The aim of the present study was to investigate the influences of acute water and land exercises on pain, state anxiety and salivary cortisol concentration in chronic low back pain (LBP) patients. Ten myofascial LBP patients participated in the experiment. Their mean age was 60.2 (SD : 9.0) yrs, and their mean duration of pain was 5.6 (3.7) yrs. The water and the land exercise programs consisted of the same physical movements, and prescribed according to the intensity of ratings of perceived exertion (RPE) 11. The heart rate of the participants was measured during exercise to monitor exercise intensity. Results showed that the mean heart rate during exercises (except Warming up and Cooling down) were 88.1±1.6 bpm for water exercise, and 97.0±2.1 bpm for land exercise (p<0.01) . Significant decreases were found in pain score (visual analogue scale ; VAS, p<0.05) and state anxiety (p<0.01) after water exercise. Salivary cortisol concentration showed a significant increase after water exercise (p<0.05) . No significant changes were shown after land exercise in VAS, state anxiety and salivary cortisol concentration. From these results, we suggested that acute water exercise has the benefit in chronic LBP patients of decreasing pain and state anxiety compared with acute land exercise. In addition, salivary cortisol concentration might be much more influenced by exercise intensity than physical or psychological stress such as pain and anxiety.

Thirteen female swimmers (ranging in age from 15 to 18 years) were selected as subjects and divided into two groups; group A (subjects of experiment) consisted of six subjects in whom low pressure was loaded and group B (subjects of control) consisted of seven in whom low pressure was not given.
During training, circuit weight training was performed in a low pressure environment and it was combined with conventional swimming training. We studied the effect of these types of training on their red-cell 2, 3-diphosphoglycerate, salivary cortisol, and plasma testosterone.
(1) The 2, 3-DPG level showed a greater increase after loading exercise than at the time of resting in both groups A and B. The increase was highly significant in group A. Additionally, 10 days after the removal of the loading, hemoglobin and hematocrit levels were significantly decreased in groups A and B, and a significant increase in 2, 3-DPG was observed in group A.
(2) Only after loading low pressure was the cortisol level higher in group A than in group B. However, there was no significant difference between the two groups in the amount of exercise loading when heart rate was used as the index.
(3) Testosterone tended to show a greater increase after exercise loading than on the first day of the experiment. However, neither an effect of exposure to low pressure on testosterone nor a significant difference between the two groups was observed.
According to the results, in swimming, an endurance contest, physical changes during training are almost the same in group A and B, but it is considered that a concurrent severe hypoxic condition as a result of low pressure loading brings about homeostasis in the living body and the homeostasis leads to an attempt to increase oxygen uptake by the tissues, yeilding increased staying power.

The purpose of this study was to evaluate the effectiveness of water exercise, including functional mobility in water, performed either once or twice a week in elderly who require nursing care. Twenty-one subjects were assigned to two groups. Ten subjects trained once a week for 6 months. Eleven subjects trained twice a week for 6 months. Water exercise consisted of warming up on land and walking,ADL exercise,resistance training, stretching and relaxation in water. Functional mobility was evaluated by FIM during pre-exercise,after 3 months and 6 months. There were significant improvements in functional mobility after 6 months compared to pre-exercise in both groups. Functional mobility in the group who trained once a week did not improve at 3 months compared to pre-exercise. Although the group who trained twice a week showed a dramatic improvement in functional mobility after 3 months compared to pre-exercise, and no change after 3 months compared to after 6 months. These results indicate that water exercise once or twice a week for 6 months, including functional mobility in elderly who require nursing care, can improve functional mobility, especially, exercise twice a week could improve it within 3 months.

The purpose of this study was to investigate the kinetics of Vco₂during incremental exercise. The subjects were 7 males, age 21-28 years, exercised at two steady state work loads (540 kpm/min, 810 kpm/min) and incremental work load which was increased stepwise by every 1 min from 180 kpm/min to exhaustion. The Vo₂and Vco₂during steady state exercise (4 to 5 min) were determined by the Douglas bag method and arterialized blood samples were taken for lactate (LA) analysis and blood gas analysis. The Vo₂, Vco₂, and blood lactate were also determined throughout the incremental exercise. At exhaustion, mixed venous Pco₂ (PVco₂) was determined by the CO₂rebreathing method.
1) The Vco₂values at rest and during steady state exercise were linearly related to the Vo₂values. When the regression line was compared with Vco₂during the incremental exercise on the same Vo₂, the Vco₂during the incremental exercise below the anaerobic threshold showed lower values.
2) The total sum of the difference in Vco₂between steady state and incremental exercise was defined as CO₂store. The calculated CO₂store and CO₂store per body weight were significantly related to PVco₂at exhaustion in incremental exercise, respectively (r=0.954, r=0.954) .
3) At work load below the anaerobic threshold, Vco₂was linearly related to Vo₂. If the Vco₂above the anaerobic threshold is estimated from Vo₂using the regression line obtained at work load below the anaerobic threshold, the estimated Vco₂will be lower than the measured Vco₂. The total sum of the difference in the Vco₂was defined as CO₂excess. The CO₂excess and the CO₂excess per body weight were significantly related to ΔLAmax (the difference between LA at 3rd min after exhastion and LA at exercise below the anaerobic threshold), respectively (r=0.870, r=0.930) .
4) HCO₃^-calculated from blood gases (pH and Pco₂) was significantly related to LA (r=-0.902) . The increase of 1 mM/1 in LA was corresponding to the decrease of 0.843 mEq/l in HCO₃^-.
5) From these results, it appeared that the expired Vco₂during the incremental exercise consisted of the stored Vco₂, the exceeded Vco₂, and the produced Vco₂ (Vco₂metabolically produced from Vo₂) .

Oxygen uptake and cardiorespiratory parameters were measured during submaximal and maximal work in flume swimming, bicycling and treadmill running, in order to compare physiological responses of swimmers to those three types of exercise. Subjects were divided into three groups according to the level of swimming training, i, e., 5 less trained water polo players (group A), 5 male well trained college swimmers (group B) and 14 male elite swimmers (group C) .
V_2max during swimming in group A (3.11 1/min) was 5% lower than during bicy cling, while those in group B (3.63 1/min) and C (4.12 1/min) were 9% and 11% higher, respectively. Comparing with running, Vo_2max during swimming was 19% lower in group A, and was about the same in group B.
V_E and V_E/ Vo₂ were lower during submaximal and maximal swimming compared with bicyling and running, in all groups except the maximal work of group C. Lower V_E during swimming resulted from lower f as well as lower V_T. The difference in V_A between during swimming and during running, bicycling was small compared with that in V_E.
Q during swimming increased almost linearly with Vo₂ in all groups. At a given Vo_2submax, Q was about the same in three types of exercise. Q during maximal swimming in group A (19.7 1/min) and B (21.3 1/min) were similar compared with bicycling, but were 16% and 11% lower compared with running, respectively. Q_max during swimming in group C (23.8 1/min) was 5% higher compared with bicycling.
HR increased almost linealy with Vo₂ in all exercise. At a given Vo_2submax, HR was 4-5 beats/min less during running than during bicycling, and was 10-20 beats/min less during swimming than during those two types of exercise. HR_max was lower during swimming compared with bicycling or running in all groups. A similar Q at submaximal work during three types of exercise resulted from higher SV and lower HR in swimming.

1)Continuing medical education (CME) systems were researched in 10 countries. In all countries but one CME is mandatory. Only Spain has voluntary CME, as does Japan.
2)The traditional CME systems in many countries were changed after 2000. We believe this change reflects a global revolution associated with a new wave of medical risk management.
3)To provide better medical services, we must keep improving Japan's CME system. Such improvement is an important responsibility to society.