Published papers

The purpose of this study was to investigate changes over time in instrumental activities of daily living (IADL), physical function, physical frailty, cognitive function, and nutritional status after transcatheter aortic valve implantation (TAVI). Fifty consecutive older patients with aortic stenosis as possible candidates for TAVI were prospectively enrolled. Their average age was 84.6 ± 3.1 years, and 39 (78%) were female. The results of the linear mixed-effects model for the isometric knee extension muscular strength showed a significant change. IADL and nutritional status were significantly different preoperatively compared with 6 months postoperatively after transfemoral TAVI.

目的 本研究では,アクティブガイドの認知・知識・信念・行動意図の現状と,身体活動・座位行動,個人属性との関連を明らかにする。方法 オンライン調査会社に登録する20〜69歳のモニター7,000人を対象に,横断的調査を実施した。アクティブガイドの認知は,純粋想起法と助成想起法により,知識は「1日の推奨活動時間(18〜64歳/65歳以上)」と「今から増やすべき身体活動時間(プラス・テン)」を数値回答で調査した。信念と行動意図はアクティブガイドに対応する形で新たに尺度を作成し,信念の合計得点と行動意図を有する者の割合を算出した。身体活動は多目的コホート研究(JPHC study)の身体活動質問票から中高強度身体活動量を,特定健診・保健指導の標準的な質問票から活動レベルを算出した。座位行動は国際標準化身体活動質問表(IPAQ)日本語版を使用した。記述的要約を実施した後,従属変数を認知・知識・信念・行動意図のそれぞれの項目,独立変数を身体活動量,座位行動,個人属性(性別,年代,BMI,配偶者の有無,教育歴,仕事の有無,世帯収入)とし,ロジスティック回帰分析でこれらの関連を検討した。結果 アクティブガイドの認知率は純粋想起法で1.7%,助成想起法で5.3〜13.4%であった。知識の正答率は,「1日の推奨活動時間(18〜64歳)」で37.2%,「1日の身体活動時間(65歳以上)」で7.0%,「プラス・テン」で24.8%,3項目すべて正答で2.6%だった。信念の中央値(四分位範囲)は21(16〜25)点であった(32点満点)。行動意図を有する者は,「1日の推奨活動量」で51.4%,「プラス・テン」で66.9%だった。ロジスティック回帰分析の結果,認知・知識・信念・行動意図は中高強度身体活動量や活動レベルでいずれも正の関連が観察された一方で,座位行動では一貫した関連は観察されなかった。個人属性は,評価項目によって異なるが,主に年代や教育歴,仕事の有無,世帯年収との関連を認めた。結論 本研究より,アクティブガイドの認知や知識を有する者は未だ少ない現状が明らかとなった。さらにアクティブガイドの認知・知識・信念・行動意図を有する者は身体活動量が多いことが明らかとなったが,座位行動は一貫した関連が観察されず,この点はさらなる調査が必要である。さらに,今後は経時的な定点調査も求められる。(著者抄録)

近年、小学校の温熱環境が児童の学習効率や健康状態に影響を及ぼすことが報告されている。また、温冷感には代謝量が影響しており、性別、年齢、活発さによる個人差が生じる可能性がある。以上より、温熱環境が児童の健康を維持するために重要な要素であり、その評価には、基礎代謝量や身体活動習慣の個人差を考慮することが必要であると考えられる。本研究では、小学校における温熱環境と温冷感・諸症状の関連について、身体活動を考慮した検討を行った。

Objective: This study examined the association between use of heating and sedentary behavior (SB) and physical activity (PA) at home among Japanese adults in winter.Methods: This cross-sectional study was conducted from November to April from 2014 to 2017. Participants (n=3,874) who intended to conduct insulation retrofitting were recruited by construction companies from 46 prefectures excluding Okinawa Prefecture and wore an accelerometer on their waist for 2 weeks. The association between heating use and log-transformed SB and PA at home was analyzed using a sex-stratified multilevel model (random-intercept model) with 3 levels; day-level variables (e.g., indoor temperature and log-transformed accelerometer wear time as an offset), nested within individual-level (e.g., age and body mass index), and nested within household-level (e.g., household income, number of housemates). The degree of association with the dependent variable was given by exponential transforming the unstandardized regression coefficient.Results: Data from 3,482 participants were analyzed. In the multilevel model, not using a kotatsu was associated with about 2% shorter SB time [men: exp(B)=0.98, p=0.022; women: exp(B)=0.98, p=0.020], an about 10% greater number of breaks in SB time [men: exp(B)=1.10, p=0.001; women: exp(B)=1.11, p<0.001], and 5-7% greater PA [men: exp(B)=1.07, p=0.005; women: exp(B)=1.05, p=0.012] than using a kotatsu. Heating the changing room was also related to shorter SB time, a greater number of breaks in SB time and greater PA in men and women.Conclusions: Not using a kotatsu and heating the changing room were associated with shorter SB and greater PA at home. Warming by heating the entire home, rather than partially heating just the living room, may decrease SB and increase PA in winter.

Objective: We introduced the physical activity promotion project "Fujisawa +10" and aimed to provide reference information regarding evaluation methods and research findings translating to health education and promotion.Contents: We conducted a community-wide intervention to promote physical activity based on the Japanese physical activity guideline (Active Guide) in cooperation with Fujisawa city. The intervention's key message was "Plus Ten (+10: be active for 10 more minutes than now). We implemented this project in 4 districts for 2 years from 2013, and evaluated its pre- and post-implementation effects using population-based surveys (Phase 1). The RE-AIM evaluation revealed a low degree of reaching residents and improved active guide knowledge, but unchanged physical activity levels. From 2015, we applied it to all districts, considering the Phase 1 results (Phase 2). We aimed to improve the degree of reach and focused on group exercise interventions intended to spread to residents. Elderly individuals who performed the group exercise showed improved physical fitness one year later and consistent physical activity and cognitive function. Then, the number of participants increased by 21% in a year. We extracted features of rules, roles, and tools as important aspects of smooth group activities, and created manuals. These findings are still utilized in Fujisawa city health promotion.Conclusion: This project involved RE-AIM evaluations and strategy improvement. Our findings were translated into the city's policy and scaled up. In Japan, in addition to increases in the practices, it is necessary to further disseminate and implement evaluation frameworks such as the RE-AIM model.