[Associations between psychological attitudes toward exercise and fitness club membership resignation among new members: A cohort study].

Objectives　Approximately 40% of new fitness club (FC) members drop out within the first six months; however, the factors associated with FC membership resignation are largely unknown. This study aimed to identify the association between psychological attitudes toward exercise and FC membership resignation.Methods　We conducted a cohort study enrolling participants from 17 FCs. All individuals who became members at FCs between April 1st, 2015 and March 31st, 2016 (n=5,421) were invited to participate in the study, and those who agreed to participate completed a self-administered baseline questionnaire (n=2,934). We excluded participants aged <20 years (n=167) and those with missing values (n=702). Psychological factors were evaluated using the short version of the perceived benefit and barriers to exercise scale. Participants were followed until September 30th, 2016, at which time we assessed the FC membership drop-out rate. Cox proportional-hazards models were used to evaluate the association between perceived benefits/barriers of exercise and FC membership resignation. Sub-analyses were then conducted, stratifying by gender and age group.Results　A total of 2,065 participants were included in the analyses. The mean (standard deviation) age was 39.0 (15.0) years and 28.8% were male. Over 10.1 (4.4) months of newly-joined member follow-up, the FC membership drop-out rate was 24.6 instances per 1000 person-months. Multivariable analyses revealed no significant factors associated with FC membership drop-out. However, men aged 40-59 years who had a high physical benefit score and who perceived improving physical fitness as a benefit, were less likely to resign their memberships (hazard ratio [HR], 95% confidence interval [CI], 0.72 [0.52-1.00]). However, women aged <40 years with a high discomfort score and who saw discomfort as a barrier were more likely to resign membership (HR, 1.10 [1.01-1.19]). Women aged 40-59 years with high social benefit scores and who perceived social interaction as a benefit were less likely to resign their memberships, as were women with higher lack of motivation to exercise scores and who perceived lack of motivation as a barrier to exercise (HR for social benefit, 0.84 [0.74-0.97]; HR for lack of motivation, 0.85 [0.73-0.99]). Among both male and female participants aged ≥60 years, higher self-improvement scores, indicating that peer recognition was perceived as a benefit of exercise, was associated with higher HR for drop-out (men, 2.52 [1.10-5.81]; women, 1.31 [1.00-1.72]).Conclusions　The results revealed gender and age differences in the association between the perceived benefits/barriers of exercise and FC membership dropout. Implementing programs based on enrollees' characteristics and psychological factors may contribute to preventing FC dropout in the future.

Simple-measured leg muscle strength and the prevalence of diabetes among Japanese males: a cross-sectional analysis of data from the Kameda health study.

[Purpose] The aim of this study was to investigate the relationship between leg muscle strength, measured by a very simple one-leg stand-up test, and the prevalence of diabetes among Japanese males to raise awareness of diabetes prevention. [Participants and Methods] This cross-sectional analysis was conducted in 1,800 Japanese males (median [interquartile range] age, 61 [56-67] years) who completed health examinations and a one-leg stand-up test. The prevalence of diabetes was defined if any of the following conditions applied: 1) fasting blood glucose level more than 126 mg/dl, 2) two-hour blood glucose level more than 200 mg/dl (75-g oral glucose tolerance test), 3) HbA1c more than 6.5%, 4) diagnosed with diabetes by a physician, and/or 5) treated for diabetes. [Results] There were 490 participants with diabetes, and 517 participants were unable to complete the sit-to-stand task. When males, who could stand up, were used as a reference, the odds ratio for the prevalence of diabetes was significantly higher among those who were unable to stand up on neither leg than those who successfully stood up on both right and left legs after adjustment for covariates. [Conclusion] Low leg muscle strength, as measured by the one-leg stand-up test, was associated with a higher prevalence of diabetes among Japanese males. Because of its simplicity, this test could be useful detecting individuals who are at increased risk of developing diabetes.

The impact of a new exercise facility on physical activity at the community level: a non-randomized panel study in Japan.

BACKGROUND: Considering that building a sports facility is a major investment to promote population health, it is important to understand whether it is effective in increasing the level of physical activity (PA) in the community. This study examined the impact of building a new multipurpose exercise facility on community-level PA in Japan. METHODS: This non-randomised panel study compared two sites: an intervention site where a new exercise facility was built (opened after baseline data collection) and a control site where there was no such additional exercise facility. From each site, 3200 adult residents (aged 30-74 years) were randomly selected at baseline (2013) and at follow-up (2015). The number of participants retained for analysis was 845 at baseline and 924 at follow-up for the intervention site, and 821 at baseline and 1018 at follow-up for the control site. The outcomes were participants' self-reported PA, perceived availability of PA facilities, awareness of others being active, and willingness to engage in PA. We examined the interaction terms between the sites and time of measurement in regression analyses to examine whether the magnitude of change from baseline to follow-up differed between the two sites. RESULTS: The changes in the proportion of participants meeting the PA guideline and those engaging in moderate-to-vigorous intensity PA were not significantly different between the intervention and control sites. The intervention site had a greater increase in the proportion of participants who were aware of PA facilities from baseline to follow-up than in the control site. The odds ratio for awareness of others being active approached significance, suggesting that there was a tendency at the intervention site towards a greater increase in the proportion of participants who noticed physically active people. CONCLUSIONS: This study did not find community-level increases in PA after the construction of the exercise facility. However, a significant improvement in the awareness of PA facilities was observed in the intervention site. A sustained community-level effort to promote PA, possibly including social components, and a further tracking of residents' PA are needed to take a full advantage of the new exercise facility and to assess its long-term impact. TRIAL REGISTRATION: UMIN-CTR UMIN000034116 (retrospectively registered: 13 September 2018).

High Hematocrit Levels Are Associated with Risk of Cardiovascular Mortality among Middle-Aged Japanese Women: The Ibaraki Prefectural Health Study (IPHS).

In Japan, heart disease and cerebrovascular disease were the second and fourth leading cause of death, respectively in 2014. Hematocrit, the ratio of the red blood cells to the total volume of blood is known to play a role in cardiovascular diseases. However, the relationship between elevated hematocrit and the risk of cardiovascular disease based on sex has not been examined in Asian countries. We analyzed data from the Ibaraki Prefectural Health Study, a community-based large cohort study, which included 87,533 individuals, aged 40 to 79 years living in 38 municipalities of the Ibaraki Prefecture, who had completed an annual health checkup in 1993, and were followed until 2013. The hematocrit levels of the subjects were categorized into 5 quintiles (Q1-Q5), and hazard ratios for cause-specific mortality were calculated using the Cox proportional hazards regression models. Age and other cardiovascular risk factors were the covariates in the study. During the follow-up for a mean of 17.9 years, 1,207 deaths (615 men and 592 women) due to acute myocardial infarction (AMI) were reported in this population. The p values for the trend in the Q3-Q5 groups were 0.661 for men and 0.020 for women. Additionally, these values were significant in younger (40 to 59 years) women but not in older (60 to 79 years) women. This study is the first one to demonstrate an association between high hematocrit level and risk of AMI mortality in younger Japanese women, but not in men and older women.

Stand-up test overestimates the decline of locomotor function in taller people: a cross-sectional analysis of data from the Kameda Health Study.

[Purpose] The purpose of this study was to identify which physical attribute could influence each outcome in the Stand-up test and the Two-step test and the degree of their involvement. [Participants and Methods] The participants were 2,476 people (1,674 males and 802 females), who underwent a two-day health checkup and were requested to take the Locomotive Syndrome Risk Test (Locomo Test). Participants were divided into groups under the Locomo level based on the result of Locomo Test by gender. Furthermore, the relationship between each physical attributes (quartile) based on the result of Locomo Test and the Locomo level was evaluated. [Results] According to the relationship between each physical attributes and Locomo level 1 in the Stand-up test, height showed a positive relationship and the multivariable adjusted odds ratio significantly increased with taller height in both genders. Body weight and BMI showed a negative relationship, although rather weak positive relationship, it was identified in waist circumference. On the other hand, there was no clear correlation between each physical attribute and Locomo level 1 in the Two-step test. [Conclusion] The findings indicate The Stand-up test would overestimate the decline of locomotor function in taller people and would underestimate it in shorter individuals.

Incentive program to strengthen motivation for increasing physical activity via conjoint analysis.

Objectives　Promoting physical activity is a key public health issue. Incentive programs have attracted attention as a technique for promoting physical activity. For the use of effective incentives, there is a need to clarify the most effective incentive program conditions for the promotion of physical activity. Therefore, the present study used the conjoint analysis to examine the effective incentive program conditions for strengthening the motivation to increase physical activity.Methods　Data on 1,998 subjects (aged 40-74) were analyzed. The main variables in this study were physical activity (IPAQ-Short Form) and the strengthening of motivation to increase physical activity. The incentive programs that were implemented, comprised four factors: 1) cash equivalents (1,000 yen, 2,000 yen, and 3,000 yen); 2) duration between increase in physical activity and receipt of the incentive (1, 2, or 3 months); 3) method to record the physical activity (recording sheet, recording website, and automatic pedometer recording); and 4) lottery (yes or no). Eleven incentive programs were created, which was the minimum number required for comparison of these factors and levels. The average importance of each of the four factors was calculated to compare their contributions to the strengthening of the motivation to increase physical activity. The utility of each level was also calculated to compare their contributions to the strengthening of motivation. All statistics were stratified by age (≤65 years and 65+ years) and physical activity (<150 min/week, 150+ min/week) for additional analysis.Results　Cash incentives and the lottery ranked equally on average importance, followed by duration and recording methods. Utility was higher for each factor, as follows: 1) more valuable cash incentives, 2) shorter duration, 3) automatic pedometer recording, and 4) no lottery. There was no notable difference in the average importance and utility of age and physical activity.Conclusions　The results of this study suggest that no lottery and more valuable incentives were important for improving the effectiveness of incentive programs in increasing physical activity. Moreover, these two factors would be important regardless of age and physical activity levels. Further intervention studies on incentive programs for increasing physical activity considering the present results are needed.

The prevalence and basic characteristics of knee pain in community-dwelling independent elderly: A complete survey.

Objectives　The objectives of this study were to determine the prevalence of knee pain in independent community-dwelling elderly people and to examine the basic characteristics (sex and age) of those experiencing knee pain.Methods　Survey on the health status and lifestyle habits was conducted for all (6,790) independent elderly who were 65 years or older, living in Tsuru City, Yamanashi Prefecture, Japan. The survey was carried out using a mailing questionnaire for 1 month from January 12 to February 11, 2016. Knee pain was defined as subjective pain in and around the knee joint in either one or both knees, on most days during the past month. Participants answered "Yes" if they were experienced knee pain, and "No" if they did not experience knee pain. Sex and age were investigated as basic characteristics of the participants by the questionnaire. The prevalence rate of knee pain was calculated as follows: the total number of people with knee pain divided by the total number of the respondents in the study. To examine the relationships between knee pain and age or sex, these basic characteristics were analyzed using a Chi-square test for the prevalence of knee pain within sex and age groups.Results　The number of survey respondents was 5,328 (response rate: 78.5%). The number of valid respondents with complete data was 5,186 (valid response rate: 76.4%). The number of subjects who responded "with knee pain" was 1,733. The prevalence rate of knee pain was 33.4%. In addition, sex and age demonstrated strong associations with the prevalence of knee pain (both, P<0.001). In other words, the prevalence rate was higher in the elderly women than in elderly men and increased with age.Conclusion　The present study suggested that one in three independently living elderly who live in medium-sized local municipalities in Japan experience chronic knee pain. The basic characteristics of a community-dwelling independent elderly with knee pain are to be a woman and older age.

Errata: The relevant factors for knee pain in community-dwelling elderly: A cross-sectional study.

Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH), Vol. 63 (2016) No. 9 p. 560-568: p563(Tables 1, 2).

A cross-sectional study on the factors related to cognitive decline in community-dwelling elderly.

AIM: The aim of this study was to examine the relationship between cognitive decline and physical activity, sitting time, and social participation among elderly people living independently in a local community. METHODS: In January 2015, 1,133 independently-living elderly individuals from a local Japanese community completed self-administrated questionnaires. A total of 929 participants completed the questionnaire (valid response rate: 82.0%). A multiple logistic regression analysis was conducted to examine the relationship between cognitive decline, physical activity, sitting time, and social participation. The factors related to cognitive decline were examined using three statistical models: (1) Model 1 was not adjusted for any factors; (2) Model 2 was adjusted for age, education level, smoking status, and drinking status; and (3) Model 3 was adjusted for the covariates in Model 2, plus depression. RESULTS: Cognitive decline was observed in 33% of men and 26% of women. The results indicated that decreased social participation was significantly related to cognitive decline in Models 1 and 2. For men, local community activity and political/economic activity were significantly associated with cognitive decline in Models 1 and 2. Among women, physical activity was significantly related to cognitive decline in Model 1. There was also a significant association between social participation and cognitive decline in Models 1 and 2; decreased volunteer activity was significantly related to cognitive decline in all three models. CONCLUSION: The results of the present study indicated that attending volunteer activities was significantly related to cognitive decline in women.

Body Mass Index and Kidney Stones: A Cohort Study of Japanese Men.

BACKGROUND: In Japan, the incidence of kidney stones has increased markedly in recent decades. Major causes of kidney stones remain unclear, and limited data are available on the relationship between overweight/obesity and the incidence of kidney stones. We therefore evaluated body mass index (BMI) and the incidence of kidney stones in Japanese men. METHODS: Of the workers at a gas company, 5984 males aged 20-40 years underwent a medical examination in 1985 (baseline). This study includes 4074 of the men, who were free of kidney stones at baseline and underwent a second medical examination performed between April 2004 and March 2005. BMI was calculated from measured height and weight in 1985, and men were categorized into tertiles. The development of kidney stones during follow-up was based on self-reports from questionnaires at the second medical examination. RESULTS: The average duration of follow-up was 19 years, with 258 participants developing kidney stones during this period. Using the lowest BMI (1st tertile) group as a reference, the hazard ratios (95% confidence intervals [CIs]) for the 2nd and 3rd BMI tertiles were: 1.26 (95% CI, 0.92-1.73) and 1.44 (95% CI, 1.06-1.96), respectively (P for trend = 0.019). After additionally adjusting for potential confounders, such as age, systolic blood pressure, cardiorespiratory fitness, cigarette smoking, and alcohol consumption, the hazard ratios were 1.28 (95% CI, 0.93-1.76) and 1.41 (95% CI, 1.02-1.97), respectively (P for trend = 0.041). CONCLUSIONS: These results suggest that increased BMI is a risk factor for kidney stones in Japanese men.

Association of household income and education with eating behaviors in Japanese adults: a cross-sectional study.

BACKGROUND: Socioeconomic inequalities as social determinants of health are important issues in public health and health promotion. However, the association between socioeconomic status and eating behaviors has been investigated poorly in Japanese adults. To fill this gap, the present study examines the association of eating behaviors with household income and education. METHODS: The sample comprised 3,137 Japanese adults (1,580 men and 1,557 women) aged 30 to 59 years who responded to an Internet-based cross-sectional survey in 2014. Data on the following eating behaviors were collected via self-report: "taking care of one's diet for health," "eating vegetables," "frequency of eating breakfast," "frequency of family breakfasts," "frequency of family dinners," "using the information on nutrition labels," and "conversations with family or friends during meals." Self-reported data on socioeconomic status (household income and education) and demographic variables (gender, age, district of residence, marital status, residence status, and employment status) were also collected. The associations between eating behaviors and household income or education were tested using binomial logistic regression analysis with eating behaviors as dependent variables and household income and education as independent variables. A trend P -value was calculated for three categories of household income (less than 3,000,000 JPY, 3,000,000-7,000,000 JPY, and over 7,000,000 JPY) and education (junior high/high school, 2-year college, and 4-year college/graduate school). RESULTS: Higher household income and education were significantly associated with higher rates of eating vegetables, using the information on nutrition labels, and conversation with family or friends during meals in Japanese men and women. Higher household incomes were significantly associated with lower rates of frequency of family breakfasts in Japanese men and lower rates of frequency of family dinners in Japanese men and women. CONCLUSIONS: Higher socioeconomic status as indicated by household income or education was associated with eating more vegetables and conversation with family or friends during meals in Japanese men and women. Socioeconomic status should be considered in health promotion and diet improvement.

The relevant factors for knee pain in community-dwelling elderly: A cross-sectional study.

Objective To clarify the comprehensive relevant factors for knee pain in elderly men and women independently living in the community.Methods A health and lifestyle survey was conducted using 1,133 independent living elderly participants from a district in local community. Demographics, health status, lifestyle, knee pain, and physical activity were measured. Knee pain was evaluated based on whether the individual had reported experiencing pain when he or she was walking at the ground level during the last two weeks. The International Physical Activity Questionnaire Short Version assessed physical activity and sitting time. With regards to physical activity, subjects were classified into two groups -"non-sufficiency" or "sufficiency"- based on the recommendation by the World Health Organization of 150 minutes per week. With regards to sitting time, subjects were classified into two groups -"long time" or "short time"- based on a median value of 5 hours of sitting time per week. The demographic variables evaluated were age, sex, education, and marital status. Health status was evaluated by measuring the individual's Body mass index (BMI) and by their current disease history. Lifestyle was evaluated based on the individual's dietary habits, alcohol consumption, and smoking status. Each variable was classified into two groups. Multiple logistic regression analysis was used to examine the association of knee pain with physical activity, sitting time, dietary habits, drinking, smoking, and BMI in men and women. All variables were entered simultaneously as independent variables. The models were adjusted for sex, age, education, marital status, and health status.Results The number of valid respondents for the analysis was 801 (response rate: 70.7%), including 365 men (74.9±6.9 years) and 436 women (74.9±6.9 years). Survey responses for men and women who had reported experiencing knee pain suggested that, only physical activity was significantly associated with knee pain in men (P=0.035). The odds ratio (OR) and 95% confidential interval (95% CI) for knee pain were 0.605 and 0.308-0.964, respectively. In women, BMI and dietary habits were significant relevant factors for knee pain (P=0.023 and P=0.004, respectively). The OR for BMI and dietary habits were 0.595 and 0.547, respectively while the 95% CI were (0.380-0.931) and (0.364-0.823), respectively.Conclusion The results of this study suggest that physical activity was a related factor for knee pain in men. In contrast, BMI and dietary habits were relevant factors for knee pain in women.

Dynapenic Obesity and Prevalence of Type 2 Diabetes in Middle-Aged Japanese Men.

BACKGROUND: The independent and combined associations of muscle strength and obesity on the prevalence of type 2 diabetes in Japanese men remain unclear. METHODS: Hand grip strength was cross-sectionally evaluated between 2011 and 2013 to assess muscle strength in 5039 male workers aged 40 to 64 years. Weight and height were measured, and overweight/obesity was defined as a body mass index ≥25 kg/m(2). The prevalence of type 2 diabetes, defined as fasting plasma glucose ≥126 mg/dL and/or hemoglobin A1c ≥6.5% and/or self-reported physician-diagnosed diabetes, was evaluated. Odds ratios (OR) and 95% confidence intervals (95% CI) for the prevalence of type 2 diabetes were obtained using a logistic regression model. RESULTS: In total, 611 participants had type 2 diabetes, and 1763 participants were overweight/obese. After adjustment for covariates, we found an inverse association between muscle strength and the prevalence of type 2 diabetes (P for trend <0.01). In addition, when the analyses were stratified by obesity status, the multivariable-adjusted OR per 2-standard-deviation increase in muscle strength was 0.64 (95% CI, 0.49-0.83) in the overweight/obese group, compared to a weaker relationship in the normal-weight group (OR 0.79 per 2-standard-deviation increase; 95% CI, 0.60-1.06). CONCLUSIONS: Dynapenia, an age-related decrease in muscle strength, is associated with increased prevalence of type 2 diabetes, and this relationship is stronger in overweight/obese middle-aged Japanese men than in normal-weight men.

Socioeconomic position and work, travel, and recreation-related physical activity in Japanese adults: a cross-sectional study.

BACKGROUND: The aim of this study was to examine the association between socioeconomic position and the domains of physical activity connected with work, travel, and recreation in Japanese adults. METHODS: A total of 3269 subjects, 1651 men (mean ± standard deviation; 44.2 ± 8.1 years) and 1618 women (44.1 ± 8.1 years), responded to an Internet-based cross-sectional survey. Data on socioeconomic (household income, educational level) and demographic variables (age, size of household, and household motor vehicles) were obtained. To examine the associations between socioeconomic position and physical activity, logistic regression analysis was used to calculate the odds ratio (OR) and confidence interval (CI) for "active" domains of physical activity. RESULTS: Men with a household income of ≥ 7 million yen had significantly lower work-related physical activity than the lowest income group (OR 0.51; 95 % CI, 0.35-0.75), but significantly greater travel-related (OR 1.37; 1.02-1.85), recreational (OR 2.00; 1.46-2.73) and total physical activity (OR 1.56; 1.17-2.08). Women with a household income of ≥ 7 million yen had significantly greater recreational physical activity (OR 1.43; 1.01-2.04) than the lowest income group. Their total physical activity was borderline significant, with slightly more activity in the high-income group (OR 1.36; 1.00-1.84), but no significant differences for work- and travel-related physical activity. Men with higher educational level (4-year college or higher degree) had significantly lower work-related (OR 0.62; 0.46-0.82), and greater travel-related physical activity (OR 1.33; 1.04-1.71) than the lowest educated group, but there were no significant differences in recreational and total physical activity. Women with a 4-year college or higher degree had significantly greater travel-related physical activity than the lowest educated group (OR 1.49; 1.12-1.97), but there were no significant differences in any other physical activity. There was no relation between working full time and physical activity in men, but women working full-time have significantly lower and not higher travel related physical activity. (OR 0.75; 0.59-0.96). CONCLUSIONS: This study suggests that lower socioeconomic position is associated with more work-related physical activity, and less travel-related, recreational and total physical activity, and that this was more pronounced in men than in women.

Reference values for cardiorespiratory fitness and incidence of type 2 diabetes.

BACKGROUND: In "Physical Activity Reference for Health Promotion 2013" the Japan Ministry of Health, Labour and Welfare publication gives reference values for cardiorespiratory fitness (CRF) required for good health. We examined the associations between the CRF reference values and incidence of type 2 diabetes. METHODS: This prospective cohort study enrolled 4633 nondiabetic Japanese men aged 20 to 39 years at baseline. CRF was measured using the cycle ergometer test, and maximal oxygen uptake was estimated. On the basis of the CRF reference value, participants were classified into 2 groups: those with values less than the reference value (under-RV) and those with values equal to or greater than reference value (over-RV). Hazard ratios (HRs) and 95% CIs for incident type 2 diabetes were estimated using a Cox proportional hazards model. RESULTS: A total of 266 participants developed type 2 diabetes during the 14 years of follow-up. As compared with the under-RV group, the over-RV group had a significantly lower multivariable-adjusted HR for type 2 diabetes (HR 0.67; 95% CI, 0.51-0.89). In receiver operating characteristic analysis, the optimal CRF cut-off value for predicting incident type 2 diabetes was 10.8 metabolic equivalents (sensitivity, 0.64; specificity, 0.64), which was close to the CRF reference value of 11.0 metabolic equivalents. CONCLUSIONS: The reference CRF value appears to be reasonably valid for prevention of type 2 diabetes, especially among Japanese men younger than 40 years. Development of type 2 diabetes can be prevented by maintaining a CRF level above the reference value.

[Characteristics of the number of steps in the National Health and Nutrition Survey].

OBJECTIVES: The mean number of steps measured in the National Health and Nutrition Survey is employed for the assessment of physical activity/exercise in "Health Japan 21," and is used to represent the amount of physical activity/exercise that citizens engage in. In this study, we clarified the characteristics of the data on the number of steps, drawn from the National Health and Nutrition Survey. METHODS: Among the data from the National Health and Nutrition Surveys conducted from 2008 to 2010, data from 21,914 participants on daily number of steps and pedometer attachment were analyzed. On a nutritional intake questionnaire, subjects who responded on the physical status item that they had attached the pedometer all day long were assigned to the "Whole-day-attached" group. Their means, medians, outliers, and frequency distribution were then compared with those in a "Non- whole-day-attached" group. RESULTS: Subjects assigned to the "Non- whole-day-attached" group accounted for about 8% of cases in 2008, 2009, and 2010. In all three years, the mean number of steps in the "Whole-day-attached" group was 1,076 to 1,472 higher than that in the "Non-whole-day-attached" group. In both groups, outliers were present, and the frequency distribution showed a broad range on the side indicating a higher number of steps. Accordingly, the mean value was higher than the median value by approximately 600 steps. CONCLUSION: As data on the number of steps measured in the National Health and Nutrition Survey includes individuals not attaching the pedometer all day (approximately 8% of cases), the data are not normally distributed. Therefore, when utilizing these data as representative of citizens' physical activity/exercise, their characteristics should be taken into consideration.

A Community-Wide Walking Promotion Using Maps and Events for Japanese Older Adults.

Objective: This study evaluated the effect of a community-wide walking intervention (involving walking maps and events) on older residents' walking and environmental perceptions. Method: In this nonrandomized quasi-panel study, older adults living in an intervention and control site were recruited at baseline and follow-up. All households in the intervention site received maps and were invited to participate in a walking event monthly. The intervention lasted for 21 months. The outcomes were walking frequency, duration, and perceptions of local environments. Results: We did not find a significant improvement in walking frequency or duration in the intervention site relative to the control site. However, there was a significant increase in the awareness of others being active and a marginal increase in the perception of aesthetics in the intervention site. Discussion: The increased awareness of others being active may be a positive step in the stages of change toward engagement in physical activity.

Use of health promotion manga to encourage physical activity and healthy eating in Japanese patients with metabolic syndrome: a case study.

BACKGROUND: The present case study investigated the feasibility of using manga (Japanese-style comic books) to promote physical activity and healthy eating behavior in Japanese patients with metabolic syndrome. METHODS: A one-arm pre-post intervention was conducted in a Japanese suburban community. Twenty participants with a diagnosis of metabolic syndrome were recruited via health checkups. Health promotion manga were developed by the researcher, a publishing specialist, and a professional illustrator. We measured participants' self-reported physical activity, eating behavior, and psychological readiness to change toward engaging in healthy behavior. RESULTS: At 1 month after the intervention there were no significant differences in physical activity scores, but small positive changes in vigorous (R2 = 0.02) and moderate (R2 = 0.01) physical activity scores were observed. Total healthy eating behavior scores were significantly improved (p < 0.05, R2 = 0.47). In addition, participants reported positive change in psychological readiness, such as increased intention to engage in healthy behavior, enhanced self-efficacy, and benefits of using manga. CONCLUSIONS: This study demonstrates that manga interventions have potential to encourage healthy eating in patients with metabolic syndrome.

Association between dipstick proteinuria and hearing impairment in health check-ups among Japanese workers: a cross-sectional study.

OBJECTIVE: Prevention of hearing impairment is important because it is difficult to recover from it. Epidemiological studies have examined the risk factors for hearing impairment; however, the association between dipstick proteinuria and hearing impairment has not been previously examined. This study aimed to clarify the association between dipstick proteinuria and hearing impairment. DESIGN: Cross-sectional study. SETTING: Office and factory workers from all over Japan. PARTICIPANTS: The total number of subjects was 7005. All were employees of the same company. Of these, we recruited 6192 subjects who underwent dipstick urine test and hearing test by audiometry in annual health check-ups (mean age 44.9 years, men 88.3%). PRIMARY OUTCOMES: Hearing tests were performed at two frequencies (1 kHz, 4 kHz) as prescribed by law in Japan. We defined the inability of subjects to respond to 30 dB at 1 kHz and/or 40 dB at 4 kHz as overall moderate hearing impairment. In addition, we defined moderate hearing impairment at 1 kHz (4 kHz) as an abnormal finding at 1 kHz (4 kHz). We examined the associations between degree of dipstick proteinuria and hearing impairment after adjustment for age, sex, body mass index, hypertension, diabetes mellitus, serum creatinine level and history of noisy work environment. RESULTS: Overall moderate hearing impairment was noted in 324 subjects (5.2%). Of these, 107 subjects (1.7%) had moderate hearing impairment at 1 kHz and 278 subjects (4.5%) at 4 kHz. Dipstick proteinuria was significantly associated with overall moderate hearing impairment, as well as moderate hearing impairment at both 1 kHz and 4 kHz. The prevalence of overall moderate hearing impairment among subjects with proteinuria ≥2+ was 23.5%, while that among subjects without proteinuria was 5.2% (p<0.01). CONCLUSIONS: Dipstick proteinuria was associated with moderate hearing impairment in Japanese workers.

The association of single and combined factors of sedentary behavior and physical activity with subjective cognitive complaints among community-dwelling older adults: Cross-sectional study.

Subjective cognitive complaints (SCC) might be a meaningful indicator of dementia onset or mild cognitive impairment, and identifying the related factors of SCC could contribute to preventing these diseases. However, the relationship between SCC and lifestyle factors remains largely unproven. The purpose of this study was to examine the association of type of sedentary behavior, physical activity, or their combination with SCC among community-dwelling older adults. In 2016, 6677 community-living elderly were recruited to participate in a survey investigating cognition, physical activity, and sedentary behavior. In total, 5328 participants responded to the questionnaire (79.8% valid response rate). SCC was assessed using the National Functional Survey Questionnaire (Kihon checklist). The relationships between SCC and physical activity, sedentary behavior (reading books or newspapers, and television viewing), or combined physical activity and sedentary behavior were examined via multiple logistic regression analysis. The analysis revealed that moderate-to-vigorous physical activity (≥150 min/week) was significantly related with a lower risk of SCC (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.74-0.97), and that reading behavior showed a dose-response relationship with SCC (OR for 10-20 min/day = 0.63; 95% CI = 0.53-0.75; OR for 20-30 min/day = 0.59; 95% CI = 0.49-0.71; OR for ≥30 min/day = 0.47; 95% CI = 0.39-0.57). In addition, among those reporting high physical activity and ≥30 min/day for reading time, the OR for SCC was 0.40 (95% CI = 0.32-0.50) compared with the combined group reporting lower physical activity and non-readers. The present study shows that increased physical activity and reading time may be related to a reduced risk for SCC among community-dwelling older adults.