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Background: The goal of the present study was to determine knee extensor muscle strength (KEMS) and degree of renal dysfunction associated with an exercise capacity of ≥5 metabolic equivalents (METs) in male chronic heart failure (CHF) patients with chronic kidney disease (CKD)., Methods: In this cross-sectional study of 75 male CHF patients with CKD (65.3 ± 11.6 years), we measured clinical characteristics, peak [Formula: see text], estimated glomerular filtration rate (eGFR), and KEMS. Patients were divided into two groups by exercise capacity: ≥5 METs group (n = 41) and <5 METs group (n = 34). Cutoff values for KEMS and eGFR resulting in an exercise capacity of ≥5 METs were selected with ROC curves. Patients were divided into four groups according to cutoff values, and numbers of patients attaining an exercise capacity of ≥5 METs were compared between groups., Results: Age was significantly higher although eGFR, Hb, and KEMS were lower in the <5 METs versus ≥5 METs group (P < 0.001). Multiple logistic regression analysis revealed a positive significant relation between KEMS and eGFR and exercise capacity of ≥5 METs. Exercise capacity of ≥5 METs was associated with KEMS of approximately 1.69 Nm/kg and an eGFR of 45.7 mL/min/1.73 m(2). The number of patients attaining an exercise capacity of ≥5 METs in the patients who did not reach both cutoff values was significantly lower than that in any other patients (P < 0.001)., Conclusion: KEMS and eGFR may be useful indices for predicting attainment of exercise capacity of ≥5 METs in male CHF patients with CKD.

Purpose: Exercise capacity of fewer than 5 metabolic equivalents (METs) has been associated with high risk of death and poor physical functioning in male patients with heart failure (HF). Therefore, we aimed to determine upper and lower extremity muscle strength levels required to attain an exercise capacity of 5 or more METs in male outpatients with HF., Methods: We enrolled 148 male HF patients (age 60.1 ± 1.0 years). Peak oxygen uptake (peak (Equation is included in full-text article.)o2) was assessed by cardiopulmonary exercise testing (CPX). After CPX, we further divided the patients into groups according to exercise capacity: 5 or more METs (group A, n = 85) and fewer than 5 METs (group B, n = 63). Handgrip strength and knee extensor and flexor muscle strengths were assessed as indices of upper and lower extremity muscle strength, respectively. Receiver operating characteristic curves were used to select cutoff values for upper and lower extremity muscle strength resulting in an exercise capacity of 5 or more METs in these patients., Results: Exercise capacity of 5 or more METs in male HF patients was equivalent to approximately 35.2 kgf of handgrip strength and 1.70 Nm/kg of knee extensor and 0.90 Nm/kg of knee flexor muscle strengths., Conclusions: These upper and lower extremity muscle strength values may be useful target goals for improvement of exercise capacity, risk management, and activities of daily living in male HF patients.

Background: No previous studies have fully investigated the exercise training effect on the skeletal muscle strength and volume to improve the exercise capacity in patients with myocardial infarction (MI). The present study was performed based on a hypothesis that the relationship between exercise capacity, skeletal muscle strength and volume might be changed by the amount of skeletal muscle volume in MI patients up to 3 months after the onset., Methods: Seventy patients with MI underwent symptom-limited cardiopulmonary exercise testing using a treadmill. The lower limb muscle volume (MV) was evaluated according to electrical impedance analysis and the maximal knee extension strength (Peak torque: PT) was measured by a Biodex. All patients participated in 12-week exercise training program. The subjects were divided into 2 groups on the basis of MV: Group H, MV>==22 kg; Group L, MV<22 kg. Delta values were calculated as follows: the value at 3 months minus the value at 1 month., Results: A positive and significant correlation was observed between the delta PT and delta peak VO(2) (r=0.50, p<0.005) only in the L group. No significant correlation was observed between the delta peak VO(2) and the delta lower limb MV or between the delta lower limb MV and the delta PT in the 2 groups., Conclusions: Cardiac rehabilitation program combined with resistance and aerobic training improved exercise capacity and increased not the skeletal muscle volume but the skeletal muscle strength in patients with MI in their recovery phase. It was presumed that the improvement of exercise capacity was determined by the skeletal muscle strength not by the muscle volume especially in MI patients with low muscle volume.

Objective: Indices of exercise capacity such as peak oxygen uptake (VO2peak) and muscle strength are important in association with reduced mortality. The present study compared differences in VO2peak and muscle strength indices (grip strength and knee extensor and flexor muscle strength) with disease severity and investigated the relation of these variables in congestive heart failure (CHF) patients., Design: The study comprised 102 patients with stable CHF (93 men, age 61.4 +/- 10.2 yrs) with left ventricular ejection fraction (LVEF) <40% by echocardiography. We used New York Heart Association (NYHA) functional class to index disease severity. VO2peak, grip strength, knee extensor, and flexor muscle strength were determined. Patients were divided into three groups by NYHA class: class I (n = 39), class II (n = 49), and class III (n = 14)., Results: Age, sex, and LVEF did not differ according to NYHA class. VO2peak and all muscle strength indices decreased with increases in NYHA class (P < 0.05). VO2peak correlated positively with all muscle strengths (P < 0.05). Stepwise linear regression analysis revealed that grip and knee extensor strength were important in predicting VO2peak., Conclusions: Exercise capacity and disease severity in CHF patients may be influenced not only by lower-limb but also upper-limb muscle strength.

Previous studies have reported that skeletal muscle strength is closely related to exercise capacity in patients with myocardial infarction (MI). However, none of the previous studies have fully investigated the correlation between exercise capacity and the skeletal muscle volume (MV). Seventy patients with MI underwent symptom-limited cardiopulmonary exercise testing using a treadmill. The MV was evaluated by electrical impedance analysis and the maximal knee extension strength (Peak torque: PT) was measured by a Biodex. The subjects were divided into 2 groups according to the MV (group L, MV < 22 kg; group H, MV > or = 22 kg). The PT was positively and significantly correlated with the peak V(.)O(2) in both the L and H groups (r = 0.70 versus r = 0.71). The MV of the lower limbs was positively correlated with the peak V(.)O(2) in the L group (r = 0.57), but not in the H group. The lower limb MV was positively and significantly correlated with PT in the L group (r = 0.48), but not in the H group. The exercise capacity of patients with MI is thought to depend on both the strength and volume of the skeletal muscle. In MI patients with high muscle volume, exercise capacity was determined by skeletal muscle strength alone.

Background Lower leg strength at hospital discharge is strongly associated with poor prognosis in older patients with acute decompensated heart failure (ADHF). Improving leg strength is important in acute-phase cardiac rehabilitation (CR). Aims This study aimed to clarify whether a change in leg strength occurs during hospitalization of older ADHF patients receiving CR and whether it affects leg strength at discharge. Methods and results We enrolled 247 ADHF patients who underwent CR during hospitalization. They were divided into the non-older patient group (<75 years; n = 142) and older patient group (≥75 years; n = 105). Quadriceps isometric strength (QIS), body mass-corrected QIS (%BM QIS), and change in QIS during hospitalization (QIS ratio) were evaluated in all patients. Physical function in the stable phase was measured by the Performance Measure for Activities of Daily Living-8 (PMADL-8). The QIS value increased during hospitalization in the non-older patient group (30.0 ± 11.1 vs. 31.6 ± 10.9 kgf, P < 0.001) but did not increase in the older patient group (19.1 ± 6.3 vs. 19.5 ± 6.1 kgf, P = 0.275). Multiple regression analysis revealed that PMADL-8 significantly predicted %BM QIS at discharge in the non-older patient group (β = −0.254, P = 0.004), whereas in the older patient group, QIS ratio and PMADL-8 significantly predicted %BM QIS at discharge (β = 0.264, P = 0.008 for QIS ratio and β = −0.307, P = 0.003 for PMADL-8). Conclusions Leg strength was not improved in older ADHF patients during hospitalization even if they received CR, and this affected leg strength at discharge, suggesting that careful skeletal muscle intervention should be provided during hospitalization, and patients need to continue exercise after discharge. [ABSTRACT FROM AUTHOR]