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We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. Although respiratory muscle function is indispensable for life support, its evaluation has not been included in the regular assessment of respiratory function or adequately evaluated in clinical practice. Considering this situation, we prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass. It was jointly prepared by the representative authors and authorized by the Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy and Japanese Association of Rehabilitation Nutrition. Geriatr Gerontol Int 2023; 23: 5-15.

Objective: To estimate the minimal clinically important difference (MCID) of quadriceps and inspiratory muscle strength after a home-based pulmonary rehabilitation program (PRP) in chronic obstructive pulmonary disease (COPD). Method: Eighty-five COPD patients were included. Quadriceps maximal voluntary contraction (QMVC) was measured. We measured maximal inspiratory mouth pressure (PImax), the 6-minute walk distance (6MWD), the chronic respiratory questionnaire (CRQ) and the modified Medical Research Council dyspnoea score (mMRC). All measurements were conducted at baseline and at the end of the PRP. The MCID was calculated using anchor-based (using 6MWD, CRQ, and mMRC as possible anchor variables) and distribution-based (half standard deviation and 1.96 standard error of measurement) approaches. Changes in the five variables were compared in patients with and without changes in QMVC or PImax >MCID for each variable. Results: Sixty-nine COPD patients (age 75±6 years) were analysed. QMVC improved by 2.4 (95%CI 1.1-3.7) kgf, PImax by 5.8 (2.7-8.8) cmH(2)O, 6MWD by 21 (11-32) meters and CRQ by 3.9 (1.6-6.3) points. The MCID of QMVC and PImax was 3.3-7.5 kgf and 17.2-17.6 cmH(2)O, respectively. The MCID of QMVC (3.3 kgf) could differentiate individuals with significant improvement in 6MWD and PImax from those without. Conclusion: The MCID of QMVC (3.3 kgf) can identify a meaningful change in quadriceps muscle strength after a PRP. The MCID of PImax (17.2 cmH(2)O) should be used with careful consideration, because the value is estimated using distributionbased method.

[Purpose] The effect of physical activity on systemic inflammation remains unclear and might be negative in patients with chronic obstructive pulmonary disease (COPD) and lower weight. We investigated the amount of physical activity as the time spent in posture and movement and its association with systemic inflammation. [Participants and Methods] In this retrospective cross-sectional pilot study, we evaluated 11 patients with COPD (age, 73 ± 7 years; body mass index, 18.9 ± 2.9 kg/m2). A recently developed triaxial accelerometer was used to measure the time spent in posture and movement. We also evaluated body composition, physiological indexes, and serum levels of inflammatory cytokines. Single correlation coefficients were calculated as the association between physical activity and other outcomes. [Results] The walking time was 36 ± 32 min/d, and the standing time was 151 ± 118 min/d. The time spent walking significantly correlated with the fat-free mass index (r=0.73) and interleukin (IL)-8 level (r=0.76). The time spent standing significantly correlated with the C-reactive protein (r=0.80) and IL-6 levels (r=0.74). [Conclusion] These data indicate that increased physical activity is associated with higher systematic inflammation. We should consider that the systemic inflammation may have been affected by the increased physical activity of the patients with COPD and lower weight in this study.

Purpose Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease characterized by airflow limitation and is associated with decreased balance and increased fall risk. Since falls are related to increased mortality, interventions targeting balance and fall risk could reduce morbidity and mortality. The objective of this review was to systematically assess the effects of exercise-based interventions on fall risk and balance in patients with COPD. Methods PubMed, Web of Science, EMBASE, and CINAHL were screened for randomized controlled trails and within-group studies evaluating effects of exercise-based interventions on fall risk or balance in patients with COPD. Data were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results Fifteen studies were identified, 6 randomized controlled trails and 9 within-group studies. All interventions reported positive effects on balance outcomes. No studies reported fall risk. Taking current recommendations of balance outcome measures in patients with COPD into account, pulmonary rehabilitation combined with balance training had the highest effect size. Nine papers had concerns regarding bias, mostly due to the lack of blinding outcome assessors. Conclusions Exercise-based interventions have a positive effect on balance in patients with COPD. Pulmonary rehabilitation with balance training seems to have the most beneficial effect on balance. The effects on fall risk, as well as the long-term intervention effects remain unclear. A standardized balance assessment and research on long-term effects and fall risk are recommended.

Background Ultrasound imaging has been widely used for imaging of the diaphragm thickness (Tdi) and thickening. Few studies assessed the Tdi using ultrasonography in patients with chronic obstructive pulmonary disease (COPD). We measured the Tdi and thickening in patients with COPD compared with healthy younger and healthy older adults to reveal the influence of ageing and/or COPD. Methods Thirty-eight male patients with COPD (age 72 ± 8 years), 15 healthy younger (age 22 ± 1 years) and 15 healthy older (age 72 ± 5 years) male volunteers were recruited. We measured Tdi at total lung capacity (TdiTLC ), functional residual capacity (TdiFRC ) and residual volume (TdiRV ) using B-mode ultrasonography. We calculated the change ratio of TdiTLC and TdiRV (ΔTdi%). We used a one-way analysis of variance and multiple comparison test for the comparison analysis. Results The TdiTLC and the ΔTdi% were significantly lower in patients with COPD compared to the healthy adults. There was no significant difference in these values with age. There was no between group difference in the TdiFRC or TdiRV . Conclusions Our results indicate significant differences in TdiTLC and ΔTdi% between patients with COPD and healthy adults. Therefore, diaphragm ultrasonography can assess diaphragm dysfunction associated with COPD. We suggest that it is better to use TdiTLC and ΔTdi% (not only Tdi at rest) to assess diaphragm function.

Objectives: We aimed to identify the quadriceps muscle strength (QMS) thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD). Methods: We measured the quadriceps isometric maximum voluntary contraction (QMVC) and calculated the QMVC values normalized to weight (QMVC-BW), height squared (QMVC-H2), and body mass index (QMVC-BMI) in 113 patients with COPD. The functional exercise capacity was evaluated using the 6-minute walk distance (6MWD), and 6MWD 0.90) with maximal sensitivity. P-values

Objectives We aimed to identify the inspiratory muscle strength thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD). Methods We measured the maximum static inspiratory mouth pressure (PImax) and the percentage of predicted values (%PImax) in 113 patients with COPD. Six-minute walk distance (6-MWD) was measured as an indicator of functional exercise capacity, and a 6-MWD of 0.90) and maximal sensitivity. Statistical significance was set at P Results The data of 96 patients (74 ± 6 years old; forced expiratory volume in 1-s [FEV1], 56.5 ± 26.2% predicted) were analyzed; three women and 14 participants with missing data were excluded. Multivariate logistic regression models identified significant associations of PImax (odds ratio at 99% confidence interval [CI]: 0.95 [0.92–0.98]) and %PImax (odds ratio at 99% CI: 0.97 [0.95–0.99]) with 6-MWD, after adjustments for height and FEV1. C-statistics showed that the area under the curves (99% CI) of PImax and %PImax were comparable (0.87 [0.77–0.96] and 0.83 [0.72–0.94]). The thresholds of PImax and %PImax were 45.1 cmH2O and 66%; PImax and %PImax also had moderate positive likelihood ratios of 4.44 and 5.00. Conclusions Thresholds of inspiratory muscle strength in men with COPD could help clinicians evaluate whether their patient's inspiratory muscle strength is inadequate to achieve a 6-MWD of ≥350 m, and identify patients who should be targeted for inspiratory muscle training.

Background and objective Diaphragm function might be useful to predict nocturnal oxygen desaturation in COPD. Ultrasonography has been widely used for the assessment of the diaphragm. We aimed to investigate the relationship between the contractile capability of the diaphragm assessed by ultrasonography and the nocturnal percutaneous arterial oxygen saturation (NSpO2) in COPD. Methods Twenty-eight male patients with COPD (age, 73 ± 7 years; forced expiratory volume in 1 s (FEV1 ), 54.2 ± 17.0% predicted) were included. The thickness of the diaphragm (Tdi) was assessed by ultrasonography. We calculated the change ratio of Tdi at the end of maximal inspiration and expiration (%ΔTdi). The mean value of NSpO2 (NSpO2mean ), the percentage of total sleep time (TST) with desaturation above 4% (DA4%) and the percentage of TST with saturation below 90% (SB90%) were measured by overnight oximetry. Daytime arterial oxygen pressure (PaO2 ) and maximal inspiratory mouth pressure (PImax ) were also measured. Results All participants had mild or no daytime hypoxaemia (PaO2 , 77.3 ± 8.6 mm Hg). The NSpO2mean , DA4% and SB90% were significantly correlated with %ΔTdi, PaO2 , %PImax of the predicted value and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. The %ΔTdi and PaO2 were predictors of NSpO2mean by multiple regression analysis. Conclusion This study suggested a close relationship between the NSpO2 and the contractile capability of the diaphragm assessed by ultrasonography in COPD. The %ΔTdi combined with PaO2 might predict NSpO2 in COPD patients with mild or no daytime hypoxaemia.

Masahiro Iwakura,1,2 Kazuki Okura,2 Kazuyuki Shibata,1,2 Atsuyoshi Kawagoshi,2 Keiyu Sugawara,2 Hitomi Takahashi,2 Takanobu Shioya1 1Department of Rehabilitation, Akita City Hospital, 2Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan Background: Little is known regarding the relationship between balance impairments and physical activity in COPD. There has been no study investigating the relationship between balance and objectively measured physical activity. Here we investigated the association between balance and physical activity measured by an activity monitor in elderly COPD patients. Materials and methods: Twenty-two outpatients with COPD (mean age, 72±7 years; forced expiratory volume in 1 second, 53%±21% predicted) and 13 age-matched healthy control subjects (mean age, 72±6 years) participated in the study. We assessed all 35 subjects’ balance (one-leg standing test [OLST] times, Short Physical Performance Battery total scores, standing balance test scores, 4 m gait speed, and five-times sit-to-stand test [5STST]) and physical activity (daily steps and time spent in moderate-to-vigorous physical activity per day [MV-PA]). Possible confounders were assessed in the COPD group. The between-group differences in balance test scores and physical activity were analyzed. A correlation analysis and multivariate regression analysis were conducted in the COPD group. Results: The COPD patients exhibited significant reductions in OLST times (P=0.033), Short Physical Performance Battery scores (P=0.013), 4 m gait speed (P

Yoshino Terui,1 Masahiro Iwakura,1,2 Eriko Suto,3 Atsuyoshi Kawagoshi,2 Keiyu Sugawara,2 Hitomi Takahashi,2 Kouichi Hasegawa,3 Sachiko Uemura,1 Masahiro Satake,1 Takanobu Shioya1,4 1Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan; 2Department of Rehabilitation Medicine, Akita City Hospital, Akita, Japan; 3Department of Rehabilitation, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Japan; 4Geriatric Health Services Facility Nikonikoen, Akita, Japan Background: Individuals with COPD may experience ambulatory difficulty due to both effort intolerance arising from respiratory dysfunction and impaired balance control during walking. However, the trunk movement during walking has not been evaluated or adjusted for patients with COPD. The Lissajous index (LI) visually and numerically evaluates the left–right symmetry of the trunk movement during walking and is useful in clinical practice. In COPD patients, the LI is used as an indicator of the left–right symmetry of the trunk during walking. Here, we used the LI to evaluate the symmetry of COPD patients based on bilateral differences in mediolateral and vertical accelerations, and we investigated the correlation between the patients’ symmetry evaluation results and their physical function.Patients and methods: Sixteen stable COPD patients (all males; age 71.3±9.2 years) and 26 healthy control subjects (15 males; age 68.2±6.9 years) participated in this study. They performed the 10-minute walk test at a comfortable gait speed wearing a triaxial accelerometer, and we measured their trunk acceleration for the evaluation of symmetry. Motor functions were also evaluated in the patients with COPD.Results: The average mediolateral bilateral difference and LI values of the COPD patients were significantly larger than those of the healthy subjects. The COPD patients’ LI values were significantly correlated with their static balance.Conclusion: The LI measured using a triaxial accelerometer during walking is useful in balance assessments of patients with COPD. Keywords: chronic obstructive pulmonary disease, gait, accelerometer, Lissajou index, balance

Abnormalities of spatiotemporal gait parameters are frequently observed in chronic obstructive pulmonary disease (COPD). However, associations of gait parameters with clinical outcomes and their implementation into clinical practice have not been established.To investigate gait abnormalities and their association with clinical outcomes of COPD.This study included 34 male outpatients with COPD and 16 community-dwelling healthy men aged ≥65 years. The subjects underwent a ten-metre walk test wearing an accelerometer. Data on gait speed, step length, cadence, walk ratio, acceleration magnitude, and standard deviation of step time (step time SD) were collected. Forced expiratory volume in 1-second, modified Medical Research Council dyspnoea score, six-minute walk distance (6MWD), quadriceps muscle strength (QMVC), and physical activity (daily steps and time spent in moderate to vigorous physical activity per day) were measured in the COPD group as clinical outcomes of COPD. We tested group differences in gait parameters, associations between gait parameters and COPD clinical outcomes, and predictive capability of gait parameters for reductions in 6MWD, QMVC, and daily steps in COPD.All gait parameters except walk ratio deteriorated in COPD. Step time SD and gait speed were significant independent predictors of 6MWD in COPD (B=-0.440, p = 0.001, B = 0.339, p = 0.007, respectively). Step length was a significant independent predictor of QMVC (B=-0.609, p 0.001) and daily steps (B=-0.453, p = 0.006). Step length was a significant predictor of muscle weakness and physical inactivity, and step time SD was significant in predicting poor 6MWD in COPD.Significant associations between gait abnormalities measured by an accelerometer and deficits in extra-pulmonary features of COPD were observed. An accelerometer-based gait analysis could be an alternative approach to assessing gait abnormalities and screening of functional decline in COPD.

Summary Purpose We evaluated the effects of low-intensity and home-based pulmonary rehabilitation (PR) on physical activity (PA) and the feedback provided by a pedometer in stable elderly patients with chronic obstructive pulmonary disease (COPD). Methods We assessed PA using a newly developed triaxial accelerometer (A-MES™, Kumamoto, Japan), which measures the time spent walking, standing, sitting and lying down. Twenty-seven elderly patients with COPD (age 74 ± 8 yrs; %FEV 1 56.6 ± 18.7%) participated. They were randomly selected to undergo PR (pulmonary rehabilitation only) or PR + P (PR plus the feedback from using a pedometer). Their PA and pulmonary function, exercise capacity (6-min walking distance; 6MWD), quadriceps femoris muscle force (QF) were evaluated before the PR began (baseline) and at 1 year later. We compared the patients' changes in PA and other factors between the baseline values and those obtained 1 year later and analyzed the relationships between the changes in PA and other factors in the both groups. Results The increase in the time spent walking in the PR + P group (51.3 ± 63.7 min/day) was significantly greater than that of PR group (12.3 ± 25.5 min/day) after the PR. The improvement rate of daily walking time after PR was significantly correlated with that of the 6MWD and QF in all subjects. Conclusions These data suggest that low-intensity and home-based PR with the feedback from using pedometer was effective in improving PA, and the improvements of physiological factors were correlated with increased walking time in stable elderly patients with COPD.

Purpose: Previous studies demonstrated that malnutrition, weight loss, and reduced physical activity are strong predictors of mortality among individuals with advanced COPD, which is known to be a systemic inflammation. We investigated the association between systemic inflammation and the time spent moving by COPD patients with weight loss. Subjects and Methods: In this retrospective cross-sectional study, we evaluated 11 patients with COPD (age 73 ± 7 yrs; 9 men, 2 wamen; BMI: 18.9 ± 2.9kg/m2; FEV1 54.8 ± 22.4% pred) with the use of a triaxial accelerometer (A-MES Activity Monitor, Kumamoto, Japan), measuring the time each patient spent walking, standing, sitting and lying for 3 consecutive days. We also evaluated each patient9s body composition, skeletal muscle strength, exercise tolerance, health-related quality of life, and serum levels of inflammatory cytokines. Pearson’s product-moment correlation coefficient and Spearman’s rank correlation coefficient were used for to determine the single correlations between physical activity and other measurements. Results: The time spent walking was significantly correlated with the fat-free mass index (r=0.726, p=0.017) and interleukin (IL)-8 level (r=0.758, p=0.018). The time spent standing was significantly correlated with the C-reactive protein level (r=0.797, p=0.018) and IL-6 level (r=0.742, p=0.035). Conclusions: These data indicate that to improve the reduced skeletal muscle function of COPD patients with weight loss, it may be effect to increase their physical activity. However, we should consider that the systemic inflammation that may have contributed to the reduction of these patients9 weight may also rise with increased physical activity.

Purpose: We investigated the validity of a triaxial accelerometer system for measuring the time spent lying down, sitting, standing, walking, and operating a wheelchair by control subjects and stroke patients in a convalescence ward. Methods: Physical activities were measured using a new triaxial accelerometer system (A-MES; Activity Monitoring and Evaluation System) that consists of two sensors, a station, and analytical software used with a personal computer. In Experiment 1, the times that the healthy subjects (n = 12) spent operating a wheelchair, lying down, sitting, standing, and walking were measured both by the A-MES and by videotaping (video time). In Experiment 2, the amounts of time spent by the stroke patients not able to walk without support (n = 30) as they were lying down, sitting, standing, walking, and operating a wheelchair were measured by the A-MES. Results: The time spent operating a wheelchair measured with the A-MES was significantly correlated with the video time in the healthy subjects. The stroke patients’ average times (minutes) of total, operating a wheelchair, lying down, sitting, standing, and walking were 601.0 ± 18.1, 57.1 ± 28.8, 265.0 ± 86.3, 263.3 ± 60.6, 7.8 ± 7.0, and 7.7 ± 6.0, respectively. Conclusions: The A-MES accurately evaluated the stroke patients’ time spent operating a wheelchair. The stroke patients’ mean time spent operating a wheelchair over the course of one day was 57.1 ± 28.8 min in a Center for Rehabilitation.

Miura S, Satake M, Tamura Y, Ikeda M, Kawagoshi A, Sugawara K, Takahashi H, Homma M, Sakata S, Shioya T. Evaluation of walking time according to walking speed using a triaxial accelerometer system. Jpn J Compr Rehabil Sci 2013; 4: 73−79. Purpose: The primary purpose of this study was to quantify the walking time in daily life as slow and fast walking times using a newly improved triaxial accelerometer system. The secondary purpose was to study the slow and fast walking times of healthy young and elderly adults and stable patients with chronic obstructive pulmonary disease (COPD) using this system. Methods: Twenty-six healthy young subjects, 15 healthy elderly adults, and 11 stable COPD patients participated in this study. The subjects’ time spent walking, standing, sitting, and lying down were assessed using an activity monitoring and evaluation system (A-MESTM). We evaluated the slow and fast walking times according to changes in the detection threshold in the system’s software. Results: The distinguishing speed was found to be 2 km/h, and thus we divided the subjects’ walking time into slow (

Background: Slow gait speed (GS) is well recognized in elderly COPD. However which parameter of gait contributes to GS has been uncertain. We aimed to investigate the determinants of GS among gait parameters, and the relationships between the gait parameters and clinical characteristics in elderly COPD. Methods: Twenty-three outpatients with COPD (age, 71±7years, FEV 1 , 53±23%pred) and 13 healthy controls (age, 72±6 years) performed 10-m gait test at their usual pace wearing a tri-axial accelerometer on their low back. Step time (Step-T), step length (Step-L), GS, and Step-T standard deviation were estimated as the gait parameters. FEV 1 , MMRC scores, 6-min walk distance, quadriceps strength, one-legged stance time, and daily steps were evaluated as the clinical characteristics of COPD. The between-group differences in the gait parameters were analyzed. Correlation analysis and stepwise multivariate regression analysis were conducted among the gait parameters to clarify the determinants of GS in the COPD group. Correlations of each gait parameter to the clinical characteristics were determined in the COPD group. Results: Significant reductions in all gait parameters were observed in COPD (all p Conclusions: Short Step-L mainly contributed to slow GS among three gait parameters. Step-L were significantly correlated with all clinical characteristics. These results suggest that an approach to Step-L may improve GS in elderly COPD.

Objective: The aim of this study was to assess gait symmetry/asymmetry using a tri-axial accelerometer in elderly COPD. Methods: Gait symmetry/asymmetry wasevaluated in 16 elderly COPD (age; 71.3±9.2 years, FEV 1 ; 58.4±20.1%pred), 17 healthy subjects(age; 63.4±2.0 years) and 16 stroke patients with hemiplegia(age; 54.9±12.3 years) as for control. They performed 10m walking twice wearing a tri-axial accelerometer (MG-M1110, LSI Medience, Japan) attached to the back at lower lumbar spine (L3). Medio-lateral and vertical acceleration during walking were expressed as continuous waveforms and the bilateral surrounded area by waveforms was compared as Lissajous Index (LI). LI of 0 indicates perfect symmetry. Pulmonary function, leg muscle strength and one-leg standing test (OLST) were evaluated. Intra-class correlation coefficients (ICC) and Bland-Altman analysis were used for the relative reliabilities of LIs of COPD and stroke patients. Results: ICCs of COPD and stroke patients were 0.934 (p Conclusion: LI measured by a tri-axial accelerometer evaluated gait symmetry/asymmetry accurately and might be clinically useful for the evaluation of balance in elderly COPD patients.

Background: Little is known regarding the relationship between balance impairments and physical activity in COPD. We aimed to investigate the association between balance and physical activity measured by an accelerometer in elderly COPD. Materials and Methods: Twenty-two outpatients with COPD (age, 72±7 years; FEV 1 , 53±21%pred) and 13 age-matched healthy control subjects (age, 72±6 years) were participated. We assessed balance (one-leg standing test [OLST] times, Short Physical Performance Battery [SPPB] total scores, standing balance test scores, 4-m gait speed [4MGS], and five times sit-to-stand test [5STST] times) and physical activity (daily steps) in both groups. Possible confounders were assessed in the COPD group. We analyzed the between-group differences in balance test scores and physical activity. Correlations among balance, daily steps, and possible confounders were determined. Multivariate regression analysis was conducted using one balance measure with the strongest correlation to daily steps as the dependent variable and the daily steps and possible confounders that correlated to the balance measure as predictors. Results: The COPD patients exhibited significant reductions in OLST times (p=0.033), SPPB scores (p=0.013), 4MGS (p Conclusions: Impairments in balance and reductions in physical activity were observed in the COPD group. Deficits in balance are independently associated with physical activity.

Aim: The standard inspiratory muscle training (IMT) for COPD patients was low-intensity (30% maximal inspiratory mouth pressure: PImax) for 30 minutes until Langer (2015) showed that high-intensity (>50% of PImax) training of 30 breaths (3-5 minutes) was effective. We investigated the efficacy of moderate-intensity (40% of PImax) and short-duration (30 breaths) IMT in elderly patients with COPD. Methods: Sixteen outpatients with stable COPD (Age: 72 ± 7years, FEV1: 53.4 ± 19.9% predicted) were followed for three months a combined protocol of low-intensity exercise training (ET) and two daily, 30-breath IMT sessions using the POWERbreathe Medic PlusTM set at 40% of PImax. PImax was measured as inspiratory muscle strength. The 6 minutes walking test (6MWT) included walking distance (6MWD), dyspnea and fatigue scale by modified Borg scale was performed as exercise capacity. Further, the quadriceps femoris muscle force (QF) was measured. All measurements were assessed before and after IMT/ET. Results: PImax (mean of difference: 23.6cmH2O, P Conclusion: Our results suggest that 30-breath sessions of moderate IMT combined ET increases PImax and exercise capacity of elderly COPD patients. Further, regression analysis results indicated that the increase in PImax might improve 6MWD.

Diaphragm function might be useful to predict nocturnal oxygen desaturation in COPD. Ultrasonography has been widely used for the assessment of the diaphragm. We aimed to investigate the relationship between the contractile capability of the diaphragm assessed by ultrasonography and the nocturnal percutaneous arterial oxygen saturation (NSpOTwenty-eight male patients with COPD (age, 73 ± 7 years; forced expiratory volume in 1 s (FEVAll participants had mild or no daytime hypoxaemia (PaOThis study suggested a close relationship between the NSpO

SummaryBackgroundOne of the major pathophysiologies in advanced chronic obstructive pulmonary disease (COPD) has been attributed to systemic inflammation. Meta-analysis of the 2005 Cochrane Database concluded the effect of nutritional supplementation alone on stable COPD was insufficient to promote body weight gain or exercise capacity. The aim of this study was to investigate the effectiveness of nutritional supplementation therapy using a nutritional supplement containing whey peptide with low-intensity exercise therapy in stable elderly patients with COPD.MethodIn stable elderly COPD patients with %IBW and %FEV1 of less than 110 and 80%, respectively, anti-inflammatory nutritional supplementation therapy was added to low-intensity exercise therapy. Thirty-six COPD patients were divided into those with and those without the ingestion of an anti-inflammatory nutritional supplement containing whey peptide, which exhibited an anti-inflammatory effect. These two groups were designated as the nutritional support and the control groups, respectively. The body composition, skeletal muscle strength, exercise tolerance, health-related QOL (HRQOL), and inflammatory cytokines were evaluated before and three months after nutritional support combined with exercise therapy in both the nutritional support group and the control group.ResultsIn the nutritional support group, the body weight, %IBW, FM, energy intake, %AC, Alb, PImax, PEmax, 6MWD, WBI, emotional function, and CRQ total were significantly increased, and the levels of hsCRP, IL-6, IL-8, and TNF-α were reduced significantly, while no significant change was noted in any item of physiological evaluation or any biomarker in the control group.ConclusionConcomitant use of a anti-inflammatory nutritional supplement containing whey peptide, which exhibits an anti-inflammatory effect, with exercise therapy in stable elderly COPD patients with %IBW

〔目的〕本研究は，最大吸気圧40％負荷での吸気筋トレーニングの効果と，その効果がトレーニング終了時よりどの程度維持可能であるかを検討することである。〔対象〕対象は健常な学生12名とした。〔方法〕POWERbreatheTMを用い，40％PImax負荷で吸気筋トレーニングを4週間継続し，トレーニング終了後12週間にわたってその効果持続性を検証した。〔結果〕トレーニング終了時には吸気筋力，吸気筋耐久力，運動耐容能が有意に増加したものの，概ねトレーニング終了後12週までにはいずれもトレーニング開始前の値まで低下した。〔結語〕4週間の40％PImax負荷による吸気筋トレーニングは呼吸筋を有意に増強するが，トレーニングを休止すると，その効果は概ね12週のみしか持続しない。

Background: The Short Physical Performance Battery (SPPB) is commonly used in frail older people and in screening for sarcopenia. In general older population, the SPPB relates to functional exercise capacity and skeletal muscle function. However, it has been unclear whether SPPB score is associated with physical activity (PA) in chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the usefulness of SPPB as an assessment tool for PA in elderly patients with stable COPD. Methods: In twelve patients with COPD (Age 69.9±8.9years, FEV 1 48.8±26.4%pred), SPPB score, spirometry, 6-min walk distance (6MWD), quadriceps strength (QS), one leg standing (OLS), physical activity (PA: steps/day), health status (COPD Assessment Test; CAT), nutritional status (body mass index; BMI), and modified Medical Research Council dyspnea (mMRC) score were measured. Correlation analysis was conducted to determine whether SPPB score was associated with PA in COPD. Results: SPPB score (10.3±2.2) was significantly correlated with PA (4619.3±2753.3steps/day, r=.649, p=.042), age (r=.824, p=.002), mMRC score (2.0±0.7, r=.746, p=.021), OLS (33.4±21.0sec, r=.716, p=.020), and 6MWD (424.7±164.3m, r=.664, p=.036). While, SPPB score was not significantly correlated with FEV 1 (r=.237, p=.539), QS (66.6±16.6%body weight, r=.266, p=.458), CAT (15.7±4.7, r=.142, p=.695), and BMI (21.1±2.1kg/m 2 , r=.363, p=.302). Conclusions: The SPPB that is a valid, simple and practical assessment tool might be associated with physical activity, dyspnea, exercise capacity, and balance in patients with elderly COPD in home-based or clinical setting.

Purpose: The objective of this study was to evaluate the effects of low-intensity and home-based pulmonary rehabilitation (PR) and the feedback provided by a pedometer on physical activity (PA) in stable elderly patients with chronic obstructive pulmonary disease (COPD). Methods: We assessed PA using A-MES™(Kumamoto, Japan), which measures the time spent in position and moving. 27 elderly patients with COPD (age 74 ± 8 yrs) participated. They were randomly selected to undergo PR (pulmonary rehabilitation only) or PR+P (PR plus the feedback was given the number of steps monthly from using a pedometer) group. Their PA and pulmonary function, physiological factors were evaluated before the PR began (baseline) and at 1 year later. We compared the patients9 changes in PA between the baseline values and those obtained 1 year later. Results: The increase in the time spent walking in the PR+P group (51.3 ± 63.7 min/day) was significantly greater than that of PR group (12.3 ± 25.5 min/day) after the PR. Conclusions: These data suggest that low-intensity and home-based PR with the feedback from using pedometer was effective in improving PA in stable elderly patients with COPD.

Masahiro Satake,1 Takanobu Shioya,1 Sachiko Uemura,1 Hitomi Takahashi,2 Keiyu Sugawara,2 Chikage Kasai,2 Noritaka Kiyokawa,2 Toru Watanabe,2 Sayaka Sato,2 Atsuyoshi Kawagoshi2 1Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan; 2Department of Rehabilitation, Akita City Hospital, Akita, Japan Abstract: The purpose of this study was to investigate the relationship between dynamic hyperinflation and dyspnea and to clarify the characteristics of dyspnea during the 6-minute walk test (6MWT) in chronic obstructive pulmonary disease patients. Twenty-three subjects with stable moderate chronic obstructive pulmonary disease (age 73.8±5.8 years, all male) took part in this study. During the 6MWT, ventilatory and gas exchange parameters were measured using a portable respiratory gas analysis system. Dyspnea and oxygen saturation were recorded at the end of every 2 minute period during the test. There was a significant decrease in inspiratory capacity during the 6MWT. This suggested that dynamic hyperinflation had occurred. Dyspnea showed a significant linear increase, and there was a significant negative correlation with inspiratory capacity. It was suggested that one of the reasons that dyspnea developed during the 6MWT was the dynamic hyperinflation. Even though the tidal volume increased little after 2 minutes, dyspnea increased linearly to the end of the 6MWT. These results suggest that the mechanisms generating dyspnea during the 6MWT were the sense of respiratory effort at an early stage and then the mismatch between central motor command output and respiratory system movement. Keywords: field walking test, chronic respiratory diseases, respiratory gas analysis, inspiratory capacity, IC, inspiratory reserve volume, IRV, Borg CR-10 scale, COPD

Atsuyoshi Kawagoshi,1,2 Noritaka Kiyokawa,2 Keiyu Sugawara,2 Hitomi Takahashi,2 Shunichi Sakata,3 Saori Miura,4 Sachie Sawamura,5 Masahiro Satake,1 Takanobu Shioya1 1Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, 2Department of Rehabilitation, Akita City Hospital, Akita, 3Kumamoto Technology and Industry Foundations, Kumamoto, 4Department of Rehabilitation, Saitama Medical University, Saitama, 5Department of Rehabilitation, Research Institute for Brain and Blood Vessels-Akita, Akita Prefecture Hospital Organization, Akita, Japan Background: The purpose of this study was to quantify the walking time and frequency of postural changes in daily life in patients with chronic obstructive pulmonary disease (COPD) using a new triaxial accelerometer system. Methods: Twenty-six elderly patients with stable COPD (age 76.8 ± 6.2 years; percent forced expiratory volume in one second [%FEV1] 52.9% ± 26.3%) and 20 age-matched elderly subjects (age 73.0 ± 4.2 years; %FEV1 124.0% ± 22.3%) participated in the study. The subjects’ time spent walking (slow, fast), standing, sitting, and lying down and the frequency of their postural changes (getting up, standing up) were assessed for 7 consecutive days using an Activity Monitoring And Evaluation System (A-MES™). We analyzed the relationships among walking times, frequency of postural changes, and physiologic factors in both COPD patients and controls. Results: The COPD patients’ total walking time, including slow (