The Effects of Aquatic Walking on the Blood Pressure of Elderly People / 日本温泉気候物理医学会雑誌

  Aquatic walking, which is influenced by the physical characteristics of water such as buoyancy, resistance, water pressure, and water temperature, is known to be effective for reducing stress on joints and increasing muscular strength. However, there is no consensus on its influence on blood pressure changes in elderly people. To address this uncertainty, we researched the effects of aquatic walking on the blood pressure of elderly people. Study participants were 48 females enrolled in a class to prevent the need for nursing care. In accordance with the diagnostic criteria for hypertension, participants were divided into two groups based on initial blood pressure measurements: a “high blood pressure group” with 27 people and a control group with 21 people. Both groups did the following program once a week for five weeks: 10 minute warmup, 15 minutes of aquatic walking (forward, backward, and sideways walking), 10 minute break, and additional 10 minutes of aquatic walking. Systolic blood pressure, diastolic blood pressure, heart rate, and average blood pressure of the participants were recorded. Results showed that the high blood pressure group showed significant decreases in systolic blood pressure after one week, and significant decreases in both diastolic blood pressure and average blood pressure from three weeks onward. No significant change was evident in the control group. However, comparing values measured immediately before and after aquatic walking showed that the control group had a significant post-aquatic walking increase in both systolic and diastolic blood pressures as well as a significant decrease in heart rate. Similar significant post-aquatic walking increases in systolic and diastolic blood pressures as well as a significant decrease in heart rate was also evident in the high blood pressure group from five weeks onward, once their measured values had improved. These results suggest that continuing an aquatic walking program will lower the blood pressure of elderly individuals meeting the diagnostic criteria for hypertension, but it is necessary to be attentive to physical condition because blood pressure increases immediately after aquatic walking in non-hypertensive individuals.

Physiological Effects of Strength Training Incorporating Blood Flow Restriction Underwater / 日本温泉気候物理医学会雑誌

  Strength training performed while restricting blood flow is believed to cause the secretion of growth hormones under low load intensities and allow for muscle hypertrophy and increased muscle strength. This has potential clinical applications for elderly individuals and people with existing conditions. However, previous research has been performed on land, with hemodynamics and growth hormone secretion trends for training performed underwater unclear. Against this background, we investigated the effects of blood flow restriction training underwater on hemodynamics and plasma growth hormone (GH) levels. Twelve healthy university students were divided into two groups: a localized immersion group where only the upper limb of the dominant hand was submerged, and a whole-body immersion group where participants were submerged to the xiphoid process. Immersed according to respective group protocols, both groups performed flexion and extension of the shoulder joint for 10 minutes with a pressurized cuff at the base of the upper arm under both 0 mmHg and 50 mmHg cuff pressures. Measured hemodynamics were heart rate, systolic blood pressure, and diastolic blood pressure. Plasma GH levels were measured from blood samples. This study revealed that underwater blood flow restriction strength training induced plasma GH level secretion under 50 mmHg conditions. In addition, high levels of GH secretion were shown in the localized immersion group for strength training even when the cuff was not pressurized. Conversely, no significant differences were evident in any measured hemodynamic categories. Results suggest that, in addition to cuff pressure, blood flow restriction training is affected by the body part immersed in water.

The Effects of Aquatic Walking on the Blood Pressure of Elderly People / 日本温泉気候物理医学会雑誌

  Aquatic walking, which is influenced by the physical characteristics of water such as buoyancy, resistance, water pressure, and water temperature, is known to be effective for reducing stress on joints and increasing muscular strength. However, there is no consensus on its influence on blood pressure changes in elderly people. To address this uncertainty, we researched the effects of aquatic walking on the blood pressure of elderly people. Study participants were 48 females enrolled in a class to prevent the need for nursing care. In accordance with the diagnostic criteria for hypertension, participants were divided into two groups based on initial blood pressure measurements: a “high blood pressure group” with 27 people and a control group with 21 people. Both groups did the following program once a week for five weeks: 10 minute warmup, 15 minutes of aquatic walking (forward, backward, and sideways walking), 10 minute break, and additional 10 minutes of aquatic walking. Systolic blood pressure, diastolic blood pressure, heart rate, and average blood pressure of the participants were recorded. Results showed that the high blood pressure group showed significant decreases in systolic blood pressure after one week, and significant decreases in both diastolic blood pressure and average blood pressure from three weeks onward. No significant change was evident in the control group. However, comparing values measured immediately before and after aquatic walking showed that the control group had a significant post-aquatic walking increase in both systolic and diastolic blood pressures as well as a significant decrease in heart rate. Similar significant post-aquatic walking increases in systolic and diastolic blood pressures as well as a significant decrease in heart rate was also evident in the high blood pressure group from five weeks onward, once their measured values had improved. These results suggest that continuing an aquatic walking program will lower the blood pressure of elderly individuals meeting the diagnostic criteria for hypertension, but it is necessary to be attentive to physical condition because blood pressure increases immediately after aquatic walking in non-hypertensive individuals.

Physiological Effects of Strength Training Incorporating Blood Flow Restriction Underwater / 日本温泉気候物理医学会雑誌

  Strength training performed while restricting blood flow is believed to cause the secretion of growth hormones under low load intensities and allow for muscle hypertrophy and increased muscle strength. This has potential clinical applications for elderly individuals and people with existing conditions. However, previous research has been performed on land, with hemodynamics and growth hormone secretion trends for training performed underwater unclear. Against this background, we investigated the effects of blood flow restriction training underwater on hemodynamics and plasma growth hormone (GH) levels. Twelve healthy university students were divided into two groups: a localized immersion group where only the upper limb of the dominant hand was submerged, and a whole-body immersion group where participants were submerged to the xiphoid process. Immersed according to respective group protocols, both groups performed flexion and extension of the shoulder joint for 10 minutes with a pressurized cuff at the base of the upper arm under both 0 mmHg and 50 mmHg cuff pressures. Measured hemodynamics were heart rate, systolic blood pressure, and diastolic blood pressure. Plasma GH levels were measured from blood samples. This study revealed that underwater blood flow restriction strength training induced plasma GH level secretion under 50 mmHg conditions. In addition, high levels of GH secretion were shown in the localized immersion group for strength training even when the cuff was not pressurized. Conversely, no significant differences were evident in any measured hemodynamic categories. Results suggest that, in addition to cuff pressure, blood flow restriction training is affected by the body part immersed in water.

AMOUNT AND INTENSITY OF PHYSICAL ACTIVITY IN RELATION TO CARDIORESPIRATORY FITNESS IN JAPANESE MIDDLE-AGED AND ELDERLY MEN / 体力科学

PORPOSE: This study aimed to investigate the relation between cardiorespiratory fitness(CRF) and physical activity, especially vigorous physical activity, in Japanese middle-aged and elderly men.METHODS: Eighty-five men aged 30-69 years participated in this study. CRF was assessed by measuring the maximal oxygen uptake based on weight (VO₂max/wt) in an incremental test on a bicycle ergometer. METs·h/week was measured as the parameter of physical activity by using accelerometers. We defined the amount of physical activity higher than 3 METs as “Physical activity ; PA”in this study. Then, PA was divided into “Moderate physical activity ; MPA”(higher than 3 METs and below 6 METs)and “Vigorous physical activity ; VPA”(higher than 6 METs).RESULTS : CRF was positively correlated with PA(r=0.318, P<0.01), MPA(r=0.230, P<0.05), and VPA(r=0.301, P<0.01) and negatively correlated with age(r=-0.607, P<0.001), BMI(r=-0.369, P<0.01), and waist circumference(WC)(r=-0.486, P<0.001). After adjusting for age and WC, the multiple regression analysis revealed that PA was positively correlated with CRF(P<0.01). VPA was positively correlated with CRF(P<0.05) after adjusting for age, WC, and MPA. MPA was not correlated with CRF in the case of adjusting for age and WC.CONCLUSION : This study suggested that physical activity higher than 3 METs was positively associated with cardiorespiratory fitness independently of age and waist circumference, and particularly vigorous physical activity may contribute to increased cardiorespiratory fitness in middle-aged and elderly men. Thus physically active life with maintenance of adequate waist circumference may help to prevent age-related decline in cardiorespiratory fitness.

PREDICTION MODELS OF SARCOPENIA IN JAPANESE ADULT MEN AND WOMEN / 体力科学

The purpose of this study was to develop prediction models of sarcopenia in 1,894 Japanese men and women aged 18-85 years. Reference values for sarcopenia (skeletal muscle index, SMI; appendicular muscle mass/height², kg/m²) in each sex were defined as values two standard deviations (2SD) below the gender-specific means of this study reference data for young adults aged 18-40 years. Reference values for predisposition to sarcopenia (PSa) in each gender were also defined as values one standard deviations (1SD) below. The subjects aged 41 years or older were randomly separated into 2 groups, a model development group and a validation group. Appendicular muscle mass was measured by DXA. The reference values of sarcopenia were 6.87 kg/m² and 5.46 kg/m², and those of PSa were 7.77 kg/m² and 6.12 kg/m². The subjects with sarcopenia and PSa aged 41 years or older were 1.7% and 28.8% in men and 2.7% and 20.7% in women. The whole body bone mineral density of PSa was significantly lower than in normal subjects. The handgrip strength of PSa was significantly lower than in normal subjects. Stepwise regression analysis indicated that the body mass index (BMI), waist circumference and age were independently associated with SMI in men; and BMI, handgrip strength and waist circumference were independently associated with SMI in women. The SMI prediction equations were applied to the validation group, and strong correlations were also observed between the DXA-measured and predicted SMI in men and women. This study proposed the reference values of sarcopenia in Japanese men and women. The prediction models of SMI using anthropometric measurement are valid for alternative DXA-measured SMI in Japanese adults.

Retraction: PREDICTION MODELS OF SARCOPENIA IN JAPANESE ADULT MEN AND WOMEN / 体力科学

The purpose of this study was to develop prediction models of sarcopenia in 1,894 Japanese men and women aged 18-85 years. Reference values for sarcopenia (skeletal muscle index, SMI; appendicular muscle mass/height2, kg/m2) in each sex were defined as values two standard deviations (2SD) below the gender-specific means of this study reference data for young adults aged 18-40 years. Reference values for predisposition to sarcopenia (PSa) in each gender were also defined as values one standard deviations (1SD) below. The subjects aged 41 years or older were randomly separated into 2 groups, a model development group and a validation group. Appendicular muscle mass was measured by DXA. The reference values of sarcopenia were 6.87 kg/m2 and 5.46 kg/m2, and those of PSa were 7.77 kg/m2 and 6.12 kg/m2. The subjects with sarcopenia and PSa aged 41 years or older were 1.7% and 28.8% in men and 2.7% and 20.7% in women. The whole body bone mineral density of PSa was significantly lower than in normal subjects. The handgrip strength of PSa was significantly lower than in normal subjects. Stepwise regression analysis indicated that the body mass index (BMI), waist circumference and age were independently associated with SMI in men; and BMI, handgrip strength and waist circumference were independently associated with SMI in women. The SMI prediction equations were applied to the validation group, and strong correlations were also observed between the DXA-measured and predicted SMI in men and women. This study proposed the reference values of sarcopenia in Japanese men and women. The prediction models of SMI using anthropometric measurement are valid for alternative DXA-measured SMI in Japanese adults.

METABOLIC SYNDROME RISK FACTORS IN RELATION TO AEROBIC FITNESS IN JAPANESE MIDDLE-AGED AND ELDERLY PEOPLE －ANALYSIS BASED ON “EXERCISE AND PHYSICAL ACTIVITY REFERENCE FOR HEALTH PROMOTION 2006 (EPAR2006)”－ / 体力科学

PORPOSE: This study aimed to compare the prevalence of metabolic syndrome (MS) risk factors and its components in different levels of aerobic fitness established by “Exercise and Physical Activity Reference for Health Promotion 2006 (EPAR2006)” in Japanese middle-aged and elderly people.METHOD: Men (n=102) and women (n=133), aged 30-69yrs, participated in this study. The prevalence of MS risk factors was evaluated as the number of MS risk factors, according to the diagnostic criterion for Japanese-specific MS. Aerobic fitness was quantified as maximal oxygen uptake (VO₂max). Subjects were classified into the three groups by aerobic fitness level based on “Reference values” and “Reference range” established in EPAR2006; 1) High fitness group (H); VO₂max (mL/kg/min) is higher than “Reference values”, 2) Medium fitness group (M); VO₂max is below “Reference values” but within “Reference range”, 3) Low fitness group (L); VO₂max is lower than “Reference range”.RESULTS: In men, M and L groups showed significantly higher frequency of risk factors for MS than H group (H: 1.09±0.98, M: 1.81±1.07, L: 2.27±0.70, P＜0.01). In women, L group showed significantly higher frequency of risk factors for MS than H and M groups (H: 0.57±0.80, M: 0.81±1.01, L: 1.53±1.07, P＜0.01).CONCLUSION: These results suggest that higher MS risk appears when the VO₂max is lower than “Reference values” in men, and below “Reference range” in women, and that particularly, men with low aerobic fitness have higher MS risk.

Ventricular Septal Defect with Pulmonary Hypertension / 日本心臓血管外科学会雑誌

Ventricular Septal Defect (VSD) is the most frequent cardiovascular anomaly. VSD causes pulmonary hypertension through stenotic changes in the pulmonary vasculature, and this progress depends on the size of defect and associated cardiovascular anomalies. Since surgical repair has been performed in childhood for patients without a tendency toward spontaneous closure of VSD, operations in elderly patients, especially those aged over 40, are rare. We report an elderly patient with VSD complicated with severe pulmonary hypertension who underwent surgical repair. A 66-year-old man was admitted to our hospital because of general fatigue, chest oppression and palpitations. The pulmonary to systemic pressure ratio was 0.66. The oxygen saturation stepped up at the right ventricle level. The pulmonary to systemic blood flow ratio was 2.9, shunt ratio was 71% and resistance ratio was 0.12. The VSD was 18mm in diameter at the perimembranous trabecula and was closed with a Dacron patch through a right atrium incision. The lung biopsy specimen revealed little occlusive pulmonary vascular disease, Grade I according to the Heath-Edwards criteria. The patient had an uneventful recovery.

A Case of Successful Surgical Treatment for Lutembacher Syndrome in an Elderly Patient / 日本心臓血管外科学会雑誌

A 71-year-old woman with Lutembacher syndrome was admitted for severe congestive heart failure and cardiac cachexia. The preoperative cardiac catheterization showed a huge secundum atrial septal defect (Qp/Qs=3.08) with mitral valve stenosis, tricuspid valve regurgitation, atrial fibrillation and severe pulmonary hypertension. Patch closure of atrial septal defect, mitral valve replacement (SJM 25mm) and tricuspid annuloplasty (Key's method) were performed. However, she suffered prolonged respiratory failure postoperatively. Enforced alimentation for cardiac cachexia and careful administration for sustained heart failure resuscitated her severe postoperative status. The postoperative cardiac catheterization showed sufficient decrease of pulmonary pressure. Reports of successful surgical correction for Lutembacher syndrome in elderly are extremely rare. This is the oldest case of successful correction for Lutembacher syndrome in Japan. From our experience, the surgical treatment for Lutembacher syndrome should be considered even in elderly patients.

Effects of Intermittent Tepid Blood Cardioplegia on Patients with Prolonged Aortic Cross-clamping / 日本心臓血管外科学会雑誌

We studied the effects of intermittent tepid blood cardioplegia on patients with prolonged aortic cross-clamping. Forty patients undergoing coronary artery bypass grafting with cross-clamp time of greater than 120 minutes were studied. The patients were divided into two groups according to the cardioplegic solutions, cold (4°C) crystalloid cardioplegia (Cold) and tepid (30°C) blood cardioplegia (Tepid). Cardiac function, myocardial enzyme and clinical outcomes were compared between the groups. Mean aortic cross-clamp time were 150±10 minutes in the Cold group and 149±4 minutes in the Tepid group. Recovery rate of spontaneous rhythm after cross-clamp removal and postoperative left ventricular stroke work index were significantly greater in the Tepid group than those in the Cold group. Duration of ventilation and ICU stay were significantly shorter and total release of CK-MB, requirements of dopamine during 48 hours after the operation and the incidence of low-output syndrome were significantly less in the Tepid group. There were no early deaths in the Tepid group versus three early deaths in the Cold group. In conclusion, intermittent tepid blood cardioplegia provided superior postoperative cardiac function and clinical results to conventional cold crystalloid cardioplegia, thus the technique appears to be safe for patients requiring prolonged aortic cross-clamping.

Changes of Thyroid Function and Hemodynamic State in Patients Undergoing Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

Perioperative changes in thyroid function and hemodynamic state were studied in 6 hypothyroid patients and 15 euthyroid patients who underwent coronary artery bypass grafting. Serum free T₃ and total T₃ concentrations declined significantly in hypothyroid patients after the surgery. Serum total T₃ concentration decreased significantly also in euthyroid patients, indicating the occurrence of“euthyroid sick syndrome”in this group. Hypothyroid patients resulted in significantly lower left ventricular stroke work index despite greater central venous pressure and pulmonary capillary wedge pressure, and greater requirements of dopamine and dobutamine compared with those in euthyroid patients. The results indicated poorer postoperative cardiac performance in hypothyroid patients. Serum free T₃ concentration after cardiopulmonary bypass demonstrated a significant positive correlation with left ventricular stroke work index measured simultaneously. Preoperative serum free T₃ concentration showed a significant negative correlation with the postoperative dopamine and dobutamine requirements. Therefore, the results suggest that free T₃ has inotropic effects and the concentration of this hormone can be a predictor for a incidence of postoperative low cardiac output. In conclusion, since hypothyroid patients undergoing coronary artery bypass grafting are prone to have low cardiac output status, careful perioperative management, including hormone replacement therapy, is required for the patients.

A Case of Two-staged Operation for Stanford Type B Dissecting Aneurysms with Acute Renal Failure / 日本心臓血管外科学会雑誌

A 59-year-old man was admitted for treatment of Stanford type B acute dissecting aneurysm with acute renal failure. He had begun hemodialysis one month after onset, because digital subtraction angiography (DSA) revealed that the truelumen was narrowed by a dilated false channel just above the renal artery. Initially axillo-femoral bypass was performed to treat renal failure, and the patients was easily weaned from hemodialysis. Eight months after the first operation, descending thoracic aorta replacement was performed. The patient is doing well one year after operation. In conclusion, axillo-femoral bypass yielded good results because our patient recovered from renal failure and could undergo radical operation safely. Axillo-femoral bypass allowed evaluation of the hemodynamic study before radical operation.