Published papers

In the context of global population ageing and concentration in cities, the population aged 80 and over (80+) is growing rapidly. Japan has the fastest ageing population and longest healthy average life expectancy, while health decline becomes pronounced and care needs increase in the 85+ age group post the ‘average life expectancy’. The healthy ageing of older urban community dwellers is a pressing issue in world initiatives for sustainable urbanisation. However, for the 85+ age group, less is known about how promoting/inhibiting factors and their pathways influence healthy ageing, and related longitudinal studies remain insufficient. Using data from a longitudinal cohort study conducted from 2008–2009 to 2014–2015 among independent dwellers aged 85+ in central Tokyo (men = 203, women = 232), this study analysed the impact pathways of environmental, social, and behavioural factors on health and survival to explore promoters and potential risks on healthy ageing by gender, with multi-group structural equation modelling (SEM) and Bayesian SEM. For both genders, there was a positive chained pathway starting from friends as facilitators through positive interactions between 'social participation’ and 'active behaviour' to 'ageing-related health'. Additionally, their personal networks were small, suggesting that men with family-centred networks and women with non-family-centred networks require different approaches and supports. Implications of the results are discussed, and an organised social watch and support system, which becomes more important in the ‘new normal’ for urban dwellers aged 85+, is recommended.

Objective: This study aimed to determine trends in adverse events during voluntary physical activity and sports performed by Sakae Ward residents. Methods: This mixed study quantitatively and qualitatively analyzed the data obtained from a questionnaire (selective and free text) regarding accidents and injuries during sports activities conducted by Sakae Ward in 2017 for people who voluntarily engaged in sports activities. Of the 518 responses, 473 were included in the analysis. Results: There were 94 cases (20%) with adverse events in the last 5 years. Soccer, badminton, and volleyball, in that order, had the most frequently reported adverse events. Sprain/ligament injuries of the lower extremities (26 cases), muscle/tendon injuries of the lower extremities (20 cases), and contusions of the head/face (7 cases) were the most common injuries. The results of free descriptions also confirmed the occurrence of serious injuries such as Achilles tendon rupture, anterior cruciate ligament injury of the knee joint, skull fracture, femur fracture, and cerebral hemorrhage. Muscle and tendon injuries (16 cases) were distinctive among residents in the 50–60 age group, while falls (11 cases) was distinctive in the 60–70 age group. Conclusion: The study results show that lower limb injuries such as sprained ankle joints and adverse events such as falls among the elderly occurred during physical activity and sports voluntarily performed by Sakae Ward residents. Therefore, preventive measures and countermeasures should be taken to prevent these adverse events.

Objective: The purpose of this cross-sectional study was to evaluate the sedentary behavior of community-dwelling older adults aged 85–89 years using an accelerometer, and to investigate its correlates, including TV viewing time, from a multifaceted perspective. Methods: We asked 1,026 participants in the 2017–2018 baseline survey of “The Kawasaki Aging and Wellbeing Project” to wear an accelerometer for 7 consecutive days. Of these, we evaluated sedentary behavior of valid data from 914 people (473 women). Using multiple regression analysis by gender, we investigated the correlation of 25 factors with sedentary behavior ─24 factors in 3 domains (physical condition, socio-economic condition, and lifestyle) and age. Results: The average (SD) total sedentary time and the proportion of sedentary time to wearing time of men and women were 9.4 (1.9) hours/67% per day and 8.6 (1.8) hours/59% per day, respectively. Moreover, men’s proportion of prolonged sedentary time (≥ 30 minutes) was higher than that of women. For men, the following factors were correlated with sedentary behavior in order of strength of association: screen time and BMI (positive); household work time, gardening score, exercise time, walking speed, grip strength, and ADL (negative). For women, the correlated factors were BMI and screen time (positive); household work time, sleep time, exercise time, ADL, and outing score (negative). Conclusion: The sedentary behavior of community-dwelling older adults in their late 80s was correlated not only to screen time but also to physical condition factors (such as BMI, walking speed, grip strength, and ADL), and lifestyle factors (such as household work, gardening, exercise, sleep, and going out).

Objective: We aimed to examine the effects of insulation retrofitting on sedentary behavior time (SBT) and light-to-vigorous physical activity (LVPA) at home in adults during winter. Methods: Adults intending to retrofit their insulation participated in a 14-day baseline survey in winter and a follow-up survey 1–4 years after retrofitting. Participants were classified into an intervention (insulation retrofitting) or a control (non-insulation retrofitting) group. SBT and LVPA changes were calculated using an accelerometer and questionnaires. A multilevel model was fitted to estimate the effects of insulation retrofitting on these changes. As a secondary analysis, the change in dressing room temperature (Td) from baseline was added as an independent variable in the model, categorized as a decrease in Td (<-1.0°C), no change in Td (-1.0°C to +0.9°C), a small increase in Td (+1.0°C to +4.9°C), and a large increase in Td (≥+5.0°C). Results: Of the 1751 participants, 1640 were in the intervention group. Both groups experienced an increase in Td. The intervention group experienced a slight increase in outside temperature, whereas the control group experienced a significant increase in outside temperature. Insulation retrofitting was not significantly associated with SBT and LVPA at home; however, the change in Td was significantly associated with SBT and LVPA. Compared to no change in Td, the large increase in Td was associated with a decrease in SBT and an increase in LVPA. In contrast, the decrease in Td was associated with an increase in SBT and a decrease in LVPA. Conclusion: Insulation retrofitting was not associated with changes in SBT and LVPA in adults during winter. However, improving room temperature, including Td, could potentially decrease SBT and increase LVPA in adults. Further research is needed to confirm the effect of insulation retrofitting on SBT and LVPA.

This study examined the seasonal patterns of physical activity (PA) and sedentary behavior (SB) and the relationship between PA and SB and the indoor thermal environment in each season. 98 of 131 the participants were analyzed.1) Daily moderate-to-vigorous PA was significantly greater in fall than in winter.2) Adjusting the accelerometer wearing time, outdoor PA and SB were not significantly related to season, but indoor moderate-to-vigorous PA were significantly greater in fall and summer than in winter.3) Using a kotatsu in winter was associated with longer SB and less light-intensity PA than using an air conditioner.

BACKGROUND: While community-wide interventions to promote physical activity have been encouraged in older adults, evidence of their effectiveness remains limited. We conducted a qualitative study among older adults participating in regular group exercise to understand their perceptions of the physical, mental, and social changes they underwent as a result of the physical activity. METHODS: We conducted a qualitative study with purposeful sampling to explore the experiences of older adults who participated in regular group exercise as part of a community-wide physical activity intervention. Four focus group interviews were conducted between April and June of 2016 at community halls in Fujisawa City. The participants in the focus group interviews were 26 older adults with a mean age of 74.69 years (range: 66-86). The interviews were analysed using the constant comparative method in the grounded theory approach. We used qualitative research software NVivo10(R) to track the coding and manage the data. RESULTS: The finding 'regular group exercise contributes to balanced health in older adults' emerged as an overarching theme with seven categories (regular group exercise, functional health, active mind, enjoyment, social connectedness, mutual support, and expanding communities). Although the participants perceived that they were aging physically and cognitively, the regular group exercise helped them to improve or maintain their functional health and enjoy their lives. They felt socially connected and experienced a sense of security in the community through caring for others and supporting each other. As the older adults began to seek value beyond individuals, they gradually expanded their communities beyond geographical and generational boundaries. CONCLUSIONS: The participants achieved balanced health in the physical, mental, and social domains through regular group exercise as part of a community-wide physical activity intervention and contributed to expanding communities through social connectedness and mutual support. Health promotion through physical activity is being increasingly emphasized. The study results can help to develop effective physical activity programs for older adults in the community.

OBJECTIVE: Physical activity is known to be preventive against various non-communicable diseases. We investigated the relationship between daily physical activity level and plasma metabolites using a targeted metabolomics approach in a population-based study. METHODS: A total of 1,193 participants (male, aged 35 to 74 years) with fasting blood samples were selected from the baseline survey of a cohort study. Information on daily total physical activity, classified into four levels by quartile of metabolic equivalent scores, and sedentary behavior, defined as hours of sitting per day, was collected through a self-administered questionnaire. Plasma metabolite concentrations were quantified by capillary electrophoresis mass spectrometry method. We performed linear regression analysis models with multivariable adjustment and corrected p-values for multiple testing in the original population (n = 808). The robustness of the results was confirmed by replication analysis in a separate population (n = 385) created by random allocation. RESULTS: Higher levels of total physical activity were associated with various metabolite concentrations, including lower concentrations of amino acids and their derivatives, and higher concentrations of pipecolate (FDR p <0.05 in original population). The findings persisted after adjustment for age, body mass index, smoking, alcohol intake, and energy intake. Isoleucine, leucine, valine, 4-methyl-2-oxoisopentanoate, 2-oxoisopentanoate, alanine, and proline concentrations were lower with a shorter sitting time. CONCLUSIONS: Physical activity is related to various plasma metabolites, including known biomarkers for future insulin resistance or type 2 diabetes. These metabolites might potentially play a key role in the protective effects of higher physical activity and/or less sedentary behavior on non-communicable diseases.

High-quality diets and regular physical activity (PA) are considered healthy behaviors (HBs). HBs are associated with many health outcomes and are expected to improve quality of life. Although implementing HBs is important, the relationship between dietary patterns (DPs) and PA has not been well investigated, especially among those aged ≥ 85. This study used data from the Tokyo Oldest Old survey on Total Health study to examine the relationship between DPs and PA in a cross-sectional study. The dietary survey used the brief self-administered diet history questionnaire to estimate the intake of 58 foods. After energy adjustment, principal component analysis was performed to identify major DPs. A validated questionnaire was used to evaluate PA, and linear regression analysis was used to investigate the association between DPs and PA, considering confounders. A total of 519 participants were included. Three major DPs ('Various plant foods', 'Fish and mushrooms', 'Cooked rice and miso soup') were identified. 'Various plant foods' was similar to DPs previously named 'Healthy' or 'Prudent', and its trend was positively associated with higher PA. This study observed the implementation of HBs even among those aged ≥ 85, suggesting that a trend toward a healthier diet is associated with higher PA.

This study aimed to evaluate the inter-rater reliability of streetscape audits among online observations using the Microscale Audit of Pedestrian Streetscapes-Global version (MAPS-Global) in Japan. MAPS-Global observations were conducted on routes with distances ranging from 400 to 725 m from a residence toward a non-residential destination. Google Street View audits were independently conducted by two trained raters on each route. A tiered scoring system was applied to summarize the items at multiple levels of aggregation. Positive and negative valence scores were created based on the expected association with physical activity. Inter-rater reliability analyses were performed using kappa statistics or intraclass correlation coefficients (ICC). Of the 32 older adults participating in an intervention study in the community-wide physical activity promotion project in Fujisawa City, 19 addresses were used, excluding those with nearby addresses. Results demonstrated “excellent” agreement for most of the summary scores analyzed (kappa or ICC values of 0.75 or higher [80.4 %]), while 6.5 % of items exhibited “good” agreement (ICC = 0.60–0.74). By contrast, only 13.0 % of the scales had ICC values lower than 0.60 (“fair” or “poor” reliability). The results illustrated high reliability for the grand summary scores and composite subscale measures. However, caution should be exercised when interpreting subscale scores for less frequently observed negative attributes and aesthetic/social characteristics. The results presented in this study support the application of online observations using MAPS-Global in urban areas of Japan, which could be implemented to inform decisions related not only to physical activity but also to traffic safety.

BACKGROUND: Recently, stretching-support cushions (SC) have become available for use during stretching exercises in the seated position. However, the effects of a SC consisting of a 20-deg posterior support cushion on flexibility-related outcomes when combined with stretching exercises are not well understood. Here, a randomized controlled trial involving 32 healthy over-middle aged women (56.9 +/- 7.4 years old) was performed to investigate the additional effects of stretching program with SC on the flexibility compared with the identical program without SC. METHODS: The participants were randomly assigned to stretching exercises with SC (EX-SC, N.= 16) or the identical stretching exercises without SC (EX, N.= 16). We investigated the additional effects of using SC on flexibility by measuring the degree of hip abduction, pelvic tilt, and maximum forward reaching distance, sit and reach test, and passive torque of right hamstrings during passive knee extension before and after the single session of program. RESULTLTS: After performing the stretching exercises with (EX-SC group) and without (EX group) the SC, significantly change in pelvic tilt in the seated straddle split position was observed in the EX-SC group (21.0 +/- 28.9 to 33.1 +/- 24.0 deg) compared with the EX group (22.1 +/- 20.8 to 26.9 +/- 22.8 deg; P<0.05). For all other flexibility-related parameters, only the time effects were significant (P<0.05). CONCLUSIONS: Taken together, the present results suggest that use of a SC is beneficial for performing stretching exercises when seated to avoid a `rounded-back position'.

The aim of this study is to clarify the effect of e-health community health promotion program, which consists of both online diet record system and off-line health activities. 49 participants are surveyed concerning self-rated sense of understanding and sense of control about calorie intake, nutrition balance, and physical activity along with basic information, internet usage and lifestyle habit are surveyed during 2009-2011. Self-rated sense of achievement regarding dietary understanding and dietary sense of control significantly increased in a group that utilized the online diet record system. Further analysis shows that the usage of the diet record system affects the self-rated sense of achievement while neither age, sex, answers of the preliminary questionnaire nor session participation had any effect. (C) 2016 The Authors. Published by Elsevier B.V.

To evaluate the association of serum BDNF concentration with high-intensity interval training, 12 healthy male volunteers, aged 28-48 years, completed 16-week high-intensity interval training (HIIT) using ergometer. Training program consisted of > 90% VO2 peak for 60 sec separated by 60 sec active rest period for 8-12 sets twice weekly for 16-week. Maximal exercise tolerance tests were performed before (0-week), 4-week, and 16-week after the intervention program. VO2 peak as well as peak watt was linearly increased after 4-week (9% for both VO2 peak and peak watt) and 16-week HIIT training (15% for VO2 peak and 18% for peak watt, p< 0.01). However, there was no change in serum BDNF concentration by HIIT. On the other hand, there was a positive association of serum BDNF concentration at baseline with % increase in peak watt after the intervention (ρ=0.60, p< 0.05). The association between BDNF and exercise training is still unclear, and more studies are needed to clarify the above positive association.

We aimed to evaluate the associations of individual-level social capital (SC) and physical activity (PA) among Japanese elderly men and women. Individuals aged 65 or above were selected via population-based random sampling of 3000 adults, aged 20 years or above and living in Fujisawa city, who were asked to complete self-administered questionnaires. The sample consisted of 260 men [median (25-75% tile) age 73 (68-78) yrs] and 274 women [73 (68-78) yrs]. The daily duration of PA, SC [e.g., norms of reciprocity (mutual support in the community), social networks (relationship with community people, exchange with other generations), social participation (participation in community organization activities)], socio-economic status [educational attainment, work with income, perceived household economic status], and demographic characteristics [sex, age, living arrangements, BMI, physical limitations] were assessed. Multivariate logistic regression analyses were used to calculate odds ratios (OR) for associations of SC with PA, stratified by sex. High level of mutual support in the community, relationship with community people, and exchange with other generations were associated with longe

This study aimed to prospectively record the occurrence of adverse events and near-misses during sports in middle-aged and older adults who voluntarily engaged in sports in the community and to clarify the frequency and characteristics of such events. Participants were comprised of 14 groups (14 sports) of middle-aged and older adults who voluntarily played sports in Sakae Ward, Yokohama. The follow-up period was 14 months (November 1, 2022, to December 31, 2023). Representatives of the target groups reported once a month to Sakae Ward via postcards regarding the status of their activities and the occurrence of adverse events and near-misses. The survey items included the age of the main participants in each group, number of activities during the month, duration of each activity, number of participants per activity, adverse events, and near-misses during sports. During the 14-month observation, eight adverse events and two near-misses were reported in the 14 groups, mainly comprising middle-aged and older adults. Of the eight adverse events, four were falls, all occurring in those aged ≥70 years and triggered by environmental problems. In this study, there were only two near-misses compared to eight adverse events, suggesting that the participants may have been unaware of near-misses. Therefore, even for sports played by groups of residents, it is important to identify risks by assessing health conditions prior to exercise and to implement initiatives to foster safety awareness among participants, such as hazard prediction training.

Background: Polydoctoring can increase the risk of care fragmentation among patients with multimorbidity, but its impact on health outcomes remains unclear. Aim: To determine the effects of polydoctoring, as measured by the regularly visited facilities (RVF) indicator, on patient outcomes among older individuals with multimorbidity. Design & setting: Data from the ongoing prospective cohort study, Kawasaki Aging and Wellbeing Project (KAWP), was utilised in this study. Among the 1026 KAWP participants aged 85–89 years, those with two or more chronic conditions were enrolled in this study. Method: Care fragmentation and polydoctoring was evaluated using the RVF, which is a new indicator that measures the number of medical facilities consistently involved in a patient’s care. Based on RVF, mortality was analysed using the Cox proportional hazards model, with adjustments for age, sex, frailty, and number of comorbidities. Results: A significant reduction in mortality rates was observed in participants with an RVF of ≥3 and 2–4 comorbidities (hazard ratio [HR] 0.43, 95% confidence interval [CI] = 0.18 to 0.99, P value = 0.048). However, no significant difference in mortality based on RVF was observed for those with ≥5 comorbidities. Notably, individuals with ≥5 comorbidities and an RVF of 0 had a significantly higher HR for death (HR 2.68, 95% CI = 1.05 to 6.84, P value = 0.039). Conclusion: In older patients with multimorbidity, polydoctoring may reduce mortality in patients with ≤4 coexisting conditions, but it does not significantly impact mortality in those with ≥5 conditions. These findings provide insights for healthcare decision making in managing older patients with multimorbidity.

Abstract Although cross-sectoral cooperation is important at all levels, in practice it often remains at a declarative level. Different sectoral policies and the resulting measures to promote HEPA are usually disconnected, uncoordinated and without the necessary synergies. This pertains especially to local environments with less financial and expert support, such as small rural communities, where people have few HEPA options that are suitable and attractive for vulnerable groups: children and adolescents, elderly and people with disabilities. “Development of indicators for the assessment of the provision of settlements with green spaces for outdoor physical activity” is a research project co-funded by the Slovenian Research and Innovation Agency, the Ministry of Health and the Ministry of Natural Resources and Spatial Planning and implemented at the Urban Planning Institute of the Republic of Slovenia. The aim of the project is to define indicator(s) for the provision of green spaces for PA and active lifestyles in settlements, which could be used at local level to assess, improve, and monitor the situation. We took a medium-sized city and a small rural community as pilot projects, the latter often being a disadvantaged environment in terms of HEPA in spatial planning compared to larger cities. On the pilots, our objectives have been to establish cooperation at the local level between at least three different sectors and to test methodology and indicators developed in the project to assess the provision of green spaces to promote PA in selected environments, thus enabling more equitable and inclusive spatial conditions for HEPA at the local level. The presentation will present the approach, results and overall experiences with the work implemented in the pilot project of a rural community. It will highlight the benefits of cross-sectoral cooperation for more effective local level HEPA policies to ensure the inclusive and equitable access to green spaces in settlements. Funding source Slovenian Research and Innovation Agency, grant no. V5-2232

Background: Associations between physical activity (PA) and quality of life (QOL) have usually been studied in people in their 60s and 70s, however little is known about these associations in older age groups. We aimed to examine the association between PA and QOL in Japanese adults aged 85–89 years and investigate the types of exercises/sports in this population. Methods: This cross-sectional study (n = 914) used baseline data from the Kawasaki Aging and Well-being Project (KAWP), a longitudinal cohort study of older adults aged 85–89 years. Health-related QOL and psychological well-being were assessed using the EuroQoL 5D-5L (EQ-5D-5L) and the WHO Five Well-Being Index (WHO-5), respectively. PA was objectively and subjectively measured using a triaxial accelerometer and modified Zutphen Physical Activity Questionnaire, respectively. Associations were analyzed using multivariable regression analysis. Results: Higher PA was significantly associated with a higher EQ-5D-5L index score (coefficient, 0.004; 95%CI [0.001, 0.008], standardized coefficient, 0.142). In contrast, no association was observed between PA and the WHO-5 total score (coefficient, 0.103; 95%CI [-0.066, 0.271], standardized coefficient, 0.068). Calisthenics were the most commonly performed sports or exercises (27.4% of male and 47.6% of female participants). The subgroup of participants with > median PA had a longer walking duration than their counterparts, and the following sports/exercises were more frequently performed in addition to calisthenics; resistance training and others among male participants: stretching/yoga among female participants. Conclusions: Our findings suggest that PA is associated with a better health-related QOL. However, no association was observed between PA and psychological well-being in this population. We found that calisthenics were the most commonly performed and that more physically active older adults performed several types of exercises/sports in addition to calisthenics and walking for longer durations. Since few studies have investigated the types of exercises/sports in this age group, these findings would be helpful for interventions to maintain PA and QOL in this age group. Trial registration: UMIN000026053.

The global outbreak of novel coronavirus infection in the winter of 2020 led to city lockdowns and curfews in many parts of the world, forcing university athletes to suspend training. De-training negatively affects athletic performance. In school sports, temporary closures due to infectious diseases often occur yearly. Therefore, this study aimed to clarify the differences in the changes in various physical fitness factors between two different residential environments during the suspension of team activities. The observation period was 7 months, from March to September 2020. The baseline period was defined as the period before the voluntary suspension of team activities (March), the de-training period was the timeframe of suspension of team activities (April-May), and the follow-up period was defined as the period after the resumption of team practice (June-September). The study participants included 17 dormitory students and 14 home-schooled students in a university rugby team. The dormitories were equipped with training equipment and space for minimal training. The team staff provided a training program for both dormitory and non-dormitory students, which could be followed at home during periods when team practices were suspended. This study showed sig-nificant differences between dormitory and home-schooled students in the maximum lifting weight measurement of narrow chinning at baseline and after de-training. Other physical fitness factors did not differ significantly between groups or measurement periods. Although this study sample size was small and sufficient power could not be obtained, home weight training could maintain a certain level of maximum muscle strength as in the present study, suggesting that preparation for back exercises that can be performed at home is essential for the back muscles.