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      Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients: A Pilot Study

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          Abstract

          We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 ± 12.6 years, n = 21, M = 18) were randomly assigned to the control ( n = 10) and the KAATSU RT group ( n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5–7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.

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          Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

          Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.
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            Psychophysical bases of perceived exertion

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              Bioelectrical impedance analysis--part I: review of principles and methods.

              U KYLE (2004)
              The use of bioelectrical impedance analysis (BIA) is widespread both in healthy subjects and patients, but suffers from a lack of standardized method and quality control procedures. BIA allows the determination of the fat-free mass (FFM) and total body water (TBW) in subjects without significant fluid and electrolyte abnormalities, when using appropriate population, age or pathology-specific BIA equations and established procedures. Published BIA equations validated against a reference method in a sufficiently large number of subjects are presented and ranked according to the standard error of the estimate. The determination of changes in body cell mass (BCM), extra cellular (ECW) and intra cellular water (ICW) requires further research using a valid model that guarantees that ECW changes do not corrupt the ICW. The use of segmental-BIA, multifrequency BIA, or bioelectrical spectroscopy in altered hydration states also requires further research. ESPEN guidelines for the clinical use of BIA measurements are described in a paper to appear soon in Clinical Nutrition.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                02 February 2021
                February 2021
                : 10
                : 3
                : 547
                Affiliations
                [1 ]Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; hironaga_0722@ 123456yahoo.co.jp (H.O.); sibasaki@ 123456dokkyomed.ac.jp (I.S.); fukuda-h@ 123456dokkyomed.ac.jp (H.F.)
                [2 ]Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; tnasuno@ 123456dokkyomed.ac.jp (T.N.); hirokane1010@ 123456gmail.com (H.K.); hyagi881@ 123456mac.com (H.Y.); s-toyoda@ 123456dokkyomed.ac.jp (S.T.); inouet@ 123456dokkyomed.ac.jp (T.I.)
                [3 ]Department of Medical KAATSU Training, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
                [4 ]Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; kata-s@ 123456dokkyomed.ac.jp (S.K.); i-hayato@ 123456dokkyomed.ac.jp (H.I.); yu-mizu@ 123456dokkyomed.ac.jp (Y.M.); mizusima@ 123456dokkyomed.ac.jp (T.M.)
                [5 ]Department of Health and Sport Sciences, Premedical Sciences, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; auematsu@ 123456dokkyomed.ac.jp
                [6 ]School of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka 433-8558, Japan; tomohiro-y@ 123456seirei.ac.jp
                [7 ]University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ Groningen, The Netherlands; t.hortobagyi@ 123456umcg.nl
                Author notes
                [* ]Correspondence: nakat@ 123456dokkyomed.ac.jp
                Author information
                https://orcid.org/0000-0001-9545-7529
                https://orcid.org/0000-0001-8526-5486
                https://orcid.org/0000-0002-8260-833X
                https://orcid.org/0000-0002-7585-0945
                Article
                jcm-10-00547
                10.3390/jcm10030547
                7867301
                33540756
                8c35ef50-f7c4-4381-b9cd-b5756f406228
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 04 January 2021
                : 28 January 2021
                Categories
                Article

                cardiac surgery,resistance exercise,muscle hypertrophy,cardiac rehabilitation,moderate blood flow restriction,kaatsu training,sarcopenia

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