Kazuhiro P. Izawa

Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: a randomized, controlled trial.

Izawa KP, Watanabe S, Omiya K, Hirano Y, Oka K, Osada N, Iijima S: Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: A randomized, controlled trial. Am J Phys Med Rehabil 2005;84:313–321. Objective:To evaluate the effect of the self-monitoring approach (SMA) on self-efficacy for physical activity (SEPA), exercise maintenance, and objective physical activity level over a 6-mo period after a supervised 6-mo cardiac rehabilitation (CR) program. Design:We conducted a randomized, controlled trial with 45 myocardial infarction patients (38 men, seven women; mean age, 64.2 yrs) recruited after completion of an acute-phase, exercise-based CR program. Patients were randomly assigned to an SMA group (n = 24) or control group (n = 21). Along with CR, the subjects in the SMA group self-monitored their weight and physical activity for 6 mos. The SMA used in this study was based on Bandura’s self-efficacy theory and was designed to enhance confidence for exercise maintenance. The control group participated in CR only. All patients were evaluated with the SEPA assessment tool. Exercise maintenance, SEPA scores, and objective physical activity (average steps per week) as a caloric expenditure were assessed at baseline and during a 6-mo period after the supervised CR program. Results:Mean period from myocardial infarction onset did not differ significantly between the SMA and control groups (12.1 ± 1.3 vs. 12.2 ± 1.2 mos, P = 0.692). All patients maintained their exercise routine in the SMA group. Mean SEPA score (90.5 vs. 72.7 points, P < 0.001) and mean objective physical activity (10,458.7 vs. 6922.5 steps/wk, P < 0.001) at 12 mos after myocardial infarction onset were significantly higher in the SMA than control group. SEPA showed significant positive correlation with objective physical activity (r = 0.642, P < 0.001). Conclusions:SMA during supervised CR may effectively increase exercise maintenance, SEPA, and objective physical activity at 12 mos after myocardial infarction onset.

Long-term exercise maintenance, physical activity, and health-related quality of life after cardiac rehabilitation

Izawa KP, Yamada S, Oka K, Watanabe S, Omiya K, Iijima S, Hirano Y, Kobayashi T, Kasahara Y, Samejima H, Osada N: Long-term exercise maintenance, physical activity, and health-related quality of life after cardiac rehabilitation. Am J Phys Med Rehabil 2004;83:884–892. Objective:The purpose of this study was to determine exercise maintenance rate, leisure-time objective physical activity level, and health-related quality of life in relation to exercise maintenance over the 6-mo period after a supervised 5-mo recovery-phase cardiac rehabilitation program in acute myocardial infarction patients. The study also investigated whether exercise maintenance resulted in reproducible health-related quality-of-life outcomes comparable with those of the Japanese normal population. Design:This observational study comprised 109 acute myocardial infarction patients (89 men, 20 women; mean age, 63.5 ± 10.1 yrs). Physiologic outcomes (peak oxygen uptake, handgrip, and knee-extension strength) measured at 1 and 6 mos after acute myocardial infarction onset were compared. Completed exercise maintenance and health-related quality-of-life questionnaires and results of electronic pedometer recordings to evaluate leisure-time objective physical activity level were assessed 6 mos after cardiac rehabilitation. Results:The mean period from acute myocardial infarction to evaluation of outcomes was 18.8 ± 3.4 mos. Ninety of 109 patients (82.6%) continued exercise for >6 mos after cardiac rehabilitation (exercise group); 19 patients (17.4%) quit exercise after cardiac rehabilitation (nonexercise group). Improvement in physiologic outcomes was noted at 6 mos vs. those at 1 mo, but outcomes were not significantly different between groups. The exercise group performed significantly better than the nonexercise group for leisure-time objective physical activity level and scored significantly higher than the nonexercise group for seven of eight health-related quality of life measures, attaining scores similar to those of the Japanese normal population. Conclusions:At >18 mos after acute myocardial infarction, the exercise maintenance rate in our patients remains high, and exercise maintenance may be one of the factors contributing to improvement of health-related quality of life and leisure-time objective physical activity level.

Handgrip strength as a predictor of prognosis in Japanese patients with congestive heart failure.

Background Whether upper-extremity and lower-extremity muscle strength can predict a prognosis of congestive heart failure (CHF) patients is unclear. This study evaluated the impact of muscle strength on long-term mortality in patients with CHF. Design Prospective observational study of male Japanese CHF patients. Methods Clinical characteristics (age, body mass index, left ventricular ejection fraction, heart failure etiology, and medications) were obtained from hospital records of 148 male outpatients with stable CHF. Brain natriuretic peptide was determined as an index of disease severity. Peak oxygen uptake ( V . O 2 ), handgrip, and knee extensor muscle strength were also determined. Results After 1331.9 ± 700.3 days of follow-up, 13 cardiovascular-related deaths occurred, and the patients were divided into two groups: survival (n = 135) and nonsurvival (n = 13). No significant differences were found between the groups in clinical characteristics, brain natriuretic peptide levels, and knee extensor muscle strength. Peak ( V . O 2 ) (P = 0.011) and handgrip strength (P = 0.008) were significantly lower in the nonsurvival versus survival group. Left ventricular ejection fraction, peak ( V . O 2 ), and handgrip strength were found by univariate Cox proportional hazards analysis to be significant prognostic indexes of survival. Multivariate analysis, however, revealed handgrip strength to be an independent predictor of prognosis. A handgrip strength cutoff value of 32.2 kgf was determined by the analysis of receiver-operating characteristics and was assessed. Kaplan-Meier survival curves after log-rank test showed significant prognostic difference between the two groups (P = 0.008). Conclusion Handgrip strength may be useful for forecasting prognosis in patients with CHF. Eur J Cardiovasc Prev Rehabil 16:21-27

Muscle strength in relation to disease severity in patients with congestive heart failure.

Izawa KP, Watanabe S, Yokoyama H, Hiraki K, Morio Y, Oka K, Osada N, Omiya K: Muscle strength in relation to disease severity in patients with congestive heart failure. Am J Phys Med Rehabil 2007;86:893–900. Objective:Indices of exercise capacity such as peak oxygen uptake (&OV0312;O2peak) and muscle strength are important in association with reduced mortality. The present study compared differences in &OV0312;O2peak and muscle strength indices (grip strength and knee extensor and flexor muscle strength) with disease severity and investigated the relation of these variables in congestive heart failure (CHF) patients. Design:The study comprised 102 patients with stable CHF (93 men, age 61.4 ± 10.2 yrs) with left ventricular ejection fraction (LVEF) <40% by echocardiography. We used New York Heart Association (NYHA) functional class to index disease severity. &OV0312;O2peak, grip strength, knee extensor, and flexor muscle strength were determined. Patients were divided into three groups by NYHA class: class I (n = 39), class II (n = 49), and class III (n = 14). Results:Age, sex, and LVEF did not differ according to NYHA class. &OV0312;O2peak and all muscle strength indices decreased with increases in NYHA class (P < 0.05). &OV0312;O2peak correlated positively with all muscle strengths (P < 0.05). Stepwise linear regression analysis revealed that grip and knee extensor strength were important in predicting &OV0312;O2peak. Conclusions:Exercise capacity and disease severity in CHF patients may be influenced not only by lower-limb but also upper-limb muscle strength.

GENDER-RELATED DIFFERENCES IN CLINICAL CHARACTERISTICS AND PHYSIOLOGICAL AND PSYCHOSOCIAL OUTCOMES OF JAPANESE PATIENTS AT ENTRY INTO PHASE II CARDIAC REHABILITATION

OBJECTIVE To examine gender differences in clinical characteristics and physiological and psychosocial outcomes at entry into phase II cardiac rehabilitation. DESIGN Cross-sectional study. SUBJECTS The study comprised 442 consecutive patients with cardiac diseases assessed at entry into a phase II cardiac rehabilitation programme. METHODS Clinical characteristics of the patients, such as age, education, marital status, employment and body mass index, were obtained from hospital records. Oxygen uptake, handgrip and knee extensor muscle strength were measured to assess physiological outcomes. Self-efficacy for physical activity, hospital anxiety depression scale and health-related quality of life assessed by Short Form-36 were evaluated to assess psychosocial outcomes. RESULTS The number of married women and their levels of education, employment and body mass index were significantly lower, and their ages higher, than those of the men. Measures of physiological outcome in women were significantly lower than those in men. Measures of self-efficacy for physical activity and Short Form-36 physical and emotional subscale scores were lower and anxiety levels higher in women than in men. CONCLUSION Cardiac rehabilitation programmes exclusively for women focusing on physiological outcomes, group counselling, and training to enhance physical and emotional domains may encourage increased participation by women in cardiac rehabilitation.

Age-related differences in physiologic and psychosocial outcomes after cardiac rehabilitation.

Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, Osada N, Omiya K, Iijima S: Age-related differences in physiologic and psychosocial outcomes after cardiac rehabilitation. Objective:To examine differences in physiologic and psychosocial outcomes between age groups after an exercise-based supervised-recovery phase II cardiac rehabilitation outpatient program. Design:This is a longitudinal observational study. The study assessed 442 consecutive cardiac patients. Patients were divided into the middle-aged group (<65 yrs, n = 242) and older-age group (≥65 yrs, n = 200). Peak oxygen uptake, handgrip and knee extensor muscle strength, upper- and lower-body self-efficacy for physical activity, and physical component summary and mental component summary scores as assessed by SF-36 were measured at 1 and 3 mos after the onset of acute myocardial infarction or cardiac surgery and were compared. Results:All physiologic and psychosocial outcomes increased significantly between months 1 and 3 in both groups. However, increases were greater in the middle-aged vs. older-aged group in peak oxygen uptake (+13.1% vs. +8.7%, P < 0.01), knee extensor muscle strength (+17.6% vs. +13.3%, P = 0.01), lower-body self-efficacy for physical activity (+17.3% vs. +12.7%, P = 0.02), and physical component summary score (+5.4% vs. +2.7%, P = 0.02). Conclusions:Age-related differences in various physiologic and psychosocial measures indicated greater improvement from an exercise-based supervised recovery-phase II cardiac rehabilitation outpatient program in middle-aged vs. older-aged patients. Older adults may derive equal mental or emotional benefit from such a cardiac rehabilitation program but do not experience as much improvement in physiologic outcomes as middle-aged adults.

The relation between Geriatric Nutritional Risk Index and muscle mass, muscle strength, and exercise capacity in chronic heart failure patients.

a Graduate School of Health Sciences, Kobe University, Kobe, Japan b Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan c Department of Physical Therapy, Tokushima Bunri University, Tokushima, Japan d Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan e Division of Cardiology, St. Marianna University Toyoko Hospital, Kawasaki, Japan f Department of Cardiology, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan g Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA h Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan i Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

Peak time of acute coronary syndrome in patients with sleep disordered breathing.

BACKGROUND Recently, sleep disordered breathing (SDB) has gained attention in the field of cardiology. Until now, no study describing the relationship between acute coronary syndrome (ACS) and SDB has been carried out in Japan. METHODS Among ACS patients admitted to our hospital, 44 patients (mean age 60.6+/-13.5 years) who received a portable polysomnography to measure apnea hypopnea index (AHI) were selected for this study. The circadian pattern of ACS onset was studied in 6-h intervals. In addition, all subjects were divided into three groups according to AHI severity (AHI < 5, 5 < or = AHI < 15, and 15 < or = AHI). Then, a comparative study between peak time of ACS and AHI severity was conducted for each group. RESULTS In the AHI < 5 group, 66.0% patients suffered from ACS between 12:00 h and 18:00 h and 17.0% between 18:00 h and 24:00 h, and a total of 83.0% patients had ACS between 12:00 h and 24:00 h. In the 5 < or = AHI < 15 group, 49.9% patients had ACS between 24:00 h and 06:00 h, 16.7% patients between 06:00 h and 12:00 h. 12:00-18:00 h and 18:00-24:00 h showed no significant difference. All 22 patients in the 15 < or = AHI group suffered from ACS between 24:00 h and 12:00 h. CONCLUSION The results of this study suggest a possible relationship between SDB and the onset of ACS between midnight to morning.

Determination of the Effectiveness of Accelerometer Use in the Promotion of Physical Activity in Cardiac Patients: A Randomized Controlled Trial

OBJECTIVE To investigate the effect of the self-monitoring of physical activity by hospitalized cardiac patients attending phase I cardiac rehabilitation (CR). DESIGN Randomized controlled trial. SETTING University hospital CR program. PARTICIPANTS CR patients (N=126) with a mean age of 59.1 years. INTERVENTIONS Patients were randomly assigned to the self-monitoring group (group A, n=63) or the control group (group B, n=63). Along with CR, group A patients performed self-monitoring of their physical activity at the beginning of a phase I CR program (acute in-hospital phase for inpatients) and ending just before they began a phase II CR program (postdischarge recovery phase for outpatients). MAIN OUTCOME MEASURES Physical activity (averages of daily number of steps taken and daily energy expenditure for 1wk) as measured by accelerometer was assessed in both groups at baseline (t1) and before the beginning of phase II CR (t2). RESULTS Although there were no significant differences in physical activity values between groups A and B at t1, values of group A at t2 were significantly higher than those of group B (8609.6 vs 5512.9 steps, P<.001; 242.6 vs 155.9kcal, P<.001). CONCLUSIONS Self-monitoring of patient physical activity from phase I CR might effectively increase the physical activity level in preparation for entering a phase II CR program. Results of the present study could contribute to the development of new strategies for the promotion of physical activity in cardiac patients.

Relationship of thresholds of physical performance to nutritional status in older hospitalized male cardiac patients.

Nutrition is the focus of a new treatment target in older hospitalized cardiac patients. However, little is known about the differences in nutritional status in relation to physical performance in these inpatients. We determined the differences in physical performance based on the Geriatric Nutritional Risk Index (GNRI) and physical performance cut‐off values according to the GNRI in older male cardiac inpatients.