Tai Chi Chuan (TCC) exercise has been shown to improve cognitive task-switching performance in older adults, but the extent of this positive effect varies among individuals. Past research also shows that brain white matter integrity could predict behavioral gains of cognitive and motor learning. Therefore, in this randomized controlled trial (NCT02270320), we examined whether baseline integrity of three target white matter tract groups was predictive of task-switching improvement after 12-week TCC training in middle-aged and older adults. Thirty-eight eligible participants were randomly assigned to a TCC group (n = 19) and a control group (n = 19). Cognitive task-switching and physical performances were collected before and after training. Brain diffusion spectrum MR images were acquired before training and the general fractional anisotropy (GFA) of each target white matter tract group was calculated to indicate baseline white matter integrity of that group. Correlation and regression analyses between these GFAs and post-training task-switching improvement were analyzed using adjusted p-values. After 12 weeks, significant task-switching and physical performance improvements were found only in the TCC group. Moreover, higher baseline GFA of the prefronto-striato-thalamo-prefrontal loop fibers (r = −0.63, p = 0.009), but not of the prefronto-parietal/occipital (r = −0.55, p = 0.026) and callosal (r = −0.35, p = 0.189) fiber groups, was associated with greater reductions of task-switching errors after the TCC training. Multiple regression analysis revealed that baseline GFA of the prefronto-striato-thalamo-prefrontal loop fibers was the only independent white matter integrity predictor of task-switching error reductions after TCC training (β = −0.620, adjusted R2 change = 0.265, p = 0.009). These findings not only highlight the important role of baseline integrity of the prefronto-striatal circuits in influencing the extent of positive cognitive task-switching effects from short-term TCC training, but also implicate that preserving good white matter integrity in the aging process may be crucial in order to gain the best cognitive effects of exercise interventions.

Studies have shown that Tai Chi Chuan (TCC) training has benefits on task-switching ability. However, the neural correlates underlying the effects of TCC training on task-switching ability remain unclear. Using task-related functional magnetic resonance imaging (fMRI) with a numerical Stroop paradigm, we investigated changes of prefrontal brain activation and behavioral performance during task-switching before and after TCC training and examined the relationships between changes in brain activation and task-switching behavioral performance. Cognitively normal older adults were randomly assigned to either the TCC or control (CON) group. Over a 12-week period, the TCC group received three 60-min sessions of Yang-style TCC training weekly, whereas the CON group only received one telephone consultation biweekly and did not alter their life style. All participants underwent assessments of physical functions and neuropsychological functions of task-switching, and fMRI scans, before and after the intervention. Twenty-six (TCC, N = 16; CON, N = 10) participants completed the entire experimental procedure. We found significant group by time interaction effects on behavioral and brain activation measures. Specifically, the TCC group showed improved physical function, decreased errors on task-switching performance, and increased left superior frontal activation for Switch > Non-switch contrast from pre- to post-intervention, that were not seen in the CON group. Intriguingly, TCC participants with greater prefrontal activation increases in the switch condition from pre- to post-intervention presented greater reductions in task-switching errors. These findings suggest that TCC training could potentially provide benefits to some, although not all, older adults to enhance the function of their prefrontal activations during task-switching.

PURPOSE: The aims of this randomized, assessor-blinded clinical trial are to investigate the effect of exercise 25 min or more per day on the bedside exercise device in heart or liver transplantation recipients who are at-risk for functional deterioration during a long inpatient stay after transplantations. METHODS: Adult patients who received a heart or liver transplantation were randomized to either UCFit exercise group or usual care group. UCFit exercise group will exercise on the bedside exercise device which uses foot pedals that record exerted forces against adjustable resistances, measure repetitions of upper and lower extremity cycling movements, and give feedback about performance via a wireless internet connection. Usual care group was only encouraged to increase the amount of physical activities. The outcome measure was level of independence for walking, walking speed, 6-minute walking distance, Short-Form 36 health-related quality of life, heart rate variability, knee strength, and cardiorespiratory fitness. RESULTS: Thirty-five patients who received a heart (n=13) or liver (n=22) transplantation participated at a median of 8 days after surgery. No adverse events were reported during the median study period of 15 days. The UCFit exercise group (n=15) showed increased standard deviation of all NN intervals (SDNN) from 16.5±13.0 ms to 26.3±18.7 ms, compared to the usual care group (n=20) from 18.4±18.9 ms to 16.6±17.9 ms (p= 0.01 during interaction analysis); and increased the square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) from 8.8±7.6 ms to 22.3±24.9 ms, compared to the usual care group from 18.4±32.8 ms to 16.5±30.4 ms (p= 0.03). The UCFit exercise group achieved a trend toward greater 6-minute walking distance and higher knee strength at discharge compared to the usual care group. No significant between-group differences were detected in the other outcomes of interest. CONCLUSIONS: In this ongoing trial of bedside exercise with remote monitoring for inpatient organ transplantation rehabilitation, exercise 25 min or more per day showed increased heart rate variability of the study subjects in the early postoperative period. Supported by Grant MOST 104-2314-B-002 -221 -MY3 from Ministry of Science and Technology, Taiwan.

PURPOSE: Few studies have examined the benefits of exercise immediately after heart or liver transplantation. This prospective, randomized, and assessor-blinded study compared the effect of high feedback (HF) versus low feedback (LF) about performance on an instrumented bedside exercise ergometer in organ transplantation recipients. METHODS: Adult patients who received a heart or liver transplantation were randomized to either HF or LF about daily leg cycling. Data were transmitted via a wireless internet connection to the investigators from the intensive care unit or ward. HF subjects were encouraged to look at the summary of daily data about pedaling and to progress more activities for the legs. LF subjects were only encouraged to increase their total cycling time. The outcome measure was level of independence for walking, walking speed, 6-minute walking distance, Short-Form 36 health-related quality of life, and cardiorespiratory fitness. RESULTS: Eighty-five patients who received a heart (n=29) or liver (n=56) transplantation participated at a median of 8 days after surgery. No adverse events were reported during the median study period of 17 days. The HF group (n=44) achieved greater energy expenditure (p< 0.05), with a trend toward greater 6-minute walking distance at discharge compared to the LF group (n=41). No significant between-group differences were detected in outcomes of interest. Of note, participants who performed cycling exercise for 24 minutes or more per day (n=41) had significantly greater independence for walking, walking speed, 6-min walking distance, health-related quality of life scores in physical functioning and vitality, and cardiorespiratory fitness compared with patients using the bedside device for less than 24 minutes per day (n=44). CONCLUSIONS: In this first trial of bedside exercise with remote monitoring for inpatient organ transplantation rehabilitation, augmented feedback alone did not improve outcomes of interest. Exercise for 24 minutes or more per day, however, appeared to be efficacious and warrants further investigation, since the procedures were safe in the early postoperative period. Supported by Grant NSC 101-2314-B-002 -006 -MY3 from Ministry of Science and Technology, Taiwan (ClinicalTrials.gov Identifier: NCT01705015)

PM&RVolume 6, Issue 8S2 p. S101-S101 Poster Presentation No. 18 Benefits of Cardiac Rehabilitation in Heart Failure Patients Receiving Continuous-Flow Left Ventricular Assist Device in Early Postoperative Period Chen-Yu Hung, Chen-Yu HungSearch for more papers by this authorSsu-Yuan Chen, Ssu-Yuan ChenSearch for more papers by this authorShoei-Shan Wang, Shoei-Shan WangSearch for more papers by this authorChing Lan, Ching LanSearch for more papers by this author Chen-Yu Hung, Chen-Yu HungSearch for more papers by this authorSsu-Yuan Chen, Ssu-Yuan ChenSearch for more papers by this authorShoei-Shan Wang, Shoei-Shan WangSearch for more papers by this authorChing Lan, Ching LanSearch for more papers by this author First published: 18 September 2014 https://doi.org/10.1016/j.pmrj.2014.08.296Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume6, Issue8S28th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM)August 2014Pages S101-S101 RelatedInformation

The three major factors that influence our health and longevity are genetics, the environment, and behavior [1]. From the 1980s, the fast development of computer technology has significantly changed human’s working environment, behavior, and lifestyle. Physical inactivity and obesity are prevalent worldwide, thus causing a major public health problem.According to theGlobalHealthObservatoryReport from theWorldHealth Organization [2], insufficient physical activity is the 4th leading risk factor formortality. People who are insufficiently physically active have an increased risk of 20% to 30% in all-cause mortality compared to people who engage in moderate intensity physical activity ≧30 minutes for most days of the week. Participation in 150 minutes of moderate physical activity a week or its equivalent is estimated to reduce the risk of ischemic heart disease by approximately 30%, the risk of diabetes by 27%, and the risk of breast and colon cancer by 21%–25% [2]. Traditional exercise training mainly focuses on the younger population and pursuing significant improvement of physical fitness. In the “graying” world, however, new exercise recommendations are needed for the senior population and many “apparently healthy” individuals who may have chronic diseases. Before the mid-1990s, physical activity guidelines recommended vigorous intensity exercise for at least 20 minutes continuously, 3 days a week, with the goal of improving physical fitness and body composition [3]. In 1995, the American College of Sports Medicine (ACSM) and US Centers for Disease Control and Prevention (CDC) [4] issued a landmark report on physical activity and health. The New guidelines recommended that “every adult should accumulate 30 minutes or more of moderate physical activity on most, preferably all, days of the week.” Subsequently, the National Institute of Health [5] and the US Surgeon General [6] issued similar recommendations for physical activity and public health in 1996. These publications called attention to the health-related fitness of regular physical activity, and even moderate exercise intensity that did not meet traditional criteria for improving fitness may significantly improve health [5].

Exercise training is the cornerstone of rehabilitation for patients with cardiovascular disease (CVD). Although high-intensity exercise has significant cardiovascular benefits, light-to-moderate intensity aerobic exercise also offers health benefits. With lower-intensity workouts, patients may be able to exercise for longer periods of time and increase the acceptance of exercise, particularly in unfit and elderly patients. Tai Chi Chuan (Tai Chi) is a traditional Chinese mind-body exercise. The exercise intensity of Tai Chi is light to moderate, depending on its training style, posture, and duration. Previous research has shown that Tai Chi enhances aerobic capacity, muscular strength, balance, and psychological well-being. Additionally, Tai Chi training has significant benefits for common cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, poor exercise capacity, endothelial dysfunction, and depression. Tai Chi is safe and effective in patients with acutemyocardial infarction (AMI), coronary artery bypass grafting (CABG) surgery, congestive heart failure (HF), and stroke. In conclusion, Tai Chi has significant benefits to patients with cardiovascular disease, and it may be prescribed as an alternative exercise program for selected patients with CVD.

Tai Chi Chuan (Tai Chi) is a Chinese traditional mind-body exercise and recently, it becomes popular worldwide. During the practice of Tai Chi, deep diaphragmatic breathing is integrated into body motions to achieve a harmonious balance between body and mind and to facilitate the flow of internal energy (Qi). Participants can choose to perform a complete set of Tai Chi or selected movements according to their needs. Previous research substantiates that Tai Chi has significant benefits to health promotion, and regularly practicing Tai Chi improves aerobic capacity, muscular strength, balance, health-related quality of life, and psychological well-being. Recent studies also prove that Tai Chi is safe and effective for patients with neurological diseases (e.g., stroke, Parkinson's disease, traumatic brain injury, multiple sclerosis, cognitive dysfunction), rheumatological disease (e.g., rheumatoid arthritis, ankylosing spondylitis, and fibromyalgia), orthopedic diseases (e.g., osteoarthritis, osteoporosis, low-back pain, and musculoskeletal disorder), cardiovascular diseases (e.g., acute myocardial infarction, coronary artery bypass grafting surgery, and heart failure), chronic obstructive pulmonary diseases, and breast cancers. Tai Chi is an aerobic exercise with mild-to-moderate intensity and is appropriate for implementation in the community. This paper reviews the existing literature on Tai Chi and introduces its health-promotion effect and the potential clinical applications.

Patients with coronary artery disease (CAD) who suffer persistent symptoms and reduced quality of life while receiving medical therapy are considered for revascularization.1 Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the most common methods of revascularization for symptomatic CAD. These two interventions can reduce ischemic symptoms such as angina or dyspnea,2 thus improving the ability to undertake physical training. Shorter length of hospitalization,3 earlier return to work,4 and better life adaptation5 were reported in patients undergoing PCI. However, the incidence rate of restenosis following PCI is higher than CABG,6 and PCI patients who required further interventions outnumbered the patients who underwent CABG.7-8 A recent meta-analysis study found that the mortality rate and the rate of revascularization were significantly lower in the CABG group than the PCI group (9.9% vs 24.5%).9 In a subgroup analysis, the 5-year mortality rate of DM patients was also lower in the CABG group. In the era of drug-eluting stent (DES), the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial10 found that major adverse cardiovascular events rates at 12 months were significantly higher in the PCI group (17.8% vs 12.4%), and the rate of revascularization was lower in the CABG group (5.9% vs 13.5%), but stroke was significantly higher in the CABG group (2.2% vs 0.6%). However, the application of new surgical technique, such as off-pump CABG (OPCAB) may reduce the rate of stroke after surgery. In general, CABG remains the method of choice in patients with left main disease, multivessel disease, especially in diabetic patients, or patients with left ventricular dysfunction, in the event of failure of PCI, and in-stent restenosis.11 Although the procedure risk is higher for patients receiving CABG, the extent of revascularization is more complete,12 and hence the potential of training is higher than patients with PCI. The objective of this study is to review the effect of exercise training program in patients with CABG.

The study aim was to assess sympathetic vasomotor response (SVR) by using pulsed wave Doppler (PWD) ultrasound in patients with multiple system atrophy (MSA) and correlate with the tilt table study. We recruited 18 male patients and 10 healthy men as controls. The SVR of the radial artery was evaluated by PWD, using inspiratory cough as a provocative maneuver. The response to head-up tilt was studied by a tilt table with simultaneous heart rate and blood pressure recording. The hemodynamic variables were compared between groups, and were examined by correlation analysis. Regarding SVR, MSA patients exhibited a prolonged latency and less heart rate acceleration following inspiratory cough. Compared with the tilt table test, the elevation of heart rate upon SVR was positively correlated to the increase of heart rate after head-up tilt. The correlation analysis indicated that the magnitude of blood pressure drop from supine to upright was positively associated with the SVR latency but negatively correlated with the heart rate changes upon SVR. The present study demonstrated that blunted heart rate response might explain MSA's vulnerability to postural challenge. PWD may be used to predict cardiovascular response to orthostatic stress upon head-up tilt in MSA patients.

ABSTRACTIn this study, we sought to assess the cardiopulmonary functions in three pediatric heart transplant recipients, two of whom are with dilated cardiomyopathy, whereas one is with cyanotic heart disease, in early postoperative period. Cardiopulmonary exercise testing was performed using an incremental cycling at 1 mo after surgery. The results revealed that our study subjects had obvious impairment in workload, oxygen consumption, and oxygen pulse at peak exercise and ventilatory threshold at 1 mo after orthotropic heart transplantation. The pediatric orthotropic heart transplantation recipients also showed a high resting heart rate (90–106 beats/min), a low peak heart rate (109–117 beats/min) during exercise, and continuous heart rate acceleration till 1 to 3 mins after the cessation of exercise. In conclusion, pediatric orthotropic heart transplant recipients have a low cardiopulmonary endurance during the early postoperative period. An early structured, individualized cardiopulmonary rehabilitation program for pediatric orthotropic heart transplant recipients will be an area for future evaluation and research.

Regular exercise improves physical capacity and quality of life in healthy individuals and patients with chronic disease. However, the major limitation of exercise participation lies in pathological abnormalities and limited accessibility. Chinese mind-body exercises, such as Tai chi, are easily accessible and have potential benefits for health promotion. Previous studies have shown that Tai chi is beneficial to aerobic capacity, muscular strength, microcirculation, and some cardiovascular risk factors. Furthermore, Tai chi appears to be safe and effective for patients with acute myocardial infarction (AMI), those who underwent a coronary artery bypass grafting surgery or had congestive heart failure.[1] The interplay of sympathetic and vagal outputs of the central autonomic network through sinoatrial node produces beat-to-beat heart rate variability (HRV), and cardiac vagal function can be evaluated by spectral HRV analysis. Cardiac vagal modulation decreased in various pathological conditions, such as AMI and heart failure, and decreased HRV was found to be associated with poor clinical outcome. Low-frequency (LF) and high-frequency (HF) spectral HRV components are distinguished in a spectrum calculated from short-term recordings of heart beats, and LF and HF power may be measured in normalized units. Vagal activity is the major contributor to the HF component, and LF reflects both sympathetic activity and vagal activity. The LF/HF ratio is considered to mirror sympathovagal balance or to reflect the sympathetic modulations. Exercise training may significantly increase HRV, and deep breathing has been shown to affect the depolarization of the sinus node and increase vagal outflow. Tai chi is an exercise integrating diaphragmatic breathing into body motions, and hence may increase HRV and has the potential benefits to better cardiovascular health. There are three studies that reported the effect of Tai chi to HRV in healthy subjects.[2–4] Vaananen et al.[2] reported that HRV increases immediately after Tai chi exercise in young and old male healthy subjects. Lu et al.[3] reported that Tai chi practitioners displayed higher HRV than the sedentary controls, which implied that Tai chi might enhance the vagal modulation and tilt the sympathovagal balance toward decreased sympathetic modulation. In a recent study, Audette and colleagues[4] reported that Tai chi training in sedentary women displayed increased HF power, representing increased vagal activity, and decreased LF power, representing decreased sympathetic activity in the Tai chi group. Although these studies showed positive effect to HRV, they usually recruited a small number of subjects and did not control the breathing rate. In this issue of the Journal, Figueroa and colleagues[5] reported that they measured the autonomic responses (HRV and BP variability) and rate pressure product (RPP) for a Tai chi group and nontrained sedentary controls at rest and at two stressor phases (hand gripping and standing). The Tai chi group practiced classical Yang Tai chi for a minimum of 2 h/week and at least 6 months of training. Each training session consisted of 40 min of Tai chi practice, which comprised 108 movements. The respiratory rate was controlled at 12 breaths/min during the measurement of the autonomic variables to prevent the influence of breathing depth and frequency on HRV. The Tai chi group maintained a greater HF component at rest and during the isometric grip stressor phase, which indicated increased vagal outflow. Additionally, sympathetic outflow and RPP were significantly lower in the Tai chi group at rest, during the isometric grip and standing stressor phases. The results imply that the Tai chi group is more efficient in myocardial oxygen utilization during resting and pathological stress, and the autonomic responses favored parasympathetic outflow. Furthermore, Figueroa and colleagues also found that LF modulation of systolic blood pressure (BP) variability, a noninvasive marker of sympathetic vasomotor modulation, was significantly lower at rest, during the isometric contraction and standing for the Tai chi group. Although increased variability of BP has been reported to be associated with higher incidence or mortality of cardiovascular disease, there is conflicting evidence whether BP variability can predict future cardiovascular events. More research is needed to substantiate the effect of exercise training to BP variability. Although this study showed potential benefits of Tai chi to the autonomic function, its design is cross-sectional and the number of subjects is relatively small. To demonstrate the benefits of Tai chi to autonomic function, further longitudinal studies recruiting more subjects are needed. In addition, although increased parasympathetic flow shows benefits in some cardiac patients, whether it shows similar cardiaovascular benefits in healthy people remains to be elucidated.

Objective: To detect early subclinical signs of autonomic dysfunction in the cardiovascular system and explore the mechanism of orthostatic hypotension (OH) in patients with multiple system atrophy (MSA). Methods: Eighteen male patients with possible MSA and 10 healthy men were recruited. The hemodynamic responses to head-up tilt and tilt-reversal were studied by an electrically-powered tilt table and a non-invasive cardiac output measurement (NICOM) system. Results: At supine, there was no significant difference in blood pressure, heart rate (HR), stroke volume, cardiac output and total peripheral resistance between MSA patients and healthy controls. During tilting upright, OH developed in 5 MSA patients, with a 23.7 +/- 4.8 mmHg drop in systolic blood pressure. Patients with OH were older and exhibited higher scores in unified Multiple System Atrophy Rating Scale part I than patients without OH. The stroke volume, cardiac output and total peripheral resistance did not differ between groups. The controls had the most significant HR elevation (6.5 +/- 2.5 bpm) during tilt-up, followed by patients without OH (2.8 +/- 1.6 bpm) and those with OH (-0.2 +/- 2.2 bpm). A similar trend of HR decrease was observed during return to supine posture. The process of tilt-reversal altered HR more significantly than head-up tilt in controls (8.0 +/- 2.9 vs 6.5 +/- 2.5 bpm; P=0.031) and patients without OH (4.2 +/- 2.1 vs 2.8 +/- 1.6 bpm; P=0.032), but not in patients with OH (1.2 +/- 1.5 vs -0.2 +/- 2.2 bpm; P=0.380).Conclusions: The HR change during postural challenge showed significant difference between MSA patients and healthy controls. Impaired HR responsiveness contributed to OH in MSA. Monitoring HR during the tilt table test may be a practical and useful method to detect early autonomic dysfunction in patients with MSA.

The minute ventilation - carbon dioxide production relationship (VE/VCO2 slope) and ventilatory equivalent for carbon dioxide at ventilatory threshold (VE/VCO2 at VT) has been demonstrated to be associated with reduced short- and medium-term survival in many circumstances such as heart failure and post-major surgery. However, there exist a broad variety of data processing methods for expired gas analysis, including time-averaged and breath-averaged. PURPOSE: To determine the level of agreement in VE/VCO2 slope between different data processing methods for cardiopulmonary exercise testing (CPET) and to explore their ability to discriminate between healthy subjects and patients with corrected Tetralogy of Fallot (TOF). METHODS: We retrospectively analyzed the CPET data of 51 healthy subjects and 51 adult patients with corrected TOF. The expired gas data were processed through different methods (raw; time-averaging: 10s, 15s, 30s and 60s; breath-averaging: moving 5 breath, moving 11 breath and middle 5 of 7 breath). We recorded the VE/VCO2 slope in each data processing method and VE/VCO2 at VT. A Bland-Altman analysis was used to assess the level of agreement in VE/VCO2 slope between the different data processing methods. RESULTS: The Bland-Altman analysis indicates that the 95% limits of agreement in VE/VCO2 slope between 30s and 10s time-averaged methods range from -0.74 to 0.44. The two methods consistently provide similar findings. The 95% limits of agreement in VE/VCO2 slope between 5 breath-averaged and 10s time-averaged methods ranged from -1.03 to 2.76, which might include clinically important discrepancies. As for between group comparison, there was a statistically significant difference in VE/VCO2 at VT between healthy subjects and patients with corrected TOF (25.8 vs 27.2, p = 0.025), while no significant difference was observed in VE/VCO2 slope (p > 0.05) with different data processing methods. CONCLUSIONS: There was no clinical significant difference in VE/VCO2 slope within different time-averaged methods or within different breath-averaged methods, while clinically important discrepancies might exist between time-averaged and breath-averaged methods. The VE/VCO2 at VT is the only analyzed parameter that could discriminate between healthy and TOF subjects.

We investigated the gender-specific effects of physical activity, BMI and WC on glucose intolerance in an elderly Taiwanese population (n = 1344) aged 65 and above, who participated in the Elderly Nutrition and Health Survey in Taiwan in 1999–2000. In this cross-sectional study, physical activity was assessed using the Modified Baecke Questionnaire for Older Adults (MBQOA). Categories of physical activity level were defined by tertiles of MBQOA scores. Glucose intolerance in subjects not previously diagnosed with diabetes was categorized according to 2003 American Diabetes Association criteria. After adjustment for potential confounders, physical activity was significantly inversely associated with the presence of undiagnosed type 2 diabetes and impaired fasting glucose (IFG) in older women. In older men, the association was less clear. BMI and WC were significantly positively associated with the presence of undiagnosed diabetes in men and were significantly associated with IFG in both sexes. In older women, undiagnosed diabetes was strongly associated with increased WC, but not with BMI. Our findings highlight that older women with low physical activity or high WC, and older men with high BMI or WC are important target populations for interventions to prevent glucose intolerance.

Scarce small sample studies have demonstrated the exercise benefits to heart transplantation recipients (HTR) in the early postoperative period. Additionally, the effects of exercise training on Asian HTR remain uncertain. PURPOSE: The aim of this retrospective study was to examine the effects of an early post-operative phase II cardiac rehabilitation program (CRP) on aerobic capacity in HTR, and explore the factors associated with the exercise training effects. METHODS: The study included 47 clinically stable HTR (age: 47±14 years (mean±SD); Male/Female: 37/10) who started phase II CRP within 6 months after surgery (time post-transplant: 68±33 days) and completed the supervised training program (3 days/week, 42 days at least). Each training session comprised 5-10 minutes of warm up, 25-30 minutes of cycling or treadmill walking, and 10 minutes of cool down. The exercise intensity was set at 50-80% of peak oxygen uptake (VO2peak) according to patient's condition. A graded bicycle exercise test was conducted at baseline and after CRP to assess changes in cardiorespiratory function. RESULTS: After CRP (training duration: 81±25 days), the HTR displayed significant increase in VO2peak (14.8±3.4 mL/kg/min to 18.6±4.6 mL/kg/min, P < 0.001), peak work rate (68±20 watt to 91±22 watt, P < 0.001), peak heart rate (133±16 beat/min to 143±18 beat/min, P < 0.001), and body weight (63.4±11.8 kg to 66.4±12.9 kg, P < 0.001). The change of VO2peak after CRP was positively associated with male gender (P = 0.027), negatively associated with advanced age (P < 0.001), baseline body weight (P < 0.001), and the increased body weight (P = 0.007) after CRP in multiple linear stepwise regression analysis. CONCLUSION: Early post-operative phase II CRP for Asian HTR is effective in improving the aerobic capacity. The change of aerobic capacity is significantly associated with gender, age, baseline body weight, and the increased body weight after CRP.

It remains unclear whether Tai Chi Chuan (TCC) instead of swimming yields a training-specific effect on dynamic balance. The objective of the present study is to test if the practice of TCC provides a distinctive benefit of balance in the elderly. The participants in TCC (n=32) and swimming groups (n=20) practiced regular swimming and TCC respectively for at least 3 years before the recruitment. Thirty-four healthy and active elderly volunteers were also recruited as the control group. To evaluate balance, we used SMART Balance Master that yields balance parameters including maximal stability, center-of-pressure velocity, and percentage ankle strategy obtained under six different balance conditions. We evaluated eye-hand coordination by measuring the movement time required to accurately point from one target to the next. In the most challenging balance conditions, the TCC group performed significantly better than the swimming and control groups. In eye-hand coordination tasks, both the TCC and swimming groups yielded significantly shorter movement time compared with the control group; however, no significant difference was observed between them. We concluded that both TCC and swimming improve eye-hand coordination in the elderly. However, TCC yields a better training effect on dynamic balance.

To evaluate the training effect of Tai Chi Chuan (TCC) in postural control and backward fall prevention in the elderly, balance assessment and visually guided lower limb response time were analyzed in a case-control study conducted in a community setting. Thirty-one elderly subjects (mean age: 68.2 +/- 6.8 years) participated in the TCC group, 30 community-dwelling elderly subjects with matched age and body composition served as the elderly control group, with 13 young adults (mean age: 27.5 +/- 3.8 years) serving as young controls. The TCC group had practiced TCC regularly five times per week, for over 30 min per day for at least 4 years. Lower limb response time were measured using a computerized dance machine that we developed, which contains two blocks during testing: single and dual feet. The motor planning of the latter is more complex than the former. Postural control was assessed by computerized posturography (Smart Balance Master). Compared to the elderly controls, the TCC group demonstrated significantly better balance performance in sway-referenced support, which is more challenging. Moreover, the TCC group had better dual feet response than the elderly controls in the forward-backward, forward-right and forward-left directions. Practicing TCC may improve motor responses and postural control in the elderly, particularly in more challenging situations. Subjects showed better postural responses to unexpected perturbation in the forward-backward and forward-sideways direction than sideways or backward-sideways directions, which may have clinical relevance.

OBJECTIVET'ai chi chuan (TCC) is a traditional Chinese exercise and is beneficial for health. Nevertheless, its effect on cardiovascular risk factors in dyslipidemic patients is not clear. The aim of this study was to evaluate the effect of TCC training on coronary heart disease (CHD) risk factors in patients with dyslipidemia.DESIGNThis was designed as a case-controlled study.SETTINGThe study was conducted in a community setting.SUBJECTSFifty-three (53) patients (males: 24; females: 29) with dyslipidemia completed this study.INTERVENTIONSThe TCC group included 28 patients who participated in a 12-month yang TCC training program. The usual-care group included 25 patients who maintained a sedentary lifestyle during this study.OUTCOME MEASURESExercise testing was conducted at baseline and after 1 year of training. Body composition, lipid profile, fasting glucose and insulin levels, and inflammatory markers were also measured before and after training.RESULTSAfter training, the TCC group showed an increase in V(.)O(2peak) from 25.2 +/- 4.2 to 27.4 +/- 4.1 mL x kg(1) x min(1); while the usual-care group displayed a significant decrease from 25.6 +/- 4.9 to 24.1 +/- 4.0 mL x kg(-1) x min(-1). The TCC group also showed a reduction in blood pressure, triglyceride, total cholesterol, low density lipoprotein cholesterol, plasma insulin, homeostasis model assessment index, and high-sensitivity C-reactive protein. Conversely, the usual-care group showed no significant improvement in these cardiovascular risk factors.CONCLUSIONSA 12-month TCC training program significantly improves aerobic capacity and CHD risk factors in patients with dyslipidemia.

Coronary heart disease (CHD) is the leading cause of death in the developed countries and many developing countries. Exercise training is the cornerstone of cardiac rehabilitation program for patients with CHD, and exercise intensities in the 50-70% heart rate reserve have been shown to improve functional capacity. However, recent studies found exercise with lower intensity also displayed benefits to CHD patients, and increased the acceptance of exercise program, particularly unfit and elderly patients. Tai Chi Chuan (TC) is a traditional conditioning exercise in the Chinese community, and recently it has become more popular in the Western societies. The exercise intensity of TC is low to moderate, depending on the training style, posture and duration. Participants can choose to perform a complete set of TC or selected movements according to their needs. Previous research substantiates that TC enhances aerobic capacity, muscular strength, endothelial function and psychological wellbeing. In addition, TC reduces some cardiovascular risk factors, such as hypertension and dyslipidemia. Recent studies have also proved that TC is safe and effective for patients with myocardial infarction, coronary bypass surgery and heart failure. Therefore, TC may be prescribed as an alternative exercise program for selected patients with cardiovascular diseases. In conclusion, TC has potential benefits for patients with CHD, and is appropriate for implementation in the community.