論文

目的：対象の運動施設におけるプログラムへ反映するため，運動施設の利用を希望する運動習慣のない高齢者における運動開始の促進・阻害要因を探索することを目的とした．方法：対象の運動施設の運動プログラム体験会に参加した60～85歳の高齢者を対象とした．混合研究法の収斂デザインを用い，体験会後に質問紙調査を実施し，運動習慣の有無と運動開始の促進・阻害要因の関連について検討した．質問紙回答者のうち運動習慣がない高齢者を対象に運動開始の促進・阻害要因について半構造化面接を実施した．得られた逐語録から帰納的アプローチによるテーマ分析を行い，質問紙と半構造化面接の結果をまとめた．結果：質問紙調査は59名から回答を得た（平均年齢71.8歳，SD 7.6, 女性46名）．促進要因については運動習慣の有無で有意差がなく，阻害要因については「めんどうくさい」の回答割合が運動習慣なし群で有意に高かった（P=0.024）．半構造化面接を9名（年齢61～84歳，女性5名）に実施し，運動開始の促進要因として運動する意欲を高める要因，運動施設を利用しようと思ったきっかけ，運動施設における指導の3つが挙がり，阻害要因として運動する意欲を下げる要因がテーマに挙がった．結論：対象の運動施設の利用を希望する運動習慣のない高齢者は，運動に関する不安や，目標や効果に対して，指導者のサポートを求めていることが示された．

The Japanese Society of Physical Fitness and Sports Medicine (JPFSM) comprises members from diverse research fields and professional backgrounds. Recently, "Professional Networks" were established to further activate personnel exchange and research activities among members with specific professional qualifications. This report describes the background, basic policies, and future activity plans of the newly launched "Medical Doctors Network." The Medical Doctors Network organized its steering committee during the 78th Annual Meeting of JPFSM in 2024. The network established three core policies: 1) promotion of interaction and information exchange, 2) facilitation of interdisciplinary cooperation, and 3) contribution to the development of the next generation. At the kick-off meeting held during the 79th Annual Meeting, participants engaged in active discussions regarding the roles of medical doctors within the society. Future plans include organizing symposia on clinical topics, such as exercise therapy in medical practice, to encourage participation from medical members. Through these activities and collaboration with other professional networks, the Medical Doctors Network aims to contribute to the advancement of physical fitness science and the resolution of social issues related to health and exercise.

It is unclear whether combined leg and arm high-intensity interval training (HIIT) improves fitness and morphological characteristics equal to those of leg-based HIIT programs. The aim of this study was to compare the effects of HIIT using leg-cycling (LC) and arm-cranking (AC) ergometers with an HIIT program using only LC. Effects on aerobic capacity and skeletal muscle were analyzed. Twelve healthy male subjects were assigned into two groups. One performed LC-HIIT (n=7) and the other LC- and AC-HIIT (n=5) twice weekly for 16 weeks. The training programs consisted of eight to 12 sets of >90% VO2 (the oxygen uptake that can be utilized in one minute) peak for 60 seconds with a 60-second active rest period. VO2 peak, watt peak, and heart rate were measured during an LC incremental exercise test. The cross-sectional area (CSA) of trunk and thigh muscles as well as bone-free lean body mass were measured using magnetic resonance imaging and dual-energy X-ray absorptiometry. The watt peak increased from baseline in both the LC (23%+/-38%; P<0.05) and the LC-AC groups (11%+/-9%; P<0.05). The CSA of the quadriceps femoris muscles also increased from baseline in both the LC (11%+/-4%; P<0.05) and the LC-AC groups (5%+/-5%; P<0.05). In contrast, increases were observed in the CSA of musculus psoas major (9%+/-11%) and musculus anterolateral abdominal (7%+/-4%) only in the LC-AC group. These results suggest that a combined LC- and AC-HIIT program improves aerobic capacity and muscle hypertrophy in both leg and trunk muscles.

Evidence on the effects of a community-wide intervention (CWI) on population-level physical activity (PA), especially in the long term, is limited. Therefore, we evaluated the five-year effect of CWI on promoting PA through information dissemination, education, and community support primarily targeting older adults, by incorporating Japanese guidelines, in Fujisawa City, from 2013. To assess the effect of the whole-city intervention, we distributed questionnaires in 2013, 2015, and 2018 to three independent random samples of 3,000 community-dwelling adults (aged ≥ 20 years) using a quasi-experimental study design. Three separate samples responded to the survey (41% at baseline, 46% at the two-year mark, and 48% at the five-year follow-up). The primary outcome was change in PA participation. At the five-year follow-up, PA (median: 120 minutes/day) was significantly higher than at baseline (86 minutes/day) and the two-year follow-up (90 minutes/day). The results of the multivariate analysis indicated that PA among older adults—the primary target population of the CWI—increased significantly at the five-year follow-up, compared to those aged 20–64 (mean difference of change between groups: 14.7 minutes/day, P= 0.029). Among older adults, PA was significantly lower in those with poorer perceived economic status than in their more well-off counterparts at the two-year follow-up (P= 0.003); however, there was no significant difference at the five-year follow-up (P= 1.000). There was a positive interaction between group and period (mean difference of change between groups: 40.9 minutes/day, P= 0.001). In conclusion, the five-year CWI targeting older adults, incorporating national guidelines, improved population-level PA.

The purpose of this study was to compare the characteristics of starters and non-starters with respect to the anthropometric and physical fitness in a Japanese university rugby team. Our sample pool consisted of 54 players of the K University rugby team, who were registered for the official games (all 7 games/year) in 2018 and 2019. The starter group (26 players) comprised of players with more than 3 games/year while the non-starter group (28 players) comprised of players that registered for official games but played less than 3 games. Anthropometric parameters, such as height, body mass, skinfold (8 items), girth (5 items), body composition, muscular strength, intermittent endurance, and sprint time, were assessed. We found that the starter group for forwards had lower skinfold (Biceps, Iliac crest, Supraspinale, Abdominal, Front thigh, and Medial calf) and percentage body fat than in the non-starter group. The starter group for backs had muscle strength of narrow chinning is higher than in the non-starter group. Finally, our study helped to clarify the physical factors that influence the difference in athletic performance between starters and non-starters in university rugby team. The forward starters had lower percentage body fat and better body composition and backs starters had better narrow chinning. The findings provide information to university rugby players who want to become starters, as well as help the coaching staff understand the factors that need to be strengthened in the players.

Background: Mobile apps and peer support are known to effectively promote physical activity in older adults, which, in turn, improves physical function. Previously, we investigated the feasibility and impact of using digital peer-supported apps (DPSAs) to increase physical activity among older adults over a 3-month period. However, the long-term feasibility and impact on sustainable behavior change remain unknown. Objective: This study aims to evaluate the 12-month feasibility of the DPSA and to obtain preliminary estimates of its effects on physical activity and physical function among older Japanese adults. Methods: This nonrandomized controlled trial recruited older adults aged 65 years or older from 2 physical activity programs. Participants chose either the intervention (app program + exercise instruction) group or the control (exercise instruction only) group. Only those participants who had completed the 3-month intervention and wished to continue in the 12-month follow-up intervention study were included. DPSA feasibility was assessed using retention and adherence rates. Physical activity was assessed using accelerometers, capturing daily step count, light-intensity activity, moderate to vigorous intensity activity, and sedentary behavior. Physical function was evaluated using grip strength and the 30-second chair stand test (CS-30). Accelerometer measurements were collected every 3 months over 12 months (5 time points, including baseline), whereas physical function was measured at baseline, 3 months, and 12 months. Results: The follow-up study included 44 of 66 participants from the 3-month intervention study, with 26 participants in the intervention group and 18 participants in the control group. The 12-month retention rate for participants in the DPSA intervention group was 73% (19/26), whereas the retention rate among all 41 participants, including those who chose not to participate in the follow-up study, was 46% (19/41). The adherence rate was 85.9%. The average number of steps per day (95% CI) in the intervention group changed before and after DPSA use (P=.048). We observed an increase of 1736 (β=1736, 95% CI 232-3241) steps per day compared with baseline. No significant change was observed in the control group. There were significant within-group differences in CS-30 scores for both intervention (P<.001) and control (P=.03) groups over the 12-month period. Specifically, there was a significant change in CS-30 scores (95% CI) between the baseline and 12-month assessments for the intervention (β=6.5, 95% CI 3.8-9.1; P<.001) and control (β=3.8, 95% CI 0.6-7.1; P=.02) groups. Conclusions: Participants with long-term DPSA use observed increases in average daily steps and CS-30 scores before and after DPSA use, although only a limited number of older adults had long-term access to the DPSA. Identifying ways to expand long-term DPSA use among older adults is necessary. Additionally, randomized controlled trials should be conducted to determine the long-term effects of DPSAs on physical activity and function in older adults.

【はじめに、目的】厚生労働省は 2013 年に「健康づくりのための身体活動指針（アクティブガイド）」、2024 年に「健康づくりのための身体活動・運動ガイド 2023（アクティブガイド 2023）」を公表した（以下、身体活動指針）。その普及と活用は、身体活動の推進に関与する医療分野の専門職として、理学療法士にとって重要な課題である。しかしながら、この点に関して理学療法士を対象とした国内の調査はほとんど行われていない。本研究は、理学療法士における身体活動指針の認知および知識、臨床における評価・指導の実施状況、さらに身体活動指導の自信度や支援ニーズを明らかにすることを目的とした。【方法】2025 年 2 月から 3 月にかけて、本学の臨床実習施設 123 施設に勤務する理学療法士を対象に、無記名のオンライン調査を実施した。身体活動指針の認知は、純粋想起法と助成想起法で調査した。指針の知識は、推奨身体活動量 3 項目、筋力トレーニングの頻度 1 項目、座位行動に関する推奨事項 1 項目の計 5項目で構成した。さらに、臨床現場における身体活動の評価・指導の実施状況、身体活動指導に関する自信度（0 ～ 10 点）、および支援ニーズ（自由記載）について尋ねた。得られたデータは記述統計により分析した。【結果】有効回答は 192 名であり、98.5％が医療施設に勤務していた。身体活動指針を認知していた者は 19.3％、知識 5 項目をすべて正答した者は 4.2％にとどまった。身体活動評価を「常に実施している／実施することが多い」と回答した者は 64.1％であり、そのうち約 30％は活動量計などの客観的指標を使用していた。身体活動促進に焦点を当てた指導を「常に実施している / 実施するときが多い」と回答した者は 55.7％、指導に対する自信度は平均 4.8 点（標準偏差 2.1）であった。支援ニーズに関する自由記載では「、卒前・卒後教育の充実」「、簡便な評価指標の導入」、 「現場で活用可能な資料・動画の提供」などが挙げられた。【考察】理学療法士における身体活動指針の認知と知識は限定的であり、臨床での評価・指導の実践にも課題を認めた。今後、身体活動の促進においては、教育機会の拡充と、現場で即応的に活用できるツールや教材の提供が不可欠である。特に、客観的な評価手法の導入と、指導に対する自信を高める支援体制の整備が、実践の質と継続性の向上に寄与すると考えられる。【倫理的配慮】本研究は東京都立大学荒川キャンパス倫理審査委員会の承認を得て実施した。対象者は調査説明文書を確認し、Web 上の同意欄にチェックを入れた上で、無記名で調査に回答を完了した者とした。

目的:本研究の目的は高齢者におけるポリファーマシー,抗コリン作動薬及び鎮静作用薬の使用による薬剤負荷の影響を調査することである.方法:川崎市在住非介護高齢者コホートThe Kawasaki Wellbeing Projectにて2017年3月から12月までに参加した396名を対象とした.ベースライン時の薬剤情報から薬剤数を算出,抗コリン作動薬及び鎮静作用薬に該当する薬剤から対象者のDrug Burden Index(DBI)を算出し薬剤負荷とした.アウトカム指標であるADL,IADL,MMSE,J-CHS,EQ5D5Lについて多変量回帰分析を行い,使用薬剤数又はDBIとの関連性を検討した.調整には性別,年齢,疾患数,教育歴,飲酒歴,喫煙歴を用いた.結果:解析の対象となった389名において年齢の中央値は86歳,男性は48%にあたる187名であった.ポリファーマシーに該当した対象者は243名(62%)であり,DBI該当薬の使用者は142名(36.5%)となった.各アウトカム指標の結果から本集団は身体機能,QOLが高く,フレイルのリスクの低い集団であることが分かった.使用薬剤数はJ-CHS(β:0.04),EQ5D5L(-0.01)と有意に負の関連を示し,DBIスコアはEQ5D5L(-0.04)と有意に負に関連していた.結論:調査結果から本集団は一般的な高齢者と比較すると身体機能及び認知機能の高い健康な集団であることが示された.しかし,ポリファーマシー及び抗コリン作動薬及び鎮静作用薬による薬剤負荷は高齢者のフレイル,QOLの低下と関連していることが示唆された.今後はより大規模で多角的な調査項目を含めた長期間の観察を行うことが望ましい.(著者抄録)

目的:対象の運動施設におけるプログラムへ反映するため,運動施設の利用を希望する運動習慣のない高齢者における運動開始の促進・阻害要因を探索することを目的とした.方法:対象の運動施設の運動プログラム体験会に参加した60～85歳の高齢者を対象とした.混合研究法の収斂デザインを用い,体験会後に質問紙調査を実施し,運動習慣の有無と運動開始の促進・阻害要因の関連について検討した.質問紙回答者のうち運動習慣がない高齢者を対象に運動開始の促進・阻害要因について半構造化面接を実施した.得られた逐語録から帰納的アプローチによるテーマ分析を行い,質問紙と半構造化面接の結果をまとめた.結果:質問紙調査は59名から回答を得た(平均年齢71.8歳,SD 7.6,女性46名).促進要因については運動習慣の有無で有意差がなく,阻害要因については「めんどうくさい」の回答割合が運動習慣なし群で有意に高かった(P=0.024).半構造化面接を9名(年齢61～84歳,女性5名)に実施し,運動開始の促進要因として運動する意欲を高める要因,運動施設を利用しようと思ったきっかけ,運動施設における指導の3つが挙がり,阻害要因として運動する意欲を下げる要因がテーマに挙がった.結論:対象の運動施設の利用を希望する運動習慣のない高齢者は,運動に関する不安や,目標や効果に対して,指導者のサポートを求めていることが示された.(著者抄録)

Background: The effectiveness and implementation evaluation of evidence-based interventions are critical. Purpose: This study evaluated a multicomponent exercise (MCE) program for older adults who were not engaging in regular exercise at a private fitness center. Methods: This randomized controlled trial recruited community-dwelling older adults who attended public lectures. The intervention group (IG) participated in MCE sessions that incorporated aerobics, muscle-strengthening, and balance exercises, once or twice weekly, for 12 weeks. The control group (CG) participants maintained their usual lifestyles. Physical function and activity levels were measured before and after the 12-week study period. Physical function measures included a 30-s chair stand, timed up-and-go (TUG) test, and one-leg standing test. Physical activity was evaluated using total exercise time (TET) and an accelerometer. Implementation outcomes were assessed for their reach, effectiveness, implementation, and maintenance using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Program adherence and fidelity were also assessed. Between-group comparisons were performed using a linear mixed-effects model. Results: Of 148 lecture attendees, 65 (43.9%) participated in the study. The IG (n = 32) showed significant differences in TUG (P < 0.001) compared to baseline, with significantly better TUG test performance (P = 0.004) than the CG. There was a 75% adherence rate with 12 or more sessions attended and 81.3% (26/32) of participants in IG continued the program for 24 weeks. Conclusion: The MCE program resulted in high adherence, fidelity, and improved mobility; it also promoted physical function and continued participation among older Japanese adults.Clinical Trial RegistrationUMIN Clinical Trials Registry (UMIN-CTR ID: UMIN000050860).

Background: Physical inactivity is a high-priority public health issue because of its negative impact on quality of life and well-being. Although socioeconomic factors (SEF) are known to influence physical activity, few studies have explored their association with regular exercise (RE). This gap highlights the need for further research on the associations between SEF and RE. Methods: This cross-sectional study used secondary data from the 2022 Sasakawa Sports Foundation National Sports-life Survey conducted in June and July 2022. The dependent variable was RE, and the independent variables were SEF (education, income, and occupation). A modified Poisson regression analysis was performed. Results: The data of 2318 participants (53% male) with a mean (SD) age of 51 (16) years were analyzed. Those with higher education, higher income, and certain types of occupations were more likely to engage in RE. Subgroup analysis revealed differences in the associations with age, sex, and city size. Conclusions: This study showed that individuals with higher SEF, such as education and income, generally had higher levels of RE. However, part-time worker or nonworker individuals were more likely to be engaged in RE than employees. Each SEF may be differently associated with RE; and therefore, public health interventions should be tailored to specific subgroups defined by SEF to promote RE and reduce health inequalities.