Community-level group sports participation and all-cause, cardiovascular disease, and cancer mortality: a 7-year longitudinal study.

BACKGROUND: Community-level group sports participation is a structural aspect of social capital that can potentially impact individual health in a contextual manner. This study aimed to investigate contextual relationship between the community-level prevalence of group sports participation and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality in older adults. METHODS: In this 7-year longitudinal cohort study, data from the Japan Gerontological Evaluation Study, a nationwide survey encompassing 43,088 functionally independent older adults residing in 311 communities, were used. Cause of death data were derived from the Japanese governmental agency, The Ministry of Health, Labour and Welfare, for secondary use. "Participation" was defined as engaging in group sports for one or more days per month. To analyze the data, a two-level survival analysis was employed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS: Among the participants, 5,711 (13.3%) deaths were identified, with 1,311 related to CVD and 2,349 to cancer. The average group sports participation rate was 28.3% (range, 10.0-52.7%). After adjusting for individual-level group sports participation and potential confounders, a higher community-level group sports participation rate was found to be significantly associated with a lower risk of both all-cause mortality (HR: 0.89, 95% CI: 0.83-0.95) and cancer mortality (HR: 0.89, 95% CI: 0.81-0.98) for every 10% point increase in the participation rate. For CVD mortality, the association became less significant in the model adjusted for all covariates (HR: 0.94, 95% CI: 0.82-1.09). CONCLUSIONS: Our findings support the existence of a preventive relationship between community-level group sports participation and the occurrence of all-cause and cancer mortality among older individuals. Promoting group sports within communities holds promise as an effective population-based strategy for extending life expectancy, regardless of individual participation in these groups.

Do changes in the frailty score differ by the type of group sports and exercises participated in? A 3-year longitudinal study.

BACKGROUND: Older adults who engage in group sports and exercises achieve greater health benefits than those who exercise by themselves. The benefits of group participation may vary depending on the type of sports/exercise they engage in. The present study aimed to identify the association between specific sports and exercise types performed in groups and evaluate the longitudinal changes in multidimensional frailty scores among community-dwelling older adults in Japan. METHODS: We used 3-year follow-up data from the Japan Gerontological Evaluation Study and analyzed 33,746 men and 36,799 women aged ≥ 65 years. To elucidate the relationship between participation in 20 types of group sports/exercises in 2016 (baseline) and the change in frailty score (using the Kihon Checklist, KCL) from 2016 to 2019, we performed linear regression analyses through multivariate adjustments for age group, self-rated health, marital status, living alone, occupational status, years of education, alcohol drinking status, smoking status, equivalent income, and disease status using an inverse probability weighting method. P < 0.05 was considered statistically significant. RESULTS: The mean change in KCL scores over 3 years was + 0.62 and + 0.61 points in men and women, respectively, implying the degree of frailty worsened. The sports/exercise types that significantly prevented increments in KCL scores for both sexes compared to non-participants were hiking (men: B, - 0.36; women: B, - 0.29), walking (men: B, - 0.26; women: B, - 0.24), tennis (men: B, - 0.23; women: B, - 0.24), ground golf (men: B, - 0.21; women: B, - 0.19), and weight exercises (men: B, - 0.19; women: B, - 0.16). CONCLUSION: Participation in specific sports and exercise groups offer significant physical and psychological benefits for frailty prevention among older adults in Japan. The results of this study may offer substantive evidence to encourage older adults to participate in group activities for the prevention of multidimensional frailty. It will also help public health stakeholders to decide which type of sports and exercise groups to promote in a community.

Association between Increasing Social Capital and Decreasing Prevalence of Smoking at the Municipality Level: Repeated Cross-Sectional Study from the JAGES.

As smoking cessation is crucial for both individual and public health, this study aimed to elucidate the association between changes in social capital and in terms of smoking at the level of municipal units in Japan. Using repeated cross-sectional data from the Japan Gerontological Evaluation Study, we analyzed data from adults aged 65 years or older from 69 municipal units that participated in two survey waves. We received valid responses from 91,529 and 86,403 older people in 2013 and 2019, respectively, and aggregated all variables by municipal units. For the dependent variable, we used the units' prevalence of smoking for both years. The independent variables were the percentages of social capital indicators, such as social participation, social cohesion, and reciprocity for each of the 69 municipal units. The mean prevalence of smoking increased from 9.7% in 2013 to 10.2% in 2019. Multiple regression analysis revealed that increases in the percentages of sports group participation, receiving emotional and instrumental social support, and reciprocity were significantly associated with decreased prevalence of smoking, after we adjusted for confounding variables. This study indicates that building social capital might be useful in promoting smoking cessation and that its indicators could be useful in monitoring efforts.

Correlates of engaging in sports and exercise volunteering among older adults in Japan.

This study aimed to identify factors associated with engaging in sports and exercise volunteering among older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study (JAGES), a nationwide mail survey of 20,877 older adults from 60 municipalities. Multilevel mixed-effects logistic regression analysis was used to investigate the correlation between engaging in sports and exercise volunteering and 39 variables classified into five factors: (1) demographic and biological, (2) behavioral, (3) psychological, cognitive, and emotional, (4) social and cultural, and (5) environmental factors. Among the analyzed samples, 1580 (7.6%) participants volunteered a few times/year or more often. Factors that showed positive association with the volunteering were older age, a current drinking habit, excellent self-rated health, high proportion of sports group participants in a living area, low municipal population density, and rich social and cultural features (i.e., social cohesion, support, network, and participation). Meanwhile, those that had a negative association were women, low level of education, deteriorated instrumental activities of daily living, having a past or current smoking habit, poor self-rated health, and depressive symptoms. We clarified the characteristics of the population that is more likely to participate in sports and exercise volunteering as well as those of the population that is less likely to participate and requires support.

Community-level educational attainment and dementia: a 6-year longitudinal multilevel study in Japan.

BACKGROUND: As the understanding of the association between community-level education and dementia is insufficient, this study examined the contextual association of community-level prevalence of low educational attainment on the risk of dementia incidence. With this study, we further explored the potential differences in the aforementioned associations for urban and non-urban areas. METHODS: We analyzed 6 years of prospective cohort data from the Japan Gerontological Evaluation Study, beginning with the baseline data collected between 2010 and 2012, for 51,186 physically and cognitively independent individuals aged ≥65 years (23,785 men and 27,401 women) from 346 communities in 16 municipalities across 7 prefectures. We assessed dementia incidence using available data from the long-term care insurance system in Japan. We dichotomized education years as ≤9 and ≥ 10 years and aggregated individual-level educational attainment as a community-level independent variable. Model 1 covariates were age and sex. Income, residential years, disease, alcohol, smoking, social isolation, and population density were added in Model 2. We conducted multiple imputation to address the missing data. We performed a two-level (community and individual) survival analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The results indicate that the cumulative incidence of dementia during the follow-up period was 10.6%. The mean proportion with educational attainment of ≤9 years was 40.8% (range: 5.1-87.3%). Low community-level educational attainment was significantly associated with higher dementia incidence (HR: 1.04; 95% CI: 1.01-1.07), estimated by 10 percentage points of low educational attainment after adjusting for individual-level educational years and covariates. While the association was significant in non-urban areas (HR: 1.07; 1.02-1.13), there was no association in urban areas (HR: 1.03; 0.99-1.06). CONCLUSIONS: Older people living in communities with low educational attainment among their age demographic develop dementia more often compared with those living in areas with high educational attainment after adjusting for individual-level educational attainment and covariates; the association was pronounced in non-urban areas. Securing education for adolescents as a life course and population approach could thus be crucial in preventing dementia later in life among older people living in non-urban areas.

Community-Level Sports Group Participation and the Risk of Cognitive Impairment.

PURPOSE: Community-level group participation is a structural aspect of social capital that may have a contextual influence on individual health. We investigated the contextual effect of community-level prevalence of sports group participation on the risk of cognitive impairment among older individuals. METHODS: We analyzed prospective cohort data from the Japan Gerontological Evaluation Study, a nationwide survey of 40,308 functionally independent older individuals from 346 communities. Cognitive impairment was assessed by the nationally standardized dementia scale proposed by the Ministry of Health, Labour and Welfare of Japan. Participation in a sports group 1 d per month or more frequently was defined as "participation." We applied a two-level multilevel survival analysis to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: The cumulative incidence of cognitive impairment during the 6-yr follow-up period was 9.8%. The mean proportion of sports group participation was 25.2% (range, 0.0%-56.5%). Higher prevalence of community-level sports group participation was associated with a lower risk of cognitive impairment (HR, 0.92; 95% CI, 0.86-0.99, estimated by 10 percentage points of participation proportion) after adjusting for individual-level sports group participation, sex, age, disease, obesity, social isolation, alcohol, smoking, education, income, depression, daily walking time, population density, and sunlight hours. We found cross-level interaction between individual- and community-level sports group participation (HR, 0.87; 95% CI, 0.76-0.99). CONCLUSIONS: We found a contextual preventive effect of community-level sports group participation on developing cognitive impairment among older individuals. Furthermore, the benefit may favor sports group participants. Therefore, promoting sports groups in a community setting may be effective as a population-based strategy for the prevention of dementia.

Community-level Sports Group Participation and Older Individuals' Depressive Symptoms.

PURPOSE: Community-level group participation is a structural aspect of social capital that may have a contextual influence on an individual's health. Herein, we sought to investigate a contextual relationship between community-level prevalence of sports group participation and depressive symptoms in older individuals. METHODS: We used data from the 2010 Japan Gerontological Evaluation Study, a population-based, cross-sectional study of individuals 65 yr or older without long-term care needs in Japan. Overall, 74,681 participants in 516 communities were analyzed. Depressive symptoms were diagnosed as a 15-item Geriatric Depression Scale score of ≥5. Participation in a sports group 1 d·month or more often was defined as "participation." For this study, we applied two-level multilevel Poisson regression analysis stratified by sex, calculated prevalence ratios (PR), and 95% confidence intervals (CI). RESULTS: Overall, 17,420 individuals (23.3%) had depressive symptoms, and 16,915 (22.6%) participated in a sports group. Higher prevalence of community-level sports group participation had a statistically significant relationship with a lower likelihood of depressive symptoms (male: PR, 0.89 (95% CI, 0.85-0.92); female: PR, 0.96 (95% CI, 0.92-0.99), estimated by 10% of participation proportion) after adjusting for individual-level sports group participation, age, diseases, family form, alcohol, smoking, education, equivalent income, and population density. We found statistically significant cross-level interaction terms in male participants only (PR, 0.86; 95% CI, 0.77-0.95). CONCLUSIONS: We found a contextual preventive relationship between community-level sports group participation and depressive symptoms in older individuals. Therefore, promoting sports groups in a community may be effective as a population-based strategy for the prevention of depression in older individuals. Furthermore, the benefit may favor male sports group participants.

Systemic chemotherapy using paclitaxel and carboplatin plus regional hyperthermia and hyperbaric oxygen treatment for non-small cell lung cancer with multiple pulmonary metastases: preliminary results.

PURPOSE: The purpose of this retrospective case series was to evaluate the toxicity and efficacy of systemic chemotherapy using paclitaxel and carboplatin plus regional hyperthermia (HT) and hyperbaric oxygen treatment (HBO) for non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: Twenty-two patients with NSCLC with multiple pulmonary metastases intravenously received paclitaxel (50 mg/m(2)), carboplatin (area under the curve of 1.0-1.5) and 10% glucose weekly for 3 out of 4 weeks. Hyperthermia (HT) of the whole thoracic region was also administered weekly during intravenous infusion of carboplatin in all patients. In addition, 16 (72%) of 22 patients received hyperbaric oxygen (HBO) treatment immediately after weekly chemotherapy. A total of 107 cycles were performed in 16 patients with HBO, and 27 cycles in 6 patients without HBO. The toxicity and efficacy of these patients were retrospectively analyzed. RESULTS: Both the hematologic and non-hematologic toxicities were mild and leucopenia/neutropenia of > or = grade 3 was seen in one patient, while pneumonitis of > or = grade 3 occurred in one patient. Fourteen (64%) of 22 patients had an objective response. The median time to progression of disease in all patients was 8 months and in 16 patients with HBO was 9 months. Four (44%) of 9 patients with prior chemotherapy including paclitaxel and carboplatin obtained objective responses. CONCLUSIONS: The novel combined therapy of paclitaxel and carboplatin with HT and HBO may therefore be a feasible and promising modality for treating NSCLC with multiple pulmonary metastases, and the results justify further evaluation to clarify the benefits of this treatment regimen.