Relationship Between Neighborhood Food Environment and Diet Variety in Japanese Rural Community-dwelling Elderly: A Cross-sectional Study.

BACKGROUND: Food access is an important aspect of health promotion for the elderly. The aim of this study was to investigate the relationship between distance to the nearest food store and diet variety in rural community-dwelling elderly Japanese. METHODS: This cross-sectional study analyzed data from 1,103 elderly participants surveyed by mail in rural areas of Japan. Diversity of food intake was assessed using the diet variety score (DVS). Street network distance from home to food store was calculated and categorized by quartile using a geographic information system and analyzed in relation to diet using multivariable regression with the primary outcome as low DVS. Sub-analysis of the association with DVS was conducted for each food store category (convenience store, supermarket, and small food store). The association between intake frequency of each food group and distance was also analyzed. RESULTS: Participants in the fourth quartile of distance to food store had significantly higher prevalence ratio (1.15; 95% CI, 1.01-1.32) for low DVS than those in the first quartile. There was a significant tendency between greater distance to food store and lower DVS (P for trend = 0.033). Supermarkets and convenience stores, in particular, showed significant associations. Greater distance was significantly associated with lower frequency of meat and fruit intake. CONCLUSION: There was significant association between distance to nearest food store and diet variety in rural Japanese elderly. These findings suggest the importance of interventions for areas at high risk of low diet variety, such as places far away from food stores.

Fundamental movement skills in preschoolers before and during the COVID-19 pandemic in Japan: a serial cross-sectional study.

BACKGROUND: Physical inactivity during the coronavirus disease 2019 (COVID-19) pandemic may have hindered the development of fundamental movement skills in preschoolers. This serial cross-sectional study compared fundamental movement skills by age group before and during the COVID-19 pandemic (2019-2020), among Japanese preschoolers aged 3-5 years. METHODS: Of the 22 preschools within Unnan City, Shimane Prefecture, Japan, 21 (95.5%) and 17 (77.3%) participated in the 2019 and 2020 surveys, respectively. We analyzed 608 and 517 preschoolers in both surveys. Fundamental movement skills were objectively assessed with a 25 m run, standing long jump, and softball throw, based on the Japanese physical activity guidelines for preschoolers. Mann-Whitney U tests were used to compare the fundamental movement skills data between periods. RESULTS: For the 25 m run, participants aged 5 years were faster before than during the pandemic (p = 0.018), while participants aged 3 and 4 years showed no significant differences. Participants aged 3-5 years showed no significant differences before and during the pandemic for the standing long jump (p ≥ 0.072). For the softball throw, all grades scored higher before than during the pandemic (p < 0.001). CONCLUSIONS: These findings suggest that the COVID-19 pandemic impeded the development of fundamental motor skills, especially for object control skills. This highlights the need for interventions aimed at developing fundamental motor skills in preschoolers during and after the pandemic.

Is being a regular player with fewer teammates associated with musculoskeletal pain in youth team sports? A cross-sectional study.

BACKGROUND: Musculoskeletal pain (MSP) is a commonly reported symptom in youth sports players. Some sports-related risk factors have been reported, but previous studies on extrinsic risk factors did not focus on management of team members (e.g., regular or non-regular players, number of players) for reducing sports-related MSP. This study aimed to examine the association of playing status (regular or non-regular players) and team status (fewer or more teammates) with MSP in youth team sports. METHODS: A total of 632 team sports players (age: 12-18 years) in public schools in Unnan, Japan completed a self-administered questionnaire to determine MSP (overall, upper limbs, lower back, and lower limbs) and playing status (regular or non-regular players). Team status was calculated as follows: teammate quantity index (TQI) = [number of teammates in their grade]/[required number of players for the sport]. Associations between the prevalence of pain and joint categories of playing and team status were examined by multivariable-adjusted Poisson regression. RESULTS: A total of 272 (44.3%) participants had MSP at least several times a week in at least one part of the body. When divided by playing or team status, 140 (47.0%) regular and 130 (41.7%) non-regular players had MSP, whereas 142 (47.0%) players with fewer teammates (lower TQI) and 127 (41.8%) players with more teammates (higher TQI) had MSP. When analyzed jointly, regular players with fewer teammates had a higher prevalence of lower back pain compared with non-regular players with more teammates (21.3% vs 8.3%; prevalence ratio = 2.08 [95% confidence interval 1.07-4.02]). The prevalence of MSP was highest in regular players with fewer teammates for all other pain outcomes, but this was not significant. CONCLUSION: Regular players with fewer teammates have a higher risk of lower back pain. Future longitudinal investigations are required.

[Fall risk and fracture. Exercise for fall prevention in the elderly].

On the basis of evidence obtained in previous studies, this paper outlines effective music therapy programs for group instructions and the basic contents of exercise and training that the elderly are able to do at home by themselves in their daily lives to reduce the risk of falls. The contents of effective exercise and training are to take a series of steps as quickly as possible, back and forth and to the right and left, in a standing position in combination with vertical movement in large amplitude for center of gravity. Furthermore, simple movements such as obeying an order of "right face", as well as dynamic movements that mostly involve higher brain functions such as instant thinking and judgment, are more effective. It should be noted that it is not sufficient for instructors to merely demand that the elderly do effective exercise. To prevent falls by the participants and to also obtain comprehensive effects such as satisfaction, amusement, and quality of life (QOL) , it is important to pay appropriate attention to parts other than the narrowly-defined evidence elements, such as modifications to maintain compliance and consideration of people with locomotive syndrome.

Effectiveness of intervention for low back pain in female caregivers in nursing homes: a pilot trial based on multicenter randomization.

OBJECTIVES: Although the importance of stretching exercise for pain-relieving and patient education is well documented for chronic lumbago patients, it is uncertain how effective on-the-job training (OJT) is for female caregivers in nursing homes. In the present pilot trial based on multicenter randomization, we evaluated the intervention effect of a lecture and stretching exercise on caregivers in nursing homes. METHODS: Eighty-eight female caregivers (four nursing homes) volunteered to participate in this study, and they were separated into two groups randomly. For the intervention group, guidance by an orthopedist and an exercise instructor were provided as one OJT, and stretching exercises for only 6 min every day were recommended for low back pain prevention to the caregivers. Low back pain visual analogue scale (VAS), physical fitness, and mental and physical health were compared at baseline and immediately after the intervention. RESULTS: A total of 29 (33%) participants withdrew by 12 weeks. Regarding the reasons for withdrawal, 28 participants resigned, and one took a leave of absence due to exacerbation of lumbago. Adherence to the stretching exercises was 2.3 ± 1.3 (mean ± SD) times per week. No significant differences were seen for any outcome measurements. The high adherence group (≧3 times per week) did not show a change in the VAS, but the low adherence group (<3 times per week) and control group showed a tendency towards an increased score (p = 0.068). CONCLUSIONS: Even with the conduct of one OJT, and exercises of only 6 min every day, the adherence of caregivers was low, and there appeared to be few effects of the OJT.

Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study.

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults. Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders. Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17-3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19-3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04-2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04-2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19-2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01-2.25 for Q4 vs. Q1). Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.

Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies.

BACKGROUND: The objective of this review was to summarize findings on aquatic exercise and balneotherapy and to assess the quality of systematic reviews based on randomized controlled trials. METHODS: Studies were eligible if they were systematic reviews based on randomized clinical trials (with or without a meta-analysis) that included at least 1 treatment group that received aquatic exercise or balneotherapy. We searched the following databases: Cochrane Database Systematic Review, MEDLINE, CINAHL, Web of Science, JDream II, and Ichushi-Web for articles published from the year 1990 to August 17, 2008. RESULTS: We found evidence that aquatic exercise had small but statistically significant effects on pain relief and related outcome measures of locomotor diseases (eg, arthritis, rheumatoid diseases, and low back pain). However, long-term effectiveness was unclear. Because evidence was lacking due to the poor methodological quality of balneotherapy studies, we were unable to make any conclusions on the effects of intervention. There were frequent flaws regarding the description of excluded RCTs and the assessment of publication bias in several trials. Two of the present authors independently assessed the quality of articles using the AMSTAR checklist. CONCLUSIONS: Aquatic exercise had a small but statistically significant short-term effect on locomotor diseases. However, the effectiveness of balneotherapy in curing disease or improving health remains unclear.

Nationwide one-decade survey of hip fractures in Japan.

BACKGROUND: To elucidate the characteristics of hip fractures and the current status of their treatment in Japan, the Japanese Orthopaedic Association (JOA) conducted a nationwide hip fracture survey from 1998 to the present. The aim of the current report was to present the changes in patient distribution by age and fracture type, cause of fracture, treatment selection, and duration of hospitalization for a study period of one decade. METHODS: A tally of all hip fractures that occurred in patients between 2001 and 2008 was conducted in JOA-authorized hospitals and in Japanese Clinical Orthopaedic Association (JCOA) hospitals. Registration forms were sent to these hospitals each year, and registration was performed based on their hospital records. RESULTS: The mean response rate was 51.8%, and the total number of patients aged ≥35 with new hip fractures between 2001 and 2008 was 402 760. A drastic increase in the number of patients, especially those aged ≥90 was observed over the course of the decade. More trochanteric fractures occurred than neck fractures during the observational period; however, the neck/trochanter ratio increased over time. Simple falls were the most common cause of fracture. About 94% patients were treated surgically with about a 5-day presurgical hospital stay, and the mean hospitalization period was 40.7 days in 2008. CONCLUSIONS: This one-decade survey demonstrated a drastic increase in the number of patients over the course of the decade in Japan. Appropriate treatment and prevention of hip fractures, including the treatment of osteoporosis and more effective interventions for preventing falls, are important issues to address to reduce the burden of this fracture.

Environmental correlates of physical activity in driving and non-driving rural Japanese women.

OBJECTIVE: This study examined the relationship between physical activity and the environment among rural Japanese women, and whether that relationship varied with driving status. METHODS: 434 women aged 40-64 years in Unnan City, rural Japan, were surveyed in 2006 about physical activity and their neighborhood environments. The proximity and frequency of public transport were measured using geographic information systems software. RESULTS: Perceived good access to public transport and recreational facilities, presence of bike lanes, and good aesthetics were among factors positively associated with being physically active. The interaction between the convenience of bus service and driving status was statistically significant (P=0.023). Non-drivers residing in areas where bus service was moderately convenient were more likely to be active than those who were without it. CONCLUSION: These findings suggested that driving status is a potential modifier of the relationship between physical activity and the convenience of bus service and that convenient bus service is important for promoting physical activity especially in non-drivers.

Effectiveness of comprehensive health education combining lifestyle education and hot spa bathing for male white-collar employees: a randomized controlled trial with 1-year follow-up.

BACKGROUND: Physical activity is known to prevent obesity and metabolic syndrome in middle-aged and elderly people; however, the effectiveness of a comprehensive health education program for male white-collar employees is uncertain. METHODS: Forty-three men volunteered to participate in this study and were randomly assigned into 2 groups. The intervention group participated in a 2-hour program comprising comprehensive health education and hot spa bathing, offered once every 2 weeks, in addition to individualized programs once a week, for 24 weeks. The control group received only general health guidance. We compared their lifestyle characteristics and physical and mental health criteria at baseline, immediately after the intervention, and 1 year after the end of the intervention. RESULTS: Rates of adherence to individualized programs were 60.0 +/- 27.2% and 30.5 +/- 29.6% at the end of the intervention and at 1 year after the end of the intervention, respectively. Significant (P < 0.05) interaction of criteria was observed for cluster of differentiation 4+ (CD4+) cells and the ratio of cluster of differentiation 4+ to 8+ (CD4/8) cells, which were used to represent the participants' immunological function. We divided the intervention group into 2 subgroups on the basis of their attendance. Among the resulting 3 groups, significant interaction of criteria was observed for CD4+ and CD4/8 cells. In addition, the high attendance group had the highest CD4+ count and CD4/8 ratio. CONCLUSIONS: Participants who attended classes and/or performed the supplementary individualized programs tended to maintain their immunological function and to experience a decrease in body fat percentage. However, few effects were noted in participants with poor adherence, even in the intervention group.

[Prevention of falls].

Falls among the elderly mainly result from aging, lack of exercise, and physical and/or mental disorders. They cause fractures and other injuries. It is necessary that likelihood of falling should be evaluated from the view point of both decreased physical function and fear of falling. General exercise including balance training is considered to be most effective to reduce falls. We must take good care not to cause falling and resultant fracture due to exercise of falls prevention program. Many sided intervention, including a check and counseling on medication and environmental improvement, walking in the sunshine, which stimulates vitamin D biosynthesis and so on, are needed. Further studies on falls prevention among the elderly with dementia and males receiving hormonal therapy with prostatic cancer are necessary.

Association of low back and knee pain with falls in Japanese community-dwelling older adults: A 3-year prospective cohort study.

AIM: To examine whether the chronicity and intensity of low back pain (LBP) or knee pain (KP) was associated with the occurrence of falls among a community-dwelling older population. METHODS: This was a community-based 3-year prospective cohort study. In 2009, baseline questionnaires were mailed to 3080 randomly selected residents aged 60-79 years; 2534 residents (82.3%) responded to the baseline survey, and 1- and 3-year follow-up surveys were subsequently mailed to them. The data for 1890 respondents who had no falls in the past year at baseline were analyzed. Associations between pain status (chronicity, intensity and persistence) and the occurrence of falls were analyzed by multivariable-adjusted logistic regression. RESULTS: A total of 197 (13.6%) participants had at least one fall during 12 months at 3-year follow up; of those, 68 (4.8%) had multiple falls, and 65 (4.5%) resulted in an injury. Chronicity and intensity of LBP were associated with injurious falls (P for trend = 0.033 and P for linearity = 0.041, respectively), and KP was associated with at least one fall (P for trend = 0.021 and P for linearity = 0.040, respectively). In addition, participants who had chronic pain persistently at both baseline and 1-year follow up had a higher risk of falls (LBP for injurious falls; adjusted odd ratio 2.46, 95% confidence interval 1.08-5.63, KP for at least one fall; adjusted odd ratio 2.39, 95% confidence interval 1.29-4.44), compared with those who had no pain at both time-points. CONCLUSIONS: LBP and KP chronicity, intensity and persistence of chronic pain were associated with a greater risk of falls in older adults. Geriatr Gerontol Int 2017; 17: 875-884.

Association between knee pain and gait speed decline in rural Japanese community-dwelling older adults: 1-year prospective cohort study.

AIM: The present study examined whether knee pain was associated with decline in maximum gait speed (MGS) in a rural mountainous region. METHODS: This was a population-based 1-year prospective cohort study. A total of 658 men and women aged 60 years and older participated in the baseline survey in 2006, and 400 individuals participated in the follow-up survey in 2007. We compared the incidence of meaningful decline in gait speed (≥0.1 m/s) in older adults with different knee pain levels (none, mild, severe), estimating incidence rate ratio (IRR) by multivariable-adjusted Poisson regression model. RESULTS: Meaningful decline in MGS presented in 24.3% of participants, especially in men (30.3%). Baseline knee pain level was significantly related to meaningful decline in MGS after adjustment of potential confounders (IRR 1.79 for mild pain, 1.84 for severe pain; P for trend <0.01). In sensitivity analyses with change in MGS as the continuous variable, the association was not significant, but a similar negative association with knee pain was confirmed (mild pain ß = -0.040, severe pain ß = -0.088; P for trend = 0.104). In addition, older adults with knee pain at both baseline and follow up had a higher risk of meaningful decline in MGS (IRR 2.33, 95% CI 1.59-3.40) compared with those who had no pain at baseline or follow up. CONCLUSIONS: Knee pain was associated with a decline in gait speed at 1-year follow up. Prevention and treatment of knee pain might be important for suppression of decline in physical function in older adults.

Effectiveness of Pilates exercise: A quality evaluation and summary of systematic reviews based on randomized controlled trials.

OBJECTIVE: The objective of this review were to summarize evidence for the effectiveness of Pilates exercise (PE) and to assess the quality of systematic review (SRs) based on randomized controlled trials (RCTs). STUDY DESIGN: A systematic review of SRs based on RCTs. METHODS: Studies were eligible if they were RCTs. Studies included those with one treatment group in which PE was applied. We searched the following databases from 1995 up to August 20, 2014: MEDLINE via PubMed, CINAHL, Web of Science, Global Health Library, and Ichushi-Web. We also searched All Cochrane Database and Campbell Systematic Reviews up to August 20, 2014. Based on the International Classification of Diseases-10 (ICD-10), we identified a disease targeted for each article. RESULTS: Nine studies met all inclusion criteria. As a whole, the quality of the articles was good. Seven studies were about "Musculoskeletal system and connective tissue (M5456)". There were two studies in "Factors influencing health status and contact with health services (Z723)". The traits of participants were for females and the comparatively young- and middle-aged. Five SRs for chronic low back pain (CLBP) concluded that there was pain-relief and functional improvement of the intervention in the short term, but two SRs were inconclusive about the effectiveness of PE. There were no adverse events described in any of the studies. CONCLUSION: Although no SR reported any adverse effect or harm by PE, there was pain-relief and functional improvement attributed to PE in the short term in participants with CLBP. There was also evidence of improved flexibility and dynamic balance, and of enhanced muscular endurance in healthy people in the short term. In addition, there may have been an effect on body composition in the short term.

Association between musculoskeletal pain and trips or falls in rural Japanese community-dwelling older adults: a cross-sectional study.

AIM: The present study examined whether low back pain (LBP) and knee pain (KP) are associated with trips and falls in rural Japanese community-dwelling older adults. METHODS: A population-based cross-sectional survey of community-dwelling older adults was carried out in Unnan City, Shimane Prefecture, in Japan. A total of 499 men and women aged 60 years and older living in the community were recruited from 2008 to 2010. The main outcome measures were self-rated recent trip frequency and self-reported experience of falls in the past year. RESULTS: Trips and falls presented in 44.0% and 15.9% of participants, respectively. LBP was not associated with trips, but was significantly associated with falls: severe pain versus single fall (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.04-6.03); and severe pain versus multiple falls (OR 11.09, 95% CI 2.41-51.10). KP was significantly associated with trips: mild pain versus trips (OR 1.81, 95% CI 1.20-2.72); mild pain versus multiple falls (OR 4.47, 95% CI 1.21-16.50); severe pain versus trips (OR 3.83, 95% CI 1.82-8.04); and severe pain versus multiple falls (OR 7.26, 95% CI 1.51-34.86). Participants with both pain sites were associated with trips (OR 2.44, 95% CI 1.45-4.12) and multiple falls (OR 10.79, 95% CI 1.33-87.19). CONCLUSIONS: Severe LBP was associated with single and multiple falls, whereas KP was associated with trips and multiple falls, irrespective of severity of pain. In addition, participants with both pain types were associated with trips and multiple falls.

Similar age-related changes in running performance and growth in adolescent monozygotic twins.

The purpose of this study was to assess the similarities in the pattern of age-related change in the running performance and physical growth in adolescent monozygotic (MZ) twins. The total sample was 70 boys and 100 girls, including 14 pairs of male and 25 pairs of female MZ twins. Performance of the 50 m dash and endurance run (1,500 m for boys and 1,000 m for girls), and stature and body mass were measured longitudinally at yearly intervals from 12 to 17 years of age. The within-pair resemblance was compared between MZ twin pairs (MZ) and control pairs (CP), which were selected from the other subjects matched with each member of MZ for the initial values. The within-pair similarity in performance and growth curves was quantified by an average Euclidean distance coefficient (d(jk)) and a coefficient of shape differences (z(jk)) and a graphical analysis on the d(jk)-z(jk) coordinate. The time relationship between two curves was assessed by the arrangement of the sign of within-pair differences (number of runs, NR). Within-pair differences of measured value at the first and the last measurements were also examined. MZ generally showed smaller d(jk) and z(jk), clustering around the origin on the d(jk)-z(jk) coordinate. Frequency of observation of NR = 1, which means one member of a pair had consistently larger values than the other, tended to be lower in MZ in performance items. Within-pair differences in the last measurements were generally greater in CP. It was concluded that MZ twins have meaningful similarities in the pattern of age-related changes in running performances and physical growth during adolescence. Am. J. Hum. Biol. 12:623-632, 2000. Copyright 2000 Wiley-Liss, Inc.

Secular change in running performance of Japanese adolescents: A longitudinal developmental study.

A 5-year longitudinal cohort study of the running development of Japanese adolescents was conducted at a secondary school in Tokyo from 1968 to 1994. The purpose was to investigate changes in the pattern of development over time. The test items were an endurance run (1,500 m for boys and 1,000 m for girls) and a dash (50 m for both sexes). The total number of subjects was 512 boys and 516 girls in the endurance run, and 825 boys and 895 girls in the dash. These students entered the first grade of the school from 1968 to 1989 at the age of 12 years, and were followed for the next 5 years. In the analyses, a quadratic regression model was used to characterize intra-individual, age-related changes in running performance. The model fit the observed data, and the validity of the model was confirmed. Secular changes in the running development of boys were minimal over the last 30 years. Changes in girls, however, had three different patterns: 1) an overall decrease in performance with an almost unchanged estimated performance in the first grade, 2) a greater decrease in the late-teenage years, and 3) a decrease in the age of maximal performance. Secular changes in physical growth (stature and body mass index) could not fully explain the secular changes in the running development of girls, suggesting that the underlying causes may be social and cultural. Am. J. Hum. Biol. 10:765-779, 1998. © 1998 Wiley-Liss, Inc.

[Practices and strategies for the prevention of falls in the osteoporotic elderly].

Among seniors with osteoporosis, falls can cause devastating injuries such as hip fractures even with only weak impacts. We have begun a combined medical examination and educational program for exercise to prevent injurious falls. To make fall prevention practices more widespread, we hold one-day simplified fall prevention program and instruction courses for practitioners.

[The basic idea and exercise program of "fall and fracture prevention school" for elderly people].

With the arrival of an aging society in Japan, accidents among elderly people involving falls and bone fractures are on the increase. Efforts to prevent such accidents are strongly required, so the concept of a "fall and fracture prevention school" is spreading. The aims of these classes are to make elderly people aware of the condition of their bodies and to improve deteriorating physical ability through exercise programs, since the latter is the cause of such falls. In conducting an exercise program for the elderly, it is important to make it enjoyable as well as safe.

Effectiveness of horticultural therapy: a systematic review of randomized controlled trials.

AIM: To summarize the evidence from randomized controlled trials (RCTs) on the effects of horticultural therapy (HT). METHODS: Studies were eligible if they were RCTs. Studies included one treatment group in which HT was applied. We searched the following databases from 1990 up to August 20, 2013: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi-Web, GHL, WPRIM, and PsyclNFO. We also searched all Cochrane Database and Campbell Systematic Reviews up to September 20, 2013. RESULTS: Four studies met all inclusion criteria. The language of all eligible publications was English and Korean. Target diseases and/or symptoms were dementia, severe mental illness such as schizophrenia, bipolar disorder, and major depression, frail elderly in nursing home, and hemiplegic patients after stroke. These studies showed significant effectiveness in one or more outcomes for mental health and behavior. However, our review especially detected omissions of the following descriptions: method used to generate randomization, concealment, blinding, and intention-to-treat analysis. In addition, the results of this study suggested that the RCTs conducted have been of relatively low quality. CONCLUSION: Although there was insufficient evidence in the studies of HT due to poor methodological and reporting quality and heterogeneity, HT may be an effective treatment for mental and behavioral disorders such as dementia, schizophrenia, depression, and terminal-care for cancer.