Hemophilia is a bleeding disorder caused by a congenital abnormality of blood coagulation. Until the mid-1970s, patients with hemophilia (PWH) were advised to refrain from physical activity (PA) because of a perceived increased risk of bleeding. Since then, PA, which is recognized as being essential for health maintenance, is now recommended by the World Federation of Hemophilia. Moreover, a number of studies reported that PA can improve treatment efficacy and prevent bleeding in PWH. Physical assessment and intervention in PA are currently used in clinical practice. However, the necessity of PA is not emphasized, and many PWH generally have low- to- no PA. Therefore, a behavior change approach to encourage patient motivation is becoming ever more important. In this article, we review articles addressing PA in PWH and discuss strategies to encourage PA through a behavior change approach by focusing on factors relevant to hemophilia, such as benefits and bleeding risk of PA, risk management of bleeding, PA characteristics, and difficulty with exercise adherence. The trust relationship between clinicians and patients, a transtheoretical model of behavior change, and motivation theory as approaches to promote PA are introduced. Finally, we review a case report of the clinical success of a behavior change approach to promote PA. Many PWH find it difficult to continue PA because of aging, fear of bleeding, insufficient recognition of PA benefits, and psychological problems. Therefore, it is essential and important to perform prophylaxis with PWH and to heighten their understanding of the benefits and risks of PA, before initiating the exercise regimen. For those patients who find it difficult to participate in PA, it is necessary to plan individual-based behavior change approach and encourage self-efficacy.

Between 1962 and 1977 approximately 2% of Denver kidney transplant patients developed colon perforation. The single commonest cause was diverticulitis of the left colon (6/13 cases). In spite of drastic reduction or discontinuation of immunosuppression, only 5/13 patients survived for more than 90 days after operation. Analysis of this experience suggests that the high mortality rate associated with this complication can be reduced by early operation which removes the perforation from the peritoneal cavity (either exteriorization or resection) without primary intestinal reanastomosis. We believe that candidates for kidney transplantation with a history of previously symptomatic diverticulosis coli should have elective colon resection prior to transplantation. Any kidney transplant patient with lower abdominal signs should be investigated and treated aggressively.

This study was conducted to determine the effect of footwear modification on patients with neuromusculoskeletal disorders. Two analyses, the center of pressure and the in-shoe plantar pressures, were studied with the help of healthy volunteers so that the effect of shoe modifications could be assessed. The ground force under the sole of the shoe was measured while the subjects were walking, and the plantar pressure at the foot-insole interface and its distribution were measured while the subjects were in both the standing and walking positions, wearing the trial shoes. The trial shoes had three different types of heels-standard heel, Thomas heel, and reverse Thomas heel-and had three different locations for the rocker bar--just under the metatarsophalangeal joint, 1 cm behind the metatarsophalangeal joint, and 1 cm before the metatarsophalangeal joint. The shift change at the center of pressure showed that the Thomas heel generally pushed the center of pressure more laterally and the reverse Thomas heel shifted it medially more than the standard heel did. While the subjects were in a stable standing position wearing the Thomas heel shoes, the medial forefoot and the lateral heel region's pressure showed significant reduction in the plantar pressure and the lateral forefoot and the medial heel showed a tendency to rise, compared with the standard heel condition. When the trial shoes' heels were changed to the reverse Thomas heel, the above changes tended to reverse. Tests at the foot-insole interface showed that the different types of heels and the location of the bar could change not only the pressure distribution but also the duration of the plantar pressure under the lateral area that shifted to the medial area when the subjects walked. This pressure measurement method was very useful for the design and evaluation of such footwear.

Background Some cases of advanced heart failure with dilated cardiomyopathy (DCM) are complicated by neuromuscular diseases, such as muscular dystrophy. The prognosis in DCM with muscular dystrophy is worse than that of DCM alone [1]. Lamin mutations are associated with significant arrhythmia and cardiomyopathy burden, and mutation of the lamin A/C gene is associated with variable skeletal muscle involvement [2]. Therefore, the prognosis in a patient with DCM is worse if the patient also has a lamin gene mutation.

Background: It remains unclear whether serum uric acid level increases after the cessation of smoking. Methods: In 2000, we conducted a cross-sectional study on the effects of smoking cessation on serum uric acid levels by analyzing the results of annual health check-ups in the Japanese male working population (n = 16,642). Results: The serum uric acid level (6.18 mg/dL) was the highest in ex-smokers, followed by that in never-smokers (6.10 mg/dL) and that in current smokers (5.98 mg/dL). Ex-smokers weighed 0.6 kg more than the never-smokers and 1.5 kg more than the current smokers. The frequency of alcohol intake was closely correlated to the smoking habits. The serum uric acid levels declined in all groups, after adjustments for age, body mass index, and alcohol intake, though the levels in ex-smokers were 0.2 mg/dL higher than those in current smokers. Conclusion:The results suggested that alcohol intake contributed considerably to the serum uric acid levels and that smoking itself may have suppressed these levels via metabolic effects or the action of superoxides.

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This study investigated the effectiveness and safety of interval training during in-hospital treatment of patients with advanced heart failure. Twenty-four consecutive patients with advanced symptomatic heart failure who were referred for cardiac transplant evaluation were recruited. After performing aerobic exercise for approximate intensity, high-intensity interval training (HIIT) was performed. The protocol consisted of 3 or 4 sessions of 1-min high-intensity exercise aimed at 80% of peak VO or 80% heart rate reserve, followed by 4-min recovery periods of low intensity. In addition to the necessary laboratory data, hand grip strength and knee extensor strength were evaluated at the start of exercise training and both at the start and the end of HIIT. Knee extensor strength was standardized by body weight. The BNP level at the start of exercise training was 432 (812) pg/mL and it significantly decreased to 254 (400) pg/mL (p < 0.001) at the end of HIIT. Hand grip strength did not change during course. By contrast, knee extensor strength significantly increased during HIIT [4.42 ± 1.43 → 5.28 ± 1.45 N/kg, p < 0.001], whereas the improvement of knee extensor strength was not significant from the start of exercise training to the start of HIIT. In addition, the change in knee extensor strength during HIIT was significantly associated with the hemoglobin A1c level at the start of exercise (R = - 0.55; p = 0.015). HIIT has a positive impact on skeletal muscle strength among in-hospital patients with advanced heart failure.

Leuprorelin was not effective in this small long-term treatment trial in SBMA. The possibility that earlier treatment might be beneficial may deserve further study.