] Walking speed, step length and cadence showed no significant differences between the two groups. The hip abductor moment of the ER group was significantly higher than that of the RR group. [Conclusion] Our results suggest that early muscle strengthening of hip abductor and adductor muscles might improve hip abductor moment at discharge.

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[Purpose] To clarify the movement of the sternum brought about by rotation of the thoracolumbar spine, we measured its spatial positional changes. [Subjects and Method] The subjects were 12 normally healthy persons. The subjects performed left and right thoracolumbar rotation of 30 degrees in a normal sitting position with the pelvis fixed. Before and after movement, we measured the spatial coordinates of the upper and lower ends of the sternum with a custom built simplified spatial measurement device, and analyzed the movement of the sternum in three dimensions. [Results] Using intra-class correlation coefficients and Cronbach's α, a high correlation was found in the reliability of measurement between two measurements. The spatial position of the sternum in the median position was vertical in the frontal plane and internally inclined in the saggital plane, in agreement with the positions according to anatomy texts. At the time of thoracolumbar spine rotation, the distance moved by the upper and lower ends of the sternum were almost of the same magnitude. Furthermore, when turning to the right, a notable rightward inclination, and when turning to the left a notable leftward inclination of the sternum was seen, confirming that it inclines in the direction of thoracolumbar rotation. [Conclusion] The sternum acts to stabilize the thoracic cavity, but we also found that it has characteristic movement which is different from that of the thoracic cavity.

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[Purpose] The influence on respiratory function of the pressure exerted by a pillow placed behind the back for position change was examined. [Subjects] The subjects were 22 normal healthy males with no history of respiratory or cardiovascular disease. [Method] The tidal volume (TV) and expiratory reserve volume (ERV) were calculated from the respiratory function under two conditions: with the pillow placed at the back in side-lying (P1), and with the pillow placed between the scapular arch and the pelvic girdle in side-lying (P2). At the same time, the distance moved by the diaphragm (DD) was measured by an ultrasound diagnostic imaging device. [Results] In P1, a significantly lower value for TV, a significantly higher value for ERV, and a significantly shorter value of DD were shown. [Conclusion] Ventilation was decreased in P1, and the results suggest that the decrease in diaphragm movement resulted from increased residual air in the lungs putting them in an expanded state.

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[Purpose] The purpose of this study was to investigate whether a chosen movement pattern was organized depending on a goal-oriented task. [Subjects] Eleven healthy adults aged 25 to 35 years (median 28 y) and 10 frail, community-dwelling older persons 67 to 86 years (median 77 y) participated. [Methods] Subjects were videotaped standing up from a supine position repeatedly, for 20 times. The goal-oriented task was several steps toward a goal following rising. Movement patterns of three body regions were used to classify the videotaped performances. The data collection was performed by a VanSant(1988). [Results] There was consistency of the movement pattern and a decrease in movement pattern items in the goal-oriented task of the older group. [Conclusion] It is important to clarify the factors with which the combination of movement patterns was organized.

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[Purpose] The needs for physical therapy at home and community centers are diverse due to variation in social structure. This study researched how clinical training is offered in regional rehabilitation facilities. [Subjects and Methods] A questionnaire survey was conducted among physiotherapists who work in healthcare facilities for the elderly or facilities for home-visit rehabilitation services. A total of 300 therapists at 150 facilities were surveyed. [Results] Many physiotherapists considered it advisable to have clinical training through elective courses at regional rehabilitation facilities for training. [Conclusions] A new framework different from the traditional training approach is needed. To this end, not only the objectives or procedures of clinical training, but also the training course as a whole may need to be overhauled.

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[Purpose] The purpose of this study was to disclose histopathological changes of the intermuscular adipose tissue of the rat thigh during experimental knee joint contracture. [Methods] Wistar male rats (9 weeks old, n=36) were divided randomly into a control group (n=15) and knee joint immobilization group (n=21). In the immobilized group, left hindlimb knee joints were immobilized with plaster casts for 2 weeks. After the experimental period, we observed intermuscular adipose tissue of the thigh under a light microscope. We divided the rats into four groups on the basis of histopathological change. [Results] In the immobilized group, fat cells of the intermuscular adipose tissue showed a tendency toward atrophy and disappearance (71%), in contrast to the control group. [Conclusion] Rat knee, joint immobilization induces intermuscular adipose tissue atrophy. The results indicate the possibility that the intermuscular adipose tissue took part in the joint contracture.

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[Purpose] The purpose of this study was to clarify the relationship between physical function and spinal alignment in the saggital plane of elderly men. [Subjects and Method] Using a spinal mouse, we measured thoracic kyphosis and lumbar lordosis angles as the spinal alignment in the saggital plane of 57 elderly men (average age 74.8 ± 5.8). Using quadriceps femoris strength, grip strength, toe-grip strength, forward reach in the long sitting position, one-leg standing time, maximum walking speed, the Timed Up and Go (TUG) test, 10m obstacle course walking time, and the six-minute walking distance as physical function we sought relationships with spinal alignment in the saggital plane. [Results] We found relationships with the lumbar lordosis angle for all items except grip strength, forward reach in long sitting, and TUG. [Conclusion] The results suggest the possibility that the physical function of elderly males is related to the lumbar lordosis angle.

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[Purpose] Human bipedal locomotion is accompanied not only by motion of the leg but by the motion of the body in which every part is adjusted skillfully. When a physiotherapist evaluates gait, a comprehensive gait analysis including motion of the leg joints, trunk and head is conducted. [Subjects] Twelve healthy adults were the subjects. [Methods] Standing, comfortable gait, step over (10 cm, R. leg only), and step over (30 cm, R. leg only) were recorded. Three local coordinates were measured and three angles, head segment angle, thoracic segment angle and pelvic segment angle were calculated. [Results] A significant difference was found between level walking and 30 cm step over in the tilt of the pelvis. [Conclusion] The results suggest that step over depends on the tilting of the pelvis and the bending of the thorax and that alternate movement of the pelvis and the thorax is a key point.

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[Purpose] The effect of temporomandibular disorder (TMD) symptoms on mouth opening in two head positions was examined. [Subjects] The subjects were 22 adults who were not receiving dental treatment. [Method] In upright sitting (UP) and in forward head posture (FHP), in maximal mouth opening, range of mouth opening and left and right mandibular head movement distance were compared between TMD and no TMD subjects. [Results] For the two groups of subjects, there were no significant differences in range of mouth opening, and left and right mandibular head movement distance between head positions. For the no TMD group, in the UP position, significant positive correlations were seen between left and right mandibular head movement distance, and between range of mouth opening and both left and right mandibular head movement distance; and in the FHP position, significant positive correlations were found between left and right mandibular head movement distance, and between range of mouth opening and left mandibular head movement distance. For the TMD group the same relationships were found only in the UP position; no significant relationships were found in the FHP position. [Conclusion] The results suggest the possibility that coordinated movements of the jaw are easily disturbed by head position in subjects having TMD symptoms.

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[Purpose] In a preparatory study investigating the utility of mechanomyograms for muscle activity evaluation, we examined and compared the relationship between voluntary contraction of the deltoid muscle and muscle activity with electromyograms (EMGs) and mechanomyograms (MMGs). [Subjects] The subjects were 8 normally healthy persons (average age 21.4 ± 0.5 years). [Method] Maximal voluntary isometric contraction (MVC) with the right shoulder joint at 90 degrees abduction was calculated, and the integrated EMG (IEMG) and integrated MMG (IMMG) at 10%, 20% and 30% of MVC was determined, and compared with each MVC value. [Results] Significant increases (p<0.01) between each MVC load value were found for both IEMG and IMMG. In addition, IMMG showed an almost equal increase for each load step, whereas equal increases in relation to load were not seen for IEMG. [Conclusion] MMG reflected increases in muscle force better than EMG, suggesting the possibility of its usefulness as a parameter of muscle activity.

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[Purpose] We investigated the efficacy of constraint-induced (CI) movement therapy for stroke patients living at home and attending a day-care center. [Subjects] The subjects were 6 post-stroke patients fulfilling a suitable standard who received rehabilitation for upper extremity hemiparesis at our hospital's day-care center. [Method] With the upper limb of the non-paralyzed side constrained, the arm of the paralyzed side received intensive achievement task intervention 5 h per day for 2 weeks (10 weekdays in total). The assessment items, the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL) and the Fugl-Meyer assessment scale (FM), were performed pre- and post-CI therapy, and at 3 and 6 months after CI therapy. [Results] Significant improvements in WFMT time and MAL were found post-intervention. Also, the efficacy of the intervention was maintained at 3 and 6 months post-intervention in all of the cases we could evaluate. [Conclusion] The results suggest, that CI therapy performable in general procedures of out-patient rehabilitation improved upper limb function and raised limb functionality.

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[Purpose] I introduce efforts for the improvement and development of teaching with instructional design (ID) in this paper. [Practice] I participated in a practical ID seminar given by the National Institute of Multimedia Education (NIME) from April 21st to July 22nd, 2008 (93 days), and practiced e-learning in an internal disability class in the second semester of the year at our college. I could select educational necessary taxonomic items because I shaped educational ideal and human resource cultivation vision and understand what to learn in the class. I could give a class with composure because I had made clear the goal and process prior to the class starting and planned the class program. [Conclusion] At present, a decline in the quality of teaching is feared because of a shortage of teachers. ID is a significant method for improving the effect of teaching. I think ID should be utilized as a teaching method creating objective results for faculty development.

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[Purpose] At submaximal exercise intensity, many subjects are found who show a respiratory exchange ratio of less than 1.0. We report on our experience of investigating problems with an expiratory gas analysis apparatus (A) and encouraging the medical equipment makers to improve their product. [Subjects] The subjects were 20 normal healthy adults with an average age of 22.3 years. [Method] We examined problems with A from the measurements of expired gas volume and minute ventilation. First we performed an examination of each of the expiratory gas volumes using the Douglas bag method with respect to the measurement values at maximal exercise in an incremental load test by A and another company's apparatus, B. Then we performed a comparison of the pattern changes of each expiratory gas volume from both sets of apparatus. Expiratory gas volumes at maximal exercise were investigated with Pearson's correlation coefficient, and pattern changes were analyzed by two-way layout analysis of variance. After raising the problem points with the manufacturer, in order to perform a more detailed investigation we investigated the existence of systemic errors in both apparatus with Bland-Altman analysis. [Results] In the Douglas bag method, we found high correlations for both apparatus ranging from r=0.89 to r=0.99 for minute ventilation (VE), oxygen uptake (VO₂), and carbon dioxide output (VCO₂); an interaction was found only with the respiratory exchange ratio for the pattern changes between both apparatus. [Conclusion] There were no problems with the VE meter and gas concentration meter of apparatus A, but we conjectured there was a problem with the part sending gas to the CO₂ meter. We renewed our understanding of the importance of measurement values and an indication of where the problem part is when requesting improvements from a medical equipment maker.

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