[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to investigate the independent and joint effects of cardiorespiratory fitness (CRF) and body mass index (BMI) on cancer mortality in a low body mass index population.
BMC Public Health 09/2014; 14(1):1012. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mechanical ventilation (MV) is a life-saving intervention in patients who are incapable of maintaining adequate pulmonary gas exchange due to respiratory failure or other disorders. However, prolonged MV is associated with the development of respiratory muscle weakness. We hypothesized that a single exposure to whole-body heat stress would increase diaphragm expression of heat shock protein 72 (HSP72) and that this treatment would protect against MV-induced diaphragmatic atrophy. Adult male Wistar rats (n = 38) were randomly assigned to one of four groups: an acutely anesthetized control group (CON) with no MV; 12-h controlled MV group (CMV); 1-h whole-body heat stress (HS); or 1-h whole-body heat stress 24 h prior to 12-h controlled MV (HSMV). Compared to CON animals, diaphragmatic HSP72 expression increased significantly in the HS and HSMV groups (P < 0.05). Prolonged MV resulted in significant atrophy of type I, type IIa, and type IIx fibers in the costal diaphragm (P < 0.05). Whole-body heat stress attenuated this effect. In contrast, heat stress did not protect against MV-induced diaphragm contractile dysfunction. The mechanisms responsible for this heat stress-induced protection remain unclear, but may be linked to increased expression of HSP72 in the diaphragm.
Journal of applied physiology (Bethesda, Md. : 1985). 07/2014;
[Show abstract][Hide abstract] ABSTRACT: Body weight in young growing and young adult animals was reduced by a high dietary density of whey protein concentrate; however, it is unclear whether dietary proteins similarly affect body weight in aging animals. Here, we examined whether whey protein or whey peptide ingestion suppressed body fat accumulation and affected protein expression and phosphorylation in skeletal muscle in aging mice.
[Show abstract][Hide abstract] ABSTRACT: Context: Intramyocellular lipid (IMCL) accumulation is observed in both insulin-resistant subjects and insulin-sensitive endurance athletes (athlete's paradox). We hypothesized that the expression pattern of fatty acid transporters may influence oxidative capacity and determine the association between IMCL and insulin resistance. Objective: To investigate the muscle expression of fatty acid transporters and their function related to insulin sensitivity in IMCL-accumulated subjects. Design and Setting: The study subjects were 36 non-obese healthy men. Their IMCL levels were measured by (1)H-magnetic resonance spectroscopy and their insulin sensitivity was evaluated by steady state glucose infusion rate (GIR) during euglycemic-hyperinsulinemic clamp. Gene expression levels in the vastus lateralis were evaluated by qRT-PCR. We compared the clinical phenotypes and the expression levels of genes involved in lipid metabolism in skeletal muscle between IMCL-accumulated high-GIR (H-GIR) subjects (n = 8) and low-GIR (L-GIR) subjects (n = 9). The functions of candidate fatty acid transporters were determined by in vitro analyses. Results: Compared with the L-GIR group, body fat was lower and maximum oxygen uptake was higher in the H-GIR group. Several lipid oxidation genes in muscle were up-regulated in the H-GIR group, and this was associated with increased expression of higher plasma membrane-associated fatty acid-binding protein (FABPpm) and decreased expression of fatty acid transport protein (FATP)-1. Overexpression of FABPpm in C2C12 myotubes increased fatty acid oxidation coupled with the elevated expression of genes related to fatty acid oxidation. These changes were not observed in FATP1 overexpressed myotubes. Conclusions: Differences in the gene expression of fatty acid transporters may, at least in part, affect insulin sensitivity in IMCL-accumulated non-obese men.
The Journal of clinical endocrinology and metabolism. 06/2014;
[Show abstract][Hide abstract] ABSTRACT: Walking combined with blood flow reduction (BFR-walk) elicits muscle hypertrophy. However, the skeletal muscle intracellular signaling behind this response is currently unknown.
To investigate the effects of BFR-walk on mechanistic target of rapamycin (mTOR) and mitogen-activated protein kinase (MAPK) signaling pathways in young men.
Six young men performed 20 minutes of treadmill walking at 55 % of their predetermined maximum oxygen uptake. A pressure cuff belt was applied to the most proximal thigh of only one leg (BFR-Leg, external compression was 240 mmHg) whereas the other leg (CON-Leg) was without BFR during walking. Muscle biopsies were taken from the vastus lateralis of the CON-Leg before exercise and in both legs 3 hours after exercise.
Erk1/2 phosphorylation levels were significantly (p<0.05) increased after exercise in both legs, however, only the BFR-Leg saw an increased phosphorylation of p38. For mTOR signaling, there were no changes in Akt, mTOR, or S6K1 phosphorylation levels before or after walking. However, eEF2 phosphorylation level was significantly (p<0.05) lower for the BFR-Leg 3 hours after walking compared with CON-Leg.
BFR-walk exercise may activate some intracellular signaling cascades that are associated with muscle hypertrophy in young men. This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Protein ingestion after resistance exercise increases muscle protein synthesis (MPS) in a dose-dependent manner. However, the molecular mechanism(s) for the dose-dependency of MPS remains unclear. This study aimed to determine the dose response of mammalian target of rapamycin (mTOR) signaling in muscle with ingestion of protein after resistance exercise.
Fifteen male subjects performed four sets of six unilateral isokinetic concentric knee extensions. Immediately after exercise, eight subjects consumed water only. The other seven subjects, in a randomized-order crossover design, took either a 10 [3.6 g essential amino acids (EAA)] or 20 g (7.1 g EAA) solution of whey protein. Muscle biopsies from the vastus lateralis muscle were taken 30 min before and 1 h after resistance exercise. Phosphorylation of Akt (Ser473), mTOR (Ser2448), 4E-BP1 (Thr37/46), and S6K1 (Thr389) was measured by western blotting.
Concentric knee extension exercise alone did not increase phosphorylation of Akt and mTOR 1 h after exercise, but ingesting protein after exercise significantly increased the phosphorylation of Akt and mTOR in a dose-dependent manner (P < 0.05). 4E-BP1 phosphorylation significantly decreased after resistance exercise (P < 0.05), but subjects who took 10 or 20 g of protein after exercise showed increased 4E-BP1 from post-exercise dephosphorylation (P < 0.05). S6K1 phosphorylation significantly increased after resistance exercise (P < 0.05), and 20 g of protein further increased S6K1 phosphorylation compared with ingestion of 10 g (P < 0.05).
These findings suggest that whey protein intake after resistance exercise activates mTOR signaling in a dose-dependent manner in untrained men.
[Show abstract][Hide abstract] ABSTRACT: Repeated high intensity sprints incur substantial anaerobic metabolic challenges and create an acidic muscle milieu that is unfavorable for subsequent performance. Hyperventilation, resulting in respiratory alkalosis, acts as a compensatory mechanism for metabolic acidosis. This study tested the hypothesis that hyperventilation performed during recovery intervals would attenuate performance decrement in repeated sprint pedaling. Thirteen male university athletes performed ten sets of 10 s maximal pedaling on a cycle ergometer with a 60 s recovery between sets under control (spontaneous breathing) and hyperventilation conditions in a crossover, counter-balanced manner. Pedaling load (kp) was set at 0.075 × body mass. Peak and mean power outputs were documented for each set to compare performance decrements over 10 sets between conditions. Hyperventilation (60 breaths/min and PETCO2 maintained at 20-25 mmHg) was performed 30 s before each sprint set. This intervention successfully increased blood pH by 0.03-0.07 but lowered PCO2 by 1.2-8.4 mmHg throughout exercise (P < 0.001). The peak and mean power outputs, and blood [La] accumulation were not significantly different between the conditions. However, a significant condition × time interaction existed for peak power (P = 0.035) and mean power (P = 0.023), demonstrating an attenuation in power decrement in later sprint sets with hyperventilation. In conclusion, hyperventilation implemented during recovery intervals of repeated sprint pedaling attenuated performance decrements in later exercise bouts that was associated with substantial metabolic acidosis. The practical implication is that hyperventilation may have a strategic role for enhancing training effectiveness and may give an edge in performance outcomes.
The Journal of Strength and Conditioning Research 07/2013; · 1.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to investigate the factors affecting ball velocity at the final instant of the impact phase (t1) in full instep soccer kicking. Five experienced male university soccer players performed maximal full instep kicks for various foot impact points using a one-step approach. The kicking motions were captured two dimensionally by a high-speed camera at 2,500 fps. The theoretical equation of the ball velocity at t1 given in the article was derived based on the impact dynamics theory. The validity of the theoretical equation was verified by comparing the theoretical relationship between the impact point and the ball velocity with the experimental one. Using this theoretical equation, the relationship between the impact point and the ball velocity was simulated. The simulation results indicated that the ball velocity is more strongly affected by the foot velocity at the initial instant of the impact phase than by other factors. The simulation results also indicated that decreasing the ankle joint reaction force during ball impact shifts the impact point that produces the greatest ball velocity to the toe side and decreasing the ankle joint torque during ball impact shifts the impact point that produces the greatest ball velocity to the ankle side.
Journal of applied biomechanics 07/2012; 28(3):258-70. · 1.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined the effects of high-intensity resistance training (HIT) and low-intensity blood flow-restricted (LI-BFR) resistance training on carotid arterial compliance. Nineteen young men were randomly divided into HIT (n = 9) or LI-BFR (n = 10) groups. The HIT and LI-BFR groups performed 75 and 30 %, respectively, of one-repetition maximum (1-RM) bench press exercise, 3 days per week for 6 weeks. During the training sessions, the LI-BFR group wore elastic cuffs around the most proximal region of both arms. Muscle cross-sectional area (CSA), 1-RM strength, and carotid arterial compliance were measured before and 3 days after the final training session. Acute changes in systolic arterial pressure (SAP), plasma endothelin-1 (ET-1), nitrite/nitrate (NOx), and noradrenalin concentrations were also measured during and after a bout of training session. The training led to significant increases (P < 0.01) in bench press 1-RM and arm and chest muscle CSA in the two training groups. Carotid arterial compliance decreased significantly (P < 0.05) in the HIT group, but not in the LI-BFR group. There was a significant correlation (r = -0.533, P < 0.05) between the change in carotid arterial compliance and the acute change in SAP during training sessions; however, ET-1 and NOx did not correlate with carotid arterial compliance. Our results suggest that muscle CSA and strength increased following 6 weeks of both HIT and LI-BFR training. However, carotid arterial compliance decreased in only the HIT group, and the changes were correlated with SAP elevations during exercise sessions.
[Show abstract][Hide abstract] ABSTRACT: This study was undertaken to investigate and compare the effects of proprioceptive neuromuscular facilitation (PNF) stretching and static stretching on maximal voluntary contraction (MVC). Thirteen male university students (age, 20 ± 1 years; height, 172.2 ± 4.6 cm; weight, 68.4 ± 6.7 kg; mean ± SD) completed three different conditions on three non-consecutive days in randomized order: static stretching (SS), PNF stretching (PNF), and no stretching (control, CON). Each condition consisted of a 5-minute rest accompanied by one of the following activities: (a) control, (b) static stretching, or (c) PNF stretching. The hip flexion range of motion (ROM) was evaluated immediately before and after the activity. The MVC of knee flexion was then measured. Surface electromyography was recorded from the biceps femoris and vastus lateralis muscles during MVC tests and stretching. Although increases in ROM were significantly greater after PNF than after SS (P < 0.01), the decreases in MVC were similar between the two treatments. These results suggest that, although PNF stretching increases ROM more than static stretching, PNF stretching as well as static stretching is detrimental to isometric maximal strength.
The Journal of Strength and Conditioning Research 03/2012; · 1.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: α-Actinins are actin-binding proteins, and two isoforms (α-actinin-2 and -3) are major structural components of the sarcomeric Z line in mammalian skeletal muscle. Based on human and knockout mice studies, α-actinin-3 is thought to be associated with muscle force output and high contraction velocities. However, fiber-type specific expression of α-actinin isoforms is not well understood and may vary among species. In this study, we investigated the expression of α-actinin isoforms and the difference between fiber types in rat skeletal muscle and compared it with those of humans and mice from previous reports. Soleus and plantaris muscles were analyzed immunohistochemically to identify muscle fiber types and α-actinin protein expression. α-Actinin-2 was stained in all muscle fibers in both the soleus and plantaris muscles; i.e., all α-actinin-3 co-expressed with α-actinin-2 in rat skeletal muscles. The proportions of α-actinin-3 expression, regardless of fiber type, were significantly higher in the plantaris (75.8 ± 0.6%) than the soleus (8.0 ± 1.7%). No α-actinin-3 expression was observed in type I fibers, whereas all type IIx+b fibers expressed α-actinin-3. α-Actinin-3 was also expressed in type IIa fibers; however, approximately 75% of type IIa fibers were not stained by α-actinin-3, and the proportion varied between muscles. The proportion of α-actinin-3 expression in type IIa fibers was significantly higher in the soleus muscle than the plantaris muscle. Our results showed that fiber-type specific expression of α-actinin isoforms in rats is more similar to that in humans compared to that of the mouse, whereas the proportion of α-actinin-3 protein varied between muscles.
Biochemical and Biophysical Research Communications 02/2012; 419(2):401-4. · 2.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In recent years, shoes having rounded soles in the anterior-posterior direction have been commercially introduced, which are commonly known as unstable shoes (US). However, physiological responses during walking in US, particularly at various speeds, have not been extensively studied to date. The purpose of this study was to investigate the effect of wearing unstable shoes while walking at low to high speeds on the rate of perceived exertion (RPE), muscle activation, oxygen consumption (VO2), and optimum speed. Healthy male adults wore US or normal walking shoes (WS), and walked at various speeds on a treadmill with no inclination. In experiment 1, subjects walked at 3, 4, 5, 6, and 7 km·h(-1) (duration, 3 min for all speeds) and were recorded on video from the right sagittal plane to calculate the step length and cadence. Simultaneously, electromyogram (EMG) was recorded from six different thigh and calf muscles, and the integrated EMG (iEMG) was calculated. In experiment 2, RPE, heart rate and VO2 were measured with the walking speed being increased from 3.6 to 7.2 km·h(-1) incrementally by 0.9 km·h(-1) every 6 min. The optimum speed, defined by the least oxygen cost, was calculated from the fitted quadratic relationship between walking speed and oxygen cost. Wearing US resulted in significantly longer step length and lower cadence compared with WS condition at any given speed. For all speeds, iEMG in the medial gastrocnemius and soleus muscles, heart rate, and VO2 were significantly higher in US than WS. However, RPE and optimum speed (US, 4.75 ± 0.32 km·h(-1); WS, 4. 79 ± 0.18 km·h(-1)) did not differ significantly between the two conditions. These results suggest that unstable shoes can increase muscle activity of lower legs and energy cost without influencing RPE and optimum speed during walking at various speeds.
Journal of sports science & medicine 01/2012; 11(4):632-7. · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Macroautophagy (autophagy) is an intracellular catalytic process. We examined the effect of running exercise, which stimulates cardiac work physiologically, on the expression of microtubule-associated protein 1 light chain 3 (LC3)-II, an indicator of autophagy, as well as some autophagy-related proteins in rat cardiac muscle. The left ventricles were taken from rats immediately (0 h), and at 0.5h, 1h or 3h after a single bout of running exercise on a treadmill for 30 min and also from rats in a rest condition. In these samples, we evaluated the level of LC3-II and p62, and the phosphorylation level of mammalian target of rapamycin (mTOR), Akt and AMP-activated protein kinase alpha (AMPKα) by Western blotting. The exercise produced a biphasic change in LC3-II, with an initial decrease observed immediately after the exercise and a subsequent increase 1h thereafter. LC3-II then returned to the rest level at 3h after the exercise. A negative correlation was found between the LC3-II expression and mTOR phosphorylation, which plays a role in inhibiting autophagy. The exercise increased phosphorylation of AMPKα, which stimulates autophagy via suppression of mTOR phosphorylation, immediately after exercise. The level of p62 and phosphorylated Akt was not altered significantly by the exercise. These results suggest for the first time that a single bout of running exercise induces a biphasic change in autophagy in the cardiac muscle. The exercise-induced change in autophagy might be partially mediated by mTOR in the cardiac muscle.
Biochemical and Biophysical Research Communications 11/2011; 414(4):756-60. · 2.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Increases in the number of satellite cells are necessary for the maintenance of normal muscle function. Endurance training enhances the satellite cell pool. However, it remains unclear whether exercise intensity or exercise duration is more important to enhance the satellite cell pool. This study examined the effects of different intensity and duration of endurance training on the satellite cell pool in rat skeletal muscle.
Forty-one 17-week-old female Sprague-Dawley rats were assigned to control (n = 8), high intensity and high duration (n = 7), high intensity and low duration (n = 8), low intensity and high duration (n = 9) and low intensity and low duration (n = 9) groups. Training groups exercised 5 days per week on a motor driven treadmill for 10 weeks. After the training period, animals were anaesthetized and the plantaris muscles were removed, weighed and analysed for immunohistochemical and histochemical properties.
Although no significant differences were found in muscle mass, mean fibre area and myonuclei per muscle fibre between all groups, the percentage of satellite cells was significantly higher in the high-intensity groups than in the other groups (P < 0.05).
Increases in the satellite cell pool of skeletal muscle following endurance training depend on the intensity rather than duration of exercise.
[Show abstract][Hide abstract] ABSTRACT: We recently reported that α-actinin adaptation occurs at the isoform level. This study was undertaken to clarify the effects of: (1) ageing-induced shift of myosin heavy chain (MyHC) composition and (2) endurance exercise training on α-actinin isoforms in rat plantaris muscle.
Adult (18 mo) and old (28 mo) male Fischer 344 rats were assigned to either sedentary control or endurance exercise training groups. Animals in the training groups ran on a treadmill for 8 week with training intensity adjusted to be equal for adult and old groups. After the training was completed, the plantaris muscles were taken for analyses of α-actinin-2, α-actinin-3, and MyHC composition and metabolic enzyme activities.
The proportion of type IIb MyHC was lower, and that of type I MyHC was higher in old animals than in adult animals. α-actinin-3 was significantly lower in old animals than in adult animals. No significant difference was found in α-actinin-2 and citrate synthase (CS) activity between adult and old animals. Citrate synthase activity was higher in trained animals than in sedentary animals. Endurance training produced a fast-to-slow shift within type II MyHC isoforms in both adult and old animals. α-actinin-2 was significantly higher in trained animals than in sedentary animals. No significant difference was found in α-actinin-3 between trained and sedentary animals.
These results support the α-actinin adaptation at the isoform level and show that the α-actinin-3 expression depends on the amount of type II MyHC, whereas α-actinin-2 expression is associated with improvement of muscular aerobic capacity.
[Show abstract][Hide abstract] ABSTRACT: This study investigated the effect of heat stress (HS) on mammalian target of rapamycin (mTOR) signaling involved in translation initiation after resistance exercise in human skeletal muscle. Eight young male subjects performed four sets of six maximal repetitions of knee extension exercises, with or without HS, in a randomized crossover design. HS was applied to the belly of the vastus lateralis by using a microwave therapy unit prior to and during exercise. Muscle biopsies were taken from the vastus lateralis before, immediately after, and 1 h after exercise. HS significantly increased the phosphorylation of Akt/PKB, mTOR, and ribosomal protein S6 at 1 h after exercise (P < 0.05), and the 4E-BP1 phosphorylation level, which had initially decreased with exercise, had recovered by 1 h after exercise with HS. In addition, the phosphorylation of ribosomal S6 kinase 1 was significantly increased immediately after exercise with HS (P < 0.05). These results indicate that HS enhances mTOR signaling after resistance exercise in human skeletal muscle.
The Journal of Physiological Sciences 03/2011; 61(2):131-40. · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study was performed to investigate the effects of long-term heat stress on mass, strength and gene expression profile of human skeletal muscles without exercise training. Eight healthy men were subjected to 10-week application of heat stress, which was performed for the quadriceps muscles for 8 h/day and 4 days/week by using a heat- and steam-generating sheet. Maximum isometric force during knee extension of the heated leg significantly increased after heat stress (~5.8%, P < 0.05). Mean cross-sectional areas (CSAs) of vastus lateralis (VL, ~2.7%) and rectus femoris (~6.1%) muscles, as well as fiber CSA (8.3%) in VL, in the heated leg were also significantly increased (P < 0.05). Statistical analysis of microarrays (SAM) revealed that 10 weeks of heat stress increased the transcript level of 925 genes and decreased that of 1,300 genes, and gene function clustering analysis (Database for Annotation, Visualization and Integrated Discovery: DAVID) showed that these regulated transcripts stemmed from diverse functional categories. Transcript level of ubiquinol-cytochrome c reductase binding protein (UQCRB) was significantly increased by 10 weeks of heat stress (~3.0 folds). UQCRB is classified as one of the oxidative phosphorylation-associated genes, suggesting that heat stress can stimulate ATP synthesis. These results suggested that long-term application of heat stress could be effective in increasing the muscle strength associated with hypertrophy without exercise training.
[Show abstract][Hide abstract] ABSTRACT: Aims/Introduction: Accumulation of intramyocellular lipid (IMCL) is associated with insulin resistance. However, the factors affecting the change in IMCL remain to be elucidated. The aim of the present study was to determine the factors that influence the change in IMCL level after high-fat loading.Materials and Methods: The study subjects were 37 non-obese men. Each subject consumed a high-fat diet for 3 days after a normal-fat diet for 3 days. After each diet program, IMCL levels in the tibialis anterior (TA-IMCL) and soleus (SOL-IMCL) were measured by proton magnetic resonance spectroscopy. Glucose infusion rate (GIR) was evaluated by euglycemic hyperinsulinemic clamp as an index of peripheral insulin sensitivity.Results: The high-fat diet significantly increased TA-IMCL and SOL-IMCL by ∼30 and ∼20%, respectively (P < 0.05), whereas it did not significantly alter GIR. The increase in SOL-IMCL, but not in TA-IMCL, negatively correlated with serum high molecular weight (HMW)-adiponectin (r = −0.36, P < 0.05) and HMW-/total-adiponectin ratio (r = −0.46, P < 0.05). Although high-fat diet-related changes in SOL-IMCL showed high inter-individual variations, in subjects doing exercise, changes in SOL-IMCL (r = 0.55, P < 0.05) and TA-IMCL (r = 0.61, P < 0.05) positively correlated with daily physical activity level. In contrast, in sedentary subjects, changes in SOL-IMCL (r = −0.50, P < 0.01) and TA-IMCL (r = −0.48, P < 0.05) negatively correlated with daily physical activity.Conclusions: HMW-adiponectin and daily physical activity are determinants of IMCL accumulation by a high-fat diet. Intriguingly, the effect of daily physical activity on the change in IMCL depends on the level of regular exercise. (J Diabetes Invest,doi: 10.1111/j.2040-1124.2010.00091.x, 2011)
Journal of Diabetes Investigation. 12/2010; 2(4):310 - 317.
[Show abstract][Hide abstract] ABSTRACT: Limited data are available on the relationship between muscular and performance fitness (MPF) and the incidence of type 2 diabetes.
A cohort of 3792 Japanese men completed a medical examination that included MPF and cardiorespiratory fitness tests. MPF index composite score was calculated using Z-scores from vertical jump, sit-ups, side step, and functional reach tests.
The mean follow-up period was 187 months (15.6 years). There were 240 patients who developed type 2 diabetes during follow-up. Relative risks and 95% confidence intervals (CI) for incidence of diabetes across baseline quartiles of MPF index composite score were obtained using the Cox proportional hazards model while adjusting for age, BMI, diastolic blood pressure, cigarette smoking, alcohol intake, and family history of diabetes. The relative risks for developing diabetes across quartiles of MPF index composite scores (lowest to highest) were 1.0 (referent), 1.15 (95% CI 0.83-1.60), 1.10 (0.78-1.55), and 0.57 (0.37-0.90) (P for trend = .061). These results were attenuated after adjustment for cardiorespiratory fitness (P for trend = .125).
This prospective study suggests that MPF is a predictor of type 2 diabetes, although its predictive ability was attenuated after adjusting for cardiorespiratory fitness.
Journal of physical activity & health 09/2010; 7(5):627-32. · 1.95 Impact Factor