Takuji Adachi

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.

Duration of moderate to vigorous daily activity is negatively associated with slow walking speed independently from step counts in elderly women aged 75 years or over: A cross-sectional study

OBJECTIVES This study aimed 1) to examine whether objectively measured duration of moderate to vigorous physical activity (MVPA) was associated with slow walking speed, independent from step counts, in elderly women aged 75 or over (old-old) and 2) to determine a possible cut-off value for duration of MVPA related to slow walking speed. METHODS Participants were 350 community-dwelling old-old women. Slow walking speed was defined as usual walking speed <1.0m/s. Duration of MVPA (activity at an intensity >3 metabolic equivalents) and number of step counts were measured using a uniaxial accelerometer over 1 wk. Body mass index, grip strength, back and leg pain, cognitive function, executive function, and presence of depression were also assessed. Participants with missing data were excluded from the main analysis. RESULTS The mean age of the participants was 79.9±3.6 y. The prevalence of slow walking speed was 14.9%. Multiple logistic regression analysis showed that the duration of MVPA was significantly and inversely associated with slow walking speed, independent from step counts and other confounding factors (adjusted odds ratio=0.94 per 1min/d increment, 95% confidence interval=0.73-0.99; p=0.031). This relationship was also observed in sensitivity analysis that included all participants. A MVPA cut-off value of 8.7min/d was determined using the receiver operating characteristic analysis. CONCLUSION The findings from the present study suggest that promoting MVPA may be helpful to prevent slow walking speed. The validity of MVPA for predicting slow walking speed needs to be confirmed in future prospective studies.

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.