論文

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.

目的：栄区セーフコミュニティの活動の一環として実施されたアンケート調査から，栄区民が自主的に実施している運動・スポーツ中における有害事象（事故・けが）の現状と傾向を捉えることを目的とした。 方法：2017年に栄区が自主的に運動・スポーツを実施している者を対象に実施した「スポーツ活動時に発生した事故・けがに関するアンケート（選択式・自由記述）」から得られたデータを量的・質的に解析を行った混合研究である。回答が得られた518件のうち，解析が可能であった473件を解析対象として実施した。 結果：過去5年間の活動で有害事象があったのは94件（20%）であった。サッカー，バドミントン，バレーボールの順に報告数が多く，下肢の捻挫・靭帯損傷（26件），下肢の筋・腱損傷（20件），頭部・顔面の打撲（7件）が多く発生していた。自由記述の結果からアキレス腱断裂，膝関節前十字靭帯損傷，頭蓋骨骨折，大腿骨骨折，脳出血が発生していた。年代別では，40~50代の筋・腱損傷（16件），60~70代の転倒（11件）が特徴的であった。 結論：地域住民が自主的に実施している運動・スポーツ中において，足関節捻挫などの下肢の傷害や高齢者の転倒といった有害事象が発生していることが明らかとなった。これらに対する予防策，対策を講じる必要性が示唆された。

目的：85–89歳の地域在住高齢者の座位行動を客観的に評価し，テレビ視聴時間を含む関連要因について多面的に検討する。 方法：The Kawasaki Aging and Wellbeing Project（KAWP）のベースライン（2017–18年）調査の参加者1,026名に連続7日間の加速度計装着を依頼し，有効データ914名（女性473名）の座位行動を客観的に評価した。重回帰分析を男女別に行い，座位行動との関連要因を３領域（身体状況，社会経済状況，生活習慣）の24因子と年齢，計25因子から検討した。 結果：総座位時間・装着時間に占める座位時間の割合は男性1日平均（標準偏差）9.4（1.9）時間・67%，女性8.6（1.8）時間・59%と男性が女性より長く座っており，30分以上継続する座位時間の割合も女性より高かった。重回帰分析により座位行動と関連が認められた要因は，関連が強い順に，男性ではテレビ視聴時間・BMI（正），家事時間・園芸スコア・運動時間・歩行速度・握力・ADL（負），女性ではBMI・テレビ視聴時間（正），家事時間・睡眠時間・運動時間・ADL・外出スコア（負）であった。 結論：80歳台後半の地域在住高齢者の座位行動にはテレビ視聴以外に，BMI・歩行速度・握力・ADLなどの身体状況要因，家事・園芸・運動・睡眠・外出などの生活習慣要因が多面的に関連していた。

目的：断熱改修が冬季の住宅内の座位行動と身体活動に及ぼす影響を検討した。 方法：断熱改修に意欲的な成人を募集し，冬季2週間のベースライン調査（改修前）と，その1～4年後の同時期に追跡調査（改修後）を行った。住宅内の座位時間と低強度以上の身体活動量（light-to-vigorous physical activity; LVPA）は，加速度計と外出記録から評価した。断熱改修を行った介入群と断念した対照群に対象者を分け，住宅内の座位時間とLVPAの変化との関連を線形混合モデルで検討した。また，脱衣所室温変化量［低下（-1℃未満），変化なし（-1℃以上+1℃未満），上昇小（+1℃以上+5℃未満），上昇大（+5℃以上）］を説明変数に加えた解析も実施した。 結果：1,751名（介入群1,640名，対照群111名）を解析対象とした。脱衣所室温は介入群で有意に上昇したが，群間で調査期間のずれが生じたことなどにより，対照群の室温も外気温の上昇に伴い上昇していた。多変量解析の結果，断熱改修と住宅内の座位時間・LVPAの変化に有意な関連は認められなかった。ただし，脱衣所室温変化量は有意に関連していた。室温が変化しなかった場合に比べて，5℃以上改善した場合は，座位時間が減少し，LVPAは増加したが，室温が低下した場合には，座位時間が増加し，LVPAは減少した。 結論：断熱改修は住宅内の座位時間とLVPAの変化に関連していなかった。ただし，脱衣所等の室温改善は，住宅内の座位行動を抑制し，LVPAを増加させる可能性が示唆された。今後も検証が必要である。

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 longer PA time in men after adjusting for potential confounders in the final model (OR = 2.40 (95% CI: 1.24-4.67), 5.28 (1.42-19.66), and 4.24 (1.15-15.67), respectively). In women, relationship with community people and participation in community organization activities were associated with longer PA time (3.10 (1.32-7.26) and 2.50 (1.27-4.91), respectively). The association of individual-level SC and PA differed between men and women. Future studies can investigate whether similar results can be obtained in other areas or attempt to conduct a large-scale survey.

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.

本研究は新型コロナウイルス感染症によるチーム練習中断期間において，学生寮と実家の異なる居住環境が体⼒要素の変化に及ぼす影響を明らかにすることを目的とした．観察期間は2020年3－9月の7ヶ月で，ベースライン，2ヶ月間のチーム練習中断後，その後の追跡期間の3時点で体力要素を評価した．解析対象は学生寮群17名，実家群14名であった．なお，チーム練習中断期間中は，学生寮にはトレーニングエリアが設置され，両群共にチームスタッフから居住環境で実施可能なトレーニングプログラムの提供があった．その結果，学生寮，実家のどちらの居住環境においても体重，最大筋力，間欠的持久力はチーム練習中断期間で維持されていた．