Randomized controlled trial to examine the tolerability of bronchoscopy with and without pharyngeal laryngeal anesthesia (TACOYAKI study).

BACKGROUND: The SARS-CoV-2 pandemic, pharyngeal anesthesia such as nebulizer or lidocaine pump spray is the risk of droplet transmission to health care workers from coughing due to spraying anesthesia. Absence of pharyngeal anesthesia may induce coughing and reduce patient and operator satisfaction, but the efficacy of pharyngeal anesthesia under sedation is still limited. Therefore we evaluated a prospective, randomized, single-blind trial to evaluate efficacy of pharyngeal anesthesia in patients receiving sedation. MATERIALS AND METHODS: We conducted a randomized comparison of pharyngeal anesthesia with or without bronchoalveolar lavage in patients undergoing bronchoscopy at our hospital between March and October 2022. Pharyngeal anesthesia was performed using 8％ lidocaine spray and the operators were blinded to eliminate bias. Two hundred patients were entered into the study and divided into two groups: those who received pharyngeal anesthesia(control group) and did not receive pharyngeal anesthesia(test group). The primary endpoint was the operator's satisfaction with the procedure. The secondary endpoints were the patient's cough during the examination as perceived by the operator, cough and discomfort experienced by the patient and the dose of analgesic/sedative/lidocaine administered. These scales were scored from 0 to 100. RESULT: In primary endpoint, there was no significant difference in the operator-rated procedure satisfaction between the 2 groups. The median for the discomfort score for patients in the control group was tendency higher than in the test group. There were no significant differences in other secondary endpoints. CONCLUSION: Pharyngeal anesthesia may not be recommended for flexible bronchoscopy performed under combined sedation and analgesia. TRIAL REGISTRATION: Registration number: UMIN000046975Date of registration: 2022/03/07.

Effects of lunges inserted in walking (eccentric walking) on lower limb muscle strength, physical and cognitive function of regular walkers.

INTRODUCTION: Walking is a popular exercise but does not increase lower limb muscle strength and balance. We hypothesized that muscle strength, physical and cognitive function would be improved by inserting lunges in conventional walking. METHODS: Eleven regular walkers (54-88 years) who had more than 5000 steps in exercise walking a day at least 5 days a week participated in this study. They walked as usual for the first 4 weeks and included lunges and descending stairs or slope walking (i.e., eccentric walking) for the next 8 weeks. The steps of eccentric walking were gradually increased from 100 to 1000 steps per week over 8 weeks. RESULTS: The average steps per day were 10,535 ± 3516 in the first 4 weeks, and 10,118 ± 3199 in the eccentric walking period without a significant difference. No significant changes in maximal voluntary isometric contraction torque of the knee extensors (MVC), 30-s chair stand (CS), 2-min step, balance assessed by center of pressure movement area with eyes close, sit and reach, a digit symbol substitution test (DSST) for cognitive function were observed in the first 4 weeks. However, significant (P < 0.05) improvements were evident in MVC (18.6 ± 15.7%), CS (24.2 ± 17.3%), balance ( - 45.3 ± 34.5%), and DSST (20.8 ± 16.7%) from weeks 4 to 12. Serum complement component 1q concentration decreased (P < 0.05) from weeks 4 to 12, although no changes in serum glucose, triglyceride, and cholesterol concentrations were observed. CONCLUSION: These results supported the hypothesis, and suggest that eccentric walking provides effects that are not achieved by conventional walking.

[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.

[Relationship between low back pain and physical activity and sitting time among community-dwelling older adults: A cross-sectional study].

Objectives　Japan has a high prevalence of low back pain among older adults requiring long-term care, which results in increasing expenses; therefore, prevention measures are necessary. This study aimed to examine the relationship between low back pain and physical activity and sitting time according to sex and age (65-74 years [young-old adults]; ≥75 years [old-old adults]) who had not received long-term care certification.Methods　A self-administered survey was mailed to 7,080 adults >65 years of age residing in Tsuru City (Yamanashi Prefecture, Japan) from January to February 2018, and had not received long-term care certification. Demographic information, health status (body mass index and medical history), lifestyle (dietary habits, alcohol consumption, and smoking), presence of low back pain, physical activity, sitting time, and social participation were measured. Low back pain was evaluated by asking, "Did you experience pain in parts of the body other than the knees for the past month?" Those who answered, "experienced low back pain" were categorized as "with low back pain". The short form of the International Physical Activity Questionnaire was used to assess physical activity, which was categorized into three groups: <150, 150-299, and ≥300 min/week. Sitting time was divided into two groups: <480 and ≥480 min/day. Multiple logistic regression analysis was used to determine the association between low back pain and physical activity and sitting time, according to sex and age.Results　Of the 7,080 individuals surveyed, 4,877 responded (2,217 male, 2,660 female), corresponding to a response rate of 68.9%. The number of older adults with low back pain was 1,542 (31.6%) including 673 (30.4%) males and 869 (32.7%) females. The rate of low back pain in young-old adults was 29.8% and 33.6% in old-old adults. There was no significant relationship between lower back pain and physical activity among the young-old adults. In the old-old adults, there was a significant relationship in the male ≥300 min group (odds ratio [OR] 0.66 [95%CI 0.48-0.89]), and in both female 150-299 (OR 0.69 [95%CI 0.48-0.99]) and ≥300 (OR 0.59 [95%CI 0.44-0.80]) min/week groups.Conclusion　The complaint rate for low back pain was approximately 30%, regardless of sex or age. These results suggest that interventions to prevent low back pain are necessary. Moreover, physical activity, but not sitting time, was associated with low back pain in both males and females among the old-old adults.

Do the Impacts of Mentally Active and Passive Sedentary Behavior on Dementia Incidence Differ by Physical Activity Level? A 5-year Longitudinal Study.

BACKGROUND: It has not been determined whether mentally active sedentary behavior (MASB) and passive sedentary behavior (PSB) differentially affect cognitive function and whether these associations differ according to physical activity (PA) level. We examined the comparative impacts of MASB and PSB on dementia onset and aimed to understand whether the associations differed by PA level. METHODS: We conducted a 5-year longitudinal study involving all community-dwelling older adults in a rural area in Japan (n = 5,323). Dementia onset was examined using long-term care insurance data. PA was evaluated using the International Physical Activity Questionnaire and categorized as low (<2.5 metabolic equivalent of task [MET]-h/week), moderate (2.5-16.0 MET-h/week), or high (≥16.0 MET-h/week). We also assessed PSB (TV-watching time; <1 h/day, 1-3 h/day, ≥3 h/day) and MASB (Book-reading time; <10 min/day, 10-30 min/day, ≥30 min/day). To examine the associations of MASB and PSB with dementia onset, we performed the Fine-Gray models accounting for competing risk of death. RESULTS: During the follow-up period, 606 (11.4%) participants developed dementia. MASB was independently associated with a lower risk of dementia; the magnitude of the impact was significant at higher PA levels. There was no association between PSB and developing dementia across all PA levels. Furthermore, dementia risk for individuals with high PA levels and moderate or high MASB levels was approximately 60% lower than those with low PA levels and low MASB. CONCLUSION: Providing interventions to promote MASB, which reduces dementia risk, and PA, which increases MASB's effect on dementia incidence, can be beneficial in delaying or preventing dementia onset.

Association of social participation (including inconsistent participation) with the progression of frailty among older adults: Community-based cohort study in Japan.

AIM: This study examined the relationship between continuity of social participation and progression of frailty among community-dwelling older adults, by baseline frailty level. METHODS: This study was part of a 3-year community-based cohort study among adults aged ≥65 years, living independently in a rural municipality in Japan. Mail surveys were carried out in 2016, 2018 and 2019. This study involved 2799 participants who responded to the question about social participation in every survey. Frailty was evaluated by Kihon Checklist total scores. Social participation was categorized into consistent non-participation, interrupted recent non-participation, interrupted recent participation and consistent participation. We assessed the relationship between social participation and change in frailty scores using general linear regression analysis, stratifying the participants into groups by their frailty level at baseline. RESULTS: There was a smaller frailty score increase in the robust (ß -0.61, 95% CI -0.99 to -0.22) and prefrail groups (ß -0.73, 95% CI -1.18 to -0.27) for consistent participation than consistent non-participation. Interrupted recent participation showed significant suppression in the prefrail group (ß -0.96, 95% CI -1.60 to -0.32). Social participation had no clear effect on progression in the frail group. CONCLUSIONS: Consistent social participation might reduce the progression of frailty in robust and prefrail people. Inconsistent participation might also help to reduce progression in prefrail older adults. It is important for prefrail older adults to return to their social activities and continue to engage as long as possible, even if their participation was intermittent in the past. Geriatr Gerontol Int 2023; 23: 25-31.

Inter-rater reliability of streetscape audits using online observations: Microscale Audit of Pedestrian Streetscapes (MAPS) global in Japan.

This study aimed to evaluate the inter-rater reliability of streetscape audits among online observations using the Microscale Audit of Pedestrian Streetscapes-Global version (MAPS-Global) in Japan. MAPS-Global observations were conducted on routes with distances ranging from 400 to 725 m from a residence toward a non-residential destination. Google Street View audits were independently conducted by two trained raters on each route. A tiered scoring system was applied to summarize the items at multiple levels of aggregation. Positive and negative valence scores were created based on the expected association with physical activity. Inter-rater reliability analyses were performed using kappa statistics or intraclass correlation coefficients (ICC). Of the 32 older adults participating in an intervention study in the community-wide physical activity promotion project in Fujisawa City, 19 addresses were used, excluding those with nearby addresses. Results demonstrated "excellent" agreement for most of the summary scores analyzed (kappa or ICC values of 0.75 or higher [80.4 %]), while 6.5 % of items exhibited "good" agreement (ICC = 0.60-0.74). By contrast, only 13.0 % of the scales had ICC values lower than 0.60 ("fair" or "poor" reliability). The results illustrated high reliability for the grand summary scores and composite subscale measures. However, caution should be exercised when interpreting subscale scores for less frequently observed negative attributes and aesthetic/social characteristics. The results presented in this study support the application of online observations using MAPS-Global in urban areas of Japan, which could be implemented to inform decisions related not only to physical activity but also to traffic safety.

Physical activity and/or sedentary behaviour and the development of functional disability in community-dwelling older adults in Tsuru, Japan: a prospective cohort study (the Tsuru Longitudinal Study).

OBJECTIVES: To clarify the association between moderate-to-vigorous physical activity (MVPA) and/or sedentary behaviour (SB) and the incidence of functional disability (FD) in older adults. DESIGN: Prospective cohort study. SETTING: Local municipality of Tsuru, Yamanashi, Japan. We conducted a baseline survey in January 2016. Follow-up was commenced on 1 February 2016 and completed on 31 October 2018. PARTICIPANTS: All individuals (6661 people) aged >65 years who were independently living in the community were eligible. METHODS AND OUTCOME MEASURES: MVPA (min/week) and SB (min/day) were measured using self-administered questionnaires in 5311 independently living older adults who participated in this study. The follow-up period was 33 months, and the incidence of FD was objectively determined by experts. The participants were divided into three groups based on MVPA distribution (non-MVPA, 0 min; short-MVPA, 1-299 min and long-MVPA, ≥300 min/week) and into two groups based on the median value of SB (short-SB,<190 min; and long-SB, ≥190 min/day). The participants were also classified into six categories based on different combinations of MVPA and SB. Cox proportional hazards model was used to calculate the HR and 95% CI for FD development with MVPA, SB and a combination of these behaviours. RESULTS: Among the included participants, 2415 were male and 2896 were female. The mean ages (SD) of the male and female participants were 74.5 (6.8) and 74.9 (6.9) years, respectively. The total number of participants with chronic conditions was 3489 (65.7%). Using the non-MVPA group as the reference, the multivariable-adjusted HR (95% CI) was 0.68 (0.54 to 0.84) in the short-MVPA group and 0.53 (0.41 to 0.69) in the long-MVPA group. Regarding SB, the short-SB group had an HR of 0.86 (0.71 to 1.03) compared with the long-SB group. The combined behaviour showed the lowest HR in the long-MVPA and short-SB group 0.49 (0.34 to 0.72) and the long-MVPA and long-SB group 0.49 (0.34 to 0.68), respectively. CONCLUSIONS: Long-MVPA had a robust association with FD development, whereas short-SB had a modest association. Moreover, a combination of these behaviours had a stronger association than individual behaviours. If the identified associations are assumed to be causal in nature, these findings suggest that encouraging older adults to engage in MVPA and reduce SB in their daily lives could be effective to prevent or delay FD development.

Bidirectional relationship between insomnia and frailty in older adults: A 2-year longitudinal study.

BACKGROUND: Most previous studies that examined the association of insomnia with frailty used cross-sectional designs. The temporal relationship between these factors is therefore largely unknown. This study aimed to examine the bidirectional relationship between insomnia and frailty by sex. METHODS: A 2-year longitudinal study involving all community-dwelling older adults living in a rural area in Japan (n = 3844). Validated measures of insomnia and frailty were employed. Insomnia was assessed using the Athens insomnia scale, and frailty using the Kihon checklist. We performed a cross-lagged panel model, adjusted for age, sex, years of education, employment status, self-rated health, complications (hypertension, diabetes, stroke, or osteoarthritis), BMI, physical activity, alcohol consumption, and smoking status, and assessed differences by sex. RESULTS: Poor sleep predicted the onset and worsening of frailty during follow up (standardized coefficient [95% confidence interval]: 0.076 [0.045, 0.107]). Frailty also predicted severe insomnia symptoms (0.074 [0.044, 0.104]). However, the temporal association between these conditions varied by sex. In older men, the effect of frailty on insomnia was stronger than that of insomnia on frailty. However, in women, the impact of insomnia on frailty was stronger than that of frailty on insomnia. CONCLUSIONS: The primary potential cause of the association between insomnia and frailty may vary by sex, being frailty in men and insomnia in women. Sex-specific interventions to improve sleep quality and duration, and maintain functional abilities in daily life may contribute to the prevention and management of both frailty and insomnia in older adults.

[Effect of an exercise program targeting knee pain on medical costs of elderly community-dwelling adults].

Objectives　The aim of this study was to examine the effect of an exercise program targeting knee pain on longitudinal medical costs (MC) of elderly community-dwelling adults.Methods　A community-based health program using specific exercises for improving knee pain was held from January to February, 2015. Twenty-eight individuals participated in the program (intervention group) and seventy individuals were selected from the respondents of a health and lifestyle survey by matching age, sex, and baseline value of severity of knee pain as a control group. Twenty individuals from the intervention group and twenty-nine from the control group were included in the final analysis. The changes in MC from 2014 to 2018 were compared between the two groups using a linear mixed-effects model.Results　The effect of the program on MC, estimated as a change from the baseline in 2014, showed a reduction of -5.6×103 yen/person (95% CI: -39.2-28.0) for the entire four-year period after the intervention. However, this difference was not significant. The changes in MC each year after the intervention were 9.3×103 yen/person (95% CI: -39.6-58.3) in 2015, -2.0×103 yen/person (95% CI: -44.4-40.5) in 2016, -10.3×103 yen/person (95% CI: -42.5-21.9) in 2017, and 8.2×103 yen/person (95% CI: -39.1-55.4) in 2018.Conclusion　The exercise program did not show a clear benefit in reducing the MC of elderly community-dwellers during the four years after the intervention. Further research with longer study durations and larger sample populations would be necessary to determine the effect of such intervention programs on MC.

Longitudinal associations of social group engagement with physical activity among Japanese older adults.

BACKGROUND: Although social group engagement (SGE) has been suggested to affect physical activity (PA) in older age, the longitudinal relationship between these variables is unclear. This study used 2-year panel data to investigate the link between changes in SGE and changes in PA among community-dwelling older adults. METHODS: This study was a 2-year community-based longitudinal study enrolling older adults living in a rural municipality in Japan. The subjects were all residents in the study area aged ≥ 65 at the baseline. Mail surveys were administered in 2016 and 2018. The 3688 subjects responding to both surveys were included in the analyses. PA was evaluated with the International Physical Activity Questionnaire, and weekly time and metabolic equivalent were computed. SGE was assessed in each wave and classified as consistent engagement (engagement reported in both surveys), new engagement (non-engagement at baseline and engagement at follow-up), leaving the group (engagement at baseline and non-engagement at follow-up), and consistent non-engagement (non-engagement in both surveys). Analysis of covariance was performed to examine the associations of changes in SGE with changes in PA. RESULTS: Compared with those with consistent non-engagement, who showed declines in every PA category, subjects with consistent engagement or new engagement showed significantly smaller changes in total PA, moderate-intensity PA, and brisk walking. Leaving the group (vs. consistent non-engagement) was associated with maintaining moderate-intensity PA. CONCLUSIONS: SGE helps to suppress the age-associated decline in PA in older age, with new engagement and continuous engagement, especially, mitigating decreasing PA.

[Physical parameters and physical function in older drivers with driving-related anxiety: the Nakagawa Study].

AIM: This study investigated whether driving-related anxiety was independently associated with physical parameters and physical function in community-dwelling older people. METHODS: Participants were 523 community-dwelling older drivers (353 men and 170 women). Participants self-reported driving-related anxiety when driving in familiar environments, and completed physical assessments: visual impairment, auditory impairment, cerebrovascular disease (CVD), hand grip strength, knee extension strength, timed up and go (TUG), chair stand, one leg standing with open eyes, functional reach, vertical jump, preferred gait speed and maximal gait speed. Participants were divided into a driving-related anxiety group (72.8±5.1 years; 21 men, seven women) and a no-anxiety (non-anxiety) group (70.7±4.7 years; 325 men, 163 women). We examined physical performance differences between the anxiety and non-anxiety groups using analysis of covariance, and investigated the relationship between anxiety, physical function and performance using logistic regression analysis (forward stepwise selection). RESULTS: The driving-related anxiety group was significantly older, with higher rates of visual impairment, auditory impairment, and CVD than the non-anxiety group. The anxiety group exhibited independently poorer TUG and maximal gait speed (P<0.05 for both). Logistic regression analysis revealed significant relationships between anxiety and visual impairment (odds ratio [OR]: 5.6, 95% confidence interval [CI]: 2.5-12.6), auditory impairment (OR: 3.0, 95% CI: 1.3-7.0), TUG (OR: 1.46, 95% CI: 1.1-1.9) and CVD (OR: 3.1, 95% CI: 1.0-9.4) (P<0.05 for all). CONCLUSIONS: Driving-related anxiety was significantly associated with worse physical performance, visual impairment, auditory impairment, and CVD in community-dwelling older drivers.

Metabolomics with 15N Labeling for Characterizing Missing Monoterpene Indole Alkaloids in Plants.

Monoterpene indole alkaloids (MIAs) in medicinal plants remain uncharacterized owing to their complicated structure by metabolomics using liquid chromatography-tandem mass spectrometry (LC-MS/MS) despite their pharmaceutical importance. We demonstrate an untargeted metabolome analysis with 15nitrogen (N) labeling to characterize MIAs having an indolic skeleton in the flowers, leaves, petioles, stems, and roots of Catharanthus roseus. Principal component analysis using 15N- and nonlabeled metabolome data showed that N-containing metabolites (N-metabolites) are labeled with 15N. Paring of the 15N- and nonlabeled precursor ions were performed using the criteria of retention time, difference of m/z value, and a nonlabeled product ion at m/z 144.08 that indicates an indolic skeleton. The mass shift of the m/z value of the product and precursor ions to their 15N-labeled ions identified the number of N of their ions. Finally, molecular formula of 45 MIAs was unambiguously identified using the identified N number. The alkaloid network analysis using the MS/MS similarity showed the structural commonness and uniqueness among the MIAs. Of them, antirhine was identified using an authentic standard compound. Multimetabolomics using LC-MS/MS and imaging mass spectrometry showed that antirhine accumulates considerably in the epidermis and vascular cylinder of the roots. The developed approach showed the existence of the missing MIAs. The modification of this approach will identify other MIAs that contain a hydroxylated or methoxylated indolic skeleton.

Automated colorimetric determination of nanomolar urea in seawater by gas-segmented continuous flow analysis using a liquid waveguide capillary cell.

A sensitive automated colorimetric method for the determination of nanomolar concentration of urea in seawater is presented. The colorimetry was based on the diacetyl monoxime method and the automated system was constructed by a gas-segmented continuous flow analyzer equipped with a 100 cm path length of liquid waveguide capillary cell. The most suitable surfactant for the system was hexadecyl-trimethyl-ammonium-bromide as compared to Brij-35, sodium dodecyl sulfate, and Triton X-100. Blank selection using a 3% NaCl solution, filtered subtropical surface seawater, and filtered deep seawaters with and without urease treatment showed that the filtered deep seawater with urease treatment had the lowest absorbance and was appropriate. The sample volume needed for the analysis was 1.8 mL, and the analysis rate was 10 samples h-1. Calibration curves showed good linearity for 0-1000 nM urea-N concentration range (r2 = 0.999). The detection limit was 5 nM urea-N. The coefficient of variation for the analysis of seawater samples collected in the subtropical North Pacific was <5% at 30 and 29 nM urea-N. The proposed analytical system was applicable to vertical observation in the subtropical North Pacific.

Diurnal repeated exercise promotes slow-wave activity and fast-sigma power during sleep with increase in body temperature: a human crossover trial.

The effects of exercise on sleep have been explored from various perspectives, but little is known about how the effects of acute exercise on sleep are produced through physiological functions. We used a protocol of multiple daytime sessions of moderate-intensity aerobic exercise and examined the subsequent effects on sleep structure, core body temperature (CBT), distal-proximal skin temperature gradient (DPG), and subjective parameters. Fourteen healthy men who did not exercise regularly were evaluated under the baseline (no exercise) and exercise conditions on a within-subject crossover basis. Under the exercise condition, each participant performed a 40-min aerobic workout at 40% of maximal oxygen intake, four times between morning and early evening. We observed a 33% increase in slow-wave sleep (SWS; P = 0.005), as well as increases in slow-wave activity (SWA; P = 0.026), the fast-sigma power/SWA ratio (P = 0.005), and subjective sleep depth and restorativeness the following morning. Moreover, both CBT and the DPG increased during sleep after exercise (P = 0.021 and P = 0.047, respectively). Regression analysis identified an increased nocturnal DPG during sleep after exercise as a factor in the increase in SWA. The fast-sigma/SWA ratio correlated with CBT. The performance of acute exercise promotes SWS with nocturnal elevation in the DPG. Both CBT and fast-sigma power may play a role in the specific physiological status of the body after exercise. NEW & NOTEWORTHY We used multiple daytime sessions of moderate-intensity aerobic exercise to examine the effects on the sleep structure, core body temperature (CBT), distal-proximal skin temperature gradient (DPG), and subjective parameters. Significant increases in slow-wave activity (SWA), CBT, DPG, fast-sigma power, and subjective parameters were observed during the night and the following morning. Nocturnal DPG is a factor in the increased SWA.

Comparison between eccentric and concentric resistance exercise training without equipment for changes in muscle strength and functional fitness of older adults.

PURPOSE: The present study tested the hypothesis that resistance exercise training focusing on eccentric muscle contractions would improve muscle strength and functional physical fitness more than concentric contraction-focused resistance training in older adults. METHODS: Healthy older adults (65-84 years) were placed into eccentric (ECC; n = 9) or concentric training group (CON; n = 8). They performed 4-6 basic manual resistance exercises focusing on either eccentric or concentric muscle contractions once at a community centre and at least twice at home a week for 8 weeks. Muscle thickness of the quadriceps femoris (MT), knee extensor maximal voluntary isometric contraction strength (MVC), 30-second chair stand (CS), 3-metre timed up and go (TUG), 2-minute step (2MS), sit and reach (SR), and static balance with eyes open and closed (Bal-EC) were assessed before and 7 days after the last community centre session. RESULTS: Changes in MT (ECC: 21.6 ± 9.2% vs CON: 6.7 ± 7.1%), MVC (38.3 ± 22.6% vs 8.2 ± 8.4%), CS (51.0 ± 21.7% vs 34.6 ± 28.3%), TUG (16.7 ± 9.9% vs 6.3 ± 7.7%), 2MS (9.9 ± 6.0% vs 6.0 ± 7.3%) and Bal-EC (35.1 ± 6.7% vs 8.8 ± 16.2%) from baseline were greater (P < 0.05) for the ECC than the CON group. CONCLUSION: These results show that the eccentric manual resistance exercise training was more effective for improving lower limb strength, mobility, and postural stability of older adults when compared with the concentric training. This suggests the significance of emphasising eccentric muscle contractions in movements to maintain and improve physical function.

The association of single and combined factors of sedentary behavior and physical activity with subjective cognitive complaints among community-dwelling older adults: Cross-sectional study.

Subjective cognitive complaints (SCC) might be a meaningful indicator of dementia onset or mild cognitive impairment, and identifying the related factors of SCC could contribute to preventing these diseases. However, the relationship between SCC and lifestyle factors remains largely unproven. The purpose of this study was to examine the association of type of sedentary behavior, physical activity, or their combination with SCC among community-dwelling older adults. In 2016, 6677 community-living elderly were recruited to participate in a survey investigating cognition, physical activity, and sedentary behavior. In total, 5328 participants responded to the questionnaire (79.8% valid response rate). SCC was assessed using the National Functional Survey Questionnaire (Kihon checklist). The relationships between SCC and physical activity, sedentary behavior (reading books or newspapers, and television viewing), or combined physical activity and sedentary behavior were examined via multiple logistic regression analysis. The analysis revealed that moderate-to-vigorous physical activity (≥150 min/week) was significantly related with a lower risk of SCC (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.74-0.97), and that reading behavior showed a dose-response relationship with SCC (OR for 10-20 min/day = 0.63; 95% CI = 0.53-0.75; OR for 20-30 min/day = 0.59; 95% CI = 0.49-0.71; OR for ≥30 min/day = 0.47; 95% CI = 0.39-0.57). In addition, among those reporting high physical activity and ≥30 min/day for reading time, the OR for SCC was 0.40 (95% CI = 0.32-0.50) compared with the combined group reporting lower physical activity and non-readers. The present study shows that increased physical activity and reading time may be related to a reduced risk for SCC among community-dwelling older adults.

Efficacy of the traditional Japanese medicine goreisan for the resolution of spermatic cord hydrocele in children.

PURPOSE: Goreisan, a traditional Japanese medicine, has previously been used for hydrostatic modulation. This retrospective study investigated the efficacy of goreisan for spermatic cord hydrocele resolution in children. METHODS: Seventy-two boys treated for spermatic cord hydrocele between 2012 and 2015 were included; Goreisan was administered to 16 [group G, median age 3 (1-8) years], and 56 were followed without medication [group C, median age 1 (0-8) years]. An age-matched comparison was conducted between 14/16 group G patients (group g) and 14/56 group C patients (group c). RESULTS: Incidences of resolution were higher in groups G and g than in groups C and c, respectively, both during the study period and within the first 6-month observation period; groups G and g also had a significantly lower incidence of surgery for hydrocele than in groups C and c, respectively. The interval from the commencement of observation until hydrocele resolution was significantly shorter in group G than in group C, but not in group g than in group c. CONCLUSION: Goreisan can effectively promote the resolution of spermatic cord hydrocele in children and may be a valid treatment choice for this condition.

The prevalence and basic characteristics of knee pain in community-dwelling independent elderly: A complete survey.

Objectives　The objectives of this study were to determine the prevalence of knee pain in independent community-dwelling elderly people and to examine the basic characteristics (sex and age) of those experiencing knee pain.Methods　Survey on the health status and lifestyle habits was conducted for all (6,790) independent elderly who were 65 years or older, living in Tsuru City, Yamanashi Prefecture, Japan. The survey was carried out using a mailing questionnaire for 1 month from January 12 to February 11, 2016. Knee pain was defined as subjective pain in and around the knee joint in either one or both knees, on most days during the past month. Participants answered "Yes" if they were experienced knee pain, and "No" if they did not experience knee pain. Sex and age were investigated as basic characteristics of the participants by the questionnaire. The prevalence rate of knee pain was calculated as follows: the total number of people with knee pain divided by the total number of the respondents in the study. To examine the relationships between knee pain and age or sex, these basic characteristics were analyzed using a Chi-square test for the prevalence of knee pain within sex and age groups.Results　The number of survey respondents was 5,328 (response rate: 78.5%). The number of valid respondents with complete data was 5,186 (valid response rate: 76.4%). The number of subjects who responded "with knee pain" was 1,733. The prevalence rate of knee pain was 33.4%. In addition, sex and age demonstrated strong associations with the prevalence of knee pain (both, P<0.001). In other words, the prevalence rate was higher in the elderly women than in elderly men and increased with age.Conclusion　The present study suggested that one in three independently living elderly who live in medium-sized local municipalities in Japan experience chronic knee pain. The basic characteristics of a community-dwelling independent elderly with knee pain are to be a woman and older age.

A cross-sectional study on the factors related to cognitive decline in community-dwelling elderly.

AIM: The aim of this study was to examine the relationship between cognitive decline and physical activity, sitting time, and social participation among elderly people living independently in a local community. METHODS: In January 2015, 1,133 independently-living elderly individuals from a local Japanese community completed self-administrated questionnaires. A total of 929 participants completed the questionnaire (valid response rate: 82.0%). A multiple logistic regression analysis was conducted to examine the relationship between cognitive decline, physical activity, sitting time, and social participation. The factors related to cognitive decline were examined using three statistical models: (1) Model 1 was not adjusted for any factors; (2) Model 2 was adjusted for age, education level, smoking status, and drinking status; and (3) Model 3 was adjusted for the covariates in Model 2, plus depression. RESULTS: Cognitive decline was observed in 33% of men and 26% of women. The results indicated that decreased social participation was significantly related to cognitive decline in Models 1 and 2. For men, local community activity and political/economic activity were significantly associated with cognitive decline in Models 1 and 2. Among women, physical activity was significantly related to cognitive decline in Model 1. There was also a significant association between social participation and cognitive decline in Models 1 and 2; decreased volunteer activity was significantly related to cognitive decline in all three models. CONCLUSION: The results of the present study indicated that attending volunteer activities was significantly related to cognitive decline in women.