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To examine the effect and safety of cardiac rehabilitation (CR) program in high-risk cardiac patients and compare these results to those of control CR participants without high-risk criteria.
A total of 12 high-risk cardiac patients were recruited as subjects. The high-risk criteria were: advanced heart failure with left ventricular ejection fraction (LVEF) of less than 30%, a recent history of cardiac arrest or dangerous arrhythmia, and cardiac device insertion. Another 12 CR participants without any high-risk criteria mentioned above were recruited as controls. Both groups underwent 6 to 8 weeks of CR exercise training. Exercise tolerance tests were performed before and after completion of the CR program. After CR completion, both groups were evaluated and their results were compared.
After completion of the CR exercise program, both groups showed significant increases in peak oxygen uptake (VO2peak) and LVEF. In the control group (n=12), VO2peak increased from 25.9 to 31.8 mL/kg/min (changing rate, +21.4%±22.1%) and LVEF increased from 56.1% to 59.1% (changing rate, +5.3%±8.4%). In the high-risk group (n=12), VO2peak increased from 16.8 to 21.0 mL/kg/min (changing rate, +28.6%±21.4%) and LVEF increased from 26.1% to 29.4% (changing rate, +16.1%±12.9%). There was no serious cardiovascular event during all exercise hours.
High-risk cardiac patients who completed a supervised CR program demonstrated significant improvements in VO2peak and LVEF without any serious cardiovascular event. The improvement rate was similar to that of control group.
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To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population.
A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests.
SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers.
This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.
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To investigate whether the polymorphisms of
Genomic DNA from 121 ischemic stroke patients and 201 healthy control subjects were extracted, and polymerase chain reaction products were sequenced. To investigate the association of polymorphisms and the development, and National Institutes of Health Stroke Scale (K-NIHSS), logistic regression models were analyzed.
Polymorphism of the untranslational region of
These results indicate the possibility that
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To compare and analyze the effects of cardiac rehabilitation (CR) in two groups based on the peak respiratory exchange ratio (RERpeak) 1.1 values using the exercise tolerance test (ETT) results, and to investigate the reasons for early termination of ETT.
Patients with acute coronary syndrome who participated in CR exercise training were selected and all subjects underwent 6 weeks of CR exercise training. ETT was performed on a treadmill using a Modified Bruce Protocol before and after CR exercise training. According to the result of the first ETT, the subjects were divided into two groups: those with an RERpeak≥1.1 (n=33) and those with an RERpeak<1.1 (n=22). We investigated the reasons for ETT termination and compared the effect of CR between the groups.
The reasons for the early termination of the first ETT in the RERpeak<1.1 group were subjective dyspnea, abnormal cardiovascular responses, leg fatigue and other problems. After a 6-week CR, the peak oxygen consumption (VO2peak) and ETT time increased, and the rate of perceived exertion (RPE) and RPP (rate pressure product) at stage 3 decreased in both the RERpeak<1.1 and RERpeak≥1.1 groups.
CR exercise training improved exercise capacity, not only in the RERpeak≥1.1 group, but also in the RERpeak<1.1 group. This means that patients with a lower exercise tolerance could also benefit from the effects of CR. Thoughtful consideration to identify the direct and indirect causes for the early termination of ETT would be necessary to improve the efficiency of CR.
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To observe the effect and safety of cardiac rehabilitation (CR) exercise in ischemic cardiomyopathy and to compare the results between patients with preserved left ventricular ejection fraction (LVEF) and reduced LVEF.
Patients with ischemic cardiomyopathy with LVEF <50% were included as subjects. The patients were classified into the preserved LVEF (pLVEF; LVEF 41%–49%) group and the reduced LVEF (rLVEF; LVEF ≤40%) group. Patients underwent hourly aerobic exercise training sessions with an intensity of 60%–85% of heart rate reserve, three times a week for 6 weeks. Graded exercise test and transthoracic echocardiogram were performed in all study patients before and after completion of the CR exercise program.
After completion of the CR exercise program, both groups (pLVEF, n=30; rLVEF, n=18) showed significant increases in LVEF and VO2max. In the pLVEF group, LVEF and VO2max increased from 45.1%±4.8% to 52.5%±9.6% (p<0.001) and from 24.1±6.3 to 28.1±8.8 mL/kg/min (p=0.002), respectively. In the rLVEF group, LVEF and VO2max increased from 29.7%±7.7% to 37.6%±10.3% (p<0.001) and from 17.6±4.7 to 21.2±5.1 mL/kg/min (p<0.001), respectively. Both groups completed their exercise program safely.
In both groups, patients with ischemic cardiomyopathy who completed a 6-week supervised CR exercise program demonstrated remarkable improvements in cardiopulmonary function. This result implies that neither of the two groups showed higher efficacy in comparison to each other, but we can conclude that CR exercise in the rLVEF group was as effective and safe as that in the pLVEF group.
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To evaluate the relationships between tongue pressure and different aspects of the oral-phase swallowing function.
We included 96 stroke patients with dysphagia, ranging in age from 40 to 88 years (mean, 63.7 years). Measurements of tongue pressure were obtained with the Iowa Oral Performance Instrument, a device with established normative data. Three trials of maximum performance were performed for lip closure pressure (LP), anterior hard palate-to-tongue pressure (AP), and posterior hard palate-to-tongue pressure (PP); buccal-to-tongue pressures on both sides were also recorded (buccal-to-tongue pressure, on the weak side [BW]; buccal-to-tongue pressure, on the healthy side [BH]). The average pressure in each result was compared between the groups. Clinical evaluation of the swallowing function was performed with a videofluoroscopic swallowing study.
The average maximum AP and PP values in the intact LC group were significantly higher than those in the inadequate lip closure group (AP, p=0.003; PP, p<0.001). AP and PP showed significant relationships with bolus formation (BF), mastication, premature bolus loss (PBL), tongue to palate contact (TP), and oral transit time (OTT). Furthermore, LP, BW, and BH values were significantly higher in the groups with intact mastication, without PBL and intact TP.
These findings indicate that the tongue pressure appears to be closely related to the oral-phase swallowing function in post-stroke patients, especially BF, mastication, PBL, TP and OTT.
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To examine the safety and effectiveness of cardiac rehabilitation on patients resuscitated from cardiac arrest due to acute myocardial infarction.
The study included 23 subjects, including 8 with history of cardiac arrest and 15 without history of cardiac arrest. Both groups underwent initial graded exercise test (GXT) and subsequent cardiac rehabilitation for 6 weeks. After 6 weeks, both groups received follow-up GXT.
Statistically significant (p<0.05) increase of VO2peak and maximal MVO2 but significant (p<0.05) decrease of submaximal MVO2 and resting heart rate were observed in both groups after 6 weeks of cardiac rehabilitation. An increasing trend of maximal heart rates was observed in both groups. However, the increase was not statistically significant (p>0.05). There was no statistically significant change of resting heart rate, maximal heart rate, maximal MVO2, or submaximal MVO2 in both groups after cardiac rehabilitation. Fatal cardiac complications, such as abnormal ECG, cardiac arrest, death or myocardial infarction, were not observed. All subjects finished the cardiac rehabilitation program.
Improvement was observed in the exercise capacity of patients after aerobic exercise throughout the cardiac rehabilitation program. Therefore, cardiac rehabilitation can be safely administered for high-risk patients with history of cardiac arrest. Similar improvement in exercise capacity can be expected in patients without cardiac arrest experience.
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To compare the low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) with high frequency (20 Hz) rTMS on motor functional improvement of the affected upper extremity in subacute stroke patients.
Forty patients with subacute ischemic stroke participated in this study. The first group received 10 sessions of 20 Hz rTMS at ipsilesional M1 area and the other group received 10 sessions of 1 Hz rTMS at contralesional M1 area. Motor training of the hemiparetic hand was conducted after each rTMS train. All the patients received conventional occupational therapy immediately after each rTMS session. Manual function test (MFT), Fugl-Meyer Assessment scale (FMS), Modified Barthel Index (MBI), Brunnstrom recovery stage, and grip strength were used to assess motor function before, at the end of, and one month after the last session of rTMS.
No adverse side effects were reported during the course of the experiment using rTMS. No significant difference in motor function of the affected upper extremity was observed between the two groups before rTMS. Significant improvements in MFT, FMS, MBI, and Brunnstrom stage were observed in the both groups at the end of the last rTMS session and one month later (p<0.05). No significant difference was found between the two groups (p>0.05).
There was no significant difference in motor function of the affected upper extremity between 1 Hz and 20 Hz rTMS during the subacute period of ischemic stroke. Thus, we cannot conclude which has a greater effect.
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The dilated cardiomyopathy is the common type of cardiomyopathy, and its distinctive characteristic is the systolic dysfunction. Not many reports were issued about the efficacy of cardiac rehabilitation in patients with an advanced dilated cardiomyopathy until yet. A 50-year-old man who was diagnosed with dilated cardiomyopathy with congestive heart failure was admitted to the emergency room after a sudden collapse and a ventricular fibrillation was presented in the actual electrocardiogram. After three months, the patient participated in an 8-week cardiac rehabilitation program with electrocardiogram monitoring for 50 minutes per session at five times per week. The maximal oxygen consumption improved from 13.5 to 19.4 mL/kg/min during this time. At 3.9 metabolic equivalents, the myocardial oxygen demand decreased from 21,710 to 12,669 mmHg.bpm and the Borg's scale of perceived exertion decreased from 15 to 9. The left ventricular ejection fraction improved from 14% to 19%. So in this case report will be presented a patient after a successful cardiac rehabilitation program. Before this the patient suffered from a much more advanced dilated cardiomyopathy and was resuscitated from cardiac arrest.
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To confirm the improvement in arterial endothelial function by aerobic exercise training, flow-mediated dilation (FMD) was tested by ultrasonography.
Patients who received percutaneous coronary intervention due to acute coronary syndrome were included. The patients who participated in cardiac rehabilitation (CR) program were categorized as the CR group, and others who did not participate as the control. Both groups underwent initial graded exercise test (GXT) and FMD testing. Subsequently, the CR group performed aerobic exercise training sessions. Patients in control only received advice regarding the exercise methods. After six weeks, both groups received follow-up GXT and FMD testing.
There were 16 patients in each group. There were no significant differences in the general characteristics between the groups. The VO2peak was 28.6±4.7 mL/kg/min in the CR group and 31.5±7.4 mL/kg/min in the control at first GXT, and was 31.1±5.1 ml/kg/min in the CR group and 31.4±6.0 ml/kg/min in the control at the follow-up GXT in six weeks. There was a statistically significant improvement in VO2peak only for CR group patients. FMD value was 7.59%±1.26% in the CR group, 7.36%±1.48% in the control at first and 9.46%±1.82% in the CR group, and 8.31%±2.04% in the control after six weeks. There was a statistically significant improvement in FMD value in the CR group.
According to the results of GXT and FMD testing, six-week exercise-based CR program improved VO2peak and endothelial functions significantly. Thus, exercise-based CR program is necessary in patients with coronary artery disease.
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To compare the rate of progression of de novo lesion between the cardiac rehabilitation (CR) and control groups.
This is a retrospective observational study. Patients who received drug-eluting stent (DES) due to acute coronary syndrome were included as subjects. The CR group received eight weeks of early CR program, and sustained a self-exercise program in the homes. The control group was instructed to exercise independently. Nine months after the first insertion of DES, we implemented follow-up coronary angiography, and compared the rate of progression of de novo lesion by quantitative angiographic measurement between the two groups.
A total of 81 patients were recruited as subjects to CR group (n=32) or control group (n=49). At nine months, late luminal loss was 0.04±0.23 mm in the CR group and 0.00±0.31 mm in the control group (p=0.54, observed power=0.10). Late loss was -0.90%±9.53% in the CR group and 0.80%±11.15% in the control group (p=0.58, observed power=0.05). No target lesion revascularization procedures were needed in the CR group, while two in the control group (p=0.25). In the CR group, mean VO2max was significantly improved from 24.36±5.00 to 27.68±5.24 mL/kg/min (p<0.001).
We could not observe a statistically significant difference in the progression rate of de novo lesion between the CR and control groups. Thus the current amount of nine months exercise-based CR program does not seem to have a distinct impact on the retardation of de novo coronary lesion in patients who received percutaneous coronary intervention with DES.
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To find out the predictive value of the ΣΔST/ΔHR index for restenosis after percutaneous coronary intervention (PCI).
Subjects of this research were patients who participated in a cardiac rehabilitation (CR) program as six to eight weeks of a hospital-based program after receiving PCI to treat acute coronary syndrome (ACS). The patients received coronary angiography (CAG) at the onset of the ACS and nine months after that, and also received an exercise tolerance test (ETT) at the start of the CR program and several days before receiving a follow-up CAG. In ETT, we used the sum of the ST depression (ΣΔST index) of leads II, III, aVF, V4-6 as well as the sum of the ΔST/ΔHR (heart rate) (ΣΔST/ΔHR index) in the same leads and the sum of the ΔST/ΔRPP (rate pressure product) (ΣΔST/ΔRPP index) in the same leads. We compared the predictive power of each index of ETT for restenosis after PCI.
The sensitivity, specificity, positive predictive value, and negative predictive value of ΣΔST index were 69%, 47%, 31%, and 82%. The ΣΔST/ΔHR index was 13.7±5.2 in the restenosis group and 9.3±5.6 in the patent group (p=0.017). The sensitivity, specificity, positive predictive value, and negative predictive value of this index were 85%, 63%, 44%, and 92%. The ΣΔST/ΔRPP index were 0.10±0.08 in the restenosis group and 0.06±0.04 in the patent group (p=0.016). The sensitivity, specificity, positive predictive value, and negative predictive value of this index were 54%, 76%, 44%, and 83%.
The ΣΔST/ΔHR index showed a much higher sensitivity and negative predictive value for restenosis after PCI compared to the ΣΔST index.
To observe the contrast spreading patterns in the retrodiscal (RD) approach for transforaminal epidural steroid injections and their effect on pain reduction.
Patients with L5 radiculopathy who were scheduled to receive lumbar TF-EPB were consecutively included. We randomly divided them into the L4-5 RD and L5-S1 RD groups and administered 1 cc of contrast dye into epidural space. We observed the shape and the location of contrast dye on the anterior-posterior and lateral views. We injected 1 cc of 0.5% lidocaine mixed with 20 mg of triamcinolone, and checked the pain intensity before and two weeks after the procedure by using visual analogue scale (VAS).
In the L4-5 RD group (n=30), contrast spread over the L4 nerve root in 27 cases and the L4 and L5 nerve roots in 3 cases. In the L5-S1 RD group (n=33), contrast spread over the L5 nerve root in 20 cases, the S1 nerve root in 3 cases, and the L5 and the S1 nerve roots in 10 cases. The contrast spreading patterns could be divided into 4 patterns: the proximal root in 40 cases, the distal root in 19 cases, the anterior epidural space in 3 cases and an undefined pattern in 1 case.
In RD lumbar TF-EPB, the contrast dye mostly went into the cephalic root and about 60% spread over the proximal nerve root. There was less pain reduction when the contrast dye spread over the distal nerve root.
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Effect of Needle Tip Position on Contrast Media Dispersion Pattern in Transforaminal Epidural Injection Using Kambin’s Triangle Approach
To survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR.
All cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescriptions. We measured all cardiac complications, including death, symptoms, abnormal hemodynamic responses, and electrocardiogram (ECG) abnormality during exercise training, for 10 years. A total of 975 patients (68% male; mean age, 58.9±10.6) were included in this study. Initial indications for CR were recent percutaneous transluminal coronary angioplasty (PTCA) (75%), post-cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%).
The study population underwent 13,934 patient-hours of monitoring exercise. No death, cardiac arrest or acute myocardial infarction (AMI) occurred during exercise (0/13,934 exercise-hours). Fifty-nine patients experienced 70 cardiovascular events during the 13,934 exercise-hours (1/199 exercise-hours); there were 17 cases of angina only (1/820 exercise-hours), 31 cases of ECG abnormalities only (1/449 exercise-hours), 12 cases of angina with ECG abnormalities (1/1,161 exercise-hours), and 10 cases of abnormal hemodynamic responses (1/1,393 exercise-hours).
Early hospital-based CR is safe enough that no death, cardiac arrest or AMI occurred during the 13,934 patient-hours of monitoring exercise. However, risk stratification for exercise-induced cardiovascular events, proper exercise prescriptions, and intensive ECG monitoring are required prior to initiation of the monitoring exercise.
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To compare the rate of restenosis between a cardiac rehabilitation (CR) group and a control group within three different generations of drug eluting stents (DES).
Patients who received DES due to an acute coronary syndrome were included. They were divided into a CR group and a control group. The CR group received six to eight weeks of early cardiac rehabilitation program in a hospital setting, and sustained a self-exercise program for six months in a community. The control group was instructed to exercise by themselves after leaving the hospital. Nine months after the first onset of disease, we implemented a coronary angiography and compared the two groups. In addition, we divided the patients into three subgroups according to the generation of DES, and compared the rate of restenosis between the CR group and control group within these three subgroups.
At 9 months, in-stent restenosis, measured as an in-segment late luminal loss (LLL) of the stented coronary area, was smaller in the CR group (n=52) 0.16±0.42 mm compared to the control group (n=51) 0.39±0.78 mm (p<0.05). A reduction of LLL in the CR group compared to the control group was consistent among the three different generations of DES.
The CR program is strongly associated with a significant reduction in LLL in the stented coronary segments, regardless of the generation of DES.
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To evaluate the effects of power walking (PW) training on a treadmill in patients with coronary heart disease (CHD) and to compare the cardiovascular effects of PW with usual walking (UW).
Patients were recruited as participants in phase 2 cardiac rehabilitation program after receiving percutaneous coronary intervention (PCI) due to acute coronary syndrome from our hospital. The participants were divided into the PW group (n=16) and UW group (n=18). All participants received graded exercise test (GXT) and significant difference in maximal oxygen consumption (VO2Max) was not observed between the groups. Aerobic exercise training on treadmill was given for 50 minutes per session, three times a week, for six weeks. Physiological and hematological parameters were tested before and 6 weeks after the cardiac rehabilitation program. Exercise duration, VO2Max, heart rate, blood pressure, and rate pressure product were evaluated through graded exercise test. Hematological measurements included serum lipid profile, and high-sensitivity C reactive protein (hs-CRP).
There were no significant differences in resting heart rate, maximal heart rate, resting systolic and diastolic blood pressures, lipid profile, hs-CRP, VO2Max, and RPP between the PW group and UW group. However, after 6 weeks of the intervention, VO2Max in the PW group (36.03±5.69 ml/kg/min) was significantly higher than that in the UW group (29.73±5.63 ml/kg/min) (p<0.05).
After six weeks of phase 2 cardiac rehabilitation program, the PW group showed significant improvement in VO2Max than the UW group. Thus, it will beneficial to recommend power walking in cardiac rehabilitation program.
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To determine if an early regular cardiac rehabilitation program would have an adverse effect on myocardial function after acute myocardial infarction (AMI).
Patients who received percutaneous coronary intervention (PCI) after AMI were divided into the exercise group and control group in accordance with their willingness to participate. Patients in the exercise group (n=18) received ECG monitored exercise for six weeks and were instructed to maintain self exercise in their communities for four months. The control group (n=16) patients were just instructed of risk factor control. All the subjects underwent echocardiography at the time of the AMI as well as six months later. The echocardiography parameters, including the left ventricular ejection fraction (LVEF), stroke volume (SV), left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), were measured.
In the exercise group, the LVEF increased to 59.58±9.24% and 61.58±9.63% after six weeks and six months, respectively (p<0.05), but SV, LVEDD and LVESD did not change (p>0.05).
Active participation in the cardiac rehabilitation program approximately two weeks after AMI did not have an adverse effect on the size of the left ventricle and myocardial function.
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