[Questionnaire survey of municipalities on policies to promote physical activity among residents: An examination by administrative sector and population size].

Objectives　National policies to promote physical activity and exercise have been formulated by several ministries and agencies in Japan. This study aimed to examine the formulation and implementation of such policies in municipalities by administrative sector and population size.Methods　After stratifying all municipalities in Japan at the population level, we randomly selected 272 municipalities. We collected 1,632 cases in six sectors (health, sports, education, urban planning, transportation, and environment) within these municipalities.　A questionnaire survey on the status of policy formulation, implementation, and coordination among departments was conducted as a cross-sectional study. Differences between groups of municipalities were statistically analyzed using Fisher's exact test. The survey period was from September 2018 to March 2019.Results　A total of 616 responses were collected (response rate 37.7%). The response rates for health and education were lower than those for the other sectors. The rate of policy formulation to promote physical activity was extremely high in the health and sports sectors, and there was slight variation by population size. In contrast, formulation rates were generally low in the urban planning, transportation, and environment sectors, especially in smaller municipalities. In the sectors mentioned above, physical activity promotion projects mainly involved the development of exercise and sports infrastructures. Health, sports, and education were the primary sectors that used those environments. Regarding interdepartmental coordination in policy implementation, a cooperative relationship existed among the health, sports, and education sectors and between the urban planning and transportation sectors. However, smaller municipalities were found to have fewer opportunities for such collaboration and tended to implement policies independently.Conclusion　This study clarifies the policy formulation and implementation for promoting physical activity in municipalities at the national level in Japan. In addition, their characteristics were identified based on different administrative sectors and population size. These results are expected to be used in future local government policies.

[Treatment indications for sarcopenia: a systematic review of exercise intervention effect].

OBJECTIVE: To evaluate exercise intervention efficacy for the prevention and treatment of sarcopenia in the elderly. METHODS: We conducted a systematic literature search of randomized controlled trials in the Physical Activity Guidelines Advisory Committee Report (before 2007), Pubmed, the Cochrane database, and Igaku Chuo Zasshi (January 2006 to August 2009). DATA EXTRACTION: Two authors independently extracted relevant data. A total of 951 articles were found by search engines, and 9 studies were finally selected after a review by 2 experts. The content of these studies, especially duration, sets, periods, frequency, and intensity of exercise intervention were extracted and summarized in a results table. Five of 6 articles concluded that high-intensity resistance training significantly increased soft lean tissue and muscle mass. The remaining 3 articles indicated that moderate-intensity resistance training did not affect soft lean tissue or muscle mass. CONCLUSION: This systematic review suggested that high-intensity resistance training with sufficient periods, frequency, repetitions, and sets is effective to counteract the loss of muscle mass associated with advancing age.

Effects of wind and rain on thermal responses of humans in a mildly cold environment.

The purpose of the present study was to clarify the effects of wind and rain on peripheral heat loss by non-exercising minimally clothed humans in a mildly cold environment. Seven healthy young male subjects wearing only shorts rested in a standing position for 20 min at an ambient temperature of 15 degrees C under three conditions: without exposure to wind or rain (CON), with exposure to wind (3 m/s) (WIND) and with exposure to wind (3 m/s) and rain (40 mm/h) (WIND + RAIN). Mean heat loss measured using a heat flux transducer was significantly greater in the subjects exposed to WIND + RAIN compared to those exposed to CON and WIND conditions (p < 0.01). Metabolic heat production was significantly greater under WIND + RAIN than under CON and WIND (p < 0.01). Decrease in heat storage was significantly larger at WIND + RAIN compared with CON and WIND (p < 0.01). Mean skin temperature was significantly lower under WIND + RAIN than under CON and WIND conditions (p < 0.01). These results indicate that peripheral heat loss significantly increases when humans are exposed to wind and rain for a short period (20 min) under a mildly cold condition.

[Effectiveness of a community health service program using exercise intervention for elderly people with osteoarthritis of the knees: a randomized controlled trial].

OBJECTIVE: The objective of this study was to evaluate the effectiveness of an exercise program conducted as part of community health services to improve pain and physical function in elderly people with osteoarthritis of the knee (knee OA). METHODS; The subjects were 88 (12 males aged 77.8 +/- 5.4 years and 76 females aged 73.2 +/- 5.3 years) community-dwelling independent elderly people with knee OA who participated voluntarily in exercise classes sponsored by Musashino city of Tokyo. They were allocated randomly to the intervention group (n = 44) and the control group (n = 44). For the intervention group, exercise classes of 90 min duration were held 8 times over 3 months. The exercise program comprised flexibility exercises (stretching of knee and ankle joints), resistance exercises (strengthening of quadriceps, extension and flexion of the knee joint with an elastic band), and movement exercises (turning over, getting up, standing up). The subjects were instructed to perform these exercises at home every day. Knee pain scores (Western Ontario and McMaster Universities OA Index; WOMAC), peak torque of joint during knee flexion and extension, range of motion (ROM) of the knee joint, and functional fitness (standing and walking ability) were evaluated before and after the intervention period. RESULTS: Significant inter-group differences were observed for peak torque during knee flexion and standing and walking ability of females. Assessment of interactions between time and group by repeated measure ANOVA adjusted for age and sex revealed significance differences for the WOMAC score (P = 0.031), the peak torque during knee extension (P = 0.016) and knee flexion (P = 0.000), ROM (P = 0.037), standing ability (P = 0.000)and walking ability (P = 0.000). The effect of the intervention was 0.44 for WOMAC score, 0.23 for peak torque during knee extension, 0.64 for knee flexion, 0.32 for ROM, 0.81 for standing ability, and 1.13 for walking ability. CONCLUSIONS: These results suggested that the exercise program for elderly people with knee OA improved knee pain and physical function.

[Efficacy of a community-based weight reduction program to improve exercise and diet behavior in overweight adults].

OBJECTIVE: The study was a non-randomized, parallel-group comparison to evaluate the efficacy of a community-based weight reduction program with exercise and diet modification for overweight adults using existing community health services. METHODS: The study population consisted of 1,115 community-dwelling people who underwent annual health checkups in 2002 and were screened by exclusion criteria (age> 65, body mass index (BMI) < 24.2). They received a mail request to select one of two courses; a usual single-session health instruction course (control group) or a 9-month weight management course (intervention group). Forty six patients registered in the intervention group, and fifty patients in the control group. The analyzed sample consisted of 76 participants (9 males and 67 females) excluding dropouts from November 2002 to July 2003. Intervention included monthly classes (2 hours per class, 9 classes) consisting of an individual support program for behavioral change and a community support program for continuation after the class. The control group participants received conventional instructions based on their health status. RESULTS: No significant inter-group differences were observed at baseline, except in age and height of females. The mean BMI decreased from 27.2 (SD = 2.8) kg m(-2) to 25.3(3.1) kg m(-2) in the intervention group, and 26.4 (1.7) kg m(-2) to 26.1(1.7) kg m(-2) in the control group. Repeated measures analysis of variance showed significant time and group interaction adjusted for gender and age. The proportion showing maintenance and action in stage of exercise behavior increased in the intervention group (31% to 60%), but remained stable in the control group (45% to 48%) . The proportion showing maintenance and action in stage of diet behavior increased in the intervention group (24% to 80%), but remained stable in the control group (29% to 26%). CONCLUSION: Community-based weight reduction programs may be effective to facilitate change in exercise and diet behavior for body weight reduction in overweight adults.

Impact of lifestyle intervention on physical activity and diet of Japanese workers.

OBJECTIVE: To evaluate the effectiveness of the Life Style Modification Program for Physical Activity and Diet (LiSM-PAN) in comparison to a conventional healthcare program. METHOD: Subjects with risk factor(s) for chronic disease were allocated as a cluster to the LiSM group (n=92) or the Control group (n=85). The LiSM-PAN program consisted of counseling plus social and environment support, and the Control program consisted of written feedback for changing physical activity and dietary practice. Intervention was conducted for 6 months during 2001-2002 and with data analysis during 2003-2004 in Tokyo, Japan. The main outcomes were leisure time exercise energy expenditure (L.E.E.E.), maximum oxygen uptake (VO2max), dietary habits, body mass index (BMI), blood pressure, blood glucose, and lipid parameters. RESULTS: The LiSM group showed a significantly greater increase in L.E.E.E. than the Control group at the end of the intervention (mean inter-group difference: 400.6 kcal/week, 95% CI: 126.1, 675.0 kcal/week). No significant mean inter-group differences were observed in dietary habits. The LiSM group showed significantly greater decreases in BMI, systolic blood pressure, and LDL-cholesterol than the Control group. CONCLUSION: The LiSM-PAN program produced greater positive changes in L.E.E.E., dietary habits, and risk factors for cardiovascular diseases in high-risk middle-aged male workers compared to the Control program.

Effects of a 5-year exercise-centered health-promoting programme on mortality and ADL impairment in the elderly.

OBJECTIVE: the effects of regular exercise over 5 years on mortality and ADL impairment were evaluated in elderly people. DESIGN: intervention study. SETTING: Tsuru City, Yamanashi Prefecture, Japan. METHODS: the subjects of this study were 245 elderly people living at home. Of these individuals, 155 (56 males aged 76.5+/-4.2 years at the baseline level; 99 females aged 76.2+/-4.8 years) who voluntarily participated in our original health-promoting programme were regarded as an intervention group. The remaining 90 (29 males aged 77.6+/-5.2 years at the baseline level; 61 females aged 77.3+/-5.1 years) were regarded as a control group. The programme was a 5-year intervention consisting of collective sessions given six times a year every 2 months. The intervention was a combination of an exercise programme based on theories of exercise physiology and a support programme based on health education theories. The relative risks of death and ADL impairment adjusted for age, presence or absence of cardiovascular or musculo-skeletal disorders, and functional fitness level at the baseline were calculated using logistic regression analysis. RESULTS: the rates of participant compliance per year were 67.7% in the first year of the intervention period and gradually decreased thereafter to 43.9% in the last year. Amongst female subjects the percentage of those who exercised habitually at the end of the study period was the same as that in the baseline in the intervention group but was significantly lower at the end of the study in the control group (chi2 = 10.576, P < 0.01). The relative risk of death in the intervention group was 1.0 (95% CI 0.22-4.51) amongst the males and 0.16 (95% CI 0.03-0.81) amongst the females. Relative risk of ADL impairment was 0.22 (95% CI 0.03-1.42) amongst the males and 0.36 (95% CI 0.13-1.02) amongst the females. CONCLUSION: These findings suggest that the improved mortality and state of independence in the female portion of the intervention group occurred as a result of increased physical exercise levels in daily life. However, validation of our results must await research that employs a randomized control trial to avoid various biases and confounding factors between the intervention and the control groups.

A 6-year cohort study on relationship between functional fitness and impairment of ADL in community-dwelling older persons.

We measured functional fitness in older subjects and performed a follow-up survey for 6 years to clarify whether the level of functional fitness at a given point contributes to prediction of the subsequent occurrence of impairment of functions necessary for independent living. The longitudinal data were obtained for 391 persons aged 60 years or over, who were independently living in the community. Four items of functional fitness, i.e. the ability to perform standing/sitting movements, ability to perform traveling movements, ability to perform housekeeping movements, and ability to perform personal grooming activities, were assessed. The relationship between functional fitness and the risk of the occurrence of impairment of independence in daily living was evaluated using a binomial logistic regression model. In males, all the 4 items of functional fitness were significantly related to the risk of impairment of activities of daily living (ADL). In females, however, none of the items was significantly related to the risk of ADL impairment. In conclusion, functional fitness appears to be valid as a predictive parameter of future occurrence of ADL impairment in relatively healthy and independent elderly males. However, its validity in elderly females needs further evaluation.