Relationship between Changes in Fatigue and Exercise by Follow-Up Period / 가정의학회지

BACKGROUND: Fatigue is one of the most common presenting symptoms in primary care in Korea. In this study, we aimed to determine the effect of exercise intervention on the severity of fatigue of unknown medical cause during a period of follow-up. METHODS: We used the data collected from an outpatient fatigue clinic in Seoul National University Bundang Hospital. The study was conducted from March 3, 2010 to May 31, 2014. We measured the body mass index of each patient and evaluated variables including lifestyle factors (smoking, alcohol consumption, and regular exercise), quality of sleep, anxiety, depression, stress severity, and fatigue severity using questionnaires. A total of 152 participants who completed questionnaires to determine changes in fatigue severity and the effect of exercise for each period were evaluated. We used univariate analysis to verify possible factors related to fatigue and then conducted multivariate analysis using these factors and the literature. RESULTS: Of 130 patients with the complaint of chronic fatigue for over 6 months, over 90 percent reported moderate or severe fatigue on the Fatigue Severity Scale and Brief Fatigue Inventory questionnaires. The fatigue severity scores decreased and fatigue improved over time. The amount of exercise was increased in the first month, but decreased afterwards. CONCLUSION: There was no significant relationship between changes in the amount of exercise and fatigue severity in each follow-up period. Randomized controlled trials and a cohort study with a more detailed exercise protocol in an outpatient setting are needed in the future.

Association between Muscle Loss and Urinary Incontinence in Elderly Korean Women / 가정의학회지

BACKGROUND: Incontinence and muscle loss are important senior health issues. Nevertheless, there are no available domestic or international studies on the association between urinary incontinence and muscle loss. The aim of this study was to investigate the association between muscle loss and urinary incontinence in elderly Korean woman. METHODS: Korean women (1,313) > or =65 years of age whose complete body composition data were collected using dual X-ray absorptiometry were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Class I and II losses of the appendicular, truncal, and total muscle mass were defined using adjustments for weight and height. Each participant's incontinence status was collected using constructed questionnaires. Multiple logistic regression was performed to examine the association between muscle loss and incontinence. RESULTS: On the basis of physician-diagnosed incontinence, weight- and height-adjusted muscle loss showed no association with urinary incontinence (weight-adjusted muscle loss: class I adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.34 to 1.73; class II aOR, 1.37; 95% CI, 0.59 to 3.18; height-adjusted muscle loss: class I aOR, 0.51; 95% CI, 0.18 to 1.51; class II aOR, 1.86; 95% CI, 0.22 to 15.79). Similar results were observed for truncal muscle and total muscle mass as well as self-reported urinary incontinence. CONCLUSION: Our study found no association between urinary incontinence and appendicular, truncal, and total muscle loss in elderly Korean women.

Relationship between Low Muscle Mass and Metabolic Syndrome in Elderly People with Normal Body Mass Index

BACKGROUND: Metabolically obese normal weight (Wt) occurs in people who have high prevalence of cardiovascular disease even with normal body mass index (BMI). In this study, we determined the relationship between low muscle mass and metabolic syndrome which is known to be associated with cardiovascular disease in aged people with normal BMI. METHODS: This study used the data of Korea National Health and Nutrition Examination Survey. Aged people (> or = 65 years) with normal BMI (18.5 to 22.9 kg/m2) were enrolled. Low muscle mass class I was defined as appendicular skeletal muscle divided by Wt 1 to 2 standard deviation below the mean of gender specific young healthy adult and class II was defined as below 2 standard deviations. RESULTS: The prevalence of low muscle mass class I and II were 18.8% and 5.2% in men and 11.2% and 2.2% in women, respectively. In men and women, low muscle mass and metabolic syndrome was associated with each other after adjusting for age. After further adjusting for BMI, smoking status, alcohol consumption, and exercise frequency, the relationship was maintained in aged men. Moreover in aged men, the risk of metabolic syndrome was increased according to the grade increase in low muscle mass class. CONCLUSIONS: In the aged with normal BMI, low muscle mass was a risk factor of metabolic syndrome. Furthermore, in normal BMI men, when the degree of low muscle mass was enhanced, the risk of metabolic syndrome was increased.

Clinical Significance of Left Ventricular Torsional Parameters during Supine Bicycle Cardiopulmonary Exercise Echocardiography

BACKGROUND: Left ventricular (LV) torsion plays an important role in both LV systolic and diastolic function. Notwithstanding the fact that speckle tracking imaging echocardiography (STI) is a validated method to measure LV torsion, few data regarding the clinical significance of LV torsional parameters using STI on exercise capacity during exercise echocardiography were reported. METHODS: Fifty four participants completed the supine bicycle cardiopulmonary exercise echocardiography under a symptom-limited protocol. LV torsion was defined as the net difference between LV peak apical rotation, and basal rotation divided by LV diastolic longitudinal length. LV basal, and apical short-axis rotations at each stage were analyzed by STI. RESULTS: LV torsion measurement was feasible in 43/54 (80%) at peak exercise. The LV torsions were increased during exercise, and even until the recovery. Peak twisting, and untwisting velocities were significantly increased during exercise, but were decreased at recovery. As expected, baseline torsion was positively correlated with LV ejection fraction and baseline apical peak untwisting velocity has correlation with E/E' (r=0.50, p<0.01 and r=0.30, p<0.05, respectively). Interestingly, apical peak twisting velocity at peak exercise was significantly correlated with maximal O2 consumption and VO2 interval change (r=0.50, p<0.01 and r=0.33, p<0.05, respectively). CONCLUSION: It was feasible to measure LV torsion by STI at every step during exercise echocardiography, although the feasibility was relatively low at peak exercise. LV torsional parameters during exercise showed significant relations with exercise capacity as well as LV systolic and diastolic functions.