Preoperative CKD stage correlated significantly with the progress of early postoperative CR after cardiac surgery. Independent determinants of achieving JCS early postoperative CR guideline goal were postoperative AKI in patients with or without CKD, and POFB/PBW only in patients without CKD.

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Background: As few studies have examined physical functioning changes after cardiac surgery, the factors related to the decline in physical functioning remain unclear. This study aimed to investigate the factors related to physical functioning decline after cardiac surgery in older patients. Methods: The final study sample consisted of 523 older (!65 years) patients (age 74.2 AE 6.1 years, 66% male) who underwent cardiac surgery at 8 Japanese institutions. We excluded patients who were unable to walk independently or had a slow gait speed (<0.8 m/s) before surgery, and those who were unable to regain independent walking after surgery. We divided the patients into two groups, a decline-in-gaitspeed group and a non-decline-in-gait-speed group, according to whether their gait speed was less than 0.8 m/s at discharge. We analyzed patients' clinical characteristics to identify the factors that predicted the postoperative decline in gait speed. Results: Eighty-nine patients (17.0%) showed a postoperative decline in gait speed. Multivariate logistic regression analysis showed that the following factors predicted a postoperative decline in gait speed: age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.02-1.11]; estimated glomerular filtration rate (OR 0.98, CI 0.96-0.99); preoperative gait speed (OR 0.01, CI 0.00-0.08); and the postoperative day on which the patient could walk independently (OR 1.08, CI 1.02-1.14). Conclusions: Physical functioning declined in 17% of patients after surgery. The decline could be predicted by several clinical factors, including some that are modifiable. These results suggest that further interventional research on rehabilitation before and after cardiac surgery for older patients might help overcome the decline in physical functioning.

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The aim of this multicenter study was to determine the relationship between POAF and patients' progress in early rehabilitation after heart valve surgery. Methods: We enrolled 302 patients (mean age, 69 10 years) who had undergone heart valve surgery. POAF was monitored using continuous electrocardiogram telemetry, and the Short Physical Performance Battery (SPPB) was used to assess lower-extremity function before surgery and at the time of discharge. Progress in early rehabilitation was evaluated by the duration from the surgery to independent walking. We determined factors associated delayed early rehabilitation and evaluated the interplay of POAF and delayed early rehabilitation in increasing the risk of decline in lower-extremity function from preoperatively to hospital discharge. Results: Multivariate analysis determined POAF to be independent predictors of delayed early rehabilitation after heart valve surgery (OR: 3.906, P = .01). The association between delayed early rehabilitation and decline in lower extremity function was stronger in patients with POAF (OR: 2.73, P = .041) than in those without (OR: 2.22, P = .052). Conclusions: POAF was clinical predictors of delayed early rehabilitation in patients undergoing heart valve surgery. The combination of POAF with delayed early rehabilitation conferred a high risk of decline in lowerextremity function during hospitalization.

In lower exercise capacity patients with HF had slower [Formula: see text]O and [Formula: see text]E kinetics during and after the 6MWT.

[Purpose] This study aimed to evaluate the effect of in-hospital physical activity on patient prognosis after lower extremity bypass surgery for peripheral arterial disease. [Subjects and Methods] A total of 13 patients (16 limbs; 11 males and 2 females; mean age [standard deviation], 72.8 [5.9] years) who underwent lower extremity bypass surgery for Fontaine stage 2 peripheral arterial disease were included in this study and assigned to either an active group (n = 6) to perform increased physical activity after surgery or an inactive group (n = 7) to perform decreased physical activity after surgery. Daily in-hospital physical activity levels were measured continuously with a triaxial accelerometer. The occurrence of adverse cardiovascular events within a 2 year follow-up period was compared between groups. [Results] At discharge, the patients in the active group were able to walk more steps daily than those in the inactive group. The incidence of adverse events was 16.7% in the active group and 71.4% in the inactive group. [Conclusion] A higher in-hospital physical activity level was associated with a better long-term prognosis after lower extremity bypass surgery in patients with peripheral arterial disease.

We aimed to investigate the characteristics of changes in amount of physical activity of patients with peripheral arterial disease (PAD) before/after endovascular treatment (EVT) combined with exercise training. Twenty-two patients with peripheral arterial disease at stage-II of the Fontaine classification who received EVT combined with exercise training were included in this study. A tri-axial accelerometer was used to record physical activity every day from the day before surgery to 3 months after discharge from hospital. The mean number of walking steps before surgery was 2664 steps (611 steps-5404 steps), whereas those after surgery was 3393 (567 steps-7578 steps). Ankle Brachial Index (from 0.69 to 1.03; p < 0.001), maximum walking distance (from 728.2 to 1271.8 m; p < 0.05) and Vascu-QOL (from 98.9 to 137.9; p < 0.01) showed improvement between before and after surgery. Physical activity of patients with PAD was still low at 3 months after surgery even though walking ability, QOL, and self-efficacy were improved after EVT combined with exercise training. Among the 22 patients, the number of walking steps increased in 17 of them and decreased in 5 of them. Compared with the patients in the increased-steps group, those in the decreased-steps group were significantly older (p < 0.05), and had a significantly higher cardiovascular event rate within the first 3 months after surgery (p < 0.05). These results suggested that, not only the improvement of walking ability, but increase in physical activity after EVT combined with exercise training is also important for short-term prognosis.