Exercise intensity has been identified as a major determinant of the excess post-exercise oxygen consumption (EPOC). However, no studies have compared the prolonged EPOC after supramaximal intermittent exercise and supramaximal continuous exercise. Six young healthy male [age=26±3 (mean±SD) yr ; stature=175.4±5.7 cm ; body weight=66.8±6.7 kg ; maximal oxygen uptake (VO₂max)=44.1±8.5 ml/kg/min] xercised on separate days on a cycle ergometer at two equated total energy expenditures (intermittent exercise : 7×30-second intervals at 150%VO₂max with intervening 15-seconds rest periods ; continuous exercise : 5 min at 105%VO₂max) and then sat quietly in an armchair for 3h. A control trial without any exercise was also performed in a counterbalanced research design. The VO₂, carbon dioxide output (VCO₂), pulmonary ventilation (VE), respiratory exchange ratio (RER), heart rate (HR) and blood lactate concentration (LA) were measured before exercise, during exercise and during the 3-h recovery period. The mean VO₂ after intermittent trial at 150%VO₂max were higher than these of the control trial and the continuous trials at 105%VO₂max for 3-h recovery periods (p<0.05). The 3-h EPOC value for intermittent exercise trial (10.5±2.4L) was significantly greater than that of continuous exercise trial (4.8±2.7L) (p<0.05). The mean RER values for intermittent exercise trial were significantly lower than those of the control trial during 60-180 min post-exercise (p<0.05). We examined the effect of supramaximal exercise intensity on the magnitude of 3-h EPOC after 12-fasting. In the present study, 3-h EPOC was significantly greater for supramaximal intermittent exercise compared with the supramaximal continuous exercise when the amounts of work output performed are same. Therefore, our results indicate that exercise intensity may be a primary factor of 3-h EPOC even in a supramaximal exercise and that one of mechanisms for the 3-h EPOC would be related to the promoted lipid metabolism.

Objective : We performed a systematic review to investigate improvements in body function and structure, activity, and health-related quality of life from exercise programs of >150 days' duration in patients with knee osteoarthritis (OA). Methods : We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data were collected on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, proprioception, time to climb a flight of stairs, disability as assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC), walking distance (e.g., 6-min walking-distance test), walking time (e.g., time to walk arbitrary distances), walking velocity, and health-related quality of life assessed using the SF-36^® Health Survey (SF-36). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to determine the quality of the evidence. Results: Forty-one RCTs were identified. Outcomes that were significantly affected by exercise programs of >150 days were knee flexion muscle strength at a functional level, time to climb a flight of stairs and walking distance at activity level, and SF-36 General Health, Physical Functioning, Role-Physical, and Bodily Pain scales. The quality of evidence for these outcomes was moderate to high. Conclusion : In patients with knee OA, improvements in body function, activity, and health-related quality of life can be maintained with exercise programs of >150 days' duration, and these findings are supported by a moderate to high level of evidence.

Objective: To determine the appropriate time points to start regular exercise which could reduce age-related anxiety and impaired social behavior. Methods: For this study, 8-week-old male Wistar rats were divided into three groups: no exercise (NoEX), short-term exercise (S-Ex), and long-term exercise (L-Ex) groups. S-Ex-group rats started treadmill exercise at 12 months of age, while L-Ex rats started from at 2 months of age. Exercise rats were forced to walk on the treadmill three times per week, with 1- to 2-day intervals for 10 minutes during the first 2 weeks, at 10 m/min until 17 months of age, and at 8 m/min thereafter. At 19 months of age, behavioral tests were performed to assess the effects of exercise on age-induced behavioral change as well as quantitative polymerase chain reaction were done to uncover the mechanism behind the behavioral changes. Results: Anxiety-like behavior was improved by long-term exercise. Additionally, rats belonging to the S-Ex and L-Ex groups showed improved social behavior and increased curiosity about interesting objects. The qPCR data showed that treadmill exercise suppressed the expression of immediate-early genes in the prefrontal cortex of the aged rats. Conclusion This study suggests that long-term exercise represses early response genes, and in this way, it increases resistance to stress, diminishes anxiety-related behavior, and improves social behavior. These findings underscore the need to consider appropriate time to start exercise to prevent stress induced anxiety related behavior.

It remains unclear how much rehabilitation training is suitable for stroke patients aged ≥ 75 years. To investigate this, especially in convalescent rehabilitation wards, we studied 65 patients (28, ≦ 74 years；37 ≧ 75 years) with cerebral infarction hospitalized in the acute care ward and then in a convalescent rehabilitation ward. From their medical records, we collected data regarding the length of their hospital stay, total amount of rehabilitation training, and activities of daily living evaluated using the total scores of the functional independent measure (FIM) measured on admission to the acute care and convalescent rehabilitation wards, respectively. From these data, we calculated the absolute functional gain, relative functional gain, and average amount of rehabilitation training per day. The correlation of each item and age was analyzed. Items that significantly correlated with age were compared between ≦ 74 and ≧ 75 years age groups. As a result, the absolute functional gain and average amount of rehabilitation training per day were not significantly different between groups. The relative functional gain was significantly lower in the ≧ 75 years group than in the ≦ 74 years group. The total FIM scores at discharge showed a positive correlation with the amount of rehabilitation training in patients aged ≧ 75 years. We believe that a large amount of rehabilitation training is beneficial for patients aged ≧ 75 years with cerebral infarction.

It remains unclear how much rehabilitation training is suitable for stroke patients aged ≥ 75 years. To investigate this, especially in convalescent rehabilitation wards, we studied 65 patients (28, ≦ 74 years；37 ≧ 75 years) with cerebral infarction hospitalized in the acute care ward and then in a convalescent rehabilitation ward. From their medical records, we collected data regarding the length of their hospital stay, total amount of rehabilitation training, and activities of daily living evaluated using the total scores of the functional independent measure (FIM) measured on admission to the acute care and convalescent rehabilitation wards, respectively. From these data, we calculated the absolute functional gain, relative functional gain, and average amount of rehabilitation training per day. The correlation of each item and age was analyzed. Items that significantly correlated with age were compared between ≦ 74 and ≧ 75 years age groups. As a result, the absolute functional gain and average amount of rehabilitation training per day were not significantly different between groups. The relative functional gain was significantly lower in the ≧ 75 years group than in the ≦ 74 years group. The total FIM scores at discharge showed a positive correlation with the amount of rehabilitation training in patients aged ≧ 75 years. We believe that a large amount of rehabilitation training is beneficial for patients aged ≧ 75 years with cerebral infarction.

The transcatheter left atrial appendage occluding device, WATCHMAN, can be used to prevent thromboembolism in patients with nonvalvular atrial fibrillation who are at high risk of bleeding during anticoagulation. We report an emergent surgical case of cardiac tamponade due to the left atrial appendage perforation with the WATCHMAN device implantation. An 83-year-old woman with recurrent paroxysmal atrial fibrillation (CHA2DS2-VASc score 4, HAS-BLED score 3) after catheter ablation was scheduled for the WATCHMAN device implantation. During implantation, the patient developed cardiac tamponade and underwent emergent surgery with cardiopulmonary bypass for active bleeding despite pericardial drainage. The bleeding was caused by the left atrial appendage perforation, and suture exclusion of the left atrial appendage was performed.