Shinichiro Morishita

Gender differences in health‐related quality of life, physical function and psychological status among patients in the early phase following allogeneic haematopoietic stem cell transplantation

The aim of this study was to examine gender differences in quality of life (QOL), physical function and psychological status before and in the early phase after allogeneic haematopoietic stem cell transplantation (allo‐HSCT).

Relationship between corticosteroid dose and declines in physical function among allogeneic hematopoietic stem cell transplantation patients

PurposeThe aim of this study was to investigate the relationship between corticosteroid dose and degree of physical function decrease in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients during the early stage of recovery. We further investigated the confounding factors affecting loss of physical function.MethodsThe study included 113 patients who underwent allo-HSCT between July 2007 and April 2012 at Hyogo College of Medicine Hospital in Japan. Physical function was assessed using tests for hand-grip strength, knee-extensor strength, and the 6-min walk test (6MWT). Fatigue was measured using the Piper Fatigue Scale. Total corticosteroid dose, frequency of physical therapy, body weight, and nutritional status were also collected from medical records.ResultsTotal corticosteroid dose was correlated with decrease of hand-grip and knee-extensors strength (P < 0.01) but was not correlated with 6MWT performance. Results of multivariate analysis confirmed that low physical function was associated not only with high corticosteroid dose but also with low frequency of physical therapy, increase in fatigue, and body weight loss (P < 0.05). Also, hemoglobin levels were associated with 6MWT (P < 0.05).ConclusionsThis study showed the relationship between corticosteroid dose and declines in physical function and also showed other clinical factors affecting loss of physical function among allo-HSCT patients. Our results indicate that the effectiveness of rehabilitation may be influenced by corticosteroid treatment.

Safety and feasibility of physical therapy in cytopenic patients during allogeneic haematopoietic stem cell transplantation

This study aimed to investigate the safety and feasibility of physical therapy in cytopenic patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT), and to investigate the effect of physical therapy on physiological functions and quality of life (QOL) in allo-HSCT patients. The study cohort included 321 patients who underwent allo-HSCT. To investigate the safety and feasibility of physical therapy during cytopenia, patients were assigned to the physical therapy group (n = 227) or the control group (n = 94). To determine the effects of physical therapy, patients were divided according to the frequency with which they underwent physical therapy (n = 51 per group). Handgrip strength, knee extensor strength and a 6-min walk test were used as measures of physiological function. Short-Form 36 was used to assess QOL. The physical therapy group had higher rate of achieving engraftment and lower death rate than the control group (P < 0.05). After HSCT, the high-frequency physical therapy group showed significantly less decline than the low-frequency physical therapy group with respect to physical functioning of QOL (P < 0.01). Physical therapy is quite beneficial and can be performed safely and feasibly in cytopenic patients during allo-HSCT.

Rating of Perceived Exertion for Quantification of the Intensity of Resistance Exercise

Rating of perceived exertion (RPE) is widely used in exercise tests using cycle ergometers (incremental aerobic exercise) for patients with cardiovascular and metabolic diseases such as hypertension and type 2 diabetes. On the other hand, RPE has also been used widely for determining the intensity of resistance exercise for healthy subjects. RPE anchoring is associated with percentage of 1 repetition maximum or the percentage of maximal voluntary contraction. This short communication explains a concrete method of RPE to quantify the intensity of resistance exercise. Physicians, physical therapists, and medical staff should use RPE for determining the intensity of resistance exercise in clinical practise.

Effects of Ultrasound Therapy on Calcificated Tendinitis of the Shoulder

In general, surgery is recommended for calcificated tendinitis of the shoulder if the patients have symptoms after conservative treatments, including needle aspiration and physical therapy. Many researchers agree about the need for adequate physical therapy consisting of range of motion exercise, muscle strengthening exercises and electrophysical agents. Some researchers report that ultrasound (u/s) promotes angiogenesis and calcium uptake to fibroblasts, but there are few studies about u/s effects on calcificated tendinitis of the shoulder. The purpose of this study was to evaluate the u/s therapy effect on calcification, pain during active movement, and to identify factors related to improvement in a randomized controlled fashion. We used the stratified random allocation method to assign 40 consecutive patients to experimental and control groups, so each group consisted of 20 patients. The experimental group was treated by u/s therapy and therapeutic exercises, and the control group was treated with therapeutic exercises only. All patients in both groups came to our department 3 times per week and u/s therapy was performed 3 times per week until the end of the study. First, we classified the calcifications as type I (clearly circumscribed and with dense appearance on radiography), type II (dense or clearly circumscribed appearance) and type III (translucent or cloudy appearance without clear circumscription) according to the classification of Gartner and Heyer. Radiography was performed every one month, and the main outcome measure was the change from the base-line of the calcification on radiography at the end of the treatment. The three point scale of Gartner and Heyer was used, in which a score of 1 indicates no change or a worsening of the condition, a score of 2 a decrease of at least 50 percent in the area and density of the calcification, and a score of 3 a complete resolution of the calcification. We also examined the affected shoulders for presence or absence of pain in active movement at the start and at the end of the study. The calcifications improved significantly and fewer patients had pain during active movement in the experimental group. There was a statistical significant disease duration difference from the first clinical presentation between scores 2 and 3 in the experimental group. The results of this study suggest that u/s therapy helps to resolve calcifications of shorter disease duration. Calcifications of longer disease duration tended to persist in spite of u/s therapy, but we thought treatment of 27-38 times (95% CI), until score 2 was attained, was a desirable strategy.

Physical function was related to mortality in patients with chronic kidney disease and dialysis

Previous studies have shown that exercise improves aerobic capacity, muscular functioning, cardiovascular function, walking capacity, and health‐related quality of life (QOL) in patients with chronic kidney disease (CKD) and dialysis. Recently, additional studies have shown that higher physical activity contributes to survival and decreased mortality as well as physical function and QOL in patients with CKD and dialysis. Herein, we review the evidence that physical function and physical activity play an important role in mortality for patients with CKD and dialysis. During November 2016, Medline and Web of Science databases were searched for published English medical reports (without a time limit) using the terms “CKD” or “dialysis” and “mortality” in conjunction with “exercise capacity,” “muscle strength,” “activities of daily living (ADL),” “physical activity,” and “exercise.” Numerous studies suggest that higher exercise capacity, muscle strength, ADL, and physical activity contribute to lower mortality in patients with CKD and dialysis. Physical function is associated with mortality in patients with CKD and dialysis. Increasing physical function may decrease the mortality rate of patients with CKD and dialysis. Physicians and medical staff should recognize the importance of physical function in CKD and dialysis. In addition, exercise is associated with reduced mortality among patients with CKD and dialysis.

Balance function in patients who had undergone allogeneic hematopoietic stem cell transplantation

A previous study reported a 45% incidence of falling among allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients during hospitalisation. We investigated balance and physical function in allo-HSCT patients. Thirty patients (18 men and 12 women) who underwent allo-HSCT between February 2013 and September 2014 were included in this study. Patients were evaluated for up to 3 weeks before and 7 weeks after transplantation. Balance was evaluated using the Timed Up and Go test (TUG) and length of centre of pressure (CoP). Physical function was assessed using hand-grip strength, knee-extensor strength tests, and the 6 min walk test (6MWT). TUG and length of CoP were significantly increased following HSCT (P<0.01). Hand-grip strength, knee-extensor strength, and the 6MWT score decreased significantly after allo-HSCT (P<0.01). TUG and length of CoP were negatively correlated with hand grip and knee-extensor strength (P≤0.05). The allo-HSCT patients in this study had worsened dynamic and static movements of the CoP after transplantation as well as decline of physical function. Rehabilitation staff, nurses, and physicians should recognize the decreased balance function of patients who have undergone allo-HSCT.

Prevalence of Sarcopenia in Cancer Patients: Review and Future Directions

Background: Sarcopenia, or skeletal muscle loss, is a common problem in post-treatment cancer patients and can negatively affect physical function and quality of life (QOL). This condition has recently received special attention in the cancer literature because it is associated with reduced physical activity and increased mortality in patients with cancer. The aim of this brief review was to evaluate the prevalence of sarcopenia in cancer patients. Methods: A comprehensive literature search was conducted to examine the prevalence of sarcopenia in cancer patients. PubMed was searched for articles published from January 1950 to March 30, 2014, using the keywords ‘sarcopenia or sarcopenic’ AND ‘cancer or malignancy or neoplastic’. For evaluating effectively the prevalence of sarcopenia, the search was limited to studies with a cross-sectional or longitudinal design. Results: A total of 28 articles met the established criteria. These previous studies showed the prevalence of sarcopenia differed widely between different cancer diagnoses, ranging from 14%-78.7% based on the cancer diagnosis. Cancer patients with sarcopenia were found to have lower QOL, worsened fatigue, decreased physical function, and longer hospital stay relative to cancer patients without this condition. Conclusion: Sarcopenia cancer patients may need physical exercise for improved physical function and QOL. Currently, few studies have been conducted on sarcopenia in cancer patients, and more studies are needed for investigating the prevalence of sarcopenia in these patients.

Impaired skeletal muscle oxygenation following allogeneic hematopoietic stem cell transplantation is associated with exercise capacity

IntroductionImpaired skeletal muscle oxygenation potentially contributes to reduced exercise capacity in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients during early recovery and may explain altered hemoglobin responses to exercise following allo-HSCT. We investigated whether skeletal muscle oxygenation parameters and hemoglobin parameters in the tibialis anterior decreased following allo-HSCT, and whether these results were associated with declines in exercise capacity.MethodsWe used near-infrared spectroscopy during and following a repeated isometric contraction task at 50% of maximal voluntary contraction in 18 patients before and after allo-HSCT.ResultsThe rate of decrease in the muscle oxy-hemoglobin saturation (SmO2; an index of skeletal muscle oxygenation) was significantly lower after allo-HSCT (P < 0.01). In contrast, total hemoglobin (an index of hemoglobin) was not different after allo-HSCT. Furthermore, SmO2 during and following exercise was associated with exercise capacity (r = 0.648; P = 0.004 vs. r = 0.632; P = 0.005).ConclusionThe results of this study reveal that although the peripheral hemoglobin response was not altered by allo-HSCT, skeletal muscle oxygenation was decreased following allo-HSCT. Furthermore, the decrease in skeletal muscle oxygenation was associated with a reduction in exercise capacity.

Changes in Oxyhemoglobin Concentration in the Prefrontal Cortex and Primary Motor Cortex During Low- and Moderate-Intensity Exercise on a Cycle Ergometer

The present study investigated whether changes in oxyhemoglobin (O2Hb) concentration over time differed across brain regions according to differences in gross movement intensity. Thirteen healthy adults (21.2 ± 1.0 years, 8 women) participated in this study. After 180 s of rest, the participants performed 600 s of exercise on a cycle ergometer. Exercise intensity was set at 30%VO2peak and 50%VO2peak. The prefrontal cortex (PFC) and primary motor cortex (M1) were chosen as regions of interest. In addition, mean arterial pressure (MAP) and scalp blood flow (SBF) were measured simultaneously. O2Hb concentration in PFC and M1 was significantly decreased in initial phase of the exercise, while it was significantly increased from the mid to final phase for both intensities compared with resting state values (p < 0.01). The O2Hb concentrations in the PFC and M1 were significantly decreased in the initial exercise phase. However, the MAP and SBF values did not exhibit a similar pattern. The main findings of our study were the follows: (1) During cycle ergometer exercise at the 30% and 50% O2Hb peak, the after O2Hb concentrations were transiently decreased in the initial exercise phase, and the concentrations then steadily increased in both the PFC and M1; and (2) the duration of the transient decreases in the O2Hb concentrations varied according to the brain region and exercise intensity.