Association between flexibility activity and blood-pressure change among older adults in Japan: A 5-year longitudinal study.

This longitudinal study examined the relationship between flexibility-activity and blood-pressure (BP) change among older adults in Japan. Our study included 452 older adults who took part in our survey in both 2012/2013 and 2017/2018. The seated systolic blood pressure (SBP) and diastolic BP (DBP) were measured both at baseline and at the 5 years follow-up. The frequencies of the different physical activities at baseline were assessed using a questionnaire. A generalized linear mixed model was used to estimate the non-standardized coefficient (B) of BP change associated with flexibility activity, after adjustments for sex, age, body mass index, smoking status, alcohol consumption, antihypertensive medication use, history of heart disease, walking time, and muscle-strengthening activity as a fixed-effect, and area of residence as a random-effect. Higher flexibility-activity frequency was significantly associated with reduced SBP (B = -0.77 [95% confidence intervals = -1.36, -0.18], p for linear trend = 0.01, p for quadratic trend = 0.85) and DBP (-0.33 [-0.71, 0.05], p for linear trend = 0.09, p for quadratic trend = 0.04). Engaging in flexibility activity for 3 days per week was significantly associated with a reduction in DBP (B = -4.16, 95% CI [-7.53, -0.79], p = 0.02) compared with that in the reference group (0 days per week). Interaction tests were not significant between basic variables (sex, age, BMI, and antihypertensive medication) and flexibility. In conclusion, higher flexibility activity frequency was associated with a reduction in BP in older adults. Future longitudinal and interventional studies should examine the effects of flexibility activity on cardiovascular disease prevention.

Advocating for Implementation of the Global Action Plan on Physical Activity: Challenges and Support Requirements.

BACKGROUND: There is limited understanding of the challenges experienced and supports required to aid effective advocacy of the Global Action Plan on Physical Activity (GAPPA). The purpose of this study was to assess the challenges experienced and supports needed to advocate for the GAPPA across countries of different income levels. METHODS: Stakeholders working in an area related to the promotion of physical activity were invited to complete an online survey. The survey assessed current awareness and engagement with the GAPPA, factors related to advocacy, and the perceived challenges and supports related to advocacy for implementation of the GAPPA. Closed questions were analyzed in SPSS, with a Pearson's chi-square test used to assess differences between country income level. Open questions were analyzed using inductive thematic analysis. RESULTS: Participants (n = 518) from 81 countries completed the survey. Significant differences were observed between country income level for awareness of the GAPPA and perceived country engagement with the GAPPA. Challenges related to advocacy included a lack of support and engagement, resources, priority, awareness, advocacy education and training, accessibility, and local application. Supports needed for future advocacy included guidance and support, cooperation and alliance, advocacy education and training, and advocacy resources. CONCLUSIONS: Although stakeholders from different country income levels experience similar advocacy challenges and required supports, how countries experience these can be distinct. This research has highlighted some specific ways in which those involved in the promotion of physical activity can be supported to scale up advocacy for the GAPPA. When implementing such supports, consideration of regional, geographic, and cultural barriers and opportunities is important to ensure they are effective and equitable.

Usefulness of Implementation Outcome Scales for Digital Mental Health (iOSDMH): Experiences from Six Randomized Controlled Trials.

OBJECTIVES: Measuring implementation outcomes for digital mental health interventions is essential for examining the effective delivery of these interventions. The "Implementation Outcome Scale of Digital Mental Health" (iOSDMH) has been validated and used in several trials. This study aimed to compare the iOSDMH for participants in six randomized controlled trials (RCTs) involving web-based interventions and to discuss the implications of the iOSDMH for improving the interventions. Additionally, this study examined the associations between iOSDMH scores and program completion rate (adherence). METHODS: Variations in total scores and subscales of the iOSDMH were compared in six RCTs of digital mental health interventions conducted in Japan. The web-based intervention programs were based on cognitive behavioral therapy (2 programs), behavioral activation (1 program), acceptance and commitment (1 program), a combination of mindfulness, behavioral activation, and physical activity (1 program), and government guidelines for suicide prevention (1 program). Participants were full-time employees (2 programs), perinatal women (2 programs), working mothers with children (1 program), and students (1 program). The total score and subscale scores were tested using analysis of variance for between-group differences. RESULTS: Total score and subscale scores of the iOSDMH among six trials showed a significant group difference, reflecting users' perceptions of how each program was implemented, including aspects such as acceptability, appropriateness, feasibility, overall satisfaction, and harm. Subscale scores showed positive associations with completion rate, especially in terms of acceptability and satisfaction (R-squared = 0.93 and 0.89, respectively). CONCLUSIONS: The iOSDMH may be a useful tool for evaluating participants' perceptions of features implemented in web-based interventions, which could contribute to improvements and further development of the intervention.

Evaluation of pre-Games effects of the Tokyo 2020 Olympic Games on Japanese population-level physical activity: a time-series analysis.

BACKGROUND: The Olympic Games represent an opportunity to create a 'physical activity legacy' that promotes physical activity at the population level in the host nations and cities. However, previous studies showed little increase in population-level physical activity following the Olympics. The upsurge of public interest in sports and physical activity participation before the Olympics may diminish rapidly following the Games. We examined the pre-Games effects of the Olympics on Japanese population-level physical activity after the announcement of Tokyo's successful bid for the 2020 Olympic and Paralympic Games in September 2013. METHODS: We used publicly available data from serial cross-sectional surveys conducted with nationally or regionally representative samples in Japan seven years before and after the announcement (from 2006-2020). The outcomes were 1) daily step counts and 2) exercise habit prevalence (≥ 30 min/day, ≥ 2 days/week, and over a year) from the National Health and Nutrition Surveys Japan (NHNS-J; 14 time points; aggregated data); and 3) sports participation (at least once a week) from the National Sports-Life Survey conducted every two years (NSLS; eight time points; individual-level data of 18,867 adults) and from the Public Opinion Survey on Sports Participation of Tokyo Residents (POSSP; eight time points; aggregated data). Age- and gender-adjusted regression models were used to estimate changes in the outcomes before and after the announcement. RESULTS: There were no significant pre-Games effects of the Olympics on national-level physical activity participation among Japanese adults. Sports participation (56.4% and 57.5%, respectively; P = 0.518), daily steps (6,535 and 6,686 steps/day; P = 0.353), and exercise habit (30.7% and 29.1%, P = 0.309) did not change significantly before and after the announcement. Although an increase in sports participation among Tokyo residents was not found in the NSLS (61.5% and 59.3%, P = 0.227), it was observed in the POSSP (49.1% and 57.7%, P = 0.019). Nonetheless, this increase might not be related to the pre-Games effects since the trend diminished following the announcement. CONCLUSIONS: Population-level physical activity did not show significant changes until 2020. Realising the physical activity legacy of an Olympics may require strategic promotion and cross-agency partnership implementation in the pre- and post-event period.

Evaluating the feasibility of a remote-based training program supported by information and communications technology in the older adults living at home.

BACKGROUND: Exercise has been one of the key strategies for preventing frailty. While training programs for preventing frailty have been mainly developed in person, which have now become difficult to perform due to the coronavirus disease pandemic. It would be worthwhile to explore a feasibility of methods for a remote-based training with information and communications technology (ICT) in the pre-frail/robust older adults living at home. METHODS: We assessed the feasibility of a remote-based training with ICT device in terms of 1) a measurement accuracy and 2) whether it could be used for remote-based training of different intensities. To evaluate a measurement accuracy of the ICT device, we evaluated an inter-rater reliability between a true score and scores obtaining from the ICT device in 20 participants aged 65 years and older. Intraclass correlation was calculated. To evaluate a feasibility of remote-based training interventions of different intensities, we did a parallel, randomized, active controlled trial. Participants aged 65 years or older were randomly allocated to the two 3-month intervention programs with different intensity of exercise with the ICT (i.e., an Exercise-Intensive program and a Light-load exercise program). The primary outcome was 3-month scores of the 30-s chair-stand test (CS-30), which was compared between two groups using mixed models for repeated measures to account for within-person correlations. RESULTS: The ICT device showed a high intraclass correlation of over 0.99 for all outcomes including CS-30. Between Aug and Oct 2020, 70 participants (36 and 34 in the Exercise-Intensive and Light-load exercise programs, respectively) were randomized. After 3 months of intervention, CS-30 scores and other physical function improved in both groups. Difference in the 3-month CS-30 scores between two programs was found to be 0.08 (95% confidence interval: - 2.64, 2.79; p = 0.955), which was not statistically significant. No harmful incidents, such as falls, occurred in either group. CONCLUSION: We showed a remote-based training with ICT device in the older adults living at home was feasible. Further studies are warranted to determine what kind of remote exercise intervention programs is more effective for maintaining a physical performance and, beyond that, preventing frailty. TRIAL REGISTRATION NUMBER: UMIN000041616 (05/09/2020) https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000047504&type=summary&language=E.

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.

Parental Working Hours and Children's Sedentary Time: A Cross-sectional Analysis of the J-SHINE.

BACKGROUND: Sedentary behaviors are prevalent among children and can have a detrimental effect on their health. Little is known about the influence of parental time on children's sedentary behavior. This study examined the association between parental working hours and children's sedentary time. METHODS: Cross-sectional data were drawn from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE) in 2010 and 2011. Participants were 886 children aged 7-18 years and their parents. The primary outcome was self-reported sedentary time after school that comprised screen time and non-screen time. The main explanatory variable was parental working hours. We used multiple regression analysis adjusting for sociodemographic factors. RESULTS: Children's mean sedentary time was 222 (standard deviation [SD], 123) min/day; 144 (SD, 108) min/day screen time and 78 (SD, 65) min/day non-screen time. Children whose mothers worked ≥20 hours/week had 28 (95% CI, 9 to 48) min/day longer sedentary time than children of homemakers (240 min/day vs 214 min/day). The longer maternal working hours, the longer sedentary time (P for trend <0.01). In contrast, children whose fathers worked ≥48 hours/week had 82 (95% CI, -156 to -7) min/day shorter sedentary time than children of non-working fathers (179 min/day vs 264 min/day). When limited to children whose fathers worked, there was no statistically significant association between children's sedentary time and paternal working hours. CONCLUSIONS: Children with mothers who work long hours or fathers not working tend to sit more. Supplementing the shortages in resources for childcare may be necessary among those families.

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.

Large-Scale Fandom-based Gamification Intervention to Increase Physical Activity: A Quasi-experimental Study.

PURPOSE: Gamification, the use of game design elements in nongame contexts, in combination with insights from behavioral economics, has been applied increasingly to behavior change interventions. However, little is known about the effectiveness or scalability of this approach, especially in the long term. We tested a large-scale smartphone-based intervention to encourage physical activity among Japanese baseball fans using gamification techniques that leveraged fandom and interteam competition inherent in sports. METHODS: A quasi-experimental study was conducted among fans of the Japanese Pacific League. The app, Pa-League Walk, included gamification elements, such as competition between opposing teams' fans based on total daily step counts on game days (>60,000 free downloads since March 2016). We analyzed daily steps of 20,052 app users, supplemented by online survey data of 274 users and 613 matched controls. Difference-in-differences estimators evaluated change in daily steps before and after app installation in users versus matched controls. RESULTS: Users' daily steps increased by 574 (95% confidence interval, 83-1064) steps 3 months after installation, compared with controls. The increase was maintained for up to 9 months (559 (99-1018) more steps per day vs baseline), attenuating over a longer follow-up. Positive effect modification was found by high-frequency of the app use (P < 0.001) but not by other covariables (P ≥ 0.14) such as education or income. Days with 10,000-step achievement increased from 24.4% to 27.5% after the additional introduction of incentives (digital player photographs; P < 0.001). CONCLUSIONS: Using existing fandom and solidarity, the gamification app increased physical activity at scale among baseball fans, including people with lower socioeconomic status underrepresented in traditional health programs.

Impacts of ambient temperature and seasonal changes on sports injuries in Madrid, Spain: a time-series regression analysis.

OBJECTIVES: Recreational physical activity is an integral part of our society, and the injuries caused by sports activities are a concern for public health. We studied the effect of outdoor ambient temperature on hospital emergency department visits caused by sports injuries in Madrid, Spain, and accounted for its seasonal changes. METHODS: We used a time-series design. Data was analysed with quasi-Poisson regression models. We calculated the proportion of emergency visits attributable to seasonal changes before and after adjusting for daily ambient temperature. We modelled the association between emergency visits and temperature using distributed lag non-linear models. RESULTS: The proportion of emergency visits attributable to seasonal changes was 24.1% and decreased to 7.6% after adjusting for temperature. We found a high risk of emergency visits associated with cold and hot temperatures, whereas the risk was higher for heat. CONCLUSION: Sports and recreational physical activity injuries are not rare events; therefore, appropriate healthcare decisions should consider the impact of outdoor ambient temperature and seasonal changes.

Implementation Outcome Scales for Digital Mental Health (iOSDMH): Scale Development and Cross-sectional Study.

BACKGROUND: Digital mental health interventions are being used more than ever for the prevention and treatment of psychological problems. Optimizing the implementation aspects of digital mental health is essential to deliver the program to populations in need, but there is a lack of validated implementation outcome measures for digital mental health interventions. OBJECTIVE: The primary aim of this study is to develop implementation outcome scales of digital mental health for different levels of stakeholders involved in the implementation process: users, providers, and managers or policy makers. The secondary aim is to validate the developed scale for users. METHODS: We developed English and Japanese versions of the implementation outcome scales for digital mental health (iOSDMH) based on the literature review and panel discussions with experts in implementation research and web-based psychotherapy. The study developed acceptability, appropriateness, feasibility, satisfaction, and harm as the outcome measures for users, providers, and managers or policy makers. We conducted evidence-based interventions via the internet using UTSMeD, a website for mental health information (N=200). Exploratory factor analysis (EFA) was conducted to assess the structural validity of the iOSDMH for users. Satisfaction, which consisted of a single item, was not included in the EFA. RESULTS: The iOSDMH was developed for users, providers, and managers or policy makers. The iOSDMH contains 19 items for users, 11 items for providers, and 14 items for managers or policy makers. Cronbach α coefficients indicated intermediate internal consistency for acceptability (α=.665) but high consistency for appropriateness (α=.776), feasibility (α=.832), and harm (α=.777) of the iOSDMH for users. EFA revealed 3-factor structures, indicating acceptability and appropriateness as close concepts. Despite the similarity between these 2 concepts, we inferred that acceptability and appropriateness should be used as different factors, following previous studies. CONCLUSIONS: We developed iOSDMH for users, providers, and managers. Psychometric assessment of the scales for users demonstrated acceptable reliability and validity. Evaluating the components of digital mental health implementation is a major step forward in implementation science.

Association between hilliness and walking speed in community-dwelling older Japanese adults: A cross-sectional study.

PURPOSE: This cross-sectional study investigated the association between hilliness and walking speed in community-dwelling older adults, and whether it varied according to their car-driving status. METHODS: Data were collected from 590 participants aged 65 and older living in Okinoshima Town, Shimane prefecture, Japan, in 2018. Comfortable walking speed (m/s) was objectively assessed. Hilliness was measured by the mean land slope (degree) within a 500-m or 1000-m network buffer around each participant's home using a geographic information system. A multiple linear regression examined whether the land slope was associated with walking speed, adjusted for sex, age, body mass index, smoking habits, alcohol consumption habits, exercise habits, chronic disease, and living arrangements. A stratified analysis by car-driving status was also conducted. RESULTS: After adjusting for all confounders, the land slope within the 500-m or 1000-m network buffer was negatively associated with walking speed (B = -0.007, 95% CI [-0.011, -0.002]; B = -0.007, 95% CI [-0.011, -0.003], respectively). The stratified analysis by car-driving status showed that living in a hilly area was negatively associated with walking speed among non-drivers in the 500-m or 1000-m network buffer (B = -0.011, 95% CI [-0.017, -0.004]; B = -0.012, 95% CI [-0.019, -0.006]), though there were no associations among drivers. CONCLUSIONS: A hilly environment is positively associated with slow walking speed in community-dwelling older adults in Japan. Moreover, car-driving status potentially modifies the relationship between living in a hilly environment and slow walking speed.

An evidence-based assessment of the impact of the Olympic Games on population levels of physical activity.

Pre-Olympic Games predictions commonly include an increase in population-based physical activity in the host city, as often stated in the bid, but the post-Olympic Games effects on physical activity have not been summarised. In this Series paper, we aim to do the following: examine mentions of a physical activity legacy in pre-Olympic bid documentation; analyse existing physical activity surveillance data collected before, during, and after the Olympic Games in hosting areas around the world; and evaluate Google Trends data surrounding the London 2012 Olympic Games as a case study of community interest in the topic of exercise during the time of the Olympic Games. Before 2007, little mention of physical activity was made in pre-Olympic Games documentation, but, after that, most documents had targets for population physical activity or sports participation. The synthesis of available surveillance data indicates that there was no change in the prevalence of physical activity or sports participation, except for the 2008 Summer Olympics in Beijing and the 1998 Winter Olympics in Nagano; although, the increase in participation in Nagano might not be attributable to the Olympic Games since there was no change in participation in winter sports. The Google Trends data showed an acute spike in searches with the term "Olympic" immediately associated with the London Olympic Games period and showed a sustained peri-Olympic increase in searches with the term "exercise". By themselves, the Olympic Games have not improved population-wide physical activity but might be an important missed public health opportunity. Such a legacy will require strategic planning and partnerships across the International Olympic Committee and the Olympic, sport, and public health agencies and a thorough evaluation framework implemented throughout the pre-Olympic Games and post-Olympic Games period in the host country.

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.

Estimating the Impact of Sustained Social Participation on Depressive Symptoms in Older Adults.

BACKGROUND: Social participation has been suggested as a means to prevent depressive symptoms. However, it remains unclear whether a one-time boost suffices or whether participation needs to be sustained over time for long-term prevention. We estimated the impacts of alternative hypothetical interventions in social participation on subsequent depressive symptoms among older adults. METHODS: Data were from a nationwide prospective cohort study of Japanese older adults ≥65 years of age (n = 32,748). We analyzed social participation (1) as a baseline exposure from 2010 (approximating a one-time boost intervention) and (2) as a time-varying exposure from 2010 and 2013 (approximating a sustained intervention). We defined binary depressive symptoms in 2016 using the Geriatric Depression Scale. We used the doubly robust targeted maximum likelihood estimation to address time-dependent confounding. RESULTS: The magnitude of the association between sustained participation and the lower prevalence of depressive symptoms was larger than the association observed for baseline participation only (e.g., prevalence ratio [PR] for participation in any activity = 0.83 [95% confidence interval = 0.79, 0.88] vs. 0.90 [0.87, 0.94]). For activities with a lower proportion of consistent participation over time (e.g., senior clubs), there was little evidence of an association between baseline participation and subsequent depressive symptoms, while an association for sustained participation was evident (e.g., PR for senior clubs = 0.96 [0.90, 1.02] vs. 0.88 [0.79, 0.97]). Participation at baseline but withholding participation in 2013 was not associated with subsequent depressive symptoms. CONCLUSIONS: Sustained social participation may be more strongly associated with fewer depressive symptoms among older adults.

[Evaluation of physical activity using smartphones and wearable devices in healthcare: Current situation and future perspectives].

Abstract　With the growing popularity of mobile health (mHealth) devices, including smartphones and wearable devices, information and communications technology has gained high importance in healthcare settings. This study aimed to summarize the current trends in physical activity research wherein mHealth devices are used and provide perspectives for future research. Until recently, questionnaire surveys were primarily used to evaluate physical activity. While questionnaire surveys are effective for subjective evaluation, the use of mHealth devices enables large-scale, real-time, objective evaluation of physical activity. In addition, mHealth devices automatically collect and aggregate data. This allows researchers to perform retrospective analysis of a wide range of indicators of physical activity and health. Particularly, the use of smartphones is highly likely to contribute to large-scale monitoring and health interventions because of their ubiquity. Even though there are fewer users of wearable devices (wrist-worn devices) than those of smartphones, using wearable devices allows for the evaluation of 24-hour movement patterns. The use of wearable devices helps perform further precise analysis that focuses not only on the total amount of physical activity but also on the quality, including measures of intensity, duration, frequency, type, and time. Moreover, some wrist-worn devices measure physiological information such as heart rate and may also provide location information. Combining such data with information from an accelerometer associated with a device may allow for further specific and detailed evaluation of physical activity. The validity of physical activity assessment using major mHealth devices has been confirmed in several studies and is comparable to that of pedometers and accelerometers developed for research purposes. Evaluation of physical activity using mHealth devices involves issues related to the representativeness of the target population and continuity of data, as well as the need for ethical considerations based on privacy policies. While mHealth devices may be used by individuals as a health management tool, it is also expected that the evaluation of physical activity using mHealth devices will be performed in various settings such as epidemiological and clinical studies on physical activity, as well as community services wherein indicators of physical activity are used.

Social participation and physical prefrailty in older Japanese adults: The Shimane CoHRE study.

As older adults in an early stage (prefrailty) of frailty may return to a healthy state, it is necessary to examine the prevention of prefrailty. In this context, the number and types of social participation activities associated with physical prefrailty in community-dwelling older adults have remained relatively unexplored. This cross-sectional study investigates this issue by analyzing 616 participants living in Okinoshima, Shimane, a rural area of Japan, in 2019. Frailty was assessed using the 5-item frailty phenotype (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity). Data on social participation were obtained using a questionnaire based on participants' level of involvement with volunteer groups, sports clubs/groups, neighborhood associations, religious organizations/groups, and community elderly salons; their answers were categorized as "yes" if they answered "several times per year or more" and "no" if they answered "never." Binominal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of prefrailty by the number or types of social participation activities, adjusted for gender, age, body mass index, smoking, medication-taking, educational attainment, working status, and living arrangement. Of the 616 participants, 273 (44.3%) and 28 (4.5%) had prefrailty and frailty, respectively. The analysis showed that the number of social participation activities was significantly associated with lower odds of prefrailty (OR = 0.83; 95% CI, 0.74-0.94). Regarding the types of social participation, sports clubs/groups were associated with lower odds of prefrailty (OR = 0.47; 95% CI, 0.31-0.73). Participation in neighborhood associations was associated with prefrailty/frailty (OR = 0.57; 95% CI, 0.37-0.86). These results suggest that increasing the number of social participation activities or involvement in sports clubs/groups and neighborhood associations may be important to prevent physical prefrailty in the older population.

Population strategy for promoting physical activity.

Physical inactivity is a globally prevalent phenomenon even though the health benefits of physical activity are well-known. The development of population strategies that effectively promote physical activity is necessary to reduce the individual and social burden of physical inactivity. Quality evidence informing strategies to promote physical activity at scale, however, is limited. Among cluster randomized trials examining the effectiveness of multistrategic, community-wide interventions aimed at promoting physical activity, only 1 trial (the COMMUNICATE study) successfully achieved a population-level increase in physical activity. This trial adopted social marketing techniques and network intervention (eg, word of mouth) in close collaboration with the target population (community residents). Although most previous studies ended their interventions within 1 to 3 years, the COMMUNICATE study took 5 years to achieve a population-level increase in physical activity. These findings suggest the need for a more focused approach (1 behavior at a time) as a basic marketing principle. Promoting physical activity at scale is a tough challenge but not impossible. Sophisticated approaches are necessary.

Prevalence and Correlates of Physical Activity Among Children and Adolescents: A Cross-Sectional Population-Based Study of a Rural City in Japan.

BACKGROUND: Although moderate-to-vigorous physical activity (MVPA) has multiple health benefits, current participation in recommended MVPA level and its determinants among Japanese children and adolescents remain unclear. Therefore, this cross-sectional study investigated the prevalence of meeting recommended MVPA level and its correlates among Japanese children and adolescents. METHODS: Using the Japanese version of the World Health Organization (WHO) Health Behaviour in School-aged Children survey questionnaire, we confirmed the prevalence of meeting recommended MVPA level in all primary schools (PS) and junior high schools (JHS) in Unnan City, Japan. We evaluated its association with school grade, gender, body weight status, screen time, consumption of breakfast, physical activity (PA) preference, and population density using Poisson regression. RESULTS: We found that 20.1% of the 1,794 students (9-15 years old) met the WHO recommendation. Meeting recommended MVPA level was significantly associated with being in the sixth grade of PS (prevalence ratio [PR] 0.57; 95% confidence interval [CI], 0.39-0.84) and first (PR 1.52; 95% CI, 1.16-1.99), second (PR 1.45; 95% CI, 1.10-1.90), and third grade of JHS (PR 0.40; 95% CI, 0.26-0.62) (vs fourth grade of PS); being a boy (PR 1.33; 95% CI, 1.12-1.59) (vs girl); liking PA (PR 3.72; 95% CI, 2.22-6.22) (vs dislike); and belonging to a medium-population-density (PR 0.73; 95% CI, 0.61-0.88) or low-population-density area (PR 0.67; 95% CI, 0.48-0.94) (vs high-population-density area). CONCLUSIONS: About 20% of Japanese children and adolescents engaged in the recommended MVPA level. MVPA was associated with grade, gender, preference for PA, and population density.