松浦 広昂

Background/Objectives: The COVID-19 pandemic restrictions had negative effects on cardiac rehabilitation. The difference in the location of cardiac rehabilitation practice during the COVID-19 pandemic decreased the amount of aerobic exercise and the patient's physical function at discharge. Therefore, we introduced a mini-ergometer to the ward to provide quantitative aerobic exercise. This study aimed to evaluate physical function at discharge after the introduction of a mini-ergometer to the ward in patients with heart failure. Methods: We included a total of 117 consecutive patients who were admitted to a university hospital and underwent a cardiac rehabilitation program for heart failure between June 2020 and September 2022. Patients were divided into two groups: Group A (n = 54), which included those admitted before the introduction of the mini-ergometer, and Group B (n = 63), which included those admitted after the introduction of the mini-ergometer. Data, including age, sex, and functional status, were obtained. Additionally, the duration of each rehabilitation exercise was measured. Results: Group B had a significantly higher 6 min walking distance at discharge than Group A (Group A: 236.0 m vs. Group B: 290.0 m, p = 0.020). Furthermore, Group B had a significantly longer ergometer exercise duration than Group A (Group A: 0 min vs. Group B: 25.0 min, p < 0.001). Conclusions: The results showed that the introduction of the mini-ergometer to the ward could ensure quantitative exercise loads even under restricted access to rehabilitation centers during the COVID-19 outbreak, thereby improving physical function at discharge in patients with heart failure.

Abstract Background Step count is used to quantify activity in individuals using accelerometers. However, challenges such as difficulty in detecting steps during slow or irregular gait patterns and the inability to apply this method to wheelchair (WC) users limit the broader utility of accelerometers. Alternative device-specific measures of physical activity exist, but their specificity limits cross-applicability between different device sensors. Moving standard deviation of acceleration (MSDA), obtained from truncal acceleration measurements, is proposed as another alternative variable to quantify physical activity in patients. Objective This study aimed to evaluate the validity and feasibility of MSDA for quantifying physical activity in patients with stroke-induced hemiparesis by comparing it with the traditional step count. Methods We enrolled 197 consecutive patients with stroke hemiparesis admitted to a convalescent rehabilitation ward. Using the hitoe system, a smart clothing–based physical activity measurement system, we measured the MSDA of trunk movement and step count. The correlation between MSDA and step count was examined in all participants. Based on their daily living mobility levels, measured using the Functional Independence Measure (FIM), participants were categorized into 6 subgroups: FIM1-4, FIM5 (WC), FIM5 (walking), FIM6 (WC), FIM6 (walking), and FIM7 (walking). Intersubgroup differences in MSDA were analyzed. Results A strong correlation was observed between MSDA and step count (r=0.78; P&lt;.001), with a stronger correlation in the walking group (r=0.79; P&lt;.001) compared with the WC group (r=0.55; P&lt;.001). The Shapiro-Wilk test indicated no significant results for MSDA across all subgroups, supporting a normal distribution within these groups. In contrast, the step count data for the WC subgroups showed significant results, indicating a deviation from a normal distribution. Additionally, 10.2% (20/197) of participants recorded zero steps, demonstrating a floor effect in the step count data. The median MSDA values for the 6 subgroups (FIM1-4, FIM5 WC, FIM5 walking, FIM6 WC, FIM6 walking, and FIM7) were 0.006, 0.007, 0.010, 0.011, 0.011, and 0.014, respectively, reflecting their levels of independence based on the FIM mobility scores. The median step counts for these subgroups were 68, 233, 1386, 367, 2835, and 4462, respectively. FIM5 participants who walked had higher step counts than FIM6 participants using WCs, though the difference was marginally but not statistically significant (P=.07), highlighting the impact of mobility type (walking vs WC). Conclusions The results suggest the validity of MSDA as a variable for physical activity in patients with stroke, applicable to patients with stroke irrespective of their mobility measures. This finding highlights the potential of MSDA for use in individuals with motor impairments, including WC users, underscoring its broad utility in rehabilitation clinical practice.