[Purpose] We analyzed the gradient of the time vs. tension curve during muscle exertion and investigated a measurement method of the characteristics of muscle exertion in order to evaluate muscle strength. [Subjects] The subjects were 47 healthy men and women. [Method] Knee extension strength at maximum effort was measured for 5 s, and we determined the maximum muscle strength (MS), the MS exertion time (MSt), the ratio of MS/MSt, the increase in muscle strength/100 ms (MI₁₀₀) and its maximum value (MI_max) from the tension at 10 ms intervals from the start of measurement. We also determined the correlation coefficients among these parameters, and their relationship to MS. [Results] Differences among individuals in MSt were large, but MI_max had the highest correlations with MS and MS/MSt. [Conclusion] MSt had big differences among the subjects and was not constant, but MI_max was highly correlated with MS and MS/MSt, suggesting its possible use as an index for expressing the characteristics of muscle power output.

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[Purpose] The aim of this study was to clarify the influence on stepping over of different visual information. [Subjects] The subjects were 41 healthy students. [Method] Subjects walked and stepped over an obstacle while 1) looking straight ahead, and 2) looking at the obstacle. We measured subjects' toe and heel clearances from the upper edge of the obstacle and the vertical reaction force after stepping over. [Results] Both toe and heel clearance were significantly smaller when looking at the obstacle than when looking straight ahead. No significant difference was found in the vertical reaction force between the two conditions. [Conclusion] The results suggest that when walking on the street, those who give attention to obstacles reduce their risk of losing balance and have a high energy efficiency.

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[Purpose] The purpose of this study was to predict the factors related to falls among nursing home residents. [Subjects] The subjects were 34 elderly residents of a geriatric health services facility. [Methods] A four-month prospective study was done. Items for measurement were selected based on the Modified Stroop Test (MST), the Trail Making Test, the Revised Edition of the Simplified Hasegawa Intelligence Scale, and the Fall-related Behavior Check List. Other surveys included levels of care required and fall experience in the six months prior to the tests. [Results] Significant differences were observed between the fall group and the no-fall group in MST scores, the number of risk behaviors as determined by the Fall-related Behavior Check List and fall experience in the previous six months. [Conclusion] The results suggest that MST scores, the number of risk behaviors and fall experience in the last six months are useful measurements for predicting falls.

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[Purpose] In this study, we performed a behavior analysis intervention with the aim of reducing the frequency of rest room falls of a resident of a long-term care facility for the elderly and investigated the result. [Subjects] The subject was a 69-year-old resident of a long-term care facility for the elderly. He had a history of multiple stroke events, lumbar hernia and dementia. [Method] Baseline was the period before falls increased, Increase was the period when falls increased, Intervention was the period when the intervention was performed and the number of inappropriate behaviors was recorded, and Follow-up was the period after the intervention. As a countermeasure to the situation in the Increase period, we implemented an intervention providing an environment to assist with and strengthen appropriate behaviors. To examine the result of the intervention the number of falls in each period were examined using the independent chi-square test. [Results] The fall frequency calculated as the number of falls per month was 1.3 in the Baseline, 7.5 in the Increase, 0.7 in the Intervention, and 1.1 in the Follow-up periods. Falls significantly decreased in the Intervention period when compared with the Increase period, and falls showed no significant difference from Baseline in the Intervention and Follow-up periods. [Conclusion] We consider the behavior analysis intervention was effective at achieving the goal of reducing the frequency of rest room falls for this case.

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[Purpose] The purpose of this study was to evaluate the state of skeletal muscle after ischemic re-perfusion for different lengths of time. [Subjects] Forty-one eight-week-old female Wistar rats were divided into seven experimental groups. [Methods] Ischemia to the right lower limb was done at a pressure of 300 mmHg for 90 minutes. The re-perfusion was evaluated after one hour and after one to five days. The soleus muscle relative weight ratios and the soleus muscle fiber cross-section minor axis were used to evaluate the muscle atrophy. [Results] The soleus muscle relative weight ratios significantly decreased in the "96-hour group". The soleus muscle fiber cross-section minor axis significantly decreased in the "72-hour group". [Conclusion] Ischemic re-perfusion results in edema and muscle atrophy in the rat soleus muscle.

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[Purpose] We investigated the minimum number of measurements needed for reproducibility of the simple reaction time, the vocal response to an auditory signal, in sitting, standing and supine. [Subjects] The subjects were 34~36 physical therapy students, and 24~27 healthy elderly persons who participated in government sponsored physical strength measurement and exercise guidance for falls prevention, who had no history of orthopedic or central nervous system disorders. [Method] The simple reaction time was measured 10 times in sitting, standing and supine. We investigated the reproducibility as well as the number of consecutive measurement times needed for there to be no difference from the average of 10 measurements using the intra-class correlation coefficient (ICC (1,1)) and the paired t test. [Results] For young people, the minimum number of repeated measurements delivering a value which was not significantly different from the average of 10 measurements and having an ICC(1,1) ≥0.9 was 2~3 in sitting, 1~2 in standing, and 3~4 in supine. Similarly for the elderly subjects, the number of times was 3~4 in sitting, 3~4 in standing, and 2~3 in supine. [Conclusion] The results suggest that measurements need to be made 3 times with young subjects and 4 times with old subjects if the measurement times are unified for the 3 positions.

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[Purpose] The purpose of this study was to investigate the relationship between the movement of the scapula and trunk during arm anterior elevation. [Subjects] Subjects were 20 healthy men. [Methods] We used a slant to measure the angle of scapula rotation, and we used Scion Image to measure the angle of the trunk at 0, 30, 60, 90, 120, and 150 degrees of arm anterior elevation. We investigate the relationship between the movement of the scapula and trunk by regression analysis. [Results] There is significant relationship between scapula rotation and the trunk. This relationship is best fitted with a third order polynomial equation. [Conclusion] We found a correlation between the movement of the scapula and trunk. We consider that when scapula rotation reaches 6.9 degrees the movement of the trunk switches from flexion to extension.

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[Purpose] To study the benefits of passive exercise machine-based training (passive training) on frail elderly persons receiving care insurance benefits. [Subjects] The subjects were frail elderly day-care users who were 67 years of age or older (Exercise group 18, Control group 14). [Methods] Twelve weeks of passive training, twice a week, 40 min per day was conducted at a day care facility. Arm curl(AC), chair stand (CS), up and go (UG), sit and reach (SR), back scratch (BS), functional reach (FR), 12 min walk were measured for (12MD) all participants before and after the training. [Results] Significant interaction was noted in AC, CS, UG, SR, BS, and 12MD performance between the training and control groups. A significant improvement was noted in these variables in the exercise group compared to the control group. [Conclusion] Passive exercise was found to be beneficial for day-care user subjects.

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[Purpose] This study examined the relations between balance ability and physical function and ability, and differences in balance ability across the GOLD stages of patients with COPD. [Subjects]The subjects were 31 in-patients with stable COPD (age: 75.7 ± 6.8 years old). [Methods] We measured balance ability, physical function and ability. The relationships between balance ability and physical function and ability were analyzed with Pearson's product moment correlation coefficient. Differences among the GOLD stages were analyzed by ANOVA, and the post-hoc test was the Tukey method. [Results] There were significant correlations between TUG and physical function and ability, and between total trajectory, periphery area and physical ability. In addition, there were significant difference between GOLD stage I+II and GOLD stage IV for total trajectory, periphery area, single-leg standing time and TUG. [Conclusion] We showed that GOLD stage IV has a high probability of low balance ability, increasing the risk of falls.

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[Purpose] This study investigated the improvement of functional activity after primary total knee arthroplasty (TKA) to determine whether or not functional activity definitely improves with time. [Methods] The participants were 40 people suffering from knee osteoarthritics, who underwent primary TKA. The functional activity was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale (17 items, Japanese version) preoperatively, at the time of discharge and after discharge. [Results] In all items, there was a significant improvement after discharge compared to preoperatively, and at the time of discharge compared to preoperatively. The following three items were significantly improved and one item was significantly worse after discharge compared to discharge time. [Conclusions] The functional activities that significantly improved after discharge compared to discharge time were activities that were not often performed during hospitalization. They were improved by performing them after discharge in real life scenarios and progress was shown with time.

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[Purpose] The purpose of this case series was to illustrate promising outcomes of an exercise therapy using an active therapeutic movement (ATM) device for patients with mechanical low back pain. [Subjects] A total of 14 patients (mean age, 45.4 years) with mechanical low back pain agreed to participate in this study. [Methods] Intervention involved therapeutic exercises using the ATM device twice a week for 4 weeks, followed by a 4-week follow-up period. A questionnaire on pain during trunk flexion or extension (visual analogue scale: VAS) and the Roland-Morris disability questionnaire (RDQ) were collected at baseline, and after the intervention and follow-up periods. [Results] Mean VAS at baseline was 55.4 mm (SD 13.7). Statistically significant improvements in VAS pain were seen at 4 weeks and 8 weeks (p<0.01). Mean RDQ at baseline was 7.4 (SD 4.9). Statistically significant improvements in RDQ were exhibited at 4 weeks, and 8 weeks. [Conclusion] The therapeutic exercise using the ATM device was effective in the short term on pain and improved RDQ results in patients with mechanical low back pain.

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[Purpose] The aim of this study was to investigate the effect of different objects held in front of the chest and belts worn on the wrist joints during level walking on energy expenditure. [Subjects and Method] Fifteen healthy subjects (8 men and 7 women aged 24 years old) volunteered to walk on a treadmill. The subjects performed walking on a treadmill under three conditions: 1 kg belts worn on both wrist joints (wrist), holding two 500cc cups almost filled with water and a 500 g belt in a can held in front of the chest (cup), and holding the two 1 kg belts in the can held in front of the chest (belt). The tasks were performed in a random order at two different speeds (1.5 and 3.5 km/h). The work test began with a 3 min rest period and was followed by a 24 min exercise period, 4 min for each condition, and the walking speed of the treadmill was raised from 1.5 to 3.5 km/h after 12 min. Oxygen consumption, heart rate and cadence were measured. [Results] At the slow and fast walking speeds, significant differences existed in oxygen consumption and heart rate among the three gait conditions. At the slow walking speed, however, a significantly higher cadence in cup than in belt was found. On the other hand, a significant difference existed in cadence among the three gait conditions at the fast walking speed. [Conclusion] We conclude that the greater metabolic cost at the fast walking speed is caused by muscle mass activities controling the physical jolts by increasing cadence to maintain the water in the cup.

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[Purpose] We examined the influence of age and sex on the simple reaction time, the vocal response to an auditory signal, in sitting, standing and supine. [Subjects] The subjects were 34 young persons and 65 elderly persons. [Method] Measurements of the response timer were performed in sitting, standing and supine. The measurement times were 3 for the young subjects, and 4 for the elderly subjects. Then we performed a comparative study of the subjects in each position by age and gender. [Results] Among the 3 positions, significant differences in the reaction times were not found among young and elderly males and young females. Among elderly females, the response time was significantly prolonged in supine compared to sitting and standing. In the comparisons of each gender, the reaction times of elderly males were significantly prolonged compared to that of young males in supine. In the comparisons of each age group, young females had significantly prolonged reaction times compared to young males in all of the three positions. [Conclusion] The reaction times of the elderly females were prolonged in supine, compared to sitting and standing, suggesting the involvement of arousal. We consider further investigations involving activity status are required.

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[Purpose] The aim of this study was to clarify the activity of the lower limb area of the sensory motor cortex during bicycle ergometer exercise at light loads using functional near infra-red spectrometry (fNIRS) and its relationship with exercise load as well as the temporal changes in cortex activity. [Subjects and Method] The subjects were 9 healthy adults. There were 4 exercise tasks of constant work and pedaling rates, and 2 tasks of changing the pedaling rate (but not work rate) during exercise. Each of the tasks were performed in 3 contiguous sets, and we examined and compared the changes in oxygenated hemoglobin (oxyHb) at 5-second intervals from the start of exercise. [Results] In the 4 tasks of constant work and pedaling rates, the change in oxyHb over 5~10 seconds from the start of exercise was significantly higher than over 0~5, 10~15 and 15~20 seconds, and the transient increase in oxyHb decreased despite the continuation of exercise. In the 2 tasks in which the pedaling rate was changed, we found that oxyHb gradually decreased after the initial increase at the start of exercise, but increased again with increase of the pedaling rate. [Conclusion] We revealed the activity of the lower limb area of the primary motor cortex during bicycle ergometer exercise. We also demonstrated that the effect of changing the pedaling rate during exercise is to increase the blood flow in the lower limb area of the primary motor cortex.

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[Purpose] We analyzed the relationships among the Borg scale, double product (DP), heart rate (HR) and systolic blood pressure (SBP) at 60%, 70% and 80% maximum heart rate (HRmax) induced by repeated standing exercise. [Subjects] The subjects were 18 healthy adults (average age of 27.0 years, 10 men and 8 women). [Method] After 5 min rest in the sitting position, subjects performed repeated standing exercise to achieve heart rates of 60%, 70% and 80% HRmax. HR, DP and SBP were measured. [Results] A significant relationship was found between the Borg scale and DP at all of the heart rates, but no significant relationship was found between HR and the Borg scale. [Conclusion] We discovered that in repeated standing exercise, the Borg scale and HR are not necessarily in agreement. The results suggest that, when conducting repeated standing exercise, rather than undertaking risk management using the relationship between the Borg scale and HR alone, it is necessary to follow the changes in DP for the risk management of exercise therapy.

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[Purpose] The purpose of this study was to identify the determinants of fluidity in the sit-to-walk task (STW). [Subjects] Fifteen healthy adults participated. [Methods] The normal conditions of the STW involved a self-selected speed, normal seat height (100% of knee height), and normal target location (in front of the chair). Changes in the conditions included maximum speed, different seat heights (low chair/high chair), and different target locations (right oblique/left oblique). For each condition, fluidity was assessed using the Fluidity Index (FI). The FI was calculated from the motion of the center of gravity provided by a 3-D motion capture system. [Results] The FI at maximum speed or with a high chair was significantly higher than that under normal conditions. However, there were no significant differences in the FIs between the low chair or oblique target locations and normal conditions. [Conclusion] These findings indicate that task conditions influence the fluidity in the STW performed by healthy adults. This suggests that task conditions should be considered at the time of assessment or for practicing strategy during the STW.

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[Purpose] The aim of this study was to undertake an overall assessment of physical function, lower limb strength, walking ability, average function, etc., and investigate the relationships with grip strength in elderly community-dwelling women. [Subjects] The subjects were 265 elderly women living in F town of F prefecture who had an average age of 73.7 ± 6.4 years. [Method] We examined the relationships between grip strength and individual items of physical function such as femoris quadriceps strength, toe-grip strength, one-leg standing time, long-sitting forward reach, maximum walking speed, six-minute walking test (6MWT), 10 m obstacle course time, timed up-and-go test (TUG), and upper body raise. [Results] The items showing a significant correlation with grip strength were toe-grip and femoris quadriceps strength, one-leg standing time, maximum walking speed, TUG, 10 m obstacle course time and 6WMT, but no significant relationship was found with long-sitting forward reach. [Conclusion] The results suggest grip strength reflects the gross physical strength, inclusive of lower limb strength, standing balance and walking ability, of elderly community-dwelling women, and is an easy and useful test method.

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[Purpose] The purpose of this study was to determine the effects of ischemia and immobility on muscle atrophy in rats. [Subjects] Twenty-one eight-week-old Wistar female rats were randomly divided into three experimental groups: "immobile", "ischemic and immobile", and "ischemic". The left hind limb of the "immobile" group was used as the "control" group. [Methods] Ischemia and/or immobility were applied to the right hind limbs of the experimental groups. The relative weight ratios of the soleus muscles and the soleus muscle fiber cross-section minor axes were used for the evaluation of muscle atrophy. [Results] The soleus muscle relative weight ratios were highest in the "normal" group and decreased in order in the following groups "ischemia", "ischemia and immobile", "immobile". The soleus muscle fiber cross-section minor axes were highest in the "normal" group and decreased in order in the following groups "ischemia", "immobile", "ischemia and immobile". [Conclusion] Our results suggest that muscle atrophy caused by immobility and that caused by ischemia are independent entities.

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[Purpose] To compare spinal curvature and trunk muscle activity during slump sitting and upright sitting between a kneeling chair and a conventional chair. [Subjects] The subjects were 10 healthy adult women (25.7 ± 4.9 years). [Methods] Trunk muscle activity and spinal curvature were measured with the subjects maintaining slump sitting and upright sitting postures on the conventional and kneeling chairs. [Results] Subjects had a significantly more lordotic spinal curvature when maintaining a slump sitting posture on a kneeling chair than on a conventional chair. In addition, they had significantly lower trunk muscle activity when maintaining a upright sitting posture on a kneeling chair than on a conventional chair. [Conclusion] These results suggest that, compared to a conventional chair, the use of a kneeling chair enables a more efficient upright sitting posture with lower trunk muscle activity, as well as a more efficient slump sitting posture with a smaller reduction in lordosis of the lumbar spine.

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[Purpose] The changes of knee angle during gait are known as double knee action, however, there are instances when the measurement method does not show this `normal' pattern. Accordingly, we devised a method for attaching a goniometer, measured the changes in knee angle during gait, and investigated and categorized similar pattern types. [Subjects] The subjects were 63 healthy men and women. [Method] An electronic goniometer was attached with tape to the outside of the lower limb and the changes in knee angle were measured in barefoot walking. The gait was categorized according to the patterns of knee angle change in the stance phase. [Results] Gait could be categorized into the basic types of normal, small extension in the late stance phase, small extension on heel contact, small flexion in the mid-stance phase, and flexion occurring twice in the mid-stance phase, and various compound types of them. [Conclusion] We confirmed that in barefoot walking, there are patterns of knee angle change which are not of the `normal' type and categorized them.

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[Purpose] We investigated the effects of training the upper extremity using the haptic device (HD) on healthy elderly persons to establish the quantitative assessment of level of disorder (motor, sensory, and cognition) and also motor and sensory therapy for the upper extremity in stroke patients. [Subjects] Seven healthy elderly persons participated after giving their informed consent. [Methods] The subjects performed the Point task and the Wave task with the right arm in five kinesthetic modes. [Results] Performance time (time) and error quantity of the haptic grip position in the root-mean-square (R.M.S.) and Time* R.M.S. (TR) at the start of training and at the end of training were compared. Differences were found between the Point task and the Wave task. Differences were noticed at the end of training in both tasks and they were, dependent on the presence or absence of kinesthetic or type of kinesthetic mode. [Conclusion] The results suggest how to set a training target and to select a task for a training target, and how to set systematic training by selection of a kinesthetic mode, as well as the selection of an index for the effectiveness of training for more appropriate application.

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[Purpose] The object of this study was to investigate the influence of 12-h daily joint immobilization on the development of joint contracture in rats. [Subjects and Method] Fourteen, 8-week-old Wistar rats were divided into two groups of seven animals. For one group, the left hindlimbs were left alone (Control) while the right hindlimbs were fixed in maximum plantar flexion throughout the experimental period of 7 days. The remaining seven animals had their right hindlimbs fixed for 12 h/day during the experimental period. [Results] Joint fixation for 12 h/day initiated the development of joint contracture. [Conclusion] There is a need to study whether or not joint fixation of less than 12 h/day leads to the development of joint contracture.

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[Purpose] This study investigated whether a short-period high intensity exercise induced oxidative stress in lungs. [Subjects] Subjects were 11 healthy young males. [Methods] Before and after the short-period high intensity exercise Wingate test performed on a cycle ergometer, exhaled breath condensate (EBC) was collected for 15 minutes. We measured hydrogen peroxide (H₂O₂) concentration and biological antioxidant potential (BAP) in EBC before and after the exercise. [Result] The H₂O₂ concentration and BAP in EBC did not show any significant changes after the exercise. [Conclusion] The short-period high intensity exercise has little impact on the H₂O₂ content in EBC of healthy young subjects.

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[Purpose] This study aimed to evaluate patients' recovery process of physical function and Health-Related Quality of Life (HRQOL) after Total Knee Arthroplasty (TKA). [Subjects] The subjects were 40 knee osteoarthritis patients in TKA rehabilitation. [Methods] The Timed-Up-and-Go test (TUG), the knee extensor strength, and one-leg standing (OLS) time with open eyes were measured. The Modified-WOMAC and the SF-36 were used for evaluation of HRQOL. [Results] All the scores, including the Modified-WOMAC pain score and the SF-36 scores of physical functioning, bodily pain, general health perceptions and social functioning at one month post-TKA and the Modified-WOMAC knee function score at three months post-TKA, were significantly improved. All the scores regarding physical function and HRQOL were significantly negatively correlated in terms of changes and initial values, except the OLS time with open eyes. [Conclusion] These results suggest that HRQOL improves within one month following TKA, and that physical function improves within three months after TKA.

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[Purpose] In 2006, the upper limit of exercise time was increased from 6 to 9 units in our convalescent rehabilitation ward. We investigated the effect of this increase in training amount in relation to ADL. [Subjects] Subjects were discharged stroke patients of a convalescent rehabilitation ward: 122 who performed 5~6 exercise units in 2005, and 41 who performed 7~9 exercise units from April to September in 2008. [Method] We compared the total scores of the FIM motor items (FIM-M), the increase in FIM-M (∂FIM-M: discharge score - admission score), FIM efficiency (∂FIM-M/length of stay), and the discharge-to-home rate (Home%) between the two groups. [Results] The group who performed 7~9 exercise units had significantly higher ∂FIM-M, FIM efficiency and Home% than the group who performed 5~6 units. [Conclusion] We consider that the training increase effectively improved ADL.

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[Purpose] We provided behavior analysis based transfer assistance training, analyzed the result and investigated the issues and outcomes of the training. [Subject and Method] The subject was an experience staff nurse who was possibly giving over-assistance in the care of institutionalized disabled elderly. First we provided didactic instruction on techniques in applied behavior analysis, then we provided modeling and feedback for the techniques described in the didactic training for 4 months. We analyzed the effect of the training using a single case design. [Results] The results revealed that "appropriate assistance" had increased at the end of the practical training. Moreover, the over-assistance given to those being cared for at baseline, had improved to close to the minimum necessary assistance at the end of training and this continued in the follow-up period. [Conclusion] We consider the training was successful, however issues remain concerning the subject's comprehension of the training, and the length of the training effect.

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[Purpose] We investigated the relation between activities of daily living (ADL) of patients with femoral neck non-union and the state of femoral neck fractures. [Methods] Four patients with femoral neck fracture (Garden Type IV) were subjected to physical therapy, the progress of their ADL and the state of the bone fracture by X-ray were assessed. [Results] Although all hip fractures became a false joint, all patients gained standing ability due to decreasing pain of fracture by two months. X-rays showed narrowing and calcification of the space in the femoral pseudo joint. This radiological feature is associated with the degree of pain. [Conclusion] Early physical therapy for femoral neck fracture patients was effective at securing good ADL even for non-union hip fracture patients as it prevented muscle atrophy and pain due to stabilization of the pseudoarthrosis.

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In muscle contraction, ATP reflects the dynamics of blood flow and promotes the resynthesis of muscle fatigue. In order to improve the efficiency of skeletal muscle metabolism, understanding of its work style, strength and frequency needs to be considered. However, in previous research, although various factors improved blood flow dynamics no consensus has been reached regarding the frequency and the strength of contraction. Therefore, in this paper, the phosphorylation efficiency in the triceps surae muscle was examined from the viewpoint of the muscle blood flow and muscle fatigue. Furthermore, we considered its effectiveness and the utility of exercise prescription of muscle contraction in physical therapy.

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Exercise intensity of 50%VO₂max for more than thirty minutes per day is recommended for arterial wall distensibility by the Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases (2007). However, there are a lot of patients who cannot exercise at 50%VO₂max, and it is a high risk for cardio-pulmonary function. In order to establish a more optimal exercise intensity, which is safe for individuals, we need to investigate the effect of arterial wall distensibility at low intensity, to clarify the range of exercise intensity which improves arterial wall distensibility. Therefore in this review, we focus on and summarize muscle pumping of calf muscles that include the soleus, known as "The Second Heart", which can increase stroke volume and is a factor in improvement of arterial wall distensibility through increased venous return.

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The response of non-working muscle blood flow to exercise is highly complex. Despite early reports that "global" nonworking muscle blood flow decreases during exercise, more recent studies have provided evidence to suggest that exercise causes increases in non-working muscle blood flow. In addition, recent studies have suggested that central neural mechanisms include feedforward control of signals descending from higher brain centers (central command) contributing to the regulation of non-working muscle blood flow during exercise. This review focuses on the integrating mechanisms underlying the regulation of non-working muscle blood flow during exercise, in relation to central command.

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