Authorship：Lead author,　Corresponding author   International / domestic magazine：Domestic journal  

DOI： 10.1007/s10157-019-01819-1

PubMed

Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: No longitudinal study has investigated the impact of combination of kidney function (KF) and physical function (PF) on cognitive decline in these patients. METHODS: We conducted a 2-year prospective cohort study enrolling 131 patients ≥ 65 years with pre-dialysis chronic kidney disease (CKD). We assessed cognitive function with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). We calculated %MoCA-J based on the rate of change between baseline and follow-up MoCA-J scores, and defined cognitive decline over 2 years as a %MoCA-J of less than the first quartile value. We defined eGFR ≥ 30 as mild-to-moderate and eGFR < 30 mL/min per 1.73 m2 as severe. In addition, low PF was defined as low handgrip strength (< 26 for men and < 18 kgf for women) and/or low gait speed (< 0.8 m/s). Patients were classified into four groups: group 1, patients with mild-to-moderate impairment in KF and high PF; group 2, with mild-to-moderate impairment in KF and low PF; group 3, with severe impairment in KF and high PF; and group 4, with severe impairment in KF and low PF. RESULTS: Eighty-four patients completed follow-up assessment. Multivariate logistic regression analysis showed that the combination of severe impairment in KF and low PF was significantly associated with cognitive decline (odds ratio 5.73). However, no significant cognitive decline was observed in patients with either severe impairment in KF or low PF alone. CONCLUSIONS: We may need to focus on maintaining PF in older patients with advanced CKD may help to prevent cognitive decline.

DOI： 10.1007/s10157-019-01698-6

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

AIM: Chronic kidney disease (CKD) is a risk factor for declining cognitive and physical function. However, the prevalence of mild cognitive impairment (MCI) and its relationship with physical function is not clear. Therefore, our aim was to evaluate the prevalence of MCI and the relationship between MCI and physical function among older adults with pre-dialysis CKD. METHODS: We conducted a cross-sectional study of 120 patients, aged ≥65 years (mean age, 77.3 years), with pre-dialysis CKD but without probable dementia (Mini Mental State Examination <24). MCI was evaluated using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). For analysis, patients were classified into two cognitive function groups: normal (MoCA-J ≥ 26) and MCI (MoCA-J < 26). Physical, clinical, and biochemical parameters were compared between the groups. Logistic and linear regression analyses were used to evaluate the specific association between cognitive and physical function. RESULTS: Seventy-five (62.5%) patients belonged to the MCI group. Significant differences between the two groups were identified for gait speed, balance, age, and haemoglobin concentration. After adjustment for covariates, only gait speed was significantly associated with MCI (odds ratio, 0.06; 95% confidence interval, 0.009-0,411). CONCLUSION: The prevalence of MCI among older adults with pre-dialysis CKD was as high as 62.5%. The association between MCI and reduced gait speed supports the possible interaction between physical and cognitive functions and the need for early screening.

DOI： 10.1111/nep.13173

PubMed

Authorship：Lead author  

Repository URL： http://hdl.handle.net/10466/00017831

Publishing type：Research paper (scientific journal)  

Background::

Exercise therapy is the key to preventing admission of patients with type2 diabetes mellitus (T2DM). However, a few studies have examined the effects of exercisetherapy on patients with T2DM undergoing inpatient diabetes self-management education andsupport (IDSMES).

Objective::

This study investigated whether exercise therapy influenced the incidence of admissionafter discharge in patients with T2DM undergoing IDSMES.

Methods::

This retrospective cohort study included patients with T2DM who underwentIDSMES between June 2011 and May 2015. Overall, 258 patients were included in this study.The exercise therapy program was implemented in June 2013. Accordingly, patients diagnosedbetween June 2011 and May 2013 were categorized as the non-exercise therapy program group,while those diagnosed between June 2013 and May 2015 were categorized as the exercise therapyprogram group. Outcomes were incident diabetes-related and all-cause admissions within 1year of discharge. Multiple logistic regression models were used to estimate the odds ratios(ORs) and 95% confidence intervals (CIs) of the exercise therapy program’s impact on the outcomes.

Results::

Within 1 year of discharge, 27 (10.5%) patients underwent diabetes-related admissionsand 62 (24.0%) underwent all-cause admissions. Multiple logistic regression analyses showed asignificant association of the exercise therapy program with incident diabetes-related and allcauseadmissions [OR: 0.22 (95% CI: 0.08–0.59) and 0.44 (95% CI: 0.22–0.86), respectively].

Conclusion::

Exercise therapy programs significantly lowered the incidences of diabetes-relatedand all-cause admissions. This indicates that implementing exercise therapy during hospitalizationmay be important for preventing admissions of patients with T2DM receiving IDSMES.

DOI： 10.2174/0115733998269490231106190128

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.hrtlng.2023.05.015

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: This study aimed to investigate the relationship between physical activity (PA) levels and short-term changes in skeletal muscle characteristics in patients with subacute hemiparetic stroke. MATERIALS AND METHODS: This prospective observational study included 76 patients with stroke who received inpatient care in a convalescent rehabilitation ward. The PA level was measured as the duration of daily total PA (≥ 1.5 metabolic equivalents) using a triaxial accelerometer for 7 days after admission. The outcomes were changes in the quadriceps muscle quality and quantity on the affected and unaffected sides, as assessed by ultrasonography at admission and 1 month after admission. RESULTS: Multiple regression analysis indicated that the duration of total PA was significantly associated with a percentage change in quadriceps muscle quality (p = 0.011) and quantity (p = 0.012) on the affected side. However, no significant relationship was observed between the muscle quality and quantity on the unaffected side. CONCLUSIONS: The results revealed that PA was associated with changes in the quadriceps muscle quality and quantity on the affected side in patients with subacute hemiparetic stroke. These findings highlight the importance of promoting PA in stroke rehabilitation to improve muscle properties and functional outcomes.

DOI： 10.1080/09638288.2023.2272715

PubMed

要介護状態になる前の被介護者の家事負担割合を評価し、介護負担感との関連について検討した。日本の20～89歳の配偶者介護者272名を対象に、2021年2月にオンライン調査を実施した。介護者負担感はZarit Burden Interviewを用いて評価し、低介護者負担感は40点以下、中～高介護者負担感は41点以上と定義した。さらに、「要介護状態になる前に、あなたのパートナーは家事にどの程度貢献していましたか」に対する介護者の回答を10段階のリッカート尺度で採点し、1～4点の負担割合が低く、5～10点を負担割合が高いと定義した。その結果、夫が介護者で妻が被介護者の場合の低介護者負担感群は99名、中～高介護者負担感群は33名、妻が介護者で夫が被介護者の場合の低介護者負担感群は92名、中～高介護者負担感群は48名であった。多変量ロジスティック回帰分析の結果、夫が介護者の場合、要介護状態になる前の妻の家事負担割合の高さが介護負担感と有意に関連していた(OR 4.55、95%CI 1.20～17.27)が、妻が介護者の場合はそのような関連は認められなかった(OR 0.85、95%CI 0.37～2.29)。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: A relationship between body mass index and functional recovery in older survivors of stroke is unclear. Therefore, this study aimed to investigate the association of body mass index with post-stroke functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation. METHODS: This was a multicenter retrospective observational study of 757 older survivors of stroke, from six convalescent rehabilitation hospitals in Japan. The participants were classified into seven categories according to body mass index at admission. The measurements included outcomes of the absolute gain in the motor subscale of the Functional Independence Measure. Poor functional recovery was defined as gain < 17 points. Multivariate logistic regression analysis was performed to examine the impact of these body mass index categories on poor functional recovery. RESULTS: The mean motor gains were highest in the 23.5-25.4 kg/m2 group (28.1 points), and lowest in the < 17.5 kg/m2 group (220.0 points). The results of the multivariate regression analyses (reference; 23.5-25.4 kg/m2 group) showed that the < 17.5 kg/m2 group (odds ratios 4.30; 95 % confidence intervals 2.09-8.87), the 17.5-19.4 kg/m2 group (1.99; 1.03-3.87), the 19.5-21.4 kg/m2 group (1.93; 1.05-3.54), and the ≥ 27.5 kg/m2 group (3.34; 1.33-8.42) were significantly associated with poor functional recovery, but not in the other groups. CONCLUSIONS: Older survivors of stroke with high-normal weight had the most favorable functional recovery among the seven groups. Meanwhile, both low and extremely high body mass indexes were associated with poor functional recovery.

DOI： 10.1016/j.clineuro.2023.107881

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Although knee extensor muscle strength is strongly associated with postoperative walking ability (PWA) in patients undergoing total knee arthroplasty (TKA), few studies have considered the impact of both knee extensor and flexor muscle strength. This study aimed to determine whether operative side knee flexor and extensor muscle strength before surgery affects the PWA of patients who undergo TKA while accounting for potential covariates. This multicenter retrospective cohort study involved four university hospitals, and patients who underwent unilateral primary TKA were included. The outcome measure was the 5-m maximum walking speed test (MWS), which was completed 12 weeks postoperatively. Muscle strength was measured as the maximum isometric muscle strength required for knee flexor and extensor. Three multiple regression models with a progressively larger number of variables were developed to determine the predictors of 5-m MWS at 12 weeks post-TKA surgery. One hundred thirty-one patients who underwent TKA were enrolled in the study (men, 23.7%; mean age, 73.4 ± 6.9 years). Age, sex, operative side knee flexor muscle strength before surgery, Japanese Orthopaedic Association knee score, and preoperative walking ability were significantly associated with PWA in the final model of the multiple regression analysis (R2 = 0.35). The current findings suggest that the operative side knee flexor muscle strength before surgery is a robust modifiable predictor of improved PWA. We believe that further validation is needed to determine the causal relationship between preoperative muscle strength and PWA.

DOI： 10.1097/MRR.0000000000000572

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.leukres.2023.107057

PubMed

DOI： 10.19020/cd.0000002398

DOI： 10.23736/S1973-9087.22.07581-5

PubMed

家族介護者を対象にオンライン調査による横断研究を実施し、被介護者の嚥下障害の重症度が家族介護者の介護負担に及ぼす影響について検討した。評価項目はZarit介護負担尺度(ZBI;41点以上を重い介護負担と定義)、Functional Oral Intake Scaleによる嚥下障害の重症度(レベル1[経口摂取なし]～レベル7[正常])などとした。介護者を被介護者の経口摂取状況により、経管栄養群(レベル1～3)420名、食事形態改良群(レベル4～6)233名、通常群(レベル7)47名に分けて検討した。ZBIは食事形態改良品群で有意に高く、介護負担の重い介護者の割合は、通常群25.2%、食事形態改良品群39.5%、経管栄養群23.4%であった。交絡因子調整後の多変量解析の結果、食事形態改良品群と介護負担に有意な関連が認められたが、経管栄養と介護負担に関連は認められなかった(正常群を基準としてオッズ比はそれぞれ1.55、0.68)。以上から、嚥下障害に関連した介護負担を軽減するためには、嚥下障害の重症度を考慮する必要があることが示唆された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

INTRODUCTION: Dysphagia has received much attention as a factor that affects caregiver burden. However, few studies have examined how its severity can affect caregiver burden. This study aimed to examine the effect of dysphagia severity on caregiver burden. METHODS: A cross-sectional online survey was carried out among family caregivers. We assessed caregiver burden using the Zarit Burden Interview. The dysphagia severity was assessed using the Functional Oral Intake Scale, and the caregivers were divided into three groups based on care receivers' oral intake status (levels 1-3: tube-feeding group; levels 4-6: texture-modified food group; level 7: normal group). To investigate the relationship between caregiver burden and dysphagia severity, univariable and multivariable logistic regression analyses were applied to caregiver burden. RESULTS: The Zarit Burden Interview was significantly higher in the texture-modified food group, and the proportions of high caregiver burden reached 25.2%, 39.5% and 23.4% in the normal group, texture-modified food group and tube-feeding group, respectively. The multivariable analyses applied to caregiver burden (reference, normal group) showed that the texture-modified food group was significantly associated with caregiver burden (OR 1.55, 95% CI 1.04-2.32), whereas the tube-feeding group had no relationship with caregiver burden (OR 0.68, 95% CI 0.31-1.49). CONCLUSIONS: Our study showed that the intake of texture-modified food significantly affected caregiver burden even after adjusting for confounding factors, whereas the use of tube feeding did not increase caregiver burden. These results suggest that it is necessary to consider dysphagia severity to reduce dysphagia-related caregiver burden. Geriatr Gerontol Int 2022; ••: ••-••.

DOI： 10.1111/ggi.14468

PubMed

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ggi.14468

高齢心不全患者の日常生活動作(ADL)低下を予測可能な栄養状態評価ツールを調べた。2019年10月〜2020年10月に当急性期病院へ入院した65歳以上のHF患者91名を前向きに組み入れた。栄養状態の評価尺度には、Controlling Nutritional Status(CONUT)、高齢者栄養リスク指数、栄養学的予後指数、簡易栄養状態評価の4種を使用した。ADLを計測するにはバーセルインデックス(BI)を用いた。入院の約2週間前から退院時にかけてのBIの変化量を算出し、その集団分布で最下位の四分位群に属した26名(男性18名、年齢中央値81.5歳)をBI低下群と定めた。残りのBI維持群65名(男性44名、年齢中央値79歳)と比較した場合、CONUTスコアはBI低下群で有意に上昇していたが、他の3尺度のスコアには両群間で有意差は認められなかった。多変量ロジスティック回帰分析でも、CONUT高スコアは、BI低下リスクの増大と有意に関連していることが示された(調整済オッズ比0.24、95%CI 0.08〜0.75)。高齢心不全患者の入院早期ADL低下を予測するための栄養状態評価ツールとしてはCONUTが適切であることが明らかになった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Falls and fractures are serious geriatric adverse events worldwide, and skeletal muscle is considered to be a key factor in these incidents. The objective of this study was to investigate the combined effect of lower muscle quality and quantity on the incidence of falls and fall-related fractures in a 3-year follow-up period among community-dwelling older adults. METHODS: We recruited community-dwelling adults aged 65 years and older who were living independently in 2018. A total of 773 older participants were analyzed in this study. The outcomes were incident falls and fall-related fractures during the 3-year follow-up period. At baseline, we assessed muscle quality and quantity using ultrasonography, and we categorized the participants into four groups based on their combination of poor/better muscle quality and poor/better muscle quantity. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of the relationships among items in the four groups and the time to incident falls and fall-related fractures. RESULTS: During the 3-year follow-up period, 178 participants (23.0 %) had a fall incident and 51 participants (6.6 %) had fall-related fractures. Older adults with lower muscle quality and quantity had significantly elevated risks of incident falls according to multivariate analyses using older adults with better muscle quality and quantity as the reference (adjusted HR: 1.54 [95 % CI 1.06-2.23]). However, there were no significant differences in fall-related fractures among the four groups. CONCLUSION: We found that lower muscle quality and quantity led to higher incidents of falls; thus, identifying community-dwelling older adults with lower muscle quality and quantity is necessary to provide them fall preventive measures and maybe to reduce fall-related outcomes.

DOI： 10.1016/j.bone.2022.116474

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Objectives: This study examined the social factors affecting the frequency of going out, and social isolation related to the frequency of daily conversation, stratified by gender. Method: The participants comprised 1,016 community-dwelling older Japanese adults, who were categorized into four groups: those who are (1) not isolated socially and go out every day, (2) not isolated socially and do not go out every day, (3) socially isolated and go out every day, and (4) socially isolated and do not go out every day. We performed a logistic regression analysis to assess the relationship between the frequency of daily conversation and the four groups. Results: Our multivariable logistic regression analysis (reference, group 1) showed that the coexistence of poor social factors significantly affected men (group 2: odds ratio [OR] 2.13 [1.10 to 4.12]; group 3: OR 2.92 [1.70 to 5.00]; and group 4: OR 4.28 [2.43 to 7.54]). For women, the frequency of going out was related to daily conversation only with social isolation group (group 2: OR 1.51 [0.77 to 2.98]; group 3: OR 2.42 [1.25 to 4.68]; and group 4: OR 3.81 [2.08 to 7.00]). Conclusion: Our findings suggest that promoting daily conversations of community-dwelling older adults can help prevent related health adversities.

DOI： 10.1007/s12126-022-09494-6

PubMed

Other URL： https://link.springer.com/article/10.1007/s12126-022-09494-6/fulltext.html

Publishing type：Research paper (scientific journal)  

【目的】本研究の目的は2型糖尿病(T2DM)患者の身体活動量(PA)と下肢機能の関連性を明らかにすることである.【方法】研究デザインは横断研究とし,外来T2DM患者149名(65.0±6.2歳,男性59%)を対象とした.PAは加速度計を用いて7日間の測定を行い,8つのPA指標を算出した.下肢機能の指標としては5回立ち上がりテストを用い,下肢機能維持群と非維持群に分類した.統計解析としてロジスティック回帰分析(ステップワイズ法)を用い,下肢機能維持に関連するPA指標を探索的に分析した.【結果】下肢機能維持と有意な関連を認めたPAの項目は歩数/日(OR:1.175,95%信頼区間1.049-1.317単位変化:1000歩)のみであった.その他のPAパラメーターは有意な関連を認めなかった.【結語】外来T2DM患者において下肢機能の維持には歩数が関連していた.(著者抄録)

DOI： 10.11213/tonyobyo.65.81

保存期慢性腎臓病(CKD)患者における腎性貧血と上下肢筋力との関連について検討した。外来通院していたCKD stage G3a〜G5の保存期CKD患者251例(男性69.7%、年齢中央値73.0歳)を対象とし、ヘモグロビン(Hb)値11.0g/dL未満の貧血群と11.0g/dL以上の非貧血群に分類した。男性患者では、握力は非貧血群が34.2±8.4kgf、貧血群が29.6±8.2kgf、等尺性膝伸展筋力は非貧血群が37.8±0.4kgf、貧血群が31.8±8.9kgfといずれも貧血群で有意に低値を示した。女性患者においても両指標において貧血群の方が有意に低値を示した。重回帰分析の結果、握力は性別、年齢、Hb、推算糸球体濾過量が、等尺性膝伸展筋力は性別、年齢、Hbが独立した関連要因であった。保存期CKD患者において、貧血と上下肢筋力には有意な関連があることが示された。CKD患者の高齢化によりQOLや身体機能維持が重要なアウトカムとなっており、適切な貧血管理が求められる。

【目的】本研究の目的は2型糖尿病(T2DM)患者の身体活動量(PA)と下肢機能の関連性を明らかにすることである.【方法】研究デザインは横断研究とし,外来T2DM患者149名(65.0±6.2歳,男性59%)を対象とした.PAは加速度計を用いて7日間の測定を行い,8つのPA指標を算出した.下肢機能の指標としては5回立ち上がりテストを用い,下肢機能維持群と非維持群に分類した.統計解析としてロジスティック回帰分析(ステップワイズ法)を用い,下肢機能維持に関連するPA指標を探索的に分析した.【結果】下肢機能維持と有意な関連を認めたPAの項目は歩数/日(OR:1.175,95%信頼区間1.049-1.317単位変化:1000歩)のみであった.その他のPAパラメーターは有意な関連を認めなかった.【結語】外来T2DM患者において下肢機能の維持には歩数が関連していた.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

The clinical importance of nutritional management in activities of daily living (ADL) among older inpatients with heart failure (HF) is greatly increasing. We determined the optimal nutritional assessment tool that can predict ADL decline among older inpatients with HF. We prospectively investigated 91 inpatients aged ≥ 65 years with HF in an acute hospital. We measured their nutritional status at admission using nutrition indices: the controlling nutritional status (CONUT), the geriatric nutritional risk index, the prognostic nutritional index, and the mini nutritional assessment. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the malnutrition status assessed by each nutritional index category and the ADL decline measured by the Barthel index (BI) in the univariate and multivariate analyses. Among the participants, 28.6% (n = 26; median age 81.5 years; 69.2% men) of the participants were included in the Reduced BI group and 71.4% (n = 65; median age 79.0 years; 67.7% men) in the Maintained BI group. The Reduced BI group showed a significantly higher CONUT value than the Maintained BI group, but there were no significant differences in other nutritional indices. In the multivariate logistic regression analysis, a higher CONUT score was associated with a significantly elevated risk of Reduced BI (adjusted OR 0.24; 95%CI 0.08-0.75; p = 0.014). We found that CONUT is an appropriate nutritional assessment tool for predicting ADL decline among older inpatients with HF in the early phase of hospitalization.

DOI： 10.1007/s00380-022-02033-y

PubMed

65歳以上の自立した地域在住高齢者2920名(女性1596名、年齢中央値74歳)のコホートデータを用いて、基本チェックリスト(KCL)と入院発生率との関連を検討した。2018年に郵送法による自記式質問票調査を実施し、2020年に追跡調査を実施した。評価項目は人口統計学的特徴、ベースライン調査におけるKCL(手段的日常生活動作、運動器機能、栄養状態、口腔機能、閉じこもり、認知機能、抑うつ)、追跡調査における入院および入院理由とした。その結果、フレイル868例(29.7%)、プレフレイル1008例(34.5%)、健常1044例(35.8%)であった。また、2年間に417名(14.3%)が入院を経験していた。多変量解析の結果、健常者と比較して、フレイルでは入院発生率が有意に高かったが(調整OR 1.38)、プレフレイルではそうではなかった(調整OR 1.07)。また、多変量解析の結果、KCLにおいて、身体機能の低下および抑うつ気分が認められた場合、認められない場合と比較して、入院発生率が有意に高かった(調整OR 1.45、OR 1.35)。以上から、フレイル高齢者は入院する可能性が高く、KCLは入院リスクを推定するスクリーニングツールとなる可能性が示唆された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

AIM: To examine the relationship between the Kihon Checklist (KCL) and incidence of hospitalization among community-dwelling older adults. METHOD: We analyzed the cohort data of 2920 community-dwelling adults aged ≥65 years, who were living independently in a city in Shiga prefecture. We investigated the frailty status, instrumental activities of daily living, physical function, nutritional status, oral function, homebound status, cognitive function and mood using the KCL in the baseline survey. The outcome was incident all-cause hospitalization in the 2-year period. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the frailty status and each domain of the KCL as well as all-cause hospitalization. RESULTS: The prevalence of frailty, pre-frailty and robustness were 29.7%, 34.5% and 35.8%, respectively. During the 2-year follow-up period, 417 participants (14.3%) underwent an incident of all-cause hospitalization. The participants with frailty (adjusted OR 1.38, 95% CI 1.05-1.81) had a significantly elevated incidence of hospitalization according to the multivariate analysis compared with patients with robustness, but not in participants with pre-frailty (adjusted OR 1.07, 95% CI 0.82-1.40). Participants with low physical function (adjusted OR 1.45, 95% CI 1.12-1.87) and depressed mood (adjusted OR 1.35, 95% CI 1.08-1.70) had a significantly elevated incidence of hospitalization according to multivariate analysis compared with non-risk. CONCLUSION: These results suggest that older adults with frailty are more likely to be hospitalized and that the KCL may be the screening tool to estimate the hospitalization risk. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; ••: ••-••.

DOI： 10.1111/ggi.14331

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1002/pmrj.12689

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: Increasing physical activity (PA) improves glycemic control in patients with type 2 diabetes mellitus (T2DM). However, whether long-term objectively measured PA is related to glycemic control remains unclear. The aim of this study was to investigate the relationship between long-term objectively measured PA and glycemic control in T2DM patients. RESEARCH DESIGN AND METHODS: This prospective cohort study recruited T2DM patients admitted to a hospital-based diabetes management and education program. The primary outcome was glycemic control by hemoglobin A1c at 6 months after discharge. We defined poor glycemic control according to the Japanese Clinical Practice Guidelines. The PA was objectively measured using a three-axis accelerometer during 6 months' period after discharge. The representative value of PA was the average daily steps during the measurement period and was divided into quartiles. To determine the relationship between the daily steps and poor glycemic control, we performed a multivariate logistic regression analysis. RESULTS: Ninety-four participants were enrolled in the study. Their median age was 59 years, and 38 (40.0%) of them showed poor glycemic control. Multivariate logistic regression analysis showed that the first (Q1, ≤ 6106 steps/day) and second quartiles (Q2, 6107-8258 steps/day) had significantly elevated risks of poor glycemic control compared to Q4 (≥ 10,542 steps/day), with odds ratios of 8.55 [95% confidence intervals (CI) =1.43-51.23] and 15.62 (95% CI 2.63-92.87), respectively. CONCLUSION: We found that lesser PA was significantly associated with poor glycemic control in T2DM patients. This finding may be beneficial for clinicians while providing long-term advice to diabetic patients.

DOI： 10.2147/dmso.s307070

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Objective: Although the propulsion distance of a wheelchair is measured by some devices, measuring self-propulsion distance, excluding assistance propulsion distance by the caregiver, is difficult. This is a pilot study conducted to verify whether the propulsion distance of wheelchair users, excluding the assistance propulsion distance, can be measured using a cycle computer by attaching the touch switch.Methods: The wheelchair propulsion distance was measured using a cycle computer. We connected the touch switch and the cycle computer to the wheelchair to exclude assistance propulsion distance. We set the cycle computer to stop recording while the caregiver was touching the sensor. To confirm the propulsion distance using the cycle computer, the volunteer propelled the wheelchair on a rectangular facility with a total distance of 181 m, and the examiner confirmed the propulsion distance. The validation test to confirm the accuracy of the touch switch attached to the cycle computer was performed on a 50-m straight runway. The volunteer and caregiver propelled the wheelchair alternately by 10 m and continued until 50 m. The examiner confirmed the distance after 50-m propulsion.Results: In the 181-m rectangular facility, the propulsion distance that the volunteer propelled the wheelchair with the cycle computer was 180 m. In the 50-m straight runway, the propulsion distance was 30 m with caregiver assistance for 20 m.Conclusion: The present study showed that our modified device could measure the self-propulsion distance, excluding assistance propulsion distance in wheelchair users.

DOI： 10.1080/10790268.2019.1601936

PubMed

International / domestic magazine：Domestic journal  

DOI： 10.1007/s10157-021-02033-8

PubMed

DOI： 10.1186/s41100-021-00364-6

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVES: The objective of this study was to investigate the influence of the COVID-19 pandemic on physical activity (PA) and the incidence of frailty among initially non-frail older adults in Japan. DESIGN: A follow-up online survey. SETTING AND SUBJECTS: Among the 1,600 baseline online survey participants, 388 adults were already frail, and 275 older adults did not respond to the follow-up survey. Thus, the final number of participants in this study was 937 (follow-up rate: 77.3%). METHODS: We assessed the total PA time at four time points according to the COVID-19 waves in Japan: January 2020 (before the pandemic), April 2020 (during the first wave), August 2020 (during the second wave), and January 2021 (during the third wave). We then investigated the incidence of frailty during a one-year follow-up period (during the pandemic). RESULTS: The total PA time during the first, second, and third waves of the pandemic decreased from the pre-pandemic PA time by 33.3%, 28.3%, and 40.0%, respectively. In particular, the total PA time of older adults who were living alone and socially inactive decreased significantly: 42.9% (first wave), 50.0% (second wave), and 61.9% (third wave) less than before the pandemic, respectively. Additionally, they were at a significantly higher risk of incident frailty than those who were not living alone and were socially active (adjusted odds ratio: 2.04 [95% confidence interval: 1.01-4.10]). CONCLUSION: Our findings suggest that older adults who live alone and are socially inactive are more likely to experience incident frailty/disability due to decreased PA during the pandemic. Understanding this mechanism may be crucial for maintaining the health status of older adults.

DOI： 10.1007/s12603-021-1634-2

PubMed

維持血液透析を受けている生活保護受給者のビタミンD欠乏症の有無を検討した。日本人の維持血液透析患者106例を対象に横断後ろ向き研究を実施した。生活保護受給者16例(男性11例、女性5例、平均66.3±10.0歳)と非受給者90例(男性50例、女性40例、平均67.0±11.0歳)に分類し、血清中25(OH)D濃度が12ng/mL未満をビタミンD欠乏症と定義した。検討の結果、血清中25(OH)D濃度中央値は生活保護受給者群が11.5ng/mL、非受給者群が14.8ng/mLと受給者群の方が有意に低く、糖尿病の有病率は受給者群の方が有意に高かった(68.8% vs.30.0%)。この他のパラメータに有意な群間差はなく、身体活動レベル、血清アルブミン、血清リンにも有意差はなかった。単変量ロジスティック回帰分析ではビタミンD欠乏症の有意なリスク因子として女性が抽出され、生活保護受給との有意な関連はみられなかったが、多変量解析では女性と生活保護受給の両者がビタミンD欠乏症の有意なリスク因子となっていた。維持血液透析を受けている生活保護受給者ではビタミンD欠乏症の発症リスクが有意に高まることが示された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Higher physical activity levels during hospitalization may benefit the life-space mobility, defined as the ability to move within environments that expand from one's home to the greater community, of stroke survivors following their discharge. OBJECTIVES: This study aimed to evaluate the relationship between physical activity levels during rehabilitation hospitalization and life-space mobility among stroke survivors three months after their discharge. METHODS: We recruited 84 stroke survivors as prospective participants from four convalescent rehabilitation hospitals. Physical activity levels during hospitalization were assessed using pedometers with a three-axis accelerometer, and their average step count over 14 consecutive days prior to discharge was used as the representative set of values. Pedometers were placed on the participant's waist or wrist on the non-paretic side. The Life-Space Assessment (LSA), a validated self-reporting measure for assessing community mobility, was implemented three months following participant discharge from rehabilitation hospitals via a mail-in survey method. To determine the relationship between the participants' level of physical activity during hospitalization and the LSA score following discharge, we performed multivariate regression analysis. RESULTS: A total of 75 participants (89.3%) completed the post-discharge survey and were therefore included in the analysis. The multiple regression analysis, controlled for age, balance function, walking endurance, fear of falling, and functional status, revealed that daily step counts were significantly associated with the LSA score three months after discharge (β = 0.241, p = .026). CONCLUSIONS: Physical activity levels during hospitalization were significantly associated with the life-space mobility of stroke survivors following discharge.

DOI： 10.1080/10749357.2020.1834276

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: We aimed to evaluate the relationship between the daily wheelchair self-propulsion distance and functional recovery in subacute stroke survivors. METHODS: Seventy-four patients with stroke were prospectively recruited from four convalescent rehabilitation hospitals. All participants were unable to walk independently and required manual wheelchairs for locomotion on admission. The daily wheelchair self-propulsion distance was measured using a cycle computer that was connected to a touch switch to exclude the assistance-propulsion distance. The outcome measures were represented as the relative gain of the Functional Independence Measure (FIM) effectiveness during hospitalization. Moreover, a better functional recovery was defined as a FIM effectiveness > 50%. Participants were categorized into three groups according to tertiles of the average daily wheelchair self-propulsion distance: lowest tertile (T1, ≤0.59 km/day); middle tertile (T2, 0.60-1.23 km/day); and highest tertile (T3, ≥1.24 km/day). RESULTS: Multivariate logistic regression analysis adjusted for baseline characteristics showed that the T2 and T3 groups had a significant association with better FIM effectiveness, and their odds ratios (95% confidence interval, p) were 7.26 (1.13-45.85, p = .038), and 10.19 (1.15-91.75, p = .035), respectively. CONCLUSIONS: The daily wheelchair self-propulsion distance was significantly associated with functional recovery in subacute stroke survivors. IMPLICATIONS FOR REHABILITATION Non-ambulatory stroke survivors can obtain extra independent physical activity by using wheelchair self-propulsion, when they do not have someone to assist them with walking. This multicenter observational study revealed that the self-propulsion distance of a manual-wheelchair was significantly associated with functional recovery in subacute stroke survivors.

DOI： 10.1080/09638288.2020.1821249

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: The aim of this study was to investigate the relationship between tongue muscle quality index, which was represented as tongue muscle pressure divided by tongue muscle mass, and swallowing speed in community-dwelling older women. METHODS: The inclusion criteria for this cross-sectional study were that participants be community-dwelling older women aged 65 years and above without dysphagia. The exclusion criteria were stroke and Parkinson's disease that directly cause dysphagia. We measured tongue muscle thickness and maximum tongue pressure and the tongue muscle quality index, which was defined as the maximum tongue pressure divided by tongue muscle thickness. We investigated swallowing speed via a 100 ml water swallowing test. To assess the relationship between tongue muscle characteristics and swallowing speed, we performed stepwise multiple regression analysis. RESULTS: Ninety-three participants were enrolled in this study (mean age: 84.2 ± 4.7 years). A stepwise multiple regression analysis showed that age (β = - 0.292, p < 0.01) and tongue muscle quality index (β = 0.267, p < 0.01) were related to swallowing speed. CONCLUSION: We found that tongue muscle quality index was related to swallowing speed in community-dwelling older women. According to our findings, it is possible that the tongue muscle quality index is a useful parameter for assessing swallowing speed in older women without dysphagia.

DOI： 10.1007/s40520-019-01388-z

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Physical and cognitive/psychological functions are risk factors for incident homebound status. However, there are only a few studies exploring the factors related to homebound status in hospitalized older patients. The aim of this study was to determine the relationship between physical, and cognitive/psychological function at discharge among hospitalized older patients and the risk of undergoing homebound status after discharge. METHODS: We analyzed the cohort data of hospitalized older patients (age ≥65 years) with internal medical problems. The main outcome was the incidence of homebound status a month after discharge. Physical functions were measured by handgrip strength (HG), knee extension strength (KES), one-leg stance (OLS), and walking speed (WS). Cognitive and psychological functions were assessed using the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale-5 (GDS-5), respectively. Poisson regression models were used to estimate the risk ratios (RR) and 95 % confidence intervals (CIs) of the relationships between physical, cognitive, and psychological functions as well as the homebound status. RESULTS: A total of 178 participants who completed the follow-up were analyzed mean age (standard deviation) 76.2 (6.9) years. A month after discharge, 23 participants were deemed homebound, for a cumulative incidence (95 %CI) of 12.9 % (8.0 %-17.8 %). The RR (95 %CI) estimated by Poisson regression were 3.51 (1.30-9.48), 0.15 (0.03-0.72) and 0.11 (0.01-0.92) for low KES, maximum WS and comfortable WS, respectively. However, HG, OLS, MMSE, and GDS-5 were not significantly associated with the incidence of homebound status. CONCLUSION: Physical functions can predict the incidence of homebound status after discharge among hospitalized older patients.

DOI： 10.1016/j.archger.2020.104258

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

DOI： 10.1111/psyg.12551

PubMed

亜急性期脳卒中患者を対象に、脳卒中後アパシーの関連因子を解明する横断観察研究を施行した。2013年1月〜10月に当リハビリテーション病院へ入院した脳卒中後患者60名を組入れた。療養リハビリテーション病棟から退棟する時点で「やる気スコア」尺度(Apathy Scale)などの評価を行い、やる気スコアが16点以上でアパシー状態にあると判定されたアパシー群20名(男性12名、平均71.0±9.8歳)と16点未満の非アパシー群40名(男性26名、平均60.1±15.0歳)に分類した。両群比較ではアパシー群の方が有意に高齢であり(P=0.005)、脳卒中が梗塞型であった率が有意に高く(90%対60%、P=0.017)、うつ性自己評価尺度(Self-Rating Depression Scale)のスコアが有意に高く、1日当たりに費やす歩数は有意に少なかった。変数増減法を用いたロジスティック回帰分析の結果、脳卒中後アパシーの存在と関連する因子としては1日歩数のみが選択された(オッズ比0.69,95%CI 0.53〜0.91)。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

DOI： 10.1007/s10157-020-01907-7

PubMed

Other URL： http://link.springer.com/article/10.1007/s10157-020-01907-7/fulltext.html

Publishing type：Research paper (scientific journal)  

DOI： 10.2490/jjrmc.19005

目的:回復期脳卒中患者におけるリハビリテーション治療満足度と関連する要因を検討すること。方法:研究デザインは横断研究とした。対象は回復期病棟にてリハビリテーション治療を実施した初回発症の脳卒中患者41名(50.5±9.3歳、男性73.2%)とした。統計解析は、リハビリテーション治療満足度(CSSNS)を従属変数とし、満足度との関連が報告されている身体機能変化(SIAS-M gain)、ADL改善度(M-FIM effectiveness)、精神面(JSS-D)、楽観性(LOT-R)、サービス品質(SERVPERF)を独立変数とした重回帰分析(ステップワイズ法)を用いて検討した。結果:リハビリテーション治療満足度は55.5±8.3点であった。重回帰分析にてリハビリテーション治療満足度に関連する要因として、M-FIM effectiveness(標準化偏回帰係数β=0.48、p<0.01)とSERVPERF(標準化偏回帰係数β=0.48、p<0.01)が抽出された。結論:回復期脳卒中患者において、ADL能力を改善させることと、リハビリテーション治療のサービス品質向上に取り組むことが満足度を高める可能性が示唆された。(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: This study aims to determine whether the combination of visiting frequency of the family caregiver and frailty status has an additive effect on the incidence of dependency among hospitalized older patients. METHODS: We analyzed the prospective cohort data of hospitalized older patients (65 years and older) with internal medical problems. The main outcome showed patients' dependency from admission to a month after discharge. We investigated the visiting frequency of family caregivers and the frailty status and categorized respondents into 4 groups: group 1, visiting frequency 3-7 times a week and non-frailty; group 2, visiting frequency 0-2 times a week and non-frailty; group 3, visiting frequency 3-7 times a week and frailty; or group 4, visiting frequency 0-2 times a week and frailty. We used the Cox proportional hazards regression to estimate the hazard ratios (HR) and confidence intervals (95% CI) of relationships between the combination of visiting frequency and frailty status, and dependency. RESULTS: A total of 182 participants who completed the follow-up were analyzed. During the follow-up period, 45 participants (24.7%) showed some dependency. The hazards regression showed that the low visiting frequency group with presence of frailty had the most increased dependency, compared to other groups (adjusted HR 8.61 [95% CI 3.38-21.98]). CONCLUSIONS: The coexistence of low visiting frequency and the presence of frailty influenced dependency more strongly than each factor alone. These findings suggest that the combination of visiting frequency and frailty status is a useful predictor for future dependency.

DOI： 10.1007/s41999-020-00322-1

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Active vitamin D (calcitriol, or 1.25 (OH) 2 D) is associated with muscle weakness, falls, and fracture in community-dwelling older people. This study aimed to investigate the relationship between a serum active vitamin D level and lower extremity muscle strength in elderly patients with pre-dialysis chronic kidney disease (CKD). This cross-sectional study included 231 patients with CKD treated conservatively as outpatients. We analyzed patient background factors, including age, sex, body mass index (BMI), intact parathyroid hormone (PTH), phosphorus, calcium, albumin, serum calcitriol level as an indicator of active vitamin D, and estimated glomerular filtration rate (eGFR) collected from medical records. As an index of lower extremity muscle strength, the isometric knee extension muscle strength-to-weight ratio (kgf/kg) was calculated. The mean patient age was 75.9 ± 6.1 years (68.8% male), and the BMI was 24.1 ± 3.8 kg/m2. A significant correlation was observed between knee extensor muscle strength and serum calcitriol level (r = 0.32, p < 0.01), age (r = -0.30, p < 0.01), BMI (r = -0.31, p < 0.01), intact PTH (r = -0.22, p < 0.01), phosphorus (r = -0.29, p < 0.01), albumin (r = -0.28, p < 0.01), and eGFR (r = 0.25, p < 0.01). Multiple regression analysis showed calcitriol to be significantly associated with knee extensor muscle strength (β: 0.14, 95% confidence interval: 0-0.002, p = 0.04) after adjustment for covariates. These results suggest that the serum active vitamin D level is associated with lower extremity muscle strength in older adults with pre-dialysis CKD. It is necessary to verify whether vitamin D supplementation increases lower extremity muscle strength in pre-dialysis CKD patients.

DOI： 10.3390/ijerph17041433

PubMed

【目的】保存期CKD患者の栄養障害は、死亡や心血管イベント等のリスクが高まることが知られているが、栄養障害と身体活動量の関係は明らかではない。保存期CKD患者の栄養障害リスクと身体活動量の関連を明らかにする。【方法】保存期CKD患者108例を対象にGNRI、身体活動量(平均運動量、平均歩数)を評価した。さらに対象者を正常群(GNRI98以上)、栄養障害群(GNRI98未満)の2群に分け、身体活動量の比較を行った。【結果】2群間比較の結果、平均運動量は栄養障害群が正常群に比し有意に低値を示した。また、多重ロジスティック回帰分析の結果、平均運動量が栄養障害リスクの独立因子として抽出された。【結論】保存期CKD患者における栄養障害リスクに、身体活動量が関連することが明らかとなった。(著者抄録)

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Swallowing disorders are a serious health concern among older adults. Previous studies reported that sarcopenia may affect swallowing disorders; however, whether sarcopenia is related to the capacity to swallow (measured according to swallowing speed) in community-dwelling older adults is unclear. OBJECTIVES: The aim of this study was to investigate the relationship between sarcopenia and swallowing capacity in community-dwelling older women. METHODS: This cross-sectional observational study was conducted among community-dwelling older women in Japan. The inclusion criteria were as follows: women aged ≥65 years, with the ability to walk independently, and without dysphagia. The exclusion criterion was a history of stroke or Parkinson's disease that directly caused dysphagia. The participants were divided into a sarcopenia and a healthy group based on the criteria of the Asian Working Group for Sarcopenia 2019. We measured swallowing speed (mL/s) as the swallowing capacity by conducting a 100-mL water-swallowing test. To assess the relationship between sarcopenia and swallowing capacity, we performed a multiple regression analysis. RESULTS: Two-hundred and sixty participants were enrolled in the study. Their mean age was 82.3 ± 6.9 years, and 61 (23.5%) of them displayed sarcopenia. The mean swallowing speed was 11.5 ± 4.9 mL/s, and 17 women (6.5%) exhibited choking or a wet-hoarse voice. Multiple regression analysis revealed that sarcopenia was related to the swallowing capacity after adjusting for age, the Mini-Mental State Examination, and the number of comorbidities (β = -0.20, 95% CI -3.78 to -0.86, p = 0.002). CONCLUSIONS: We found that sarcopenia was related to the swallowing capacity in older women in this study. Future research should clarify whether a similar relationship exists in older men as well as the effect of sarcopenia on the swallowing capacity in older adults over a period of time.

DOI： 10.1159/000511359

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

DOI： 10.1007/s12603-020-1466-5

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVES: The objective of this study was to investigate changes in physical activity (PA) between January (before the COVID-19 epidemic) and April (during the COVID-19 epidemic) 2020 in community-dwelling older adults in Japan. DESIGN: Cross-sectional online survey. SETTING AND SUBJECTS: From April 23 to 27, 2020, an online survey was completed by 1,600 community-dwelling older adults in Japan. METHODS: We assessed the frailty status using the Kihon checklist, and other demographics and asked questions regarding PA at two time points: January and April 2020. We defined the total PA time (minutes) per week based on activity frequency and time. RESULTS: The study participants' mean age, proportion of women, and prevalence of frailty were 74.0±5.6 years, 50% (n=800), and 24.3% (n=388), respectively. We found a significant decrease in total PA time in April 2020 (median [interquartile range (IQR)], 180 [0 to 420]) when compared to January 2020 (median [IQR], 245 [90 to 480]) (P<0.001). We also performed a subgroup analysis according to the frailty category; total PA time significantly decreased in April 2020 when compared to January 2020 for all frailty categories (P<0.001). CONCLUSION: In conclusion, due to the COVID-19 epidemic, the total PA time in April 2020 significantly decreased compared to that in January 2020 in older adults. This finding may lead to a higher incidence of disability in the near future in older people.

DOI： 10.1007/s12603-020-1424-2

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Factors associated with functional recovery after stroke may differ by age demographics because the aging process leads to various regressive changes. The aim of this study was to identify factors related to functional recovery in Japanese patients with convalescent stroke stratified by age. A multicenter retrospective observational study was conducted in 243 patients from six convalescent inpatient rehabilitation wards. Participants were categorized into three groups: 40-64, 65-74, and ≥75 years. Demographic data, laboratory data, physical function, and cognitive function were collected upon admission, and outcome measures were represented using the relative gain of the Functional Independence Measure (FIM effectiveness) during hospitalization. Stepwise multivariate logistic analysis was performed to identify the significant factors for functional recovery in each group. In the 40-64 years group, stroke type [odds ratio (OR), 10.38; 95% confidence interval (CI), 2.22-48.59], spatial neglect (OR, 7.61; 95% CI, 2.07-28.00), and memory disorder (OR, 4.68; 95% CI, 1.08-20.30) were shown to be significant factors. In the 65-74 years group, only memory disorder (OR, 3.42; 95% CI, 1.19-9.81) was significant. In the ≥75 years group, low albumin level (OR, 3.35; 95% CI, 1.05-10.67), severe motor impairment (OR, 5.11; 95% CI, 1.14-22.97), and memory disorder (OR, 4.34; 95% CI, 1.43-13.23) were significantly related to poor functional recovery. In conclusions, the findings showed that there were different trends among the factors related to poststroke functional recovery among the three age groups.

DOI： 10.1097/MRR.0000000000000359

PubMed

International / domestic magazine：International journal  

DOI： 10.1016/j.jgo.2019.03.017

PubMed

透析前慢性腎臓病の65歳以上の高齢者において、腎機能と身体機能が長期認知機能低下に及ぼす影響を調べた。ベースライン時の身体機能は握力と歩行速度によって評価した。ベースライン時の日常生活動作をBarthel Indexによって評価した。認知機能はベースラインと2年後にMontreal Cognitive Assessment日本語版で評価した。患者を腎機能と身体機能の組合せから4群に分けた。I群は軽度-中等度腎機能障害と高身体機能、II群は軽度-中等度腎機能障害と低身体機能、III群は重度腎機能障害と高身体機能、IV群は重度腎機能障害と低身体機能とした。84例(男性73.8%、平均77.3±6.8歳)が2年の経過観察評価を終了した。I群は34例、II群は11例、III群は24例、IV群は15例であった。多変量ロジスティック回帰分析では、重度腎機能障害と低身体機能の組合せが、認知機能低下に有意に関連した。重度腎機能障害または低身体機能のみの患者に有意な認知機能低下は観察されなかった。

サルコペニアまたはダイナペニアを呈する高齢者112名を対象に、体重レジスタンス運動とビタミンD含有プロテインサプリメント摂取が骨格筋に及ぼす影響について検討した。レジスタンス運動+サプリメント摂取群28名(男性8名、女性20名、平均84.9歳)、レジスタンス運動群28名(男性10名、女性18名、平均84.7歳)、サプリメント摂取群28名(男性8名、女性20名、平均83.2歳)、対照群28名(男性13名、女性15名、平均83.9歳)の4群に分け、運動群には体重レジスタンス運動プログラムを12週間にわたり実施させ、サプリメント摂取群には1日おきに12週服用させた。検討の結果、ITT解析では膝伸展トルク、位相角、大腿直筋のエコー強度に関して有意な群間差が認められ、運動実施+サプリメント摂取群の方が他の三つの群より有意な改善がみられた。PP解析でもITT解析と同様に、運動実施+サプリメント摂取群の有意性が示された。また、正常筋量を有しながら身体機能が低値の高齢者を対象としたサブグループ解析でも、運動実施+サプリメント摂取群の方が他の三つの群より膝伸展トルク、位相角および大腿直筋のエコー強度が有意に改善していた。サルコペニアまたはダイナペニアを呈する高齢者に対して体重レジスタンス運動とプロテインサプリメント摂取を行わせることで、骨格筋の質と強度の改善が得られることが示された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

AIM: The objective of this trial was to investigate the synergistic effects of bodyweight resistance exercise and a protein supplement with vitamin D on skeletal muscle in sarcopenic or dynapenic older adults. METHODS: This was a four-arm randomized controlled trial. Sarcopenic or dynapenic older adults were recruited for this trial. After screening, a total of 112 older adults were randomly allocated among four groups; 28 older adults each were enrolled in the combined resistance exercise and nutritional supplementation group, the exercise alone group, the nutritional supplementation alone group, and the control group. Participants in the combined group and exercise alone groups took part in a bodyweight resistance exercise program for 12 weeks. Protein and vitamin D supplements were provided every day for 12 weeks for the participants in the combined group and nutritional supplementation alone groups. We assessed the echo intensity of participants' thigh muscle using ultrasonography, measured their appendicular muscle mass using a bioelectrical impedance data acquisition system, and tested their knee extension strength and physical function. RESULTS: Participants in the combined group had a significantly greater improvement in rectus femoris echo intensity and knee extension torque than those in the other groups (P < 0.05). Furthermore, the combined program increased appendicular muscle mass in sarcopenic older adults (P < 0.05), but not in older adults with low physical function with normal muscle mass. CONCLUSIONS: The present study confirmed the synergistic effect of bodyweight resistance exercise and protein supplement with vitamin D on muscle quality and muscle strength in sarcopenic or dynapenic older adults. Geriatr Gerontol Int 2019; 19: 429-437.

DOI： 10.1111/ggi.13643

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: To investigate the impact of unilateral spatial neglect with or without other cognitive impairments on recovery of independent gait in stroke survivors. DESIGN: A prospective cohort study. SUBJECTS: Ninety-four stroke survivors in an inpatient rehabilitation ward. METHODS: The presence of unilateral spatial neglect was assessed by the visuospatial perception score of the Stroke Impairment Assessment Set, and other cognitive impairments were assessed by Mini-Mental State Examination. Participants were categorized into 3 groups: group 1, unilateral spatial neglect with other cognitive impairments; group 2, unilateral spatial neglect without other cognitive impairments; and group 3, non-unilateral spatial neglect. The outcome was the walking score of the Functional Independence Measure (FIM) at discharge (score ≥ 6 or ≤ 5). RESULTS: Multivariate logistic regression analysis (reference, group 3) showed that the presence of unilateral spatial neglect with other cognitive impairments (group 1) had a significant association with dependence of gait (p = 0.003), and the odds ratio (95% confidence interval) was 5.55 (1.19-23.04). In contrast, there was no significant relationship between the presence of unilateral spatial neglect without other cognitive impairments (group 2) and dependence of gait (p = 0.207). CONCLUSION: The presence of unilateral spatial neglect without other cognitive impairments is not a significant factor for regaining independent gait. In contrast, unilateral spatial neglect becomes a strong negative factor when combined with other cognitive impairments.

DOI： 10.2340/16501977-2503

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

AIM: Phase angle (PhA) can be determined through bioelectrical impedance analysis and is a unique variable for skeletal muscle. The objective of this study was to evaluate the relationship between PhA and muscle mass/quality in older adults. In addition, we attempted to determine the cutoff value of PhA for poor muscle function. METHODS: Community-dwelling Japanese older men (n=285, 81.1±7.1 years) and women (n=724, 80.4±6.8 years) participated in this study and were classified into four groups based on the Asian Working Group for Sarcopenia (normal, presarcopenia, dynapenia, and sarcopenia). We measured PhA using bioelectrical impedance analysis, muscle quantity and quality indicators using ultrasonography, muscle strength, and physical performance and compared them in four groups. We also tried to determine the cutoff value of PhA for poor muscle function. RESULTS: We found a significant difference in PhA among the four groups in men (P<0.05), and the dynapenia (3.61±0.75°) and sarcopenia groups (3.40±0.74°) showed significantly lower values than the normal group (4.50±0.86°) (P<0.05), but not the presarcopenia group (4.12±0.85°). In women, a significant difference was also observed among the four groups (P<0.05), and the dynapenia (3.41±0.65°) and sarcopenia groups (3.31±0.66°) showed significantly lower measures than the normal group (4.14±0.71°) (P<0.05), but not the presarcopenia group (4.07±0.51°). The receiver-operating characteristic curve analysis indicated the best cutoff value of PhA (men: 4.05°, women: 3.55°) to discriminate sarcopenia and dynapenia from normal and presarcopenia. CONCLUSION: These findings suggest that PhA is a useful indicator for muscle function.

DOI： 10.1007/s12603-018-1151-0

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Handgrip strength (HS) and knee extensor muscle strength (KEMS) showed a negative correlation with the Disabilities of the Arm, Shoulder, and Hand (DASH) score at one month following cardiac surgery. We performed a longitudinal study to examine changes in HS/KEMS and DASH score during phase II cardiac rehabilitation (CR) in patients after cardiac surgery. We measured and assessed HS, KEMS, and DASH score in 41 consecutive patients at one and three months following cardiac surgery and examined the relation between these factors at three months following cardiac surgery. Wilcoxon signed-rank test and Spearman correlation coefficients were used to analyze the results. Finally, 26 patients (63.2 years, 73.1% male) were analyzed. There were significant differences from one month to three months following cardiac surgery in HS (26.78 ± 8.26 to 31.35 ± 9.41 kgf, p < 0.001), KEMS (1.53 ± 0.42 to 1.72 ± 0.46 Nm/kg, p = 0.001), and DASH score (14.76 ± 12.58 to 7.62 ± 9.29, p < 0.001). DASH score correlated negatively with HS (r = -0.41, p = 0.01) but not with KEMS (r = -0.32, p = 0.09) after three months of phase II CR. Although HS, KEMS, and DASH scores changed significantly from one to three months following cardiac surgery during phase II CR, only HS correlated negatively with DASH score at three months following cardiac surgery.

DOI： 10.3390/diseases7010032

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

International / domestic magazine：International journal  

Total pages：xi, 244p  

CiNii Books

Authorship：Lead author  

1.腎疾患患者の機能障害に対して理学療法を行うにあたり,臨床思考の進め方とそのポイントを確認してから取り組むことが求められる.2.慢性腎臓病(CKD)患者では,症状の進行に伴い,尿毒症症状や心血管疾患,電解質異常に伴う致死性不整脈など,さまざまな合併症が引き起こされる.3.CKD患者や血液透析患者では,日常生活動作能力低下や身体機能低下が引き起こされるリスクが高いこと,運動・身体活動の実施が腎機能維持に効果的であることから,理学療法実施へのニーズが高まっている.4.CKD患者や血液透析患者に対する運動療法については制限や注意に関する点が多く,心血管リスクの有無や体液量の状況,運動療法時のバイタルサインの変化,血液透析治療の内容などを把握する必要がある.5.CKD患者や血液透析患者に対する運動療法は,短期的な身体機能改善のみを目的とするのではなく,在宅での運動や日常身体活動量の増加など,長期にわたり継続できるようなアプローチとすることが必要となる.(著者抄録)

＜文献概要＞近年,透析患者に対する運動療法に注目が集まっており,さまざまなアウトカムを改善する方法としてその有用性が報告されている.その一つとして,運動療法による認知機能低下予防の効果が期待されており,複数の報告がなされている.しかし現状では透析患者に対する運動療法が認知機能維持改善に効果的と断言できるほどのエビデンスはなく,また将来的に認知症の発症予防に寄与するかについても明らかではないため,さらなる検討が必要である.

J-GLOBAL

J-GLOBAL

J-GLOBAL

J-GLOBAL

日本は超高齢社会であり高齢慢性腎臓病患者の数は増加している。加齢により生理的機能が低下し、腎機能低下や多数の併存疾患などの影響により慢性腎臓病・透析患者はサルコペニア、フレイルになりやすい。高齢者の健康寿命を延ばすことが重要とされる近年、高齢慢性腎臓病患者の幸福のためには身体機能を維持するということは必須であると考える。慢性腎臓病患者の健康寿命を考慮するうえで医療的な介入は当然だが、身体機能や栄養的側面、社会的貢献からのアプローチが大変重要になる。基本的なサルコペニア・フレイルの概念・診断からCKD患者におけるサルコペニア・フレイルの頻度・予後・対策を論文的考察を加え検討した。(著者抄録)

1.透析を行っていない保存期慢性腎臓病(CKD)患者に対する運動療法の目的は、腎機能の重症化予防、心血管疾患の発症予防、フレイルおよびサルコペニアの予防が中心となる。2.CKD患者に対するホームエクササイズは有酸素運動とレジスタンス運動を併用するとよい。3.ホームエクササイズは非監視下での実施となるため、そのような状況で実施できる運動内容を指導することが大切である。4.ホームエクササイズの実施状況を評価し、目標値に到達できた時には賞賛するなど、運動療法継続への動機づけとなるような言葉がけを行う。(著者抄録)

J-GLOBAL

J-GLOBAL

Presentation type：Symposium, workshop panel (nominated)  

Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Presentation type：Oral presentation (general)  

Presentation type：Poster presentation  

Presentation type：Oral presentation (invited, special)