Kornanong Yuenyongchaiwat

Background: There is limited evidence regarding sarcopenia in Thailand, especially in southern provinces when applying the AWGS-2019 criteria. Objective: The present study aimed to determine the prevalence and independent risk factors of sarcopenia among community-dwelling older adults in Nakhon Si Thammarat. Methods: A cross-sectional study was conducted involving 246 adults aged 60 years or older. Sarcopenia was defined using the AWGS-2019 criteria. Data collection comprised the Mini Nutritional Assessment-Short Form (MNA-SF), Abbreviated Mental Test (AMT), and physical performance assessments. Multivariable logistic regression analysis was performed to identify independent predictors, incorporating both categorical and continuous variables. Results: The prevalence of sarcopenia was 27.64%. Multivariable analysis identified age of ≥80 years or older (AOR = 4.25, 95% CI: 1.12–16.14; p = 0.033) and body mass index (BMI) below 18.5 kg/m² (AOR = 3.58, 95% CI: 1.20–10.65; p = 0.022) as significant risk factors. Protective factors included attainment of secondary education or higher (AOR = 0.12, 95% CI: 0.02–0.78; p = 0.025), BMI of 23.0 kg/m² or greater (AOR = 0.19, 95% CI: 0.09–0.40; p < 0.001), engagement in regular physical activity (AOR = 0.21, 95% CI: 0.08–0.54; p = 0.001), and normal nutritional status (AOR = 0.24, 95% CI: 0.08–0.71; p = 0.010). Further continuous analysis confirmed that each 5-year increase in age significantly increased the risk of sarcopenia (AOR = 1.52, 95% CI: 1.14–2.03; p = 0.005), while each 1 kg/m² increase in BMI was associated with a protective effect (AOR = 0.78, 95% CI: 0.69–0.88; p < 0.001). Conclusions: Sarcopenia is common among older adults in Southern Thailand. Both categorical and continuous analyses identify advanced age as a primary risk factor. In contrast, higher education, optimal body mass index, regular physical activity, and adequate nutrition serve as important protective factors. These results highlight the importance of community-based screening and targeted interventions that address nutritional adequacy and structured exercise to enhance quality of life in this population.

Incentive spirometry is widely used in respiratory rehabilitation to enhance lung expansion and prevent postoperative pulmonary complications. However, conventional devices, including volume-oriented and flow-oriented incentive spirometers, rely on subjective visual interpretation, which may limit measurement accuracy and clinical utility. A digital incentive spirometer (DIS) has been developed to provide objective, real-time measurements of inspiratory volume. This study aimed to evaluate the agreement and reliability between the DIS and a volume-oriented incentive spirometer (VIS) across different age groups. A cross-sectional study was conducted in 150 participants aged 7–80 years, stratified into five age groups with equal sex distribution. Inspiratory volume was measured simultaneously using both devices. Agreement was assessed using Bland–Altman analysis, and reliability was evaluated using intraclass correlation coefficients (ICC). The DIS demonstrated good overall reliability (ICC = 0.868, 95% CI: 0.821–0.903). The mean difference was 48.69 mL, indicating slight overestimation by the DIS. However, the limits of agreement were wide (−469.24 to 566.63 mL), suggesting limited interchangeability. Reliability varied across age groups, with the highest ICC in older adults and the lowest in adolescents. The DIS showed good reliability but limited agreement with the VIS.

Background: Patients undergoing open-heart surgery (OHS) are at risk of postoperative morbidity and mortality. Physical performance has been increasingly recognized as an important factor influencing postoperative outcomes. Therefore, the study aimed to investigate the associations and predictive value of physical performance on postoperative complications and duration of hospital stay. Methods: A prospective cohort study was conducted in 116 patients who were admitted to OHS. Preoperative assessment of physical performance, i.e., Short Physical Performance Battery (SPPB), Five Times Sit to Stand Test (5STS), gait speed (5 m walk test: 5MWT), Timed Up and Go (TUG), and handgrip strength. Duration of hospital stay and incidence of post-operative complications were recorded. Differences between participants with and without postoperative complications were analyzed using independent samples t-tests for continuous variables and chi-square tests for categorical variables. The associations between physical performance and postoperative outcomes were assessed using Spearman’s rank correlation coefficient. Hierarchical regression analysis was conducted to determine the predictive contribution of physical performance. Results: A total of 116 participants were submitted for OHS in two medical school hospitals; however, 108 individuals completed the pre-operative physical performance. The most common procedures were coronary artery bypass grafting and valve surgery. Fifty-one participants (47.22%) experienced postoperative complications, including five deaths, corresponding to 4.63% mortality. For the length of hospital stay analysis, five participants who died postoperatively were excluded, resulting in a final sample of 103 participants. Physical performance was significantly associated with the length of hospital stay (p < 0.05). Hierarchical regression analysis showed that the final prediction model explained 13.4% of the variance in length of hospital stay, with SPPB independently contributing an additional 6.0% to the model, followed by 5STS, 5MWT, handgrip strength, and TUG, which accounted for an additional 5.1%, 4.6%, 4.4%, and 3.7%, respectively. Conclusions: Preoperative physical performance was associated with length of hospital stay. While each measure explained a relatively small proportion of the variance in hospital stay, these assessments offer a simple, non-invasive, and clinically feasible approach to evaluating functional reserve before surgery. These findings highlight the importance of incorporating functional assessment into perioperative care to support risk stratification and guide rehabilitation strategies.

Introduction : Range of Motion (ROM) assessment is a critical baseline metric for diagnosis, treatment monitoring, and rehabilitation goal setting. It significantly impacts patient well-being, aligning with Sustainable Development Goal 3 (SDG 3). However, the universal goniometer (UG), presents limitations regarding accuracy and practical efficiency in clinical settings. Therefore, this study aimed to determine the concurrent validity of an electronic goniometer named Goniwear compared to the UG for measuring elbow and knee angles. Methods : The validity of Goniwear involved 40 healthy volunteers stratified by age (20–39 and 40–59 years) and sex. Simultaneous active and passive ROM measurements were conducted three times using both UG and on flexion and extension of the elbow and knee joints. Data were analyzed using the intraclass correlation coefficients (ICC), which were calculated using a two-way random-effects model, and the Bland-Altman method was used to determine the limits of agreement (LoA) between the UG and Goniwear. Results : Reliability between the two instruments ranged from poor to excellent, depending on the joint and movement type. Elbow flexion and extension demonstrated consistently good to excellent reliability in both active and passive conditions (ICC = 0.84–0.91), with minimal bias and relatively narrow LoA. Knee flexion and extension showed poor to moderate reliability (ICC = 0.44–0.55), particularly for extension, accompanied by a wide LoA. Conclusion: Agreement between the UG and Goniwear varies across joints and movement conditions. While the instruments appear interchangeable for elbow movements, caution is warranted when interpreting knee ROM due to greater measurement variability. Discussion : The Goniwear demonstrates high validity for single-axis joints with fixed pivot points, suggesting strong potential for clinical application in specific contexts. Trial Registration : The Thai Clinical Trials Registry is TCTR20251120001.

Older adults encounter progressive deterioration of all organ systems. Disease development reportedly increases with age, resulting in decreased physical performance in terms of aerobic endurance, muscular strength, and physical ability. Inspiratory muscle training (IMT) is commonly performed to improve cardiorespiratory fitness. Therefore, this study aimed to develop a resistive inspiratory muscle and determine the effect of inspiratory muscle training on respiratory muscle strength and functional capacity in older adults. Methods: Sixty older adults (age: ≥60 years), both males and females, were enrolled. All participants performed a respiratory muscle strength test (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP)) and a 6-minute walking distance test ( i.e. , submaximal functional capacity) before and after an 8-week intervention program. An inspiratory muscle training device, the Breath Trainer, an air-resistive respiratory training device connected to a smartphone via Bluetooth, was developed. Each individual was required to attach the Breath Trainer to the lower costal part of the chest wall during the training program. The breathing training group used a Breath Trainer set to 40% MIP, whereas the sham-IMT performed a training set to 0% MIP. In both groups, training involved 15 repetitions, three sessions/day, and 5 days/week. An intention-to-treat analysis was performed, followed by a two-way mixed repeated analysis of variance (ANOVA). Results: Between-group difference, the breathing training group exhibited improved respiratory muscle strength (MIP = 19.56 ± 4.54 cmH ₂ O, p < .001, MEP = 18.87 ± 43.41 cmH ₂ O, p < .001) and submaximal functional capacity (56.63 ± 17.97 meters, p = .003) compared with the sham-IMT, following the 8-week program. Discussion: An 8-week program with the Breath Trainer could improve respiratory muscle strength and submaximal functional capacity in older adults.

Exercise is an integral component of cardiac rehabilitation after open-heart surgery in both hospital and community settings, and such programs are designed to reduce adverse physical and mental health outcomes in patients undergoing cardiac surgery. Virtual reality (VR)-based aerobic exercises are used for cardiac rehabilitation. We aimed to analyze the effects of an eight-week home-based phase II cardiac rehabilitation program performed in VR on depression and quality of life (QOL) in community-dwelling individuals who underwent open-heart surgery. A randomized controlled trial was conducted, and 49 patients who underwent elective open-heart surgery were assigned to either the VR group (n=24) or the control group. Members of the control group received a paper booklet (n=25) during phase II cardiac rehabilitation. Depression and SF-36 scores were assessed at baseline and at eight weeks. The VR group showed a significant decrease in depression after eight weeks, compared to the control group (D-1.75, p=.003, n2p=0.175). The SF-36 showed no significant differences between the VR and control groups. A home-based VR exercise program has applications in phase II cardiac rehabilitation for open-heart surgery by reducing depression but not QOL. Therefore, integrating VR exercise into cardiac rehabilitation programs may offer a novel strategy to address mental health challenges.

Background: Various breathing exercises are used to enhance lung function. However, many patients have reported experiencing breathlessness and an increased work of breathing during their use, but evidence supporting this is limited. This study aimed to compare respiratory muscle activity and cardiovascular function during different breathing exercises. Methods: Forty-five healthy adults participated in this study. They were randomly assigned in a crossover design involving three breathing techniques: flow incentive spirometry, volume incentive spirometry, and costal breathing exercises with sustained maximal inspiration. Respiratory muscle activity (sternocleidomastoid, superior external intercostal, and inferior external intercostal) and cardiovascular function were assessed during each technique at baseline and during the 3^rd, 6^th, and 9^th breaths. Results: Sternocleidomastoid, superior external intercostal, and inferior external intercostal were more activated during flow incentive spirometry and volume incentive spirometry than during costal breathing exercises with sustained maximal inspiration. During flow incentive spirometry, stroke volume and heart rate significantly increased, while cardiac output significantly decreased compared to volume incentive spirometry and costal breathing exercises with sustained maximal inspiration throughout the 10 breathing cycles. Conclusion: Flow incentive spirometry and volume incentive spirometry elicited greater accessory muscle activity than costal breathing exercises with sustained maximal inspiration. Inferior external intercostal was activated in all breathing techniques. In particular, flow incentive spirometry stimulated changes in cardiovascular function more than volume incentive spirometry and costal breathing exercises with sustained maximal inspiration. Therefore, volume incentive spirometry and costal breathing exercises with sustained maximal inspiration are recommended to minimize breathing effort and cardiovascular instability.

Mild cognitive impairment (MCI) is the transitional stage between normal cognition and dementia and is associated with arterial stiffness, which may lead to cardiovascular disease. A water-based exercise (W) presents a low-impact activity for the joints and increases resistance compared to exercises performed in the air, which benefits older adults. However, little evidence has been found regarding the effect of W on promoting cognitive and physical performance in older individuals with MCI. Therefore, this study aimed to investigate and compare the post-training effects of W alone and in combination with cognitive training on cognitive function, cardiovascular fitness, and arterial stiffness in older adults with MCI. Forty-six adults with MCI, aged 65 years or older, were enrolled. Participants were divided into two groups: a W group and a water-based exercise combined with cognitive training (W-COG) group. Both groups performed an aerobic exercise program in water for 60 min per/day, 3 day/week, for 12 weeks. Participants in the W-COG group simultaneously performed aerobic exercise and cognitive training in water. Cognitive performance, cardiovascular fitness, and arterial stiffness were examined before and after the intervention. The results revealed improvements in cognitive performance and cardiovascular fitness in both the W and W-COG groups after 12 weeks of intervention. However, there were no significant differences in cognitive and cardiovascular fitness changes between the two groups. Neither the W nor the W-COG groups showed a decrease in brachial pulse wave velocity. Therefore, W interventions have the potential to enhance cognitive function, restore cognition, and improve cardiovascular fitness in older adults with MCI.

Background/Objectives: Adherence to healthy behaviors after open-heart surgery is crucial for recovery and long-term health. Traditional patient education methods can be enhanced by using technology to improve engagement and self-care. This study aimed to develop and assess the feasibility of the “Term-Jai” smartphone application for promoting healthy heart behaviors in open-heart surgery patients. Methods: The “Term-Jai” psychological theory-based application was tested quantitatively and qualitatively over a 30-day period with 13 patients (age 44–78 years) following open-heart surgery between November 2023 and March 2024. Participant engagement, healthy behaviors, user experience, and usability were assessed using the System Usability Scale (SUS), satisfaction ratings, healthy behavior questionnaires, and semi-structured interviews. Results: The application was feasible, with 70% of participants remaining engaged during the intervention. The average SUS score was 80.2 ± 10.3, indicating good usability. Participants found the application’s information useful, clear, and easy to understand, showing improvements in health behaviors following application usage. The qualitative analysis highlighted the application’s intuitive design and potential for supporting cardiac rehabilitation. High satisfaction scores suggested its effectiveness despite some barriers to application usage around technical support and personalized exercise progression. Conclusions: The “Term-Jai” application is a promising tool for promoting healthy behaviors in patients following open-heart surgery. The application shows good usability and participant satisfaction, indicating its potential for broader implementation after further refinements.