Won Hah Park

Effects of Supervised Exercise Therapy in Patients Receiving Radiotherapy for Breast Cancer

Purpose Postoperative radiotherapy for breast cancer has a number of associated complications. This study examined whether supervised moderate-intensity exercise could mitigate the complications that occur during radiotherapy. Patients and Methods Forty women were randomized before radiotherapy after various operations for breast cancer. Seventeen patients who were assigned to the exercise group performed supervised moderate-intensity exercise therapy for 50 min 3 times per week for 5 weeks. Twenty-three patients in the control group were asked to perform self-shoulder stretching exercise. The World Health Organization Quality of Life-BREF (WHOQOL-BREF), brief fatigue inventory (BFI), range of motion (ROM) of the shoulder, and pain score were assessed before and after radiotherapy. Results There were no significant differences noted at baseline between groups. In the exercise group, there was an increase in the WHOQOL-BREF and shoulder ROM and decrease in BFI and pain score after radiotherapy. On the other hand, patients in the control group showed decrease in the WHOQOL-BREF and shoulder ROM and increase in BFI and pain score after radiotherapy. There were statistically significant differences in the changes in the WHOQOL, BFI, shoulder ROM, and pain score between the groups. Conclusion Patients receiving radiotherapy for breast cancer may benefit in physical and psychological aspects from supervised moderate-intensity exercise therapy.

Exaggerated blood pressure response to exercise is associated with carotid atherosclerosis in apparently healthy men.

Objective Although an exaggerated systolic blood pressure (SBP) response to exercise is a predictor of future hypertension and cardiovascular mortality, the underlying mechanisms are not fully understood. We tested the hypothesis that an exaggerated SBP response is associated with carotid atherosclerosis in a cross-sectional study of 9073 healthy men (aged 47.8 ± 8.8 years). Methods Exaggerated SBP response was defined as an SBP of 210 mmHg or greater during a maximal treadmill test. Carotid atherosclerosis was defined as stenosis greater than 25% or intima–media thickness greater than 1.2 mm using B-mode ultrasonography. Results An exaggerated SBP response was present in 375 men (4.1%). The proportion of individuals with carotid atherosclerosis in the group with an exaggerated SBP response to exercise was higher than in the group with a normal SBP response (14.4 versus 5.3%, P < 0.001). In a multivariable logistic regression model, individuals with an exaggerated SBP (≥ 210 mmHg) response to exercise had a 2.02 times [95% confidence interval (CI) 1.33–3.05] increased risk of carotid atherosclerosis compared with individuals with an SBP response of less than 210 mmHg. The highest quartile (> 61 mmHg) group of relative exercise-induced increases in SBP showed a 1.57 (95% CI 1.18–2.08) greater risk of carotid atherosclerosis compared with individuals in the lowest quartile (< 38 mmHg) in the adjusted model. Conclusions These results suggest that an exaggerated SBP response to exercise is strongly associated with carotid atherosclerosis, independent of established risk factors in healthy men. It may be an important factor in evaluating hypertension related to target-organ damage.

The outcome of ultrasound-guided needle decompression and steroid injection in calcific tendinitis

HYPOTHESIS Needle lavage is frequently performed before consideration of surgical removal in shoulders with calcific tendinitis because this may avoid surgery. However, its role in nonoperative treatment has not been fully investigated in terms of clinical and radiographic response. We hypothesized that needle decompression and subacromial steroid injection would show good clinical results in chronic calcific tendinitis patients. MATERIALS AND METHODS Thirty-five shoulders in 30 consecutive patients with painful calcific tendinitis were treated by ultrasound-guided needle decompression and subacromial corticosteroid injection. Patients were prospectively evaluated using American Shoulder and Elbow Surgeons (ASES) and Constant scores at 1, 3, and 6 months after the intervention. Size and morphology of the calcific deposits were compared with those in baseline radiographs at each visit. RESULTS At 6 months after the index procedure, 25 shoulders (71.4%) showed ASES and Constant score improvements from 48.0 and 53.7 to 84.6 and 87.9, respectively (P < .01). Ten shoulders (28.6%) showed no symptom relief at the last follow-up. In shoulders with pain improvement, the mean size of calcific deposits reduced from 13.6 to 5.6 mm (P < .01), and in shoulders with no pain improvement or that underwent operation, mean size was 13.1 mm at initial visits and 12.7 mm at final visits (P = .75). DISCUSSION Shoulders showing little evidence of deposit size reduction at 6 months after needle decompression are less likely to achieve symptomatic improvement and may be considered as candidates for surgical removal. CONCLUSION Needle decompression with subacromial steroid injection is effective in 71.4% of calcific tendinitis within 6 months. The size of calcific deposits in patients that achieved symptom relief was reduced.

Association between cardiorespiratory fitness and arterial stiffness in men with the metabolic syndrome

AIMS We tested the hypothesis that high cardiorespiratory fitness (fitness) is associated with lower levels of arterial stiffness in 1035 (age 52 ± 6 years) men with and without the metabolic syndrome. METHODS Arterial stiffness was derived from brachial-ankle pulse wave velocity (baPWV). Fitness was directly measured by peak oxygen uptake during a standard treadmill test. RESULTS Men with the metabolic syndrome (n = 168) had significantly higher baPWV than men without the metabolic syndrome (1424 ± 175 cm/s vs. 1333 ± 150 cm/s, p < 0.05). When separated according to quartiles of fitness, men with and without the metabolic syndrome in the highest quartile of fitness had significantly lower baPWV compared to men in the lowest quartile of fitness (p < 0.05). Fitness was inversely correlated with baPWV in men with (p = -0.29, p < 0.05) and without the metabolic syndrome (p = -0.22, p < 0.05). There was no differences in baPWV levels between fit men with the metabolic syndrome and unfit men without the metabolic syndrome (fit/MetS; 1366 ± 140 vs. unfit/no MetS; 1401 ± 194 cm/s, p = 0.81). CONCLUSIONS These results demonstrate that high fitness is inversely associated with arterial stiffness in men with and without the metabolic syndrome. Increased arterial stiffness in the metabolic syndrome is attenuated by high fitness.

Relation of Cardiorespiratory Fitness to Inflammatory Markers, Fibrinolytic Factors, and Lipoprotein(a) in Patients With Type 2 Diabetes Mellitus

Increased inflammation, fibrinolytic factors, and lipoprotein(a) (LP[a]) were associated with increased cardiovascular events in patients with type 2 diabetes, whereas higher levels of cardiorespiratory fitness (CRF) were associated with a lower incidence of cardiovascular mortality. Whether CRF is associated with inflammatory markers, fibrinolytic factors, and LP(a) in patients with type 2 diabetes was investigated. A total of 425 men with type 2 diabetes (mean age 55 +/- 8 years) who participated in a medical screening program were studied. CRF was measured using peak oxygen uptake with expired gas analysis during a symptom-limited exercise test. CRF inversely correlated with C-reactive protein (CRP; r = -0.27, p <0.05), white blood cell count (r = -0.13, p <0.05), fibrinogen (r = -0.28, p <0.05), LP(a) (r = -0.53, p <0.05), tissue plasminogen activator (t-PA) antigen (r = -0.65, p <0.05), and plasminogen activator inhibitor-1 activity (r = -0.17, p <0.05). Men in the highest tertile of CRF had significantly lower CRP, white blood cell count, fibrinogen, LP(a), and t-PA than men in the lowest tertile of CRF (all p <0.05). In separate multivariable linear regression models that adjusted for age, body mass index, smoking, lipid profiles, glucose, and systolic blood pressure, CRP (beta = -0.23, p <0.05), white blood cell count (beta = -0.16, p <0.05), fibrinogen (beta = -0.24, p <0.05), LP(a) (beta = -0.28, p <0.05), and t-PA (beta = -0.69, p <0.05) were each inversely associated with CRF. Each MET increment higher peak oxygen uptake was associated with a lower odds ratio of having abnormal LP(a) (odds ratio 0.43, 95% confidence interval 0.20 to 0.91) in a multivariate logistic regression model. In conclusion, CRF was inversely associated with inflammatory markers, fibrinolytic factors, and LP(a) in men with type 2 diabetes.

Exaggerated blood pressure response to exercise is associated with inflammatory markers.

PURPOSE An exaggerated blood pressure (EBP) response to exercise has been shown to be a predictor of future hypertension and risk of cardiovascular mortality. Although EBP is associated with endothelial dysfunction and increased left ventricular hypertrophy, the underlying mechanisms are not fully understood. Inflammatory markers, C-reactive protein (CRP) and white blood cells (WBCs), were predictive of future hypertension. The objective of this study was to examine the hypothesis that increasing levels of CRP and WBCs would be related to an EBP response during exercise. METHODS Inflammatory markers were compared in 43 males with an EBP (systolic blood pressure [SBP] >or=210 mm Hg) response during maximal treadmill testing to an age and resting SBP-matched group of 42 males with a normal blood pressure response to exercise. RESULTS There were significant group differences in maximal SBP and diastolic blood pressure (DBP), exercise induced increases in SBP and DBP (P <.01), and WBCs (P <.01), but CRP did not differ between groups (P =.39). White blood cells were significantly associated with maximal SBP (r = 0.31), and the exercise-induced increase in SBP (r = 0.34). However, CRP did not correlate with the maximal blood pressure response to exercise (r = 0.11, P =.33). In a stepwise multiple regression analysis, WBC was independently associated with the exercise-induced increase in SBP (beta = 0.256, P =.011). CONCLUSIONS These results suggest that inflammation may be associated with an EBP response during exercise testing.

The relationship between arterial stiffness and increase in blood pressure during exercise in normotensive persons.

Background: Arterial stiffness is increased in hypertension, even at an earlier stage. The blood pressure (BP) response to exercise reflects the future risk of developing hypertension. We investigated the relationship between the pulse wave velocity (PWV) and the BP response to exercise to evaluate whether arterial stiffness is increased in normotensive persons with higher exercise BPs. Methods: The participants of the study were adults with normal BP (SBP < 120 mmHg and DBP < 80 mmHg) without history of clinical cardiovascular diseases, who had undergone health screening. Treadmill exercise tests were done by modified Bruce protocol, and brachial–ankle PWV (baPWV) was measured. Results: The participants were 2156 men and women (69 : 31%) with mean age of 52 ± 5 years. The baPWV correlated significantly to variables such as age, sex, baseline SBP and DBP, pulse pressure, maximal oxygen consumption (VO2max), SBP at stage 1, at stage 2 and peak exercise and hemoglobin A1c (HbA1c). In multiple regression model, SBP at stage 1 had a significant association with baPWV after an adjustment with age, sex, VO2max and SBP at rest, current smoking and HbA1c. For every 10 mmHg increase in exercise SBP, baPWV increased by 18 ± 0.3 cm/s (P < 0.001). Conclusion: In normotensive individuals, increased arterial stiffness, as reflected by baPWV, is accompanied by higher SBP at the early stage of treadmill exercise test. This finding suggests that arterial stiffening processes are present even in the normotensive setting and are correlated with BP changes during exercise

Temporal changes in cardiorespiratory fitness and the incidence of hypertension in initially normotensive subjects

Low‐cardiorespiratory fitness (CRF) has been associated with incident hypertension, but whether temporal changes in CRF are associated with incident hypertension in initially normotensive subjects are not known. We investigated the relationship of baseline CRF and longitudinal changes in CRF with incident hypertension in initially normotensive subjects.

Preoperative Factors Affecting Footprint Coverage in Rotator Cuff Repair

Background: One of the goals of rotator cuff repair is to restore the torn tendon to its original insertion anatomically. However, it is sometimes difficult to restore the entire footprint. Purpose: This study was undertaken to evaluate the variables affecting this repair coverage and to discern the differences in retear rate and clinical results between complete and incomplete footprint coverage in rotator cuff surgery. Study Design: Case series; Level of evidence, 4. Methods: From 2007 to 2009, a total of 85 consecutive repairs for medium-to-large rotator cuff tears were identified as having complete or incomplete coverage of their original footprints. We defined the complete footprint coverage (CC) group as patients who had >50% of their footprint covered during repair and the incomplete (IC) group as <50% of their footprint. Factors affecting the amount of footprint coverage were evaluated, and multivariable analysis was conducted to identify independent factors. To assess the final outcome according to the amount of footprint coverage, retear and clinical outcomes were compared between the CC and IC groups. Results: Fifty-seven repairs were defined in the CC group and 28 repairs in the IC group. Preoperatively, age, tear size in coronal oblique and sagittal oblique planes, Goutallier fatty infiltration, and atrophy of the supraspinatus affected the amount of footprint coverage in univariate analysis. In multivariable analysis, however, tear size in the coronal plane was the only independent factor affecting footprint coverage in rotator cuff repair. On postoperative MRI, 45.6% of the CC group had an intact tendon, 45.6% had a delaminated partial retear, and 8.8% had a full-thickness retear; in the IC group, 17.9% had an intact tendon, 60.7% had a delaminated partial retear, and 21.4% had a full-thickness retear. There was a statistically significant difference in the proportion of tendon integrity between groups (P = .028). Clinical scores and range of motion at final follow-up showed no difference between the 2 groups. Conclusion: Tear size in the coronal plane was the only independent factor affecting the amount of footprint coverage. Repair quality based on retear classification was different between the 2 groups. However, both complete and incomplete footprint coverage in rotator cuff repair showed no differences in clinical scores and range of motion at short-term follow-up.

Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction.

[Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability.