Relationships of Walking and non-Walking Physical Activities in Daily Life with Cognitive Function and Physical Characteristics in Male Patients with Mild Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is accompanied by dyspnea on exertion due to airflow limitation caused by bronchial stenosis, with afflicted patients being less physically active. Therefore, physical activity is important for disease management. OBJECTIVES: This study aimed to examine the relationships of walking and non-walking physical activities with cognitive function or physical characteristics of patients with mild COPD in a community without respiratory rehabilitation. DESIGN: Cross-sectional study. DATA SOURCES AND METHODS: We included 40 male patients (mean age, 75.7 ± 6.7 years) with stable mild COPD. A three-axis accelerometer was used to evaluate walking and non-walking physical activities in daily life. Cognition, respiratory function, skeletal muscle mass, limb muscle strength, exercise capacity, and health-related quality of life were assessed. RESULTS: Regarding daily exercise amount (metabolic equivalents × hours; Ex), 87.5% of the participants had walking activities of 0-2 Ex, while 67.5% had non-walking activities of 1-3 Ex. Walking activity was significantly correlated with cognitive function (P < .05), walking distance (P < .01), and health-related quality of life (P < .05), but not with muscle mass. However, non-walking activity was significantly correlated with the body mass index (P < .05), muscle mass (P < .05), and walking distance (P < .01), but not with cognitive function. Moreover, the relationship between non-walking activity and health-related quality of life was weaker than the corresponding relationship with walking activity. CONCLUSION: In patients with mild COPD, walking and non-walking physical activities showed different relationships with cognitive function and physical characteristics. The findings suggest that self-management of such patients requires maintenance of both walking and non-walking activities in a balanced manner.

Walking distance in incremental shuttle walking test as a predictor of physical activity in patients diagnosed with low-risk chronic obstructive pulmonary disease.

OBJECTIVES: Research on the determinants of physical activity in mildly symptomatic patients with chronic obstructive pulmonary disease is lacking. This study examined the predictors of physical activity in patients with low-risk chronic obstructive pulmonary disease. METHODS: A total of 41 male patients with chronic obstructive pulmonary disease belonging to Group A of the Global Initiative for Chronic Obstructive Lung Disease were included. Regarding the objective index, the physical activity (number of steps/day and the amount of Ex (metabolic equivalent × hours)/day) of the participants was measured with a tri-axis accelerometer. In addition, regarding the evaluation index, respiratory function and dynamic lung hyperinflation were measured by a spirometer, skeletal muscle mass was measured using bioelectrical impedance analysis, skeletal muscle strength (grip and lower limb muscle strength) was measured using a dynamometer, exercise capacity was measured by the incremental shuttle walking test, and health-related quality of life was measured. RESULTS: Significant correlations were found between the number of steps per day and age (ρ = -0.501, p < 0.01), forced vital capacity predictive values (ρ = 0.381, p < 0.05), dynamic lung hyperinflation (ρ = 0.454, p < 0.01), grip strength (ρ = 0.318, p < 0.05), and walking distance in incremental shuttle walking test (ρ = 0.779, p < 0.01), but not skeletal muscle mass, lower limb muscle strength, or health-related quality of life. A multiple-regression analysis with the number of steps per day as the dependent variable extracted only walking distance in incremental shuttle walking test, yielding a moderate single-regression equation (steps/day = -934.909 + 11.052 × walking distance in incremental shuttle walking test, adjusted R2 = 0.548, p < 0.001). CONCLUSION: It was suggested that the amount of physical activity of patients with low-risk chronic obstructive pulmonary disease could be predicted by walking distance in incremental shuttle walking test.

A simple way to treat mitral valve prolapse: chordal replacement using a new mitral leaflet retractor.

OBJECTIVES: The most difficult aspect of chordal replacement during mitral valve repair is to determine the correct length of the new chordae. A simple technique of chordal replacement was developed employing the new mitral leaflet retractor that enables easy adjustment of the length of artificial chordae. METHODS: For prolapse of the anterior mitral leaflet (AML), the level of the normal opposing posterior leaflet can be used to determine the length of new chordae. We developed a double-headed leaflet retractor with which both mitral leaflets can be retracted simultaneously at the same level. This retractor makes it easy to tie the slippery Gore-Tex sutures for artificial chordae adjusting the length of the new chordae on AML to the level of the opposing normal posterior leaflet. We employed this retractor for the creation of artificial chordae in 55 consecutive patients with degenerative AML prolapse between 2005 and 2013. A ring annuloplasty was concomitantly performed to stabilize the reconstruction. RESULTS: We had no hospital death. Follow-up was 100% complete with a mean follow-up duration of 1181 ± 839 (range 50-2892) days. Reoperation-free survival at 5 years was 98.2%. Freedom from moderate-to-severe mitral regurgitation was 88.0% at 5 years. At follow-up, all non-reoperated survivors were in New York Heart Association Class I or II. CONCLUSIONS: We have reported the chordal replacement using the new double-headed mitral leaflet retractor. Our leaflet retractor is a convenient tool representing an easy creation of artificial chordae in mitral valve repair.