Published papers

Background: Sarcopenia and frailty often worsen in older adults because of declines in activities of daily living and social connections that are associated with chronic diseases and traumatic injuries such as falls and fractures. Exercise intervention for sarcopenia can take more than three months to improve muscle mass, muscle strength, and walking speed. Thus, a specialized intervention system for shorter periods of time is needed. This study aimed to examine the short-term efficacy of an exercise program utilizing the wearable cyborg Hybrid Assistive Limb (HAL) lumbar type on physical function and frailty prevention. Methods: This randomized, single-blind, parallel-group study involved 79 community-dwelling older adults with physical frailty or locomotive syndrome assigned to an intervention group (40) with the HAL lumbar type exercise program or a control group (39) without the exercise program. The intervention group underwent trunk training (including trunk and hip flexion, standing and sitting from a single sitting position, and squats) and gait training (treadmill and parallel bars) twice a week for 5 weeks while wearing the HAL lumbar type. The 10-m usual and maximum walking speeds, Timed Up and Go test, 5-times chair-standing test, 5-question Geriatric Locomotive Function Scale (GLFS-5), body-fat percentage, and muscle mass were measured before and after the intervention and analyzed using the intention-to-treat method. Results: The intervention (23% male; mean age, 74.7±4.7 years) and control (21% male; mean age, 75.1±4.1 years) groups did not differ significantly in baseline characteristics. Seventy-seven participants completed the program; two withdrew for personal reasons. The mean difference (standard error) between the groups for the primary outcome (usual walking speed) was 0.35 (0.04) m/s; the time-by-group interaction was significant (p<0.001). Secondary outcomes (maximum walking speed, Timed Up and Go test, 5-times chair-standing test, and GLFS-5) were significantly improved in the intervention group. Body composition was unchanged in both groups. Conclusions: In community residents with physical frailty and locomotive syndrome not requiring nursing care, a 5-week exercise program using the HAL lumbar type is a promising option for frailty prevention, improving physical function and resulting in clinically meaningful improvements in most physical functions over a short time period.

The coronavirus disease 2019 (COVID-19) pandemic has hampered group exercise. We aimed to determine the relationship between group-exercise implementation status in 2018 and 2020 and the incidence of frailty in 2020, including the COVID-19 pandemic among older adults in Japan. This longitudinal study included older adults belonging to senior clubs, divided into four groups based on the continuity of group-exercise participation. Frailty was assessed using the Kihon Checklist, in which total scores of ≥8 points indicated frailty status. The relationship between group-exercise implementation status and the incidence of frailty was evaluated using Poisson regression with robust variance. Exercise time at the individual level in each group was analyzed using Wilcoxon signed-rank tests. Overall, 1,241 participants were included, in which 249 individuals (20.1%) developed frailty. Compared to older adults who continued group exercise, those who discontinued group exercise (adjusted relative risk: 1.70, 95% confidence interval: 1.26–2.30) were more likely to become frail. Regarding the median exercise time (interquartile range), older adults who discontinued group exercise showed a significant decrease, from 25.7 (12.9–51.7) min/day to 17.1 (6.4–30.0) min/day; but those who started group exercise showed a significant increase from 19.3 (6.4–41.4) min/day to 20.0 (6.4–47.6) min/day. Group exercise implementation status in 2018 and 2020 was associated with incidence of frailty in 2020, including the COVID-19 pandemic. It was concluded that supporting group exercise is important for the prevention of frailty, even under social restrictions owing to infectious diseases.

身体活動促進と SDGs 達成を関連づけたシステムズアプローチの重要性について論じた。慶應スポーツ SDGs センターでは，スポーツを通じた地球と人々のウェルビーイング共存を目指す活動が進行中である。世界保健機関の「身体活動に関する世界行動計画 2018?2030（GAPPA）」を基に，身体活動の促進が健康，経済，社会，環境へ多様な効果をもたらすとされる。日本国内では「健康日本 21（第三次）」や地域介入事例「ふじさわプラス・テン」などが推進され，身体的・精神的・社会的健康を統合的に改善する。これらの取り組みが，持続可能な社会の構築に向けて貢献することが期待される。

Objective: To present a logic model for increasing daily steps in the population and to categorize interventions using a ladder of interventions. Additionally, an example action plan is provided.Methods: Relevant policies and studies were reviewed, and 23 experts were interviewed. The logic model, based on the SLOTH model (Sleep, Leisure, Occupation, Transportation, Household), categorized daily life domains and considered steps during work, transportation, and at home & in the community as intermediate outcomes. Individual interventions were categorized using a ladder of interventions. An example action plan introduced multi-strategic community-wide interventions with evidence of success in promoting physical activity at the community level.Results: The logic model outlined individual interventions categorized by implementing entities (government, workplaces, health insurance associations, schools, related organizations). By envisioning domains of walking, specific measures emerged to increase step counts. The proposed individual interventions included not only information provision and health education but also interventions corresponding to levels 1-6 of the ladder of interventions. Multi-strategic community-wide intervention is an intervention that works on multiple levels of factors from individual to environment in a multifaceted manner, indicating the need for collaboration with various organizations and residents on a long-term basis from the perspective of the target population.Conclusion: Efforts should be directed not only within the health and welfare sector but also across various sectors such as education, sports, urban planning, and urban transportation. Strategies tailored to specific domains of daily life and from the perspective of residents should be considered, and a long-term, systematic approach is needed.

This study aimed to clarify the challenges and strategies for sustainable operation by analyzing the management of the K Club, a senior citizens’ club in Fujisawa City, Kanagawa Prefecture, which doubled its membership between 2015 and 2023, achieving both revitalization and sustainability. The research focused on the club’s operations from 2009 to 2023 and employed a mixed-method approach. Data were collected through interviews with members, archival research, and participant observation. Qualitative data underwent reflexive thematic analysis, while quantitative data were assessed using descriptive statistics. The study identified four key strategies for sustainable operation:（1）Adaptive leadership,（2）Next-Generation Succession-Based Management,（3）Flexible organizational management, and（4）Community co-creation and empathy platform. While upholding independent perspectives, these strategies are closely interrelated and contribute together to the organization’s revitalization and sustainability. Furthermore, these strategies not only facilitate the sustainable operation of senior citizens’ clubs but also significantly promote social participation among older adults and foster regional revitalization.

(Purpose) The study aim was to examine the longitudinal association between cardiorespiratory fitness (CRF) and blood pressure in older adults practicing combined exercise training at a health promotion facility. (Methods) Medical checkup data were obtained from 585 individuals (244 men and 341 women) who practiced combined exercise training at Fujisawa City Health and Medical Center at two or more of five time points from 2017 to 2021. A linear mixed-effects model was used for the statistical analysis to estimate the change in blood pressure on CRF (peak oxygen uptake) at each time point. The adjusted variables were age, obesity status, smoking status, and the use of antihypertensive medications. (Results) The most common number of medical examinations was two (42.6% of men and 51.6% of women). An analysis using linear mixed-effects models showed that an increase in CRF was associated with a decrease in systolic blood pressure. No significant association was observed for diastolic blood pressure. Regarding pulse pressure, an increase in CRF of 1mL/kg/min was associated with a decrease in pulse pressure of 0.27mmHg in men and 0.45mmHg in women. (Conclusions) In community-dwelling older adults, an increase in CRF reduced systolic blood pressure and pulse pressure.

Objective: The purpose of this study was to examine whether 1) health literacy is associated with the awareness of the Japanese physical activity guidelines (Active Guide) and 2) health literacy moderates the association between awareness of Active Guide and physical activity.Methods: A nationwide, cross-sectional Internet survey of 7,000 Japanese adults was conducted. The survey items included those related to the awareness of Active Guide, two physical activity variables (amounts of moderate-to-vigorous physical activity and sufficient level of physical activity), health literacy, and demographic factors.Results: Logistic regression analysis revealed significant correlation between health literacy and the awareness of Active Guide. Furthermore, logistic and multiple regression analyses showed that the interaction term of health literacy with awareness of Active Guide was negatively and significantly correlated with physical activity variables. Further stratified analysis indicated that while awareness of Active Guide was significantly and positively correlated with physical activity among groups with low and high health literacy, regression coefficients for the low health literacy group were greater than those for the high health literacy group.Conclusion: The results implied that individuals with higher health literacy were more likely to be aware of Active Guide and that the positive association between the awareness of Active Guide and physical activity was stronger among those with lower health literacy than those with higher health literacy.

目的:本研究では,ヘルスリテラシーがアクティブガイドの認知と関連しているかどうかと,ヘルスリテラシーの程度によって,アクティブガイドの認知と身体活動との関連性が異なるかどうかを検証した.方法:この横断研究では,社会調査会社の全国の調査モニター7,000名にインターネットによる質問紙調査を行い,アクティブガイドの認知,身体活動(中強度以上の身体活動量,身体活動レベル),ヘルスリテラシー,および基本属性の関連性を評価した.結果:アクティブガイドの認知を従属変数としたロジスティック回帰分析の結果,ヘルスリテラシー得点が有意に正の関連をしていた.身体活動の両指標を従属変数とした重回帰分析とロジスティック回帰分析の結果,アクティブガイドの認知とヘルスリテラシーとの交互作用項が有意に負の関連をしていた.ヘルスリテラシーの程度で層化した分析を行った結果,ヘルスリテラシー低群でもヘルスリテラシー高群でも,アクティブガイドの認知は身体活動の両指標と有意に正の関連をしていた.ただし,偏回帰係数やオッズ比は,ヘルスリテラシー高群よりもヘルスリテラシー低群のほうが大きかった.結論:本研究により,ヘルスリテラシーが高い人々のほうがアクティブガイドを認知している傾向にあること,および,ヘルスリテラシーが低い人々においてアクティブガイドの認知と身体活動との正の関連性が顕著な傾向にあることが明らかとなった.(著者抄録)

Background: As public policies have the potential to change the entire system of physical activity (PA) promotion and to create conducive environments, they are particularly relevant to address the persistently low levels of PA across the world. Furthermore, World Health Organization’s (WHO’s) Global Action Plan on Physical Activity highlights the relevance of local governments as important partners for policy action. However, our knowledge on how local PA promotion policy compares across countries remains limited. Methods: We conducted an exploratory study as part of the LoGoPAS project to compare the status quo of local PA policies across five municipalities in five different countries. Using purposive sampling, Jyväskylä (Finland), Nice (France), Erlangen (Germany), Fujisawa (Japan), and Cluj-Napoca (Romania) were selected. Data were collected and analysed via desk research and expert consultation using the CAPLA-Santé, a validated tool designed to assess relevant aspects of local PA promotion policies. Results: The analysis showed that the main responsibility for PA promotion varied between municipalities, resting either with the sport or the health sector. A total of 50 relevant PA policy documents were identified, focusing on multiple settings and target groups. Budgets for PA promotion differed across municipalities. Research on PA was reported to have informed policy development in some but not all cases. Across countries, political support was identified as a key driver of local PA promotion. Conclusion: LoGoPAS is the first study to apply the CAPLA-Santé outside of France and the first to use it for an international comparative analysis. Results highlight the ability of the tool to provide insights into local PA policy development, contents, and implementation worldwide. While this study provided a cross-sectional in-depth analysis of the status quo in select municipalities, future research could also aim to assess policies at a large scale, ie, for multiple municipalities and/or on a regular basis.

＜文献概要＞日本では平均寿命・健康寿命ともに延伸し,百寿時代を迎えているが,要介護の原因には認知症や運動器障害が多く,身体活動・運動の役割が重要である。高齢者における適切な身体活動は,死亡リスクや疾患発症リスクを低下させ,転倒・骨折・認知症予防にも効果がある。身体活動増加とともに,特に筋力トレーニングや多要素運動が有効であり,日常の座位行動を減らすことも推奨される。フレイル・サルコペニア・ロコモティブシンドロームといった加齢に伴う機能低下も,運動や栄養,社会参加によって予防・改善が可能である。地域介入の事例として「ふじさわプラス・テン」を紹介するとともに,安心・安全な運動支援体制の整備と普及が重要であること,科学的根拠に基づいた身体活動の推進が,健康長寿社会の実現に寄与することをまとめた。

目的:国民の日常生活における歩数の増加に向けて,ロジックモデルを示し,個別施策については介入のはしごに基づいてレベル分けを行う.また,アクションプランの例を示す.方法:関連する政策・先行研究の検討,専門家23名へのインタビューを行った.ロジックモデルは,身体活動を場面別にとらえるSLOTHモデル(S:睡眠,L:余暇,O:仕事,T:移動,H:家庭・地域)を参考に,「仕事中の歩数」「移動での歩数」「家庭・地域での歩数」を中間アウトカムとして作成した.また,個別施策を介入のはしごを用いて整理した.アクションプランの例は,地域全体のレベルで身体活動推進に成功したエビデンスがある多面的地域介入を紹介した.結果:ロジックモデルでは事業の実施主体(行政,職域,保険者,学校,関連団体)別に個別施策を示した.歩く場面を想定することで,歩数増加のための具体的な対策が浮かび上がった.提案した個別施策には,情報提供や健康教育のみならず,介入のはしごのレベル1～6に相当する対策も多く含まれた.多面的地域介入は地域全体で身体活動を促進するために,単一のアプローチではなく,個人から環境まで複数のレベルの要因に多面的に働きかける介入であり,対象者の目線で様々な組織や住民と協力して長期的に取り組む必要性が示された.結論:健康・福祉部門だけではなく,教育・スポーツ,都市計画・都市交通といった様々な部門の施策にも着目して対策を進める必要がある.場面ごとの対策,住民目線での対策を考え,長期にわたり計画的に取り組む必要がある.(著者抄録)

Background and objective: Physical activity (PA) confers protection to individuals from the risk of death. However, in the very old, the dose-response relationship between PA and all-cause mortality and the possible biological mediators of this association are less known. We investigated whether PA predicts 6-year all-cause mortality and what biomarkers mediate the association. Design: Prospective cohort data from the Tokyo Oldest Old Survey on Total Health study. Setting: Community-dwelling population. Participants: A total of 441 women and men aged over 85 years. Measurements: Questionnaire-based PA was assessed at baseline and 3-year and 6-year follow-up visits. Survival status was confirmed up to the 6-year follow-up visit (153 deaths, 34.7%). Data of plasma albumin, cholinesterase, NT-proBNP, interleukin-6, cystatin C, and HbA1c levels were collected. For mediation analysis for survival analysis, we used the baseline PA and biomarkers with Weibull distribution accelerated failure time model and linear regression model adjusted for age, sex, body mass index, smoking, education level, and Mini-Mental State Examination. Results: A curvilinear relationship was observed in the association between baseline PA and all-cause mortality. Compared to the inactive (0 METs*h/week), light amount of PA was associated with a lower risk of mortality. Compared to the highest tertile of PA (11.2 METs*h/week), higher PA did not reduce the risk of death. Circulation levels of albumin and cholinesterase mediated the association between baseline PA and all-cause mortality (proportion mediated, 54%, both; p < 0.05). Conclusions: Compared to completely inactive, light PA reduces the risk of all-cause mortality in the very old population. Mediation analysis suggests that protein synthesis in the liver may mediate the association between PA and all-cause mortality. Further studies are needed to understand the underlying association between PA, nutrition, and death.