Home-based exercise may not decrease the insulin resistance in individuals with metabolic syndrome.

BACKGROUND: This study investigated the differences in exercise self-efficacy, compliance, and effectiveness of home-based exercise in individuals with and without metabolic syndrome (MetS). METHODS: One hundred and ten individuals at risk for diabetes participated in this study. Subjects were categorized into individuals with MetS and individuals without MetS. Metabolic risk factors and exercise self-efficacy were evaluated for all subjects before and after 3 months of home-based exercise. Univariate analysis of variance was used to compare the effectiveness of a home-based exercise program between individuals with and without MetS. RESULTS: The home-based exercise program improved body mass index and lipid profile in individuals at risk for diabetes, regardless of MetS status at baseline. Individuals without MetS had higher exercise self-efficacy at baseline and performed greater exercise volume compared with individuals with MetS during the intervention. The increased exercise volume in individuals without MetS may contribute to their better control of insulin resistance than individuals with MetS. Furthermore, baseline exercise self-efficacy was correlated with exercise volume executed by subjects at home. CONCLUSIONS: We conclude that home-based exercise programs are beneficial for individuals at risk for diabetes. However, more intensive and/or supervised exercise intervention may be needed for those with MetS.

Increased patellar tendon microcirculation and reduction of tendon stiffness following knee extension eccentric exercises.

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To measure and compare patellar tendon stiffness and microcirculation in college tennis players and nonathletic students when performing eccentric knee extension exercises that do and do not reduce tendon stiffness. BACKGROUND: Previous studies suggest that tendon microcirculation response during exercises may vary based on the tendon's plastic properties. Methods The study included 3 groups of college-age male students: tennis players who performed 4 sets of either 40 (n = 12) or 80 (n = 13) repetitions of eccentric knee extension exercise and nonathletic students (n = 14) who performed 4 sets of 40 repetitions. Tendon stiffness was measured before and after exercise completion. Changes in total hemoglobin and oxygen saturation (OSat) were analyzed while performing the 4 sets. Comparisons were made within and between the groups. The level of association between tendon microcirculation and stiffness reduction was assessed. RESULTS: The 2 groups (player/4 × 80 and student/4 × 40) exhibiting patellar tendon stiffness reductions (P<.008) showed higher total hemoglobin and OSat levels, above the pre-exercise levels, in the fourth set compared to the first set of exercises (P<.004). The tennis players who performed 4 sets of 40 repetitions exhibited higher OSat levels in the fourth set than in the first set (P = .004) but had no reduction in tendon stiffness. Changes in OSat levels in the fourth set were correlated with patellar tendon stiffness reductions (r = -0.381, P = .02). CONCLUSION: We conclude that there was increased patellar tendon microcirculation after performing knee extension eccentric exercises that resulted in a reduction in tendon stiffness.

Reduced risk for metabolic syndrome and insulin resistance associated with ovo-lacto-vegetarian behavior in female Buddhists: a case-control study.

INTRODUCTION: The association of vegetarian status with the risk of metabolic syndrome (MetS) is not clear. In Asia, Buddhists often have vegetarian behavior for religious rather than for health reasons. We hypothesize that the vegetarian in Buddhism is associated with better metabolic profiles, lower risk for the MetS and insulin resistance (IR). METHODS: We enrolled 391 female vegetarians (~80% lacto-ovo-vegetarians) and 315 non-vegetarians from health-checkup clinics at a Buddhist hospital in Taiwan. RESULTS: The vegetarian status was associated with lower body mass index, smaller waist circumference, lower total cholesterol, lower low density lipoprotein-cholesterol (LDL-C), and lower HDL-C in multivariate linear regression analyses. Despite having lower HDL-C level, the vegetarians had significantly lower total cholesterol/HDL-C and LDL-C/HDL-C ratios. After adjusting the other covariates, the risks for the MetS were lower for ovo-lacto-vegetarians of 1-11 years and >11 years respectively by 54% (odds ratio [OR] =0.46, 95%C.I.:0.26-0.79) and 57% (OR=0.43, 95%C.I.:0.23-0.76) compared to non-vegetarians by the IDF criteria. Likewise, they were lower respectively by 45% (OR=0.55, 95%C.I.:0.32-0.92) and 42% (OR=0.58, 95%C.I.:0.33-0.997), for the MetS by the modified NCEP criteria. In the subgroup of non-diabetic subjects, the vegetarians also had lower risk for IR by HOMA compared to the non-vegetarians (OR=0.71, 95%C.I.:0.48-1.06). CONCLUSION: The vegetarian behavior, mainly lacto-ovo-vegetarian, related to Buddhism, although not meant for its health effects, is associated with reduced risk for the MetS and IR and may potentially provide metabolic and cardiovascular protective effects in women.

Electrophysiologic changes with incremental exercise in obstructive sleep apnea.

INTRODUCTION: In patients with obstructive sleep apnea (OSA), intermittent apnea and hypopnea might cause different adaptations in inspiratory and peripheral muscles. In this study we aimed to determine the changes that occur in muscle activation characteristics during incremental exercise testing in patients with severe OSA. Surface electromyography of inspiratory muscles and knee extensors was performed. METHODS: Eleven men with severe OSA and 11 matched controls were recruited. Changes in muscle activity were compared by determining root mean square (RMS) and median power frequency (MPF) values obtained at different exercise intensities. RESULTS: The ratios of RMS to oxygen consumption in inspiratory muscles and vastus lateralis increased significantly at peak workload in the control group (P < 0.05), but not in the OSA group. CONCLUSIONS: Patients with severe OSA demonstrated an inability to increase motor unit recruitment of inspiratory muscles and knee extensors during incremental exercise.

Gender differences in myocardial perfusion defect in asymptomatic postmenopausal women and men with and without diabetes mellitus.

BACKGROUND: To compare the results of myocardial perfusion imaging (MPI) of asymptomatic postmenopausal women and age-matched men and to investigate the effect of diabetes mellitus (DM) on gender differences and the risk estimation of coronary heart disease (CHD). METHODS: Sixty-seven postmenopausal women and 27 men low in Framingham Global Risk Score (FGRS) were recruited from year 2008 to 2009 in northern Taiwan. Each subject underwent blood tests, a cardiopulmonary exercise test, an electrocardiograph (ECG), and MPI. RESULTS: Women had similar percentages of predicted oxygen consumption and ECG changes at peak exercise, but lower oxygen pulse and rate-pressure product. They also had significantly higher summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) than men, despite showing much lower scores for the FGRS than men. Women with DM had a lower 10-year risk of CHD assessed by the United Kingdom Prospective Diabetes Study (UKPDS) risk engine, but significantly higher SSS and SDS than men. In the subjects with abnormal MPI, the extent of ischemia was small to moderate in men, whereas in 50% of the women, the extent of ischemia was large. CONCLUSION: The results of this preliminary study suggest that asymptomatic postmenopausal women had more abnormalities in MPI and those with DM had a higher SSS and SDS than age-matched men. The risk of CAD may still be underestimated by the UKPDS.

The effects of exercise training on levels of vascular endothelial growth factor in tumor-bearing mice.

BACKGROUND: Vascular endothelial growth factor (VEGF) affects tumor growth and metastasis by mediating angiogenesis. Vascular endothelial growth factor overexpression is considered a predictor of poor prognosis in cancer patients. Exercise may increase the circulating levels of VEGF, which is important to angiogenesis. We examined the effects of exercise training on VEGF levels and tumor growth in male C57BL/6 mice inoculated with Lewis lung cancer cells. METHODS: Thirty-two mice were randomly assigned to either the tumor control (TC, n=16) group or the tumor exercise (TE, n=16) group. Half of the mice in TE group received aerobic interval exercise training, and the other half received aerobic continuous exercise training for 4 weeks. The animal weights and tumor volumes were assessed three times per week. Serum VEGF levels were determined at baseline, 2 and 4 weeks. The solid tumor, lung and liver were excised and evaluated at study completion. RESULTS: There was a significant increase in VEGF levels after the 4-week exercise training program in TE group, but no significant changes were observed in TC group. CONCLUSIONS: Although exercise training increased serum VEGF levels, group differences were not evident in our study. Exercise training did not alter the survival rate or tumor growth in tumor-bearing mice.

Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database.

BACKGROUND: Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients' functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. METHODS: Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. RESULTS: The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). CONCLUSIONS: In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet.

Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy.

PURPOSE: Peak oxygen consumption (VO(2peak)) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer (NSCLC). The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity, as assessed by VO(2peak), and other related factors in patients with NSCLC receiving targeted therapy. METHODS: A total of 24 participants with adenocarcinoma were randomly assigned to either the control group (n = 11) or the exercise group (n = 13). Subjects in the exercise group participated in individualized, high-intensity aerobic interval training of exercise. The outcome measures assessed at baseline and after 8 weeks were as follows: VO(2peak) and the percentage of predicted VO(2peak) (%predVO(2peak)), muscle strength and endurance of the right quadriceps, muscle oxygenation during exercise, insulin resistance as calculated by the homeostasis model, high-sensitivity C-reactive protein, and quality of life (QoL) questionnaire inventory. RESULTS: No exercise-related adverse events were reported. After exercise training, VO(2peak) and %predVO(2peak) increased by 1.6 mL kg(-1) min(-1) and 5.3% (p < 0.005), respectively; these changes were associated with improvements in circulatory, respiratory, and muscular functions at peak exercise (all p = 0.001). The exercise group also had less dyspnea (p = 0.01) and favorably lower fatigue (p = 0.05) than baseline. CONCLUSIONS: Patients with NSCLC receiving targeted therapy have quite a low exercise capacity, even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms.

Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis.

OBJECTIVES: To determine the effect of exercise on the physical function, activities of daily living (ADLs), and quality of life (QOL) of the frail older adults. DATA SOURCES: Relevant articles published between 2001 and June 2010 were searched in PubMed, MEDLINE, EMBASE, the Chinese Electronic Periodical Service, CINAHL, and the Cochrane Library databases. STUDY SELECTION: The participants were selected based on the predetermined frailty criteria and randomly assigned to either an exercise or control group. The intervention for the exercise group was a single or comprehensive exercise training program, whereas usual care was provided to the control group. DATA EXTRACTION: The characteristics and outcome measures of the included studies were identified independently by 2 investigators. DATA SYNTHESIS: The effect sizes of physical function assessed by the timed up and go test, gait speed, the Berg Balance Scale (BBS), the ADL questionnaires, and QOL measured by the Medical Outcomes Study 36-Item Short-Form Health Survey were calculated, using a weighted mean difference (WMD) and a 95% confidence interval (CI) to represent the results. Compared with the control group, the exercise group increased their gait speed by .07 m/s (95% CI .02-.11), increased their BBS score (WMD=1.69; 95% CI .56-2.82), and improved their performance in ADLs (WMD=5.33; 95% CI 1.01-9.64). The exercise intervention had no significant effects on the Timed Up & Go test performance and the QOL between the groups. CONCLUSIONS: Exercise is beneficial to increase gait speed, improve balance, and improve performance in ADLs in the frail older adults.

C-reactive protein and heart rate recovery in middle-aged men with severe obstructive sleep apnea.

OBJECTIVE: The study aimed to evaluate whether the inflammatory marker "high-sensitivity C-reactive protein (hsCRP)" level was associated with impaired heart rate recovery at 1 min after exercise termination (HRR-1) in middle-aged patients with severe obstructive sleep apnea (OSA). METHODS: Thirty middle-aged male patients (40-64 years old) with severe OSA (apnea-hypopnea index [AHI] ≥ 30 h(-1)) and 30 subjects without OSA (AHI < 5 h(-1)), matched with age and body mass index (BMI), were recruited. All subjects underwent an overnight polysomnography and completed a symptom-limited maximal exercise test. Cardiopulmonary parameters included peak oxygen consumption (VO(2peak)) and heart rate response during and immediately after exercise. Fasting blood samples were drawn for hsCRP analysis. RESULT: Patients with severe OSA had significantly higher hsCRP levels (0.18 vs. 0.07 mg/dl, P < 0.01), lower reduced HRR-1, peak heart rate, and VO(2peak) values than those in the controls. The hsCRP levels significantly correlated with HRR-1 in the OSA group (r = -0.69, P < 0.01) after adjustment for VO(2peak) (r = -0.66, P < 0.01). Furthermore, stepwise multiple regression analysis showed that HRR-1 and AHI were significant predictors of hsCRP levels in all participants (adjusted R(2) = 0.53, P < 0.01). CONCLUSIONS: Blunted HRR was shown in middle-aged men with severe OSA, and it was associated with high hsCRP levels significantly.

Myocardial perfusion image in asymptomatic postmenopausal women with physical inactivity and overweight.

OBJECTIVE: This study aimed to investigate whether physical inactivity and overweight deteriorate myocardial perfusion and cardiac function in asymptomatic postmenopausal women. METHODS: A prospective cross-sectional study design was used. Postmenopausal women recruited in this study were categorized into groups based on activity level and BMI: physically active, normal-weight group (PANw, n = 15, 60.9 ± 6.0 years), physically inactive, normal-weight group (PIANw, n = 13, 57.2 ± 5.0 years) and physically inactive, overweight group (PIAO, n = 26, 58.5 ± 5.8 years). Each subject took cardiopulmonary function tests and ECG-gated exercise (201)Tl myocardial perfusion imaging (MPI). Perfusion abnormalities, cardiac function indices, and (201)Tl lung-to- heart ratio (LHR) were derived. RESULTS: The PIANw women had lower exercise capacity than PANw women. More subjects in PIANw (46%) or PIAO (48%) groups had worsening in left ventricular ejection fraction (LVEF) by exercise than subjects in PANw (7%) group. The PIAO women exhibited significantly lower exercise capacity and higher rest LHR than PANw women (LHR 0.41 ± 0.05 vs. 0.36 ± 0.06; p = 0.014). Abnormal MPI tended to increase in PIANw (38%) and PIAO (46%) women when compared with the PANw (27%) group. CONCLUSIONS: Physically inactive, overweight postmenopausal women had higher rest (201)Tl lung uptake and worsening LVEF by exercise and tended to have higher prevalence of inducible ischemia, suggesting higher cardiovascular risks although asymptomatic.

Effects of exercise training in heart transplant recipients: a meta-analysis.

OBJECTIVES: Muscle wasting and exercise intolerance are common in heart transplant recipients. Most studies on the effects of exercise training have used relatively small sample sizes and are heterogeneous in nature. The purpose of this meta-analysis was to systematically review the relevant studies and investigate the effects of exercise training on exercise capacity and muscle strength in heart transplant recipients. METHODS: A systematic search was adopted from electronic databases and relevant references, using medical subject heading key words related to heart transplantation and exercise. Only randomized controlled trials with exercise intervention versus usual care were included. The data were expressed as the weighted mean differences with 95% confidence intervals (CIs). RESULTS: Altogether 6 studies were included. Peak oxygen consumption (VO(2)) was reported in 4 trials (117 patients), and muscle strength was reported in 3 trials (67 patients). Peak VO(2) was significantly increased by 2.34 ml/kg/min (95% CI 0.63-4.05). One-repetition maxima of the chest press (23.28 kg, 95% CI 0.64-45.91) and leg press (28.84 kg, 95% CI 5.70-51.98) were significantly improved by exercise training. CONCLUSION: Exercise training is recommended for heart transplant recipients to improve peak VO(2) and muscle strength despite the small number of trials included in this meta-analysis.

Physical training is beneficial to functional status and survival in patients with prolonged mechanical ventilation.

BACKGROUND/PURPOSE: Early physical training is necessary for severely deconditioned patients undergoing prolonged mechanical ventilation (PMV), because survivors often experience prolonged recovery. Long-term outcomes after physical training have not been measured; therefore, we investigated outcome during a 1-year period after physical training for the PMV patients. METHODS: We conducted a prospective randomized control trial in a respiratory care center. Thirty-four patients were randomly assigned to the rehabilitation group (n = 18) and the control group (n = 16). The rehabilitation group participated in supervised physical therapy training for 6 weeks, and continued in an unsupervised maintenance program for 6 more weeks. The functional independence measurement (FIM) was used to assess functional status. Survival status during the year after enrollment, the number of survivors discharged, and the number free from ventilator support were collected. These outcome parameters were assessed at entry, immediately after the 6 weeks physical therapy training period, after 6 weeks unsupervised maintenance exercise program, and 6 months and 12 months after study entry. RESULTS: The scores of total FIM, motor domain, cognitive domain, and some sub-items, except for the walking/wheelchair sub-item, increased significantly in the rehabilitation group at 6 months postenrollment, but remained unchanged for the control group. The eating, comprehension, expression, and social interaction subscales reached the 7-point complete independence level at 6 months in the rehabilitation group, but not in the control group. The 1-year survival rate for the rehabilitation group was 70%, which was significantly higher than that for the control group (25%), although the proportion of patients discharged and who were ventilator-free in the rehabilitation and control groups did not differ significantly. CONCLUSION: Six weeks physical therapy training plus 6 weeks unsupervised maintenance exercise enhanced functional levels and increased survival for the PMV patients compared with those with no such intervention. Early physical therapy interventions are needed for the PMV patients in respiratory care centers.

Effect of aerobic interval training on exercise capacity and metabolic risk factors in people with cardiometabolic disorders: a meta-analysis.

PURPOSE: To compare the effectiveness of high-intensity aerobic interval training (AIT) with active recovery and continuous moderate-intensity exercise (CME) on exercise capacity and metabolic risk factors in adults with cardiometabolic disorders through a systematic review and meta-analysis. METHODS: Studies were selected from 5 electronic databases (PubMed, MEDLINE, CINAHL, Physiotherapy Evidence Database [PEDro] and Cochrane Library Register of Controlled Trials). Randomized controlled trials (RCTs), published in English, that compared the effects of AIT with CME on exercise capacity and metabolic risk factors in adults with cardiometabolic disorders were included. Aerobic interval training was defined as high-intensity training separated by active recovery periods; CME incurred identical energy expenditure as AIT. Each trial was evaluated using the PEDro scale. Weighted mean difference (WMD) and 95% CIs were used to determine the effect size for each outcome. RESULTS: Six RCTs with 153 participants (40 overweight/obesity, 19 with metabolic syndrome, and 94 with heart disease) were included. The mean value on the PEDro scale for these studies was 5.0. Aerobic interval training significantly increased peak oxygen consumption (WMD, 3.6 mL·kg·min; 95% CI, 2.3-4.9) with a trend of decreasing fasting glucose (WMD, -0.4 mmol/L; 95% CI, -0.9 to 0.2, P = .18) compared with CME. The effects on other metabolic risk factors were similar between AIT and CME. CONCLUSION: Analysis of a limited number of studies with small sample sizes indicates that AIT is superior to CME in terms of improving exercise capacity. Further high quality studies with larger sample size are required to confirm this finding in adults with cardiometabolic disorders.

Home-based exercise improves the quality of life and physical function but not the psychological status of people with chronic heart failure: a randomised trial.

QUESTIONS: Are anxiety and depression correlated with physical function, disability, and quality of life in people with chronic heart failure? Does 8 weeks of home-based exercise improve anxiety, depression, physical function, disability, and quality of life in these patients? Do the changes in these outcomes correlate? DESIGN: Randomised trial. PARTICIPANTS: 51 people with clinically stable chronic heart failure were randomised into an experimental group (n=24) or a control group (n=27). INTERVENTION: The experimental group undertook an individualised home-based exercise program, 30 minutes per session, 3 sessions per week for 8 weeks, with regular telephone follow-up and consultations. The control group maintained their usual activity during this period. OUTCOME MEASURES: The Hospital Anxiety and Depression Scale, six-minute walk test, Groningen Activity Restriction Scale, and Minnesota Living with Heart Failure Questionnaire were administered at baseline and 8 weeks. RESULTS: At baseline, anxiety and depression were inversely moderately correlated with walking distance, activity, and quality of life. Compared with controls, the experimental group improved significantly more in their walking distance (by 21m, 95% CI 7 to 36) and their quality of life (by 7 points on the 105-point Minnesota score, 95% CI 1 to 12). In the experimental group, the changes in quality of life correlated moderately strongly with changes in anxiety (r=0.539, p=0.01). CONCLUSIONS: Anxiety and depression were associated with physical function, disability, and quality of life in people with chronic heart failure. Home-based exercise improved quality of life and physical function significantly but not psychological status in these patients.

Comparison of inspiratory muscle strength training effects between older subjects with and without chronic obstructive pulmonary disease.

BACKGROUND/PURPOSE: Inspiratory muscle strength training (IMST) has been traditionally recommended for patients with chronic obstructive pulmonary disease (COPD) to improve respiratory strength. Respiratory strength is reduced as age increases. However, few studies have focused on the effects of IMST on older adults without COPD. METHODS: Subjects were divided into training non-COPD (TNC, n = 24) and training COPD (TC, n = 12) according to their forced expiratory volume in 1 second (% predicted). Both groups received 6 weeks of IMST, with training at 75-80% of maximal inspiratory pressure using pressure threshold trainers. A second group of COPD subjects served as controls (CC, n = 24), which received no training. Dyspnea was measured using the basic dyspnea index. Health-related quality of life was measured using the SF-36. The SF-36 subcategories, physical component summary and mental component summary were compared. A 6-minute walk test was performed to determine functional status. Two-way repeated measures analysis of variance was used to compare group effects and training effects of IMST. RESULTS: Maximal inspiratory pressure was increased in both training groups (TNC: 59.1 cmH(2)O pre-IMST to 82.5 cmH(2)O post-IMST; TC: 53.2 to 72.6), but not in the CC group. Therefore, the basic dyspnea index was improved in both training groups (TNC: 9.6 to 10.8; TC: 6.2 to 7.3). Functional status was improved in the TNC group (TNC: 392.1 m to 436.3 m), but not in the TC or CC groups. Quality of life was improved in the physical component summary in both training groups. CONCLUSION: IMST increases maximal inspiratory pressure, relieves dyspnea and improves health-related quality of life in older adults. IMST especially improves functional status in subjects without COPD. IMST benefits subjects with COPD and those without COPD. Therefore, IMST as a treatment tool is not confined to patients with COPD.

The application of infrared thermography in evaluation of patients at high risk for lower extremity peripheral arterial disease.

OBJECTIVE: We investigated the usefulness of infrared thermography in evaluating patients at high risk for lower extremity peripheral arterial disease (PAD), including severity, functional capacity, and quality of life. METHODS: A total of 51 patients (23 males; age 70 ± 9.8 years) were recruited. They completed three PAD-associated questionnaires, including walking impairment, vascular quality of life, and 7-day physical activity recall questionnaires before a 6-minute walking test (6MWT). Ankle-brachial index (ABI) and segmental pressure were analyzed for PAD diagnosis and stenotic level assessment. The cutaneous temperature at shin and sole were recorded by infrared thermography before and after the walk test. Detailed demographic information and medication list were obtained. RESULTS: Twenty-eight subjects had abnormal ABI (ABI <1), while PAD was diagnosed in 20. No subjects had non-compressible artery (ABI >1.3). Demographic profiles and clinical parameters in PAD and non-PAD patients were similar, except for age, smoking history, and hyperlipidemia. PAD patients walked shorter distances (356 ± 102 m vs 218 ± 92 m; P < .001). Claudication occurred in 14 patients, while seven failed in completing the 6MWT. The rest temperatures were similar in PAD and non-PAD patients. However, the post-exercise temperature dropped in the lower extremities with arterial stenosis, but was maintained or elevated slightly in the extremities with patent arteries (temperature changes at sole in PAD vs non-PAD patients: -1.25 vs -0.15°C; P < .001). The exercise-induced temperature changes at the sole were not only positively correlated with the 6MWD (Spearman correlation coefficient = 0.31, P = .03), but was also correlated with ABI (Spearman correlation coefficient = 0.48, P < .001) and 7-day physical activity recall scores (Spearman correlation coefficient = 0.30, P = .033). CONCLUSION: By detecting cutaneous temperature changes in the lower extremities, infrared thermography offers another non-invasive, contrast-free option in PAD evaluation and functional assessment.

Home-based exercise for middle-aged Chinese at diabetic risk: a randomized controlled trial.

OBJECTIVE: To evaluate short- (3 months) and long-term (9 months) effects of home-based exercise on adiponectin, exercise behavior and metabolic risk factors in middle-aged adults at diabetic risk. METHODS: One hundred and thirty-five middle-aged adults (38 men, 97 women) with at least one diabetic risk factor were randomly assigned to either a home-based exercise group (Ex-group) or a usual care group (C-group). Outcome measures included plasma adiponectin, exercise self-efficacy, physical activity, and metabolic risk factors, as follows: insulin levels, insulin resistance by homeostasis model assessment (HOMA-IR), physical fitness, and components of metabolic syndrome. This study was conducted in metropolitan Taipei from 2004 to 2005. RESULTS: The Ex-group had improvements in exercise self-efficacy (+2.5, p = 0.01), body mass index (BMI) (-0.6 kg/m2, p < 0.001) and flexibility (+2.4 cm, p < 0.001) at 3-month follow-up and maintained BMI and flexibility at 9-month follow-up. The Ex-group exhibited significantly increased physical activity while the C-group exhibited decreased physical activity at 9-month follow-up (p < 0.001). No intervention effect was found on adiponectin (p = 0.64) or other outcome measures over time. CONCLUSIONS: Home-based exercise did not improve adiponectin levels, but significantly improved exercise behavior, and certain metabolic risk factors, with the effects maintained for 9-months in subjects with type 2 diabetic risk.

Vascular endothelial growth factor-A and changes in a tumor-bearing mouse model with Lewis lung cancer.

Vascular endothelial growth factor-A (VEGF-A) affects tumor growth and metastasis through stimulation of angiogenesis. The purpose of this study was to describe features of Lewis lung cancer (LLC) in mice and compare the serum VEGF-A levels with those of normal control mice. Two groups of mice were compared: one was subcutaneously injected with LLC cells (n=16) and the other served as the normal control (n=6). The serum VEGF-A levels were measured by ELISA prior to inoculation, and at 7, 21 and 35 days post-inoculation. The tumor weight and the metastatic condition were evaluated on day 35. Changes in body weight and serum VEGF-A concentration over a period of time were compared between the groups using generalized estimating equations. The relationship between the primary tumor and the metastatic condition was analyzed using the Spearman's rank correlation test. The survival rate was 56.3% on day 35 post-tumor inoculation. No difference was found between the groups with regard to gastrocnemius muscle weight on day 35 post-inoculation [0.1315±0.0066 g vs. 0.1308±0.0069 g (normal control)]. In tumor-bearing mice, the weight gain at sacrifice was less (0.24±0.45 vs. 1.93±0.47 g, P=0.01), the final mean tumor volume and weight were 4264.69±1038.32 mm(3) and 3.70±0.83 g, the number of nodules in the lungs and livers was 6.33 (range 0-20) and 2.22 (range 0-11), respectively, and the serum VEGF-A levels were significantly higher than those of control mice. In conclusion, lower body weight gain, metastasis in the liver and lungs, and elevated VEGF-A levels are features of LLC in mice.

Sarcopenia, cardiopulmonary fitness, and physical disability in community-dwelling elderly people.

BACKGROUND: Sarcopenia refers to the loss of skeletal muscle mass with aging. It is believed to be associated with functional impairment and physical disability. OBJECTIVE: The purposes of this study were: (1) to compare the physical activity, muscle strength (force-generating capacity), cardiopulmonary fitness, and physical disability in community-dwelling elderly people with sarcopenia, borderline sarcopenia, and normal skeletal muscle mass in Taiwan and (2) to test the hypothesis that sarcopenia is associated with physical disability and examine whether the association is mediated by decreased muscle strength or cardiopulmonary fitness. DESIGN: This was a cross-sectional investigation. METHODS: Two hundred seventy-five community-dwelling elderly people (148 men, 127 women) aged > or =65 years participated in the study. The participants were recruited from communities in the district of Zhongzheng, Taipei. Predicted skeletal muscle mass was estimated using a bioelectrical impedance analysis equation. The skeletal muscle mass index (SMI) was calculated by dividing skeletal muscle mass by height squared. Physical disability was assessed using the Groningen Activity Restriction Scale. Physical activity was assessed using a 7-day recall physical activity questionnaire. Cardiopulmonary fitness was assessed using a 3-minute step test, and grip strength was measured to represent muscle strength. RESULTS: Cardiopulmonary fitness was significantly lower in elderly people with sarcopenia than in those with normal SMIs. Grip strength and daily energy expenditure (kcal/kg/day) were not significantly different between the participants with sarcopenia and those with normal SMIs. The odds ratio for physical disability between the participants with sarcopenia and those with normal SMIs was 3.03 (95% confidence interval=1.21-7.61). The odds ratio decreased and the significant difference diminished after controlling for cardiopulmonary fitness. LIMITATIONS: A causal relationship between sarcopenia and physical activity, cardiopulmonary fitness, and physical disability cannot be established because of the cross-sectional nature of study design. CONCLUSIONS: Sarcopenia was associated with physical disability in elderly men. The association between sarcopenia and physical disability was mediated to a large extent by decreased cardiopulmonary fitness.