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Health literacy (HL) is an important decision factor for health. Both low HL and low physical function cause adverse events in cardiovascular disease patients, but their relationship is not well documented. To clarify the relationship between HL and physical function of patients participating in cardiac rehabilitation and calculate the cutoff value of the 14-item HL scale (HLS) for low handgrip strength, this multicenter clinical study named the Kobe-Cardiac Rehabilitation project for people around the World (K-CREW) was conducted among four affiliated hospitals with patients who underwent cardiac rehabilitation. We used the 14-item HLS to assess HL, and the main outcomes were handgrip strength and Short Physical Performance Battery (SPPB) score. The study included 167 cardiac rehabilitation patients with a mean age of 70.5 ± 12.8 years, and the ratio of males was 74%. Among them, 90 patients (53.9%) had low HL and scored significantly lower in both handgrip strength and SPPB. Multiple linear regression analysis revealed that HL was a determinant factor (β = 0.118, p = 0.04) for handgrip strength. Receiver operating characteristic analysis revealed the cutoff value of the 14-item HLS for screening for low handgrip strength was 47.0 points, and the area under the curve was 0.73. This study showed that HL was significantly associated with handgrip strength and SPPB in cardiac rehabilitation patients and suggests the possibility of early screening for low HL to improve physical function in cardiac rehabilitation patients with low HL., (© 2023. Springer Nature Japan KK, part of Springer Nature.)

Slow gait speed and restricted life-space mobility predict cognitive decline and dementia in healthy older adults, yet the relation between gait speed or life-space mobility and cognitive function remains poorly understood in patients with coronary artery disease (CAD). We, therefore, examined the following relations: that between gait speed and cognitive function, and mild cognitive impairment (MCI) and that between life-space mobility and cognitive function, and MCI. We conducted a cross-sectional study of 240 non-dementia patients who met the study criteria from 2132 consecutive CAD patients. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Gait speed was measured to perform gait trials at the patients' usual walking pace, and life-space mobility was evaluated using the Life-Space Assessment (LSA). We investigated the relation between gait speed or life-space mobility and cognitive function by Pearson correlation analysis, whereas multivariable logistic regression analysis was conducted for detecting MCI. Gait speed and LSA scores were positively associated with the MoCA-J score (r = 0.54, p < 0.001 and r = 0.44, p < 0.001, respectively), and both were independently associated with MCI in the multivariable logistic regression analysis (odds ratio 0.007, p < 0.001, and odds ratio 0.98, p = 0.038, respectively). Cognitive impairment can be easily detected by assessment of gait speed and life-space mobility. Interventions to improve gait speed and life-space mobility may lead to the improvement of cognitive function and MCI in patients with CAD.

Activities of daily living (ADL) are maintained in patients with mild cognitive impairment (MCI), but, in patients with cardiovascular disease, ADL may have already declined. MCI combined with cardiac disease may accentuate the decline of ADL in these patients. Because the relationship between MCI and ADL in patients with cardiovascular disease is unclear, we examined the associations between MCI and ADL in these patients. We conducted a cross-sectional study of 114 patients with cardiovascular disease but without probable dementia. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). We classified patients into the normal cognitive group and MCI group, and compared their clinical characteristics, physical function [Short Physical Performance Battery (SPPB), gait speed, handgrip strength, and knee extensor muscle strength], and ADL [via the Functional Independence Measure (FIM)]. We used logistic regression analysis to evaluate the specific association between MCI and ADL. The incidence of MCI was 36.0%. Significant differences between the two groups were identified for age, body mass index, estimated glomerular filtration rate, albumin, dyslipidemia, educational background, SPPB, gait speed, handgrip strength, and FIM. However, after adjustment for covariates, only FIM was significantly associated with MCI (odds ratio 0.74, 95% confidence interval 0.65-0.84, p < 0.001). ADL was the only independent factor significantly associated with MCI in patients with cardiovascular disease. ADL may be hindered in these patients, even at an early stage of MCI. Therefore, early intervention is necessary to prevent ADL decline from the time of MCI onset or before.