Influences of remote exercise training for community-dwelling older adults in Japan during the COVID-19 pandemic.

[Purpose] The coronavirus disease (COVID-19) pandemic has caused sudden lifestyle changes. This study aimed to determine the limitations in activity and the influences of remote exercise training on community-dwelling older adults during a state of emergency in Japan. [Participants and Methods] In May 2020, during the COVID-19 state of emergency, we carried out a mail survey of community-dwelling older adults who had previously participated in a disability prevention program in Ami town, Ibaraki, Japan. The mail included a brochure on exercises and a DVD. The attached exercise program was comprised of 10 different exercises, which could be conducted in approximately 30 minutes. [Results] Of the 191 older adults, 73 responded to this survey (38.2%), of which 42 (58.5%) participants had decreased outdoor exercise activity, and 50 (68.5%) decreased the amount of time spent on physical activities during the COVID-19 state of emergency. There were significant reductions (19.2-22.5%) in the perceived exercise load for each posture after two weeks of remote exercise training with DVD (n=26). [Conclusion] Our results suggested that the remote exercise training with the brochure and DVD may be effective. Since this study involved a small number of participants, future studies should involve larger populations.

A Short-Duration Combined Exercise and Education Program to Improve Physical Function and Social Engagement in Community-Dwelling Elderly Adults.

Exercise is a key intervention for improving older adults' physical function and life expectancy. Here, we investigated a short-term intervention program designed to improve the physical functioning of elderly adults in a community-dwelling setting. We examined the effect of a 5-week combined exercise and education program on the physical function, social engagement, mobility performance, and fear of falling in 42 subjects older than 65 years. Eleven subjects dropped out. There was significant improvement in the 30-second chair stand test (p < .001) and timed up-and-go test (p < .001) between the baseline and the last session. At the end of the intervention, the subjects' social engagement was significantly higher than at baseline (p = .022), but this improvement was not maintained in the follow-up assessment. These results suggest that a combined exercise and education program can improve the physical function and social engagement of elderly individuals living in a community dwelling.

Investigation of the Female Athlete Triad in Japanese Elite Wheelchair Basketball Players.

Background and objectives: Para-sports have become increasingly competitive, necessitating greater physical activity; secondary disorder prevention is therefore crucial. Among secondary disorders, the female athlete triad (FAT) is defined as low energy availability (EA), menstrual dysfunction, and low bone mineral density (BMD); although studied in able-bodied athletes, reports on female para-athletes are scarce. We retrospectively investigated the FAT in wheelchair basketball players in the Japanese national team. Materials and Methods: Thirteen female wheelchair basketball players (mean age: 28.9 ± 8.1 years) were enrolled. The medical history (underlying diseases, gynecological disorders, and stress fractures), athletic and sport-specific parameters (wheelchair basketball classification, and wheelchair usage conditions), hematological status (hemoglobin, iron, estradiol, progesterone, total P1NP, and TRACP-5b levels), nutritional status (total energy, protein, calcium, and iron intake), body composition (BMD and lean body mass (LBM)), and EA were assessed. Results: Two (15.4%) had pertinent gynecological histories and six (46.2%) had menstrual cycle disorders. Three (23.1%) experienced excessive menstrual flow and nine (69.2%) had menstrual pain. No stress fractures were reported. All laboratory data were within normal limits. Total energy and iron intakes based on age-specific requirements were 99.8% and 59.8%, respectively. Iron and hemoglobin levels correlated with menstrual flow (ρ = -0.63, p = 0.019 and ρ = -0.56, p = 0.046, respectively). The mean total BMD was 109.2%, and the mean EA (41.4 kcal/kg LBM) was lower than recommended levels. The leg BMD in spinal disorders was significantly lower than that in skeletal disorders (p = 0.003). The arm LBM was higher (150.6%) than that of age-matched controls. Conclusion: Among female wheelchair basketball players with FAT, the total BMD was comparable to that of age-matched controls; however, leg BMD in spinal disorders was significantly lower than that in skeletal disorders. Players with heavy menstrual flow had lower hemoglobin and iron levels. Further research is needed on the FAT to optimize health and sports performance among para-athletes.

Influence of Functional Classification on Skill Tests in Elite Female Wheelchair Basketball Athletes.

Background and objectives: Wheelchair basketball players are classified into four functional classes according to the player's "volume of action", characterized by trunk movement and stability. As this classification is based on a kinematic point of view, test items might be differentially affected by the functional classification level. We aimed to clarify field-based skill test items closely related to the functional classification level. Materials and Methods: Twenty-six female wheelchair basketball athletes (Japan National Team candidates) completed seven field-based skill tests (20 m sprint, agility T-test, figure-eight with a ball test, the Yo-Yo 10 m recovery test, and three types of maximal passes), and anthropometric measurements were applied. Results: Significant differences among the classification levels were found for one-hand maximal passes (baseball and hook passes) and the figure-eight with a ball test. Furthermore, performance in the 20 m sprint and 10 m Yo-Yo recovery tests significantly differed between classes 1 and 4. Conclusions: The test items most influenced by the classification levels were one-hand passes, which require trunk stability and balance not only in the horizontal plane, but also in the sagittal and frontal planes. Coaches should consider which test items are strongly affected by the functional classification level when assessing a player's performance.

Comparison of sleep status among three Japanese national wheelchair basketball teams.

[Purpose] Sufficient sleep is required for maximal performance and good mood. Japan has three national wheelchair basketball teams: Top male, Top female, and Under-23 (U23) male teams. Using these team members as model, this study investigated the difference of sleep status of wheelchair basketball players by age and gender. [Subjects and Methods] There were 44 participants: 14 in the Top male team (29.5 ± 5.2 years), 18 in the Top female team (30.6 ± 9.2 years), and 12 in the U23 team (19.1 ± 2.0 years). Sleep status was assessed with the Pittsburgh Sleep Quality Index (PSQI); higher scores indicate poor sleep quality. [Results] PSQI scores in the Top male and female teams were higher than in the U23 team. The Top teams showed shorter sleep duration and worse sleep efficacy than the U23 team. Time spent in bed and sleep duration in the female team were shorter than in the Top male and U23 teams. More male players reported "feel too hot" as the reason for sleep disturbance than female players. [Conclusion] Players in the Top Japanese national wheelchair basketball teams had poorer sleep status than U23 players. Among female players, the reason for insomnia was less sleep duration. For males, the reason for insomnia was "feel too hot."

Correlation between sleep and psychological mood states in female wheelchair basketball players on a Japanese national team.

[Purpose] Although some studies suggest the importance of getting adequate sleep for enhancing mood, there is not yet sufficient evidence on the relationship between sleep and mood states in athletes, especially for athletes with physical disability. The purpose of this study is to reveal relationships between sleep and psychological mood states in female wheelchair basketball players. [Subjects and Methods] Seventeen female wheelchair basketball players (30.9 ± 9.4 years old) on a Japanese national team participated. Sleep states were assessed with the Pittsburgh Sleep Quality Index (PSQI), and mood states with the Japanese version of the Profile of Mood States short form (POMS-SF). Spearman's rank correlations were computed. [Results] The mean PSQI score was 5.4 ± 2.6 points, and 9 athletes (52.9%) exceeded the cutoff point (5.5) for insomnia. Higher sleep efficiency (rS=0.58), fewer sleep disturbances (rS=-0.58), and lower total PSQI score (rS=-0.51) were significantly correlated with higher vigor. Lower likelihood of daytime dysfunction was also significantly correlated with lower tension (rS=0.50). [Conclusion] Vigor was the mood state most frequently correlated with sleep variables. Because vigor is a known key psychological factor in optimal performance, the findings are valuable for wheelchair basketball players.

Right half-field eye patching may not be an effective approach for chronic hemispatial neglect--a two-case investigation.

Right half-field eye-patched glasses intervention was performed in two chronic stroke patients with unilateral spatial neglect. Eye movement on the neglect side, the center of gravity as an index of the internal midline bias, neglect sign tests, and the regional cerebral blood flow (rCBF) were measured before and after intervention. The improvement of eye movement was not shown clearly after intervention. The center of gravity shifted significantly to the right and backward. Letter and star cancellation tests were improved in both the cases. Line bisection test showed improvement in one patient. However, line cancellation and line bisection tests were worsened in the other. The rCBF was not changed after intervention. This case study suggests that right half-field eye patching might not be an effective intervention.

[Effects of Square-Stepping Exercise inducing activation of the brain's cognitive function in community-dwelling older Japanese females--Focus on the baseline cognitive function level and age].

AIM: The purpose of this study was to investigate whether the degree of improvement in cognitive function achieved with an exercise intervention in community-dwelling older Japanese women is affected by the participant's baseline cognitive function and age. METHODS: Eighty-eight women (mean age: 70.5±4.2 years) participated in a prevention program for long-term care. They completed the Square-Stepping Exercise (SSE) program once a week, 120 minutes/session, for 11 weeks. We assessed participants' cognitive function using 5 cognitive tests (5-Cog) before and after the intervention. We defined cognitive function as the 5-Cog total score and defined the change in cognitive function as the 5-cog post-score minus the pre-score. We divided participants into four groups based on age (≤69 years or ≥70 years) and baseline cognitive function level (above vs. below the median cognitive function level). We conducted two-way analysis of variance. RESULTS: All 4 groups improved significantly in cognitive function after the intervention. There were no baseline cognitive function level×age interactions and no significant main effects of age, although significant main effects of baseline cognitive function level (P=0.004, η(2)=0.09) were observed. CONCLUSION: Square-Stepping Exercise is an effective exercise for improving cognitive function. These results suggest that older adults with cognitive decline are more likely to improve their cognitive function with exercise than if they start the intervention with high cognitive function. Furthermore, during an exercise intervention, baseline cognitive function level may have more of an effect than a participant's age on the degree of cognitive improvement.

[Determinants of changes in physical fitness after a square-stepping exercise program in community-dwelling older Japanese females].

AIM: The purpose of this study was to investigate determinants of changes in physical fitness after a fall-prevention exercise program in older females. METHODS: The study subjects included 83 community-dwelling females 65 years of age or older (mean age: 70.4±4.0 years) living in Kasama City, rural Japan. All subjects participated in a fall-prevention exercise program called square-stepping exercise (SSE) conducted once a week for 11 weeks. In order to assess the physical fitness benefits of by the exercise program, we measured the results of five physical performance tests: grip strength, one leg stand, sit and reach, timed up and go and the choice-stepping reaction time. In addition, we evaluated comprehensive physical fitness scores based on the standardized total score of the five physical performance tests. The changes in the comprehensive physical fitness score between baseline and after the program was used as the dependent variable, while the baseline values of age, education, clinical history, physical activity, Lubben social network scale, geriatric depression scale, five cognitive function test result, comprehensive physical fitness score and percentage of attendance were treated as independent variables. RESULTS: A stepwise multiple regression analysis revealed that the change in comprehensive physical fitness score correlated significantly with the baseline values of age (ß=-0.273), the five cognitive function test result (ß=0.293) and comprehensive physical fitness score (ß=-0.607). CONCLUSIONS: These results suggest that older females with a low level of physical fitness at baseline are more likely to improve their physical fitness with a period of exercise training. However, the improvements in physical fitness are lower in older females with a low level of cognitive function than in those with a high level of cognitive function.

[Evaluation of the association between cognitive impairment and the vitamin D levels among community-dwelling Japanese pre-frail elderly individuals].

AIM: Cognitive impairment is the second leading cause of long-term care, and the number of cognitively impaired elderly individuals is increasing. Cognitive impairment has been reported to be associated with a low vitamin D level. However, many elderly individuals are deficient in vitamin D due to undernutrition and a house-bound status. It is unknown whether cognitive impairment is independently associated with the vitamin D level. The aim of this study was to examine the association between cognitive impairment and the levels of vitamin D among community-dwelling Japanese pre-frail elderly individuals. METHODS: A cross-sectional survey was conducted in two towns (latitude: 36 degrees north) from June 2006 to January 2011. The subjects included 316 community-dwelling pre-frail elderly individuals 65 years of age or older (mean±SD: 77.0±5.7 yr) who attended a program for nursing care prevention. A questionnaire-based interview was conducted regarding activities of daily living. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured. Age and gender were recorded, as well as the presence of cognitive impairment determined according to the Mini Mental State Examination (MMSE). The factors associated with an MMSE score of ≤23 were examined using a multiple logistic regression analysis. RESULTS: Of the subjects, 21.2% were men and 30.6% had an MMSE score of ≤23. The mean MMSE score was 25.3±3.7. The prevalence of severe deficiency of 25(OH)D was 1.7%, and only 14.0% of the participants had a sufficient vitamin D level. The multiple logistic regression analysis suggested that an MMSE score of less than 23 was significantly associated with the levels of iPTH and 25(OH)D among the pre-frail men, but not the women. CONCLUSIONS: Our data suggest that the vitamin D level is significantly associated with cognitive impairment in pre-frail elderly men.

Evaluation of hand functions and distal radioulnar joint instability in elite wheelchair basketball athletes: a cross-sectional pilot study.

BACKGROUND: Wrist injury affects wheelchair basketball players' performance; however, the relationship between distal radioulnar joint (DRUJ) instability and hand functions is unclear. This cross-sectional pilot study investigated DRUJ instability in elite female wheelchair basketball athletes using force-monitor ultrasonography. METHODS: Nine elite female wheelchair basketball athletes (18 wrists) were included in the study. A triangular fibrocartilage complex (TFCC) injury was confirmed using magnetic resonance imaging (MRI). Hand functions were evaluated based on the range of motion (ROM) of wrist palmar flexion, dorsiflexion, radial deviation, and ulnar deviation; grip strength; arm circumference; forearm circumference; and DRUJ instability or pain using the ballottement test. The Mann-Whitney U test was used to compare parameters between the TFCC-injured and intact wrists. Radioulnar displacement was measured using force-monitor ultrasonography and pressure data, and the displacement-to-force ratio was used as an indicator of DRUJ instability. The correlation between the DRUJ displacement-to-force ratio and each hand function assessment was evaluated using Pearson correlation coefficient for the TFCC-injured and intact wrists. A generalized linear mixed model (GLMM) was used to estimate the relationship between hand functions and DRUJ instability. RESULTS: TFCC injuries in seven wrists were confirmed using MRI findings (38.9%). The ulnar deviation ROM values of the TFCC-injured wrist (n = 7) and intact (n = 11) groups were 38.6 ± 8.0° and 48.6 ± 7.8°, respectively. The ulnar deviation ROM was significantly smaller in the TFCC-injured wrists (p = 0.02, r = - 0.54). In the TFCC-injured wrists, no correlation was observed between the displacement-to-force ratio and the hand function assessment. In contrast, the displacement-to-force ratio negatively correlated with grip strength, arm circumference, and forearm circumference in the intact wrists (Pearson correlation coefficient r = - 0.78, - 0.61, and - 0.74, respectively). The GLMM showed that the displacement-to-force ratio significantly affected grip strength, arm circumference, and forearm circumference in the intact group. CONCLUSIONS: In intact wrists, correlations were observed between hand functions such as upper arm/forearm strength and DRUJ stability evaluated using ultrasound. Maintaining and strengthening grip strength, forearm circumference, and arm circumference are associated with DRUJ stability and may be related to TFCC injury prevention in wheelchair basketball athletes. TRIAL REGISTRATION: The protocol was registered with the UMIN Clinical Trials Registry (UMIN000043343) [Date of first registration: 16/02/2021].

[Association of the physical activity of community-dwelling older adults with transportation modes, depression and social networks].

AIM: The purpose of this study was to cross-sectionally examine the relationships among leisure, household and occupational physical activity with the frequency of going out by various transportation modes, depression and social networks in older adults. METHODS: We randomly selected a total of 2,100 community-dwelling adults aged 65 to 85 years of age from the Basic Resident Register. Of these, 340 people were the subjects of this study. The scales of measurement used were the Physical Activity Scale for the Elderly, the Lubben Social Network Scale (LSNS) and the Geriatric Depression Scale (GDS). RESULTS: In a regression model, leisure-time physical activity significantly correlated with frequency of going out by bicycle (ß=0.17) and LSNS score (ß=0.17). Household physical activity and occupational physical activity were significantly correlated with LSNS score (ß=0.21) and frequency of going out by motor vehicle (ß=0.25), respectively. For total physical activity, in the 3 above-mentioned activities a significant correlation was observed among frequency of going out by bicycle (ß=0.10), by motor vehicle (ß=0.23), GDS score (ß=-0.16) and LSNS score (ß=0.23). CONCLUSION: These results indicate that the frequency of going out by bicycle and by motor vehicle were significant factors to predict leisure and occupational physical activity. Furthermore, social networks appear to be important determiners in leisure and household physical activity in community-dwelling older adults.

Skeletal Muscle Mass and Higher-Level Functional Capacity in Female Community-Dwelling Older Adults.

PURPOSE: In this study, our purpose was to examine the relationship between skeletal muscle mass and higher-level functional capacity in female community-dwelling older adults. Participant(s) and Methods: In this cross-sectional study, we targeted 55 female community-dwelling older adults aged 65 years and above participating in long-term care prevention classes in Ibaraki Prefecture between 2018 and 2020. We excluded individuals with cognitive impairment and those judged as having sarcopenia. The variables of interest included age, height, weight, body mass index, skeletal muscle mass index (SMI), handgrip strength, step count, and family structure. We calculated the SMI by dividing the extremities' total lean mass by the square of the height (in m), while the number of steps was calculated using the three-axis accelerometer Actigraph GT3X®. We measured skeletal muscle mass via bioelectrical impedance analysis using the InBody270 body composition analyzer and muscular strength as grip strength. RESULTS: We observed significant relationships between skeletal muscle mass and Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) (ß = 0.336, p < 0.01) and handgrip strength (ß = 0.230). CONCLUSION: In this study, a relationship between skeletal muscle mass and higher-level functional capacity was demonstrated among elderly female community residents.

Mediating role of instrumental activities of daily living ability on cognitive function of older adults living alone: A 4-year longitudinal study from the Kasama study.

ABSTRACT: The aim of this study was to clarify the effect of living alone on the cognitive function of older people and the mediating effect of instrumental activities of daily living (IADL) ability.The data for a final sample of 3276 participants aged 65 years and above who did not require long-term care at the baseline were used from a 4-year prospective cohort study conducted in Kasama City, Japan. Demographic data including age, sex, and depression at baseline were used as covariates. The Kihon checklist evaluated the IADL ability at baseline and cognitive function at follow-up. The characteristics of those living alone and with others were compared using the student t test and χ2 test. The effect of living alone on cognitive function was analyzed using logistic regression analysis. Mediation analyses determined the mediating effects of IADL.A total of 325 participants were living alone; they were significantly older than those living with others, more likely to be female, not provide emotional support, and have low physical function, more severe depression, and lower IADL disability. Living alone had a significantly lower risk of cognitive decline at follow-up than living with others. The mediation analysis revealed that IADL disability at follow-up was significantly associated with cognitive decline. Thus, greater IADL ability decreased cognitive decline risk.Older people living alone had a significantly lower risk of cognitive decline, and cognitive function significantly mediated IADL ability. Health support for enhancing IADL abilities may help older people living alone maintain good cognitive function.

A Novel Exercise for Enhancing Visuospatial Ability in Older Adults with Frailty: Development, Feasibility, and Effectiveness.

We aimed to develop a novel exercise to improve visuospatial ability and evaluate its feasibility and effectiveness in older adults with frailty. A non-randomized preliminary trial was conducted between June 2014 and March 2015. We recruited 35 adults with frailty (24 women), aged 66-92 years. Participants were assigned to either locomotive- or visuospatial-exercise groups. All participants exercised under the supervision of physiotherapists for 90 min/week for 12 weeks. The visuospatial exercise participants used cubes with six colored patterns and were instructed to "reproduce the same colored pattern as shown in the photo", using the cubes. In the locomotive exercise group, lower extremity functional training was provided. Rates of retention and attendance measured feasibility. Most participants completed the intervention (77.3%, locomotive; 84.6%, visuospatial) and had good attendance (83.8%, locomotive; 90.7%, visuospatial). Mini-mental state examination (MMSE), clock drawing test (CDT), and seven physical performance tests were conducted before and after interventions. The improvement in the MMSE score, qualitative analysis of CDT, grip strength, and sit and reach assessments were significantly greater in the visuospatial exercise group than in the locomotive exercise group. The cube exercise might be a feasible exercise program to potentially improve visuospatial ability and global cognition in older adults with frailty.

[Determinant factors encouraging work motivation: a study of care staff working in health services facilities for elderly people].

PURPOSE: Work motivation among care workers influences the quality of care for facility residents. The purpose of this study was to identify related factors in care staff. METHOD: Sixty hundred and seven care staff working at 25 health services facilities for elderly people participated in this study. We applied a theoretically derived model of specific relationships among work motivation, jobsatisfaction, profession identity, job competence, interprofessional working and profession image. These factor relationships were then tested using a structural equation modeling technique. RESULTS: Profession identity, job competence and the profession image of caring were shown to have direct influences on work motivation. In addition, job satisfaction, inter professional working, profession images of nursing and rehabilitation responsibilities were shown to have indirect influences. CONCLUSION: These data suggest that improving profession identity, job competence and the profession image of caring are important to enhance work motivation of care staff.

Factors associated with overweight status, obesity, and sedentary behavior in elementary and junior high school students.

BACKGROUND: Sedentary behavior increases the risks of obesity and cardiovascular disease in adults, but these relationships are uncertain in elementary and junior high school students. We investigated whether sedentary behavior is related to overweight status and obesity in high-risk children with lifestyle diseases. METHOD: A cross-sectional study was performed in 115 children and primary caregivers who attended a lecture for preventing child lifestyle diseases in Ibaraki prefecture, Japan. The main outcome measure was excess weight (percent overweight). Factors associated with excess weight in children were evaluated using multiple regression analysis. Basic physical and demographic characteristics, biochemical data (total cholesterol [TC], low and high density lipoprotein cholesterol [LDL-C and HDL-C], alanine aminotransferase [ALT]), blood pressure, child and parental sedentary time, parental BMI, and family environment were evaluated. RESULTS: In total, 107 children were eligible for participation in the study. Excess weight in these children was 28.6 ± 18.4. Sedentary time was 337.2 ± 122.5 min/day in children and 347.0 ± 196.2 min/day in parents. Multiple regression analysis revealed that children's sedentary behavior (ß = 0.02, (95%CI: 0.00 to 0.04)) and HDL-C (ß = -0.59, (95%CI: -0.81 to -0.38)) as independent predictors of children's excess weight. CONCLUSION: Study findings suggest that decreasing children's sedentary behavior in addition to greater physical activity is important for the prevention of overweight status and obesity in high-risk children with lifestyle diseases. Reduction of sedentary time, and engaging in regular exercise are all important for proper weight maintenance in children.

Daily Life Physical Activity Modulates the Effects of an Exercise Program on Lower-Extremity Physical Function in Japanese Older Adults.

BACKGROUND AND PURPOSE: Decreasing daily life physical activity (PA) outside an exercise program might hinder the benefit of that program on lower-extremity physical function (LEPF) in older adults. The purpose of this study was to investigate how daily life PA modulates the effects of an exercise program on LEPF. METHODS: The participants were 46 community-dwelling older adults (mean age, 70.1 ± 3.5 years) in Kasama City, a rural area in Japan. All participated in a fall-prevention program called square-stepping exercise once a week for 11 weeks. We evaluated their daily life PA outside the exercise program with pedometers and calculated the average daily step counts during the early and late periods of the program. We divided participants into 2 groups on the basis of whether or not they decreased PA by more than 1000 steps per day between the early and late periods. To ascertain the LEPF benefits induced by participating in the exercise program, we measured 5 physical performance tests before and after the intervention: 1-leg stand, 5-time sit-to-stand, Timed Up and Go (TUG), habitual walking speed, and choice-stepping reaction time (CSRT). We used a 2-way analysis of variance to confirm the interaction between the 2 groups and the time effect before and after the intervention. RESULTS: During the exercise program, 8 participants decreased their daily life PA (early period, 6971 ± 2771; late period, 5175 ± 2132) and 38 participants maintained PA (early period, 6326 ± 2477; late period, 6628 ± 2636). Both groups significantly improved their performance in TUG and CSRT at the posttest compared with the baseline. A significant group-by-time interaction on the walking speed (P = .038) was observed: participants who maintained PA improved their performance more than those who decreased their PA. DISCUSSION: Square-stepping exercise requires and strengthens dynamic balance and agility, which contributed to the improved time effects that occurred in TUG and CSRT. On the contrary, because PA is positively associated with walking speed, maintaining daily life PA outside an exercise program may have a stronger influence on walking speed. To enhance the effectiveness of an exercise program for young-old adults, researchers and instructors should try to maintain the participant's daily life PA outside the program. CONCLUSION: Regardless of decreasing or maintaining daily life PA, the square-stepping exercise program could improve aspects of LEPF that require complex physical performance. However, a greater effect can be expected when participants maintain their daily life PA outside the exercise program.

A survey of deep tissue injury in elite female wheelchair basketball players.

OBJECTIVE: To investigate deep tissue injuries (DTIs) in elite female wheelchair basketball players and identify factors associated with their occurrence. METHODS: Study participants were 22 female wheelchair basketball players on the Japanese national team. The sacral and bilateral ischial regions of each participant were examined using ultrasonography to detect DTIs. RESULTS: DTIs were found in 15 players (68.2%). DTIs were more frequent in players with a central nervous system disorder (CNSd) (85.7%) than in those with skeletal system disease (SSd) (37.5%, p = 0.020), and in players using a wheelchair in daily life (84.6%) than those using a wheelchair only for basketball (44.4%, p = 0.046). Players with pelvic instability were more likely to have DTIs (90.9% vs. 45.5%, p = 0.017). DTIs were deeper in the ischial region than the sacral region (p = 0.022). Players with CNSd had more DTIs in sacral regions (90% vs. 10%, p = 0.014). Players with DTIs had lower systolic blood pressure (sBP), red blood cell (RBC) count, and serum creatinine levels (sCr) (all p < 0.05). CONCLUSIONS: Ischial DTIs were deeper than sacral DTIs. Players with CNSd had more sacral DTIs than those with SSd. CNSd, wheelchair use in daily life, pelvic instability, and lower sBP, RBC, and sCr increased the risk of DTIs.

Correlates of shoulder pain in wheelchair basketball players from the Japanese national team: A cross-sectional study.

OBJECTIVE: To reveal correlates of shoulder pain in wheelchair basketball players from the Japanese national team. METHODS: Study participants were 19 males (29.7 ± 5.2 years) and 21 females (29.0 ± 8.2 years) players. We assessed shoulder pain using the wheelchair user's shoulder pain index (WUSPI). As potential correlates of shoulder pain, age, ability class, practice time and years of experience in wheelchair basketball were collected. RESULTS: The total WUSPI score for men (16.18 ± 17.39 points) was significantly higher than that for women (8.62 ± 15.70 points). In men, higher age was significantly correlated with greater shoulder pain for total WUSPI score and on two WUSPI items. Lower ability in wheelchair basketball was correlated with men's greater shoulder pain on three WUSPI items. In men, there were also significant correlations between longer years of experience and greater shoulder pain for total WUSPI score and on three WUSPI items. For women, there were significant correlations between longer practice time and less pain for total WUSPI score and on four WUSPI items. CONCLUSIONS: Because top male wheelchair basketball players have a higher risk of shoulder pain than female players, daily care of shoulder and periodic medical checkups are needed, especially for older male players with lower ability and more experience.