Background:This study explored the relationship between handgrip strength (HGS) and pulmonary function, respiratory muscle strength, and cardiopulmonary endurance in older adults. Methods:We recruited 128 community-dwelling older adults. Correlations between HGS, pulmonary function parameters, respiratory muscle strength, and cardiopulmonary endurance were analyzed. Results:Forced vital capacity (r = 0.180, P < .05), maximum voluntary ventilation (r = 0.180, P < .05), and 2-minute step test (r = 0.204, P < .05) were weakly correlated with HGS. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) had moderate correlations with HGS (r = 0.431 for MIP, 0.492 for MEP, P < .001). Conclusion:HGS was correlated with pulmonary function, respiratory muscle strength, and cardiorespiratory endurance.

Background: Objective of this study was to investigate the effect of home-based pulmonary rehabilitation in older individuals with lung tumors after video-assisted thoracoscopic surgery. Method: Thirty-six subjects were recruited. The control group received standard care, whereas the experimental group underwent a 6-week home-based pulmonary rehabilitation additionally. Assessments were conducted at 2, 6, and 12 weeks after discharge from the hospital. Results: Exercise capacity significantly improved in the rehabilitation group at 2-week follow-up. Inspiratory muscle strength and lung expansion capacity significantly improved at 2- and 6-week follow-ups. Conclusion: Home-based pulmonary rehabilitation could shorten the recovery time of certain physical functions.

Background: Aging may result in autonomic nervous dysfunction. Heart rate variability (HRV) is a non-invasive method to measure autonomic nervous activities. Many studies have shown that HRV contributes to the risk assessment of diseases. A Polar V800 heart rate monitor is a wearable device that measures R-R intervals, but has only been validated in younger adults under limited testing conditions. There is no validation of the V800 under mental stress or in dual task testing conditions. Therefore, this study investigated the validity of the Polar V800 heart rate monitor for assessing R-R intervals and evaluated if there were differences on HRV parameters under different situations in community-dwelling elderly adults. Methods: Forty community-dwelling elderly adults were recruited. Heart rates were recorded via electrocardiogram (ECG) and the V800 under sitting, during an arithmetic test, during a naming test, a self-selected walking velocity test (SSWV), and dual tasks (SSWV performing mental arithmetic test and SSWV performing naming test). Indices of time and frequency domains of HRV were calculated afterwards. The intra-class correlation coefficient (ICC) analysis and effect size were calculated to examine the concurrent validity between the V800 and the ECG. Results: All HRV indices from the V800 were highly correlated with the ECG under all tested conditions (ICC = 0.995–1.000, p < 0.001) and the effect size of bias was small (<0.1). Conclusion: Overall, the V800 has good validity on the assessment of HRV in community-dwelling elderly adults during sitting, mental arithmetic test, naming test, SSWV, and dual tasks.

Background and objectives: The main target of inspiratory muscle training (IMT) is to improve diaphragm function in patients with COPD who have inspiratory muscle weakness. Ventilatory demand is already increased during quiet breathing in patients with COPD, and whether threshold load imposed by IMT would active more accessory muscle remained to be determined. The purpose of this study was to examine diaphragm and sternocleidomastoid (SCM) activation during IMT with intensities of 30% and 50% maximal inspiratory pressure (P-Imax). Methods: Patients with COPD and a P-Imax lower than 60 cmH(2)O were recruited for the study. Surface electromyography (EMG) was used to measure diaphragm and SCM activation, and group-based trajectory modeling (GBTM) was used to identify activation patterns during IMT. The generalized estimating equation (GEE) was then used to detect differences of variables between various breathing tasks. Statistical significance was established at p < 0.05. Results: A total of 30 patients with COPD participated in this study. All patients demonstrated significant increases in diaphragm and SCM activation during 30% and 50% PImax of IMT than during quiet breathing (all p < 0.001). Diaphragm demonstrated two distinct patterns in response to IMT: low activation (n = 8) and high activation (n = 22) group using GBTM analysis. Conclusion: Diaphragm and SCM were substantially activated during IMT in patients with COPD who had inspiratory muscle weakness. Regardless of whether diaphragm activation was high or low, SCM was activated to a greater extent in response to IMT.

OBJECTIVE:The aim of the study was to investigate the treatment effects of transcranial direct current stimulation combined with neuromuscular electrical stimulation on the motor function of upper extremity in persons with stroke.DESIGN:This study was a pilot double-blind randomized controlled trial. Twenty-six patients due to stroke onset of more than 6 mos were randomly allocated to three groups: transcranial direct current stimulation combined with neuromuscular electrical stimulation group, transcranial direct current stimulation group, or control group. In addition to conventional rehabilitation, all subjects received one of the three protocols in a total of 15 sessions for 3 wks.RESULTS:A significant difference among the three groups was found for the change scores of the Fugl-Meyer Assessment upper extremity subscale from pretreatment to 1-mo follow-up (P = 0.02), in favor of the transcranial direct current stimulation combined with neuromuscular electrical stimulation group. Moreover, the transcranial direct current stimulation combined with neuromuscular electrical stimulation group showed significant within-group improvement on the Fugl-Meyer Assessment upper extremity (from preintervention to postintervention, P = 0.01) and the Action Research Arm Test (from preintervention to postintervention and to 1-mo postintervention, P = 0.03 and P = 0.04, respectively).CONCLUSIONS:This preliminary study reveals that combining transcranial direct current stimulation and neuromuscular electrical stimulation with regular rehabilitation programs may enhance better upper extremity functional improvement than regular rehabilitation programs alone in patients with chronic stroke.

PURPOSE:This study is aimed at investigating the effect of low-intensity electrical stimulation on the voluntary activation level (VA) and the cortical facilitation/inhibition of quadriceps in people with chronic anterior cruciate ligament lesion. METHODS:Twenty former athletes with unilateral ACL deficiencies (ACL group) and 20 healthy subjects (healthy control group) participated in the study. The quadriceps VA level, motor-evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) elicited by transcranial magnetic stimulation were tested before and after 30 minutes of low-intensity electrical stimulation (ES). RESULTS:Before ES, the quadriceps VA in the ACL lesion legs of the ACL group was lower compared to the legs of the healthy control group (P < 0.05). The MEP sizes in the ACL lesion legs and the healthy control were not significantly different. The ACL lesion legs showed lower SICI and higher ICF compared to the healthy control group (P < 0.05). After ES, the quadriceps VA level increased and the SICI-ICF was modulated only in the ACL lesion legs (P < 0.05) but not in the healthy controls. CONCLUSIONS:Low-intensity ES can normalize the modulation of intracortical inhibition and facilitation, thereby ameliorating the activation failure in individuals with ACL lesion.

Background: This study used novel human neurophysiologic models to investigate whether the mechanism of rate-sensitive H-reflex depression lies in the pre-synaptic or postsynaptic locus in humans. We hypothesized that pre-synaptic inhibition would suppress la afferents and H-reflexes without suppressing alpha motor neurons or motor evoked potentials (MEPs). In contrast, post-synaptic inhibition would suppress alpha motor neurons, thereby reducing H-reflexes and MEPs. Methods: We recruited 23 healthy adults with typical rate-sensitive H-reflex depression, 2 participants with acute sensory-impaired spinal cord injury (SCI) (to rule out influence of sensory stimulation on supra-spinal excitability), and an atypical cohort of 5 healthy adults without rate-sensitive depression. After a single electrical stimulation to the tibial nerve, we administered either a testing H-reflex or a testing MEP at 50-5000 ms intervals. Results: Testing MEPs were not diminished in healthy subjects with or without typical rate-sensitive H-reflex depression, or in subjects with sensory-impaired SCI. MEP responses were similar in healthy subjects with versus without rate-sensitive H-reflex depression. Conclusions: Results from these novel in vivo human models support a pre-synaptic locus of rate-sensitive H-reflex depression for the first time in humans. Spinal reflex excitability can be modulated separately from descending corticospinal influence. Each represents a potential target for neuromodulatory intervention.

Leg cycling is one of the most common modes of exercise used in athletics and rehabilitation. This study used a novel cycling setting to elucidate the mechanisms, central vs. peripheral fatigue induced by different resistance with equivalent works (watt∗min). Twelve male adults received low and relatively high resistance cycling fatigue tests until exhausted (RPE > 18) in 2 weeks. The maximal voluntary contraction, voluntary activation level, and twitch forces were measured immediately before and after cycling to calculate General (GFI), central (CFI), and peripheral (PFI) fatigue indices of knee extensors, respectively. The results showed that the CFI (high: 92.26 ± 8.67%, low: 78.32 ± 11.77%, p = 0.004) and PFI (high: 73.76 ± 17.32%, low: 89.63 ± 11.01%, p < 0.017) were specific to the resistance of fatigue protocol. The GFI is influenced by the resistance of cycling to support the equivalent dosage. This study concluded that the mechanism of fatigue would be influenced by the resistance of fatigue protocol although the total works had been controlled.

Stroke rehabilitation using alternate hot and cold thermal stimulation (altTS) has been reported to improve motor function in hemiplegia; however, the influence of brain excitability induced by altTS remains unclear. This study examined cortical activation induced by altTS in healthy adults, focusing on motor-related areas. This involved a repeated crossover experimental design with two temperature settings (innocuous altTS with alternate heat-pain and cold-pain thermal and noxious altTS with alternate heat and cold thermal) testing both arms (left side and right side). Thirty-one healthy, right-handed participants received four episodes of altTS on four separate days. Functional magnetic resonance imaging scans were performed both before and after each intervention to determine whether altTS intervention affects cortical excitability, while participants performed a finger-tapping task during scanning. The findings revealed greater response intensity of cortical excitability in participants who received noxious altTS in the primary motor cortex, supplementary motor cortex, and somatosensory cortex than in those who received innocuous altTS. Moreover, there was more motor-related excitability in the contra-lateral brain when heat was applied to the dominant arm, and more sensory-associated excitability in the contra-lateral brain when heat was applied to the nondominant arm. The findings highlight the effect of heat on cortical excitability and provide insights into the application of altTS in stroke rehabilitation.

Case -control studies have shown that noxious thermal stimulation (TS) can improve arm function in patients with stroke. However. the neural mechanisms underlying this improvement are largely unknown. We explored functional neural activation due to noxious and innocuous TS intervention applied to the paretic arm of patients with stroke. Sixteen participants with unilateral cortical infarctions were allocated to one of two groups: noxious TS (8 patients; temperature combination: hot pain 46 degrees C to 47 degrees C, cold pain 7 degrees C-8 degrees C) or innocuous TS (n =8; temperature combination: hot 40 degrees C-41 degrees C, cold 20 degrees C-21 degrees C). All subjects underwent fMRI scanning before and after 30 min TS intervention and performed a finger tapping task with the affected hand. Immediate brain activation effects were assessed according to thermal type (noxious vs. innocuous TS) and time (pre -TS vs post -TS). Regions activated by noxious TS relative to innocuous TS (P <.05, adjusted for multiple comparisons) were related to motor performance and sensory function in the bilateral primary somatosensory cortices, anterior cingulate cortex, insula, thalamus, hippocampus and unilateral primary motor cortex, secondary somatosensory cortex at the contralateral side of lesion, and unilateral supplementary motor area at the ipsilateral side of lesion. Greater activation responses were observed in the side contralateral to the lesion, suggesting a significant intervention effect. Our preliminary findings suggest that noxious TS may induce neuroplastic changes unconstrained to the local area.

Background: Comparative studies on the six-minute walk test during overground (6MWT-C) versus treadmill (6MWT-T) are limited, and the minimal detectable change (MDC) of 6MWT-T in older adults is lacking. This study was conducted to compare the distance of 6MWT-C with that of 6MWT-T in community-dwelling older adults and to explore the factors associated with the distance discrepancy between the 2 types of 6MWT. Methods: Forty community-dwelling older adults were recruited. Lower-limb muscle strength and balance (Berg Balance Scale, BBS) were assessed. The subjects randomly received 6MWT-C and 6MWT-T and returned to repeat the testing within 1 week. Physiological responses were collected before and after 6MWTs. Results: The distance of 6MWT-C was significantly greater than that of 6MWT-T. The MDC of 6MWT-C and 6MWT-T was 54.08 and 56.54 m, respectively. The distance discrepancy of the 2 types of 6MWT was not associated with lower-limb muscle strength or BBS score. Conclusion: Compared with 6MWT-C, 6MWT-T is reliable and has similar MDC in community-dwelling older adults. However, the distances of the 2 types of 6MWT are not interchangeable.

背景與目的：踩車運動常用於促進中風患者下肢動作功能恢復的訓練。本研究目的探討中風患者接受踩車運動訓練後大腦皮質活化型態改變與下肢功能恢復之關係。方法：徵召五位慢性期中風患者接受為期四週，每週五次，每次30 min踩車運動訓練。傅格－梅爾下肢動作評估次量表及六分鐘走路測試和十公尺走路測試評估下肢動作功能恢復情況。功能性核磁共振造影分析計算受試者主動足踝背屈動作時大腦兩側感覺動作皮質區加權側化指標評估大腦間的活化程度。踩車運動訓練前和四週訓練結束後分別接受評估。結果：下肢動作功能平均分數由25.2 ± 2.9分進步至29.0 ± 2.6分；走路測試距離由254.5 ± 50.0 m進步至276.7 ± 52.3 m；走路步速測試由0.78 ± 0.22 s進步至0.90 ± 0.19 s。三位受試者患側足踝背屈動作的感覺動作皮質區呈現雙側活化，另外兩位呈現對側活化型態。結論：初步研究結果顯示慢性期中風患者接受四週踩車運動訓練後下肢動作功能、步行耐力和速度多有進步。然而，功能進步與感覺動作皮質區的活化型態並無一致關聯性。

Introduction: The purpose was to investigate the age effects on central versus peripheral sources of strength, fatigue, and central neural excitabilities. Methods: 42 healthy subjects were recruited as young group (23.73 +/- 2.15 years; n = 26) and middle-aged group (57.25 +/- 4.57 years; n = 16). Maximum voluntary contraction force (MVC), voluntary activation level (VA), and twitch force of quadriceps were evaluated to represent general, central, and peripheral strengths. Central and peripheral fatigue indexes were evaluated using femoral nerve electrical stimulation. Cortical excitabilities were evaluated using transcranial magnetic stimulation (TMS). Results: The middle-aged group had lower MVC and twitch force of quadriceps, but not VA, than young group. No between group differences were found in fatigue indexes. The cortical excitability in middle-aged group was different from young group in paired TMS with inter-stimulus interval of 7 ms. Conclusion: The age-related strength loss at early stage was primarily caused by peripheral muscular strength. The deviation of central neural excitability can be detected but the activation level was not impaired in middle-age adults.

Background Fatigue is a common symptom in the general population and has a substantial effect on individuals’ quality of life. The Multidimensional Fatigue Inventory (MFI) has been widely used to quantify the impact of fatigue, but no Traditional Chinese translation has yet been validated. The goal of this study was to translate the MFI from English into Traditional Chinese (‘the MFI-TC’) and subsequently to examine its validity and reliability. Methods The study recruited a convenience sample of 123 people from various age groups in Taiwan. The MFI was examined using a two-step process: (1) translation and back-translation of the instrument; and (2) examination of construct validity, convergent validity, internal consistency, test-retest reliability, and measurement error. The validity and reliability of the MFI-TC were assessed by factor analysis, Spearman rho correlation coefficient, Cronbach’s alpha coefficient, intraclass correlation coefficient (ICC), minimal detectable change (MDC), and Bland-Altman analysis. All participants completed the Short-Form-36 Health Survey Taiwan Form (SF-36-T) and the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) concurrently to test the convergent validity of the MFI-TC. Test-retest reliability was assessed by readministration of the MFI-TC after a 1-week interval. Results Factor analysis confirmed the four dimensions of fatigue: general/physical fatigue, reduced activity, reduced motivation, and mental fatigue. A four-factor model was extracted, combining general fatigue and physical fatigue as one factor. The results demonstrated moderate convergent validity when correlating fatigue (MFI-TC) with quality of life (SF-36-T) and sleep disturbances (PSQI) (Spearman's rho = 0.68 and 0.47, respectively). Cronbach’s alpha for the MFI-TC total scale and subscales ranged from 0.73 (mental fatigue subscale) to 0.92 (MFI-TC total scale). ICCs ranged from 0.85 (reduced motivation) to 0.94 (MFI-TC total scale), and the MDC ranged from 2.33 points (mental fatigue) to 9.5 points (MFI-TC total scale). The Bland-Altman analyses showed no significant systematic bias between the repeated assessments. Conclusions The results support the use of the Traditional Chinese version of the MFI as a comprehensive instrument for measuring specific aspects of fatigue. Clinicians and researchers should consider interpreting general fatigue and physical fatigue as one subscale when measuring fatigue in Traditional Chinese-speaking populations.

Background . Shortcomings are noted in currently available cardiopulmonary field tests for the older adult and thus relevant research is still ongoing. Purpose . The purpose of this study was to investigate the reliability and validity of a modified squat test and to establish a regression model for predicting aerobic fitness in the older adult. Methods . Twenty-five healthy men aged 60 to 75 years completed this study. Each subject performed two modified squat tests with a prototype testing equipment and a maximal exercise test to determine maximal oxygen consumption. Recovery heart rates (HR) (0~30, 60~90, and 120~150 seconds) were measured following the modified squat tests. The fitness indexes included the sum of recovery HR, recovery HR index, age-adjusted recovery HR index, and immediate HR. Results . The results revealed that the age-adjusted recovery HR index fitness had the highest intraclass correlation coefficients (ICC) of 0.9 and Pearson’s correlation coefficients of 0.71, which suggested the modified squat test can reasonably assess cardiopulmonary fitness for the older adult. The regression equation for estimating aerobic power was V˙O2max = 16.781 + 16.732 × (age-adjusted recovery HR index) + 0.02467 × (physical activity level). Conclusion . The modified squat test is a valid and reliable field test and thus can be an option to assess the cardiopulmonary fitness level of healthy older men in clinics or communities.