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Deterioration in overall health, hormonal disturbances, and erectile dysfunction (ED) contributes to limitations in sexual activity in the elderly, which is further limited by incorrect beliefs about the hazards of sexual activity in cardiac patients. We aimed to analyze the occurrence of ED in elderly men, their perception of the relevance of good sexual function, and their expectations of physicians. A cross-sectional study encompassed 731 patients with coronary artery disease (CAD) subjected to cardiac rehabilitation. Demographic data and data on modifiable risk factors and patient expectations were collected. ED was assessed using the IIEF-5 questionnaire. Relationships among the risk factors for ED, occurrence of ED, and patient expectations, as well as the changes in the indicators between 2012 and 2016, were analyzed. The mean age of men was 70.7 ± 5.1 years. The prevalence of ED was 93.0%. The IIEF-5 score was significantly associated with age, tobacco smoking, exercise tolerance, time to diagnosis of CAD, and treatment with calcium channel blockers and diuretics. Patients declared that sexual activity was overall important (47.9%) or very important (25.6%). Three hundred and sixty (49.3%) patients expected their physician to show interest in their sexual health, but the topic was addressed in only 12.5%. Over the past few years, we have observed an increase in the awareness and importance of sexual health as well as a significant increase in patients' expectations of physicians to show interest in their sexual health. Patients' expectations of discussing and receiving treatment for ED remain an unmet medical need.

Depression and anxiety are common among chronic kidney disease (CKD) patients but are rarely diagnosed and treated. Furthermore, the fraction of patients with depression is greater among hemodialyzed patients. The aim of the study was to assess the prevalence of depression symptoms, anxiety and assess the level of life satisfaction in three groups of patients based on the stage of CKD. The study group consisted of 283 patients—130 females and 153 males, mean aged was 54.7 (±15.3) with stage III–V chronic kidney disease and after kidney transplantation. The Beck Depression Inventory (BDI), the Satisfaction with Life Scale (SWLS), and the State-Trait Anxiety Inventory (STAI) were used. The highest percentage of patients with depressive symptoms was recorded in the group of dialysis patients with stage V CKD. The lowest percentage of patients with high satisfaction with life was noted in the pre-dialysis group. There was a significant relationship between BDI and STAI, SWLS in all groups while a significant relationship between BDI and handgrip strength was observed in dialysis and kidney transplantation patients. Anxiety as a trait was found to be the factor most significantly associated with depressive symptoms in each of the three patient groups. Screen testing and monitoring of the emotional state of patients with CKD are needed, regardless of the stage of the disease and treatment, including patients after kidney transplantation.

The aim of this study was to evaluate the relationship of the ankle-brachial index (ABI) level with kinetic and kinematic parameters of the gait pattern and force-velocity parameters generated by lower limb muscles. Methods: The study group consisted of 65 patients with peripheral arterial disease (PAD). The ABI value, kinetic and kinematic parameters of gait and force-velocity parameters of knee and ankle extensors and flexors were determined in all subjects. The values obtained for right and left limbs as well as the limbs with higher and lower ABI were compared. Results: Regardless of the method of analysis, the values of the gait’s kinematic and kinetic parameters of both lower limbs did not differ significantly. However, significant differences were noted in the values of peak torque, work and power of the extensor muscles of the knee and the flexor muscles of the ankle with the higher and lower ABI. Conclusion: This study demonstrated that a higher degree of ischemia worsened the level of strength, endurance, and performance of ankle flexors and extensors of the knee joint. ABI is not related to the gait pattern. The above-mentioned relationship should be taken into account in the rehabilitation process and methodological assessment.

Neopterin (NPT), a pyrazino-pyrimidine compound mainly produced by activated macrophages, has been regarded as a proinflammatory and proatherosclerotic agent. The study was designed to evaluate NPT level and its interaction with conventional peripheral artery disease (PAD) biomarkers and vascular regenerative potential in severe PAD. The study included 59 patients (females n = 17, males n = 42) aged 67.0 ± 8.2 years classified into two groups based on ankle-brachial index (ABI) measurements (ABI ≤ 0.9 n = 43, ABI ≤ 0.5 n = 16). A total of 60 subjects aged 70.4 ± 5.5 years (females n = 42, males n = 18) with ABI &gt, 0.9 constituted a reference group. NPT concentration reached values above 10 nmol/L in patients with PAD, which differed significantly from reference group (8.15 ± 1.33 nmol/L). High levels of CRP &gt, 5 mg/L, TC &gt, 200 mg/dL as well as lipoproteins LDL &gt, 100 mg/dL and non-HDL &gt, 130 mg/dL were found in the same group, indicating the relationship between NPT and conventional atherogenic markers. The endothelial progenitor cells (EPCs) tended toward lower values in patients with ABI ≤ 0.5 when compared to reference group, and inversely correlated with NPT. These findings indicate a crucial role of NPT in atheromatous process and its usefulness in monitoring PAD severity. However, the role of NPT in chronic PAD needs further studies including relatively high number of subjects.

BACKGROUND Respiratory therapy is an integral part of treatment of cardiac patients. The aim of this study was to evaluate the effect of addition of inspiratory muscle training (IMT) to second-stage cardiac rehabilitation on exercise tolerance and function of lower extremities in patients following myocardial infarction (MI). MATERIAL AND METHODS This study included 90 patients (mean age 65 years) with MI who took part in the second stage of an 8-week cycle of cardiac rehabilitation (CR). They were divided into 3 groups: group I underwent CR and IMT, group II only underwent CR, and group III only underwent IMT. Groups I and II were allocated randomly according sealed opaque envelopes. The third group consisted of patients who could not participate in standard rehabilitation for various reasons. Before and after the 8-week program, participants were assessed for maximal inspiratory and expiratory pressure (PImax and PEmax) values, exercise tolerance, and knee muscle strength. RESULTS In groups I and II, a significant increase in the PImax parameters and exercise tolerance parameters (MET) were observed. Group I had increased PEmax parameters. In group III, the same changes in the parameter values that reflect respiratory muscle function were observed. All of the examined strength parameters of the knee joint muscles demonstrated improvement in all of the investigated groups, but the biggest differences were observed in group I. CONCLUSIONS Use of IMT in the ambulatory rehabilitation program of MI patients resulted in improved rehabilitation efficacy, leading to a significant improvement in physical condition.

Background: The aim of the study was to compare the emotional state and strength-velocity parameters of patients with frailty and pre-frailty syndrome undertaking a 12-week training programme. Methods: The study was completed by 36 individuals, including 17 with frailty syndrome (FS) and 19 with pre-frailty syndrome (PFS). The age of the subjects ranged from 63 to 89 years, with a mean 69.2 years (&plusmn, 5.0). The Beck Depression Inventory (BDI), Spielberg&rsquo, s State-Trait Anxiety Inventory (STAI), and Satisfaction with Life Scale (SWLS) were used. The strength of knee muscles was evaluated. The above tests were conducted at two time points: before the training sessions (T1), and after 12 weeks of regular training sessions (T2). Results: After completion of the training programme, statistically significant differences in BDI were observed between the PFS and FS groups (especially in somatic symptoms). Following the training, BDI values in the PFS group were significantly lower (fewer depressive symptoms) than in the FS group. The parameter values describing strength capacities of the lower limbs, both at T1 and T2, proved to be higher in the PFS group. Conclusions: In individuals with pre-frailty and frailty syndrome, the 3-month physical training programme improved the strength parameters of lower limb muscles. An improvement in mood and reduction in depressive symptoms were only observed in the group of subjects with pre-frailty syndrome. Rehabilitation programmes for people with frailty syndrome should include psychotherapeutic activities in addition to physical training in order to improve the psychophysical condition of patients.

Chronic ischemia of the lower extremities often presents as intermittent claudication characterized by lower limb pain which subsides after a short break. This study aimed to provide an assessment of the spatiotemporal parameters of gait and ground reaction forces in patients with PAD participating in three forms of supervised physical training. A total of 80 subjects completed a three-month supervised physical rehabilitation program with three sessions per week. The subjects were assigned to one of three programs: group 1&mdash, standard walking training on a treadmill (TT), group 2&mdash, Nordic walking (NW) training, group 3&mdash, strength and endurance training comprised of NW with isokinetic resistance training (NW + ISO). Gait biomechanics tests (kinematic and kinetic parameters of gait) and a six-minute walk test were carried out before and after three months of physical training. Nordic walking training led to the greatest improvements in the gait pattern of patients with PAD and a significant increase in the absolute claudication distance and total gait distance. Combined training (NW + ISO) by strengthening the muscles of the lower extremities increased the amplitude of the general center of gravity oscillation to the greatest extent. Treadmill training had little effect on the gait pattern. Nordic walking training should be included in the rehabilitation of patients with PAD as a form of gait training, which can be conducted under supervised or unsupervised conditions.

Background and Aims Decreased exercise capacity due to muscle weakness and exercise intolerance reduces the ability to perform activities of daily living in patients with end-stage kidney disease. Data on exercise type in dialysis population and its muscle effects are scarce. We aimed to determine the impact of training type (strength, resistance and mixed) on cardiovascular performance, muscle function (strength-speed parameters, electrophysiological function of muscles) in patients on hemodialysis maintenance. Method Eighty six dialysis patients underwent claster randomisation and were assigned to an exercise intervention groups: A - controlled endurance training during haemodialysis using rotors (MOTOmed letto2), B - controlled force training (resistance), C - Tai Chi training on non dialysis days. Intervention lasted 6 months, 3 times a week (A, B) and 2 times a week (C) for 60 minutes. The outcome measures were spiroergometry (VO2/VO2max), strength of the lower limbs and electromyographic examination. Values at the baseline and 6 months later were compared. Results 45 patients completed intervention period and were analysed. Mean age in group A was 64±12y (n-16), in B was 60,5±10y. (n-15) and in C – 68,5±9y. (n-14). Patients did not differ markedly between groups in term of sex, BMI, dialysis vintage and comorbidities. After 6 months of training, VO2 and VO2max increased significantly only in group B (resistance training) Δ12.7 % for VO2 and 12.9% for VO2max but not in A and C group (Fig.1.). Regarding force torque of quadriceps (ΔPT) in isometric conditions the highest peak values were measured in group B (resistance training), namely increase by 13.6% (p=0.0004) in right (R) and 14% (p In groups B and C significant increases in static force moments (Δ%PT) was associated with increases in electrophysiological action (Δ%QEMG), but in group A increase in EMG activity did not correspond with rise in muscle force (Fig.2). Conclusion Differences in muscle strength and functions were observed after 6 months of various type of exercise intervention in dialysis patients. Resistance training during dialysis showed the largest improvement in cardiorespiratory function and isometric leg muscle strength.

There is a growing body of evidence for a role of vitamin D in muscle function and for its influence on athletic performance, injury profile and recovery in well-trained athletes. The aim of our study was to assess the relationship between 25(OH)D levels and hand grip strength, lower limb isokinetic strength and muscle power in elite judoists. We enrolled 25 Polish elite judoists. The mean age was 21.9±9.8 years, the mean height was 179.2±6.6 cm, the mean body mass was 79.1±8.7 kg, and the mean career duration was 11.5±3.9 years. Serum levels of 25(OH)D and parathormone (PTH) were measured by electrochemiluminescence (ECLIA) using the Elecsys system (Roche, Switzerland). Serum calcium was determined by colorimetry using the Konelab 60 system from bioMérieux (France). Lower limb strength was tested with the Biodex Multi-Joint 4 Isokinetic Dynamometer (Biodex Medical System, New York, USA), and hand grip strength was measured with a manual dynamometer (TAKEI, Japan). Muscle power was determined with the electronic jump mat OptoJump (Microgate, Bolzano, Italy). Our study showed decreased serum 25(OH)D levels in 80% of the professional judoists. The results also demonstrated a statistically significant positive correlation between vitamin D levels and left hand grip strength, muscle power assessed by vertical jump, and total work in left and right knee extensors at an angular velocity of 60°/s. Based on our results it can be concluded that in well-trained professional athletes, there may be a relationship between serum levels of 25(OH)D and skeletal muscle strength, power, and work.

Aging is associated with a progressive decline of muscle mass and/or the qualitative impairment of the muscle tissue. There is growing evidence of the prominent role of low-grade chronic inflammation in age-related changes in the neuromuscular system. The purpose of the study was to identify the inflammatory mediators responsible for deficit in functional fitness and to explain whether inflammation is related to changes in body composition and the decline of muscle strength in older men. Thirty-three old-aged males (73.5 ± 6.3 years) and twenty young-aged males (21.2 ± 1.3 years) participated in the study. The body composition (bioelectrical impedance analysis), functional capacity (6-min walking test) and knee extension strength (isokinetic test) were estimated. In serum, circulating inflammatory markers H2O2, IL-1β, TNFα, and hsCRP as well as growth factors IGF-I and PDGFBBconcentrations were determined (immunoenzymatic methods). The concentrations of H2O2, IL-1β, TNFα, and hsCRP were significantly higher in older than young men. The growth factors IGF-I and PDGFBBwere twofold lower and related to high levels of IL-1β and TNFα in the elderly. The changes in cytokines and growth factors levels were correlated with age and peak torque (TQ at 60°/s and 180°/s) in the knee extension. The result of the 6-min walking test was inversely correlated with fat mass index (FMI, r = −.983; p < .001). The generation of inflammatory mediators in older men was related to changes in body composition, maximum strength muscle, and age-related changes in skeletal muscle properties responsible for deficit in functional fitness.

Vitamin D is mainly known for its effects on the bone and calcium metabolism. The discovery of Vitamin D receptors in many extraskeletal cells suggests that it may also play a significant role in other organs and systems. The aim of our study was to assess the relationship between 25(OH)D3levels, lower limb isokinetic strength and maximum oxygen uptake in well-trained professional football players. We enrolled 43 Polish premier league soccer players. The mean age was 22.7±5.3 years. Our study showed decreased serum 25(OH)D3levels in 74.4% of the professional players. The results also demonstrated a lack of statistically significant correlation between 25(OH)D3levels and lower limb muscle strength with the exception of peak torque of the left knee extensors at an angular velocity of 150°/s (r=0.41). No significant correlations were found between hand grip strength and maximum oxygen uptake. Based on our study we concluded that in well-trained professional soccer players, there was no correlation between serum levels of 25(OH)D3and muscle strength or maximum oxygen uptake.

Introduction. A typical symptom of chronic lower-limb ischaemia is lower-limb pain, which occurs during walking forcing the patient to stop, intermittent claudication (IC). Exercise rehabilitation is the basic form of treatment for these patients. Aim. The aim of this study was to compare the effectiveness of three types of physical training programmes conducted over a 12-week period in patients with chronic lower-limb arterial insufficiency. Materials and Methods. Ninety-five people qualified for the 3-month supervised motor rehabilitation programme, conducted three times a week. The respondents were assigned to three types of rehabilitation programmes using a pseudo-randomization method: Group I (TW), subjects undertaking treadmill walking training; Group II (NW), subjects undertaking Nordic walking training; Group III (RES+NW), subjects undertaking resistance and Nordic walking training. Treadmill test, 6 Minute Walk Test (6MWT), and isokinetic test were repeated after 3 months of rehabilitation, which 80 people completed. Results. Combined training (RES+NW) is more effective than Nordic walking alone and supervised treadmill training alone for improving ankle force-velocity parameters (p Conclusions. Given both the force-velocity parameters and the covered distance, the training RES + NW gives the most beneficial changes compared to training TW alone and NW alone. All types of training increased walking distance, which is an important aspect of the everyday functioning of people with IC.

Background Patient malnutrition is a significant problem in the process of rehabilitation and treatment. One of the tools that can reveal the risk of malnutrition is a series of standardized nutritional questionnaires. Objectives The aim of the study was to assess the nutritional status of patients with end-stage renal disease (ESRD) by means of the minimal nutritional assessment (MNA) scale. Material and methods The study group included respondents suffering from ESRD who were patients of the Dialysis Center at the Clinic of Nephrology and Transplantation Medicine at the University Clinical Hospital in Wroclaw. The study was conducted in 47 dialysis patients (22 women and 25 men), mean age 69.68 ±8.95 years. A standardized MNA scale was used to evaluate the nutritional status of the patients. Results In the study group, women had a significantly lower score on the MNA scale than men (23.95 vs 25.26 points). Using the MNA scale, the risk of malnutrition was found in 13 patients, while malnutrition was found in 1 patient. Among females, the mean body mass index (BMI) was 27.28, and it was significantly correlated with the MNA score. In males, the mean BMI was 29.61, but it did not correlate with the MNA score. The time spent undergoing renal replacement therapy was 7.63 years for women and 7.24 years for men. This correlated significantly with the MNA score only in the case of men. Significant correlations were established between eating habits and MNA scores in both groups. Conclusions The results obtained using the MNA scale showed a significant risk of malnutrition in patients with ESRD. In women only, a low score on the MNA scale significantly correlated with the BMI. The time of renal replacement therapy had a significant impact on the MNA scale only in the case of men. An influence of comorbidities on the MNA scores recorded by men and women was not observed. Major health incidents and other stressful situations significantly affected the nutritional status in men.

Objective The aim of this study was to assess existing differences in the isokinetic trunk muscle strength in males and females aged between 10 and 11 years depending on body posture. Methods The study included 145 children (67 males and 78 females) divided into 2 age groups: 10-year-old males ( x ¯ = 9.98 ± 2.34 years) and females ( x ¯ = 9.85 ± 2.94 years) and 11-year-old males ( x ¯ = 11.14 ± 2.22 years) and females ( x ¯ = 11.15 ± 2.32 years). Posture in the sagittal plane was assessed by photogrammetry using the moire projection technique. Based on a classification system, the participants were divided into subgroups of males and females with normal and abnormal postures. Trunk muscle strength was measured using isokinetic dynamometry. Results A high prevalence of abnormal posture in children aged between 10 and 11 years was observed, primarily represented by an excessive curvature of the spine in the sagittal plane. The males and females with poor posture recorded lower values in isokinetic trunk muscle strength. Conclusion The results of the study point to the need for the application of suitable physiotherapy treatment (corrective measures/exercises) to treat musculoskeletal disorders to compensate for the loss of trunk flexor muscle strength in children with improper posture.

The aim of this study is to compare values of force-velocity and functional walking capacity in elderly patients with intermittent claudication with respect to the control group.The study involved 135 individuals: 85-peripheral arterial disease (PAD) group diagnosed with stage II chronic lower limb ischemia, according to Fontaine's classification, and 50-control group. The studies included an assessment of walking capacity using a six-minute walk test (6MWT) and measurement of force-velocity parameters (peak torque-PTQ, total work-TW, average power-AVGP) of the lower limbs obtained by means of a functional dynamometry under isokinetic conditions.The peripheral arterial disease group is characterized by significantly lower values of force-velocity parameters compared to the control group (p0.005). Walking capacity in this group is significantly reduced due to significant differences in the distance covered (p0.0001), walking speed (p0.01), and its intensity (p0.01). Further, a positive correlation was found between the maximum distance specified in the six-minute walk test and lower limb muscle strength in the isokinetic test.Mean values of all force-velocity parameters and walk distance were significantly higher in the control group than in the peripheral arterial disease group. In the PAD group, in both men and women, the value of the agonist/antagonist ratio of both lower limbs are lower in men and women comparing to the control group. A rehabilitation program for patients with intermittent claudication must consider exercises improving strength, exercise capacity, and endurance in patients with PAD.

Purpose. The aim of this study was to assess the impact of a 3-month physical training program, conducted in an aquatic environment with end-stage renal disease patients (ESRD), on the physical fitness and functional parameters of the knee joint muscles.Patients and Methods. The study included 20 ESDR patients with mean age64.2±13.1 y. treated with hemodialysis in Dialysis Center of the University Hospital in Wroclaw. Before and 3 months after the physical training in water, a test was performed to evaluate the physical fitness of each patient; additionally, a measurement was taken of force-velocity parameters. The 3-month training program took place on nonhemodialysis days, in the recreational pool of the University of Physical Education in Wroclaw.Results. After aquatic training cycle, an improvement was observed in all parameters measured using the Fullerton test. The value of peak torque and its relation to body mass increased in the movement of flexors and extensors of left and right lower extremities in all tested velocities.Conclusions. In assessing the physical fitness of studied women, the biggest improvement was achieved in tests assessing the strength of upper and lower extremities as well as lower body flexibility. Higher values of force-velocity parameters are conducive to women achieving better physical fitness test results.

Introduction. Patients with end-stage renal disease (ESRD) have poor physical performance and exercise capacity due to frequent dialysis treatments. Tai Chi exercises can be very useful in the area of rehabilitation of people with ESRD. Objectives. The aim of the study was to assess exercise capacity in ESRD patients participating in 6-month Tai Chi training.Patients and Methods. Twenty dialysis patients from Wroclaw took part in the training; at the end of the project, 14 patients remained (age69.2±8.6years). A 6-minute walk test (6MWT) and spiroergometry were performed at the beginning and after 6 months of training. Results. After 6 months of Tai Chi, significant improvements were recorded in mean distance in the 6MWT (387.89 versus 436.36 m), rate of perceived exertion (7.4 versus 4.7), and spiroergometry (8.71 versus 10.08 min).Conclusions. In the ESRD patients taking part in Tai Chi training, a definite improvement in exercise tolerance was recorded after the 6-month training. Tai Chi exercises conducted on days without dialysis can be an effective and interesting form of rehabilitation for patients, offering them a chance for a better quality of life and fewer falls and hospitalisations that are the result of it.

Regular exercise plays an important preventive and therapeutic role in heart and vascular diseases, and beneficially affects brain function. In blood, the effects of exercise appear to be very complex and could include protection of vascular endothelial cells via neurotrophic factors and decreased oxidative stress. The purpose of this study was to identify the age-related changes in peripheral brain-derived neurotrophic factor (BDNF) and its relationship to oxidative damage and conventional cardiovascular disease (CVD) biomarkers, such as atherogenic index, C-reactive protein (hsCRP) and oxidized LDL (oxLDL), in active and inactive men. Seventeen elderly males (61-80 years) and 17 young males (20-24 years) participated in this study. According to the 6-min Åstrand-Rhyming bike test, the subjects were classified into active and inactive groups. The young and elderly active men had a significantly better lipoprotein profile and antioxidant status, as well as reduced oxidative damage and inflammatory state. The active young and elderly men had significantly higher plasma BDNF levels compared to their inactive peers. BDNF was correlated with VO2max (r=0.765, P

Aim: The aim of the present study was to evaluate the influence of cycle exercise during hemodialysis (HD) on patients’ physical proficiency, muscle strength, quality of life and selected laboratory parameters. Patients and Methods: In a group of 29 (15 female, 14 male) HD patients (age 64.2 ± 13.1 years), 3 months of cycle training during dialysis sessions was performed. The following data were analyzed: strength of lower extremities (six-minute walk test, isokinetic knee extension, flexion peak torque), nutrition parameters (albumin, BMI), inflammation intensity (CRP, IL-6), and quality of life (SF-36v2). Results: In the six-minute walk test, the increase in walk velocity was 4% (3.56 km/h before and 3.73 km/h after cycle training; p < 0.01). At angular velocity (AV) of 60°/s, extension peak torque in the knee joint rose by 7% and at AV of 300°/s by 4% (p = 0.04). Flexion peak torque at AV of 180°/s increased by 13% (p = 0.0005). The program does not influence nutrition or inflammation parameters. No complications directly related to exercise were observed. Conclusion: Cycle exercise during dialysis is safe even in older HD patients with multiple comorbidities. It results in a significant increase in general patient walking ability and in a gain in lower extremity muscle strength.

Influence of Industrial Environments on the Development of Respiratory Systems and Morphofunctional Features in Preadolescent Boys The present study examines the differences between levels of selected structural and functional features of boys 11-13 years in age from regions with varying levels of air pollution, including an industrial and rural region. The sample consisted of 213 boys from the industrial region and 98 from the rural region. Somatic, respiratory parameters and motor abilities were evaluated in both groups. The analysis of respiratory parameters revealed significantly better development of respiratory systems in boys from the rural region. Additionally, motor abilities were also better developed in boys from the rural region.

According to European Working Group on Sarcopenia in Older People (EWGSOP) sarcopenia includes both a loss of muscle strength and a decline in functional quality in addition to the loss of muscle protein mass. In order to develop strategies to prevent and treat sarcopenia, the risk factors and causes of sarcopenia must be identified. Age-related muscle loss is characterized by the contribution of multiple factors, and there is growing evidence for a prominent role of low-grade chronic inflammation in sarcopenia. The elderly who are less physically active are more likely to have lower skeletal muscle mass and strength and are at increased risk of developing sarcopenia. Resistance training added to aerobic exercise or high-intensity interval training promote numerous changes in skeletal muscle, many of which may help to prevent or reverse sarcopenia. In this review, we provided current information on definition and monitoring, molecular mechanisms, and physical intervention to counteract sarcopenia.