[Association between indoor temperature during winter and falls at home in the past year among community-dwelling older adults: A cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan].

AIM: Some studies have reported a higher incidence of falls during winter with similar proportions of indoor and outdoor falls. We investigated the relationship between indoor temperature during winter and falls at home in the past year among community-dwelling older adults. METHODS: This cross-sectional study enrolled 964 individuals of ≥65 years of age in Japan. Participants answered questions about falls (including trips) at home within the past year, and the living room temperature was measured for 2 weeks during winter. Participants were divided into those living in cold (mean temperature near the floor <12°C), slightly cold (12-17.9°C), and warm (≥18°C) houses. The association between indoor temperature (cold vs. slightly cold vs. warm houses) and falls at home in the past year was examined using a logistic regression analysis adjusted for potential confounding factors. RESULTS: Valid data were obtained from 907 participants (mean age: 72.0±6.3 years), of whom 265,553, and 89 lived in cold, slightly cold, and warm houses, respectively. In the past year, falls occurred once in 325 (35.8%) participants and multiple times in 148 (16.3%) participants. In warm houses, the odds ratio of falling once and multiple times in the past year was 0.49 (p=0.032) and 0.34 (p=0.035), respectively, in comparison to cold houses. CONCLUSIONS: Living in cold houses may be associated with an increased risk of falling at home among older adults. Maintaining an appropriate indoor thermal environment during winter may reduce the risk of falling among individuals who spend most of their time at home.

Association between dietary patterns and subjective and objective measures of physical activity among Japanese adults aged 85 years and older: a cross-sectional study.

A healthy diet and regular physical activity (PA) are delineated as healthy behaviours. Their implementation is associated with better health outcomes and improved quality of life. There is less evidence of a relationship between dietary patterns (DP) and PA, especially in adults aged ≥ 85. Hence, this cross-sectional study investigates the association between DP and PA in people of this age group, using the data from The Kawasaki Aging and Well-Being Project. Brief-type self-administered diet history questionnaire was used to estimate the intake of fifty-eight types of food. After energy adjustment, principal component analysis was performed to identify DP. PA was measured objectively using an accelerometer and subjectively using a questionnaire validated for this age group. Thousand participants (median age: 86·9 years, men: 49·9 %) were included in the analysis. Three major DP (DP1 'various foods', DP2 'red meats and coffee', DP3 'bread and processed meats') were identified. DP1 'various foods' was similar to DP previously named 'healthy' or 'prudent' and showed a positive association with PA time (PAT) as measured by accelerometer (B, 6·25; 95 % CI 0·13, 12·37) and relatively shorter sedentary behaviour (SB) time. DP2 'red meats and coffee' and DP3 'bread and processed meats' were negatively associated with PAT and positively associated with SB time. This study observed the relationship between diet and PA behaviours in adults aged ≥ 85, with healthier and more food-diverse DP associated with longer PAT and relatively unhealthy DP with shorter PAT.

Relationship between dietary patterns and physical performance in the very old population: a cross-sectional study from the Kawasaki Aging and Wellbeing Project.

OBJECTIVES: As the world's population is ageing, improving the physical performance (PP) of the older population is becoming important. Although diets are fundamental to maintaining and improving PP, few studies have addressed the role of these factors in adults aged ≥ 85 years, and none have been conducted in Asia. This study aimed to determine the dietary patterns (DP) and examine their relationship with PP in this population. DESIGN: This cross-sectional study (Kawasaki Aging and Wellbeing Project) estimated food consumption using a brief-type self-administered diet history questionnaire. The results were adjusted for energy after aggregating into thirty-three groups, excluding possible over- or underestimation. Principal component analysis was used to identify DP, and outcomes included hand grip strength (HGS), timed up-and-go test, and usual walking speed. SETTING: This study was set throughout several hospitals in Kawasaki city. PARTICIPANTS: In total, 1026 community-dwelling older adults (85-89 years) were enrolled. RESULTS: Data of 1000 participants (median age: 86·9 years, men: 49·9 %) were included in the analysis. Three major DP (DP1: various foods, DP2: red meats and coffee, DP3: bread and processed meats) were identified. The results of multiple regression analysis showed that the trend of DP2 was negatively associated with HGS (B, 95 % CI -0·35, -0·64, -0·06). CONCLUSIONS: This study suggests a negative association between HGS and DP characterised by red meats and coffee in older adults aged ≥ 85 years in Japan.

Does health literacy moderate the psychological pathways of physical activity from guideline awareness to behavior? A multi-group structural equation modeling.

BACKGROUND: Awareness, knowledge, beliefs, and behavioral intentions of physical activity (PA) guidelines may be important mediating factors for promoting PA. However, these pathways of the psychological process to PA behavior have not been examined. These pathways may differ depending on health literacy levels. This study investigated the pathways to PA, from guideline awareness to behavior, and further examined whether they differed by health literacy. METHODS: A cross-sectional study was conducted with 7,000 Japanese participants aged 20-69 years. The participants were registered with an Internet survey company. Participants' awareness, knowledge, beliefs, and behavioral intentions regarding the PA guidelines of Japan, the volume of moderate-to-vigorous intensity PA, activity level, and health literacy were examined through a questionnaire. The PA pathways, from guideline awareness to behavior, were examined by structural equation modeling (SEM), with PA behavior as the dependent variable. Multi-group SEM was conducted to examine the moderating effect of health literacy on PA pathways. Health literacy scores were dichotomized into high and low groups in multi-group modeling by the median split. RESULTS: SEM revealed that PA guideline awareness directly affects PA behavior and has certain indirect effects through the mediation of knowledge, beliefs, and behavioral intentions. Furthermore, the multi-group SEM showed that the proportion of indirect effects (path coefficient [PC]: 0.11, 95% confidence interval [CI]: 0.10-0.13) was higher than direct effects (PC: 0.07, 95%CI: 0.03-0.11) in the high-health literacy group. In contrast, the proportion of direct effects (PC: 0.22, 95%CI: 0.15-0.30) was higher than indirect effects (PC: 0.06, 95%CI: 0.05-0.07) in the low-health literacy group. CONCLUSIONS: PA guideline awareness is both directly and indirectly associated with PA behavior, mediated by psychological pathways of knowledge, beliefs, and behavioral intentions, and influenced by health literacy. These results suggest that health literacy should be considered when implementing PA guideline-based interventions.

[Current status of awareness, knowledge, beliefs, and behavioral intentions regarding the Japanese physical activity guidelines and their relationship with physical activity and sedentary behavior].

Objective　This study clarified the current status of awareness, knowledge, beliefs, and behavioral intentions regarding the Japanese physical activity guidelines (Active Guide) and their relationship with physical activity, sedentary behavior, and the participants' characteristics.Methods　A cross-sectional study was conducted with 7,000 participants aged 20-69 years registered with an online survey company. Awareness, knowledge, beliefs, and behavioral intentions regarding the Active Guide were examined. Awareness was assessed by unprompted and prompted recall. Knowledge was assessed by numerical responses to "the recommended daily activity time (18-64 years/65 years and older)" and "physical activity time to be increased (plus-ten)," respectively. To survey the beliefs and behavioral intentions, we created a 5-point scale for the Active Guide. For physical activity, the amount of moderate-to-vigorous intensity physical activity was calculated from the Japan Public Health Center-based prospective Study (JPHC study) questionnaire. Physical activity level was calculated from the standard specific medical checkup and health guidance questionnaire. For sedentary behavior, the Japanese version of the International Physical Activity Questionnaire (IPAQ) was used. The dependent variables were awareness, knowledge, beliefs, and behavioral intentions. The independent variables were physical activity, sedentary behavior, and the participants' characteristics (gender, age, body mass index, marital status, educational background, work status, and household income). After descriptive statistics were measured, a logistic regression analysis was performed to examine the associations.Results　Unprompted and prompted recall of the Active Guide were 1.7% and 5.3-13.4%, respectively. Those with knowledge of it scored 37.2%, 7.0%, 24.8%, and 2.6% for recommended daily activity time (18-64 years), daily physical activity time (65 years and older), plus-ten, and all three items answered correctly, respectively. The median (interquartile range) score of the beliefs was 21 (16-25) points (32-point scale). Those with behavioral intentions scored 51.4% for "recommended daily activity" and 66.9% for "plus-ten." Logistic regression analysis showed that awareness, knowledge, beliefs, and behavioral intentions were positively associated with moderate-to-vigorous intensity physical activity and level. The results were inconsistent for sedentary behavior. Although personal characteristics differed based on assessment item, they were mainly associated with age, education level, employment, and household income.Conclusions　This study revealed that the number of people who had awareness and knowledge of the Active Guide remained low. Those with awareness, knowledge, beliefs, and behavioral intentions were more physically active. However, the results for sedentary behavior were not consistent. Hence, further research is required to understand this tendency. A future longitudinal study is also required.

[Identification of dietary patterns and their relationship with physical performance in adults of 85 years of age and older -A cross sectional study from The Tokyo Oldest Old survey on Total Health study].

AIM: While the proportion of people of ≥85 years of age is expected to increase, there is limited research on the dietary patterns and physical performance of this population in Japan. The purpose of this study was to identify the dietary patterns of people of ≥85 years of age who live in Tokyo and to examine the relationship with their physical performance. METHODS: Using data from the baseline survey (conducted in 2008-2009) of The Tokyo Oldest Old survey on Total Health study, the estimated 58 food intake items were aggregated into 33 items after energy adjustment, and a principal component analysis was performed. For physical performance, the results of grip strength, chair standing test, and 3 m timed up and go test conducted at normal walking speed were used. A multiple regression analysis was used to adjust for confounders and to examine the relationship between each dietary pattern and physical performance. RESULTS: The subjects of the analysis were 87.3 (86.2-88.8) years of age (median [25-75th percentile] ). From the principal component analysis, three dietary patterns were identified: "various vegetable foods", "fish and mushrooms", and "cooked rice and miso soup". A higher propensity for the "fish and mushrooms" dietary pattern was significantly associated with grip strength (partial regression coefficient, B (95% confidence interval): 0.48 (0.13-0.83) ). CONCLUSIONS: In a population of people of ≥85 years of age in Tokyo, a positive association was observed between hand grip strength and a dietary pattern characterized by fish and mushroom intake.

A community-wide intervention to promote physical activity: A five-year quasi-experimental study.

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

Behavioral changes and hygiene practices of older adults in Japan during the first wave of COVID-19 emergency.

BACKGROUND: On April 7, 2020, Japan declared a state of emergency due to the first wave of coronavirus disease 2019 (COVID-19) with the associated social distancing likely to have had a great impact on older adults' lifestyle and health. This study aimed to explore the behavioral changes and personal hygiene practices in relation with background psychosocial and health characteristics of older adults during the COVID-19 emergency. METHODS: A cross-sectional telephonic survey was conducted with the participants of the Kawasaki Aging and Wellbeing Project (KAWP), an on-going longitudinal cohort study of older adults aged 85 or older. The interviews were conducted using a structured questionnaire consisting of 11 closed questions regarding behavioral changes and personal hygiene practices during the state of emergency. Sociodemographic and health data were obtained from the KAWP baseline survey conducted 2.2 years before the telephonic survey. RESULTS: Overall, 487 participants from the KAWP responded to the telephonic survey (response rate: 89.2%). 94.5% of the respondents reported no changes in basic lifestyle habits, such as eating, sleeping, smoking, and drinking, whereas 28.1% reported a decrease in physical activity, and 54.6% reported going out less frequently. One-third of the respondents reported a decrease in the number of people to converse with, as well as the amount of time to converse. For personal hygiene practices, 93.8% reported wearing a mask when they went out, and 50.3% reported an increased frequency of handwashing. Multiple logistic regression analysis revealed that engagement in physical activity at baseline (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.23-3.08), smartphone ownership (OR = 2.15, 95% CI = 1.33-3.47), and visual impairment (OR = 1.79; 95% CI = 1.10-2.91) were independently associated with decreased physical activity during the COVID-19 emergency. Female respondents and smartphone ownership were significantly associated with more frequent handwashing. CONCLUSIONS: The study revealed that older adults in an urban setting responded to the COVID-19 emergency with behavioral changes. The findings of this study have implications for the design of preventive strategies to maintain the health and wellbeing of at-risk older adults.

The role and attitude of senior leaders in promoting group-based community physical activity: a qualitative study.

BACKGROUND: In the context of worldwide public health, it is very important to promote physical activity among the older people. This study explored the roles and attitudes of senior leaders in promoting group-based exercise in their local communities, specifically to determine the level and extent to which to elderly participation was encouraged. METHODS: This study conducted semi-structured face-to-face in-depth interviews and employed a subsequent thematic analysis. Participants included 10 club leaders and five sub-leaders who were working at senior clubs in Fujisawa-city, Kanagawa, Japan, from July to September 2018. RESULTS: Four themes emerged from the interview responses, including "unwavering attitude/conviction in relation to the vision," "leaders must set an example," "a search for balance in delegating responsibilities to members," and "creating and fostering culture and environment of mutual help." Further, each participant outlined several aims, including "achieving healthy longevity for the entire local community," "having older people promote healthy activities among the older people," and "creating a pro-health town." CONCLUSIONS: Findings indicate that policymakers, public health workers, and healthcare providers should recognize the pivotal roles that senior group leaders play in promoting healthy activities for the older people. These efforts should be strongly considered when developing policies and strategies designed to promote overall healthy longevity from a general community perspective.

[Effects of polypharmacy and anticholinergic/sedative drugs on the physical/cognitive/mental related outcomes of community-dwelling elderly people: The Kawasaki Wellbeing Project].

AIM: To assess the burdens of polypharmacy and the drug burden index in community-dwelling elder people. METHODS: The survey was conducted on 396 participants who participated in The Kawasaki Wellbeing Project from March to December 2017. We investigated the associations between the drug burden and the physical/cognitive/mental outcomes. The drug burden was determined by calculating the number of medications and the drug burden index (DBI) based on the use of anticholinergic and sedative drugs. A multivariate regression analysis was conducted for the outcome measures ADL, IADL, MMSE, J-CHS, and EQ5D5L after adjusting for the sex, age, number of diseases, education level, smoking history, and alcohol history. RESULTS: A total of 389 subjects were analyzed, the mean age of the population was 86 years old, and 187 people (48%) were male. Polypharmacy was reported in 243 people (62%), and DBI exposure was reported for 142 people (36.5%). We found that this population was physically healthy, with a median ADL of 100, and had high quality of life, with a median EQ5D5L of 0.895. Polypharmacy was found to be related to the J-CHS (ß: 0.04) and EQ5D5L (-0.01). The DBI was also related to the EQ5D5L (-0.04). CONCLUSION: These results showed that even though this population was healthier than the general Japanese elderly population, the drug burden of polypharmacy and high dosages of anticholinergic/sedative drugs exerted significant negative effects on frailty and the quality of life. Additional research should be conducted to investigate the long-term effects of polypharmacy and anticholinergic/sedative drugs on elderly people.

Community-wide physical activity intervention based on the Japanese physical activity guidelines for adults: A non-randomized controlled trial.

Very few community intervention studies that promote physical activity (PA) using guidelines and its dissemination and implementation have been conducted. Consequently, we evaluated the effectiveness of a community-wide intervention (CWI) of PA with adults based on the Japanese guidelines for promoting PA. This was a non-randomized controlled trial, with four administrative districts in Fujisawa city assigned to the intervention group and nine to the control group. The CWI, conducted from 2013 to 2015, comprised information dissemination, education, and community support. The primary outcome was change in PA participation. Secondary outcomes were CWI awareness and PA guideline knowledge. Outcomes were assessed using questionnaires distributed to two independent, random samples of 3000 community-based adults (aged ≥20years). Two separate samples-1230 adults at baseline and 1393 at the two-year follow-up-responded to the survey. The median time spent in PA did not differ between intervention and control groups after adjusting for potential confounders (adjusted difference between groups=-0.02min/day [95% confidence interval (CI): -0.11, 0.10]). However, intervention group participants were more aware of the CWI (33.8%) than were control group participants (25.2%) at the two-year follow-up (odds ratio=1.44 [95% CI: 1.06, 1.95]). A significant difference was also observed in participants' PA guideline knowledge (adjusted difference between groups=0.82% [95% CI: 0.33, 1.31]). Although significant differences in awareness and knowledge were observed between groups, this CWI did not change PA levels over two years. Future studies should investigate the long-term effects of CWIs beyond two years. TRIAL REGISTRATION NUMBER: UMIN-CTR UMIN000018389.

Regular group exercise contributes to balanced health in older adults in Japan: a qualitative study.

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® 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.

Relationships of Muscle Echo Intensity with Walking Ability and Physical Activity in the Very Old Population.

This study investigated the relationships between muscle echo intensity (EI), physical activity (PA), and functional mobility in 108 Japanese (88-92 years). We measured EI and muscle thickness (MT) at the midpoint of the anterior superior iliac spine and patella using B-mode ultrasound. Light and moderate-to-vigorous PA (LPA and MVPA) were assessed with a triaxial accelerometer. The timed up and go (TUG) test was used to measure for functional mobility. EI, but not MT, was significantly associated with both TUG scores (ß = 0.17, p = .047) and MVPA (ß = -0.31, p = .01) when adjusted by potential confounders. However, association between EI and TUG disappeared after adjusted for MVPA. Meanwhile, MVPA was significantly associated with TUG scores independent of EI (ß = -0.35, p < .001). Although EI of anterior thigh muscles might be a weaker predictor of functional morbidity than MVPA, it is a noninvasive and practical approach for assessing muscle quality in the very old.

The relationship between flow experience and sense of coherence: a 1-year follow-up study.

This study examined the relationship between flow experience and sense of coherence in 279 tai chi practitioners aged 67.9 ± 7.9 years, with a 1-year follow-up questionnaire. Our results suggest that tai chi improves sense of coherence in older adults, beginners, and long-term practitioners.

An approach for the analysis of axonal neuroinflammation by measuring dual biomarkers of oligodendrocytes and inflammatory cytokine in human plasma.

The myelin sheath surrounding axons is vulnerable to mechanical stresses after head injuries, as well as autoimmune attacks and degeneration in neurological disorders. Unfortunately, there is currently no effective method to assess these axonal conditions in individual patients. We have developed a sandwich immunoassay detecting dual signals of myelin oligodendrocyte glycoprotein (MOG) and interleukin 1B (IL1B) in human plasma ([IL1B on MOG]). While IL1B is one of common inflammation markers, its lack of tissue specificity is addressed by identifying IL1B on extracellular vesicles from oligodendrocytes isolated using anti-MOG, suggesting inflammation around axons. In 77 control subjects, plasma levels of [IL1B on MOG] did not increase more than 2 fold from baseline. During the sports season, 14% (151 football players) and 22% (18 rugby players) exhibited a substantial 2-17 fold increase, despite the absence of traumatic brain injuries. This elevation demonstrated a non-random pattern, with some individuals gradually rising towards the season's end, followed by a decline. [IL1B on MOG] levels also correlated with the clinical course of a post-concussion syndrome case. These data indicate that [IL1B on MOG] blood test is a potential marker for assessing mild axonal neuroinflammation.

Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial.

BACKGROUND: The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support-based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. OBJECTIVE: This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. METHODS: We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. RESULTS: The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. CONCLUSIONS: The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials.

Association of polydoctoring and mortality among very old persons with multimorbidity: a prospective cohort study in Japan.

BACKGROUND: Polydoctoring is a crucial aspect 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 Facility (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 utilized in this study. Among the 1,026 KAWP participants aged 85-89 years, those with two or more chronic conditions were enrolled in this study. METHOD: Care fragmentation or polydoctoring, was evaluated using the RVF, 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-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] 0.46, 95% confidence interval [CI]: 0.18-0.99). 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 1.05-6.84). CONCLUSIONS: In older patients with multimorbidity, polydoctoring reduces 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.

Epidemiology of adverse events related to sports among community people: a scoping review.

OBJECTIVES: Numerous reports have described injuries and illnesses in competitive athletes, but studies on leisure-time physical activity and associated adverse events in the general population have not been adequately reviewed. This study aimed to summarise the previous findings on this topic. DESIGN: Scoping review. DATA SOURCES: PubMed and Ichushi-Web for articles in English and Japanese, respectively (13 April 2023). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Articles on adverse events related to sports performed by 'individuals and groups active in the community' were included, whereas those on elite athletes, exercise therapy and rehabilitation, and school sports were excluded. Terms related to physical activity, exercise, sports and adverse events were used for the search strategies. RESULTS: The literature search yielded 67 eligible articles. Most articles were from the USA, Japan and Australia. Running, scuba diving, rugby and soccer were the most commonly reported sports. Adults were the most common age category in the samples. The most commonly reported adverse events were injuries; only 10 articles reported diseases. 13 longitudinal studies reported the frequency of adverse events based on the number of events/participants×exposure. CONCLUSION: Adverse events such as sports trauma, disability and certain diseases occur sometimes during sporting activities by residents; however, the articles identified in this review showed biases related to the countries and regions where they were published and the sports disciplines and types of adverse events reported, and articles reporting the frequency of adverse events were also limited. This highlights the need for more high-quality observational studies on diverse populations in the future.

Effects of combining whole-body vibration with exercise on the consequences of detraining on muscle performance in untrained adults.

This study investigated whether whole-body vibration (WBV) coupled with low-velocity exercise (EX) for 13 weeks retains muscle performance gains after 5 weeks of subsequent detraining compared with the results of an identical EX program without WBV. Thirty-two untrained healthy adults (22-49 years of age) were randomly assigned to groups that performed EX with or without WBV (EX-WBV and EX, respectively; n = 16 per group). The following outcome variables were evaluated: countermovement jump height; maximal isometric, concentric, and eccentric knee extension strengths; local muscular endurance; and lumbar extension torque before, during, and after the 13-week training period, and after 5 weeks of detraining. Compared with the EX group, significantly higher increases in countermovement jump height and isometric and concentric knee extension strengths were detected in the EX-WBV group after the 13-week training period. However, detraining caused significant declines in these 3 muscle performance tests only in the EX-WBV group (-4.8, -10.2, and -17.2%, respectively), resulting in no significant differences between the test and control groups after the detraining period. After detraining, all examined variables showed significantly better performance compared with pretraining (p < 0.05) and did not significantly differ from midtraining (7 weeks) in both groups (p > 0.05). These results suggest that muscle strength in the lower extremities, particularly isometric and concentric contractions, and muscle power might be more susceptible to short-term detraining effects when exercise is combined with WBV. Thus, it is necessary to perform regular exercise to maximize the benefits of WBV on muscle strength and power during the early stages of training in previously untrained individuals.

Relationships between flow experience, IKIGAI, and sense of coherence in Tai chi practitioners.

The purpose of this study was to examine the mental health effects of Tai chi on regular practitioners by investigating the relationships between flow experience, IKIGAI (Japanese: "Life worth living"), and sense of coherence. The results indicated that flow experience may influence IKIGAI and IKIGAI may influence sense of coherence; this suggests that IKIGAI may act as an intermediary between flow experience and sense of coherence. The results also indicated that the longer the Tai chi experience, the higher was the flow experience.