Kuniyasu Kamiya

Frailty may be a risk marker for adverse outcome in patients with congestive heart failure

To examine the availability of frailty concept with objective criteria for risk stratification in patients with congestive heart failure (CHF).

Predictive impact of daily physical activity on new vascular events in patients with mild ischemic stroke.

Background Daily physical inactivity is associated with a substantially increased risk of cardiovascular events. However, the target level of daily physical activity remains unclear. Aim We aimed to evaluate the impact of physical activity on long-term vascular events in patients with mild ischemic stroke. Methods We designed a single hospital-based prospective observational study and studied 166 ischemic stroke patients (mean age: 63·9 ± 9·2) who had a modified Rankin Scale 0–1. We measured the daily step count as a variable of the daily physical activity after three-months from the stroke onset. Other clinical characteristics including age, body mass index, blood pressure, blood laboratory tests, vascular function and medications were also assessed. The primary outcomes were hospitalization due to stroke recurrence, myocardial infarction, angina pectoris and peripheral artery disease. Survival curves were calculated by a Kaplan–Meier survival analysis, and the hazard ratios for recurrences were determined by univariate and multivariate Cox proportional hazards regression models. Results After a median follow-up periods of 1332 days, 34 vascular events (23 stroke recurrences, 11 coronary artery disease) and 7 drop-outs occurred, and the remaining patients were divided into two groups: the without recurrence group (n = 125) and the with recurrence group (n = 34). The daily step count was lower in the nonsurvivor group than in the survivor group. Univariate and multivariate Cox proportional hazards analyses revealed that the daily step counts was independent predictors of new vascular events. A daily step count cutoff value of 6025 steps per day was determined by analyzing the receiver-operating characteristics that showed a sensitivity of 69·4% and a specificity of 79·4%. The Kaplan–Meier survival curves after a log-rank test showed a significantly lower event rate in the more than 6025 steps per day group compared with the less than 6025 steps per day group (P = 0·0002). The positive and negative predictive values of less than 6025 steps were 38·0% and 91·6%, respectively. Conclusion Our data indicate that daily physical activity evaluated by step counts may be useful for forecasting the prognosis in patients with mild ischemic stroke. Daily step counts of approximately 6000 steps per day may be an initial target level for reducing new vascular events.

Predictors for increasing eligibility level among home help service users in the Japanese long-term care insurance system.

Objectives. This cross-sectional study described the prevalence of possible risk factors for increasing eligibility level of long-term care insurance in home help service users who were certified as support level 1-2 or care level 1-2 in Japan. Methods. Data were collected from October 2011 to November 2011. Variables included eligibility level, grip strength, calf circumference (CC), functional limitations, body mass index, memory impairment, depression, social support, and nutrition status. Results. A total of 417 subjects (109 males and 308 females, mean age 83 years) were examined. There were 109 subjects with memory impairment. When divided by cut-off values, care level 2 was found to have higher prevalence of low grip strength, low CC, and depression. Conclusions. Some potentially modifiable factors such as muscle strength could be the risk factors for increasing eligibility level.

Risk factors for disability progression among Japanese long-term care service users: A 3-year prospective cohort study

To examine the predictive ability of memory deterioration and grip strength for disability progression among those who utilized the home‐help service.

Predicting the Future Need of Walking Device or Assistance by Moderate to Vigorous Physical Activity: A 2-Year Prospective Study of Women Aged 75 Years and Above

Objective To examine the association between daily moderate to vigorous physical activity (MVPA) and the change in mobility function among community-dwelling Japanese women aged 75 years and above. Methods This prospective study included 330 older women aged 75 years and above who could walk without a walking device or assistance. MVPA and light-intensity physical activity (LPA) were assessed using an accelerometer for seven consecutive days. MVPA was defined as an activity with an intensity of >3 metabolic equivalents. The study outcome was a change in mobility function, defined as the need of walking device or assistance, during the two-year period. Results The results of the logistic regression analysis showed that MVPA was inversely associated with a decline in mobility function after controlling for LPA and potential confounders (adjusted odds ratio (OR) = 0.93 per 1 min/d, 95% confidence interval (CI) = 0.88–0.99; P = 0.017), whereas LPA was not when adjusted for MVPA and confounders (adjusted OR = 0.99 per 1 min/d, 95% CI = 0.96–1.01; P = 0.245). The receiver operating characteristics analysis identified a 7.9 min/d of MVPA as the cut-off value. Conclusions The results of this study suggest the importance of promoting daily MVPA for preventing mobility limitation in older women aged 75 years and above.

Mechanical ventilatory assistance may reduce dyspnea during walking especially in patients with impaired cardiopulmonary function early after cardiovascular surgery.

BACKGROUND To determine which patients effectively respond to ventilatory assistance (VA) and to examine the factors influencing patient response in patients who underwent cardiovascular (CV) surgery. METHODS We conducted the first walking session after surgery either with or without VA in a randomized order. The patients walked with 3cmH2O of inspiratory pressure support. We measured dyspnea and leg fatigue during initial walking either with or without VA by using a modified Borg scale. Ventilatory parameters were measured by mechanical ventilation before and immediately after walking. Lung function and maximal inspiratory pressure (MIP) were measured and chest radiographs were analyzed by the same cardiac surgeon on the same day as walking. RESULTS From the total of 74 patients who underwent CV surgery, 56 patients were successively enrolled in the study. Thirty-five out of 56 patients had dyspnea and 18 patients (30% of the total patients) effectively responded to VA (responders). Minute ventilation/estimated maximum voluntary ventilation immediately after walking significantly decreased with VA, and MIP was lower in responders than in non-responders after surgery. The responders revealed greater pulmonary edema scores than non-responders. CONCLUSIONS The findings of the present study suggest that VA may possibly facilitate successful mobilization early after CV surgery, especially in patients with impaired cardiopulmonary function.