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Araki N, Hirota T, Hidaka H, Horibe T, Numaguchi R, Takaki J, Nishigawa K, Yoshinaga T, Fukui T. Factors Affecting Recovery of 6-Minute Walk Distance After Coronary Artery Bypass Grafting. Circ Rep 2023; 5:317-322. [PMID: 37564878 PMCID: PMC10411994 DOI: 10.1253/circrep.cr-23-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 08/12/2023] Open
Abstract
Background: This single-center retrospective analysis investigated the number of days required for postoperative 6-minute walk distance (6MWD) to recover to preoperative values after coronary artery bypass grafting (CABG) and the factors influencing this recovery. Methods and Results: The 6MWD was measured in 101 patients (median age 69 years; 18 women) before and every day after CABG. Univariate and multivariate analyses were performed to identify factors affecting 6MWD recovery to preoperative values after CABG. The median number of days required for recovery of 6MWD after CABG was 9 (interquartile range 7-11 days). Patients were divided into 2 groups based on the median number of days required for recovery of 6MWD; there were 60 patients in the early recovery group (<9 days) and 41 in the "non-early" recovery group (38 who recovered after the median 9 days, and 3 who did not recover during hospitalization). Using univariate logistic regression analysis, diabetes (P=0.01), stroke (P=0.26), left ventricular ejection fraction (P=0.27), and grip strength (P=0.13) were selected for multivariate analysis. Multivariate logistic regression analysis revealed that diabetes (odds ratio 2.955; 95% confidence interval 1.208-7.229; P=0.02) was the only independent predictor of 6MWD recovery. Conclusions: Diabetes was the single factor influencing the recovery of postoperative 6MWD in patients undergoing CABG.
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Affiliation(s)
- Naoya Araki
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
| | - Takafumi Hirota
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
| | - Hideaki Hidaka
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
| | - Tatsuya Horibe
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
| | - Ryosuke Numaguchi
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
| | - Jun Takaki
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
| | - Kosaku Nishigawa
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
| | - Takashi Yoshinaga
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital Kumamoto Japan
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2
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Takino K, Kameshima M, Asai C, Kawamura I, Tomita S, Sato H, Hirakawa A, Yamada S. Neuromuscular electrical stimulation after cardiovascular surgery mitigates muscle weakness in older individuals with diabetes. Ann Phys Rehabil Med 2022; 66:101659. [PMID: 35272065 DOI: 10.1016/j.rehab.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cardiovascular surgery leads to postsurgical muscle weakness, probably because of muscle proteolysis and peripheral nerve dysfunction, which are augmented by aging and diabetes mellitus. OBJECTIVE We examined the effect of neuromuscular electrical stimulation (NMES) on postsurgical muscle weakness in older individuals with diabetes mellitus. METHODS We conducted a multicentre, randomized, controlled trial, and screened consecutive patients with diabetes who underwent cardiovascular surgery for eligibility (age ≥ 65 years). Those included were randomly assigned to the NMES or the sham group. The primary outcome was the percent change in isometric knee extension strength (%ΔIKES) from preoperative to postoperative day 7. Secondary outcomes were the percent change in usual (%ΔUWS), maximum walking speed (%ΔMWS), and grip strength (%ΔGS). A statistician who was blinded to group allocation used intention-to-treat analysis (student t test). RESULTS Of 1151 participants screened for eligibility, 180 (NMES, n = 90; sham, n = 90) were included in the primary analysis. %ΔIKES was significantly lower in the NMES than sham group (NMES: mean -2%, 95% confidence interval [CI] -6 to 1; sham: -13%, 95% CI -17 to -9, p < 0.001). Among the secondary outcomes, %ΔMWS was significantly lower and %ΔUWS and %ΔGS were lower, although not significantly, in the NMES than sham group. CONCLUSIONS A short course of NMES (< 1 week) mitigated postsurgical muscle weakness and functional decline in older persons with diabetes mellitus. NMES could be recommended as a part of postsurgical rehabilitation in older people with diabetes mellitus, especially those with a low functional reserve.
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Affiliation(s)
- Koya Takino
- Department of Cardiac Rehabilitation, Gifu Heart Center, 4-14-4, Yabuta-minami, Gifu, Japan; Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Japan
| | - Masataka Kameshima
- Department of Cardiac Rehabilitation, Nagoya Heart Center, 1-1-11, Sunadabashi, higasi-ku, Nagoya, Japan
| | - Chikako Asai
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, 1-21, Gobudori, Oyamacho, Toyohasi, Japan
| | - Itta Kawamura
- Department of Cardiology, Gifu Heart Center, 4-14-4, Yabuta-minami, Gifu, Japan
| | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4, Yabuta-minami, Gifu, Japan
| | - Hiroyuki Sato
- Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Akihiro Hirakawa
- Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan.
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3
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Lee-Ødegård S, Olsen T, Norheim F, Drevon CA, Birkeland KI. Potential Mechanisms for How Long-Term Physical Activity May Reduce Insulin Resistance. Metabolites 2022; 12:metabo12030208. [PMID: 35323652 PMCID: PMC8950317 DOI: 10.3390/metabo12030208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Insulin became available for the treatment of patients with diabetes 100 years ago, and soon thereafter it became evident that the biological response to its actions differed markedly between individuals. This prompted extensive research into insulin action and resistance (IR), resulting in the universally agreed fact that IR is a core finding in patients with type 2 diabetes mellitus (T2DM). T2DM is the most prevalent form of diabetes, reaching epidemic proportions worldwide. Physical activity (PA) has the potential of improving IR and is, therefore, a cornerstone in the prevention and treatment of T2DM. Whereas most research has focused on the acute effects of PA, less is known about the effects of long-term PA on IR. Here, we describe a model of potential mechanisms behind reduced IR after long-term PA to guide further mechanistic investigations and to tailor PA interventions in the therapy of T2DM. The development of such interventions requires knowledge of normal glucose metabolism, and we briefly summarize an integrated physiological perspective on IR. We then describe the effects of long-term PA on signaling molecules involved in cellular responses to insulin, tissue-specific functions, and whole-body IR.
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Affiliation(s)
- Sindre Lee-Ødegård
- Department of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway;
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway; (T.O.); (F.N.); (C.A.D.)
| | - Frode Norheim
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway; (T.O.); (F.N.); (C.A.D.)
| | - Christian Andre Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway; (T.O.); (F.N.); (C.A.D.)
- Vitas Ltd. Analytical Services, Oslo Science Park, 0349 Oslo, Norway
| | - Kåre Inge Birkeland
- Department of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway;
- Correspondence:
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4
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Trojian T, Colberg S, Harris G, Oh R, Dixit S, Gibson M, Corcoran M, Ramey L, Berg PV. American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes. Clin J Sport Med 2022; 32:8-20. [PMID: 34930869 DOI: 10.1097/jsm.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
ABSTRACT The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.
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Aminuddin A, Noor Hashim MF, Mohd Zaberi NAS, Zheng Wei L, Ching Chu B, Jamaludin NA, Salamt N, Che Roos NA, Ugusman A. The Association Between Arterial Stiffness and Muscle Indices Among Healthy Subjects and Subjects With Cardiovascular Risk Factors: An Evidence-Based Review. Front Physiol 2021; 12:742338. [PMID: 34887771 PMCID: PMC8650579 DOI: 10.3389/fphys.2021.742338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
Skeletal muscle is one of the major tissues in the body and is important for performing daily physical activity. Previous studies suggest that vascular dysfunction contributes to reduced skeletal muscle mass. However, the association between vascular dysfunction and muscle mass, muscle strength and muscle flexibility are less established. Therefore, the focus of this review was to investigate the association between arterial stiffness (AS) which is a marker of vascular function, and muscle indices among healthy and those with cardiovascular risk factors. Three databases were used to search for relevant studies. These keywords were used: "arterial stiffness" OR "vascular stiffness" OR "aortic stiffness" OR "pulse wave velocity" OR "carotid femoral pulse wave velocity" OR "pulse wave analysis" AND "muscle" OR "skeletal" OR "flexibility" OR "range of motion" OR "articular" OR "arthrometry" OR "strength" OR "hand strength" OR "pinch strength" OR "mass" OR "lean" OR "body composition." The criteria were; (1) original, full-text articles, (2) articles written in English language, (3) human studies involving healthy adults and/or adults with cardiovascular disease (CVD) or CVD risk factors (4) articles that reported the relationship between AS (measured as carotid-femoral pulse wave velocity or brachial-ankle pulse wave velocity) and muscle indices (measured as muscle mass, muscle flexibility and muscle strength) after adjusting for relevant confounders. The search identified 2295 articles published between 1971 and June 2021. Only 17 articles fulfilled the criteria. Two studies showed an inverse association between AS and muscle strength in healthy subjects, whereas in subjects with CVD risk factors, five out of seven studies found an inverse correlation between the two parameters. Eleven studies showed an inverse association between AS and muscle mass in subjects with CVD and CVD risk factors. The association between AS and muscle flexibility was not studied in any of the articles reviewed. In conclusion, there is an inverse correlation between muscle indices and AS in healthy adults and those with CVD or CVD risk factors. However, most of the studies were cross-sectional studies, hence the need for future prospective studies to address this issue.
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Affiliation(s)
- Amilia Aminuddin
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | | | | | - Lee Zheng Wei
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Beh Ching Chu
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Nur Amalina Jamaludin
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Norizam Salamt
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Nur Aishah Che Roos
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, Malaysia
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
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6
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Nishitani-Yokoyama M, Shimada K, Yamada M, Honzawa A, Kunimoto M, Sugita Y, Fujiwara K, Matsubara T, Matsumori R, Abulimiti A, Shimada A, Yamamoto T, Asai T, Amano A, Saitoh M, Morisawa T, Takahashi T, Daida H, Minamino T. Association Between Constipation and Frailty Components in Patients Undergoing Late Phase II Cardiac Rehabilitation. Cardiol Res 2021; 12:169-176. [PMID: 34046111 PMCID: PMC8139749 DOI: 10.14740/cr1246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background The Japanese Ministry of Health, Labour and Welfare reported that the overall constipation complaint rates among men and women are 2.5% and 4.6%, respectively. To evaluate the impact of constipation on patients with cardiovascular diseases, we investigated the association between constipation and frailty components in patients undergoing cardiac rehabilitation (CR). Methods We enrolled 102 consecutive patients undergoing late phase II CR (mean age: 62.7 ± 13.4 years; 68 (67%) were men). We investigated clinical characteristics, observed defecation status and evaluated frailty components assessed by the Kihon checklist. According to the Clinical Guidelines for Chronic Constipation, the subjects were divided into constipation and non-constipation groups. Results Constipation was noted in 33 patients (32%). Interestingly, the constipation complaint rate was only 15%. Age was significantly higher in the constipation group than in the non-constipation group; however, no differences in sex, underlying diseases and prevalence rates of coronary risk factors were observed between the two groups. Body mass index, hemoglobin level, albumin level and estimated glomerular filtration rate were significantly lower in the constipation group than in the non-constipation group. The prevalence of frailty was significantly higher in the constipation group than in the non-constipation group. Physical ability, seclusion and depression scores were significantly higher in the constipation group than the non-constipation group. Conclusions Constipation was associated with physical function and depression score as components of frailty in patients undergoing CR.
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Affiliation(s)
- Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Miki Yamada
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Mitsuhiro Kunimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yurina Sugita
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomomi Matsubara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Rie Matsumori
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Abidan Abulimiti
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masakazu Saitoh
- Juntendo University, Faculty of Health Science, Tokyo, Japan
| | | | | | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Juntendo University, Faculty of Health Science, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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7
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Mohammadpour S, Ghanbari M, Shahinfar H, Gholami F, Djafarian K, Shab-Bidar S. The association between healthy lifestyle score with cardiorespiratory fitness and muscle strength. Int J Clin Pract 2020; 74:e13640. [PMID: 32748532 DOI: 10.1111/ijcp.13640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The association of individual behaviours such as diet, tobacco use, body mass index (BMI) and physical activity have been investigated separately in relevance to cardiorespiratory fitness (CRF) and muscle strength. The purpose of this study is to investigate the combined association of the four mentioned lifestyle factors with cardiorespiratory fitness and muscle strength. METHODS This cross-sectional study was conducted on 271 Iranian adults, aged 18-70 years. We developed a healthy lifestyle score (HLS) that ranged from 0 to 103 (higher score reflecting better adherence to healthier lifestyle) and included four lifestyle behavioural components (diet, physical activity, smoking and BMI). The relationship between HLS, CRF and muscle strength was determined using linear and non-linear regression analysis. RESULTS HLS score was not significantly associated with VO2max (mL/kg/min) P = .43; VO2max (L min) P = .14; VO2max (LBM) (P = .79) and mean muscle strength (MMS) (kg) (P = .11), muscle strength of right hand (MSR) (kg) (P = .10) and muscle strength of left hand (MSL) (kg) (P = .16) in the unadjusted model. After adjustment for potential confounders, we found a significant association between HLS and Vo2max (L/min), MMS (kg), MSR (kg) and MSL (kg) (P < .001 for all). Also HLS and MMS (r = .06, P = .31), MSR (r = .07, P = .25), MMS (r = .05, P = .39), VO2max (mL/kg/min) (r = .01, P = .77), VO2max (L min) (r = .05, P = .35) and VO2max (LBM) (r = .002, P = .91) have no statistically significant linear relationship. CONCLUSION Adherence to healthy lifestyle may be associated with increased CRF and muscle strength after adjusting for potential confounding variables.
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Affiliation(s)
- Saba Mohammadpour
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahtab Ghanbari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hossein Shahinfar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fateme Gholami
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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8
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Wang B, Mu XL, Zhao J, Jiang HP, Li SS, Yan G, Hua YY, Ren XY, Xing LX, Liang Y, Zhang SD, Zhao YC. Effects of lifestyle interventions on rural patients with type 2 diabetes mellitus. World J Diabetes 2020; 11:261-268. [PMID: 32547700 PMCID: PMC7284015 DOI: 10.4239/wjd.v11.i6.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is rising rapidly in rural areas, and lifestyle interventions can effectively reduce the blood glucose levels of patients with T2DM. However, current dietary and exercise guidelines are still at experimental stages and are difficult for subjects to understand and implement. The Human Metabolism Analyzer provides real life interventions for the prevention and treatment of T2DM, and our pilot research has demonstrated its effectiveness and good compliance.
AIM To investigate the effect of and compliance with lifestyle interventions in rural patients with T2DM.
METHODS A total of ten rural villages were randomly selected in Chaoshui Township, Penglai City, Shandong Province, China, to conduct health screening among residents aged 50 years or older. Each rural village represented a group, and 12 patients with T2DM were randomly selected from each group (total: 120) to participate in this study and receive real life lifestyle interventions and medication guidance. Lifestyle interventions included changing the meal order (A), postprandial activities (B), resistance exercise (C), and reverse abdominal breathing (D). Diabetes education was conducted at least once a month with a weekly phone follow-up to monitor exercise and diet. Waist circumference, blood pressure, body mass index (BMI), motor function, body composition, fasting blood glucose, and glycated hemoglobin (HbA1c) were analyzed before and 3 mo after the intervention. Moreover, patient compliance and adjustments of hypoglycemic drugs were evaluated.
RESULTS A total of 109 subjects completed the study. The compliance rates for lifestyle interventions A, B, C, and D were 57.79%, 60.55%, 64.22%, and 75.23%, respectively. Among the subjects who received hypoglycemic drugs, the dose was reduced 2 to 3 times based on blood glucose in 54 (67.50%) subjects and was tapered and discontinued in 5 (6.25%) subjects within 3 mo, with no significant fluctuations in blood glucose after dose reduction and withdrawal. After lifestyle interventions, waist circumference, BMI, fasting blood glucose, and HbA1c significantly decreased (P < 0.001); motor function and body composition also significantly improved (P < 0.001).
CONCLUSION For patients with T2DM, compliance to real-life lifestyle interventions is good, and the interventions significantly improve metabolic indicators such as waist circumference, BMI, blood pressure, HbA1c, body composition, and motor function. Some patients are able to taper or discontinue hypoglycemic drugs.
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Affiliation(s)
- Bo Wang
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Xiao-Li Mu
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Juan Zhao
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Hai-Ping Jiang
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Shan-Shan Li
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Ge Yan
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Ying-Ying Hua
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Xue-Yi Ren
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Li-Xia Xing
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Yan Liang
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Shu-Dong Zhang
- Department of Internal Medicine, Yantaishan Hospital, Yantai 264025, Shandong Province, China
| | - Yu-Chi Zhao
- Department of Osteoarthropathy, Yantaishan Hospital, Yantai 264025, Shandong Province, China
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9
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Kunimoto M, Shimada K, Yokoyama M, Matsubara T, Aikawa T, Ouchi S, Shimizu M, Fukao K, Miyazaki T, Kadoguchi T, Fujiwara K, Abulimiti A, Honzawa A, Yamada M, Shimada A, Yamamoto T, Asai T, Amano A, Smit AJ, Daida H. Association between the tissue accumulation of advanced glycation end products and exercise capacity in cardiac rehabilitation patients. BMC Cardiovasc Disord 2020; 20:195. [PMID: 32326893 PMCID: PMC7178950 DOI: 10.1186/s12872-020-01484-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background Advanced glycation end products (AGEs) are associated with aging, diabetes mellitus (DM), and other chronic diseases. Recently, the accumulation of AGEs can be evaluated by skin autofluorescence (SAF). However, the relationship between SAF levels and exercise capacity in patients with cardiovascular disease (CVD) remains unclear. This study aimed to investigate the association between the tissue accumulation of AGEs and clinical characteristics, including exercise capacity, in patients with CVD. Methods We enrolled 319 consecutive CVD patients aged ≥40 years who underwent early phase II cardiac rehabilitation (CR) at our university hospital between November 2015 and September 2017. Patient background, clinical data, and the accumulation of AGEs assessed by SAF were recorded at the beginning of CR. Characteristics were compared between two patient groups divided according to the median SAF level (High SAF and Low SAF). Results The High SAF group was significantly older and exhibited a higher prevalence of DM than the Low SAF group. The sex ratio did not differ between the two groups. AGE levels showed significant negative correlations with peak oxygen uptake and ventilator efficiency (both P < 0.0001). Exercise capacity was significantly lower in the high SAF group than in the low SAF group, regardless of the presence or absence of DM (P < 0.05). A multivariate logistic regression analysis showed that SAF level was an independent factor associated with reduced exercise capacity (odds ratio 2.10; 95% confidence interval 1.13–4.05; P = 0.02). Conclusion High levels of tissue accumulated AGEs, as assessed by SAF, were significantly and independently associated with reduced exercise capacity. These data suggest that measuring the tissue accumulation of AGEs may be useful in patients who have undergone CR, irrespective of whether they have DM.
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Affiliation(s)
- Mitsuhiro Kunimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomomi Matsubara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tatsuro Aikawa
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kosuke Fukao
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomoyasu Kadoguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Abidan Abulimiti
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Miki Yamada
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Andries J Smit
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Faculty of Health Science, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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10
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Both higher fitness level and higher current physical activity level may be required for intramyocellular lipid accumulation in non-athlete men. Sci Rep 2020; 10:4102. [PMID: 32139784 PMCID: PMC7057967 DOI: 10.1038/s41598-020-61080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/20/2020] [Indexed: 11/25/2022] Open
Abstract
Accumulation of intramyocellular lipid (IMCL) is observed in individuals with insulin resistance as well as insulin-sensitive endurance athletes with high peak oxygen consumption (VO2peak), which is called the athlete’s paradox. It remains unclear whether non-athletes with higher fitness levels have IMCL accumulation and higher insulin sensitivity in general. In this study, we investigated the association between IMCL accumulation and muscle insulin sensitivity (M-IS) in subjects with high or low VO2peak. We studied 61 nonobese (BMI, 23 to 25 kg/m2), non-athlete Japanese men. We divided the subjects into four groups based on the median value of VO2peak and IMCL in the soleus muscle. We evaluated M-IS using a two-step hyperinsulinemic-euglycemic clamp. Among subjects with higher VO2peak (n = 32), half of those (n = 16) had lower IMCL levels. Both High-VO2peak groups had higher M-IS than the Low-VO2peak groups. On the other hand, M-IS was comparable between the High-VO2peak/High-IMCL and High-VO2peak/Low-IMCL groups, whereas the High-VO2peak/High-IMCL group had IMCL levels that were twice as high as those in the High-VO2peak/Low-IMCL group. On the other hand, the High-VO2peak/High-IMCL group had significantly higher physical activity levels (approximately 1.8-fold) than the other three groups. In conclusion, in nonobese, non-athlete Japanese men, subjects with higher VO2peak and higher IMCL had higher physical activity levels. IMCL accumulation is not associated with insulin resistance in individuals with higher or lower fitness levels.
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11
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Kaga H, Tamura Y, Takeno K, Kakehi S, Someya Y, Funayama T, Furukawa Y, Suzuki R, Sugimoto D, Kadowaki S, Nishitani-Yokoyama M, Shimada K, Daida H, Aoki S, Giacca A, Kanazawa A, Kawamori R, Watada H. Higher C-Peptide Level During Glucose Clamp Is Associated With Muscle Insulin Resistance in Nonobese Japanese Men. J Endocr Soc 2019; 3:1847-1857. [PMID: 31555755 PMCID: PMC6753586 DOI: 10.1210/js.2019-00167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022] Open
Abstract
Context Circulating C-peptide is generally suppressed by exogenous insulin infusion. However, steady-state serum C-peptide (SSSC) levels during hyperinsulinemic-euglycemic clamp in obese subjects are higher than in healthy subjects, which may contribute to hyperinsulinemia to compensate for insulin resistance. Even in healthy subjects, interindividual variations in SSSC levels are present; however, the characteristics of subjects with high SSSC levels in those populations have not been fully elucidated. Objective To investigate the clinical parameters associated with interindividual variations in SSSC levels in apparently healthy, nonobese Japanese men. Design and Participants We studied 49 nonobese (BMI < 25 kg/m2), healthy Japanese men. We evaluated SSSC and insulin sensitivity using hyperinsulinemic-euglycemic clamp with tracer. Intrahepatic lipid (IHL) was measured using proton magnetic resonance spectroscopy. Results We divided subjects into high and low SSSC groups based on the median SSSC value and compared their clinical parameters. Compared with the low SSSC group, the high SSSC group had IHL accumulation, impaired muscle insulin sensitivity, reduced insulin clearance, and hyperinsulinemia during a 75-g oral glucose tolerance test (OGTT). All of these factors were significantly correlated with SSSC. Conclusions In healthy, nonobese men, higher SSSC was associated with impaired muscle insulin sensitivity, IHL accumulation, and hyperinsulinemia during OGTT. These findings suggest that higher endogenous insulin secretion during hyperinsulinemia, along with reduced insulin clearance, may be an early change to maintain metabolic status in the face of moderate muscle insulin resistance, even in healthy, nonobese men.
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Affiliation(s)
- Hideyoshi Kaga
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Tamura
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kageumi Takeno
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Saori Kakehi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Someya
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Funayama
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Furukawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ruriko Suzuki
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daisuke Sugimoto
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Kadowaki
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Kazunori Shimada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Adria Giacca
- Departments of Physiology and Medicine, Institute of Medical Science and Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada
| | - Akio Kanazawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryuzo Kawamori
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Center for Identification of Diabetic Therapeutic Targets, Juntendo University Graduate School of Medicine, Tokyo, Japan
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12
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Kunimoto M, Shimada K, Yokoyama M, Matsubara T, Aikawa T, Ouchi S, Shimizu M, Fukao K, Miyazaki T, Kadoguchi T, Fujiwara K, Honzawa A, Yamada M, Shimada A, Yamamoto T, Amano A, Daida H. Relationship between the Kihon Checklist and the clinical parameters in patients who participated in cardiac rehabilitation. Geriatr Gerontol Int 2019; 19:287-292. [PMID: 30793829 DOI: 10.1111/ggi.13617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/10/2018] [Accepted: 12/25/2018] [Indexed: 11/28/2022]
Abstract
AIM The Kihon Checklist is a useful screening tool for assessing frailty in older individuals. However, the clinical significance of the Kihon Checklist in cardiac rehabilitation patients remains unclear. The present study aimed to evaluate the relationship between the Kihon Checklist and the clinical parameters in patients who participated in cardiac rehabilitation. METHODS We enrolled 845 consecutive patients (584 men, mean age 71 years) who participated in cardiac rehabilitation at Juntendo University Hospital, Tokyo, Japan, between November 2015 and October 2017. The patients were divided into non-frailty (n = 287), pre-frailty (n = 270) and frailty (n = 288) groups according to their Kihon Checklist scores. Cardiopulmonary exercise testing was carried out in 302 patients. RESULTS The frailty group was older and had a higher prevalence of history of heart failure than the non-frailty group, although left ventricular ejection fraction did not differ significantly between groups. Nutritional index, trunk and limb muscle mass, lean body weight, and grip strength were significantly lower in the frailty and pre-frailty groups than those in the non-frailty group. In the cardiopulmonary exercise test, a stepwise significant decrease in peak oxygen uptake was observed across the three groups (non-frailty 17.2 ± 3.6, pre-frailty 16.0 ± 3.4, frailty 14.4 ± 3.5 mL/kg/min, P < 0.01). Multivariate regression analyses showed that the Kihon Checklist score was significantly and independently associated with peak oxygen uptake (r = -0.34, P < 0.0001). CONCLUSIONS The Kihon Checklist, which was associated with frailty and exercise tolerance, could be used as a clinical assessment method for patients who participated in cardiac rehabilitation. Geriatr Gerontol Int 2019; 19: 287-292.
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Affiliation(s)
- Mitsuhiro Kunimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Tomomi Matsubara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuro Aikawa
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kosuke Fukao
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoyasu Kadoguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Miki Yamada
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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13
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Codella R, Ialacqua M, Terruzzi I, Luzi L. May the force be with you: why resistance training is essential for subjects with type 2 diabetes mellitus without complications. Endocrine 2018; 62:14-25. [PMID: 29730785 DOI: 10.1007/s12020-018-1603-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
Abstract
Physical activity, together with diet and pharmacological therapy, represents one of the three cornerstones in type 2 diabetes mellitus treatment and care. The therapeutic appeal of regular physical activity stems from: (i) its non-pharmacological nature; (ii) its beneficial effects on the metabolic risk factors associated with diabetes complications; (iii) its low costs. Evidence accumulated in the last years suggests that aerobic training-endurance training-constitutes a safe modality of intervention, achievable, and effective in diabetes treatment, whenever it is not limited by comorbidities. Aerobic training exerts insulin-mimetic effects and has been shown to lower mortality risk too. Anaerobic, intense physical activity, such as that of strength or power sports disciplines, is not univocally recognized as safe and simple to realize, however, it is important in stimulating energy and glucose metabolism. According to recent evidence, high-intensity training may be prescribed even in the face of cardiovascular diseases, peripheral vascular disease, or osteoarthritis. Some studies have shown resistance training to be more efficient than aerobic exercise in improving glycemic control. This review explores the most up-to-date indications emerging from literature in support of the beneficial effects of strength stimulation and resistance training in patients with type 2 diabetes without complications.
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Affiliation(s)
- Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Marta Ialacqua
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Ileana Terruzzi
- Diabetes Research Institute, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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14
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Tatulashvili S, Patois-Vergès B, Nguyen A, Blonde MC, Vergès B. Detection of glucose metabolism disorders in coronary patients enrolled in cardiac rehabilitation: Is glycated haemoglobin useful? Data from the prospective REHABDIAB study. Eur J Prev Cardiol 2018; 25:464-471. [DOI: 10.1177/2047487317754011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction Diabetes and pre-diabetes are highly prevalent in patients with a history of acute coronary syndrome. This is why screening for glucose metabolism disorders is recommended in patients following an acute coronary syndrome. The aim of our study was to determine whether glycated haemoglobin alone compared with the oral glucose tolerance test could allow effective screening for glucose metabolism disorders in acute coronary syndrome patients undergoing cardiac rehabilitation. Patients and methods Among 347 patients with a recent history of acute coronary syndrome enrolled in our cardiac rehabilitation centre, 267 patients without previously known diabetes were recruited for this prospective study with performance of both oral glucose tolerance test and glycated haemoglobin measurement. The patients were divided into three groups: newly diagnosed diabetes mellitus, pre-diabetes and normoglycaemia according to the oral glucose tolerance test and glycated haemoglobin results. The results obtained with glycated haemoglobin were compared with those obtained with the oral glucose tolerance test, considered as the reference. Results For the diagnosis of diabetes, glycated haemoglobin had a sensitivity of 72% and a specificity of 100%. Positive and negative predictive values were high at 100% and 96%, respectively. However, for the diagnosis of pre-diabetes the sensitivity of glycated haemoglobin was low at 64% as were the specificity (53%) and the positive predictive values (37%). Glycated haemoglobin overdiagnosed pre-diabetes (52% vs 30%, p < 0.0001). For the diagnosis of normoglycaemia, the sensitivity of glycated haemoglobin was also low (48%). Conclusion According to our study, glycated haemoglobin has low sensitivity and specificity for the detection of pre-diabetes in patients with coronary disease enrolled in cardiac rehabilitation, and glycated haemoglobin over-diagnoses pre-diabetes in comparison with the oral glucose tolerance test.
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Affiliation(s)
- Sopio Tatulashvili
- Service Endocrinologie, Diabétologie, Centre Hospitalier Universitaire-Dijon, France
| | | | - Amandine Nguyen
- Service Endocrinologie, Diabétologie, Centre Hospitalier Universitaire-Dijon, France
| | | | - Bruno Vergès
- Service Endocrinologie, Diabétologie, Centre Hospitalier Universitaire-Dijon, France
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15
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High-intensity aerobic interval training can lead to improvement in skeletal muscle power among in-hospital patients with advanced heart failure. Heart Vessels 2018; 33:752-759. [DOI: 10.1007/s00380-018-1120-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/05/2018] [Indexed: 12/25/2022]
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16
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Predictors of improvements in exercise capacity during cardiac rehabilitation in the recovery phase after coronary artery bypass graft surgery versus acute myocardial infarction. Heart Vessels 2017; 33:358-366. [DOI: 10.1007/s00380-017-1076-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
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17
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Kaga H, Tamura Y, Takeno K, Kakehi S, Funayama T, Furukawa Y, Nishitani-Yokoyama M, Shimada K, Daida H, Aoki S, Giacca A, Kanazawa A, Kawamori R, Watada H. Correlates of insulin clearance in apparently healthy non-obese Japanese men. Sci Rep 2017; 7:1462. [PMID: 28469173 PMCID: PMC5431197 DOI: 10.1038/s41598-017-01469-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/30/2017] [Indexed: 01/13/2023] Open
Abstract
Hyperinsulinemia observed in obese subject is caused at least in part by low metabolic clearance rate of insulin (MCRI). However, the determinants of MCRI in non-obese subjects are not fully understood. To investigate the correlates of MCRI in healthy non-obese men (BMI <25 kg/m2), we studied 49 non-obese Japanese men free of cardiometabolic risk factors. Using a 2-step hyperinsulinemic euglycemic clamp, we evaluated MCRI and insulin sensitivity. We also calculated the rate of glucose disappearance (Rd) during the clamp and muscle insulin sensitivity was defined as Rd/steady state serum insulin (SSSI) at the second step. Based on the median value of MCRI, the subjects were divided into the low- and high-MCRI groups. Subjects of the low-MCRI group had significant impairment of muscle insulin sensitivity, although Rd levels were comparable between the two groups, probably due to elevated SSSI in the low-MCRI group. Subjects of the low-MCRI group had higher total body fat content and lower VO2peak and showed no deterioration of cardiometabolic risk factors. Our results suggest that low MCRI may be early change to maintain glucose uptake and metabolic status in the face of slight impairment of muscle insulin sensitivity caused by increased adiposity and lower fitness level.
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Affiliation(s)
- Hideyoshi Kaga
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Tamura
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Kageumi Takeno
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Saori Kakehi
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Funayama
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Furukawa
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Kazunori Shimada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Adria Giacca
- Departments of Physiology and Medicine, Institute of Medical Science and Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada
| | - Akio Kanazawa
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryuzo Kawamori
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Center for Identification of Diabetic Therapeutic Targets, Juntendo University Graduate School of Medicine, Tokyo, Japan
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18
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Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39:2065-2079. [PMID: 27926890 PMCID: PMC6908414 DOI: 10.2337/dc16-1728] [Citation(s) in RCA: 1331] [Impact Index Per Article: 166.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sheri R Colberg
- Department of Human Movement Sciences, Old Dominion University, Norfolk, VA
| | - Ronald J Sigal
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jane E Yardley
- Department of Social Sciences, Augustana Campus, University of Alberta, Camrose, Alberta, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - David W Dunstan
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Paddy C Dempsey
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Edward S Horton
- Harvard Medical School and Joslin Diabetes Center, Boston, MA
| | | | - Deborah F Tate
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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19
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Armstrong MJ, Sigal RJ. Exercise as Medicine: Key Concepts in Discussing Physical Activity with Patients who have Type 2 Diabetes. Can J Diabetes 2016; 39 Suppl 5:S129-33. [PMID: 26653253 DOI: 10.1016/j.jcjd.2015.09.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 02/06/2023]
Abstract
People with type 2 diabetes stand to benefit substantially from being physically active. Practice guidelines consistently recommend that people with diabetes obtain at least 150 minutes of moderate to vigorous aerobic exercise per week. Although the message of 150 minutes per week is important, there are several other key messages regarding physical activity that may not be communicated as often or as clearly. This article gives an overview of the importance of resistance training, the dose-response relationship between physical activity and health outcomes, and the emerging evidence concerning the role of sedentary behavior in people with type 2 diabetes. This article provides valuable content for healthcare providers that will help to inform their discussions about physical activity with patients who have type 2 diabetes.
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20
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Whole-Body Strength Training Using a Huber Motion Lab in Coronary Heart Disease Patients. Am J Phys Med Rehabil 2015; 94:385-94. [DOI: 10.1097/phm.0000000000000181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Armstrong MJ, Colberg SR, Sigal RJ. Moving beyond cardio: the value of resistance training, balance training, and other forms of exercise in the management of diabetes. Diabetes Spectr 2015; 28:14-23. [PMID: 25717274 PMCID: PMC4334083 DOI: 10.2337/diaspect.28.1.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IN BRIEF Traditionally, aerobic training has been a central focus of exercise promotion for diabetes management. However, people with diabetes have much to gain from other forms of exercise. This article reviews the evidence and recommendations on resistance, balance, and flexibility training, as well as other, less traditional, forms of exercise such as yoga and Tai Chi.
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Affiliation(s)
- Marni J. Armstrong
- Department of Cardiovascular and Respiratory Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sheri R. Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA
| | - Ronald J. Sigal
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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22
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Sai E, Shimada K, Yokoyama T, Sato S, Nishizaki Y, Miyazaki T, Hiki M, Tamura Y, Aoki S, Watada H, Kawamori R, Daida H. Evaluation of myocardial triglyceride accumulation assessed on 1H-magnetic resonance spectroscopy in apparently healthy Japanese subjects. Intern Med 2015; 54:367-73. [PMID: 25748951 DOI: 10.2169/internalmedicine.54.3024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Proton magnetic resonance spectroscopy ((1)H-MRS) enables the clinician to noninvasively assess the amount of ectopic fat in the liver, skeletal muscle and myocardium. Recent studies have reported that the myocardial triglyceride (TG) content is associated with aging, metabolic disorders and cardiac dysfunction. However, the clinical usefulness of myocardial TG measurements in Japanese subjects has not been fully investigated. METHODS The myocardial TG content was evaluated using (1)H-MRS in 37 apparently healthy Japanese subjects, and the left ventricular function was measured on cardiac magnetic resonance imaging (MRI). Blood pressure, body composition and biochemical markers were measured in a fasting state, and cardiopulmonary exercise testing (CPX) was performed to evaluate exercise capacity. RESULTS The mean myocardial TG content was 0.85±0.40%. The myocardial TG content was significantly associated with the percent body fat (r=0.39), serum triglyceride level (r=0.40), estimated glomerular filtration rate (r=-0.37), anaerobic threshold (r=-0.36), maximal load of CPX (r=0.39), left ventricular end-diastolic volume (r=-0.41) and left ventricular end-systolic volume (LVESV) (r=-0.51) (all: p<0.05). In a multivariate analysis, the LVESV was found to be an independent factor of the myocardial TG content. CONCLUSION (1)H-MRS may be useful for assessing the associations between the myocardial TG content and various clinical parameters, including those reflecting obesity, metabolic disorders, cardiac morphology and exercise capacity, noninvasively, even in Japanese subjects.
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Affiliation(s)
- Eiryu Sai
- Department of Cardiology, Juntendo University Graduate School of Medicine, Japan
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Relationship between muscle mass and muscle strength, and the impact of comorbidities: a population-based, cross-sectional study of older adults in the United States. BMC Geriatr 2013; 13:74. [PMID: 23865675 PMCID: PMC3765109 DOI: 10.1186/1471-2318-13-74] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 06/24/2013] [Indexed: 12/25/2022] Open
Abstract
Background Loss of muscle mass and muscle strength are natural consequences of the aging process, accompanied by an increased prevalence of chronic health conditions. Research suggests that in the elderly, the presence of comorbidities may impact the muscle mass/strength relationship. The objectives of this study were to characterize the muscle mass/strength relationship in older adults in the USA and to examine the impact of a variety of comorbidities on this relationship. Methods Data were obtained from the National Health and Nutrition Examination Survey 1999–2002 databases. Subjects aged 50 years and older were included in the present study. Muscle mass was assessed by height-adjusted appendicular skeleton muscle mass (aASM) in kg/m2, as measured by dual-energy x-ray absorptiometry. Muscle strength was assessed via isokinetic quadriceps strength (IQS) in newton as measured by a dynamometer. The relationship between aASM and IQS was assessed adjusting for age and gender. The effects of a variety of comorbidities on IQS and/or on the relationship between IQS and aASM were assessed using multiple regression models. Results This study included 2,647 individuals, with a mean age of 62.6 years and 52.9% of whom were female. The mean (SE) aASM (kg/m2) was 7.3 (0.04), and the mean (SE) IQS (newton) was 365.0 (3.00). After adjusting for age and gender, the correlation coefficient between aASM and IQS was 0.365 (P < 0.001). Diabetes, coronary heart disease/congestive heart failure (CHD/CHF), and vision problems were significant predictors of lower muscle strength (P < 0.05) in the multiple regression models that adjusted for age, gender, and aASM, and obesity significantly modified the relationship between aASM and IQS (P < 0.05). Conclusions Among individuals aged 50 and older in the US, muscle mass and muscle strength are positively correlated, independent of the associations of age and gender with muscle mass and strength. A variety of comorbid medical conditions serve as independent predictors of lower muscle strength (e.g., diabetes, CHD/CHF, vision problems) and/or modify the relationship between muscle mass and muscle strength (e.g., obesity).
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Papakonstantinou NA, Stamou MI, Baikoussis NG, Goudevenos J, Apostolakis E. Sex differentiation with regard to coronary artery disease. J Cardiol 2013; 62:4-11. [PMID: 23642501 DOI: 10.1016/j.jjcc.2013.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 02/06/2013] [Accepted: 03/04/2013] [Indexed: 11/17/2022]
Abstract
Coronary artery disease was considered a male disease for many years. However, nowadays, coronary artery disease constitutes the leading cause of death in women, although there are a lot of gender-related differences regarding the presentation of acute myocardial infarction, its diagnosis, its treatment, short- and long-term mortality rates, and post-acute myocardial infarction complications. Generally, women have smaller and stiffer hearts and cardiac vessels, suffering a greater extent of atherosclerosis and endothelial and smooth muscle dysfunction. They are usually older than men and they have more comorbidities such as hypertension, renal impairment, and diabetes mellitus. Moreover, female coronary artery disease, the diagnosis of which is more complicated due to more false negative results of some diagnostic methods in women, is more often presented with atypical symptoms and women's symptoms of typical or atypical angina are more severe. Furthermore, women delay significantly more in seeking care and they are more frequently undertreated. Finally, women are associated with generally poorer in-hospital and long-term prognosis having almost two-fold higher early mortality and they are more prone to complications such as bleeding complications, shock, and heart failure, as well as to post-myocardial infarction depression and poorer physical function and mental health. In this review, we discuss these sex-related differences according to current literature.
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Association between myocardial triglyceride content and cardiac function in healthy subjects and endurance athletes. PLoS One 2013; 8:e61604. [PMID: 23613879 PMCID: PMC3628784 DOI: 10.1371/journal.pone.0061604] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 03/11/2013] [Indexed: 11/19/2022] Open
Abstract
Ectopic fat accumulation plays important roles in various metabolic disorders and cardiovascular diseases. Recent studies reported that myocardial triglyceride (TG) content measured by proton magnetic resonance spectroscopy (1H-MRS) is associated with aging, diabetes mellitus, and cardiac dysfunction. However, myocardial TG content in athletes has not yet been investigated. We performed 1H-MRS and cardiac magnetic resonance imaging in 10 male endurance athletes and 15 healthy male controls. Serum markers and other clinical parameters including arterial stiffness were measured. Cardiopulmonary exercise testing was also performed. There were no significant differences in clinical characteristics including age, anthropometric parameters, blood test results, or arterial stiffness between the two groups. Peak oxygen uptakes, end–diastolic volume (EDV), end–systolic volume (ESV), left ventricular (LV) mass, peak ejection rates and peak filling rates were significantly higher in the athlete group than in the control group (all P<0.02). Myocardial TG content was significantly lower in the athlete group than in the control group (0.60±0.20 vs. 0.89±0.41%, P<0.05). Myocardial TG content was negatively correlated with EDV (r = −0.47), ESV (r = −0.64), LV mass (r = −0.44), and epicardial fat volume (r = 0.47) (all P<0.05). In conclusion, lower levels of myocardial TG content were observed in endurance athletes and were associated with morphological changes related to physiological LV alteration in athletes, suggesting that metabolic imaging for measurement of myocardial TG content by 1H-MRS may be a useful technique for noninvasively assessing the “athlete’s heart”.
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Nishitani M, Shimada K, Masaki M, Sunayama S, Kume A, Fukao K, Sai E, Onishi T, Shioya M, Sato H, Yamamoto T, Amano A, Daida H. Effect of cardiac rehabilitation on muscle mass, muscle strength, and exercise tolerance in diabetic patients after coronary artery bypass grafting. J Cardiol 2013; 61:216-21. [PMID: 23332345 DOI: 10.1016/j.jjcc.2012.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 10/23/2012] [Accepted: 11/20/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND The effects of cardiac rehabilitation (CR) on muscle mass, muscle strength, and exercise tolerance in patients with diabetes mellitus (DM) who received CR after coronary artery bypass grafting (CABG) have not been fully elucidated. METHODS We enrolled 78 consecutive patients who completed a supervised CR for 6 months after CABG (DM group, n=37; non-DM group, n=41). We measured mid-upper arm muscle area (MAMA), handgrip power (HGP), muscle strength of the knee extensor (Ext) and flexor (Flex), and exercise tolerance at the beginning and end of CR. RESULTS No significant differences in confounding factors, including age, gender, ejection fraction, or number of CR sessions, were observed between the two groups. At the beginning of CR, the levels of Ext muscle strength and peak VO2 were significantly lower in the DM group than in the non-DM group. At the end of CR, significant improvement in the levels of muscle strength, HGP, and exercise tolerance was observed in both groups. However, the levels of Ext muscle strength, HGP, peak VO2, thigh circumference, and MAMA were significantly lower in the DM group than in the non-DM group. In addition, no significant improvement in thigh circumference and MAMA was observed in the DM group. At the end of CR, the levels of thigh circumference and MAMA correlated with Ext and Flex muscle strength as well as with HGP. Percent changes in the levels of Ext muscle strength were significantly correlated with those of MAMA and hemoglobin A1c. CONCLUSIONS These data suggest that improvement in muscle strength may be influenced by changes in muscle mass and high glucose levels in DM patients undergoing CR after CABG. A CR program, including muscle mass intervention and blood glucose control, may improve deterioration in exercise tolerance in DM patients after CABG.
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Affiliation(s)
- Miho Nishitani
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Sakurai T, Iimuro S, Sakamaki K, Umegaki H, Araki A, Ohashi Y, Ito H. Risk factors for a 6-year decline in physical disability and functional limitations among elderly people with type 2 diabetes in the Japanese Elderly Diabetes Intervention Trial. Geriatr Gerontol Int 2012; 12 Suppl 1:117-26. [PMID: 22435947 DOI: 10.1111/j.1447-0594.2011.00819.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM Type 2 diabetes increases the risk of disability. The purpose of this study was to clarify the explanatory factors for disability in Japanese diabetic elderly. METHODS The 6-year decline in physical disability and functional limitations was investigated among 317 elderly people with type 2 diabetes recruited in a large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial. Information about diabetes, blood examinations and complications was obtained, and basic activities of daily living (ADL) and instrumental ADL (IADL) were assessed by total score of the Barthel index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively. RESULTS After 6 years of follow up, 13.6% of patients had developed a new ADL disability and 38.3% had developed a new functional impairment. In the 65-74 years age group, basic ADL decreased only in males, whereas females became functionally impaired. In the 75-84 years age group, basic and IADL decreased in both males and females. Older age and metabolic syndrome were prognostic for impairment of basic ADL, whereas baseline IADL problems, lower cognitive function, physical inactivity and insulin therapy were significant predictors of a future decline in the IADL. CONCLUSION This study identified several factors predicting the future decline of basic ADL and IADL in diabetic elderly patients, and provided a conceptual framework that might help to clarify the pathways leading to disability. Because the specific causes of each functional problem are modifiable, comprehensive treatment and care are needed to allow Japanese diabetic elderly patients to have more favorable living conditions.
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Affiliation(s)
- Takashi Sakurai
- Center for Comprehensive Care and Research on Demented Disorders, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
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