Ying-Tai Wu

Prevalence of Sarcopenia Estimated Using a Bioelectrical Impedance Analysis Prediction Equation in Community-Dwelling Elderly People in Taiwan

OBJECTIVES: To compare a bioelectrical impedance analysis (BIA) prediction equation for estimating skeletal muscle mass (SM) with magnetic resonance imaging (MRI)‐measured SM and to investigate the prevalence of sarcopenia in community‐dwelling elderly people in Taiwan.

Efficacy of a 24-Week Aerobic Exercise Program for Osteopenic Postmenopausal Women

Abstract. Osteoporosis is one of the most common skeletal disorders affecting postmenopausal women. The purpose of this study was to investigate whether a 24-week program of aerobic high-impact loading exercise was beneficial for enhancing physical fitness and bone mineral density (BMD) in osteopenic postmenopausal women. Forty-three postmenopausal women aged 48–65 years participated in this study. The BMD of the spine (L2–L4) and right femoral neck of each woman was below 1 SD of the mean of premenopausal women, as examined by dual X-ray absorptiometry. The assignment of subjects into exercise or control group was not randomized but based on each subjects anticipated compliance to the 6-month long exercise program. Twenty-two subjects joined the exercise group and attended the training programs and 21 served as the control group. Exercise programs included treadmill walking at an intensity above 70% of maximal oxygen consumption (VO2max) for 30 minutes, followed by 10 minutes of stepping exercise using a 20-cm-high bench. The program was conducted three times per week for 24 weeks. Physical fitness measurements included testing of flexibility, muscular strength and endurance, body composition, and cardiopulmonary fitness. The results showed that the quadriceps strength, muscular endurance, and VO2max in the exercise group had significant improvements, whereas no improvement was found in any of the physical fitness parameters in the control group. The BMD of the L2–L4 and the femoral neck in the exercise group increased 2.0% (P > 0.05) and 6.8% (P < 0.05) and those in the control group decreased 2.3% (P < 0.05) and 1.5% (P > 0.05), respectively. In conclusion, aerobics combined with high-impact exercise at a moderate intensity was effective in offsetting the decline in BMD in osteopenic postmenopausal women.

Home-based exercise increases exercise capacity but not quality of life in people with chronic heart failure: a systematic review

QUESTIONS Does home-based exercise improve exercise capacity and quality of life in people with chronic heart failure? Is it safe? DESIGN Systematic review with meta-analysis. PARTICIPANTS Adults with heart failure > 3 months duration. INTERVENTION Home-based aerobic exercise with or without resistance exercise. OUTCOME MEASURES Exercise capacity (measured at the impairment level by peak VO2 and at the activity level by 6-min Walk Test), quality of life (measured by disease-specific scales), and adverse events (measured as death, hospitalisation). RESULTS 10 randomised controlled trials with 648 participants of New York Heart Association Class II or III were included. Most participants were male > or = 50 years old with an ejection fraction < or = 40%. The exercise programs ranged from 6 weeks to 9 months at low to moderate intensity (40-70% of maximum heart rate or heart rate at 70% peak VO2. Home-based exercise increased 6-min walking distance by 41 m (WMD, 95% CI 19 to 63) and peak VO2 by 2.71 ml/kg/min (WMD, 95% CI 0.67 to 4.74) more than usual activity. It did not improve scores on the Minnesota Heart Failure Questionnaire (WMD 0.5 points out of 105, 95% CI -4.4 to 5.4) or increase the odds of hospitalisation (OR 0.75, 95% CI 0.19 to 2.92) more than usual activity. CONCLUSIONS Home-based exercise increased exercise capacity safely but did not improve quality of life in patients with chronic heart failure. It could therefore be used to improve the management of people with chronic heart failure who do not have access to hospital-based exercise.

Sarcopenia, Cardiopulmonary Fitness, and Physical Disability in Community-Dwelling Elderly People

Background Sarcopenia refers to the loss of skeletal muscle mass with aging. It is believed to be associated with functional impairment and physical disability. Objective The purposes of this study were: (1) to compare the physical activity, muscle strength (force-generating capacity), cardiopulmonary fitness, and physical disability in community-dwelling elderly people with sarcopenia, borderline sarcopenia, and normal skeletal muscle mass in Taiwan and (2) to test the hypothesis that sarcopenia is associated with physical disability and examine whether the association is mediated by decreased muscle strength or cardiopulmonary fitness. Design This was a cross-sectional investigation. Methods Two hundred seventy-five community-dwelling elderly people (148 men, 127 women) aged ≥65 years participated in the study. The participants were recruited from communities in the district of Zhongzheng, Taipei. Predicted skeletal muscle mass was estimated using a bioelectrical impedance analysis equation. The skeletal muscle mass index (SMI) was calculated by dividing skeletal muscle mass by height squared. Physical disability was assessed using the Groningen Activity Restriction Scale. Physical activity was assessed using a 7-day recall physical activity questionnaire. Cardiopulmonary fitness was assessed using a 3-minute step test, and grip strength was measured to represent muscle strength. Results Cardiopulmonary fitness was significantly lower in elderly people with sarcopenia than in those with normal SMIs. Grip strength and daily energy expenditure (kcal/kg/day) were not significantly different between the participants with sarcopenia and those with normal SMIs. The odds ratio for physical disability between the participants with sarcopenia and those with normal SMIs was 3.03 (95% confidence interval=1.21–7.61). The odds ratio decreased and the significant difference diminished after controlling for cardiopulmonary fitness. Limitations A causal relationship between sarcopenia and physical activity, cardiopulmonary fitness, and physical disability cannot be established because of the cross-sectional nature of study design. Conclusions Sarcopenia was associated with physical disability in elderly men. The association between sarcopenia and physical disability was mediated to a large extent by decreased cardiopulmonary fitness.

The application of infrared thermography in evaluation of patients at high risk for lower extremity peripheral arterial disease

OBJECTIVE We investigated the usefulness of infrared thermography in evaluating patients at high risk for lower extremity peripheral arterial disease (PAD), including severity, functional capacity, and quality of life. METHODS A total of 51 patients (23 males; age 70 ± 9.8 years) were recruited. They completed three PAD-associated questionnaires, including walking impairment, vascular quality of life, and 7-day physical activity recall questionnaires before a 6-minute walking test (6MWT). Ankle-brachial index (ABI) and segmental pressure were analyzed for PAD diagnosis and stenotic level assessment. The cutaneous temperature at shin and sole were recorded by infrared thermography before and after the walk test. Detailed demographic information and medication list were obtained. RESULTS Twenty-eight subjects had abnormal ABI (ABI <1), while PAD was diagnosed in 20. No subjects had non-compressible artery (ABI >1.3). Demographic profiles and clinical parameters in PAD and non-PAD patients were similar, except for age, smoking history, and hyperlipidemia. PAD patients walked shorter distances (356 ± 102 m vs 218 ± 92 m; P < .001). Claudication occurred in 14 patients, while seven failed in completing the 6MWT. The rest temperatures were similar in PAD and non-PAD patients. However, the post-exercise temperature dropped in the lower extremities with arterial stenosis, but was maintained or elevated slightly in the extremities with patent arteries (temperature changes at sole in PAD vs non-PAD patients: -1.25 vs -0.15°C; P < .001). The exercise-induced temperature changes at the sole were not only positively correlated with the 6MWD (Spearman correlation coefficient = 0.31, P = .03), but was also correlated with ABI (Spearman correlation coefficient = 0.48, P < .001) and 7-day physical activity recall scores (Spearman correlation coefficient = 0.30, P = .033). CONCLUSION By detecting cutaneous temperature changes in the lower extremities, infrared thermography offers another non-invasive, contrast-free option in PAD evaluation and functional assessment.

Reduced Risk for Metabolic Syndrome and Insulin Resistance Associated with Ovo-Lacto-Vegetarian Behavior in Female Buddhists: A Case-Control Study

Introduction The association of vegetarian status with the risk of metabolic syndrome (MetS) is not clear. In Asia, Buddhists often have vegetarian behavior for religious rather than for health reasons. We hypothesize that the vegetarian in Buddhism is associated with better metabolic profiles, lower risk for the MetS and insulin resistance (IR). Methods We enrolled 391 female vegetarians (∼80% lacto-ovo-vegetarians) and 315 non-vegetarians from health-checkup clinics at a Buddhist hospital in Taiwan. Results The vegetarian status was associated with lower body mass index, smaller waist circumference, lower total cholesterol, lower low density lipoprotein-cholesterol (LDL-C), and lower HDL-C in multivariate linear regression analyses. Despite having lower HDL-C level, the vegetarians had significantly lower total cholesterol/HDL-C and LDL-C/HDL-C ratios. After adjusting the other covariates, the risks for the MetS were lower for ovo-lacto-vegetarians of 1–11 years and >11 years respectively by 54% (odds ratio [OR] = 0.46, 95%C.I.:0.26–0.79) and 57% (OR = 0.43, 95%C.I.:0.23–0.76) compared to non-vegetarians by the IDF criteria. Likewise, they were lower respectively by 45% (OR = 0.55, 95%C.I.:0.32–0.92) and 42% (OR = 0.58, 95%C.I.:0.33–0.997), for the MetS by the modified NCEP criteria. In the subgroup of non-diabetic subjects, the vegetarians also had lower risk for IR by HOMA compared to the non-vegetarians (OR = 0.71, 95%C.I.:0.48–1.06). Conclusion The vegetarian behavior, mainly lacto-ovo-vegetarian, related to Buddhism, although not meant for its health effects, is associated with reduced risk for the MetS and IR and may potentially provide metabolic and cardiovascular protective effects in women.

Effects of Exercise Training in Heart Transplant Recipients: A Meta-Analysis

Objectives: Muscle wasting and exercise intolerance are common in heart transplant recipients. Most studies on the effects of exercise training have used relatively small sample sizes and are heterogeneous in nature. The purpose of this meta-analysis was to systematically review the relevant studies and investigate the effects of exercise training on exercise capacity and muscle strength in heart transplant recipients. Methods: A systematic search was adopted from electronic databases and relevant references, using medical subject heading key words related to heart transplantation and exercise. Only randomized controlled trials with exercise intervention versus usual care were included. The data were expressed as the weighted mean differences with 95% confidence intervals (CIs). Results: Altogether 6 studies were included. Peak oxygen consumption (VO2) was reported in 4 trials (117 patients), and muscle strength was reported in 3 trials (67 patients). Peak VO2 was significantly increased by 2.34 ml/kg/min (95% CI 0.63–4.05). One-repetition maxima of the chest press (23.28 kg, 95% CI 0.64–45.91) and leg press (28.84 kg, 95% CI 5.70–51.98) were significantly improved by exercise training. Conclusion: Exercise training is recommended for heart transplant recipients to improve peak VO2 and muscle strength despite the small number of trials included in this meta-analysis.

Resistance training increases 6-minute walk distance in people with chronic heart failure: a systematic review

QUESTION Does resistance training, either alone or as an adjunct to aerobic training, improve cardiac function, exercise capacity and quality of life in people with chronic heart failure? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Adults with stable chronic heart failure. INTERVENTION Progressive resistance exercise training, alone or as an adjunct to aerobic training. OUTCOME MEASURES Cardiac function, exercise capacity and quality of life. RESULTS 241 participants from eight trials performed 2 to 6 months of moderate-intensity resistance training (50-75% of 1RM). Most programs consisted of 5 to 6 exercises for large limb and trunk muscles with two sets of 8 to 12 repetitions, three times a week. Resistance training significantly increased 6-minute walk distance (WMD 52 m, 95% CI 19 to 85) but not peak oxygen consumption (WMD 1.4 ml/kg/min, 95% CI -0.3 to 3.1). When used as an adjunct to aerobic training, resistance training did not significantly alter left ventricular ejection fraction (WMD -0.5%, 95% CI -4.3 to 3.3), peak oxygen consumption (WMD -0.7 ml/kg/min, 95% CI -2.3 to 1.0), or Minnesota Living with Heart Failure Questionnaire scores (WMD -0.9, 95% CI -5.4 to 3.7), compared with aerobic training alone. CONCLUSION Resistance training increased 6-minute walk distance compared to no training, but had no other benefits on cardiac function, exercise capacity, or quality of life if used alone or as an adjunct to aerobic training in people with chronic heart failure. However, further high quality, large scale, randomised trials are needed.

Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea

Repetitive inspiratory effort against an obstructed airway and intermittent hypoxia may be deleterious to the inspiratory muscles in patients with obstructive sleep apnoea (OSA). We investigated muscular dysfunction by comparing the strength, endurance and fatigability of inspiratory muscles and knee extensors in patients with newly diagnosed severe OSA compared with matched controls. The measurements included strength and endurance tests of both muscles, and a fatigue trial with simultaneous surface electromyography of the diaphragm and the vastus lateralis during voluntary contractions and in response to magnetic stimulation. To our knowledge, this is the first investigation to assess peripheral muscle performance in severe OSA patients versus controls. Patients in the OSA group exhibited significantly lower strength and endurance in both muscles than the control group. The fatigue index decreased significantly exclusively in the inspiratory muscles of OSA patients. Magnetic stimulation-evoked compound muscle action potential latencies increased and the amplitudes decreased significantly in the diaphragm, but not in the vastus lateralis after a fatigue test in the OSA group. In conclusion, a significantly lower functional performance was shown for both inspiratory muscles and knee extensors in the OSA group. However, higher fatigability was only seen in the inspiratory muscles of patients with severe OSA.

Efficacy of a Home-Based Exercise Program for Orthotopic Heart Transplant Recipients

Background:A hospital-based cardiac rehabilitation program can significantly improve the cardiopulmonary endurance and quality of life (QOL) in patients after orthotopic heart transplantation (OHT). Home-based programs for these patients have advantages of low cost and high accessibility, but little is known about their efficacy. This prospective study was designed to evaluate the effect of an 8-week home-based exercise program on muscular strength and endurance of lower limbs, aerobic capacity and QOL in OHT recipients. Methods:Thirty-seven OHT recipients were randomized into exercise (n = 14) or control (n = 23) groups. Exercise group subjects were to exercise at least 3 times a week for 8 weeks. Each subject was evaluated by Cybex testing of right quadriceps strength and endurance, 1-min sit-to-stand test, a symptom-limited maximal exercise test and QOL assessment before and after 8 weeks. Results: Subjects in the exercise group improved significantly in sit-to-stand test, fatigue index of the right quadriceps, maximal workload achieved and physical domain of QOL compared to controls after 8 weeks, regardless of older age and lower value for sit-to-stand test at baseline. Conclusions: OHT recipients can significantly improve their muscular endurance, sit-to-stand test scores and QOL after a medically directed home-based exercise program.