OBJECTIVES: Poor cardiorespiratory fitness (CRF) and high body mass index (BMI) increased the risk of developing metabolic Syndrome (MetS) mostly in Caucasians. However, the sex-specific combined association of CRF and BMI on MetS considering health-related behaviors has yet to be thoroughly examined in Japanese. This study aims to investigate the sex-specific independent and combined associations of CRF and BMI with MetS in middle-aged Japanese adults. METHODS: 421 participants were included in this cross-sectional study. CRF was estimated using a submaximal cycle ergometer. CRF and BMI were respectively divided into three categories according to tertile distribution. MetS was diagnosed based on five risk factors: waist circumference, triglycerides, high-density lipoprotein cholesterol, blood pressure, and fasting glucose. Multivariable logistic regression models were used to estimate independent and combined association of CRF and BMI with MetS. RESULTS: Results showed that 154 (57.5%) and 70 (45.8%) of men and women had MetS, respectively. Compared to men with lower CRF or higher BMI, men with middle and higher CRF or middle and lower BMI were less likely to have MetS. Compared with 'unfit and higher BMI' group, 'unfit and lower BMI', 'fit and higher BMI', and 'fit and lower BMI' groups in men showed statistically significant decreased prevalences of MetS. However, no significant associations were found in women. CONCLUSIONS: This study found significant independent and combined associations of CRF and BMI with MetS only in men, but not in women. However, prospective studies are warranted to confirm sex-specific associations of CRF and BMI with MetS.

ABSTRACT

Purpose

This study estimated an individual's genetic liability to cardiometabolic risk factors by polygenic risk score (PRS) construction and examined whether high cardiorespiratory fitness (CRF) modifies the association between PRS and cardiometabolic risk factors.

Methods

This cross-sectional study enrolled 1,296 Japanese adults aged ≥40 years. The PRS for each cardiometabolic trait (blood lipids, glucose, hypertension, and obesity) was calculated using the LDpred2 and clumping and thresholding methods. Participants were divided into low-, intermediate-, and high-PRS groups according to PRS tertiles for each trait. CRF was quantified as peak oxygen uptake (VO₂peak) per kg body weight. Participants were divided into low-, intermediate-, and high-CRF groups according to the tertile VO₂peak value.

Results

Linear regression analysis revealed a significant interaction between PRS for triglyceride (PRS_TG) and CRF groups on serum TG levels regardless of the PRS calculation method, and attenuated the association between PRS_TG and TG levels in the high-CRF group. Logistic regression analysis revealed a significant sub-additive interaction between LDpred2 PRS_TG and CRF on the prevalence of high TG, indicating that high CRF attenuated the genetic predisposition to high TG. Furthermore, a significant sub-additive interaction between PRS for body mass index and CRF on obesity was detected regardless of the PRS calculation method. These significant interaction effects on high TG and obesity were diminished in the sensitivity analysis using VO₂peak per kg fat-free mass as the CRF index. Effects of PRSs for other cardiometabolic traits were not significantly attenuated in the high-CRF group regardless of PRS calculation methods.

Conclusions

The findings of the present study suggest that individuals with high CRF overcome the genetic predisposition to high TG levels and obesity.

Urbanization represents a significant population trend, and a longer life expectancy increases the number of older people living in cities. Aging can intensify urbanization and urban design challenges. Parks or public open spaces are settings within the neighborhood that can support older people to live an active lifestyle. This study examined associations between the number of and distance to parks and physical activity levels and sedentary behavior patterns among a sample of 276 older adults in Japan. Physical activity levels and sedentary behavior patterns were objectively measured using accelerometer devices. Park measures, including distance to the nearest and second nearest park and the count of parks within network-based buffers of 800 m and 1600 m from home, were calculated using a geographic information system (GIS) software. We found that the number of parks within a 1600 m buffer from participants’ homes was associated with more breaks in sedentary behavior. This finding suggests that proximity to parks may be important to increase breaks in sedentary behavior among older adults. We found no significant associations between the selected park characteristics and physical activity. Our research adds to the evidence from the less-explored Asian context among older adults, for whom strategies to support an active lifestyle are necessary to promote healthy aging.

Abstract

Aging is the greatest risk factor for numerous diseases and mortality, and establishing geroprotective interventions targeting aging is required. Previous studies have suggested that healthy dietary patterns, such as the Mediterranean diet, are associated with delayed biological aging; however, these associations depend on nationality and sex. Therefore, this study aimed to investigate the relationship between dietary patterns identified through principal component analysis and biological aging in older men of Japan, one of the countries with the longest life expectancies. Principal component analysis identified two dietary patterns: a healthy Japanese dietary pattern and a Western-style dietary pattern. Eight epigenetic clocks, some of the most accurate aging biomarkers, were identified using DNA methylation data from whole-blood samples. Correlation analyses revealed that healthy Japanese dietary patterns were significantly negatively or positively correlated with multiple epigenetic age accelerations (AgeAccel), including AgeAccelGrim, FitAgeAccel, and age-adjusted DNAm-based telomere length (DNAmTLAdjAge). Conversely, the Western-style dietary pattern showed no significant correlation with any of the examined epigenetic AgeAccels or age-adjusted values. After adjusting for confounders, the healthy Japanese dietary pattern remained significantly negatively correlated with AgeAccelPheno and AgeAccelGrim and positively correlated with DNAmTLAdjAge. These findings suggest that a Western-style dietary pattern is not associated with biological aging, whereas a healthy Japanese dietary pattern is associated with delayed biological aging in older Japanese men. Our findings provide evidence that healthy dietary patterns may have beneficial effects on delayed biological aging in older Japanese men.

Abstract

PurposeThis study aimed to investigate the rate of high sedentary behaviour (SB) time and differences in physical outcomes (PO) and activities of daily living (ADL) based on SB time in hospitalized older cardiovascular disease (CVD) patients undergoing phase I cardiac rehabilitation (CR).MethodsOlder CVD patients were enroled from October 2020 to September 2023 and were divided into the high SB group (≥480 min/day) and low SB group (<480 min/day). The study compared patients’ clinical characteristics, usual gait speed (GS), and Five Times Sit to Stand Test (FTSST) time as indices of PO. Motor, cognitive, and total Functional Independence Measure (FIM) scores were used as indices of ADL and compared between groups using analysis of covariance.ResultsFinal analysis included 402 patients (mean age: 76.7 years, female: 35.3%). The high SB group included 48.5% of the study patients. After adjustment for baseline characteristics, GS (0.80±0.27 vs. 0.96±0.23 m/sec, p <0.001) was lower and FTSST (11.31±4.19 vs. 9.39±3.11 sec, p <0.001) was higher in the high SB group versus the low SB group. Motor (85.82±8.82 vs. 88.09±5.04 points, p <0.001), cognitive (33.32±2.93 vs. 34.04±2.24 points, p <0.001), and total FIM (119.13±10.66 vs. 122.02±6.30 points, p <0.001) scores were significantly lower in the high SB group versus low SB group after adjustment.ConclusionsIn older CVD patients in phase I CR, SB time might influence PO and ADL at discharge. It is thus necessary to consider the amount of SB time spent by these patients during daily life while hospitalized.

Sports science focuses on enhancing athletes' performance, requiring a multifaceted approach. It is evolving from a purely muscle-centred approach to an interdisciplinary one. This paper investigates built environment design science, a dimension less explored in relation to enhancing athlete performance in sports science. The discussion is divided into three categories: athlete-centric training built environment design, enhanced fan and community engagement, and improved integrative accessibility. The study also identifies future research directions, including evidence of the relative impact of the built environment, financial aspects, and performance evaluation methods. Collaboration between sports scientists and scholars in urban design, parks, transportation, landscape architecture and environmental psychology is necessary to advance this topic further.

There is evidence that higher street connectivity and availability of destinations can support walking behavior. However, the availability of data and comparability between previous studies remain a challenge. Based on a large Canadian adult sample, this study examined the associations between street layout and walking behaviors and explored whether objectively measured destinations may mediate these relationships. This study used data from 12,378 adults from Alberta's Tomorrow Project (ATP), a prospective cohort study conducted in Alberta, Canada. Walking behaviors were obtained by questionnaires. Street layout and destination measures were calculated objectively. Covariate-adjusted multivariate linear models estimated the associations between the space syntax street integration and duration of transport and leisure walking. The mediation effects of the availability of destinations in these associations were tested by the structural equation modelling. Street integration was significantly positively associated with transportation walking (b=0.01, 95% CI 0.00, 0.01, p = 0.01) (indirect effect). The availability of destinations partially mediated this association. Using the natural movement theory in space syntax, our study provides insights into using street layouts as a primary measure to (re)design the built environment to support walking.

Abstract

Purpose:Limited data are available on the relationship of parasympathetic nervous function with the prevalence of prediabetes and diabetes in men and women. We conducted a cross-sectional study to investigate the relationship between diving reflex - markers of parasympathetic nervous function - with the prevalence of prediabetes and diabetes among men and women in WASEDA'S Health Study.Methods: Participants were 199 men and 75 women who completed a medical examination, maximal exercise test, and diving reflex test. The participants were divided into tertiles based on the diving reflex indexes. The diving reflex indexes were the peak value of the R–R interval during the test (R–Rmax) and the relative difference between the baseline and peak response due to the test (R–Rchange). Odds ratios and 95% confidence intervals for the prevalence of prediabetes and diabetes were obtained using logistic regression models while adjusting for sex, age, body fat percentage, family history of diabetes, smoking status, and drinking status, sleeping hours, energy intake, and peak oxygen uptake.Results: Forty-one participants had prediabetes (n=24) or diabetes (n=17). Using the lowest diving reflex indexes as reference, we calculated odds ratios and 95% confidence intervals for the outcomes if interests. We found inverse relationships between R-Rmax and prediabetes and diabetes (P for trend = 0.104) as well as R-Rchange and diabetes (P for trend = 0.023).Conclusions: In this cross-sectional analysis, the data suggest diving reflex indexes, especially R-Rchange, may be related to the prevalence of diabetes.

Objectives The Internet has made it possible to search for, obtain, transmit, and share information. Accordingly, the ability to use health information and skills related to interactivity taken from the Internet have become important in the medical and health fields. However, there is no scale to evaluate these abilities. Therefore, this study was conducted to assess the validity and reliability of the Digital Health Literacy Instrument (DHLI) and examine the association of digital health literacy (DHL) with the characteristics of the study participants.Methods The Japanese version of the DHLI was developed using the basic guidelines for scale translation. The participants included 2,000 Japanese adults (men: 50.0%, mean age: 40.7±12.0 years) who responded to an Internet-based cross-sectional survey. The Japanese version of the DHLI, attributes, sources of health information, contents of health information taken from the Internet, and eHealth Literacy Scale (eHEALS) scores were obtained using a questionnaire. Confirmatory factor analysis and correlation with eHEALS scores were used to assess construct and criterion validities. Cronbach's alpha and correlation coefficients were computed for internal consistency and test-retest reliability. Differences in DHLI scores for each attribute and variables related to health information were examined using the analysis of variance and t-test.Results Confirmatory factor analysis revealed a goodness-of-fit index of .946, a comparative fit index of .969, and a root mean square error of approximation of .054, confirming that the Japanese version has the same seven-factor structure as the original version does. A significant positive correlation was found between DHLI and eHEALS scores (r=.40, P<.001). Cronbach's alpha was .92, and test-retest reliability was r=.88 (P<.001). DHLI scores were mainly associated with household income, health status, frequency of information searches on the Internet, and devices used. The subscale scores found difficulties in evaluating reliability, determining relevance, and adding self-generated content. Differences in DHL were observed among some sources and contents of health information on the Internet.Conclusion The Japanese version of the DHLI was a sufficiently reliable and valid instrument for assessing DHL among Japanese adults. Our results suggest that low DHL may lead to health information disparities. Therefore, it is necessary to consider support strategies for individuals who need to improve their DHL and for skills that need to be strengthened.

Abstract

The design and quality of the neighbourhood built environment can encourage health-supportive behaviours and support cardiometabolic health. However, despite the relationships between demographic and behavioural risk factors of metabolic syndrome being investigated by many studies, only some studies have directly estimated the associations between the built environment and metabolic syndrome. Using data from Canada, we examined the associations between the neighbourhood built environment and metabolic syndrome. Data from Alberta’s Tomorrow Project participants, conducted in Alberta, Canada, was used (n = 6718). Metabolic syndrome was defined as the presence of at least three clinical risk factors among lipid levels, blood pressure, and waist circumference. The normalised difference vegetation index was used to quantify the greenness of each participant’s neighbourhood. Built attributes of participants’ neighbourhoods associated with supporting physical activity, including dwelling density, intersection density, and the number of points of interest, were obtained via the Canadian Urban Environmental Health Research Consortium. Increases in the number of points of interest and total active living environment-friendliness of the neighbourhood were associated with having fewer metabolic syndrome risk factors (b = −0.11, 95% CI −0.16, −0.07 and b = −0.03, 95% CI −0.05, −0.01, respectively) and lower odds of metabolic syndrome (OR = 0.89, 95% CI 0.84, 0.094 and OR = 0.97, 95% CI 0.95, 0.99, respectively). Furthermore, higher dwelling density was associated with having fewer metabolic syndrome risk factors (b = −0.05, 95% CI −0.09, −0.01). Our findings highlight the importance of urban design to prevent and potentially manage metabolic syndrome and improve population health.

Accumulating evidence suggests that the built environment may be associated with cardiovascular disease via its influence on health behaviours. The aim of this study was to estimate the associations between traditional and novel neighbourhood built environment metrics and clinically assessed cardio-metabolic risk factors among a sample of adults in Canada. A total of 7171 participants from Albertas Tomorrow Project living in Alberta, Canada, were included. Cardio-metabolic risk factors were clinically measured. Two composite built environment metrics of traditional walkability and space syntax walkability were calculated. Among men, space syntax walkability was negatively associated with systolic and diastolic blood pressure (b = -0.87, 95% CI -1.43, -0.31 and b = -0.45, 95% CI -0.86, -0.04, respectively). Space syntax walkability was also associated with lower odds of overweight/obese among women and men (OR = 0.93, 95% CI 0.87, 0.99 and OR = 0.88, 95% CI 0.79, 0.97, respectively). No significant associations were observed between traditional walkability and cardio-metabolic outcomes. This study showed that the novel built environment metric based on the space syntax theory was associated with some cardio-metabolic risk factors.

Abstract

DNA methylation-based age estimators (DNAm aging clocks) are currently one of the most promising biomarkers for predicting biological age. However, the relationships between objectively measured physical fitness, including cardiorespiratory fitness, and DNAm aging clocks are largely unknown. We investigated the relationships between physical fitness and the age-adjusted value from the residuals of the regression of DNAm aging clock to chronological age (DNAmAgeAcceleration: DNAmAgeAccel) and attempted to determine the relative contribution of physical fitness variables to DNAmAgeAccel in the presence of other lifestyle factors. DNA samples from 144 Japanese men aged 65–72 years were used to calculate first- (i.e., DNAmHorvath and DNAmHannum) and second- (i.e., DNAmPhenoAge, DNAmGrimAge and DNAmFitAge) generation DNAm aging clocks. Various surveys and measurements were conducted, including physical fitness, body composition, blood biochemical parameters, nutrients intake, smoking, alcohol consumption, disease status, sleep status, and chronotype. The peak oxygen uptake (VO_2peak) per kg body weight had a significant negative correlation with GrimAgeAccel (r= -0.222,p= 0.008). A comparison of the tertile groups showed that the GrimAgeAccel of the highest VO_2peakgroup was decelerated by 1.6 years compared to the lowest group (p= 0.035). Multiple regression analysis suggested that rather than physical fitness, serum triglycerides, carbohydrate intake, and smoking status, were significantly associated with DNAmAgeAccel. In conclusion, the contribution of cardiorespiratory fitness to DNAmAgeAccel was relatively low compared to lifestyle factors such as smoking. However, this study reveals a negative relationship between cardiorespiratory fitness and DNAmAgeAccel in older men.

Background: The association of breaks in sedentary time with outcomes of physical function can vary according to the time of day. We examined the association of the diurnal pattern of breaks in sedentary time with physical function outcomes in older adults.
Methods: A cross-sectional analysis was conducted among 115 older adults (≥60 years). The overall and time-specific breaks (morning: 06:00-12:00; afternoon: 12:00-18:00; evening: 18:00-24:00) in sedentary time were assessed using a triaxial accelerometer (Actigraph GT3X+). A break in sedentary time was defined as at least 1 min where the accelerometer registered ≥ 100 counts/min following a sedentary period. Five physical function outcomes were assessed: handgrip strength (dynamometer), balance ability (single leg stance), gait speed (11-meter walking), basic functional mobility (time up and go), and lower-limb strength (five times sit-to-stand). Generalized linear models were used to examine the associations of the overall and time-specific breaks in sedentary time with the physical function outcomes.
Results: Participants showed an average of 69.4 breaks in sedentary time during the day. Less frequent breaks in the evening (19.3) were found than that in the morning (24.3) and the afternoon (25.3) (p<0.05). Breaks in sedentary time during the day were associated with less time on gait speed in older adults (exp (β)=0.92, 95% confidence interval [CI] 0.86-0.98; p<0.01). Time-specific analysis showed that breaks in sedentary time were associated with less time on gait speed (exp (β)=0.94, 95% CI 0.91-0.97; p<0.01), basic functional mobility (exp (β)=0.93, 95% CI 0.89-0.97; p<0.01), and lower-limb strength (exp (β)=0.92, 95% CI 0.87-0.97; p<0.01) in the evening only.
Conclusion: A break in sedentary time, particularly during the evening, was associated with better lower extremity strength in older adults. Further strategies to interrupt sedentary time with frequent breaks, with an emphasis on evening hours, can be helpful to maintain and improve physical function in older adults.

There has been a growing interest in the “metaverse,” and discourse about how this platform may contribute to different fields of science is already beginning to emerge. In this paper, we discuss key opportunities and uncertainties about how a metaverse might contribute to advancing knowledge in the interdisciplinary field of the built environment and public health aimed at reducing noncommunicable diseases.

Abstract

High-quality sleep is an important factor in sustaining health and improving well-being. Previous evidence has demonstrated the positive associations between increased physical activity and reduced sedentary behaviour (SB) with sleep quality. The substitutional relationships between SB, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) need to be considered when examining how a particular behaviour may impact sleep quality. No studies, to our knowledge, have explored these substitutional relationships in middle-aged adulthood. Using an isotemporal substitution approach, this study examined the associations of replacing sedentary time with physical activity on sleep quality measures in a sample of middle-aged adults in Japan. Data from 683 adults aged 40–64 living in Japan were used. The average daily time spent in SB, LPA, and MVPA was objectively assessed by accelerometers. Two self-reported sleep quality measures were obtained using questionnaires, including rest by sleep and sleep quality. Multivariable linear regression models were used to assess the associations of SB, LPA, and MVPA with the sleep quality measures stratified by gender. We found that each 60 min unit of SB or LPA replaced with MVPA was favourably associated with rest by sleep among women (β = 0.16, 95% CI 0.07, 0.28, p &lt; 0.001; β = 0.18, 95% CI 0.07, 0.32, p &lt; 0.05, respectively). There were no significant associations between SB, LPA, and MVPA with sleep measures in men across all three models. These findings indicate that higher MVPA has a positive association with sleep quality in middle-aged women.

Increased sedentary behaviour (SB) is reportedly associated with mortality and morbidity in cardiovascular disease. However, its relation with physical function is not well understood in phase I cardiac rehabilitation (CR). This study aimed to investigate the rate of SB and the relation between SB and physical function among patients participating in phase I CR. This prospective multicentre cohort study enrolled patients participating in CR from October 2020 to July 2022. Patients with probable dementia and difficulty walking alone were excluded. We used sitting SB time as the index of SB and the Short Performance Physical Battery (SPPB) as the index of physical function at discharge. Patients were divided into the low SB group (< 480 min/day) or high SB group (≥ 480 min/day). We analysed and compared the two groups. The final analysis included 353 patients (mean age: 69.6 years, male: 75.6%), of whom 47.6% (168 of 353) were high SB patients. Total sitting SB time was higher in the high SB group versus the low SB group (733.6 ± 155.3 vs 246.4 ± 127.4 min/day, p < 0.001), and mean SPPB score was lower in the high SB group versus the low SB group (10.5 ± 2.4 vs 11.2 ± 1.6 points, p = 0.001). Multiple regression analysis identified SB as an explanatory variable for total SPPB score (p = 0.017). Patients with high SB had significantly lower SPPB scores than those with low SB. These findings underscore the importance of considering SB when improving physical function. Effective strategies to improve physical function can be developed that consider SB in phase I CR.

INTRODUCTION: A prior study showed an association between diversity in daily activities (type, frequency, evenness) and frailty in older adults. However, the causality of this relationship is unclear. Therefore, this study aimed to clarify the relationship between activity diversity and frailty through a 2-year longitudinal study conducted among community-dwelling older adults. METHODS: We evaluated data from the 2018 and 2020 waves of the Otassha Study. Frailty was assessed using the Cardiovascular Health Study criteria, with pre-frail and frail participants defined as frail and the other participants categorized into the robust group. We enrolled a total of 207 participants who were not frail at baseline. Activity type, frequency, and evenness scores were calculated using an Activity Diversity Questionnaire. The association between each activity diversity score and the incidence of frailty was evaluated using logistic regression modeling (each diversity score was entered the model after Z-transformation). RESULTS: Of the 207 enrolled participants (median age, 73 years; age range, 65-91 years; 60.4% women), 64 (30.9%) had incident frailty during the follow-up period. A logistic regression analysis adjusting for sociodemographic and psychosomatic factors revealed odds ratios for activity type and evenness scores of 0.64 and 0.61, respectively (P < 0.05). These factors were significantly associated with the incidence of frailty. DISCUSSION: Activity type and evenness (except frequency) within daily activities were predictors of frailty during 2 years of follow-up. Engagement in diverse activities appears to be more effective in preventing frailty than does engagement in a few activities.

[Purpose] In this pilot study, we investigated the effectiveness of physical therapist-delivered acceptance and commitment therapy in older outpatients with knee osteoarthritis and chronic pain. [Participants and Methods] This single-center, open-label, parallel-group pilot randomized controlled trial included 30 patients assigned to the physical therapist-delivered acceptance and commitment therapy group (n=15) and the usual care physical therapy-only group (n=15). Both treatments were administered once a week for 8 weeks. Evaluation was performed 4 weeks before intervention, pre-intervention, post-intervention, and 4 weeks after intervention. The primary outcome was diagnosis of a physical disability, and secondary outcomes included psychological inflexibility, pain intensity, anxiety, depression, physical function, and objectively measured physical activity. [Results] Physical therapist-delivered acceptance and commitment therapy had a limited effect on physical disability, although we observed a favorable tendency. With regard to secondary outcomes, physical therapist-delivered acceptance and commitment therapy did not show significant effects. Notably, 15 patients withdrew from this study and 6 were diagnosed with coronavirus disease. [Conclusion] Physical therapist-delivered acceptance and commitment therapy did not appear to show significant effects in the present study. It is necessary to correct these issues in this study, and future studies are warranted to investigate the effects of this therapy.

Abstract

Background

Although the negative relationship between cardiorespiratory fitness (CRF) or muscular fitness and diabetes mellitus were respectively observed in many previous studies, there is still a lack of studies that include CRF and muscular fitness simultaneously. Therefore, this study aimed to investigate the relationship between the combination of CRF and muscular fitness and diabetes through a cross-sectional study. 

Methods

This study was part of WASEDA'S Health Study, a cohort study launched in 2014. We used a part of the baseline data collected for this study. Maximal exercise test using a cycle ergometer and leg extension power (LEP) test were respectively used to evaluate CRF and muscular fitness. Since LEP is affected by body weight, relative LEP (rLEP) which is LEP per body weight, was used as an index of muscular fitness. 796 men (56.5 ± 10.4 years old) who completed a medical examination and fitness tests, were divided into two groups based on CRF and rLEP, respectively. The prevalence of diabetes was collected based on a self-reported questionnaire or blood test. Odds ratios and 95% confidence intervals (CIs) for the prevalence of diabetes were obtained using logistic regression models while adjusting for age, body mass index, exercise habits, family history of diabetes, smoking habits, and drinking habits.

Results

55 (7%) participants had diabetes. Compared to participants with lower CRF or rLEP, the odds ratio (95% CIs) of diabetes in those with higher CRF or rLEP was 0.46 (0.21–0.98) or 0.34 (0.16–0.74), respectively. Furthermore, using the lower CRF and lower rLEP group as the reference, the odds ratio (95% CIs) for the lower CRF and higher rLEP group was 0.32 (0.12–0.88), and higher CRF and higher rLEP group was 0.21 (0.07–0.63), after adjusting for potential confounding factors.

Conclusions

CRF and rLEP have independent and joint inverse associations with diabetes prevalence. In addition, participants with high CRF and high rLEP had a lower prevalence of diabetes compared to those with only high CRF or only high rLEP.

Understanding the correlates of sedentary behavior among children is essential in developing effective interventions to reduce sitting time in this vulnerable population. This study aimed to identify correlates of domain-specific sedentary behaviors and objectively assessed sedentary time among a sample of children in Japan. Data from 343 children (aged 6-12 years) living in Japan were used. Domain-specific sedentary behaviors were assessed using a questionnaire. Total sedentary time was estimated using hip-worn accelerometers. Twenty-two potential correlates across five categories (parental characteristics, household indoor environment, residential neighborhood environment, school environment, and school neighborhood environment) were included. Multivariable linear regression models were used to identify correlates of domain-specific sedentary behaviors and objectively assessed sedentary time. Eight correlates were significantly associated with children's domain-specific sedentary behaviors: mother's and father's age, mother's educational level, having a video/DVD recorder/player, having a video console, having a TV one's own room, home's Walk Score®, and pedestrian/cycling safety. No significant associations were found between potential correlates and accelerometer-based total sedentary time. These findings highlight that strategies to reduce children's sedentary time should consider the context of these behaviors. For example, urban design attributes such as perceived pedestrian and cycling safety can be improved to reduce children's car sitting time.

Background
Understanding factors contributing to an individual reducing screen time is essential for promoting a healthy weight. Parents’ behavior affects children by influencing their daily decision-making through modeling, rules or restrictions, social support, and co-participation. We examined how the direct and indirect effects of parents’ and children’s behaviors regarding screen time influenced body mass index (BMI) among Japanese elementary school children.

Methods
We included 283 Japanese children, one child per household, aged 6–12 years, who were randomly selected from resident registries of two cities. The questionnaires were completed by children and their mothers and fathers. Screen time and sociodemographic attributes, including sex, age, employment status, height, and weight, were assessed using a mail-based survey. Path analyses were conducted to determine associations among children’s, fathers’, and mothers’ variables. It was hypothesized that after controlling for household income and children’s sex and age, mothers’ and fathers’ screen time on weekdays and weekends would be related to children’s weekdays and weekend screen time, respectively. In addition, we hypothesized that children’s weekday and weekend screen time was related to children’s BMI.

Results
Both fathers’ and mothers’ weekday screen times were associated with children’s weekday and weekend screen times. BMI was affected by children’s weekday screen time (0.117). The path coefficients for the indirect effects of mothers’ and fathers’ screen time on children’s BMI through children’s weekday screen time were 0.016 from the fathers’ weekday screen time and 0.024 from the mothers’ weekday screen time (GFI = .980, AGFI = .953, RMSEA = .030, AIC = 93.030).

Conclusions
Both fathers’ and mothers’ weekday screen times indirectly affected children’s BMI through children’s weekday screen time among Japanese elementary school children. The strongest indirect effects could be seen by examining the paths of a mother’s weekday screen time through children’s screen time to BMI. Mothers who spend much time with their children are role models, and their behavior could affect the child’s behavior. The findings imply that intervention strategies to reduce screen time in children should also focus on modeling the mothers’ behavior.

Abstract

Few studies have examined the association between coffee consumption and muscle mass; their results are conflicting. Therefore, we examined the association between coffee consumption and low muscle mass prevalence. We also performed an exploratory investigation of the potential effect modification by demographic, health status-related, and physical activity-related covariates. This cross-sectional study included 2085 adults aged 40–87 years. The frequency of coffee consumption was assessed using a self-administered questionnaire. Muscle mass was assessed as appendicular skeletal muscle mass/height² using a multifrequency bioelectrical impedance analyser. We defined low muscle mass using cut-offs recommended by the Asian Working Group for Sarcopenia. Multivariable-adjusted odds ratios for low muscle mass prevalence were estimated using a logistic regression model. The prevalence of low muscle mass was 5.4% (n = 113). Compared with the lowest coffee consumption group (&lt;1 cup/week), the multivariable-adjusted odds ratios (95% confidence intervals) of low muscle mass prevalence were 0.62 (0.30, 1.29) for 1–3 cups/week, 0.53 (0.29, 0.96) for 4–6 cups/week or 1 cup/day, and 0.28 (0.15, 0.53) for ≥2 cups/day (P for trend &lt;0.001). There were no significant interactions among the various covariates after Bonferroni correction. In conclusion, coffee consumption may be inversely associated with low muscle mass prevalence.

OBJECTIVES: We aimed to examine the relationship between the fat-free mass index (FFMI; FFM/height2) and appendicular skeletal muscle mass index (ASMI; ASM/height2), measured using both bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA), and investigate the effects of age and obesity. We also evaluated the suitability of BIA-measured FFMI as a simple surrogate marker of the ASMI and calculated the optimal FFMI cutoff value for low muscle mass screening to diagnose sarcopenia. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: This study included 1313 adults (women, 33.6%) aged 40-87 years (mean age, 55 ± 10 years) from the XXXX Study. METHODS: Body composition was measured using multifrequency BIA and DXA. Low muscle mass was defined according to the criteria of the Asian Working Group for Sarcopenia 2019. RESULTS: BIA-measured FFMI showed strong positive correlations with both BIA- (r = 0.96) and DXA-measured (r = 0.95) ASMIs. Similarly, in the subgroup analysis according to age and obesity, the FFMI was correlated with the ASMI. The areas under the receiver operating characteristic curve for screening low muscle mass defined by DXA-measured ASMI using BIA-measured FFMI values were 0.95 (95% CI 0.93-0.97) for men and 0.91 (95% CI 0.87-0.94) for women. The optimal BIA-measured FFMI cutoff values for screening low muscle mass defined by DXA-measured ASMI were 17.5 (sensitivity 89%, specificity 88%) for men and 14.6 (sensitivity 80%, specificity 86%) for women. CONCLUSIONS AND IMPLICATIONS: The FFMI showed a strong positive correlation with BIA- and DXA-measured ASMIs, regardless of age and obesity. The FFMI could be a useful simple surrogate marker of the ASMI for low muscle mass screening in sarcopenia in community settings. The suggested FFMI cutoff values for predicting low muscle mass are <18 in men and <15 in women.

BACKGROUND: Time spent sitting is associated adversely with health outcomes in older adults. Nevertheless, it is not clear how sedentary time may be related to appendicular skeletal muscle mass (ASM) - a key attribute of sarcopenia. This cross-sectional study examined associations of total sedentary time with ASM among community-dwelling older Japanese males and females. METHODS: Participants (n = 281, 74.3 ± 5.2 yr) wore a tri-axial accelerometer for seven days. Body mass index-adjusted ASM (kg/BMI) was derived from bioimpedance measures. Multivariate linear and quadratic regression models examined the associations of ASM with total sedentary time, stratified by sex. Restricted cubic spline models were fitted to estimate non-linear associations. Isotemporal substitution (IS) models were used to estimate the impacts of replacing 30-minute of sedentary time with light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). RESULTS: After adjustment, total sedentary time had a significant linear and negative association with ASM among females (β = -0.014; p = 0.023). For males, total sedentary time had a significant quadratic association (p = 0.020). Spline models indicated a reverse U-shaped association (p < 0.001) with total sedentary time over 9.3 h/day being associated with lower ASM. The IS models indicated that replacing 30 min/day of sedentary time with LPA would be positively and significantly associated with older females' ASM (β = 0.007, p = 0.022). CONCLUSIONS: In older Japanese adults, higher volumes of time spent sedentary were associated with lower ASM. For males, only very high volumes of sedentary time appeared to be detrimental. These adverse relationships may in part be offset by more time spent in either LPA or MVPA.

BACKGROUND: Differences in accelerometer-measured sedentary behavior and different physical activity (PA) intensities between men and women have been poorly described. The authors examined gender differences in time-use activity composition and total volume of PA. METHODS: A cross-sectional mail survey was conducted from 2013 to 2015 with a randomized sample of 6000 middle-aged (40-64 y) community-dwelling Japanese adults living in urban and regional cities. Participants wore Active style Pro HJA-350IT on their waist for 7 consecutive days. Gender differences in activity time use was examined using compositional data analysis to control for time spent in all activity measures. RESULTS: In total, 757 participants (303 men, 52.3 [7.1] y) with valid data were included in the analysis. Women spent on average 12.6% less time in sedentary behavior and 23.4% more time in light-intensity PA than men, whereas no significant difference was found for moderate to vigorous PA. Women accumulated a significantly greater volume of PA than men (17.8 vs 15.0 metabolic equivalent of task h/d). CONCLUSIONS: Japanese middle-aged women showed higher levels of PA than men because they spent more time in light-intensity PA. Given the health benefits of light-intensity PA, evaluating only moderate to vigorous PA may lead to an underestimation of women's participation in PA.

Evidence suggests that neighbourhood street connectivity is positively associated with physical activity, yet few studies have estimated its associations with sedentary behaviour. We estimated the associations between space syntax derived street integration, a novel measure of street connectivity, and sedentary behaviours among Canadian adults. Data were sourced from a population-based study–Alberta’s Tomorrow Project (n = 14,758). Items from the International Physical Activity Questionnaire captured sedentary behaviour, including sitting and motor vehicle travel time and walking. Street integration was measured within a 1600m radius of participants’ homes. Covariate-adjusted linear regression models estimated the associations between street integration and sedentary behaviour. Street integration was significantly positively associated with daily minutes of sitting on week (b 6.44; 95CI 3.60, 9.29) and weekend (b 4.39; 95CI 1.81, 6.96) days, and for week and weekend days combined (b 5.86; 95CI 3.30, 8.41) and negatively associated with daily minutes of motor vehicle travel (b -3.72; 95CI -3.86, -1.55). These associations remained significant after further adjustment for daily walking participation and duration. More research is needed to understand the pathways by which street integration positively and or negatively affects sedentary behaviour.

In the context of rapid urbanization, public open spaces in dense urban areas are critical built environment elements to support active lifestyles. Several reviews have explored the associations of public open space attributes with physically active and sedentary behavior. However, few reviews have included studies from Asia, and no studies have focused on dense urban areas. This systematic review analyzed 18 observational studies investigating associations between public open space attributes with physical activity and sedentary behavior in dense urban areas of East Asian countries, including Japan, Taiwan, China, and Hong Kong. We found that closer distance to and a greater number of public open spaces and features within them were positively associated with leisure-time physical activity. Places near water features and corridors within public open spaces were associated with more sedentary behavior. These findings inform landscape and urban design guidelines for (re)designing public open spaces to support active lifestyles in high dense urban areas.

There has been growing interest in the role of pet ownership, particularly dog ownership, in managing noncommunicable diseases. The built environment can act as a facilitator or barrier to owning a dog or dog walking. Nevertheless, limited studies conducted in different geographical contexts have examined how the built environment can influence dog ownership and dog walking. In this interdisciplinary article, using Japan as a case study, we identify key design challenges to owning and walking dogs in dense urban areas as a means of promoting health and wellbeing.

Aim: This study examined the associations between psychological inflexibility (PI) and physical disability (PD) among older patients with chronic low back and knee pain. Methods: Pain avoidance and cognitive fusion were assessed in outpatients as components of PI and PD, and sociodemographic and pain-related variables were used as covariates. Hierarchical multiple linear regression was used. The covariates were first entered, followed by PI. Results: Age and pain intensity had significant positive associations with PD. After adding PI, only pain avoidance was significantly and positively associated with PD. Conclusion: Focusing on pain avoidance may be effective for physical disability when acceptance and commitment therapy is administered to older patients with chronic low back and knee pain.

Workplace settings-both internal and external-can influence how workers are physically active or sedentary. Although research has identified some indoor environmental attributes associated with sitting at work, few studies have examined associations of workplace neighbourhood built-environment attributes with workplace sitting time. We examined the cross-sectional associations of perceived and objective workplace neighbourhood built-environment attributes with sitting time at work and for transport among desk-based workers in Japan. Data were collected from a nationwide online survey. The Abbreviated Neighborhood Environment Walkability Scale (n = 2137) and Walk Score® (for a subsample of participants; n = 1163) were used to assess perceived and objective built-environment attributes of workplace neighbourhoods. Self-reported daily average sitting time at work, in cars and in public transport was measured using a Japanese validated questionnaire. Linear regression models estimated the associations of workplace neighbourhood built-environment attributes with sitting time. All perceived workplace neighbourhood built-environment attributes were positively correlated with Walk Score®. However, statistically significant associations with Walk Score® were found for sitting for transport but not for sitting at work. Workers who perceived their workplace neighbourhoods to be more walkable reported a longer time sitting at work and in public transport but a shorter sitting time in cars. Our findings suggest that walkable workplace neighbourhoods may discourage longer car use but have workplaces where workers spend a long time sitting at work. The latter finding further suggests that there may be missed opportunities for desk-based workers to reduce sitting time. Future workplace interventions to reduce sitting time may be developed, taking advantage of the opportunities to take time away from work in workplace neighbourhoods.

BACKGROUND: Little is known about what timing and intensity of physical activity (PA) are beneficial to preventing children's late sleeping habits. We investigated the association between timing and intensity of PA and late sleeping habits among Japanese children. METHODS: The amount of PA on a weekday (light (>1.5 to <3.0 metabolic equivalents [METs]); moderate (3.0 to <6.0 METs); and vigorous (6.0 to <20.0 METs) was measured for the whole day, before school, during school, and after school, using accelerometers for population-based fourth-grade elementary school and eighth graders for 7 consecutive days between September and December 2018. Late sleeping habit (going to bed after 10 p.m. for fourth graders and after 11 p.m. for eighth graders) was assessed by questionnaires. The data of 229 fourth graders and 182 eighth graders were analyzed with Poisson regression adjusted for grade, gender, household income, body mass index (BMI), belonging to a sports club, wake-up time on weekdays, and PAs with different intensities. RESULTS: Total PA was not associated with late sleeping habits. Light-intensity PA before school was protectively associated with late sleeping habits (prevalence ratio [PR]: 0.82, 95% confidence interval [CI]: 0.68, 0.99) while PA at school or after school was not. CONCLUSION: Light-intensity PA before school may enhance the earlier bedtime of children.

Although many studies have reported that a posteriori dietary pattern is associated with metabolic health, there is little evidence of an association between dietary patterns and different metabolic phenotypes. The present study aimed to examine the association between major dietary patterns and different metabolic phenotypes (metabolically healthy non-obese [MHNO], metabolically unhealthy non-obese [MUNO], metabolically healthy obese [MHO], and metabolically unhealthy obese [MUO]) in middle-aged and elderly Japanese adults. This cross-sectional study enrolled 2,170 Japanese adults aged ≥40 years. The four different metabolic phenotypes were determined based on the presence of obesity, abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. The major dietary patterns were determined using principal component analysis based on energy-adjusted food intake. Two dietary patterns were identified: the healthy dietary pattern, which was characterized by a high intake of vegetables, fruits, potatoes, soy products, mushrooms, seaweeds, and fish; and the alcohol dietary pattern, which was characterized by a high intake of alcoholic beverages, liver, chicken, and fish. The healthy dietary pattern was associated with the MHNO and MHO phenotypes (MUNO and MUO as reference groups, respectively), and the multivariate-adjusted odds ratios (ORs) (95% confidence intervals [CIs]) in the highest quartile of healthy dietary pattern score with the lowest quartile as the reference category were 2.10 (1.40-3.15) and 1.86 (1.06-3.25), respectively. Conversely, the alcohol dietary pattern was inversely associated with the MHNO and MHO phenotypes, while the multivariate-adjusted ORs (95% CIs) in the highest quartile of the alcohol dietary pattern score with the lowest quartile as the reference category were 0.63 (0.42-0.94) and 0.45 (0.26-0.76), respectively. There were no significant interactions between sex and healthy/alcohol dietary patterns in the prevalence of the MHNO and MHO phenotypes. In conclusion, the present study's findings suggest that major dietary patterns are associated with different metabolic phenotypes in middle-aged and elderly Japanese adults. These findings provide useful evidence for maintaining metabolic health through diet regardless of obesity status.

<title>Abstract</title>Evidence for social pathways to health benefits for dog owners appears positive but less well-developed. Our study aimed to estimate the differences in social capital by dog ownership and dog walking status among young-to-middle-aged adults and older adults in Japan. Data from 3606 residents living in Japan were used. Data on social capital, dog ownership, and dog walking were collected by questionnaires. Age-stratified multivariable linear regression models were used to estimate differences in social capital scores by dog ownership and dog walking status. Among young-to-middle-aged adults, the mean of the activities with neighbours score, adjusted for covariates, was significantly higher (<italic>p</italic> &lt; 0.05) for the dog owner walkers group compared to the non-dog owners group. Among older adults, no significant differences in the marginal means of social capital scores were observed between the three groups of non-dog owners, dog owner non-walkers, and dog owner walkers. While the benefits of social capital for a healthy lifestyle have been well-documented, few means have been identified to intervene in social capital. Building on and expanding the known health benefits of dog ownership and dog walking, this study revealed modest support for the link between dog walking and activities with neighbours among young-to-middle-aged adults, but no meaningful associations were found for older adults. Additionally, no significant link was observed between dog walking and social cohesion among either age group. Future research can further improve the use of dog-based behavioural health interventions for fostering social capital.

目的:都市部における地域スポーツ事業推進に資する資料を得るため,スポーツ推進委員の連絡調整機能の特徴を明らかにすることを目的とした.方法:2020年11月〜12月に,東京都内3自治体のスポーツ推進委員18名を対象とする半構造化インタビューを実施した.スポーツ推進委員の活動内容や連絡調整の役割について尋ねた.解析にはKH Coderを用い,テキストデータより共起ネットワークを作成した.次に,Mayringの方法論に基づき,共起ネットワークによる識別を踏まえたテキストデータの比較分析により,サブカテゴリおよびカテゴリの命名を行った.結果:テキストデータから1,601語が抽出された.最も頻出していた語は「色々」であり,次いで「スポーツ推進委員」「地域」「学校」「子ども」「小学校」の順に多く出現していた.テキストデータの比較分析により,スポーツ推進委員の連絡調整機能の特徴として,42のコード,18のサブカテゴリ,7のカテゴリ(【社会資源の活用】【事業化】【動機づけ】【ネゴシエーション】【組織化】【有機的な連携】【継続的な協働】)が生成された.結論:スポーツ推進委員内部の協力的な組織体制の構築を重視するとともに,組織外部との相互作用を通じた地域への主体的な働きかけが確認された.それらの特徴は,自治体の事業推進のための機能を兼ね備えていることが明らかとなった.(著者抄録)

<title>Abstract</title>
<sec>
<title>Background and Objectives</title>
This study aimed to examine the associations between time spent in six different domains of sedentary behavior and happiness and whether social capital mediated such associations among adults and older adults living in a rural area of Japan.


</sec>
<sec>
<title>Research Design and Methods</title>
Cross-sectional data from 3357 participants (mean age: 60±16 years) were used. Six domains of sedentary behavior, happiness, and social capital were assessed using a self-report questionnaire. Age-stratified multivariable linear regression models adjusted for covariates were used to examine the associations between six domains of sedentary behavior and happiness. For relationships where the direct effect was significant, we tested the mediating effects of two social capital measures.


</sec>
<sec>
<title>Results</title>
Among both adults and older adults, more time spent viewing television was significantly associated with lower happiness scores, and more time spent engaging in other leisure activities was significantly associated with higher happiness scores. In addition, more time spent using cell phones and computers was significantly associated with lower happiness scores among the adults. Engaging in activities with neighbors significantly mediated the relationship between other leisure activities and happiness in the adults and older adults and between television viewing and happiness in the older adults.


</sec>
<sec>
<title>Discussion and Implications</title>
Our findings indicated that less television viewing and more mentally active sedentary behavior (e.g., talking with others and engaging in hobbies) were associated with greater happiness. One aspect of social capital, engaging in activities with neighbors, acts as a potential mediator for relationships between sedentary behavior and happiness.


</sec>

OBJECTIVES: To examine the associations between domain-specific sedentary and active behaviors and workers' presenteeism and absenteeism in a sample of company employees. METHODS: This study recruited participants (n = 2466) from a nationwide online survey database (Japan, 2019). Participants completed a questionnaire that captured data on relative and absolute presenteeism and absenteeism and domain-specific physical activity and sedentary behaviors. RESULTS: Daily minutes of work-related physical activity were negatively associated with relative absenteeism. Daily minutes of leisure-related physical activity were positively associated with absolute presenteeism (ie, better productivity). Daily minutes of total physical activity were negatively and positively associated with relative absenteeism and absolute presenteeism (ie, better productivity). There was also a positive association between car sitting time and absolute absenteeism. CONCLUSIONS: A change in work culture and practices that support active behaviors at work and outside of work may improve employee's productivity indices.

A rapidly growing body of literature has explored associations between urban design attributes, which are conducive to walking, and social capital. The current study aimed to build on the limitations of previous research. Specifically, this study estimated the associations between traditional and novel walkable built environment metrics and social capital among a sample of adults in Japan. Data (n = 1010) from a randomly selected cross-section of residents (40–69 years old) from two areas in Japan were included. Social capital was assessed by questionnaires. Several objective and perceived walkable built environment attributes were calculated. Covariate-adjusted multivariable linear regression models were used to estimate associations between neighborhood built attributes and the three social capital scores. Street connectivity was negatively associated with activities with neighbors (b = -0.21, 95% CI -0.31, -0.11). Perceived population density was negatively associated with all three social capital scores, including social cohesion, activities with neighbors, and social participation (b = -0.21, 95% CI -0.30, -0.11, b = -0.15, 95% CI -0.24, -0.06, and b = -0.16, 95% CI -0.29, -0.02, respectively). Traditional walkability and Walk Score® were negatively associated with activities with neighbors (b = -0.04, 95% CI -0.07, -0.00 and b = -0.09, 95% CI -0.15, -0.04, respectively). No significant associations were observed between perceived walkability and social capital scores. Space syntax walkability was negatively associated with social cohesion and activities with neighbors (b = -0.12, 95% CI -0.23, -0.01 and b = -0.11, 95% CI -0.21, -0.01, respectively). This study provided unique findings demonstrating that walkable built environments may not necessarily support social capital in ultrahigh-density Asian cities.

PURPOSE: We aimed to investigate the hypothesis that type I collagen plays a role in increasing bone mineral density (BMD) and muscle stiffness, leading to low and high risks of fatigue fracture and muscle injury, respectively, in athletes. As a potential mechanism, we focused on the effect of the type I collagen alpha 1 chain gene (COL1A1) variant associated with transcriptional activity on bone and skeletal muscle properties. METHODS: The association between COL1A1 rs1107946 and fatigue fracture/muscle injury was evaluated in Japanese athletes. Effects of the polymorphism on tissue properties (BMD and muscle stiffness) and type I collagen α1/α2 chain ratios in muscles were examined in Japanese nonathletes. RESULTS: The C-allele carrier frequency was greater in female athletes with fatigue fracture than in those without (odds ratio = 2.44, 95% confidence interval [CI] = 1.17-5.77) and lower in female athletes with muscle injury than in those without (odds ratio = 0.46, 95% CI = 0.24-0.91). Prospective validation analysis confirmed that in female athletes, muscle injury was less frequent in C-allele carriers than in AA genotype carriers (multivariable-adjusted hazard ratio = 0.27, 95% CI = 0.08-0.96). Among female nonathletes, the C-allele of rs1107946 was associated with lower BMD and lower muscle stiffness. Muscle biopsy revealed that C-allele carriers tended to have a larger type I collagen α1/α2 chain ratio than AA genotype carriers (2.24 vs 2.05, P = 0.056), suggesting a higher proportion of type I collagen α1 homotrimers. CONCLUSION: The COL1A1 rs1107946 polymorphism exerts antagonistic effects on fatigue fracture and muscle injury among female athletes by altering the properties of these tissues, potentially owing to increased levels of type I collagen α1 chain homotrimers.

Sedentary behaviour is associated with risks of detrimental health outcomes. It is crucial to understand how much time people spend in sedentary behaviour and what factors affect too much sedentary time for effective intervention. However, few studies examined the prevalence and the correlates of sedentary behaviour in Japan. Therefore, we assessed total sedentary time and its sociodemographic correlates using a nationally representative sample of adults in Japan. Cross-sectional data from Sports-Life Survey in 2016 and 2018 conducted by Sasagawa Sports Foundation was used. Participants' sociodemographic factors and total sedentary time were collected by questionnaires. We classified those with <8 h/day of total sedentary time as "low-sedentary" and those with ≥8 h/day of total sedentary time as "high-sedentary". A multiple logistic regression model was applied to calculate adjusted odds ratios and 95% confidence intervals (95% CIs) for the association of each variable with the "high-sedentary" group (≥8 h/day). In total, 5,346 participants were included in the analyses. On average, time spent in sedentary behaviour was 5.3 h/day (SD = 3.7) among Japanese adults. The percentage of "high-sedentary" was 25.3% (95% CI: 24.1-26.4) and higher body mass index (≥25 kg/m2), being unmarried, unemployment, and higher educational level (graduate school or university) were positively associated with being "high-sedentary". In conclusion, higher sedentary time was among people with higher body mass index, being unmarried, unemployed, and higher education. Intervention for reducing sedentary time should be developed, targeting people with these characteristics.

Walk Score® is a free web-based tool that provides a walkability score for any given location. A limited number of North American studies have found associations between Walk Score® and perceived built environment attributes, yet it remains unknown whether similar associations exist in Asian countries. The study's objective is to examine the covariate-adjusted correlations between the Walk Score® metric and measures of the perceived built environment in ultrahigh density areas of Japan. Cross-sectional data were obtained from a randomly selected sample of adult residents living in two Japanese urban localities. There was a large correlation between Walk Score® and access to shops (0.58; p < 0.001). There were medium correlations between Walk Score® and population density (0.38; p < 0.001), access to public transport (0.34; p < 0.001), presence of sidewalks (0.41; p < 0.001), and access to recreational facilities (0.37; p < 0.001), and there was a small correlation between Walk Score® and presence of bike lanes (0.16; p < 0.001). There was a small negative correlation between Walk Score® and traffic safety (-0.13; p < 0.001). There was a medium correlation between Walk Score® and overall perceived walkability (0.48; p < 0.001). This study's findings highlight that Walk Score® was correlated with several perceived walkable environment attributes in the context of ultrahigh density areas in Asia.

The association between a dietary pattern characterised by high alcohol intake and dyslipidaemia has not been fully investigated. Therefore, the present study aimed to investigate the association between alcohol dietary patterns and the prevalence of dyslipidaemia and its components. This cross-sectional study enrolled 2,171 men and women aged ≥40 years who were alumni of a Japanese university. To identify dietary patterns, a principal component analysis was performed based on the energy-adjusted food intake estimated by a brief-type self-administered diet history questionnaire. Three dietary patterns were identified, the second of which was named the alcohol dietary pattern and was characterised by a high intake of alcoholic beverages, liver, chicken, and fish. This alcohol dietary pattern was associated with reduced low-density lipoprotein cholesterol (LDL-C) levels. The fully adjusted odds ratios (95% confidence intervals) of high LDL-C for the lowest through highest quartile of alcohol dietary pattern score were 1.00 (reference), 0.83 (0.64-1.08), 0.84 (0.64-1.10), and 0.68 (0.49- 0.94), respectively. Subgroup analysis showed that the alcohol dietary pattern was inversely associated with the prevalence of dyslipidaemia in women, whereas it was positively associated with high triglyceride levels in men. In conclusion, the alcohol dietary pattern, characterised by a high intake of alcoholic beverages, liver, chicken, and fish, was associated with the prevalence of dyslipidaemia and its components. This finding provides useful information for the prevention and treatment of dyslipidaemia by modifying the diet.

Previous studies have not investigated the determinants of resting oxidative stress, including physical fitness, as it relates to redox regulation. The present study therefore was aimed at identifying lifestyle and biological factors that determine resting oxidative stress, including objectively measured physical fitness. In 873 middle-aged and elderly men and women, age and anthropometric parameters, lifestyle-related parameters, medication and supplementation status, physical fitness, biochemical parameters, and nutritional intake status, as well as three plasma oxidative stress markers: protein carbonyl (PC), F2-isoprostane (F2-IsoP), and thiobarbituric acid reactive substances (TBARS), were surveyed and measured. The determinants of PC, F2-IsoP, and TBARS in all participants were investigated using stepwise multiple regression analysis. In PC, age (<inline-formula>
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</inline-formula>), TG (<inline-formula>
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</inline-formula>), antioxidant supplementation (<inline-formula>
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</inline-formula>), and HbA1c (<inline-formula>
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<msup>
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<mrow>
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<mo>=</mo>
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</inline-formula>). In conclusion, the present study showed that age, anthropometric index, lifestyle-related parameters, medication and supplementation status, objectively measured physical fitness, biochemical parameters, and nutritional intake status explain less than 10% of oxidative stress at rest.

Our study examined the associations between neighborhood walkability, frailty, and the incidence of long-term care insurance (LTCI) service needs using a prospective cohort survey in a suburban town in Japan. The final sample for analyses comprised 2867 community-dwelling older adults (mean age: 73.0 years). Neighborhood walkability was measured using the Walk Score(R). A total of 387 participants (13.5%) exhibited frailty. The odds of frailty, adjusted for the covariates (sex, age, educational status, marital status, residential status, employment status, subjective economic status) among participants who lived in somewhat walkable/very walkable areas, was 0.750 (95% Confidence Interval, CI: 0.597-0.943) versus those who lived in car-dependent areas. During the 23-month follow-up, 102 participants needed LTCI services (19.0 per 1000 person-years), 41 of whom (21.0 per 1000 person-years) lived in car-dependent areas, and 61 of whom (17.9 per 1000 person-years) lived in somewhat walkable/very walkable areas. As compared with participants who lived in car-dependent areas, the incidence of LTCI service needs was not significantly lower than that of those who lived in somewhat walkable/very walkable areas. Walk Score(R) can provide the critical information for the strategies to improve walkability and prevent older adults' frailty in less walkable areas, contributing to achieving the United Nation's Sustainable Development Goals (SDGs).

Few longitudinal residential relocation studies have explored associations between urban form and physical activity, and none has used the Space Syntax theory. Using a Canadian longitudinal dataset (n = 5944), we estimated: (1) differences in physical activity between non-movers, and those relocating to neighbourhoods with less or more integrated street layouts, and; (2) associations between changes in street layout integration exposure and differences in physical activity. Adjusting for covariates, we found relative to non-movers, those who moved to more integrated neighbourhoods undertook significantly (p < .05) more leisure walking (27.3 min/week), moderate-intensity (45.7 min/week), and moderate-to-vigorous intensity physical activity (54.4 min/week). Among movers, a one-unit increase in the relative change in street integration exposure ([Street integration at follow-up-street integration at baseline]/street integration at baseline) was associated with a 7.5 min/week increase in leisure walking. Our findings suggest that urban design policies that improve neighbourhood street integration might encourage more physical activity in adults.

BACKGROUND: Sedentary behaviors and physical activity are likely to be affected by the COVID-19 outbreak, and sedentary lifestyles can increase subjective fatigue. The nonpharmaceutical policies imposed as a result of the COVID-19 pandemic may also have adverse effects on fatigue. OBJECTIVE: This study has two aims: to examine the changes in sedentary behaviors and physical activity of company workers in response to the COVID-19 pandemic in Japan and to examine relationships between changes in these sedentary behaviors and physical activity and changes in fatigue. METHODS: Data from a nationwide prospective online survey conducted in 2019 and 2020 were used. On February 22, 2019, an email with a link to participate in the study was sent to 45,659 workers, aged 20 to 59 years, who were randomly selected from a database of approximately 1 million individuals. A total of 2466 and 1318 participants, who self-reported their occupation as company workers, answered the baseline and follow-up surveys, respectively. Surveys captured fatigue, workday and daily domain-specific sedentary behaviors and physical activity, and total sedentary behaviors and physical activity. We used multivariable linear regression models to estimate associations of changes in sedentary behaviors and physical activity with changes in fatigue. RESULTS: Increases in public transportation sitting during workdays, other leisure sitting time during workdays, and other leisure sitting time were associated with an increase in the motivation aspect of fatigue (b=0.29, 95% CI 0-0.57, P=.048; b=0.40, 95% CI 0.18-0.62, P<.001; and b=0.26, 95% CI 0.07-0.45, P=.007, respectively). Increases in work-related sitting time during workdays, total sitting time during workdays, and total work-related sitting time were significantly associated with an increase in the physical activity aspect of fatigue (b=0.06, 95% CI 0-0.12, P=.03; b=0.05, 95% CI 0.01-0.09, P=.02; and b=0.07, 95% CI 0-0.14, P=.04, respectively). The motivation and physical activity aspects of fatigue increased by 0.06 for each 1-hour increase in total sitting time between baseline and follow-up (b=0.06, 95% CI 0-0.11, P=.045; and b=0.06, 95% CI 0.01-0.10, P=.009, respectively). CONCLUSIONS: Our findings demonstrated that sedentary and active behaviors among company workers in Japan were negatively affected during the COVID-19 outbreak. Increases in several domain-specific sedentary behaviors also contributed to unfavorable changes in workers' fatigue. Social distancing and teleworking amid a pandemic may contribute to the sedentary lifestyle of company workers. Public health interventions are needed to mitigate the negative effects of the COVID-19 pandemic or future pandemics on sedentary and physical activity behaviors and fatigue among company workers.

Accumulating evidence suggests that there is a socioeconomic status (SES) disparity in cardiovascular disease (CVD). We have identified key issues involved in the research on the supportive neighbourhood built environment and SES disparity in CVD and proposed future directions.

PURPOSE: Deterioration of daily activities increases frailty risk. Most of the previous research has examined the association between frailty and specific activities; nevertheless, the diversity of daily activities is also important. Although the type, frequency, and evenness of daily activities have been proposed as indicators of activity diversity, the association between these indicators and frailty remains unclear. In this study, we examined the association between activity diversity and frailty in community-dwelling older adults. MATERIALS AND METHODS: This cross-sectional study comprised 658 community-dwelling older adults aged ≥ 65 years who participated in comprehensive health check-ups in 2018. Frailty was defined using the Japanese version of the Cardiovascular Health Study criteria. Three indicators, type, frequency, and evenness of daily activities, were used to assess activity diversity across one week. Multiple logistic regression analyses were performed, with frailty as the dependent variable and the three activity diversity indicators as independent variables. Socio-demographic, physical, and mental functioning factors were adjusted as covariates. RESULTS: Of the 658 participants (median age: 72 years; age range: 65-91 years; 60.5% women), 27 (4.1%) met the criteria for frailty. The frail group had significantly lower scores for type, frequency, and evenness of daily activities, as well as Mini-Mental State Examination scores (all at p < 0.01). We found significant independent associations in all activity diversity indicators with frailty, in multiple logistic models. CONCLUSION: Activity diversity is independently associated with frailty in community-dwelling older adults.

Background–Several non-pharmaceutical policies, which include stay-at-home orders, mobility restrictions, and quarantine, have been implemented to reduce the spread of novel coron-avirus disease 2019 (COVID-19). The present study examines work style changes among company workers after COVID-19 and analyses their effects on workers’ domain-specific sedentary and active behaviours. Methods-We analysed data from a nationwide prospective online survey in Japan. The data were obtained in February 2019 (n = 3200) and in July 2020 (n = 1709) from the registered individuals of a Japanese internet research service company. The participants reported work style patterns before and after the outbreak of COVID-19 in the follow-up survey. Domain-specific sedentary behaviours and physical activities were assessed by questionnaires. Paired t-tests were used to compare work styles before and after the outbreak of COVID-19. Multivariable linear regression models were used to assess the associations between changes in work style and changes in sedentary behaviours and physical activities. Results. Workers had more working from home days and fewer office-based working days after the outbreak of COVID-19 (p < 0.001 and p < 0.001, respectively). The increase in the number of working from home days per week was significantly associated with increases in work-related sitting time and total sitting time (b = 0.16, 95% CI 0.08, 0.24, p < 0.001 and b = 0.23, 95% CI 0.11, 0.36, p < 0.001, respectively). However, it was also associated with a decrease in car sitting time (b = −0.04, 95% CI −0.06,-0.01, p < 0.001). In addition, the increase in the number of working from home days was associated with a decrease in work-related moderate physical activity (b =−0.06, 95% CI −0.10, −0.02, p < 0.001). Conclusions. Our study provided preliminary evidence of an increase in working from home days in response to COVID-19 in Japan and of how this increase in the number of working from home days has affected workers’ sedentary behaviours and physical activities. These findings shed light on the effects of COVID-19 on work styles and workers’ sedentary behaviours and physical activity.

This study reviewed previous studies and discussed the relationship between sedentary behaviour and mental health in older adults. We also discussed the impact of the COVID-19 pandemic on sedentary behaviour and mental health in older people. The findings suggest that longer sedentary time may have a negative impact on mental health. Especially, previous studies consistently reported that mentally-passive sedentary behaviour, such as television viewing, is associated with poorer mental health in older adults. The COVID-19 pandemic has affected people of all ages, including the older population, by decreasing their physical activity and increasing their sedentary time. These changes in activity have led to deterioration in mental health. Therefore, it is essential to send public health messages to people encouraging them to reduce sedentary time in their daily lives and be physically active to maintain and improve their health, including their mental health, even in the COVID-19 pandemic. It is crucial to reduce mentally-passive sedentary behaviour, such as television viewing, to maintain mental health in older people.

A key skill in archery is the ability to suppress postural tremor while aiming at a target. Providing feedback during daily archery practice is a potentially effective way of suppressing tremor. However, postural tremor is subtle and difficult to measure using vision-based techniques. This article proposes a feedback method that uses a bow equipped with a small, lightweight acceleration sensor. First, we automatically detect an archer's shooting execution cycle, including the aiming, release, and follow-through phases, by using binary classification, and then, we quantify postural tremor during aiming. Then, from the quantified postural tremor, we regress the expected total score that the archer would obtain in a series of shots during a real game. We performed an experiment with 11 members of a university archery club and achieved 1) a precision of 0.72 and recall of 0.80 in shooting detection and 2) an absolute correlation coefficient of 0.74 in score prediction with leave-one-subject-out cross-validation.

Purpose: The aim of this study was to translate the Psychological Inflexibility in Pain Scale Japanese version (PIPS-J) and inspect its validity and reliability in older patients with chronic low back pain and knee pain. Materials and Methods: The PIPS was translated into Japanese by a bilingual linguistic expert and three researchers and administered to 120 outpatients with low back pain and knee pain (61.7% women, age 73.8±7.8 years). Construct validity and criterion validity were evaluated using confirmatory factor analysis and the correlations with the Acceptance and Action Questionnaire-II Japanese version (AAQ-II-J) and the Cognitive Fusion Questionnaire Japanese version (CFQ-J), respectively. Internal consistency using Cronbach's alpha and test-retest reliability (n=43) were also examined. Results: Of all, 78.3% had low back pain, 55.6% had knee pain, and 44.2% both. The confirmatory factor analysis reproduced the original PIPS structure with two factors and indicated good model fit (GFI = 0.915, CFI = 0.970, RMSEA = 0.060). All items' standardized regression weights ranged from 0.35 to 0.80. Criterion validity was shown by correlations of r = 0.58 for PIPS-J pain avoidance with the AAQ-II-J, and r = 0.45 between PIPS-J cognitive fusion and the CFQ-J. Cronbach's alpha for the PIPS-J total score was α=0.85 (pain avoidance: 0.87; cognitive fusion: 0.68). The test-retest correlation for all 12 items was r = 0.54 (pain avoidance: 0.48; cognitive fusion: 0.54). Conclusion: Although a less relevant item was found on each of subscales, the PIPS-J appear to be fairly valid and reliable to evaluate psychological inflexibility in chronic pain among Japanese older adults.

The purpose of this study was to identify typologies of diurnal sedentary behavior patterns and sociodemographic characteristics of desk-based workers. The sedentary time of 229 desk-based workers was measured using accelerometer devices. The within individual diurnal variations in sedentary time was calculated for both workdays and non-workdays. Diurnal variations in sedentary time during each time period (morning, afternoon, and evening) was calculated as the percentage of sedentary time during each time period divided by the percentage of the total sedentary time. A hierarchical cluster analysis (Ward's method) was used to identify the optimal number of clusters. To refine the initial clusters, a non-hierarchical cluster analysis (k-means method) was performed. Four clusters were identified: stable sedentary cluster (46.7%), off-morning break cluster (26.6%), off-afternoon break cluster (8.3%), and evening sedentary cluster (18.3%). The stable sedentary cluster had the lowest variations in sedentary time throughout the day and the highest amount of total sedentary time. Participants in the off-morning and off-afternoon break clusters had nearly the same sedentary patterns but took short-term breaks during non-workday mornings or afternoons. The evening sedentary cluster had a completely different pattern, with a longer sedentary time during the evening both on workdays and non-workdays. Sociodemographic attributes such as sex, household income, educational attainment, employment status, sleep duration, and residential area, differed significantly between groups. Initiatives to address desk-based workers' sedentary behavior need to focus not only on the workplace but also on the appropriate timing for reducing excessive sedentary time in non-work contexts depending on the characteristics and diurnal patterns of target subgroups.

<title>Abstract</title>
In addition to intensity and quality, diversity of activity will be an important factor to explain health outcomes among older adults. Few studies, though, examined an association between activity diversity and health outcomes. This study aimed to examine the association between activity diversity and frailty among community-dwelling older Japanese. Participants were community-dwelling older adults who participated in a cohort study, the “Otassya-Kenshin” in 2018 . The participants were asked frequency of 20 daily activities, inside/outside chores, leisure activities with/without physically, direct/indirect contact with friends and so on, in a week and activity diversity score were calculated using the formula of Shannon’s entropy. Frailty was defined by the Japanese version of the Cardiovascular Health Study criteria. The difference in diversity score between frail and non frail were examined by t-test. Logistic regression analysis with covariates, age, sex, economic status, living alone, BMI, Mini-Mental State Examination, and IADL was adopted to find association between activity diversity score and presence of frailty. Of 652 participants (age: 72.8±6.3, women: 60.6%) analyzed, 27 (4.1%) were defined as frail. Frailty group revealed significantly lower activity diversity score than non-frailty group (0.66±0.11 vs 0.75±0.08, P&amp;lt;0.01). 0.2 point of decrease in diversity score increase 5 times chance of frailty after controlling covariates. We found significant relationship between activity diversity and health outcome among older subjects. The activity diversity may provide additional information to number or intensity of activity.

BACKGROUND: Many desk-based workers can spend more than half of their working hours sitting, with low levels of physical activity. Workplace neighbourhood built environment may influence workers' physical activities and sedentary behaviours on workdays. We reviewed and synthesised evidence from observational studies on associations of workplace neighbourhood attributes with domain-specific physical activity and sedentary behaviour and suggested research priorities for improving the quality of future relevant studies. METHODS: Published studies were obtained from nine databases (PubMed, Web of Science, PsycINFO, Scopus, Transport Research International Documentation, MEDLINE, Cochrane, Embase, and CINAHL) and crosschecked by Google Scholar. Observational studies with quantitative analyses estimating associations between workplace neighbourhood built environment attributes and workers' physical activity or sedentary behaviour were included. Studies were restricted to those published in English language peer-reviewed journals from 2000 to 2019. RESULTS: A total of 55 studies and 455 instances of estimated associations were included. Most instances of potential associations of workplace neighbourhood built environment attributes with total or domain-specific (occupational, transport, and recreational) physical activity were non-significant. However, destination-related attributes (i.e., longer distances from workplace to home and access to car parking) were positively associated with transport-related sedentary behaviour (i.e., car driving). CONCLUSIONS: The findings reinforce the case for urban design policies on designing mixed-use neighbourhoods where there are opportunities to live closer to workplaces and have access to a higher density of shops, services, and recreational facilities. Studies strengthening correspondence between the neighbourhood built environment attributes and behaviours are needed to identify and clarify potential relationships. PROTOCOL REGISTRATION: The protocol of this systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 2 December 2019 (registration number: CRD42019137341 ).

Evidence suggests a positive effect of dog ownership on physical activity. However, most previous studies used self-reported physical activity measures. Additionally, it is unknown whether owning a dog is associated with adults' sedentary behaviour, an emerging health risk factor. In this study, physical activity and sedentary behaviour were objectively collected between 2013 and 2015 from 693 residents (aged 40-64 years) living in Japan using accelerometer devices. Multivariable linear regression models were used, adjusted for several covariates. The means of total sedentary time and the number of long (≥ 30 min) sedentary bouts were 26.29 min/day (95% CI - 47.85, - 4.72) and 0.41 times/day (95% CI - 0.72, - 0.10) lower for those who owned a dog compared to those not owning a dog, respectively. Compared with non-owners, dog-owners had significantly higher means of the number of sedentary breaks (95% CI 0.14, 1.22), and light-intensity physical activity (95% CI 1.31, 37.51). No significant differences in duration of long (≥ 30 min) sedentary bouts, moderate, vigorous, and moderate-to-vigorous-intensity physical activity were observed between dog-owners and non-owners. A novel finding of this study is that owning a dog was associated with several types of adults' sedentary behaviours but not medium-to-high-intensity physical activities. These findings provide new insights for dog-based behavioural health interventions on the benefits of dog ownership for reducing sedentary behaviour.

本研究では、我が国の著名人の乳がん罹患公表が女性の乳がんに対する意識、知識、行動へ与える影響を検討することを目的とした。Web調査による横断調査へ回答が得られた20〜69歳の成人女性2,933名を分析対象とし、著名人のがん罹患情報取得者の特徴および情報取得と乳がんに対する意識・知識との関連をロジスティック回帰分析にて検討した。その結果、情報取得者の割合は77.4%で、その主な特徴は、子どもを持つ者(AOR、95%CI:1.50、1.12-1.83)、友人・同僚の乳がん罹患歴(1.82、1.46-2.27)であった。また、情報取得は、乳がんをこわいと思う意識(1.90、1.52-2.38)、乳がん検診知識(年齢:1.73、1.31-2.27、間隔:2.29、1.64-3.20)と関連し、情報取得後30.4%の者に行動変化が確認されたことから、我が国でも著名人のがん罹患公表が国民の意識、知識および行動に影響を与える可能性が示唆された。今後は、より国民のがんに対する理解を深め、がん対策を推進するためにも、著名人のがん罹患公表時に意図的なコミュニケーションや情報伝達ができるような体制・戦略の構築が必要である。(著者抄録)

AIM: To re-evaluate the suitability of calf circumference as a surrogate marker of low muscle mass measured by both bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). We also examined the effects of obesity and age on low muscle mass screening using calf circumference. METHODS: In total, 1239 adults participated in this cross-sectional study. We measured the maximum calf circumference in a standing position and appendicular skeletal muscle mass (ASM) using BIA and DXA. We defined low muscle mass based on the Asian Working Group for Sarcopenia 2019 consensus. RESULTS: Calf circumference was positively correlated with BIA-measured ASM/height2 (men: r = 0.81, women: r = 0.73) and DXA-measured ASM/height2 (men: r = 0.78, women: r = 0.76). In the subgroup analyses by obesity and age, calf circumference was also positively correlated with ASM/height2 . The optimal calf circumference cut-offs for low muscle mass screening measured by BIA and DXA were 35 cm (sensitivity 91%, specificity 84%) and 36 cm (sensitivity 82%, specificity 80%) for men, and 33 cm (sensitivity 82%, specificity 84%) and 34 cm (sensitivity 85%, specificity 72%) for women, respectively. CONCLUSIONS: Calf circumference is positively correlated with BIA- and DXA-measured muscle mass regardless of obesity and age and is a simple and accurate surrogate marker of muscle mass for diagnosing sarcopenia. Geriatr Gerontol Int 2020; 20: 943-950.

BACKGROUND: As people age, they spend more time in and around their domestic environments, within which opportunities for health-enhancing physical activity (PA) may be limited. We examined the associations of frequency of excursions from home with accelerometer-determined PA and the total and prolonged sedentary behavior (SB, sitting for ≥30 min) among community-dwelling older adults. METHODS: Overall, 434 older adults (men, 57.1 %; age, 70-79 years) wore an accelerometer (HJA-350IT, Omron Healthcare) for 7 days. Time spent in SB, light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and prolonged SB bout (≥30 min) were calculated. Frequencies of excursions from home were categorized as 0-3, 4-5, and 6-7 days/week. Associations of excursions with PA and SB were tested by analysis of covariance adjusted for sociodemographic characteristics. RESULTS: Frequencies were 14.3 %, 31.1 %, and 54.6 % for excursions 0-3, 4-5, and 6-7 days/week, respectively. For men, less frequent excursions from home were significantly associated with less MVPA and more total and prolonged SB times (estimated means [minutes/day]: MVPA, 32, 42, and 48; total SB, 589, 549, and 539; prolonged SB, 344, 288, and 265; respectively; p < 0.05). LPA was not statistically significant (p = 0.09). For women, less frequent excursions were significantly associated with all PA outcomes (SB: 536, 497, and 467; prolonged SB: 260, 213, and 204; LPA: 328, 363, and 379; MVPA: 36, 39, and 54, respectively). CONCLUSIONS: Among community-dwelling Japanese older adults, more frequent excursions from home were associated with more PA, less SB, and more-favorable SB patterns, suggesting a potential strategy for preventive-health initiatives.

通所型デイサービスを利用する要介護者17名を対象に、座りすぎ軽減を目的とした介入プログラムを3ヵ月間実施し(プログラム提供群)、その効果を、対照群(15名、通常サービス利用群)との総座位時間の比較から検討した。プログラムは、反復訓練と社会的認知理論に基づく行動変容支援を組み合わせたもので、具体的には以下の内容となっている。1)施設でのプログラム実施に加え、自宅でのホームワークを見据えた「座ったままでできる血行促進体操」。2)施設利用日以外に自宅で本プログラムの実施を促すため、体操の実施方法を記載した自宅掲示用ポスターを作成・配布するとともに、セルフ・モニタリング手帳を作成し、自宅で午前・午後・夕方の都合の良い時に各1セット(計3セット/日)プログラムを実施するよう促した。その結果、プログラム提供群(-88.8分)では通常サービス群(-22.9分)と比べ、総座位時間の有意な短縮がみられた。

Background

There are spatial disparities in cardiovascular disease (CVD) mortality related to area‐level socioeconomic status (SES) disadvantage, but little is known about the spatial distribution of CVD mortality according to built environment factors. We examined joint associations of neighborhood walkability attributes and SES with CVD mortality rates through linkage of Japanese national data sets.
Methods and Results

National data were used from the 1824 municipalities (of the 1880 potentially eligible municipalities) across Japan. The outcome was mortality from CVD for a 5‐year period (2008–2012) for each municipality. A national index of neighborhood deprivation was used as an indicator of municipality‐level SES. A national walkability index (based on population density, road density, and access to commercial areas) was calculated. Compared with higher SES municipalities, relative rates for CVD mortality were significantly higher in medium SES municipalities (relative rate, 1.05; 95% CI, 1.02–1.07) and in lower SES municipalities (relative rate, 1.09; 95% CI, 1.07–1.12). There were walkability‐related gradients in CVD mortality within the high and medium SES areas, in which lower walkability was associated with higher rates of mortality; however, walkability‐related CVD mortality gradients were not apparent in lower SES municipalities.
Conclusions

CVD mortality rates varied not only by area‐level SES but also by walkability. Those living in areas of lower walkability were at higher risk of CVD mortality, even if the areas have a higher SES. Our findings provide a novel element of the evidence base needed to inform better allocation of services and resources for CVD prevention.

BACKGROUND: Physical inactivity and sedentary behaviour (too much sitting) can contribute to renal dysfunction. However, the potential benefits of behavioural change (e.g. replacing sedentary behaviour with physical activity) on renal function are not well understood. We used isotemporal substitution to model potential impacts of behaviours on renal function by replacing time spent in one behaviour to another. METHODS: In 174 older Japanese adults (age, 50-83 years; females, 76%), the time spent in sedentary behaviour, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were assessed using an uniaxial accelerometer. Renal function was evaluated by the estimated glomerular filtration rate (eGFR) from serum creatinine and cystatin C levels. RESULTS: In univariate analyses, eGFR was significantly, albeit weakly, correlated with time spent in sedentary behaviour (rs = - 0.229), LPA (rs = 0.265), and MVPA (rs = 0.353). In the isotemporal substitution models, replacement of 30 min/day of sedentary behaviour with an equivalent LPA time was not significantly associated with eGFR (β = 2.26, p = 0.112); however, replacement with an equivalent time of MVPA was beneficially associated with eGFR (β = 5.49, p < 0.05). CONCLUSIONS: These cross-sectional findings suggest that sedentary behaviour (detrimentally) and physical activity (beneficially) may affect renal function and that replacing sedentary behaviour with MVPA may benefit renal health in older adults.

Examining the associations of eHealth literacy (eHL) with obtaining health knowledge from websites would help to clarify the causal pathway between eHL and health knowledge. This study aimed to compare the results obtained from Internet users with high or low eHL in accessing a reputable cancer website to obtain colorectal cancer (CRC) knowledge. A total of 105 participants with high eHL and 103 participants with low eHL accessed a reputable CRC website managed by the National Cancer Center and responded to Internet-based surveys before and after accessing a website in 2012. Twelve responses to knowledge statements regarding CRC were selected based on item response theory, and the differences in correct responses of pre- and post-surveys by each eHL group were compared. Two statements showed a significant increase in correct responses in the high eHL group only: "Red meat intake is a risk factor" (p = 0.002), and "Obesity is a risk factor" (p = 0.029), whereas only one response did so in the low eHL group: "Bloody stools are a symptom" (p = 0.004). Low eHL Internet users appeared less capable of obtaining knowledge of CRC by accessing information from a reputable cancer website than high eHL Internet users.

Increased sedentary behavior (SB) can adversely affect health. Understanding time-dependent patterns of SB and its correlates can inform targeted approaches for prevention. This study examined diurnal patterns of SB and its sociodemographic associations among Japanese workers. The proportion of sedentary time (% of wear time) and the number of breaks in SB (times/sedentary hour) of 405 workers (aged 40–64 years) were assessed using an accelerometer. SB patterns and sociodemographic associations between each time period (morning, afternoon, evening) on workdays and nonworkdays were examined in a series of multivariate regression analyses, adjusting for other sociodemographic associations. On both workdays and nonworkdays, the proportion of sedentary time was lowest in the morning and increased towards evening (b = 12.95, 95% CI: 11.28 to 14.62; b = 14.31, 95% CI: 12.73 to 15.88), with opposite trend for breaks. Being male was consistently correlated with SB. Other sociodemographic correlates differed depending on time-of-day and day-of-the-week. For instance, desk-based workstyles and urban residential area were associated with SB during workday mornings and afternoons, being single was related to mornings and evenings, workdays and nonworkdays. Initiatives to address SB should focus not only on work-related but time-of-day contexts, especially for at-risk subgroups during each period.

Recent research has suggested that the breadth and evenness of activity and activity diversity contribute to health outcomes among older adults. However, few established assessment tools for activity diversity have been developed. This study developed an Activity Diversity Questionnaire (ADQ) for older adults through expert consultation and a preliminary survey among 18 community-dwelling older adults. The diversity score was calculated according to Shannon's entropy. In study 1, the intraclass correlation coefficients (ICC) of the diversity scores were determined for community-dwelling older adults (n = 30). In study 2, concurrent validity was tested with participants receiving comprehensive health checkups at the Itabashi ward in Japan in 2018 (n = 766). The correlation coefficients of the diversity scores were then calculated in reference to the Tokyo Metropolitan Institute of Gerontology Index of Competence and Japan Science and Technology Agency Index of Competence. The final version of the ADQ consisted of 20 total items with excellent test-retest reliability (ICC = 0.84) and moderate correlations with both the Tokyo Metropolitan Institute of Gerontology Index of Competence and Japan Science and Technology Agency Index of Competence (r = 0.48 and 0.60, respectively). The ADQ was developed through scientific procedures and revealed sufficient reliability and validity. As such, it is a scientifically validated tool for assessing activity diversity among older adults.

Studies have shown the potential effects of sedentary behavior and physical activity on not only physical and mental health but also academic performance in children. Nevertheless, studies have only focused on either sedentary behavior or physical activity. Examining the joint effects of both behaviors on academic performance provides detailed insights into the patterns of these behaviors in relation to children's academic achievement. The present study investigated the joint longitudinal associations of physical activity and screen time with academic performance among Japanese children. The screen time and physical activity of 261 children aged 7-10 years were assessed, and their academic performance was evaluated one year later. Multivariate logistic regression analysis was used to examine the joint associations of screen time and physical activity with academic performance adjusted for demographic characteristics. Children with low screen time and physical activity had 2.04 (95% confidence interval: 1.11-3.78) times greater odds of having high academic performance compared to children with high screen time and low physical activity, while children with low screen time and high physical activity had 2.75 (1.17-6.43) times greater odds (boys; 4.12 (1.19-14.24)). Low screen time was related to high academic performance after one year, regardless of the physical activity level.

The relationships between cardiorespiratory fitness (CRF) measurements not confounded by adiposity and the prevalence of pre-diabetes mellitus (pre-DM) and diabetes mellitus (DM) are not well known. Thus, we aimed to investigate the associations of visceral fat (VF) and CRF with the prevalence of pre-DM/DM among Japanese adults. The study included 970 individuals (327 women and 643 men) who were 40-87 years old and had complete health examinations, abdominal fat area, and fitness data from WASEDA'S Health Study during 2015-2018. The VF area was measured using magnetic resonance imaging. CRF was measured using a cycle ergometer and was defined as VO2peak divided by fat free mass. The pre-DM/DM was identified based on the questionnaire and fasting blood tests. The odds ratios (ORs) and 95% confidence intervals (CIs) for prevalence of pre-DM/DM were calculated. Seventy-three participants had pre-DM and 48 participants had DM. Compared to the low VF group, the high VF group had a higher prevalence of pre-DM/DM (OR: 1.87, 95% CI: 1.18-2.96), although no significant relationship was observed between CRF and pre-DM/DM prevalence (P for trend = 0.239). The sub-group analyses also revealed no significant relationship between CRF and pre-DM/DM prevalence in the low VF group (P for trend = 0.979), although CRF values were inversely related to the prevalence of pre-DM/DM in the high VF group (P for trend = 0.024). Although CRF was not independently related to the prevalence of pre-DM/DM after adjusting for adiposity, higher VF values were related to a higher prevalence of pre-DM/DM. In addition, CRF levels were inversely associated with the prevalence of pre-DM/DM only among high VF individuals.

<bold>Background</bold>: The present study examined the cluster of domain-specific sedentary behaviors (SBs) and their associations with physical function among community-dwelling older adults to identify the target groups that require intervention for SBs. <bold>Methods</bold>: A total of 314 older adults who participated in a population-based cross-sectional survey and an on-site functional assessment in Matsudo City in Chiba participated in this study. Participants were asked to report the daily average of 6 domain-specific SBs. To identify the cluster of domain-specific SBs, hierarchical cluster analysis was performed using the Ward method. Analysis of covariance adjusted for sociodemographic factors, exercise habit, chronic disease, and total SB time was performed to examine the associations between each cluster and physical functional status. <bold>Results</bold>: The average age of the participants was 74.5 (5.2) years. The 4 clusters identified were leisure cluster, low cluster, work and personal computer use cluster, and television viewing cluster. The analysis of covariance adjusted for covariates showed that grip strength (<italic>P</italic> = .01), maximum walking speed (<italic>P</italic> = .03), and 1-leg standing time (<italic>P</italic> = .03) were significantly poorer in the television viewing cluster than other clusters. <bold>Conclusions</bold>: It has been concluded that the television viewing group identified as a high-risk group of physical functional decline; therefore, interventions targeting this group are needed to prevent physical functional decline.

This study examined the relationship between a healthy Japanese dietary pattern and micronutrient intake adequacy based on the Dietary Reference Intakes for Japanese 2015 (DRIs-J 2015) in men and women. A cross-sectional study was conducted in 1418 men and 795 women aged 40-87 years, who participated in the Waseda Alumni's Sports, Exercise, Daily Activity, Sedentariness, and Health Study. Dietary patterns were derived from principal component analysis of the consumption of 52 food and beverage items, which were assessed by a validated brief-type self-administered diet history questionnaire. Micronutrient intakes were quantified using the dietary reference intakes score (DRIs-score) for 21 micronutrients (based on DRIs-J 2015). The healthy dietary pattern score was significantly and positively correlated with the intakes of all 21 micronutrients used for constructing the DRIs-score in men and in women (each, p < 0.001). In both sexes, the healthy dietary pattern scores were strongly and positively associated with DRIs-scores (in men: ρ = 0.806, p < 0.001; in women: ρ = 0.868, p < 0.001), and the DRIs-scores reached a plateau around the highest tertile of the healthy dietary pattern score. These results indicate that a healthy Japanese dietary pattern is associated with adequate micronutrient intakes based on the DRIs-J 2015 in both men and women.

There is a dearth of evidence about how high-density living may influence dog-walking behaviour. We examined associations between neighbourhood built environment attributes and dog-ownership and dog-walking behaviour in Japan. Data from 1058 participants were used. The dog-ownership was 18.8%. All neighbourhood built attributes (excluding availability of parks) were negatively associated with dog-ownership. Among dog-owners, these same attributes were positively associated with any dog-walking in a usual week and with achieving 150-min per week of physical activity through dog-walking alone. These findings provided evidence on the importance of neighbourhood built environment attributes on dog-ownership and dog-walking behaviour in dense and compact areas. The urban design and public health implication of these findings is that the built environment attributes in high-density living areas may have different impacts on dog-ownership and dog-walking: while living in a walkable neighbourhood may not be conducive to dog-ownership, it may support dog-walking in such areas. Programs targeting dog-owners in high-density areas might be needed to encourage them to walk their dogs more. If successful, these programs could contribute to higher physical activity levels among dog-owners.

Background<br />
<br />
Although the main targets for reducing workplace sedentary behavior have been clarified, only a few studies have examined the association between social-ecological factors and workplace sedentary behavior for effective intervention. The present study aimed to examine the social-ecological factors of workplace sedentary behavior among Japanese sedentary workers.<br />
Methods<br />
<br />
Participants were recruited via a cross-sectional mail survey targeting randomly sampled 6000 middle-aged people dwelling in Matsuyama-city and Koto-ku in Japan. Participants answered a questionnaire on social-ecological factors, recorded their work time in a diary, and wore a triaxial accelerometer during waking time for 7 consecutive days. Workplace sedentary behavior was measured using accelerometer and was referred to as the work time in the recorded diary. Full-time workers who had mainly sitting work and valid accelerometer data were included in the analysis. Workplace sedentary variables were sedentary breaks per sedentary hour, sedentary time, and ≥ 30 min bouts of sedentary time. The associations between each sedentary variable and social-ecological factors were explored by conducting three multiple linear regression analyses adjusting for sociodemographic and health-related factors.<br />
Results<br />
<br />
A total of 227 participants (133 men, mean age 49.9 ± 6.9 years) were included in the analysis. In the overall sample, “typically seeing work colleagues take sedentary breaks” was significantly associated with more sedentary breaks (B [95% confidence interval {CI}=1.40 [0.07 to 2.73]) and shorter ≥30-min bouts of sedentary time (B [95% CI] = −7.08 [−13.75 to −0.40]). “I am motivated to take sedentary breaks” had an unfavorable association with less sedentary breaks (B [95% CI] = −1.36 [−2.61 to −0.12]) and longer sedentary time (B [95% CI] = 4.15 [0.29 to 8.00]). In male workers, “Too stressed to take sedentary breaks” was significantly associated with less sedentary breaks (B [95% CI] = −5.6 [−9.17 to −2.02]).<br />
Conclusions<br />
<br />
Seeing work colleagues take sedentary breaks may be important for reducing workplace sedentary behavior. Those who are more sedentary are motivated to take sedentary breaks. Male workers who feel the need to take sedentary breaks at work are more sedentary.

OBJECTIVES: The aims of this study were to examine (a) associations of two metric and space syntax measures of street layout with the cognitive function of Japanese older adults and (b) the extent to which objectively assessed physical activity mediated such associations. METHODS: Cross-sectional data from 277 older adults who lived in Japan were used. Street layout attributes were objectively calculated for each participant's geocoded home location. The Mini-Mental State Examination was used to evaluate cognitive function. Physical activity was objectively assessed with accelerometers. RESULTS: There was a statistically significant negative association between street integration and the odds of having cognitive impairment. Objectively assessed physical activity did not attenuate this relationship. CONCLUSIONS: Our findings provide unique evidence regarding the importance of the topological aspects of street layouts in (re)designing neighborhoods to support mental illness.

Different models of accelerometer have the potential to provide a different estimate of the same physical activity or sedentary behavior. Our study compared the outputs of the Active Style Pro (ASP) and ActiGraph (AG) devices in assessing predicted metabolic equivalents (METs) for specific activities under laboratory conditions. Thirty healthy young adults wore two hip accelerometers (ASP and AG), simultaneously while performing twenty-two activities (eight sedentary, eight household, and six ambulatory activities) in a controlled laboratory setting. For the AG, predicted METs for each activity was calculated using four equations based on vertical-axis and vector magnitude data. Separate paired t-tests and Bland–Altman analysis examined the difference and agreement in METs between AG using four commonly used equations and ASP measurements for each activity. AG devices using different equations calculated significantly different outcomes for most activities compared with ASP devices. The smallest differences in predicted METs estimates between ASP and AG were observed for ambulatory activities. Ambulatory activities demonstrated the best agreement between ASP and AG regardless of which AG equation was used. Our findings can be used to assist researchers in their selection of accelerometer and output estimation equations for measuring physical activity and sedentary behavior in adults.

Various accelerometers have been used in research measuring physical activity (PA) and sedentary behavior (SB). This study compared two triaxial accelerometers—Active style Pro (ASP) and ActiGraph (AG)—in measuring PA and SB during work and nonwork days in free-living conditions. A total of 50 working participants simultaneously wore these two accelerometers on one work day and one nonwork day. The difference and agreement between the ASP and AG were analyzed using paired t-tests, Bland–Altman plots, and intraclass coefficients, respectively. Correction factors were provided by linear regression analysis. The agreement in intraclass coefficients was high among all PA intensities between ASP and AG. SB in the AG vertical axis was approximately 103 min greater than ASP. Regarding moderate-to-vigorous-intensity PA (MVPA), ASP had the greatest amount, followed by AG. There were significant differences in all variables among these devices across all day classifications, except for SB between ASP and AG vector magnitude. The correction factors decreased the differences of SB and MVPA. PA time differed significantly between ASP and AG. However, SB and MVPA differences between these two devices can be decreased using correction factors, which are useful methods for public health researchers.

抑うつと時間帯別の座位行動および身体活動時間との関連について検討した。日本の2都市(江東区・松山市)の住民基本台帳より無作為に抽出した40〜64歳の成人6000名を対象とした。加速度計を7日間腰部に装着して1分ごとの加速度を収集し、metabolic equivalents(METs)より、座位行動(1.5METs以下)および中高強度身体活動(3.0METs以上)時間を評価した。記述疫学的にみた座位行動の平均時間は、平日・休日ともに朝で最も短く、昼にかけて増加し、夜になると減少していた。中高強度身体活動時間は、平日では朝で最も長く、夜にかけて減少していたが、休日では朝から昼にかけて少し増加した後、夜で減少していた。ロジスティック回帰分析の結果、抑うつ得点と覚醒時間中の座位行動および中高強度身体活動の総実施時間には有意な関連は認められなかった。時間帯別の座位行動および中高強度身体活動の実施時間についても、すべての時間帯で有意な関連は認められなかった。

Background<br />
<br />
Cross-sectional studies provide useful insight about the associations between the built environment and physical activity (PA), particularly when reasons for neighborhood choice are considered. Our study analyzed the relationship between levels of weekly transportation and leisure PA among three neighborhood designs, statistically adjusting for sociodemographic characteristics and reasons for neighborhood choice.<br />
Methods<br />
<br />
A stratified random sample of adults (age ≥20 years) living in Calgary (Canada) neighborhoods with different neighborhood designs (grid, warped-grid, curvilinear) and socioeconomic status completed a self-administered questionnaire capturing PA, sociodemographic characteristics, and reasons for neighborhood choice (response rate = 10.1%; n = 1023). Generalized linear models estimated associations between neighborhood design and transportation and leisure PA outcomes (participation [any vs. none] and volume [metabolic equivalent: h/week]), adjusting for neighborhood socioeconomic status, sociodemographic characteristics (gender, age, ethnicity, education, household income, marital status, children, vehicle access, dog ownership, and injury), and reasons for neighborhood choice (e.g., proximity and quality of recreational and utilitarian destinations, proximity to work, highway access, aesthetics, and sense of community).<br />
Results<br />
<br />
Overall, 854 participants had resided in their neighborhood for at least 12 months and provided complete data. Compared with those living in curvilinear neighborhoods, grid neighborhood participants had greater odds (p &lt; 0.05) of participating in any transportation walking (odds ratio [OR] = 2.17), transportation and leisure cycling (OR = 2.39 and OR = 1.70), active transportation (OR = 2.16), and high-intensity leisure PA (≥6 METs; OR = 1.74), respectively. There were no neighborhood differences in the volume of any transportation or leisure PA undertaken. Adjustment for neighborhood selection had minimal impact on the statistical or practical importance of model estimates.<br />
Conclusion<br />
<br />
Neighborhood design is associated with PA patterns in adults, independent of reasons for neighborhood choice and sociodemographic factors.

Researchers investigating relationships between the neighbourhood environment and health first need to decide on the spatial extent of the neighbourhood they are interested in. This decision is an important and ongoing methodological challenge since different methods of defining and delineating neighbourhood boundaries can produce different results. This paper explores this issue in the context of a New Zealand-based study of the relationship between the built environment and multiple measures of physical activity. Geographic information systems were used to measure three built environment attributes—dwelling density, street connectivity, and neighbourhood destination accessibility—using seven different neighbourhood definitions (three administrative unit boundaries, and 500, 800, 1000- and 1500-m road network buffers). The associations between the three built environment measures and five measures of physical activity (mean accelerometer counts per hour, percentage time in moderate–vigorous physical activity, self-reported walking for transport, self-reported walking for recreation and self-reported walking for all purposes) were modelled for each neighbourhood definition. The combination of the choice of neighbourhood definition, built environment measure, and physical activity measure determined whether evidence of an association was detected or not. Results demonstrated that, while there was no single ideal neighbourhood definition, the built environment was most consistently associated with a range of physical activity measures when the 800-m and 1000-m road network buffers were used. For the street connectivity and destination accessibility measures, associations with physical activity were less likely to be detected at smaller scales (less than 800 m). In line with some previous research, this study demonstrated that the choice of neighbourhood definition can influence whether or not an association between the built environment and adults’ physical activity is detected or not. This study additionally highlighted the importance of the choice of built environment attribute and physical activity measures. While we identified the 800-m and 1000-m road network buffers as the neighbourhood definitions most consistently associated with a range of physical activity measures, it is important that researchers carefully consider the most appropriate type of neighbourhood definition and scale for the particular aim and participants, especially at smaller scales.

Background. Comparability of accelerometers in epidemiological studies is important for public health researchers. This study aimed to compare physical activity (light, LPA; moderate, MPA; and moderate-to-vigorous, MVPA) and sedentary behavior (SB) data collected using two Omron triaxial accelerometer generations (Active style Pro, ASP) among a sample of Japanese workers in a free-living environment. Methods. Thirty active and sedentary workers (24–62 years) wore two types of ASP accelerometers, the HJA-350IT (350IT) and the HJA-750C (750C), simultaneously for seven consecutive days to represent a typical week. The accelerometers estimated daily average step counts and time spent per day in LPA, MPA, and MVPA. If a participant had data for ≥4 days (&gt;10 h/day) it was considered valid. The difference and agreement between the two ASPs were analyzed using a paired t-test, intra-class correlation coefficients (ICC), and a Bland–Altman analysis in total and for each type of worker. Results. Among all workers, the 750C measured significantly (p &lt; 0.05) less SB, MPA, MVPA, and more LPA compared with the 350IT. The agreements in ICC were high (ICC ≥ 0.94). Conclusions. Compared with the 350IT, the newer generation 750C ASP accelerometer may not provide equivalent estimates of activity time, regardless of the type of physical activity.

[Purpose] The purpose of this study was to identify which physical attribute could influence each outcome in the Stand-up test and the Two-step test and the degree of their involvement. [Participants and Methods] The participants were 2,476 people (1,674 males and 802 females), who underwent a two-day health checkup and were requested to take the Locomotive Syndrome Risk Test (Locomo Test). Participants were divided into groups under the Locomo level based on the result of Locomo Test by gender. Furthermore, the relationship between each physical attributes (quartile) based on the result of Locomo Test and the Locomo level was evaluated. [Results] According to the relationship between each physical attributes and Locomo level 1 in the Stand-up test, height showed a positive relationship and the multivariable adjusted odds ratio significantly increased with taller height in both genders. Body weight and BMI showed a negative relationship, although rather weak positive relationship, it was identified in waist circumference. On the other hand, there was no clear correlation between each physical attribute and Locomo level 1 in the Two-step test. [Conclusion] The findings indicate The Stand-up test would overestimate the decline of locomotor function in taller people and would underestimate it in shorter individuals.

OBJECTIVE: The aim of this study was to investigate the associations between dietary patterns and abdominal obesity among middle-aged and elderly Japanese people, using both waist circumference (WC) and visceral fat (VF) as indices. METHODS: A cross-sectional study was conducted with 829 adults (534 men and 295 women), 40 to 79 y of age, who participated in the Waseda Alumni's Sports, Exercise, Daily Activity, Sedentariness and Health Study (WASEDA'S Health Study). Dietary patterns were derived from principal component analysis. VF was measured using magnetic resonance imaging. To examine the associations of each dietary pattern with WC and VF, we calculated multivariate-adjusted means and 95% confidence intervals (CIs) of WC and VF for the tertile of each dietary pattern score. RESULTS: Two main dietary patterns were identified: "healthy Japanese" and "seafood and alcohol." The healthy Japanese dietary pattern score was inversely associated with WC and VF in men only. WC measurements were 84.9 cm (95% CI, 83.7-86.1), 83.9 cm (95% CI, 82.7-85.1), and 82.4 cm (95% CI, 81.2-83.6); Ptrend = 0.006, and VF measurements were 94.0 cm2 (95% CI, 85.6-102.4), 89.4 cm2 (95% CI, 81.1-97.7), and 80.4 cm2 (95% CI, 72.5-88.4); Ptrend = 0.027 for the lowest through the highest tertile of healthy Japanese dietary pattern scores in men. The seafood and alcohol dietary pattern was not associated with WC and VF. CONCLUSION: The healthy Japanese dietary pattern was negatively associated with WC and VF in middle-aged and elderly Japanese men.

OBJECTIVES: Social isolation is a particular problem among older people and social participation may reduce future isolation. However, it is unclear which types of activities and which level of participation are effective. This study examines the relationship between social participation and isolation among Japanese older people by employing a 3-year longitudinal study. METHODS: A mail survey was sent to 3,518 community-dwelling older people in an urban area in 2014 (baseline: BL). We then conducted follow-up mail survey on respondents who were non-isolated at BL in 2017 (follow-up: FL), with isolation being defined as being in contact with others less than once a week. An analysis was carried out on 1,070 subjects (398 men and 672 women). Social participation is defined by participation in group activities (community, senior club, hobbies, sports, volunteering, politics, industry, and religion). A logistic regression analysis was conducted to determine the association between the types of social participation and the number of organization types at BL, and isolation at FL. RESULTS: At FL, 75 men (18.8%) and 59 women (8.8%) were considered to be isolated. Among the men, participation in a hobby group and sports group both significantly reduced the degree of isolation. Moreover, participation in two organizations and three or more organizations significantly lowered the risk of isolation when compared to non-participants. Among women, there were no significant associations among particular types of social activities and isolation. On the other hand, participation in one organization and three or more organizations significantly reduced their isolation when compared to non-participants. There was a significant linear trend between the number of types of organizations and isolation, regardless of gender. CONCLUSIONS: Participation in social activities reduces future isolation in older people. Encouraging participation in social activities could help reduce negative health outcomes associated with social isolation later in life.

Walking to get to and from local destinations including shops, services, and transit stops is a major source of adults’ health-related physical activity. Research has been using space syntax measures in examining how urban form is related to such routine walking for transport. This paper proposes to apply a theory of space syntax, natural movement, which posits street layout as a primary factor influencing pedestrian movement. Discussing how this theory can link urban form (street layout) and function (land use) with walking for transport, we propose a research agenda to produce new insights and advance methods in active living research.

© The Author(s) 2018. Purpose: The purposes of this study were to examine associations between objectively measured walkable urban design attributes with Japanese older adults’ body mass index (BMI) and to test whether objectively assessed physical activity and sedentary behavior mediated such associations. Design: Cross-sectional. Setting: Matsudo City, Chiba Prefecture, Japan. Participants: Participants were 297 older residents (aged 65-84 years) randomly selected from the registry of residential addresses. Measures: Walkable urban design attributes, including population density, availability of physical activity facilities, intersection density, and access to public transportation stations, were calculated using geographic information systems. Physical activity, sedentary behavior, and BMI were measured objectively. Analysis: The relationships of walkable urban design attributes, Walk Score®, and BMI were examined by multiple linear regression with adjustment for covariates in all models. Mediation effects of the physical activity and sedentary behavior variables in these relationships were tested using a product-of-coefficients test. Results: Higher population density and Walk Score® were associated with lower BMI. Light and moderate-to-vigorous physical activities partially mediated the relationships between these walkable urban design attributes and BMI. Conclusions: Developing active-friendly environmental policies to (re)design neighborhoods may not only promote active transport behaviors but also help in improving residents’ health status in non-Western contexts.

© The Author(s) 2019. An increasing number of studies have examined neighbourhood built environment attributes associated with cycling. Some of them suggest non-linear relationships between built environment attributes and cycling. This study examined the strength and shape of associations of cycling for transport with objectively measured built environment attributes. Data were from 9146 Australian adults who took part in the 2009 South-East Queensland Travel Survey. Participants (aged 18–64 years) completed a 24-hour travel survey, in which they reported modes of travel. Residential density, Walk Score and a Space Syntax measure of street integration were calculated at a neighbourhood level using geographic information systems. Multilevel logistic regression analyses examined associations of bicycle use with each built environment attribute, which was modelled continuously and categorically. All continuous measures of the built environment attributes were associated with bicycle use. Each one-decile increment in residential density, Walk Score, and street integration was associated with 13%, 16%, and 10% higher odds of bicycle use, respectively. However, the associations appeared to be non-linear, with significant odds ratios observed only for the higher categories of each built environment attribute relative to the middle category. This study found that adults living in high-density neighbourhoods with more destinations nearby and well-connected streets were more likely to cycle for transport. However, medium-level density, access to destinations and street connectivity may not be enough to facilitate bicycle use. Further studies are needed to investigate urban design threshold values above which cycling can be promoted.

© 2019 Most walkability indices do not capture the topological structure of urban forms. Space syntax models these topological relationships. We estimated associations between the space syntax measure of street integration and walkability (SSW) and neighborhood-specific leisure (LW) and transportation (TW) walking among 4422 Canadian adults. Street integration and SSW were found to be positively associated with TW and LW participation in a usual week. A one-unit increase in SSW was associated with a 6-min increase in usual weekly minutes of TW. Street integration and SSW were also positively associated with TW participation in the last week. Higher street integration and walkability conceptualized using space syntax support neighborhood walking.

Objective<br />
<br />
We examined (1) cross-sectional and prospective associations of perceived and objectively-measured neighborhood attributes with purpose-specific walking; (2) the differences between cross-sectional and prospective associations in the sample of Japanese middle-to-older-aged adults.<br />
Methods<br />
<br />
We conducted a prospective cohort study to collect data from 544 adults aged 40 to 69 years living in two cities in Japan in 2011 and again in 2013. Generalized linear modelling was employed to examine associations of perceived and GIS-measured built environment attributes (population density, access to destinations, access to public transportation, sidewalk, and street connectivity) with four types of self-reported purpose-specific walking, namely walking for commuting (to and from work), walking during work, walking for errands (shopping, to the bank or post office), and walking for exercise.<br />
Results<br />
<br />
After adjusting for potential confounders, GIS-measured higher population density and better street connectivity were associated with increased time spent walking for commuting and exercise. Furthermore, GIS-measured better access to public transportation was related to increased time spent walking for commuting, and perceived better access to destinations was also associated with increased time spent walking for commuting and daily errands. Unexpectedly, GIS-measured better access to destinations, and perceived sidewalk presence were related to decreased time spent in work-related walking.<br />
Conclusion<br />
<br />
Living in high-density neighborhoods with well-connected streets and convenient public transportation systems, and having a higher awareness of destinations are supportive of the long-term engagement in walking for various purposes. Further studies using a prospective design with longer follow-up period to confirm these results are warranted.

OBJECTIVES: Reducing sedentary behaviour (SB) and increasing physical activity (PA) have been shown to be associated with decreased depression. However, there are yet few studies examining the potential benefits on older adults' depression, when SB is replaced with PA. This study aimed to examine the associations of objectively assessed SB, light-intensity PA (LPA) and moderate-to-vigorous PA (MVPA) with depression among a sample of Japanese older adults, and to explore impacts of substituting SB with PA on older adults' depression. DESIGN: Cross-sectional analysis. SETTING: General community. PARTICIPANTS: A total of 276 older adults aged 65-85 years living in Japan. MAIN OUTCOME MEASURES: Three behaviours including the average daily time spent in SB (≤1.5 METs); LPA (>1.5 to <3.0 METs) and MVPA (≥3.0 METs) per day were calculated by accelerometers. Depression was assessed using the Japanese version of the 15-item Geriatric Depression Scale (GDS-15). RESULTS: Less SB (β=0.129, 95% CI 0.015 to 0.243) and more LPA (β=-0.138, 95% CI -0.265 to -0.011) were found to be significantly and negatively associated with the GDS-15 score in the single-activity model. The isotemporal substitution model found that replacing only 30 min per day of SB with the same amount of LPA to be significantly and negatively associated with the GDS-15 score (β=-0.131, 95% CI -0.260 to -0.002). CONCLUSIONS: These findings indicated that substituting even small amounts of SB with LPA may contribute to less depression in older adults. Potential favourable effects can be observed for replacing only 30 min per day of SB with LPA.

OBJECTIVES: This study investigated the longitudinal association between changes in older adults' physical activity and neighborhood walkability measured by geographic information systems (GISs, (ArcGIS, ESRI Inc., Redlands, CA, USA)). METHODS: A mail survey was conducted for Japanese older adults who were randomly selected from three different settlement types. Data on walking, total moderate to vigorous physical activity (MVPA), and sociodemographic characteristics were collected at baseline (in 2010) and follow-up (in 2015). Multiple linear regression analyses were employed to assess the association between MVPA change and neighborhood walkability, adjusted for potential confounders. Effect sizes for independent variables on MVPA change were estimated. RESULTS: Data from 731 community-dwelling older adults (43.7% women) were analyzed. During the follow-up, older adults' MVPA was reduced by 94.4 min/week (-14.2%) on average (675.5 and 579.9 min/week in 2010 and 2015, respectively). Overall, older adults living in highly walkable areas showed a smaller reduction than those in low walkable areas (beta: 99.7 min/week, 95% confidence interval: 28.5⁻171.0). Similar associations were observed among those in the urban and suburban area, but not in the rural area. Walkability had larger effect sizes for explaining MVPA change than demographic characteristics. In addition, the findings for walking were similar to MVPA. CONCLUSION: Neighborhood walkability mitigated the 5-year reduction of walking and total MVPA among older adults, especially in urban areas.

Car use has been identified as sedentary behavior, although it may enhance mobility, particularly in the older population. This cross-sectional study aimed to compare the time spent in objectively determined sedentary behavior (SB) and physical activity (PA) between older drivers and non-drivers. Four hundred and fifty Japanese older adults (74.3 ± 2.9 years) who had valid accelerometer data were included. They were asked to respond to a questionnaire and wear an accelerometer (HJA-350IT, Omron Healthcare) on their waist for 7 consecutive days in 2015. To compare activity time between drivers and non-drivers, we calculated estimated means using analysis of covariance, adjusting for sociodemographic, physical, and psychological factors and accelerometer wear time. Compared to non-drivers, drivers engaged in more light-intensity PA (LPA) (drivers: 325.0 vs. non-drivers: 289.0 min/day) and moderate-to-vigorous PA (drivers: 37.5 vs. non-drivers: 30.0 min/day) and less SB (drivers: 493.4 vs. non-drivers: 535.9 min/day) (all p < 0.05). After stratification by age, sex, and residential area, larger effect of driving on PA time was found in older-older adults, in men, and in rural residents. Older drivers were found to be more physically active than non-drivers, suggesting more access to outdoor activities or expanding social network.

OBJECTIVE: The times spent in sedentary behavior (SB) and moderate-to-vigorous physical activity (MVPA) are independently associated with health outcomes; however, objective data on physical activity levels including SB among different occupations is limited. We compared accelerometer-measured times spent in SB, light-intensity physical activity (LPA), and MVPA, and the patterns associated with prolonged bouts of SB between white- and blue-collar workers. METHODS: The study population consisted of 102 full-time plant workers (54 white-collar and 48 blue-collar) who wore a triaxial accelerometer during waking hours for 5 working days. Accelerometer-measured activity levels were categorized as SB (≤1.5 metabolic equivalents (METs)), LPA (1.6-2.9 METs), and MVPA (≥3.0 METs). A sedentary bout was defined as consecutive minutes during which the accelerometer registered less than ≤1.5 METs. Accelerometer variables were compared between white- and blue-collar workers through analysis of covariance. RESULTS: During working hours, white-collar workers spent significantly more time in SB and less time in LPA than blue-collar workers (SB: 6.4 h vs. 4.8 h, 73% vs. 55% of total work time; LPA: 1.9 h vs. 3.5 h, 22% vs. 40% of total work time, p<.001), whereas the MVPA time was similar between the groups. White-collar workers spent significantly more SB time in prolonged sedentary bouts (≥30 min) compared to blue-collar workers. During leisure time, the SB, LPA, and MVPA times were similar between the groups. CONCLUSIONS: White-collar workers have significantly longer SB times than blue-collar workers during work hours, and do not compensate for their excess SB during work by reducing SB during leisure time.

Background: Inconsistent associations of neighbourhood walkability with adults' body weight have been reported. Most studies examining the relationships of walkability and adiposity are cross-sectional in design. We examined the longitudinal relationships of two walkability indices - conventional walkability and space syntax walkability, and their individual components, with weight change among adults over four years. Methods: Data were from the Physical Activity in Localities and Community study in Adelaide, Australia. In 2003-2004, 2650 adults living in 154 Census Collection Districts (CCDs) returned baseline questionnaires
in 2007-2008, the follow-up survey was completed by 1098. Participants reported their weight at baseline and at follow-up. Neighbourhood walkability indices were calculated using geographic information systems and space syntax software. Linear marginal models using generalized estimating equations with robust standard errors were fitted to examine associations of the two walkability indices and their individual components with the weight at follow-up, adjusting for baseline weight, socio-demographic variables, and spatial clustering at the level of CCD. Results: The overall mean weight gain over four years was 1.5 kg. The two walkability indices were closely correlated (r = 0.76, p &lt
0.01). No significant associations were found between the overall neighbourhood walkability indices and weight change. Among walkability components, there was a marginally significant negative association between space syntax measure of street integration and weight change: one standard deviation increment in street integration was associated with 0.31 kg less weight gain (p = 0.09). Conclusions: Using a prospective study design and a novel space-syntax based measure of walkability, we were not able to identify relationships between neighbourhood walkability with weight gain. This is consistent with other inconclusive findings on the built environment and obesity. Research on the built environment and adults' weight gain may need to consider not just local environments but also a larger scale environment within a city or workplace environment in order to capture multiple behaviours relevant to weight gain.

Evidence about the impacts of the physical activity environment on adults' weight in the context of Asian countries is scarce. Likewise, no study exists in Asia examining whether Walk Score a free online walkability tool is related to obesity. This study aimed to examine associations between multiple physical activity environment measures and Walk Score ratings with Japanese adults' body mass index (BMI). Data from 1073 adults in the Healthy Built Environment in Japan study were used. In 2011, participants reported their height and weight. Environmental attributes, including population density, intersection density, density of physical activity facilities, access to public transportation, and availability of sidewalks, were calculated using Geographic Information Systems. Walk Scores ratings were obtained from the website. Multiple linear regression analysis was conducted to examine the association between each environmental attribute and BMI. Adjusting for covariates, all physical activity environmental attributes were negatively associated with BMI. Similarly, an increase of one standard deviation of Walk Score was associated with a 0.29 (95% confidence interval (CI) of-0.49--0.09) decrease in BMI. An activity-friendly built environment was associated with lower adults' BMI in Japan. Investing in healthy community design may positively impact weight status in non-Western contexts.

Objective measures of environmental attributes have been used to understand how neighborhood environments relate to physical activity. However, this method relies on detailed spatial data, which are often not easily available. Walk Score® is a free, publicly available web-based tool that shows how walkable a given location is based on objectively-derived proximity to several types of local destinations and street connectivity. To date, several studies have tested the concurrent validity of Walk Score as a measure of neighborhood walkability in the USA and Canada. However, it is unknown whether Walk Score is a valid measure in other regions. The current study examined how Walk Score is correlated with objectively-derived attributes of neighborhood walkability, for residential addresses in Japan. Walk Scores were obtained for 1072 residential addresses in urban and rural areas in Japan. Five environmental attributes (residential density, intersection density, number of local destinations, sidewalk availability, and access to public transportation) were calculated using geographic information systems for each address. Pearson's correlation coefficients between Walk Score and these environmental attributes were calculated (conducted in May 2017). Significant positive correlations were observed between Walk Score and environmental attributes relevant to walking. Walk Score was most closely associated with intersection density (r = 0.82) and with the number of local destinations (r = 0.77). Walk Score appears to be a valid measure of neighborhood walkability in Japan. Walk Score will allow urban designers and public health practitioners to identify walkability of local areas without relying on detailed geographic data.

© 2018 The Author(s). Background: The isotemporal substitution (IS) approach can be used to assess the effect of replacing one activity with the equal duration of another activity on relevant outcomes. This study examined the associations of objectively assessed sedentary behavior (SB) and physical activity (PA) with health-related quality of life (HRQOL) in older Japanese adults, using the IS approach. Methods: Participants were 287 older Japanese adults (aged 65-84 years) who wore accelerometers for at least 7 days. We calculated the average daily time spent in SB (≤1.5 METs); light-intensity PA (LPA: > 1.5 to < 3.0 METs); and moderate- to vigorous-intensity PA (MVPA: ≥3.0 METs) per day. HRQOL was assessed using the Medical Outcomes Survey Short Form-8 questionnaire. Results: The IS models showed replacing SB or LPA with MVPA to be significantly associated with better physical component summary scores. Replacing SB with MVPA was marginally associated with better mental component summary scores. Conclusion: These findings indicate that replacing SB with the same amount of MVPA may contribute to better physical HRQOL in older adults.

Although greater sedentary time has been found to be associated with negative health impacts, little is known whether the specific pattern of sedentary behavior (i.e. sedentary bouts, breaks and durations) are associated with physical function among older adults. The present study examined the associations between objectively measured sedentary behavior and physical function among older Japanese adults. A total of 174 male and 107 female community-dwelling older Japanese adults aged 65-84 years (mean age: 74.5 ± 5.2 years) were recruited. Sedentary behavior and physical activity were assessed using a triaxial accelerometer. Physical function was measured through hand grip strength, eye-open one leg standing, 5-m walking, and timed up and go tests. Forced-entry multiple linear regression models adjusted for potential confounders were performed. After adjustment, total daily sedentary time and duration of prolonged sedentary bouts (both ≥ 30 min) were positively associated with time spent on the 5-m walking stage and timed up and go tests in older women; however, no significant associations were observed in older men or the whole sample. This paper highlights the importance of developing sedentary behavior change strategies for interventions aiming to improve mobility in in older women. Further evidence from a prospective study is required to establish directions of causality between sedentary behavior and mobility.

OBJECTIVES: This study examined cross-sectional and 2-year prospective associations of perceived and objectively measured environmental attributes with screen time among middle-aged Japanese adults. DESIGN: Prospective cohort study. SETTING: Nerima and Kanuma cities of Japan. PARTICIPANTS: Data were collected from adults aged 40-69 years living in two cities of Japan in 2011 (baseline: n=1011; 55.3±8.4 years) and again in 2013 (follow-up: n=533; 52.7% of baseline sample). MEASURES: The exposure variables were five geographic information system-based and perceived attributes of neighbourhood environments (residential density, access to shops and public transport, footpaths, street connectivity), respectively. The outcome variables were baseline screen time (television viewing time and leisure-time internet use) and its change over 2 years. Multilevel generalised linear modelling was used. RESULTS: On average, participants' screen time was not statistically different over 2 years (2.3 hours/day at baseline and 2.2 hours/day at follow-up; P=0.24). There were cross-sectional associations of objective (exp(β): 1.11; 95% CI 1.01 to 1.22) and perceived (1.12; 1.02 to 1.23) good access to public transport, perceived good access to shop (1.18; 1.04 to 1.36) and perceived good street connectivity (1.11; 1.01 to 1.23) with higher time spent in screen time at baseline. No objective and perceived environmental attributes were significantly associated with change in screen time. CONCLUSIONS: Activity-supportive neighbourhood environmental attributes appear to be related to higher levels of screen time cross-sectionally. Pattern of screen time might be maintained rather than changed over time under the same neighbourhood environments. Environmental interventions that promote physical activity may need to consider the potential negative health impact of screen time in Japan.

OBJECTIVE: The aim of this study was to examine the relationships between work engagement, productivity, and self-reported work-related sedentary behavior in Japanese adults. METHODS: The present study recruited 2572 Japanese individuals (20-59 years old) via an internet survey and assessed their demographic characteristics, work-related characteristics, and sedentary behavior. Data were analyzed with logistic regression. RESULTS: The mean proportion of work days involving work-related sedentary behavior was approximately 70% and the mean number of weekly working hours was approximately 43 hours. Among those aged 40 to 59 years, work-related sedentary behavior was associated with low work vigor (odds ratio: 1.43), dedication (1.61), absorption (1.39), and total score of work engagement (1.49). Among those aged 20 to 39 years, work-related sedentary behavior was associated with low efficiency (1.38). CONCLUSION: Reducing work-related sedentary behavior may improve workers' engagement and productivity.

BACKGROUNDS: The purpose of this study was to examine, in a sample of Japanese older adults, the associations of objectively-assessed sedentary behavior (SB) and physical activity (PA) with performance-based physical function. The isotemporal substitution (IS) approach was used to model simultaneously the effects of the specific activity being performed and the activity being displaced, in an equal time-exchange manner. METHODS: Among 287 older adults (65-84 years), we used accelerometers to identify the daily average time spent on SB (≤1.5 METs); light-intensity PA (LIPA) (>1.5 to <3.0 METs); and moderate- to vigorous-intensity PA (MVPA) (≥3.0 METs). Physical function was assessed using five performance-based measures: hand grip strength, usual and maximum gait speeds, timed up and go, and one-legged stance with eyes open. We employed three linear regression models - a single-activity model, a partition model, and an IS model - to assess the associations of SB, LIPA, and MVPA with each of the five measures of physical function. RESULTS: There were significant positive associations in the single-activity and partition models between MVPA and the measures of physical function (with the exception of hand grip strength). The IS models found that replacing SB or LIPA with MVPA was significantly and favorably associated with physical function measures. CONCLUSIONS: These findings indicate that replacing small amounts of SB and LIPA with MVPA (such as 10 min) may contribute to improvements in older adults' physical function.

Several studies have examined how the associations of built environment attributes with walking behaviors may be moderated by socioeconomic status (SES). Such understanding is important to address socioeconomic inequalities in health through urban design initiatives. However, to date, there is no study examining the moderation effects of SES in the relationships of environmental attributes and walking in non-Western countries. The current study aims to examine associations of environmental attributes with walking behaviors among Japanese adults, and to test whether these associations were moderated by area-level SES. Data on walking were collected from Japanese adults using a nationwide Internet survey (N = 4605). Built environment measures including population density, street density, distance to the nearest public open space, and distance to the nearest commercial destination were calculated using geographic information systems software. An index of neighborhood deprivation was used as an area-level indicator of SES. Logistic regression models adjusted for clustering and sociodemographic variables were used. It was found that more residents in high SES areas walked for commuting, for errands, and for exercise compared with those who lived in low SES areas. When the whole sample was examined, all environmental attributes were associated with walking behaviors (except for street density not being associated with walking for exercise). Associations of environmental attributes with walking behaviors were moderated by area-level SES only in walking for exercise. Walking for exercise was associated with higher population density, higher street density (marginally significant), and shorter distance to the nearest commercial destination only in high SES areas. Our findings showed that the associations of these environmental attributes and walking behaviors were largely consistent across different SES levels. Therefore, urban design interventions focusing on low SES areas may help to reduce socioeconomic disparities in walking.

Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle. The primary purpose of this consensus statement is to provide an integrated perspective on current knowledge and expert opinion pertaining to sedentary behaviour in older adults on the topics of measurement, associations with health outcomes, and interventions. A secondary yet equally important purpose is to suggest priorities for future research and knowledge translation based on gaps identified. A five-step Delphi consensus process was used. Experts in the area of sedentary behaviour and older adults (n=15) participated in three surveys, an in-person consensus meeting, and a validation process. The surveys specifically probed measurement, health outcomes, interventions, and research priorities. The meeting was informed by a literature review and conference symposium, and it was used to create statements on each of the areas addressed in this document. Knowledge users (n=3) also participated in the consensus meeting. Statements were then sent to the experts for validation. It was agreed that self-report tools need to be developed for understanding the context in which sedentary time is accumulated. For health outcomes, it was agreed that the focus of sedentary time research in older adults needs to include geriatric-relevant health outcomes, that there is insufficient evidence to quantify the dose-response relationship, that there is a lack of evidence on sedentary time from older adults in assisted facilities, and that evidence on the association between sedentary time and sleep is lacking. For interventions, research is needed to assess the impact that reducing sedentary time, or breaking up prolonged bouts of sedentary time has on geriatric-relevant health outcomes. Research priorities listed for each of these areas should be considered by researchers and funding agencies.

Sedentary time (ST) is an important risk factor for a variety of health outcomes in older adults. Consensus is needed on future research directions so that collaborative and timely efforts can be made globally to address this modifiable risk factor. In this review, we examined current literature to identify gaps and inform future research priorities on ST and healthy ageing. We reviewed three primary topics:(1) the validity/reliability of self-report measurement tools, (2) the consequences of prolonged ST on geriatric-relevant health outcomes (physical function, cognitive function, mental health, incontinence and quality of life) and(3) the effectiveness of interventions to reduce ST in older adults.
Methods A trained librarian created a search strategy that was peer reviewed for completeness.
Results Self-report assessment of the context and type of ST is important but the tools tend to underestimate total ST. There appears to be an association between ST and geriatric-relevant health outcomes, although there is insufficient longitudinal evidence to determine a dose-response relationship or a threshold for clinically relevant risk. The type of ST may also affect health; some cognitively engaging sedentary behaviours appear to benefit health, while time spent in more passive activities may be detrimental. Short-term feasibility studies of individual-level ST interventions have been conducted; however, few studies have appropriately assessed the impact of these interventions on geriatric-relevant health outcomes, nor have they addressed organisation or environment level changes. Research is specifically needed to inform evidence-based interventions that help maintain functional autonomy among older adults. This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.

AimSocial participation provides health benefits for older adults. However, there is the need to identify whether higher social participation is associated with older adults being more physically active and less sedentary (sitting time). We examined the associations of social participation with physical activity, and sedentary time, in a population-based sample of older Japanese adults.
MethodsA population-based, cross-sectional mail survey carried out in 2010 was used to collect data on social participation, physical activity, sedentary time and sociodemographic characteristics. Data were examined from 1146 community-dwelling, unemployed older adults (mean age 70.1 years, 43% men). Multivariate logistic regression analyses were used to calculate odds ratios (OR) for associations of social participation with physical activity and total sedentary time; and, for associations with passive and mentally-active sedentary (sitting) time.
ResultsFor both men and women, those with higher social participation were more physically active (OR 2.10, 95% CI 1.44-3.06 among men; OR 1.93, 95% CI 1.39-2.68 among women). Total sedentary time had significant associations among men (OR 0.62, 95% CI 0.42-0.90), but not among women (OR 0.80, 95% CI 0.58-1.11). Social participation was associated with less passive sedentary time (OR 0.55, 95% CI 0.38-0.81 for men; OR 0.72, 95% CI 0.51-0.99 for women).
ConclusionsPromoting social participation among older adults could contribute to increasing physical activity and reducing sedentary time, with potential benefits for chronic disease. Further research is required to elucidate the deleterious and beneficial roles of passive and mentally-active sedentary time for older adults. Geriatr Gerontol Int 2017; 17: 1921-1927.

This study aims to compare the outputs of the waist-worn Active style Pro HJA-350IT (ASP; used in studies with Asian populations), the waist-worn ActiGragh (TM) GT3X(+) using the normal filter (GT3X(+)) and the thigh-worn activPAL3 (AP) in assessing adults' sedentary behaviour (total sedentary time, number of breaks) under free-living conditions. Fifty healthy workers wore the three monitors simultaneously during their waking hours on two days, including a work day and a non-work day. Valid data were at least 10 hours of wearing time, and the differences between monitors on the sedentary outputs using the AP as criterion measurement were analyzed by ANOVA. The number of participants who had complete valid data for work day and non-work day was 47 and 44, respectively. Total sedentary time and breaks estimated by the AP were respectively 466.5 +/- 146.8 min and 64.3 +/- 24.9 times on the work day and 497.7 +/- 138.3 min and 44.6 +/- 15.4 times on the non-work day. In total sedentary time, the ASP estimated 29.7 min (95% CI = 7.9 to 51.5) significantly shorter than the AP on the work day but showed no significant difference against the AP on the non-work day. The GT3X(+) estimated 80.1 min (54.6 to 105.6) and 52.3 (26.4 to 78.2) significantly longer than the AP on the work day and the non-work day, respectively. For the number of breaks from sedentary time, on both days, the ASP and the GT3X+ estimated significantly more than the AP: 14.1 to 15.8 times (6.3 to 22.5) for the ASP and 27.7 to 28.8 times (21.8 to 34.8) for the GT3X(+). Compared to the AP as the criterion, the ASP can underestimate total sedentary time and the GT3X(+) can overestimate it, and more so at the lower levels of sedentary time. For breaks from sedentary time, compared to the AP, both the GT3X(+) the ASP can overestimate.

Background
Physical activity and physical performance relate to quality of life, mortality, and morbidity in elderly people. However, little is known about differences in physical performance related to low-intensity light physical activity (LLPA), high-intensity light physical activity (HLPA), and moderate-intensity physical activity (MPA) and how they are separated by sex in elderly populations.
Aims
This study aimed to determine differences in LLPA, HLPA, MPA, and physical performance, and associations between these measures in community-dwelling elderly men and women.
Methods
Physical activity and physical performance such as timed-up-and-go test, one-leg standing time, and maximum gait speed were measured in 181 community-dwelling elderly men (mean age, 75.1 +/- 5.3 years) and 109 women (mean age, 73.4 +/- 4.8 years) in 2013. Physical activity was classified as LLPA (1.6 +/- 1.9 METs of physical activity), HLPA (2.0 similar to 2.9 METs of physical activity), and MPA (over 3 METs of physical activity). The association between the values of these three intensities of physical activity in the participants was assessed by Pearson's correlation coefficients. Multiple linear regression analyses were used to assess the association of physical performance values with the three groups defined by accelerometer- measured physical activity intensity adjusted for sociographic, behavioral, and multiple diseases in the participants.
Results
MPA was beneficially associated with all physical performance indicators in the men (all P &lt; 0.05) and women (all P &lt; 0.05). Only HLPA showed significant associations with the timed-up-and-go test (P = 0.001) and maximum gait speed (P = 0.006) in women. Discussion These results may support the notion that not only HLPA in women but MPA in both sexes appears to improve physical performance in elderly populations. Conclusion The present study findings provide novel epidemiological evidence for the potential benefits of HLPA in women and also reinforce the potential benefits of MPA in both sexes, which is the mainstay of public health recommendations.

Background: Men are generally believed to be more physically active than women when evaluated using current physical activity (PA) guidelines, which count only moderate-to-vigorous physical activity (MVPA) in bouts lasting at least 10 min. However, it remains unclear men are truly more physically active provided that all-intensity PA are evaluated. This population based cross-sectional study aimed to examine gender differences in patterns of objectively-assessed PA in older adults.
Methods: One thousand two hundred ten community-dwelling Japanese older adults who were originally randomly selected from residential registry of three municipalities were asked to respond a questionnaire and wear an accelerometer (HJA-350IT, Omron Healthcare). The prevalence of achieving current PA guidelines, &gt;= 150 min/ week MVPA in bouts lasting at least 10 min, was calculated. Gender differences in volume of each-intensity activity (METs-hour) were assessed by analysis of covariance after adjustment for age and wear time.
Results: Data from 450 (255 men, mean 74 years) participants who had valid accelerometer data were analyzed. Women were less likely to meet the guidelines (men: 31.0, women: 21.5%; p &lt; 0.05). However, women accumulated more light-intensity PA (LPA) and short-bout (1-9 min) MVPA, and thus established higher total volume of PA (men: 22.0 METs-hour/day, women: 23.9 METs-hour/day) (p &lt; 0.05).
Conclusions: Older women were less active when evaluated against current PA guidelines, but more active by total PA. Considering accumulated evidence on health benefits of LPA and short-bout MVPA, our findings highlight the potential for the limitation of assessing PA using current PA guidelines.

We examined whether street layout a key urban design element is associated with walking and sedentary behaviors in the context of a non-Western country; and, whether such associations differ between an urban and a rural area. In 2011, 1076 middle-to-older aged adults living in an urban and a rural area of Japan reported their walking and sedentary (sitting) behaviors. Two objective measures of street layout (intersection density and street integration) were calculated. Participants exposed to more-connected street layouts were more likely to walk for commuting and for errands, to meet physical activity recommendations through walking for commuting, and less likely to drive. These relationships differed between the urban and the rural area. This shows that previous findings from Western countries on associations of street connectivity with travel behaviors may also be applicable to Japan.

Background: Sedentary behaviors (SB) are associated with health indicators; however, there are currently very few studies that have examined these associations, especially in conjunction with psychological factors, in children. The current study examined the independent relationship between objectively assessed SB, and indicators of obesity and psychological, well-being, among Japanese children. Methods: A total of 967 elementary-school children completed a cross-sectional survey. SB was measured with accelerometers for 7 consecutive days. Psychological well-being data (eg, anxiety and behavior problems) were collected via a self-report questionnaire. To determine the relationship of SB with degree of obesity and psychological well-being, linear regression analyses were conducted to relate the indicators of obesity and psychological well-being on SB, adjusted by gender, grade, percentage of moderate-to-vigorous physical activity per day, duration spent wearing the accelerometer, and degree of obesity. Results: SB was significantly related to behavioral/emotional problems (beta = .280, P = .010, R-2 = .015). There was a statistically significant relationship between SB and anxiety (beta = .206, P = .059, R-2 = .007). No significant association with degree of obesity was found. Conclusions: Excess SB relates higher levels of behavioral/emotional problems and anxiety. These results can inspire the development of interventions that promote well-being and enhance psychological health, by focusing on SB in Japanese children.

Background: It is vital to reduce the proportion of sedentary behavior in children. Understanding the duration and behavioral context is needed. The present study examined school-grade and sex differences in domain-specific sedentary times and concurrence with screen-time guidelines among Japanese elementary school children.
Methods: A total of 625 children (330 boys) were surveyed in 2010 and 2014. Using a questionnaire, data regarding participants' grade (first through third grades: lower grades; fourth through six grades: higher grades), sex, weight, and height were collected in addition to the time spent per day engaging in each specific sedentary behavior separately: (1) reading or listening to music, (2) TV or video viewing, (3) TV game use, (4) internet use excluding class, (5) homework, and (6) car travel. Two-way analysis of covariance and logistic regression analyses, adjusted for BMI and moderate to vigorous physical activity, were used to examine school-grade and sex differences in sedentary behaviors and the independent risk of exceeding recommended total daily screen time (&lt; 2 h).
Results: On 625 children, mean minutes (SD) of sedentary behavior per week in (1) - (6) were 90.3 (123.4), 535.0 (356.6), 167.3 (222.1), 23.9 (70.9), 264.9 (185.3), and 33.4 (61.2) in weekdays and 42.1 (70.0), 323.9 (232.0), 123.0 (96.4), 15.8 (49.9), 74.4 (96.4), and 71.3 (84.9) in weekends, respectively. There were differences in the minutes of sedentary behavior between participants of 2010 and 2014; e.g., TV game use and homework in weekdays and weekdays and car travel in weekends. Boys spent more time in TV game use, and girls spent more time reading, listening to music, doing homework, and car travel. Higher-grade students spent more time reading or listening to music, using a computer, and doing homework. Higher-grade students were 2.09 times (95% CI: 1.32 - 3.30) in whole week, 2.08 times (95% CI: 1.45 - 3.00) in weekday, and 1.88 times (95% CI: 1.29 - 2.74) in weekend more likely to spend &gt;= 2 h per day in domains (2) - (4) (screen-time) than lower-grade students.
Conclusions: Time spent engaging in each domain-specific sedentary behavior differed according to sex and school grade. Higher-grade students were less likely to meet screen-time guidelines. These findings highlight the need for domain-focused strategies to decrease sedentary behavior in Japanese school-age children.

Introduction
The most effective type of social participation against psychological distress in older adults is not well documented. The aim of this study was to examine whether different types of social participation are associated with changes in psychological distress level in older men and women in Japan.
Methods
Two thousand seven hundred community-dwelling older adults (aged 65-74 years, 50% women) were randomly selected from the resident registry of three cities. Of these, participants who reported social participation and psychological distress level in the baseline survey in 2010 were followed up. Psychological distress was evaluated based on K6 scales at baseline and follow-up (in 2015). Social participation level was examined using question items from the National Health and Nutrition Survey in Japan. Exploratory factor analysis was used to derive the underlying factor structure. Multiple linear regression analysis was used to examine the association between social participation and changes in psychological distress level after adjusting for covariates stratified by both gender and age group or living arrangement.
Results
Data from 825 community-dwelling older adults (45.3% women) were analyzed. Social participation was categorized into two types using factor analysis: community involvement (volunteer activities, community events, clubs for the elderly) and individual relationship (friendship, communication with family and friends, hobbies). During the 5-year follow-up, 29.5% of participants reported a deterioration in psychological distress. Higher community involvement was independently associated with lower risk of psychological distress for older women (beta = 0.099, p = 0.047), whereas there were no associations with individual relationship for either gender. Furthermore, in older women living with others, higher community involvement was also associated with lower risk of psychological distress (beta = 0.110, p = 0.048).
Conclusion
Community involvement provides older women with mental health benefits regardless of individual relationship level. Promoting community involvement may be an effective strategy for healthy mental aging.

Newspapers could provide effective and comprehensive information about cancer to the public. The present study conducted a content analysis of cancer-related articles in Japanese newspapers published in 2011. In total, 5,314 articles were identified and subsequently coded. Coding variables included cancer type, the cancer continuum, and topic of articles mentioning cancer. Approximately half mentioned at least one specific type of cancer, with the focus mostly on lung, leukemia, and breast. Stomach and colon cancers, which have the highest morbidity, were relatively underreported. The continuum received little attention, and was mentioned in only 11% of articles. Treatment was the most frequently mentioned part of the continuum, with prevention and screening mentioned only rarely. The most frequently mentioned topic was social issues. The findings suggest that cancer-related articles were found regularly throughout the year, meaning that they might be one of the most important sources of cancer information. However, they are affected by social issues and there were some imbalances in both cancer type and continuum. Considering the influence of newspapers, it would be helpful for providing more effective and accurate information to the public if Japanese newspapers increased mentions of specific types of common cancers and the cancer continuum, especially prevention.

Street layout is consistently associated with adults' travel behaviors, however factors influencing this association are unclear.
We examined associations of street layout with travel behaviors: walking for transport (WT) and car use; and, the extent to which these relationships may be accounted for by availability of local destinations. A 24-h travel diary was completed in 2009 by 16,345 adult participants of the South-East Queensland Household Travel Survey, Australia. Three travel-behavior outcomes were derived: any home-based WT; over 30 min of home-based WT; and, over 60 min of car use. For street layout, a space syntax measure of street integration was calculated for each Statistical Area 1 (SA1, the smallest geographic unit in Australia). An objective measure of availability of destinations - Walk Score - was also derived for each SA1. Logistic regression examined associations of street layout with travel behaviors. Mediation analyses examined to what extent availability of destinations explained the associations.
Street integration was significantly associated with travel behaviors. Each one-decile increment in street integration was associated with an 18% (95% CI: 1.15, 1.21) higher odds of any home-based WT; a10% (95% CI: 1.06, 1.15) higher odds of over 30 min of home-basedWT; and a 5% (95% CI: 0.94, 0.96) lower odds of using a car over 60min. Local destinations partially mediated the effects of street layout on travel behaviors. Well-connected street layout contributes to active travel partially through availability of more local destinations. Urban design strategies need to address street layout and destinations to promote active travel among residents. (C) 2016 Elsevier Inc. All rights reserved.

<p>Aim: The present study examined the effects of individual pain coping-skills training (PCST) on knee pain, pain coping strategies, physical functions, and daily physical activity among older outpatients with osteoarthritis.</p><p>Methods: Twenty-five older adults who suffered from knee pain and had been diagnosed to have knee osteoarthritis (men: n=4; 75.4±6.3 years) were assigned to either a PCST group (n=13) or a general health education group (n=12) according to their wishes. Both groups attended 20-minutes sessions once a week for 8 weeks. At the baseline, the basic attributes (e.g. gender, age, duration of knee pain, and medical history), BMI, and the severity of knee osteoarthritis were obtained. Additionally, knee pain and limitations in mobility, pain coping strategies, pain self-efficacy, exercise self-efficacy, lower muscle strength, mobility, accelerometer -based time spent in physical activity and sedentary behavior were assessed before and after the 8-week intervention period. Analyses were performed using an intention-to-treat principle. Differences in each variable between the groups were examined using an analysis of covariance. Each participant's baseline value was used as the covariate.</p><p>Results: Even after controlling for the baseline attributes and values, only the PCST group exhibited a significant improvement in pain self-efficacy (p=0.005), exercise self-efficacy (p=0.042), lower muscle strength (p=0.004) and mobility (p=0.027). Furthermore, the PCST showed a significant increase in moderate-to vigorous-intensity physical activity (p=0.052) and a decrease in medical behaviors as one of pain coping strategies (p=0.073).</p><p>Conclusion: The present study showed that PCST therefore appears to be a feasible and effective therapeutic strategy which improves self-efficacy for controlling knee pain, which may also result in increasing the self-efficacy for exercise, physical functions, and daily physical activities.</p>

[Purpose] To examine the effect of a care-prevention strength training program using a behavioral scientific method on frequency of performance and adherence to an anti-gravity muscle training program. [Subjects and Methods] Eleven community-dwelling elderly persons participated in this study. The frequency of training per week was examined and compared before, immediately after, and 6-months after the intervention. [Results] At 6 months after intervention, 9 participants had continued to perform the training. The training frequency was 0 times/week before the intervention, but it was 6 times/week after the intervention, and 3 times/week at 6 months after the intervention. In addition, frequency of training immediately and 6-months after intervention was significantly higher than that before the intervention. [Conclusion] The results suggest that using a behavioral scientific method may be effective for adherence to lower limb anti-gravity muscle training for the elderly.

Objective: To determine the effects of watching a professional baseball game on the affect and subjective happiness of elders without a specific team to support. Method: Elderly Japanese (n = 16) were instructed to watch baseball games at a ballpark. They answered a questionnaire several weeks before (baseline) and, on the day of the game, before and after watching the game. Participants' affect and happiness were assessed using the General Affect Scale and Subjective Happiness Scale, respectively. Results: Calmness had a tendency to increase from baseline to before watching the game (p = .052). Furthermore, subjective happiness significantly increased after watching the game, compared with baseline (p = .017). Discussion: Visiting a ballpark to watch a professional baseball game increased elders' subjective happiness after they had finished watching it.

<p>The present study is a systematic review of the effectiveness of acceptance and mindfulness based interventions for enhancing athletes' performance. Studies were initially identified by literature searches in multiple international and domestic databases. Search terms used included "acceptance-based", "acceptance and commitment therapy", "mindfulness", "sport", "athlete", and "performance". Studies were then assessed for inclusion by examination of their title, abstract, and full text. On this basis, 11 studies were selected for inclusion in the present review. No studies conducted in Japan met the criteria. The studies reviewed encompassed the Mindfulness-Acceptance-Commitment approach (n＝5), Mindful Sport Performance Enhancement (n＝2), and alternative interventions (n＝4). Most of the studies (n＝8) found positive effects on sport performance. In 2 other studies, enhancement of sport performance was observed during a follow-up period. These findings suggest that acceptance and mindfulness based interventions appear to be effective for enhancing sport performance. Because none of the studies reviewed was conducted in Japan, research is needed on the effects of acceptance and mindfulness based interventions on the performance of Japanese athletes.</p>

&nbsp;&nbsp;&nbsp;&nbsp;Considering the benefits of participating in school-based extracurricular sports activities (SBECSA), providing active SBECSA is important. However, heavy burden on teachers in coaching and management of SBECSA has been reported. Additionally, appropriate allowance and role allotment have not been discussed enough. It is necessary to understand the quality and quantity of task-related burdens in coaching and managing SBECSA to promote discussion. Therefore, the purpose of the study was to quantify the temporal, psychological, and economic burdens on teachers in coaching and management of SBECSA. The present study used a mixed-methods approach. Firstly, a semi-structured interview was conducted to clarify the contents of tasks about coaching and management of SBECSA. Participants were 12 teachers who work in junior high school or high school. All interview data was recorded and transcribed verbatim. Through the recording process, 26 contents of SBECSA tasks were grouped. Secondly, a self-completed questionnaire survey was conducted. 200 junior high schools and 200 high schools were recruited. Seventy-three schools agreed to cooperate in the study, and 361 SBECSA teachers answered the questionnaire. Question items were as follows: yearly hours taken for each of the 26 tasks, psychological burdens to do each of the 26 tasks, and yearly expenditure for coaching and management of SBECSA. As results, exact temporal burden for each of the 26 tasks was examined. On average, SBECSA teachers were spending approximately 1,400 hours a year for coaching and management. Regarding psychological burden, there were some tasks which were highly perceived although the temporal burdens were comparatively low. SBECSA teachers were payed approximately 136,000 yen a year to coach and manage SBECSA. In conclusion, SBECSA teachers assumed various tasks for management other than direct coaching. Contents of tasks would affect psychological burden as well as temporal length. Additionally, heavy individual payment for coaching and management of SBECSA was revealed. Increasing support for SBECSA coaching and management is necessary to decrease teachers&rsquo; burden and promote youth sports.

&nbsp;&nbsp;&nbsp;&nbsp;Recently, the carry-over of physical fitness or physical activity from childhood to adulthood has been actively discussed. However, the carry-over effect of participation in organized sports is not well understood, despite the fact that organized sports participation has a number of positive effects on physical, mental, and social aspects. Therefore, the purpose of the present study was to clarify the association of organized sports participation during school age with organized sports participation and sports volunteer participation in adulthood. The data was secondarily obtained from &ldquo;nationwide questionnaire research for promotion of sports activities according to the life stage&rdquo; conducted by the National Recreation Association of Japan. This research was conducted with 1,200 Japanese adults (612 males and 588 females) who were 20-39 years old. Path Analysis was conducted with respect to each sex. Regarding association of organized sports participation in school-age with organized sports participation in adulthood, participation in elementary school was related to that of junior high school, participation in junior high school was related to that of high school and adulthood, and participation in high school was related to that of adulthood in males. By contrast, in females, participation in elementary school was related to that of junior high and high school, participation in junior high school was related to that of high school and adulthood, and participation in high school was related to that of adulthood. With respect to association of organized sports participation in school-age with sports volunteer participation in adulthood, only organized sports participation in high school was affected in males, and only organized sports participation in junior high school was affected in females. There is a possibility that participation in organized youth sports has a carry-over effect for adult sports involvement. In order to promote organized sports participation and sports volunteer participation in adulthood, enhancing organized sports participation in school-age would be valuables.

【目的】本研究は人工膝関節全置換術（TKA）患者の退院後における身体活動量を調査し，その関連する要因について検討した。【方法】対象は変形性膝関節症により初回片側TKAを施行した37例とした。身体活動量は活動量計AM-120（カロリズム）を装着し歩数を算出した。身体機能評価はTimed up and go test（TUG），開眼片脚起立時間，30秒椅子立ち上がりテスト，5 m最大歩行速度，膝伸展筋力を測定した。自己効力感（SE）の評価は虚弱高齢者の身体活動SE尺度を用いた。各測定は術後3ヵ月に実施した。身体活動量と各因子との関連性を検討した。【結果】身体活動量は2,809.7±1,999.2歩であった。身体活動量は非術側膝伸展筋力，5 m最大歩行速度，歩行SEおよび階段SEと有意な相関を認めた。【結論】TKA患者の退院後における身体活動量は極めて低く，非術側膝伸展筋力，移動能力および身体活動SEを高めることが重要であることが示唆された。<br>

<p>【はじめに，目的】</p><p></p><p>膝痛高齢者の代表的な疾患である膝OAは外来リハビリテーションにおいて運動療法が実施され，一定の効果が得られている。しかし，膝痛高齢者は，破局思考や医療行動，不活動など不適切な痛み対処方法を選択することが多く，有効性が示されている運動療法の継続を妨げる。この課題に対して，近年では膝痛高齢者に認知行動療法を取り入れた痛み対処スキルトレーニング（PCST）が実施され，膝痛軽減，身体機能向上，膝痛の自己管理に関連する痛み対処方略や痛みセルフ・エフィカシーの改善が報告されている。しかしながら，これらの先行研究は全て諸外国によるものであり，わが国でのPCSTによる介入効果は明らかにされていない。そこで，本研究では外来リハビリテーションで運動療法を実施している膝痛高齢者に個別でのPCSTをおこない，その効果を明らかにすることとした。</p><p></p><p></p><p>【方法】</p><p></p><p>対象は膝OAの診断を受け，外来リハビリテーションに通院する高齢者で採択基準（3ヵ月以上続く膝痛，VAS30mm以上，K-L分類2以上）を満たし，除外基準（認知症が疑われる者，膝関節の手術予定者，膝関節の手術施行者，移動手段が車椅子の者，膝痛や認知行動療法に関する教室への参加経験者）に該当しない25名（男性4名，女性21名）とした。対象者の介入には医師およびPTが対象者の希望を踏まえて健康状態が両群で均等になるように，個別でのPCSTを実施するPCST群13名，健康講話を個別にて実施する健康教育群12名に振り分けた。介入は週1回8週，約20分の介入をそれぞれ実施した。調査項目は基本属性にBMI，痛み持続期間，教育歴，居住人数，現病歴，既往歴，合併症，K-L分類を調査した。効果判定に痛みの程度及び痛みによる活動制限，痛み対処方略，痛みセルフ・エフィカシー，運動セルフ・エフィカシー，下肢筋力，移動能力，3軸加速度計Active style pro（オムロン社，日本）を使用して身体活動量を調査した。解析では介入前後の2群の変化量の差異を共分散分析にて解析した。なお，共変量に性別，年齢，介入前データを設定し，介入中断者を含めたIntent-to-treat解析を用いた。</p><p></p><p></p><p>【結果】</p><p></p><p>対象者の平均年齢はPCST群で75.1±7.1歳，健康教育群で75.7歳±5.9歳であった。また，全ての基本属性において両群に有意な差異は認められなかった。また，ベースライン値においては，PCST群の破滅思考が健康教育群と比較して有意に高かった（p=0.041）。介入前後でPCST群が健康教育群と比較して有意に改善した項目は痛みセルフ・エフィカシー（p=0.005），運動セルフ・エフィカシー（p=0.042），5回立ち上がりテスト（p=0.004），TUG-t（p=0.027）であった。また，有意な改善傾向が認められた項目は痛みの対処方略の下位尺度である医薬行動（p=0.073），中高強度の身体活動量（p=0.052）であった。</p><p></p><p></p><p>【結論】</p><p></p><p>PCSTは一般的に用いる健康教育より，痛み自己管理能力，身体機能，中高強度身体活動に有効である可能性を示した。</p>

<p>【はじめに，目的】</p><p></p><p>人工膝関節全置換術（TKA）は健康関連QOL（HRQOL）を向上し，術後3ケ月または術後6ケ月時点で著明に改善することが報告されているが，本邦での報告は少ない。運動や身体活動に関するセルフ・エフィカシー（SE）はHRQOLに関係するとされている。しかしながらTKA患者の身体活動SE及びHRQOLの回復過程やHRQOLに影響を及ぼす因子について明らかにされていない。本研究の目的はTKA患者の理学療法介入終了後の身体活動SE及びHRQOLの回復過程を把握し，HRQOLに影響を及ぼす因子について検討した。</p><p></p><p></p><p>【方法】</p><p></p><p>対象は2009年8月から2016年4月までに当院で理学療法を実施した初回片側TKA患者84例84膝，手術時年齢は73.1±7.7歳，BMI26.3±4.2 kg/m²，術後在院日数25.4±6.7日でした。評価は術前，術後3ヶ月と6ヶ月とした。</p><p></p><p>膝の痛みと機能は準WOMAC，身体活動SEは虚弱高齢者の身体活動SE尺度（歩行，階段，重量物）を用いた。HRQOLの評価はSF-36v2の下位8尺度である身体機能，日常役割機能－身体，体の痛み，全体的健康感，活力，社会生活機能，日常役割機能－精神，心の健康を国民標準値に基づいたスコアリングで算出した。また身体的サマリースコア（PCS）と精神的サマリースコア（MCS）と役割/社会的サマリースコア（RCS）を用いた。</p><p></p><p>統計解析は回復過程を一元配置分散分析とBonferroni多重比較，HRQOLに影響を及ぼす因子をステップワイズ法による重回帰分析を行った。統計解析はSPSSver.19.0を用いて，有意水準は5%とした。</p><p></p><p></p><p>【結果】</p><p></p><p>各項目は術前（T1）→術後3ヶ月（T2）→術後6ヶ月（T3）の順に平均値±標準偏差で示した。</p><p></p><p>準WOMACの機能は59.5±20.2→78.4±15.0→79.8±15.2点で，T1と比較してT2とT3で，T2と比較してT3で有意に改善した。歩行SEは12.4±5.0→14.9±6.4→15.9±5.3点，階段SEは9.2±4.6→12.6±5.2→12.9±5.3点，重量物SEは15.8±6.3→18.5±5.7→18.7±5.4点となり，T1と比較してT2とT3で有意に向上した。</p><p></p><p>SF-36v2における下位8尺度は全尺度において，T1と比較してT2とT3で有意に改善した。PCSは19.6±11.9→30.3±12.1→30.8±11.9点でT1と比較してT2とT3で有意に改善した。MCSは55.1±10.8→57.0±9.2→56.0±9.0点で有意差はなかった。RCSは34.2±15.1→36.4±14.4→39.9±11.9点でT1と比較してT3で有意に改善した。</p><p></p><p>重回帰分析の結果，術後6ケ月時点のHRQOLにおいてPCSは準WOMACの機能（β＝0.625），MCSは重量物SE（β＝0.370），RCSは歩行SE（β＝0.424）が影響を及ぼす因子として抽出された。</p><p></p><p></p><p>【結論】</p><p></p><p>TKA患者の身体活動SEとHRQOLは術後3ケ月で有意に改善し，術後6ケ月まで維持されていた。HRQOLに影響を及ぼす因子として機能と身体活動SEが重要であることが示唆された。しかしながらPCSとRCSが術前と比較して有意に改善しているものの国民標準値と比較して低値であることから，HRQOLに関する理学療法介入の余地があるのではないかと考えられる。</p>

<p>Objectives The present study investigated articles on cancer prevention published in Japanese newspapers in 2011.</p><p>Methods A content analysis of news coverage on cancer primary prevention and screening was conducted. Articles which mentioned cancer risk, prevention, and screening were extracted. For all articles on prevention, the newspaper's name, month of publication, and information source were checked. Coding variables for articles on primary prevention included causes of human cancer, risk and/or prevention, and recommended screening criteria. Cancer screening articles were classified according to four coding variables: cancer screening site, subjects for screening, examination interval, and whether to promote the screening.</p><p>Results A total of 272 articles were identified and subsequently coded as either articles on primary prevention or screening. The number of articles on primary prevention was 208. The focus of these articles was mostly on food/nutrition (n=56), cancer-causing infection (n=40), and smoking (n=32). Alcohol drinking (n=12), exercise/physical activity (n=11), and obesity (n=10), which are also major lifestyle factors for cancer, were rarely mentioned. Moreover, cancer risk was more frequently mentioned than prevention. The recommended criteria for major lifestyle factors were mentioned in 13 articles. Screening was mentioned in 92 articles. Breast cancer screening was the most frequently mentioned (n=31). The screening of colon (n=18), cervical (n=18)，stomach (n=15), and lung cancer (n=10), which are recommended by the cancer control act, were mentioned in less than 20 articles. Seven articles on screening indicated subjects and interval. Only 39 articles discussed cancer-screening behaviors.</p><p>Conclusions Articles on cancer prevention were found to be published in Japanese newspapers. However, the number of articles on both primary prevention and screening was not enough, and there were some disparities in the lifestyle factors and specific type of screening that were mentioned in these articles. Considering the influence of newspapers as a source of information on cancer prevention, it is necessary to encourage publishers to increase the number of published articles on cancer primary prevention and screening in Japanese newspapers.</p>

<p>Background: Good quality measures of Japanese adults' sedentary behaviors are needed to accurately assess correlates of specific sedentary behaviors. The present study assessed criterion validity of total sedentary behavior and test-retest reliability of six domain-specific sedentary behaviors.</p><p>Methods: We administered a questionnaire, based on previous studies, that measured domain-specific sedentary behaviors. To examine validity, agreement between self-reported time spent in sedentary behaviors from the questionnaire and objectively-measured sedentary time using accelerometers was compared among 392 adults (aged 40–64 years) in two Japanese cities. For reliability, a 2-week interval test-retest was administered to a convenience sample of 34 participants.</p><p>Results: The correlation between total self-reported and objectively measured sedentary time was significant (all P < 0.001) and fair-to-good for workdays (ρ = 0.57) and whole week (ρ = 0.49), but was low for non-workdays (ρ = 0.23). The difference between the two measures was significant for whole week (z = −2.25, P = 0.03) and non-workdays (z = −5.50, P < 0.001), but was not significant for workdays (z = −0.60, P = 0.55). There was a significant positive association between the difference in the two measures and the average of these two measures (workdays: r = 0.53; non-workdays: r = 0.45; and whole week: r = 0.54, all P < 0.001). There was fair-to-good test-retest reliability of total sedentary time for each domain (workdays: interclass correlation coefficient [ICC] = 0.77, non-workdays: ICC = 0.53, and whole week: ICC = 0.7; all P < 0.01).</p><p>Conclusions: The scale of domain-specific sedentary behaviors is reliable for estimating where and for what purpose Japanese adults spend their sedentary time, and total sedentary time is valid for workdays and the whole week.</p>

Background: This study examined associations of perceived and objectively measured neighborhood environmental attributes with leisure-time sitting for transport among middle-to-older aged Japanese adults. Method: Data were collected using a postal survey of 998 adults aged 40 to 69 years. Generalized linear modeling with a gamma distribution and a log link was used to examine associations of perceived (International Physical Activity Questionnaire-Environmental module) and Geographic Information Systems (GIS)-derived built environment attributes with self-reported leisure-time sitting for transport. Results: Mean leisure-time sitting time for transport was 20.4 min/day. After adjusting for potential confounders, perceived higher residential density, GIS-measured higher population density, better access to destinations, better access to public transport, longer sidewalk length, and higher street connectivity, were associated significantly with lower sitting time for transport. Conclusion: Residents living in neighborhoods with attributes previously found to be associated with more walking tended to spend less time sitting for transport during leisure-time. The health benefits of walkability-related attributes may accrue not only through increased physical activity, but also through less sedentary time.

Little information exists on the relation between respiratory muscle strength such as maximum inspiratory muscle pressure (MIP) and sarcopenia in elderly cardiac patients. The present study aimed to determine the differences in MIP, and cutoff values for MIP according to sarcopenia in elderly cardiac patients.
We enrolled 63 consecutive elderly male patients aged aeyen65 years with cardiac disease in this cross-sectional study. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People algorithm, and, accordingly, the patients were divided into two groups: the sarcopenia group (n = 24) and non-sarcopenia group (n = 39). The prevalence of sarcopenia in cardiac patients and MIP in the patients with and without sarcopenia were assessed to determine cutoff values of MIP.
After adjustment for body mass index, the MIP in the sarcopenia group was significantly lower than that in the non-sarcopenia group (54.7 +/- A 36.8 cmH(2)O; 95 % CI 42.5-72.6 vs. 80.7 +/- A 34.7 cmH(2)O; 95 % CI 69.5-92.0; F = 4.89, p = 0.029). A receiver-operating characteristic curve analysis of patients with and without sarcopenia identified a cutoff value for MIP of 55.6 cmH(2)O, with a sensitivity of 0.76, 1-specificity of 0.37, and AUC of 0.70 (95 % CI 0.56-0.83; p = 0.01) in the study patients.
Compared with elderly cardiac patients without sarcopenia, MIP in those with sarcopenia may be negatively affected. The MIP cutoff value reported here may be a useful minimum target value for identifying elderly male cardiac patients with sarcopenia.

Background: There is little information on the association of sarcopenia with physical activity in elderly cardiac patients. This study determined differences in physical activity and cutoff values for physical activity according to the presence or absence of sarcopenia in elderly male cardiac patients.
Methods and results: Sixty-seven consecutive men aged &gt;= 65 years with cardiac disease were enrolled. We defined sarcopenia using the European Working Group on Sarcopenia in Older People algorithm. Patients were divided into the sarcopenia group (n = 25) and the non-sarcopenia group (n = 42). In the patients with and without sarcopenia of physical activities were evaluated to determine cutoff values of physical activity.
Results: After adjusting for patient characteristics, both the average daily number of steps (3361.43 +/- 793.23 vs. 5991.55 +/- 583.57 steps, P = 0.021) and the average daily energy expenditure of physical activity (71.84 +/- 22.19 vs. 154.57 +/- 16.18 kcal, P = 0.009) were significantly lower in the sarcopenia versus non-sarcopenia group. Receiver-operating characteristic analysis identified a cutoff value for steps of physical activity of 3551.80 steps/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.44 and a cutoff value for energy expenditure of physical activity of 85.17 kcal/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.27.
Conclusions: Physical activity in the male cardiac patients with sarcopenia was significantly lower than that in those without sarcopenia. The cutoff values reported here may be useful values to aid in the identification of elderly male cardiac patients with sarcopenia. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Data on the effect of increased or decreased physical activity on children's psychological status are scarce, and effect sizes are small. This study conducted two-year longitudinal research to identify associations between physical activity, sedentary behavior, and psychological well-being in Japanese school children through a mail survey completed by 292 children aged 6-12 years. Data on sociodemographics, physical activity, sedentary behavior on weekdays and the weekend, and psychometrics (self-efficacy, anxiety, and behavioral/emotional problems) were collected using a self-reported questionnaire. A logistic regression analysis was performed, calculating odds ratios for physical activity, psychometrics, and baseline age and physical activity and sedentary behavior changes. For boys, a negative association was found between increased physical activity outside school and maintained or improved self-efficacy as opposed to a positive association in girls. Increased sedentary behavior on weekdays and long periods of sedentary behavior on weekends were associated with maintained or improved behavioral/emotional problems in girls only. This two-year longitudinal study is the first of its kind conducted in Japan. Although effect sizes were small, these results may nevertheless assist in intervention development to promote psychological well-being.

目的:地域在住高齢者における腰痛の強度別の有訴率,腰痛の強度と抑うつ症状の関連,運動習慣が腰痛と抑うつ症状の関連に与える影響を横断的に明らかにすること。方法:千葉県松戸市の住民基本台帳より無作為抽出した65歳から84歳の高齢者3,000名に対して郵送法による質問紙調査を実施し,1,051名より有効回答を得た。調査内容は,腰痛の強度,抑うつ症状,運動習慣,人口学的・社会経済的属性,生活習慣,現病歴だった。腰痛の強度と抑うつ症状の関連および腰痛と運動習慣の抑うつ症状への複合的な関連を検討するため,多重ロジスティック回帰分析を行った。結果:腰痛の有訴率は47.7%(軽度:35.2%,中程度:10.0%,強度:2.5%)だった。腰痛がない者を参照群とすると,軽度の腰痛を有する者(オッズ比(OR)=1.85,95%信頼区間(95%CI):1.23-2.79),中程度以上の腰痛を有する者(OR=2.03,95%CI:1.15-3.58)は,抑うつ症状の増加と有意に関連していた。腰痛の強度と運動習慣の複合的な関連を検討した結果,腰痛なし・運動習慣あり群を参照群とすると,軽度の腰痛あり・運動習慣なし群(OR=2.85,95%CI:1.63-4.98),中程度以上の腰痛あり・運動習慣なし群(OR=2.92,95%CI:1.42-6.00)は,抑うつ症状を有することと有意に関連していた。結論:地域在住高齢者の約半数は腰痛を抱えており,その4分の1は中程度以上の腰痛を有していた。また,腰痛の強度と抑うつ症状に有意な正の関連が認められた。更に,運動習慣がない群は,ある群よりも,腰痛の強度と抑うつ症状との関連が強くなる傾向があった。(著者抄録)

Problem Statement: Many youths participate in school-based extracurricular sports activities (SBECSA). These SBECSAs contribute to positive youth development. However, SBECSAs sometimes require the outsourcing of human resources. The major reason is difficulty to manage SBECSAs by employing teachers as the primary coaching resources. Using external coaches is an effective solution for reducing the workload on teachers, and it can contribute to improving teachers’ and students’ knowledge and skills. Because teacher involvement also appears to provide benefits for students, cooperative coaching between external coaches and teachers is essential. However, the lack of evidence regarding the benefits that cooperative coaching offers students may result in inadequate cooperation. Approach: In all, 23 students who participated in SBECSAs were recruited from three junior high schools and three high schools that employed external coaches. An open-ended, semi-structured interview was conducted with each student. The KJ method was used for qualitative analysis of the responses. Purpose: The purpose of this study is to determine how external coaches and teachers impact students’ experiences in SBECSAs, and how external coaches and teachers differ and/or have similar impacts. Results: In terms of benefits from external coaches, six categories and 31 subcategories were identified. The major categories included the following: expert coaching
support for SBECSA teacher
general coaching
human network
improved SBECSA atmosphere
and equipment supply. Benefits from teachers comprised six categories and 22 subcategories. The major categories identified were as follows: general coaching
management and office work
participation in SBECSA
human network
connection with school life
and improved SBECSA atmosphere. Conclusions: Students perceived overlapping and specific benefits from both groups, which indicated that cooperative coaching would be more desirable to students than having only external coaches or teacher instruct their SBECSAs.

Associations between levels of sedentary behavior and depressive symptoms independently and in combination with different levels of physical activity remain unclear.
This study aimed to examine independent and combined associations of physical activity (PA) and sedentary behavior (SB) with depressive symptoms among Japanese adults.
An Internet-based survey collected data on depression levels (Center for Epidemiologic Studies Depression Scale), self-reported time spent in PA and SB (Japanese short version of the International Physical Activity Questionnaire), and sociodemographic variables from 2,914 adults in 2009. Binary logistic regression analyses were conducted to examine the odds ratios (ORs) for being depressed (depression scores a parts per thousand yen16) according to independent PA levels (none, insufficient, sufficient), SB levels (low, moderate, high), and nine combinations of PA and SB categories.
After adjusting for potential confounders, sufficient PA level was found to be related to lower risk of depressive symptoms independently (OR = 0.61), whereas no significant associations were observed between SB levels and depression. In the combined associations, adults in the sufficient PA/high SB (OR = 0.44), sufficient PA/moderate SB (OR = 0.56), and sufficient PA/low SB (OR = 0.57) categories were significantly less likely to have depressive symptoms in comparison with the no PA/high SB category.
Meeting physical activity recommendations is associated with a lower risk of depressive symptoms, regardless of time spent in total sedentary behavior. These results suggest that promoting physical activity may be an effective strategy against depressive symptoms among Japanese adults.

Background: In the rapidly developing use of the Internet in society, eHealth literacy-having the skills to utilize health information on the Internet-has become an important prerequisite for promoting healthy behavior. However, little is known about whether eHealth literacy is associated with health behavior in a representative sample of adult Internet users.
Objective: The aim of this study was to examine the association between eHealth literacy and general health behavior (cigarette smoking, physical exercise, alcohol consumption, sleeping hours, eating breakfast, eating between meals, and balanced nutrition) among adult Internet users in Japan.
Methods: The participants were recruited among registrants of a Japanese Internet research service company and asked to answer a cross-sectional Internet-based survey in 2012. The potential respondents (N= 10,178) were randomly and blindly invited via email from the registrants in accordance with the set sample size and other attributes. eHealth literacy was assessed using the Japanese version of the eHealth Literacy Scale. The self-reported health behaviors investigated included never smoking cigarettes, physical exercise, alcohol consumption, sleeping hours, eating breakfast, not eating between meals, and balanced nutrition. We obtained details of sociodemographic attributes (sex, age, marital status, educational attainment, and household income level) and frequency of conducting Internet searches. To determine the association of each health behavior with eHealth literacy, we performed a logistic regression analysis; we adjusted for sociodemographic attributes and frequency of Internet searching as well as for other health behaviors that were statistically significant with respect to eHealth literacy in univariate analyses.
Results: We analyzed the data of 2115 adults (response rate: 24.04%, 2142/10,178; male: 49.74%, 1052/2115; age: mean 39.7, SD 10.9 years) who responded to the survey. Logistic regression analysis showed that individuals with high eHealth literacy were significantly more likely to exhibit the good health behaviors of physical exercise (adjusted odds ratio [AOR] 1.377, 95% CI 1.131-1.678) and eating a balanced diet (AOR 1.572, 95% CI 1.274-1.940) than individuals with low eHealth literacy.
Conclusions: We found that some health behaviors, including exercise and balanced nutrition, were independently associated with eHealth literacy among Japanese adult Internet users.

Purpose
Both moderate-to-vigorous physical activity (MVPA) and sedentary behavior can be associated with adult adiposity. Much of the relevant evidence is from cross-sectional studies or from prospective studies with relevant exposure measures at a single time point before weight gain or incident obesity. This study examined whether changes in MVPA and television (TV) viewing time are associated with subsequent changes in waist circumference, using data from three separate observation points in a large population-based prospective study of Australian adults.
Methods
Data were obtained from the Australian Diabetes, Obesity, and Lifestyle study collected in 1999-2000 (baseline), 2004-2005 (wave 2), and 2011-2012 (wave 3). The study sample consisted of adults age 25 to 74 yr at baseline who also attended site measurement at three time points (n = 3261). Multilevel linear regression analysis examined associations of initial 5-yr changes in MVPA and TV viewing time (from baseline to wave 2) with 12-yr change in waist circumference (from baseline to wave 3), adjusting for well-known confounders.
Results
As categorical predictors, increases in MVPA significantly attenuated increases in waist circumference (P for trend &lt; 0.001). TV viewing time change was not significantly associated with changes in waist circumference (P for trend = 0.06). Combined categories of MVPA and TV viewing time changes were predictive of waist circumference increases; compared with those who increased MVPA and reduced TV viewing time, those who reduced MVPA and increased TV viewing time had a 2-cm greater increase in waist circumference (P = 0.001).
Conclusion
Decreasing MVPA emerged as a significant predictor of increases in waist circumference. Increasing TV viewing time was also influential, but its impact was much weaker than MVPA.

The promotion of strength training is now recognized as an important component of public health initiatives for older adults. To develop successful communication strategies to increase strength-training behavior among older adults, the identification of effective communication channels to reach older adults is necessary. This study aimed to identify the information sources about strength training that were associated with strength-training behaviors among Japanese older adults. The participants were 1144 adults (60-74 years old) randomly sampled from the registry of residential addresses. A cross-sectional questionnaire survey was conducted. The independent variables were sources of strength-training information (healthcare providers, friends, families, radio, television, newspapers, newsletters, posters, books, magazines, booklets, the Internet, lectures, other sources), and the dependent variable was regular strength-training behavior. Logistic regression analysis was used to identify potential relationships. After adjusting for demographic factors and all other information sources, strength-training information from healthcare providers, friends, books and the Internet were positively related to regular strength-training behavior. The findings of the present study contribute to a better understanding of strength-training behavior and the means of successful communication directed at increasing strength training among older adults. The results suggest that healthcare providers, friends, books and the Internet are effective methods of communication for increasing strength-training behaviors among older adults.

【はじめに，目的】地域在住高齢者における足部痛に関連する能力障害（Disabling Foot Pain；DFP）の発生を効果的に予防する方法を明らかにするため，地域在住高齢者が実施する足部自己管理行動とDFP発生状況を分析したので報告する。【方法】地域在住高齢者346名（男性215名，女性131名，第1次調査時平均年齢（S.D.）は74.03（5.21）歳）を対象とした。第1次調査は郵送自記式質問紙調査を行い，人口統計学的指標，生活習慣（飲酒・喫煙・運動習慣），足部痛・DFPの有無（日本語版Manchester Foot Pain and Disability Index；以下MFPDI-Jにより判定），足部自己管理行動に関する項目（「毎日足の状態を観察していますか」等7項目），履き物の選択行動に関する項目（「踵がしっかりとした靴を履いていますか」等靴の種類に関する9項目と「試着をして履き心地を確認していますか」等選択行動に関する4項目）について尋ねた。第1次調査の8か月後に第2次調査として対面自記式質問紙調査を実施し，足部痛・DFPの有無（MFPDI-J）を尋ねた。第1次調査と第2次調査の回答から，DFPなし群，DFP発生群，DFP改善群，DFP持続群の4群に分類し，各群の足部自己管理行動に関する項目の実施数，履き物選択行動に関する項目の実施数について一元配置分散分析を行った。さらに第1次調査時にDFPがなかった271名を抽出し第2次調査時のDFPの有無を従属変数，第1次調査時の足部自己管理行動に関する項目，履き物選択行動に関する項目，運動習慣の有無を独立変数として，多重ロジスティック回帰分析を行った。【結果】DFP発生状況は，DFPなし群244名（70.5%），発生群27名（7.8%），改善群46名（13.3%），持続群25名（13.3%）であった。一元配置分散分析では足部自己管理行動の実施数において有意な差を認め（F=5.86，p＜.01），多重比較の結果，DFP持続群はDFPなし群に比べて足部自己管理行動の実施数が有意に高かった（DFP持続群平均3.79に対しDFPなし群2.14，p＜.01）。多重ロジスティック回帰分析の結果は，履物選択行動に関する項目のうち「デザインや価格以外の要素を考慮して靴を選んでいる」（Odds ratio 2.94，95%CI 1.08-7.97）と「日常的な運動習慣がある」（Odds ratio 0.33，95%CI 0.14-0.80）が有意にDFPの発生に関連した（p＜.05）。【結語】第1次調査時にDFPがあり8か月後にも持続する者の足部自己管理行動の実施数がむしろ多く，足部自己管理行動の実施数はDFP発生・改善に単純には影響しないことがわかった。一方，第1次調査時にDFPがない対象者のみの分析では，足部自己管理行動の実施数や履物選択行動の実施数はDFPの発生に有意な関連はなく，履物の選択時に履物の外観や価格以外の要素を考慮することと日常的に運動習慣があることがDFPの発生を有意に抑制できる可能性が示唆された。履物選択時に考慮するべき内容や習慣化するべき運動内容の仔細は本研究では明らかとならないため，今後の調査・分析の課題とする。

【はじめに，目的】人工膝関節全置換術（TKA）は疼痛や身体機能を改善し，生活の質を高めるために行われる。しかしながら手術前から膝の痛みや身体機能の低下が生じ，健常者よりも身体活動量が低下しており，TKA後も身体活動量は低いといわれている。TKA患者においても三次予防を目的とした身体活動の向上に対する取り組みが重要である。これまでにTKA患者の身体活動量についての報告は散見されるが，TKA患者の退院後における身体活動量とその関連要因については明らかではない。そこで本研究ではTKA患者の身体活動量を調査し，その影響を及ぼす因子について検討した。【方法】対象は変形性膝関節症により初回TKAを施行し，退院後も外来リハビリテーションを実施した患者50例57膝とした。両側例は手術間隔を3ヵ月以上空けて実施した。手術時年齢は73.9±6.2歳，BMI26.1±3.8 kg/m²，術後在院日数25.2±9.6日で，外来リハビリテーションを週1回の頻度で術後3カ月間継続した。その際，自主トレーニングの指導と身体活動量を向上するように促した。身体活動量を歩数と定義し，計測には活動量計AM-120（タニタ社製，カロリズム）を連続7日間装着し平均歩数を算出した。身体機能評価はTimed up and go test（TUG），開眼片脚起立時間，30秒椅子立ち上がりテスト，5m最大歩行速度，膝伸展筋力を測定した。Western Ontario and McMaster Universities OA Index（WOMAC）を用いて，膝関節の痛みと機能について評価した。自己効力感の評価として，虚弱高齢者の身体活動セルフ・エフィカシー（SE）尺度（歩行，階段，重量物）を用いた。各測定は術後3ヵ月に実施した。統計解析は，身体活動量と各検討項目との関連性をSpearmanの順位相関計数にて分析した。さらに身体活動量と相関のあった各因子を独立変数，身体活動量を従属変数としてステップワイズ法による重回帰分析を行った。統計解析はSPSS ver.19.0を用いて有意水準は5%とした。【結果】TKA患者の退院後ににおける身体活動量は2886.5±1847.2歩であった。身体活動量とTUG（r＝-0.264，p＜0.05），術側開眼片脚起立時間（r＝0.312，p＜0.05），非術側開眼片脚起立時間（r＝0.339，p＜0.01），術側膝伸展筋力（r＝0.306，p＜0.05），非術側膝伸展筋力（r＝0.299，p＜0.05），5m最大歩行速度（r＝-0.471，p＜0.01），歩行SE（r＝0.465，p＜0.01），階段SE（r＝0.340，p＜0.05）との間に有意な相関を示した。重回帰分析の結果，身体活動量の影響因子として術側膝伸展筋力（β＝0.416，p＜0.01）と歩行SE（β=0.321，p＜0.01）が抽出された（R＝0.549）。【結論】TKA患者の退院後における身体活動量は極めて低く，その影響因子として身体機能では術側膝伸展筋力と心理的要因として歩行SEが重要であることが示唆された。TKA患者の身体活動量を向上させるためには膝伸展筋力強化のための筋力トレーニングに加え，歩行に関する自己効力感を高める方策が必要であることが示唆された。

【はじめに，目的】外務省海外在留邦人数の調査報告によると，海外で生活している（3か月以上海外に在留）日本人は増加傾向にある（外務省領事局政策課平成27年度要約版）。世界地域別の邦人数は，北米に次いでアジア地域で多い（37万9,498人，約29％）。アジア地域の中でも，マレーシアは，邦人のロングステイ先として，2006年から2013年にかけて世界第一となっている。近年，長時間の座位行動は，肥満，糖尿病，心疾患など種々の健康アウトカムに影響することが示されている（Biswas, et al., 2015）。しかし，海外在留邦人のライフスタイル，とくに座位行動の実態およびその関連要因に関する研究は極めて少ない。本研究の目的は，海外在留邦人における座位行動時間の実態とその関連要因について明らかにすることである。【方法】対象は，マレーシア，ペラ州都イポー市に在留している20歳以上の邦人70人である。70人に対し，現地ボランティアの協力による自記式質問紙の横断調査が実施された。座位行動時間の評価は，生活場面別座位行動尺度（石井ら2015）を用いた。我々は，平日および休日それぞれ6項目（移動2項目・仕事1項目・余暇3項目）の生活場面別座位行動時間の総計より1日あたりの総座位行動時間（分）を算出した。また，社会人口統計学的関連要因は，年齢，性，教育歴，婚姻状況，Body Mass Index（BMI），就労状況について調査した。統計学的手法には，マン・ホイットニーのU検定およびSpearmanの順位和相関係数が用いられた。統計学的有意差判定の基準は5%未満である。【結果】対象者の属性は，年齢57.8歳，男性62.9％，教育歴（＞12年）47.7％，既婚者90.1％，BMI22.5kg/m²，就労者38.6％であった。1日あたりの総座位行動時間は411.3分であった。総座位行動時間は，男性（P＜0.01）と就労者（P＜0.01）で高値を，既婚者（P=0.03）で低値を示した。また，年齢と総座位行動時間には負の相関関係（r=-0.41，P＜0.001）を認めた。【結論】海外在留邦人における1日あたりの総座位行動時間は411.3分であった。また，それに関連する社会人口統計学的要因として，年齢，性，婚姻状況，就労状況等が示された。

<p> 運動部活動は我が国の青少年にとって重要なスポーツ環境であるが、その指導・運営を担う顧問の負担が大きいことが報告されている。顧問の負担軽減のため、部活動指導手当の増額や外部指導者の活用などが検討されているものの、今一歩踏み込んだ議論がなされていないのが現状である。その理由のひとつに、顧問が担っている役割や業務の内容が不明瞭なことが挙げられる。適正な手当や外部指導者との役割分担を議論するには、業務内容を明確化する必要がある。そのため、本研究では運動部活動の指導・運営に関連する顧問の負担を定量化することを目的とした。本研究では、公立の中学校または高等学校の運動部活動顧問672名を対象に郵送法による質問紙調査を行い、運動部活動の指導・運営に関連する時間的・精神的・金銭的負担について回答を得た。その結果、顧問は年間に平均で1400時間程度を指導・運営に費やし、13万円程度の金額を自己負担していることが明らかになった。顧問は実際に練習に参加する時間のほか、多くの時間をマネジメント業務に費やしていた。また、多くの時間を費やしている業務内容が、必ずしも精神的負担も大きいわけではないことが示唆された。</p>

【目的】本研究は人工膝関節全置換術（TKA）患者の退院時における身体活動量の実態を調査し，その関連要因について検討した。【方法】対象はTKA患者で両側手術例1例を含む44例とした。身体活動量は活動量計AM-120（タニタ社製，カロリズム）を装着して，退院前の連続7日間の平均歩数を計測した。身体機能はTimed up and go test（TUG），開眼片脚起立時間，30秒椅子立ち上がりテスト，膝伸展筋力および5 m最大歩行速度を測定した。膝関節の痛みと機能はWestern Ontario and McMaster Universities Osteoarthritis Indexに準じた日本語版を用いた。Spearman の順位相関係数と各身体機能を独立変数，身体活動量を従属変数として重回帰分析を行った。【結果】TKA患者の退院時における身体活動量は2256.5±1576.7歩であった。身体活動量とTUG，術側膝伸展筋力，30秒椅子立ち上がりテストおよび5 m最大歩行速度との間に有意な相関を示した。重回帰分析の結果，身体活動量の関連要因としてTUGが抽出された（β＝－0.415，p＜0.01）。【結論】TKA 患者の退院時における身体活動量は極めて低く，身体活動量の関連要因として移動能力が重要であることが示された。

Background: Physical activity levels in childhood have decreased, making the promotion of children's physical activity an important issue. The present study examined gender and grade differences in objectively measured sedentary behavior, physical activity, and physical activity guideline attainment among Japanese children and adolescents.
Methods: In total, 329 boys and 362 girls age 3-15 years completed the survey. School grade, gender, height, and weight were collected by questionnaires and physical activity objectively measured using an accelerometer (Lifecorder Suzuken Co.). Physical activity level (in MET) was classified as sedentary (&lt;1.5), light (&gt;= 1.5 to &lt;3), moderate (&gt;= 3 to &lt;6), or vigorous (&gt;= 6). Continuous zero accelerometer counts for &gt;= 20 min were censored and a valid accelerometry study required at least 3 days (2 weekdays and 1 weekend day) with &gt;600 min/day total wear time. Two-way analysis of covariance and logistic regression analyses, adjusted for weight status and accelerometer wear time, were used to examine gender and grade differences in physical activity variables and the likelihood of physical activity guideline attainment by gender and grade level.
Results: Participants were sedentary 441.4 (SD, 140.1) min/day or 53.7 % of the average daily accelerometer wear time of 811.2 (118.7) min, engaged in light physical activity 307.1 (70.0) min or 38.4 % of wear time, moderate physical activity 34.6 (14.8) min (4.3 %), vigorous physical activity 28.3 (19.1) min (3.6 %), and took 12462.6 (4452.5) steps/day. Boys were more physically active and took more steps/day than girls. Students in higher grades were less active than those in lower grades. Boys were significantly more likely to meet physical activity guidelines than girls (OR: 2.07, 95 % CI: 1.45-2.96). Preschoolers (6.66, 4.01-11.06), lower-grade elementary school students (17.11, 8.80-33.27), and higher-grade elementary school students (7.49, 4.71-11.92) were more likely to meet guidelines than junior high school students.
Conclusions: Boys and lower-grade students engaged in more physical activity and were more likely to attain guidelines than girls and higher-grade students. These findings highlight the need for effective and sustainable strategies to promote physical activity in Japanese school children.

Purpose Environmental initiatives to support walking are keys to noncommunicable disease prevention, but the relevant evidence comes mainly from cross-sectional studies. We examined neighborhood environmental attributes associated cross-sectionally with walking and those associated prospectively with walking maintenance. Methods Data were from the Australian Diabetes, Obesity and Lifestyle study collected in 2004-2005 (baseline) and in 2011-2012 (follow-up). Participants who did not move residence during the study period (n = 2684, age range: 30-77 yr at baseline) were categorized as regular walkers (walked five times per week or more) or not at baseline. Regular walkers were divided into those who stopped and those who maintained regular walking at follow-up. Regression analyses examined relationships of regular walking and walking maintenance with perceived attributes of neighborhood destinations and pedestrian environments. Results Regular walking at baseline was significantly associated with availability of shops (odds ratio [OR] = 1.13, 95% confidence interval [CI] = 1.04-1.22), many alternative routes (OR = 1.12, 95% CI = 1.01-1.23), park or nature reserve (OR = 1.13, 95% CI = 1.02-1.26), bicycle or walking tracks (OR = 1.08, 95% CI = 1.00-1.17), and feeling safe to walk (OR = 1.18, 95% CI = 1.01-1.38). Maintenance of regular walking was associated with the availability of multiple alternative routes (OR = 1.19, 95% CI = 1.03-1.38). Having many alternative routes and walking tracks was associated with walking maintenance among those who were not or had stopped working. Conclusions Neighborhood destinations (shops and parks) and pedestrian environments (alternative routes, walking trails, and safety from crime) were found to be associated with regular walking, but only pedestrian environment attributes were found to be related to the maintenance of regular walking. Further evidence from prospective studies is required to identify other neighborhood environmental attributes that might support walking maintenance.

Purpose: Environmental initiatives to support walking are keys to noncommunicable disease prevention, but the relevant evidence comes mainly from cross-sectional studies. We examined neighborhood environmental attributes associated cross-sectionally with walking and those associated prospectively with walking maintenance. Methods: Data were from the Australian Diabetes, Obesity and Lifestyle study collected in 2004-2005 (baseline) and in 2011-2012 (follow-up). Participants who did not move residence during the study period (n = 2684, age range: 30-77 yr at baseline) were categorized as regular walkers (walked five times per week or more) or not at baseline. Regular walkers were divided into those who stopped and those who maintained regular walking at follow-up. Regression analyses examined relationships of regular walking and walking maintenance with perceived attributes of neighborhood destinations and pedestrian environments. Results: Regular walking at baseline was significantly associated with availability of shops (odds ratio [OR] = 1.13, 95% confidence interval [CI] = 1.04-1.22), many alternative routes (OR = 1.12, 95% CI = 1.01-1.23), park or nature reserve (OR = 1.13, 95% CI = 1.02-1.26), bicycle or walking tracks (OR = 1.08, 95% CI = 1.00-1.17), and feeling safe to walk (OR = 1.18, 95% CI = 1.01-1.38). Maintenance of regular walking was associated with the availability of multiple alternative routes (OR = 1.19, 95% CI = 1.03-1.38). Having many alternative routes and walking tracks was associated with walking maintenance among those who were not or had stopped working. Conclusions: Neighborhood destinations (shops and parks) and pedestrian environments (alternative routes, walking trails, and safety from crime) were found to be associated with regular walking, but only pedestrian environment attributes were found to be related to the maintenance of regular walking. Further evidence from prospective studies is required to identify other neighborhood environmental attributes that might support walking maintenance.

Background: There has been a growing interest in environmental initiatives to reduce sedentary behaviour. A few existing studies on this topic are mostly cross-sectional, focused on the general adult population, and examining neighbourhood walkability. This study examined associations of perceived environmental attributes with change in TV viewing time over seven years among older Australian adults in the Australian Diabetes, Obesity and Lifestyle (AusDiab) study.
Methods: The AusDiab study is a population-based study on diabetes and its risk factors in adults. We used the data on 1072 older adults (60+ years at baseline) collected in 2004-05 (baseline) and in 2011-12 (follow-up; 45.4% men, mean age 67.5 years). Generalized linear modelling examined associations with 7 years change in TV viewing time of nine perceived neighbourhood-environment attributes relating to local shops, alternative routes, footpaths, parks, attractiveness, natural features, bicycle/walkway tracks, local traffic, and safety.
Results: On average, participants increased their TV viewing time from 127 min/day to 137 min/day over the 7 years period. Adjusted for baseline TV viewing levels, TV viewing time at follow-up was 8% lower (95%CI: 0.85, 0.99) among those who did not perceive local traffic as a deterrent compared to those who perceived traffic as a deterrent. A trend for significant interaction between working status and the presence of a parks nearby indicated that, for those who were not working, those who reported having parks nearby had a marginal association with lower TV viewing time at follow-up than those who did not (p = 0.048).
Conclusions: Overall TV viewing time increased on average by 10 minutes/day over 7 years among older Australian adults. Local traffic that makes walking difficult or unpleasant may increase older adults' leisure-time sedentary behaviours such as TV viewing, possibly by deterring outdoor activities.

Background Little is known about differences in the risk of poor nutritional status as assessed by the Geriatric Nutritional Risk Index (GNRI) in relation to physical performance in elderly female cardiac inpatients. The present study aimed to determine both differences in physical performance based on the GNRI and physical performance cut-off values according to the GNRI in elderly female cardiac inpatients.
Methods We enrolled 105 consecutive female Japanese inpatients aged a parts per thousand yen65 years (mean age, 74.6 years) with cardiac disease in this cross-sectional study. We divided the patients into two groups according to GNRI: high-GNRI group (a parts per thousand yen92 points) (n = 71) and low-GNRI group (&lt; 92 points) (n = 34). Handgrip strength (HG), knee extensor muscle strength (KEMS), gait speed (GS), and one-leg standing time (OLST) were assessed as indices of hospital physical performance and compared between the two groups to determine cut-off values of physical performance.
Results After adjustment for age and left ventricular ejection fraction, HG, KEMS, GS, and OLST were significantly lower in the low-GNRI versus high-GNRI group. Cut-off values by ROC curve analysis were 16.2 kgf (AUC = 0.66; p &lt; 0.001) for HG, 34.3 % of body weight (AUC = 0.62; p = 0.04) for KEMS, 1.24 m/s (AUC = 0.72; p &lt; 0.01) for GS, and 8.28 s (AUC = 0.62; p = 0.04) for OLST.
Conclusions The risk of poor nutrition, as indicated by a low GNRI, might be a predictor of lower physical performance. Cut-off values determined in this study might be minimum target goals for physical performance that can be attained by elderly female cardiac inpatients.

Maximum gait speed and physical activity (PA) relate to mortality and morbidity, but little is known about gender-related differences in these factors in elderly hospitalized cardiac inpatients. This study aimed to determine differences in maximum gait speed and daily measured PA based on sex and the relationship between these measures in elderly cardiac inpatients. A consecutive 268 elderly Japanese cardiac inpatients (mean age, 73.3 years) were enrolled and divided by sex into female (n=75, 28%) and male (n=193, 72%) groups. Patient characteristics and maximum gait speed, average step count, and PA energy expenditure (PAEE) in kilocalorie per day for 2 days assessed by accelerometer were compared between groups. Gait speed correlated positively with in-hospital PA measured by average daily step count (r=0.46, P&lt
0.001) and average daily PAEE (r=0.47, P&lt
0.001) in all patients. After adjustment for left ventricular ejection fraction, step counts and PAEE were significantly lower in females than males (2651.35±1889.92 vs 4037.33±1866.81 steps, P&lt
0.001
52.74±51.98 vs 99.33±51.40 kcal, P&lt
0.001), respectively. Maximum gait speed was slower and PA lower in elderly female versus male inpatients. Minimum gait speed and step count values in this study might be minimum target values for elderly male and female Japanese cardiac inpatients.

Background: Providing information about cancer prevention might increase awareness of prevention and promote preventive behaviours. A better understanding about the prevalence and preferences of obtaining information about cancer might help to identify targeted individuals and design effective strategies for promoting cancer-preventive behaviours. Thus, the present study examined the prevalence and correlates of obtaining information about cancer among Japanese adults, and described preferences including source and content.
Methods: Data were analysed for 3,058 Japanese adults (mean age 45.0 +/- 13.4 years) who responded to an Internet-based cross-sectional survey. The data included whether information about cancer had been obtained, sources, preference for content, sociodemographic variables, health status, and cancer histories. Force-entry logistic regression analysis was used.
Results: Overall, 46.7% of respondents had obtained information about cancer. Gender, age, and education level were statistically significant correlates of doing so. Women were more likely to obtain information (OR = 1.97) as were older age groups (40-49: OR = 1.54, 50-59: OR = 2.27, 60-69: OR = 3.83), those with higher education (2 years college or equivalent degree: OR = 1.31, college graduate or higher: OR = 1.48) and those with having cancer histories (personal: OR = 3.52, family: OR = 1.57, friends/co-worker: OR = 2.09). The most prevalent source of information about cancer was mass media. Content of prevention is most needed among inconsistent contents with the frequently obtained contents.
Conclusions: Less than half of the respondents information about cancer. The finding suggests that better health communication strategies would be necessary to inform Japanese people about cancer. Understanding which subgroups were less likely to obtain information and preferences of information might be effective in promoting cancer prevention.

AimNutrition is the focus of a new treatment target in older hospitalized cardiac patients. However, little is known about the differences in nutritional status in relation to physical performance in these inpatients. We determined the differences in physical performance based on the Geriatric Nutritional Risk Index (GNRI) and physical performance cut-off values according to the GNRI in older male cardiac inpatients.
MethodsWe enrolled 251 Japanese male inpatients aged 65 years (mean age 74.7 years) with cardiac disease in the present cross-sectional study. We divided the patients into two groups according to GNRI: high-GNRI group (92 points; n=178) and low-GNRI group (&lt;92 points; n=73). In-hospital physical performance as measured by handgrip strength (HG), knee extensor muscle strength (KEMS), gait speed (GS), and one-leg standing time (OLST) was assessed and compared between the two groups to determine cut-off values of physical performance.
ResultsAfter adjustment for age, HG, KEMS, GS and OLST were significantly lower in the low-GNRI versus high-GNRI group. Cut-off values by receiver operating characteristic curve analysis were 25.75kgf (area under the curve [AUC]=0.740; P&lt;0.001) for HG strength, 46.1% for bodyweight (AUC=0.742; P&lt;0.01) for KEMS, 1.45m/s (AUC=0.782; P&lt;0.01) for GS and 11.32s (AUC=0.705; P&lt;0.01) for OLST.
ConclusionThe risk of poor nutrition, as shown by a low GNRI, could be a useful predictor of physical performance. The cut-off values determined in the present study might be expected minimum target values that can be attained by Japanese older male cardiac inpatients. Geriatr Gerontol Int 2015; 15 189-195.

The newspaper is a primary source of cancer information for the public, and newspaper articles could provide effective and comprehensible information about cancer prevention. Content analyses of cancer news coverage contribute to understanding the effect of newspaper coverage on public knowledge and behavior. The current study reviewed previous comprehensive content analyses. The news coverage was not balanced with regard to the population incidence and mortality of each cancer. Lack of balance may contribute to distortion in readers’ perceptions of cancer risk. In addition, newspaper articles rarely mentioned cancer prevention behaviors, although there was a positive association between news coverage and individuals knowledge of cancer prevention. The cancer stories in newspapers are affected by the social, existential, and religious characteristics of a country
the themes of cancer stories differ according to country. However, no study has used comprehensive content analysis to investigate cancer news coverage in Japan. Thus, comprehensive analysis of cancer story content in Japanese newspapers should be conducted to assess the value these stories have in delivering accurate information to the public.

Knee pain is one of the common symptoms experienced by elderly people. Knee pain problem is a complex issue which contains physical and psychological aspects. For example, knee pain is associated with muscle weakness, mobility limitation, cognitive difficulties, behavioral abnormalities, and emotional upheavals. Recently, non-pharmacological treatment (e.g., exercise therapy, cognitive behavioral therapy) to improve physical and psychological outcomes has been used to cope with knee pain. The aim of this review is to introduce the key studies on non-pharmacological treatment for knee pain. Some studies showed that exercise therapy was effective for alleviating knee pain and improving physical function and that cognitive behavioral therapy improved psychological parameters. Moreover, combined exercise and cognitive behavioral therapy intervention may be more effective for pain management elderly people with knee pain than non-combined therapy. However there is a lack of evidence indicating the efficacy of such combined intervention, further research is needed.

Summary: There is increasing evidence that psychological factors (e.g., pain coping strategies) play an important role in older adults' adjustment to musculoskeletal pain. Therefore, interest in the use of cognitive behavioral therapy (e.g., pain coping skills training) to help older adults manage musculoskeletal pain is growing. In the present article, the first section reviewed the background on the necessary of cognitive behavioral therapy for managing musculoskeletal pain. The second section highlighted five techniques mainly used in pain coping skills training for musculoskeletal pain: cognitive restructuring, relaxation, distraction, pleasant activity scheduling, and activity-rest cycling. The third section introduced two printed materials newly developed for pain coping skills training and exercise therapy among older Japanese with knee pain. The final section of the present paper discussed important future directions for working within this research area. The present review revealed that it is important to apply the cognitive behavioral therapy (pain coping skills training) in management of musculoskeletal pain.

School-based extracurricular sports activities are beneficial for positive youth development. However, there is a shortage of appropriate in-school coaches, and therefore recruitment of external coaches has been considered as one solution to this. A previous study has reported 4 model strategies of organizational promotion to recruit external coaches. These 4 models included "compensational support", "staff introduction", "delivery of collegiate students", and "cooperation with company". In order to promote the further development and popularization of these organizational trials, user-side evaluation is necessary. Therefore, the purpose of the present study was to clarify the strengths and problems related to these 4 organizational promotion strategy models when recruiting external coaches for school-based extracurricular sports activities from the viewpoint of teachers. The participants were 12 teachers who worked in public junior high or high schools. All of them had experience of coaching school-based extracurricular sports activities. Face-to-face semi-structured interviews were conducted with the individual participants, and all interview data were transcribed. Then, similar meaning units were grouped into themes with respect to the 4 models, strengths and problems. As a result, many specific themes for each model emerged. For instance, with regard to "compensational support", monetary support was regarded as a strength, although the early application period was a problem. With regard to "staff introduction", adequacy for beginners was a strength, but lack of mediation organization was a problem. With regard to "delivery of collegiate students", regular coaching was seen as a strength, but worry over not choosing a delivered external coach was a problem. With regard to "cooperation with company", high coaching skill was a strength, but an expensive coaching fee was a problem. Additionally, comprehensive opinions about all the models were reported, such as lack of information about the system and the need for educational coaching. These similarities and differences in the results indicated the importance of mediation system design considering the regionality and situation of the school-based extracurricular sports activity. Effective publicity and re-examination of financial manager is also needed. In addition, mediation organization and teachers should arrange previous meetings with external coaches to understand their human qualities and educational attitude. Furthermore, it would be valuable to develop the quality of external coaches through previous training or workshops. Finally, changes in the application period for each mediation system are suggested.<br>

Objective: The present study was conducted to examine the effects of providing equipment for use during school recess on elementary school children's physical activity.<br>Methods: In this cross-sectional study, 98 fifth-grade children (63 boys) from two elementary schools were assigned to an intervention group (n = 39) or a control group (n = 59). The intervention group received equipment such as volleyballs and oval balls. The children's physical activity was measured using accelerometry before and three months after receiving the equipment. Evaluated indicators were time spent engaging in sedentary, light, moderate, and vigorous physical activity during break, lunch recess, and the entire school day. Analysis of covariance—with sex, body mass index, and physical activity level prior to receipt of the equipment as covariates—was performed to examine the differences between two groups with respect to physical activity after receiving the equipment.<br>Results: During break, lunch recess, and the entire school day, data were collected from 23, 25, and 18 children in the intervention group. In the control group, it was done from 41, 42, and 37 children, respectively. During break and lunch recess, the intervention group was less likely to engage in sedentary behavior (p = 0.01, p < 0.01) and more likely to engage in light physical activity (p < 0.01, p < 0.01) than the control group. Regarding vigorous physical activity during break, the intervention group was less likely to engage in vigorous physical activity (p = 0.02). During the entire school day, the intervention group was more likely to engage in moderate physical activity (p = 0.03) than the control group.<br>Conclusion: The availability of equipment for use during recess was associated with high levels of physical activity.

Outdoor education contributes to positive youth development. Existing outdoor education in Japan has been conducted only in an "episodic" manner with a "single activity" basis in "imitation nature", although regular and various activities in "grand nature" have been considered more valuable for the growth of children. Therefore, the purposes of the present study were to develop and practice an outdoor education program that performed a "plural number" of experiences with "multiple activities" in "genuine nature", and to clarify the availability of the program. For this purpose, the "Buddy Kids Adventure Challenge Program" was developed on the basis of 12 years of practice with the "Buddy Adventure Team (Non-Profit Organization)". An inventory survey was conducted for 49 participants in the Buddy Kids Adventure Challenge Program and 26 participants′ parents to evaluate the program in 2013. Free descriptive answers for the questions with respect to experiences in the program were descriptively analyzed and a model of the growth of the participants in the Buddy Kids Adventure Challenge Program was generated. As results, self-esteem was increased by developing competence. Additionally, outdoor activities in the program and flow experience were associated. Strong relationship between adverse circumstances and flow experience were also demonstrated. The growth model of the present study showed that desiring pleasure in "grand nature" could allow participants to confront adverse circumstances. These adverse circumstances give participants flow experience and confidence by helping them to overcome adverse circumstances. Finally, self-esteem was increased and growth of participants was enhanced.

School-based extracurricular sports activities are beneficial for positive youth development. However, there is a shortage of appropriate in-school coaches, and therefore recruitment of external coaches has been considered as one solution to this. A previous study has reported four model strategies of organizational promotion to recruit external coaches. These four models included "compensational support", "staff introduction", "delivery of collegiate students", and "cooperation with company". In order to promote the further development and popularization of these organizational trials, user-side evaluation is necessary. Therefore, the purpose of the present study was to clarify the strengths and problems related to these four organizational promotion strategy models when recruiting external coaches for school-based extracurricular sports activities from the viewpoint of teachers. The participants were 12 teachers who worked in public junior high or high schools. All of them had experience of coaching school-based extracurricular sports activities. Face-to-face semi-structured interviews were conducted with the individual participants, and all interview data were transcribed. Then, similar meaning units were grouped into themes with respect to the four models, strengths and problems. As a result, many specific themes for each model emerged. For instance, with regard to "compensational support", monetary support was regarded as a strength, although the early application period was a problem. With regard to "staff introduction", adequacy for beginners was a strength, but lack of mediation organization was a problem. With regard to "delivery of collegiate students", regular coaching was seen as a strength, but worry over not choosing a delivered external coach was a problem. With regard to "cooperation with company", high coaching skill was a strength, but an expensive coaching fee was a problem. Additionally, comprehensive opinions about all the models were reported, such as lack of information about the system and the need for educational coaching. These similarities and differences in the results indicated the importance of mediation system design considering the regionality and situation of the school-based extracurricular sports activity. Effective publicity and re-examination of financial manager is also needed. In addition, mediation organization and teachers should arrange previous meetings with external coaches to understand their human qualities and educational attitude. Furthermore, it would be valuable to develop the quality of external coaches through previous training or workshops. Finally, changes in the application period for each mediation system are suggested.<br>

Use of external coaches for school-based extracurricular sports activities has been promoted because of the lack of teachers who can coach expertly and the large burden placed on teachers when coaching and managing such activities. However, it has been reported that securing external coaches through human resources is difficult. To promote the use of external coaches, previous studies have suggested some possible strategies: 1) clarifying the role and status of external coaches, and promoting cooperative coaching with external coaches and teachers; 2) interactive collection and provision of information about external coaches and schools, and improving recognition of the mediation system; 3) improving the way external coaches are recruited, and setting a suitable trial period; 4) moderating institutional limitations for coaching frequency and number of coaches; and 5) holding workshops for external coaches. However, these suggestions were made from only an individual viewpoint (i.e. that of teachers, external coaches, and potential external coaches), and did not consider organizational perspectives. In Japan, there are some organizations that help recruitment of external coaches for school-based extracurricular sports activities. It is necessary to consider the opinions of these organizations to develop more realistic and concrete promotion strategies. Therefore, the present study explored in detail the trials, problems, challenges, and strategies of organizations in order to promote the recruitment of external coaches for school-based extracurricular sports activities. Face to face semi-structured interviews were conducted involving 15 individuals in 11 organizations (2 national and 4 prefectural organizations, 3 schools, 1 university, and 1 company) supporting the recruitment of external coaches for school-based extracurricular sports activities. The interviews contained questions asking details of the recruitment system, problems, challenges and management strategies. All interviews were audio-recorded with agreement from the participants. The transcript data were integrated into 7 trials and their details, problems, challenges, and strategies were described. The results indicated that in order to promote the engagement of external coaches, a number of factors were important, including building human relationships between external coaches and teachers led by teachers that could share information, interactive collection and provision of information through mediator and cooperation with other organizations, collecting information about external coaches and interviewing them before formal acceptance, keeping the coaching non-compensatory, holding workshops and creating feedback to promote communication and learning of external coaches, and considering the continuity of the trial. Knowledge of the various problems, challenges, and strategies from an organizational perspective would contribute to improvement of recruitment strategy. The results of the present study could also provide information that is beneficial for other organizations wishing to conduct similar trials.<br>

In competitive sports, the enhancing of physical abilities, technical skills, and psychological states is vital for excelling in competition. A team' s psychological wellbeing is often the deciding factor in team sport success. Nevertheless, few efficient strategies have been made for boosting teams' psychological states, particularly during matches. Therefore, the aim of this study was to investigate practitioners' perceptions of Enjin (forming a circle) strategies used to enhance a team' s psychological acuity during matches. In addition, motivations to initiate Enjin strategies, content, and changes observed after implementing these strategies were emphasized. The study was conducted following three steps. First, a women' s collegiate basketball team' s Enjin strategies were observed and recorded during an official match. Second, a team coach and four players were interviewed concerning these strategies, after viewing a recording of the match. The participants were requested to provide (1) motivations to implement Enjin strategies; (2) Enjin content; and (3) changes experienced after implementing Enjin strategies. Third, the study results were analyzed following the KJ method. The analysis revealed seven motivations, including "routine," "desire to enhance team cohesion," and "foul play." In addition, four types of Enjin content were identified, including "encouragement," "information on tactics," "apologizing," and "battle cries." Subsequently, eleven changes, including "enhanced team cohesion" , "shared perspectives among team members," and "improved excitement levels," were identified. It was inferred that Enjin strategies enhanced the teams' psychological states, based on these results. However, additional studies involving several teams, games, events, and genders are required to complement these results.

The purpose of this cross-sectional study is to investigate the difference in physical activity among elderly living in different areas in Japan ("Bunkyo Ward in Tokyo" (Bunkyo) and "Fuchu City in Tokyo" (Fuchu) as urban areas, and "Oyama Town in Shizuoka" (Oyama) as a non-urban area). Participants were 1859 community-dwelling residents aged 65-74 years, randomly selected from the residential registry (response rate: 68.9%). A mail survey using self-administered questionnaires was conducted. Multivariate logistic regression analyses were used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) of various types of physical activity (eg, walking (Walking), going out (Going-out), bicycling (Bicycling), exercise habits (Exercise)), according to residential areas (reference category: Fuchu), stratified by gender, adjusting for socio-demographic variables. There was a significant difference in Going-out (ORs = 0.61 (95% CI: 0.44-0.86) for men, 0.48 (0.33-0.69) for women)), and Bicycling (0.04 (0.03-0.07) for men, 0.04 (0.02-0.07) for women) in Oyama compared to Fuchu. Furthermore, for women, there was a significant difference in Walking (0.56 (0.38-0.81)) and Exercise (0.59 (0.41-0.85)) in Oyama compared to Fuchu. There was a significant difference in Bicycling and Going-out for men in Bunkyo compared to Fuchu, but there was not a significant difference in other items. Low physical activity levels were observed in the elderly in the non-urban area compared to urban areas. The association was stronger in women. Regional difference might need to be taken into account for an effective physical activity intervention.

Use of external coaches for school-based extracurricular sports activities has been promoted because of the lack of teachers who can coach expertly and the large burden placed on teachers when coaching and managing such activities. However, it has been reported that securing external coaches through human resources is difficult. To promote the use of external coaches, previous studies have suggested some possible strategies: 1) clarifying the role and status of external coaches, and promoting cooperative coaching with external coaches and teachers; 2) interactive collection and provision of information about external coaches and schools, and improving recognition of the mediation system; 3) improving the way external coaches are recruited, and setting a suitable trial period; 4) moderating institutional limitations for coaching frequency and number of coaches; and 5) holding workshops for external coaches. However, these suggestions were made from only an individual viewpoint (i.e. that of teachers, external coaches, and potential external coaches), and did not consider organizational perspectives. In Japan, there are some organizations that help recruitment of external coaches for school-based extracurricular sports activities. It is necessary to consider the opinions of these organizations to develop more realistic and concrete promotion strategies. Therefore, the present study explored in detail the trials, problems, challenges, and strategies of organizations in order to promote the recruitment of external coaches for school-based extracurricular sports activities. Face to face semi-structured interviews were conducted involving 15 individuals in 11 organizations (2 national and 4 prefectural organizations, 3 schools, 1 university, and 1 company) supporting the recruitment of external coaches for school-based extracurricular sports activities. The interviews contained questions asking details of the recruitment system, problems, challenges and management strategies. All interviews were audio-recorded with agreement from the participants. The transcript data were integrated into 7 trials and their details, problems, challenges, and strategies were described. The results indicated that in order to promote the engagement of external coaches, a number of factors were important, including building human relationships between external coaches and teachers led by teachers that could share information, interactive collection and provision of information through mediator and cooperation with other organizations, collecting information about external coaches and interviewing them before formal acceptance, keeping the coaching non-compensatory, holding workshops and creating feedback to promote communication and learning of external coaches, and considering the continuity of the trial. Knowledge of the various problems, challenges, and strategies from an organizational perspective would contribute to improvement of recruitment strategy. The results of the present study could also provide information that is beneficial for other organizations wishing to conduct similar trials.<br>

目的:本研究の目的は休み時間に用具を提供することによる小学校児童の身体活動への効果を検討することである.方法:介入校(n=39)及び統制校(n=59)の各1校の小学校に在籍する5年生合計98名(男子63名)を対象とし介入研究を行った.介入校にはバレーボールや楕円球などのボールを用具として提供した.身体活動の測定には加速度計を用い,用具提供前とその3ヵ月後に測定を行った.業間休み,昼休み,平日1日の座位行動,低強度身体活動,中等度身体活動,高強度身体活動を評価した.介入校と統制校における用具提供3ヵ月後の身体活動の差を検討するため,性,BMI,用具提供前の身体活動を共変量とした共分散分析を行った.結果:分析対象者は,介入群では業間休みが23名(男子13名),昼休みが25名(15名),1日全体では18名(男子10名),統制群は業間休みが41名(男子28名),昼休みが42名(29名),1日全体では37名(男子26名)であった.業間の休み時間において,介入群は統制群と比較し,有意に座位行動[F(1,62)=7.70;p=0.01]及び高強度身体活動の割合[F(1,62)=6.31;p=0.02]が低く,低強度身体活動の割合[F(1,62)=28.73;p<0.01]が高かった.昼休みでは,介入群は座位行動の割合[F(1,65)=18.36;p<0.01]が低く低強度身体活動の割合[F(1,65)=17.11;p<0.01]が有意に高かった.また,1日全体では介入群の方が統制群よりも有意に中等度身体活動の実施割合[F(1,53)=5.06;p=0.03]が高かった.結論:休み時間に使用できる用具を提供することは,身体活動レベルの高さに影響を与えていた.本研究より,用具の提供は休み時間及び1日の身体活動促進に貢献することが示された.(著者抄録)

In competitive sports, the enhancing of physical abilities, technical skills, and psychological states is vital for excelling in competition. A team' s psychological wellbeing is often the deciding factor in team sport success. Nevertheless, few efficient strategies have been made for boosting teams' psychological states, particularly during matches. Therefore, the aim of this study was to investigate practitioners' perceptions of Enjin (forming a circle) strategies used to enhance a team' s psychological acuity during matches. In addition, motivations to initiate Enjin strategies, content, and changes observed after implementing these strategies were emphasized. The study was conducted following three steps. First, a women' s collegiate basketball team' s Enjin strategies were observed and recorded during an official match. Second, a team coach and four players were interviewed concerning these strategies, after viewing a recording of the match. The participants were requested to provide (1) motivations to implement Enjin strategies; (2) Enjin content; and (3) changes experienced after implementing Enjin strategies. Third, the study results were analyzed following the KJ method. The analysis revealed seven motivations, including "routine," "desire to enhance team cohesion," and "foul play." In addition, four types of Enjin content were identified, including "encouragement," "information on tactics," "apologizing," and "battle cries." Subsequently, eleven changes, including "enhanced team cohesion" , "shared perspectives among team members," and "improved excitement levels," were identified. It was inferred that Enjin strategies enhanced the teams' psychological states, based on these results. However, additional studies involving several teams, games, events, and genders are required to complement these results.

This study aimed to examine the association of muscle-strengthening activity with knee and low back pain, falls, and health-related quality of life among Japanese older adults. A cross-sectional survey targeted 3,000 people. The response rate was 52% and 208 respondents did not meet the inclusion criteria. Therefore, 1,351 individuals were analyzed. Muscle-strengthening activity (exercise using equipment and body weight, lifestyle activities), knee and low back pain, falls over the past year, health-related quality of life (SF-8), and potential confounders were assessed. Individuals engaging in exercise using body weight and lifestyle activity (&gt;= 2 days/week) were more likely to have knee pain. Engaging in exercise using equipment and body weight was associated with higher scores of general health. These results indicate that exercise using equipment and body weight might have a positive effect on health-related quality of life, but muscle-strengthening activities are associated with knee pain in older people.

This study aimed to determine the relation between the regression slope relating minute ventilation to carbon dioxide output (VE/VCO2 slope) and maximum phonation time (MPT), and the MPT required to attain a threshold value for VE/VCO2 slope of ≤34 in chronic heart failure (CHF) patients. This cross-sectional study enrolled 115 CHF patients (mean age, 54.5 years
men, 84.9%). VE/VCO2 slope was assessed during cardiopulmonary exercise testing (CPX). Thereafter, patients were divided into 2 groups according to exercise capacity: VE/VCO2 slope ≤34 (VE/VCO2 ≤34 group, n = 81) and VE/VCO2 slope &gt
34 (VE/VCO2 &gt
34 group, n = 34). For MPT measurements, all patients produced a sustained vowel/a:/ for as long as possible during respiratory effort from the seated position. All subjects showed significant negative correlation between VE/VCO2 slope and MPT (r = -0.51, P &lt
0.001). After adjustment for clinical characteristics, MPT was significantly higher in the VE/VCO2 ≤34 group vs VE/VCO2 &gt
34 group (21.4 ± 6.4 vs 17.4 ± 4.3 s, F = 7.4, P = 0.007). The appropriate MPT cut-off value for identifying a VE/VCO2 slope ≤34 was 18.12 seconds. An MPT value of 18.12 seconds may be a useful target value for identifying CHF patients with a VE/VCO2 slope ≤34 and for risk management in these patients.

This study aimed to determine the relation between the regression slope relating minute ventilation to carbon dioxide output ((V) over dotE/(V) over dotCO2 slope) and maximum phonation time (MPT), and the MPT required to attain a threshold value for (V) over dotE/(V) over dotCO2 slope of &lt;= 34 in chronic heart failure (CHF) patients.
This cross-sectional study enrolled 115 CHF patients (mean age, 54.5 years; men, 84.9%). (V) over dotE/(V) over dotCO2 slope was assessed during cardiopulmonary exercise testing (CPX). Thereafter, patients were divided into 2 groups according to exercise capacity: (V) over dotE/(V) over dotCO2 slope &lt;= 34 ((V) over dotE/(V) over dotCO2 &lt;= 34 group, n = 81) and (V) over dotE/(V) over dotCO2 slope &gt;34 ((V) over dotE/(V) over dotCO2 &gt;34 group, n = 34). For MPT measurements, all patients produced a sustained vowel/a:/for as long as possible during respiratory effort from the seated position.
All subjects showed significant negative correlation between (V) over dotE/(V) over dotCO2 slope and MPT (r = -0.51, P &lt; 0.001). After adjustment for clinical characteristics, MPT was significantly higher in the (V) over dotE/(V) over dotCO2 &lt;= 34 group vs (V) over dotE/(V) over dotCO2 &gt;34 group (21.4 +/- 6.4 vs 17.4 +/- 4.3 s, F = 7.4, P = 0.007). The appropriate MPT cut-off value for identifying a (V) over dotE/(V) over dotCO2 slope &lt;= 34 was 18.12 seconds.
An MPT value of 18.12 seconds may be a useful target value for identifying CHF patients with a (V) over dotE/(V) over dotCO2 slope &lt;= 34 and for risk management in these patients.

This study aimed to determine the relation between the regression slope relating minute ventilation to carbon dioxide output ((V) over dotE/(V) over dotCO2 slope) and maximum phonation time (MPT), and the MPT required to attain a threshold value for (V) over dotE/(V) over dotCO2 slope of &lt;= 34 in chronic heart failure (CHF) patients.
This cross-sectional study enrolled 115 CHF patients (mean age, 54.5 years; men, 84.9%). (V) over dotE/(V) over dotCO2 slope was assessed during cardiopulmonary exercise testing (CPX). Thereafter, patients were divided into 2 groups according to exercise capacity: (V) over dotE/(V) over dotCO2 slope &lt;= 34 ((V) over dotE/(V) over dotCO2 &lt;= 34 group, n = 81) and (V) over dotE/(V) over dotCO2 slope &gt;34 ((V) over dotE/(V) over dotCO2 &gt;34 group, n = 34). For MPT measurements, all patients produced a sustained vowel/a:/for as long as possible during respiratory effort from the seated position.
All subjects showed significant negative correlation between (V) over dotE/(V) over dotCO2 slope and MPT (r = -0.51, P &lt; 0.001). After adjustment for clinical characteristics, MPT was significantly higher in the (V) over dotE/(V) over dotCO2 &lt;= 34 group vs (V) over dotE/(V) over dotCO2 &gt;34 group (21.4 +/- 6.4 vs 17.4 +/- 4.3 s, F = 7.4, P = 0.007). The appropriate MPT cut-off value for identifying a (V) over dotE/(V) over dotCO2 slope &lt;= 34 was 18.12 seconds.
An MPT value of 18.12 seconds may be a useful target value for identifying CHF patients with a (V) over dotE/(V) over dotCO2 slope &lt;= 34 and for risk management in these patients.

Background Little is known about the differences in the geriatric nutritional risk index (GNRI) status in older patients and their relationship to accelerometer-derived measures of physical activity (PA) levels. We determined both differences in daily measured PA based on the GNRI and related cut-off values for PA in elderly cardiac inpatients.
Methods We divided 235 consecutive elderly cardiac inpatients (mean age 73.6 years, men 70.6 %) into four groups by age and GNRI: older-high group, 65-74 years with high GNRI (&gt;= 92 points) (n = 111); older-low group, low GNRI (&lt; 92 points) (n = 30); very old-high group, &gt;= 75 years with high GNRI (n = 55); and very old-low group with low GNRI (n = 39). Average step count and physical activity energy expenditure (PAEE in kcal) per day for 2 days of these inpatients were assessed by accelerometer and compared between the four groups to determine cut-off values of PA.
Results Step counts and PAEE were significantly lower in the low-GNRI versus high-GNRI groups in the older (2,742.1 vs. 4,198.1 steps, 55.4 vs. 101.3 kcal, P &lt; 0.001), and very old (2,469.6 vs. 3,423.7 steps, 54.5 vs. 79.1 kcal, P &lt; 0.001) cardiac inpatients. Respective cut-off values for step counts and PAEE were 3,017.6 steps/day and 69.4 kcal (P &lt; 0.01) in the older and 2,579.4 steps/day and 58.8 kcal in the very old cardiac inpatients (P &lt; 0.01).
Conclusion Poor nutritional status, as indicated by a low GNRI, may be a useful predictor of step counts and PAEE. The cut-off values determined in this study might be target values to be attained by older cardiac inpatients.

OBJECTIVE: Leisure-time sedentary behaviors (LTSBs) have been associated adversely with health outcomes. However, limited research has focused on different categories of LTSB. We aimed at identifying categories of LTSBs and examining their separate associations with indices of health among Japanese older adults. METHODS: A postal survey collected data on self-reported health, psychological distress, body mass index, moderate-to-vigorous physical activity (MVPA), LTSBs (five behaviors) and socio-demographic characteristics from 1,580 Japanese older adults (67% response rate; 65-74 years) in 2010. Exploratory factor analysis was used to classify LTSBs. Odds ratios (ORs) were calculated for associations of LTSB categories with self-reported health, psychological distress, overweight, and lower MVPA. Data were analyzed in 2013. RESULTS: Two categories of LTSB: passive sedentary time (consisting of TV time, listening or talking while sitting, and sitting around) and mentally-active sedentary time (consisting of computer-use and reading books or newspapers) were identified. Higher passive sedentary time was associated with a higher odds of being overweight (OR: 1.39, [95% CI: 1.08-1.80]), and lower MVPA (1.26, [1.02-1.54]). Higher mentally-active sedentary time was associated with lower odds of lower MVPA (0.70, [0.57-0.86]). CONCLUSIONS: Two types of sedentary time-passive and mentally-active-may play different roles in older adults' well-being.

Differences in recess physical activity (PA) according to perceived school environment among elementary school children were examined. Participants were 103 children from two schools in Japan. PA was measured using accelerometry for seven consecutive days. Time spent in sedentary or PA (light, moderate, or vigorous) during their morning recess (25 min) and lunch recess (15 min) was determined. The School Physical Activity Environment Scale (three factors: equipment, facility, and safety) was used to investigate perceived school environment. Environmental factor scores were assigned to low or high groups for each factor by median. An analysis of covariance, with grade as the covariate, was conducted separately by gender to examine differences in PA between two groups. During lunch recess, boys in the high-equipment group spent significantly more time in moderate PA (high: 1.5; low: 0.8 min) whereas girls in this group spent less time in light PA (9.3, 11.0). Boys in the high-facility group spent significantly less time in sedentary (2.3, 3.9) and more time in vigorous PA (2.4, 1.4) during lunch recess, and girls spent more time in moderate (2.1, 1.2) and vigorous PA (1.9, 1.3) during morning recess. Differences were observed in recess PA according to school environment perceptions. The present study may be useful for further intervention studies for the promotion of PA during recess.

Background: Although considerable evidence has demonstrated that physical activity is associated with breast cancer prevention, few studies have assessed the level of awareness of this association. Awareness is a key first step to successful of behavior change. Increasing awareness may contribute to promote physical activity and prevent breast cancer at the population level. The present study examined the prevalence and correlates of awareness about the role of physical activity in breast cancer prevention among Japanese women.
Methods: 1,000 Japanese women aged 20-69 years (mean age: 44.3 +/- 13.4 years) who responded to an internet-based cross-sectional survey. Awareness of the role of physical activity in breast cancer prevention, knowledge of breast cancer (symptom, risk factor, screening), exposure to information about physical activity and cancer, a self-reported physical activity, and sociodemographic variables (age, marital status, having a child, education level, employment status, and household income) were obtained. Force-entry logistic regression analysis was used.
Results: The prevalence of awareness was 31.5% (95% CI: 28.6-34.4). Factors significantly associated with awareness included sociodemographic variables, exposure to information, and knowledge of breast cancer. Being married (AOR, 95% CI: 1.75, 1.05-2.92) was positively related to awareness, while having children (0.65, 0.36-0.86) was negatively related. College graduates or those with higher levels of education (1.50, 1.01-2.22) were significantly more likely to be aware than those who had not graduated high school. Moreover, exposure to information (2.11, 1.51-2.95), and high knowledge of symptoms (2.43, 1.75-3.36) were positively associated with awareness. Finally, low knowledge of risk factors (0.30, 0.22-0.40) was negatively associated with awareness.
Conclusions: Japanese women through internet-based study were poorly aware of the role of physical activity in breast cancer prevention. Awareness was especially low among individuals with children and higher knowledge of risk factors whereas high in married women, those with higher educational level, exposure to information, and greater knowledge of symptoms. The findings suggest that strategies to increase the awareness about the preventive role of physical activity are needed for breast cancer prevention in consideration of subgroups with low awareness.

【はじめに，目的】地域在住高齢者における足部痛に関連する能力障害（Disabling Foot Pain；DFP）の発生を効果的に予防する方法を明らかにするため，地域在住高齢者が実施する足部自己管理行動とDFP発生状況を分析したので報告する。【方法】地域在住高齢者346名（男性215名，女性131名，第1次調査時平均年齢（S.D.）は74.03（5.21）歳）を対象とした。第1次調査は郵送自記式質問紙調査を行い，人口統計学的指標，生活習慣（飲酒・喫煙・運動習慣），足部痛・DFPの有無（日本語版Manchester Foot Pain and Disability Index；以下MFPDI-Jにより判定），足部自己管理行動に関する項目（「毎日足の状態を観察していますか」等7項目），履き物の選択行動に関する項目（「踵がしっかりとした靴を履いていますか」等靴の種類に関する9項目と「試着をして履き心地を確認していますか」等選択行動に関する4項目）について尋ねた。第1次調査の8か月後に第2次調査として対面自記式質問紙調査を実施し，足部痛・DFPの有無（MFPDI-J）を尋ねた。第1次調査と第2次調査の回答から，DFPなし群，DFP発生群，DFP改善群，DFP持続群の4群に分類し，各群の足部自己管理行動に関する項目の実施数，履き物選択行動に関する項目の実施数について一元配置分散分析を行った。さらに第1次調査時にDFPがなかった271名を抽出し第2次調査時のDFPの有無を従属変数，第1次調査時の足部自己管理行動に関する項目，履き物選択行動に関する項目，運動習慣の有無を独立変数として，多重ロジスティック回帰分析を行った。【結果】DFP発生状況は，DFPなし群244名（70.5%），発生群27名（7.8%），改善群46名（13.3%），持続群25名（13.3%）であった。一元配置分散分析では足部自己管理行動の実施数において有意な差を認め（F=5.86，p＜.01），多重比較の結果，DFP持続群はDFPなし群に比べて足部自己管理行動の実施数が有意に高かった（DFP持続群平均3.79に対しDFPなし群2.14，p＜.01）。多重ロジスティック回帰分析の結果は，履物選択行動に関する項目のうち「デザインや価格以外の要素を考慮して靴を選んでいる」（Odds ratio 2.94，95%CI 1.08-7.97）と「日常的な運動習慣がある」（Odds ratio 0.33，95%CI 0.14-0.80）が有意にDFPの発生に関連した（p＜.05）。【結語】第1次調査時にDFPがあり8か月後にも持続する者の足部自己管理行動の実施数がむしろ多く，足部自己管理行動の実施数はDFP発生・改善に単純には影響しないことがわかった。一方，第1次調査時にDFPがない対象者のみの分析では，足部自己管理行動の実施数や履物選択行動の実施数はDFPの発生に有意な関連はなく，履物の選択時に履物の外観や価格以外の要素を考慮することと日常的に運動習慣があることがDFPの発生を有意に抑制できる可能性が示唆された。履物選択時に考慮するべき内容や習慣化するべき運動内容の仔細は本研究では明らかとならないため，今後の調査・分析の課題とする。

Background: Although several studies have examined associations of perceived benefits and barriers with physical activity, no studies have focused on them corresponding to strength-training recommendations for older adults. This study examined the associations among the perceived health benefits of strength training, perceived barriers to strength straining, and stages of change for strength-training behavior in older Japanese adults. Methods: This cross-sectional survey included a random sample of 1144 adults (60-74 years) from the city of Tokorozawa. Stage of change was the independent variable, with perceived health benefits (eg, strength training can reduce body pain) and perceived barriers (eg, facilities are needed for strength training) as dependent variables. Data were analyzed by analysis of covariance and Bonferroni's multiple comparison. Results: After adjusting for demographic variables, the perceived health-benefit score for precontemplation was significantly lower than for the other four stages. The perceived barrier scores in the precontemplation and contemplation stages were significantly higher than those in the preparation and maintenance stages. Conclusions: These results suggest that information about the health benefits for older adults and about the recommended type of strength training might be useful for the development of strategies to promote strength training among older adults.

OBJECTIVES:Interviews were conducted with elderly people who had participated in the Care-Prevention Leadership Training Course (CPLTC), and had then established voluntary groups that practice care-prevention activities. This study examined the process and factors associated with the establishment of voluntary groups among subjects.;METHODS:The subjects were ten 62- to 76-year-old community-dwelling elderly in Tokyo who had taken the CPLTC. Data were obtained from 40- to 90-minute semi-structured interviews concerning the process of voluntary-group establishment. The data were then qualitatively analyzed using a modified grounded theory approach. Some of the concepts associated with the voluntary-group establishment were extracted, and organized into categories. These relationships were comparatively reviewed, and a figure for the results was constructed.;RESULTS:Subjects went through the following processes and feelings while establishing voluntary groups: "feelings that encourage participation in the local community," "opportunity for participation in the local community," "recognition of issues in the local community," "recognition of the importance of care prevention," "enhanced motivation for voluntary-group activities," and "recognition of requirements to establish a voluntary-group through its preparation." In addition, related factors were as follows; "past experience," "experience in the local community," "experience in CPLTC," "support in the local community," "support in CPLTC," "support in establishment of voluntary groups," and "feelings that promote or inhibit activities for the voluntary-group establishment." These processes were considered to be core concepts: "feelings and experiences that lead to participation in the local community," "deep understanding through experiences in the community and CPLTC," and "enhancement of motivation and skills for the activities through voluntary-group preparation.";CONCLUSION:The results showed that the community-dwelling elderly experienced gradual changes in their feelings, awareness, and related factors concerning their establishment of voluntary groups. The data showed that three points of view were important in those changes: "participation in the local community," "recognition of issues in the local community," and "enhanced motivation and skills for community activities." With transition-related factors taken into account, it is possible to effectively support elderly who are establishing voluntary groups by promoting involvement in the local community, holding courses, and providing preparatory support for group establishment.

There has been a growing interest in dog ownership and walking as a unique and potential resource to provide physical activity for many individuals in the community. The present study reviewed current trends regarding the studies on dog ownership, dog walking, and human health, and clarified the future direction of research on the topic. There is evidence to suggest that it is not dog ownership itself, but rather dog-walking that contributes to increased physical activity and the likelihood of meeting public health guidelines for physical activity. Also, a growing body of literature indicates that dogs appear to provide an important form of social support, motivation, and obligation that encourages dog owners to walk. Regarding the environmental and policy-related factors associated with dog walking, some literature showed that access to a dog-supportive park/area or living in a walkable neighborhood seems to positively affect dog owners walking with their dog. The evidence is still limited on interventions for promoting dog owners walking with their dog. With the high level of dog ownership in many industrialized countries, further evaluation of physical activity, including dog walking and use of an accelerometer, identification of factors related to dog owners' regular/irregular dog walking by means of a longitudinal study, and implementation of an intervention study related to the promotion of physical activity among dog owners with a focus on dog walking are needed.

Objective: The present study examined the prevalence and correlates of awareness about the role physical activity plays in colon cancer prevention among Japanese adults.Methods: Data were analyzed for 1,964 Japanese adults (aged 44.7 years) who responded to an internet-based cross-sectional survey. The survey was used to assess awareness of the role of physical activity in colon cancer prevention, knowledge of colon cancer, exposure to information about physical activity and cancer, a self-reported physical activity and sociodemographic variables (gender, age, marital status, education level, employment status, household income, and colon cancer history). A multivariate logistic regression analysis was used.Results: Overall, 47.5% of respondents were aware of the preventive role of physical activity on colon cancer. Respondents aged 60-69 (AOR, 95%CI: 0.59, 0.45-0.79) were significantly less likely to be aware than respondents aged 20-29 years, while those with college graduates or higher (1.32, 1.05-1.66) were more likely to be aware than those who had graduate junior high or high school. Moreover, exposure to information about cancer and physical activity (2.07, 1.71-2.51), and meeting physical activity recommendations (1.43, 1.12-1.84) were positively associated with the awareness.Conclusions: Awareness of the role of physical activity in colon cancer prevention was not sufficient. The finding suggests that strategies are needed for promoting awareness of the effect of physical activity in colon cancer prevention among Japanese adults, especially in consideration of age and education level.

Sedentary behavior, defined as participation in activities such as sitting and reclining during waking hours that do not increase energy expenditure substantially, has been gaining increased focus in physical activity research. In the last decade, sedentary behavior has emerged as a new risk factor for physical and mental health, independent of moderate to vigorous intensity physical activity. Especially, older adults spend most of their waking time in sedentary activities. Despite this high exposure, a broader base of evidence on sedentary behavior research in older adults has not yet been well reviewed. To inform future directions on sedentary behavior research among older adults, the present study provides the overview of the evidence from recently-published studies. This review includes evidence on the prevalence of objectively-measured and self-reported sedentary behaviors; the relationships with sedentary behavior (too much sitting) with multiple health outcomes; the effectiveness of interventions to reduce sedentary time and an overview of public health recommendations on reducing and breaking up sedentary time. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.

School-based extracurricular sports activity (SBECSA) is a beneficial activity for positive youth development. However, there are some problems regarding the management of SBECSA, such as the lack of SBECSA teachers who can coach expertly and the great burden for SBECSA teachers. Although the number of external coaches has not been sufficient, recruiting external coaches into SBECSA has been focused on to help resolve these issues. For further effective recruitment of external coaches, approaching the community residents who have motivation to be external coaches is important. Nevertheless, the sociodemographics associated with the motivation still have not been explored. Therefore, the purpose of the present study was to clarify the sociodemographics of community residents who have motivation to become involved in SBECSA as external coaches (potential external coaches) . An Internet-based cross-sectional survey was conducted by a social survey company with 19506 registrants aged 20-69 years. Stratified random sampling was continued till 100 potential external coaches were collected for both genders and every age group. Coaching motivation as an external coach and six sociodemographics (gender, age, occupational status, marital status, teaching credential, and coaching credential) were obtained. As a statistical analysis, logistic regression analysis was performed. Overall, 19239 participants were included in the analysis and 5.9% of them had coaching motivation. Potential external coaches were significantly less likely to be females (OR = 0.42) , people in their 30s (OR = 0.63) , 40s (OR = 0.40) , 50s (OR = 0.30) , 60s (OR = 0.24) than males and people in their 20s. In addition, workers (OR = 1.49) , students (OR = 1.52) , married people (OR = 1.32) , those who have teaching credentials (OR = 1.60) and coaching credentials (OR = 8.13) were more likely to be external coaches. In conclusion, the present study clarified the sociodemographics of potential external coaches. It is suggested in recruiting external coaches into SBECSA, providing promotion strategies which take these sociodemographic factors into account would be effective.

【目的】本研究は人工膝関節全置換術（TKA）患者の30秒椅子立ち上がりテスト（CS-30テスト）の経時的変化と痛みおよびその他の身体機能との関連性について検討した。【方法】対象はTKA患者33例39膝であった。検査項目はCS-30テスト，Timed Up and Go test（TUG），膝伸展筋力，開眼片脚起立時間，Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）の日本語版である準WOMACの膝関節の痛みおよび機能であり，各検査をTKAの術前，術後1ヵ月，術後3ヵ月の3回行った。【結果】CS-30テストは術前より術後3ヵ月，術後1ヵ月より術後3ヵ月で有意に改善した。術前のCS-30テストはTUG，術側および非術側の膝伸展筋力，術側および非術側の膝関節の痛みや機能と有意な相関を認めた。術後3ヵ月のCS-30テストはTUG，術側および非術側膝伸展筋力，術側および非術側開眼片脚起立時間，非術側膝関節の痛みおよび機能と有意な相関を示した。【結論】CS-30テストは術側だけでなく非術側の筋力や痛みなどの影響を受ける。TKA患者におけるCS-30テストは下肢筋力の指標になるだけでなく，痛みや身体機能も反映する有用な指標と考えられた。

Objectives Interviews were conducted with elderly people who had participated in the Care-Prevention Leadership Training Course (CPLTC), and had then established voluntary groups that practice care-prevention activities. This study examined the process and factors associated with the establishment of voluntary groups among subjects.<br/>Methods The subjects were ten 62- to 76-year-old community-dwelling elderly in Tokyo who had taken the CPLTC. Data were obtained from 40- to 90-minute semi-structured interviews concerning the process of voluntary-group establishment. The data were then qualitatively analyzed using a modified grounded theory approach. Some of the concepts associated with the voluntary-group establishment were extracted, and organized into categories. These relationships were comparatively reviewed, and a figure for the results was constructed.<br/>Results Subjects went through the following processes and feelings while establishing voluntary groups: "feelings that encourage participation in the local community," "opportunity for participation in the local community," "recognition of issues in the local community," "recognition of the importance of care prevention," "enhanced motivation for voluntary-group activities," and "recognition of requirements to establish a voluntary-group through its preparation." In addition, related factors were as follows; "past experience," "experience in the local community," "experience in CPLTC," "support in the local community," "support in CPLTC," "support in establishment of voluntary groups," and "feelings that promote or inhibit activities for the voluntary-group establishment." These processes were considered to be core concepts: "feelings and experiences that lead to participation in the local community," "deep understanding through experiences in the community and CPLTC," and "enhancement of motivation and skills for the activities through voluntary-group preparation."<br/>Conclusion The results showed that the community-dwelling elderly experienced gradual changes in their feelings, awareness, and related factors concerning their establishment of voluntary groups. The data showed that three points of view were important in those changes: "participation in the local community," "recognition of issues in the local community," and "enhanced motivation and skills for community activities." With transition-related factors taken into account, it is possible to effectively support elderly who are establishing voluntary groups by promoting involvement in the local community, holding courses, and providing preparatory support for group establishment.

School-based extracurricular sports activity (SBECSA) is a beneficial activity for positive youth development. However, there are some problems regarding the management of SBECSA, such as the lack of SBECSA teachers who can coach expertly and the great burden for SBECSA teachers. Although the number of external coaches has not been sufficient, recruiting external coaches into SBECSA has been focused on to help resolve these issues. For further effective recruitment of external coaches, approaching the community residents who have motivation to be external coaches is important. Nevertheless, the sociodemographics associated with the motivation still have not been explored. Therefore, the purpose of the present study was to clarify the sociodemographics of community residents who have motivation to become involved in SBECSA as external coaches (potential external coaches) . An Internet-based cross-sectional survey was conducted by a social survey company with 19506 registrants aged 20-69 years. Stratified random sampling was continued till 100 potential external coaches were collected for both genders and every age group. Coaching motivation as an external coach and six sociodemographics (gender, age, occupational status, marital status, teaching credential, and coaching credential) were obtained. As a statistical analysis, logistic regression analysis was performed. Overall, 19239 participants were included in the analysis and 5.9% of them had coaching motivation. Potential external coaches were significantly less likely to be females (OR = 0.42) , people in their 30s (OR = 0.63) , 40s (OR = 0.40) , 50s (OR = 0.30) , 60s (OR = 0.24) than males and people in their 20s. In addition, workers (OR = 1.49) , students (OR = 1.52) , married people (OR = 1.32) , those who have teaching credentials (OR = 1.60) and coaching credentials (OR = 8.13) were more likely to be external coaches. In conclusion, the present study clarified the sociodemographics of potential external coaches. It is suggested in recruiting external coaches into SBECSA, providing promotion strategies which take these sociodemographic factors into account would be effective.

Sedentary behavior, defined as participation in activities such as sitting and reclining during waking hours that do not increase energy expenditure substantially, has been gaining increased focus in physical activity research. In the last decade, sedentary behavior has emerged as a new risk factor for physical and mental health, independent of moderate to vigorous intensity physical activity. Especially, older adults spend most of their waking time in sedentary activities. Despite this high exposure, a broader base of evidence on sedentary behavior research in older adults has not yet been well reviewed. To inform future directions on sedentary behavior research among older adults, the present study provides the overview of the evidence from recently-published studies. This review includes evidence on the prevalence of objectively-measured and self-reported sedentary behaviors; the relationships with sedentary behavior (too much sitting) with multiple health outcomes; the effectiveness of interventions to reduce sedentary time and an overview of public health recommendations on reducing and breaking up sedentary time. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.

Purpose: Poor mental health (MH) is common in chronic heart failure (CHF) patients. No studies have reported a relation between MH status and objectively measured physical activity (PA) in CHF patients. The study aim was to determine self-reported MH-related differences associated with PA and target values of PA for improved MH in CHF outpatients. Methods: We divided 243 CHF outpatients (mean age 57.1 years) into two groups according to MH assessed by Short Form-36 score: high-MH (&gt;= 68 points) group (n = 148) and poor-MH (&lt;68 points) group (n = 95). Average step count (steps) and energy expenditure on PA (EE) (kcal) per day for 1 week of PA were assessed by an accelerometer and compared between groups. PA resulting in high MH was determined by the receiver-operating characteristic (ROC) analysis. Results: PA correlated positively with MH in all patients (steps: r = 0.46, p&lt;0.001; EE: r = 0.43, p&lt;0.001). After adjusting for patient characteristics, steps and EE were significantly lower in the poor-MH versus high-MH group (5020.1 +/- 280.7 versus 7174.1 +/- 221.5 steps, p&lt;0.001; 133.9 +/- 10.8 versus 215.9 +/- 8.4 kcal, p&lt;0.001). Cut-off values of 5590.8 steps and 141.1 kcal were determined as PA target values associated with improved MH. Conclusions: Poor MH status may reduce PA. Attaining PA target values may improve MH status of CHF outpatients.

There has been a growing interest in dog ownership and walking as a unique and potential resource to provide physical activity for many individuals in the community. The present study reviewed current trends regarding the studies on dog ownership, dog walking, and human health, and clarified the future direction of research on the topic. There is evidence to suggest that it is not dog ownership itself, but rather dog-walking that contributes to increased physical activity and the likelihood of meeting public health guidelines for physical activity. Also, a growing body of literature indicates that dogs appear to provide an important form of social support, motivation, and obligation that encourages dog owners to walk. Regarding the environmental and policy-related factors associated with dog walking, some literature showed that access to a dog-supportive park/area or living in a walkable neighborhood seems to positively affect dog owners walking with their dog. The evidence is still limited on interventions for promoting dog owners walking with their dog. With the high level of dog ownership in many industrialized countries, further evaluation of physical activity, including dog walking and use of an accelerometer, identification of factors related to dog owners' regular/irregular dog walking by means of a longitudinal study, and implementation of an intervention study related to the promotion of physical activity among dog owners with a focus on dog walking are needed.

Objectives: Although physical activity reduces the risk of diseases such as cancer, diabetes and cardiovascular disease, a large proportion of the population is not sufficiently physically active. Therefore, the present study examined the environmental, social, and psychological correlates for meeting the 2 recommended physical activity criteria: ≥420. min per week of at least moderate-intensity activity (MPA criterion) and ≥210. min per week of vigorous activity (VPA criterion) for colon cancer prevention among Japanese adults. Design: Cross-sectional study. Methods: The sample included 2000 Japanese adults aged 20-79 years. An Internet-based survey was used to assess seven sociodemographic variables (e.g., education level, employment status), environmental variables (home fitness equipment, access to facilities, neighborhood safety, aesthetic sensibilities, and frequency of observing others exercising, residential area), social variables (social support), psychological variables (self-efficacy, perceived positive (pros) and negative (cons) aspects of exercise), and physical activity. The adjusted odds of meeting each physical activity criterion by these variables were calculated. Results: Overall, 22.3% of the study population met the criterion of MPA, and 7.3% met the criterion of VPA. Having high self-efficacy, fewer perceived cons, possessing home fitness equipment, reporting enjoyable scenery, and living in a rural area were significantly associated with meeting the recommended criteria. Conclusions: Participants who met the 2 activity recommendations differed by self-efficacy, cons, possession of home fitness equipment, reporting of enjoyable scenery, and residential area. These findings imply that strategies to promote more intense physical activities specifically in terms of these variables may be necessary for colon cancer prevention. © 2013.

BACKGROUND: Physical activity is beneficial for adolescent health. The physical activity patterns of Japanese adolescents are relatively unknown. Therefore, this study aimed to describe the current patterns of physical activity and to identify sex and grade differences among them. METHODS: The participants comprised 714 Japanese adolescents aged 12 to 15years old (boys N=372, girls N=342) from a public junior high school in Okayama, Japan. Physical activity at school, outside of school after hours, and during lunch recess as well as the total leisure time in a usual week was assessed with a 5-item questionnaire. To assess the differences in the physical activity patterns by sex and grade, independent t tests and analysis of variance (ANOVA) were conducted, respectively. RESULTS: Boys spent significantly more time in physical activity both inside and outside of school settings than girls (p&lt
.05). Higher grade students were significantly less active than lower grade students (p&lt
.05). Furthermore, the physical activity patterns across the grades differed between settings (at school, outside of school during the after-school period, lunchtime recess, and at home). CONCLUSION: To increase physical activity levels among Japanese adolescents, implementation of after-school programs or environmental modifications developed within the school setting could be effective strategies. © 2013, American School Health Association.

Promoting engagement of external coaches in school-based extracurricular sports activities (SBECSA) is valuable for positive youth development. However, the number of external coaches is insufficient. When trying to enhance recruitment and engagement of external coaches, registrants of sports leader banks are a good potential source of external coaches. Sports leader bank is an organization that registers community residents who can coach sports and introduces them to sports organizations that need coaching. Therefore, the purpose of the present study was to identify facilitators and barriers associated with engagement in SBECSA among registrants of sports leader banks. Participants were 12 registrants of four sports leader banks who were not currently engaging in SBECSA as external coaches. Data were obtained through personal semi-structured interviews and analyzed using the KJ method that is one of qualitative analysis. As results, facilitators were categorized into four large (benefit, system, environment, and motivation), 15 middle, and 42 small categories and barriers were categorized into four large (burden, system, environment, and lack of motivation), 15 middle, and 44 small categories. Findings suggested some ways of improving the situation with external SBECSA coaches, such as developing the insurance system, promoting information about the characteristics of coaches, and encouraging schools to accept these coaches. Recruitment and engagement of external coaches can be promoted by enhancing these facilitators and reducing barriers.

The purpose of this study was to determine both an association between mortality and physical activity (PA) objectively measured by accelerometer and cutoff values for PA in Japanese outpatients with heart failure (HF). This prospective observational study comprised 170 HF outpatients (mean age, 65.2 years; 77% men). Peak oxygen uptake (VO2) and the relation between ventilation and carbon dioxide production (VE/VCO2 slope) as indices of exercise capacity were measured during cardiopulmonary exercise testing with a cycle ergometer. PA was assessed by accelerometer-measured average step count (steps) per day for 1 week. Study endpoint was cardiovascular-related death. Over an average follow-up of 1,377.1 (median, 1,335) days, 31 cardiovascular-related deaths occurred. Patients were then divided into survivor (n = 139) and nonsurvivor (n = 31) groups. Brain natriuretic peptide level was significantly different between groups. Peak VO2 and steps were also significantly lower and VE/VCO2 slope higher in the nonsurvivors versus survivors. Univariate Cox proportional hazards analysis showed brain natriuretic peptide, peak VO2, VE/VCO2 slope, and steps to be significant prognostic indicators of survival. Multivariate analysis showed PA of &lt;= 4,889.4 steps/day to be a strong and independent predictor of prognosis (hazard ratio: 2.28, 95% confidence interval: 1.31-6.30; p = 0.008). Kaplan-Meier curves after log-rank test showed significant prognostic difference between PA of &lt;= 4,889.4 and &gt;4,889.4 steps/day in the 2 groups (log-rank: 12.19; p = 0.0005). In conclusion, step count as objectively measured by accelerometer may be a prognostic indicator of mortality in Japanese outpatients with HF. (C) 2013 Elsevier Inc. All rights reserved.

子どもの身体活動および座位活動がメンタルヘルスに及ぼす影響について検討した。幼稚園、小学校、中学校を対象としたコホート研究におけるデータの一部を解析した。2010年度初回調査と2012年度調査のデータを使用した。身体活動および座位活動の実施は、2年後のメンタルヘルスや身体活動および座位活動にも関連があることが示された。現在の身体活動および座位活動は、現在のメンタルヘルスのみならず2年後のメンタルヘルスと相関関係を認めた。男子においては、現在の身体活動時間が長いと現在および2年後のメンタルヘルスが良好であることが示された。女子では現在の身体活動時間が長いと現在および2年後の自己効力感は良好であるが、行動は良好ではないことが示された。また、現在の座位活動時間が長いことは女子の2年後の不安傾向および行動、また現在の行動が、男子においては、2年後の自己効力感が良好ではないことが示された。

Background: In addition to insufficient moderate-to-vigorous physical activity (MVPA), prolonged sitting time is also a health risk for older adults. An understanding of population subgroups who have prolonged television viewing (TV) time, a predominant sedentary behavior, can aid in the development of relevant health promotion initiatives; however, few such studies have focused on older adults, the most sedentary segment of the population as a whole. The aim of this study is to examine the socio-demographic attributes associated with TV time among community-dwelling Japanese older men and women.
Methods: A population-based, cross-sectional mail survey was used to collect data on TV time, MVPA, and socio-demographic characteristics. The survey was conducted from February through March 2010. Participants were 2700 community-dwelling older adults (aged 65-74 years, 50% men) who were randomly selected from the registry of residential addresses of three cities in Japan. Data from 1665 participants (mean age: 69.5 years, 52% men) who completed all variables for the present study were analyzed. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of prolonged TV time (&gt;2 hours/day) for each socio-demographic attribute, stratified by gender.
Results: Of the 1665 participants, 810 (48.6%) watched TV for more than 2 hours/day. The median television viewing time (25th, 75th percentile) was 2.00 (1.07, 3.50) hours/day. Prolonged TV time was associated with not in full-time employment, lower educational attainment, weight status, living in regional areas and low MVPA for the whole sample. For men, prolonged TV time was associated with lower educational attainment; (OR = 1.53, 95% CI: 1.12 2.07), underweight (OR = 1.63, 95% CI: 1.02-2.60), overweight (OR = 1.57, 95% CI: 1.11-2.21), and low MVPA (OR = 1.43, 95% CI: 1.02-2.02). For women, living in regional areas (OR = 2.02, 95% CI: 1.33-3.08), living alone (OR = 1.61, 95% CI: 1.03-2.49), not driving (OR = 1.79, 95% CI 1.21-2.65), overweight (OR = 1.50, 95% CI: 1.00-2.24), and low MVPA (OR = 1.51. 95% CI: 1.05-2.17) were associated with prolonged TV time.
Conclusions: These findings identify particular socio-demographic and behavioral characteristics related to TV time among Japanese older adults. It should be noted that correlates of prolonged TV time differed by gender. Women in living situations with limited transportation options tended to spend prolonged time watching TV. Health promotion initiatives for older adults, particularly for older women, may be more effective if they take these attributes into account.

Background: Concern over the health risks of sedentary behavior has highlighted the need to examine factors associated with screen-based (television/computer) sedentary behavior. The present study examined the association of screen-based sedentary behavior with body weight and sociodemographic attributes among Japanese adults. Methods: A population-based cross-sectional study enrolled 1034 Japanese adults aged 40 to 69 years who lived in 2 Japanese cities. Sociodemographic variables, height, weight, and time spent on screen-based sedentary behavior were collected by self-administered questionnaire. Differences in screen time in relation to body mass index and weight gain since age 20 years were assessed by the Mann-Whitney U test. Independent associations of each variable with screen time were examined by forced-entry logistic regression analyses. Results: Mean (SD) age and median (interquartile range) duration of screen time per week were 55.6 (8.4) years and 832.0 (368.8-1263.1) minutes, respectively, for men, and 55.3 (8.4) years and 852.6 (426.0-1307.5) minutes, respectively, for women. Screen time among participants with weight gain was longer than among those with a weight gain of less than 10 kg (P = 0.08). Unmarried and unemployed participants had longer screen times. Participants aged 40 to 49 years were less likely than older age groups to spend time on screen-based sedentary behavior during leisure hours. Conclusions: The present findings imply that strategies are necessary to discourage screen-based sedentary behavior among all demographic groups, especially among adults who are elderly, unmarried, or unemployed. © 2013 Kaori Ishii et al.

BACKGROUND:There are no previous data on factors at multiple levels associated with the stages of change for dog walking. The current study examined psychosocial and environmental correlates of the stages of change for dog walking among Japanese dog owners.;METHODS:Dog owners (N = 1940) completed a self-administered questionnaire that included items about demographics as well as psychosocial (dog attachment, dog obligation, normative belief, social norm, social support, self-efficacy) and environmental (access to areas, neighborhood safety, enjoyable scenery, frequently observing others dog walking, area where dogs are allowed to be off the lead) factors. MANOVA and discriminant functional analysis were used.;RESULTS:The distribution of the dog owners across the stages was as follows: precontemplation (14.7%), contemplation (7.6%), preparation (39.7%), action (2.8%), and maintenance (35.2%). Although differences among the stages were found for all factors in MANOVA, the pattern of distinction among stages differed depending on the factors. Dog obligation and self-efficacy were the best predictors of the stages of change for dog walking.;CONCLUSIONS:Although psychosocial and environmental correlates differed with the stages, psychosocial factors such as the sense of obligation and self-efficacy in dog walking seem to make relatively stronger contributions to distinctions among the stages.

Background: In contemporary society, prolonged sitting has become pervasive in our lives across many settings, including transportation, the workplace, and the home. There is a rapidly accumulating evidence that large volumes of daily sedentary time (typically in the contexts of television viewing, computer use, workplace sitting, and time spent in automobiles) are adversely associated with cardio-metabolic risk biomarkers, type 2 diabetes, some types of cancer, and premature mortality. Importantly, these detrimental associations remain even after accounting for time spent in physical activity. To inform future directions on sedentary behavior research among adults, the present paper reviews the evidence from recently-published studies, applying the behavioral epidemiology framework.Contents: This review includes evidence on the relationships with sedentary behavior (too much sitting) with health risk indicators; self-report and device-based measurement of sedentary behaviors; the prevalence and trends for key sedentary behaviors; an ecological model and the environmental correlates of sedentary behavior; the effectiveness of interventions to reduce sedentary time; and, an overview of public health recommendations on reducing and breaking up sedentary time.Conclusions: Future directions for sedentary behavior research are as follows: population-based prospective studies using device-based measures to better understand the impact of sedentary time on health outcomes, prospective studies to clarify the multiple levels of determinants of prolonged sitting time in different life settings, further intervention trials to reduce and break up sedentary behaviors in domestic, workplace, and transportation environments, translational research (such as mass media campaigns) to spread messages about reducing sitting time in daily life, and experimental studies to determine underlying mechanisms and dose-response relationships.

Aim: The objective of the present study was to evaluate the long-term effectiveness of an exercise program in modifying the exercise behavior of the community-dwelling elderly subjects. Methods: This study was a single-blinded randomized controlled trial. The subjects included 52 males and 65 females 65 years of age or over who were randomly assigned to an exercise-intervention group or a health-education group. The stages of change in exercise behavior were evaluated before and one-year after the intervention period. The subjects' physical function (muscle strength, balance, walking speed) and self-efficacy in each domain of the physical function were measured during the intervention period. Results: There were no significant differences in the stages of change before the intervention between the two groups. Significant differences in the stages of change were observed in "relapse" of stages at two points in time between the two groups (p&lt
.01). A logistic regression analysis showed that "progression" of stages was associated with improvements in the timed up and go test (AOR 2.7
95% CI 1.3-5.8) and sit and reach (AOR 1.14
95%CI 1.0-1.3), while "relapse" of stages was associated with the group allocation (AOR 4.6
95%CI 1.1-18.8), self-efficacy in "Walking" (AOR 1.54
95%CI 1.0-2.3) and "Stair climbing" (AOR 0.68
95%CI 0.5-0.9) with respect to physical activity during the intervention period. Conclusions: The results suggest that exercise intervention in community-dwelling elderly subjects is effective in preventing "relapse" of exercise behavior over long periods.

Background : The purpose of the present study was to develop a school physical activity environment scale and to examine the relationship between school physical activity environment and school physical activity among Japanese elementary school children. Methods : Internet-based cross-sectional survey was conducted to 1,074 Japanese guardians who had elementary school children. Sociodemographic attributes,school physical activity environment scale and time of physical activity at school for a usual lunch time recess and after school were assessed. Results：Exploratory factor analyses identified 3 factors (equipment,facility, and safety). Confirmatory factor analyses to examine the factorial validity revealed acceptable fit indices and the reliability of the scale was acceptable. Those who perceived good these environments were significantly more likely to be physically active in school. Conclusion：The school physical activity environment scale was developed in the present study and demonstrated acceptable factorial validity,internal consistency and inter-rater reliability.

Background : The purpose of the present study was to develop a school physical activity environment scale and to examine the relationship between school physical activity environment and school physical activity among Japanese elementary school children. Methods : Internet-based cross-sectional survey was conducted to 1,074 Japanese guardians who had elementary school children. Sociodemographic attributes,school physical activity environment scale and time of physical activity at school for a usual lunch time recess and after school were assessed. Results：Exploratory factor analyses identified 3 factors (equipment,facility, and safety). Confirmatory factor analyses to examine the factorial validity revealed acceptable fit indices and the reliability of the scale was acceptable. Those who perceived good these environments were significantly more likely to be physically active in school. Conclusion：The school physical activity environment scale was developed in the present study and demonstrated acceptable factorial validity,internal consistency and inter-rater reliability.

Background: There are no previous data on factors at multiple levels associated with the stages of change for dog walking. The current study examined psychosocial and environmental correlates of the stages of change for dog walking among Japanese dog owners. Methods: Dog owners (N = 1940) completed a self-administered questionnaire that included items about demographics as well as psychosocial (dog attachment, dog obligation, normative belief, social norm, social support, self-efficacy) and environmental (access to areas, neighborhood safety, enjoyable scenery, frequently observing others dog walking, area where dogs are allowed to be off the lead) factors. MANOVA and discriminant functional analysis were used. Results: The distribution of the dog owners across the stages was as follows: precontemplation (14.7%), contemplation (7.6%), preparation (39.7%), action (2.8%), and maintenance (35.2%). Although differences among the stages were found for all factors in MANOVA, the pattern of distinction among stages differed depending on the factors. Dog obligation and self-efficacy were the best predictors of the stages of change for dog walking. Conclusions: Although psychosocial and environmental correlates differed with the stages, psychosocial factors such as the sense of obligation and self-efficacy in dog walking seem to make relatively stronger contributions to distinctions among the stages. © 2012 Human Kinetics, Inc.

Background: In rapidly developing Internet-user societies, eHealth literacy has become important in promoting wellness. Although previous studies have observed that poor health literacy is associated with less knowledge and screening practice of colorectal cancer (CRC), little is known about whether eHealth literacy is associated with these variables.
Objective: The present study examined associations between eHealth literacy, knowledge of CRC, and CRC screening practices.
Methods: Data were analyzed for 2970 Japanese adults (men, 49.9%; mean age +/- SD, 39.7 +/- 10.9 years) who responded to an Internet-based cross-sectional survey. Knowledge of the definition of CRC, its risk factors and screening practice, previous experience of CRC screening, score on the Japanese version of the eHEALS (J-eHEALS), sociodemographic attributes (sex, age, marital status, educational attainment, and household income level), and frequency of Internet usage were obtained. Sociodemographic attributes and frequency of Internet usage were used as control variables in the multiple regression and logistic regression models.
Results: eHealth literacy was positively associated with CRC knowledge (beta = .116, &lt; .001), when the covariables of both eHealth literacy and CRC knowledge were used in the multiple regression model. Moreover, after controlling for sociodemographic factors, which were significantly associated with eHealth literacy and CRC screening practice, an increase of 1 point in the eHEALS score signified that participants were 1.03 times (95% CI = 1.01-1.05) more likely to undergo CRC screening.
Conclusions: Internet users with high eHealth literacy are more likely to have knowledge and previous screening practice related to CRC compared to those with low eHealth literacy. (J Med Internet Res 2012;14(6):e153) doi:10.2196/jmir.1927

Objective: To investigate the effect of the self-monitoring of physical activity by hospitalized cardiac patients attending phase I cardiac rehabilitation (CR).
Design: Randomized controlled trial.
Setting: University hospital CR program.
Participants: CR patients (N=126) with a mean age of 59.1 years.
Interventions: Patients were randomly assigned to the selfmonitoring group (group A, n=63) or the control group (group B, n=63). Along with CR, group A patients performed selfmonitoring of their physical activity at the beginning of a phase I CR program (acute in-hospital phase for inpatients) and ending just before they began a phase 11 CR program (postdischarge recovery phase for outpatients).
Main Outcome Measures: Physical activity (averages of daily number of steps taken and daily energy expenditure for lwk) as measured by accelerometer was assessed in both groups at baseline (t1) and before the beginning of phase II CR (t2).
Results: Although there were no significant differences in physical activity values between groups A and B at t1, values of group A at t2 were significantly higher than those of group B (8609.6 vs 5512.9 steps, P&lt;.001; 242.6 vs 155.9kcal, P&lt;.001).
Conclusions: Self-monitoring of patient physical activity from phase II CR might effectively increase the physical activity level in preparation for entering a phase IT CR program. Results of the present study could contribute to the development of new strategies for the promotion of physical activity in cardiac patients.

Background: Dog ownership is emerging as an important correlate of sufficient physical activity and therefore has the potential to positively affect a portion of the population. A growing body of literature indicates that dog-walking contributes to increased physical activity. However, most of the previous studies have been conducted in Australia or the U.S. and have sampled from the general adult population. Purpose: This study examined the association between dog ownership, dog-walking, and physical activity in older Japanese adults. Methods: Participants were community-dwelling residents aged 65-74 years who responded to a population-based cross-sectional survey (N=1926). Physical activity, dog ownership, dog-walking, and sociodemographic attributes were self-reported (collected in 2010
analyzed in 2011). ANCOVAs and multivariate logistic regressions were used. Results: Overall, 14.0% of older adults were dog owners, with 71% reporting that they walked their dog for an average of 308.5±300.7 minutes/week. Dog walkers reported more minutes/week of moderate-to-vigorous physical activity (M±SE: 241.7±27.0) and total physical activity (M±SE: 698.6±40.6) than both non-dog walkers (M±SE: 110.7±41.8
M±SE: 527.2±62.9) and non-dog owners (M±SE: 164.7±9.1
M±SE: 519.2±13.7), respectively (p&lt
0.05). Dog walkers also walked more minutes per week (M±SE: 508.0±33.4) than non-dog owners (M±SE: 384.5±11.3
p&lt
0.05). Dog walkers were more likely to be sufficiently active than both non-dog walkers and non-dog owners (p&lt
0.001). Conclusions: Use of dog-walking may be a potentially viable means of intervention for increasing walking and overall physical activity in older Japanese adults. © 2012 American Journal of Preventive Medicine.

Background: Exploring the detailed pattern and correlates of dog walking is crucial to designing effective interventions to increase the proportion of dog walkers. The current study examined the prevalence and pattern of dog walking, the association between dog walking and health-related physical activity, and the correlates of dog walking among dog owners in Japan. Methods: Japanese dog owners' (n = 930) responses to an Internet-based cross-sectional survey were analyzed. A self-reported measure of physical activity, dog walking characteristics, and sociodemographic and dog-specific variables were obtained. Analyses of covariance and multivariate logistic regressions were used. Results: Overall, 64.4% of the surveyed dog owners walked their dogs. On an average, they walked their dogs 214.1 +/- 189.5 minutes per week. The dog walkers were 3.47 times more likely to meet physical activity recommendations, were significantly less likely to be unmarried (OR = 0.61), and had higher levels of attachment with their dogs (OR = 2.32) than the nondog walkers. Conclusion: The findings confirmed that dog walking significantly helps dog owners meet physical activity recommendations for health and revealed that dog-specific factors such as dog attachment might be stronger correlates of dog walking than sociodemographic factors.

Background: It is still not known whether overweight men have different patterns and socio-demographic correlates of self-reported physical activity (PA) compared with normal-weight men. Thus, this study examined the perceived PA patterns and associated socio-demographic factors among normal-weight and overweight Japanese men.
Methods: Data were analyzed for 1,420 men (aged 44.4 +/- 8.3 years) who responded to an Internet-based cross-sectional survey relating to socio-demographic variables, BMI status, and a short version of the International Physical Activity Questionnaire. Mann-Whitney, chi-square, and binary logistic regression analyses were employed.
Results: Normal-weight men were significantly more likely to attain 150 minutes per week of moderate-to-vigorous PA than overweight men (26.6 % vs. 21.3 %; p = 0.035), whereas there were no significant proportional differences in total PA and walking between the two BMI subgroups. With PA, a significant interaction was observed between BMI status and household income (p = 0.004 for total PA; p = 0.02 for walking). In the subgroup analyses, having a lower household income (odds ratio, 0.63; 95 % confidence interval, 0.41-0.96) was negatively associated with attaining 150 minutes of walking per week among normal-weight men. No significant associations between household income and attaining 150 minutes per week of total PA and walking were found among overweight men.
Conclusions: The results revealed that patterns and socio-demographic correlates of self-reported PA in overweight men are different from those in normal-weight men. This finding suggests the necessity of developing specific strategies for PA intervention among overweight men. Socio-demographic correlates of PA may be more important for normal-weight than overweight men.

AIM: Previous reports have not demonstrated the oral health-related quality of life (OHRQOL) among patients with Crohn's disease (CD). Therefore, the present study examined the relationship between the OHRQOL, oral health behavior, and subjective oral symptoms among patients with CD. METHODS: Subjects were 60 CD patients (mean age: 37.0 ± 9.0 years; range: 20-56 years). The OHRQOL was assessed using the General Oral Health Assessment Index (GOHAI). The assessment of oral health behavior, i.e., brushing frequency, snack habit, frequency of observation of the oral health status and regular dental check-up visits, and subjective oral symptoms was based on responses in self-administered questionnaires. RESULTS: The GOHAI score by gender and age groups in CD patients was lower than that of nationalnorm data in every classification. There was no significant difference in the GOHAI score between CD subjects with good and those with poor oral health behavior, but there was a significant difference between those with and without subjective oral symptoms (p<0.001). CONCLUSIONS: These results suggest that patients with CD require the management of oral symptoms and improvement of their OHRQOL.

PURPOSE: Exercise capacity of fewer than 5 metabolic equivalents (METs) has been associated with high risk of death and poor physical functioning in male patients with heart failure (HF). Therefore, we aimed to determine upper and lower extremity muscle strength levels required to attain an exercise capacity of 5 or more METs in male outpatients with HF.
METHODS: We enrolled 148 male HF patients (age 60.1 +/- 1.0 years). Peak oxygen uptake (peak (over dot)VO2) was assessed by cardiopulmonary exer cise testing (CPX). After CPX, we further divided the patients into groups according to exercise capacity: 5 or more METs (group A, n = 85) and fewer than 5 METs (group B, n = 63). Handgrip strength and knee extensor and flexor muscle strengths were assessed as indices of upper and lower extremity muscle strength, respectively. Receiver operating characteristic curves were used to select cutoff values for upper and lower extremity muscle strength resulting in an exercise capacity of 5 or more METs in these patients.
RESULTS: Exercise capacity of 5 or more METs in male HF patients was equivalent to approximately 35.2 kgf of handgrip strength and 1.70 Nm/kg of knee extensor and 0.90 Nm/kg of knee flexor muscle strengths.
CONCLUSIONS: These upper and lower extremity muscle strength values may be useful target goals for improvement of exercise capacity, risk management, and activities of daily living in male HF patients.

Background: Although regular physical activity can facilitate healthy aging, improve functional capacity, and prevent chronic diseases in the elderly, many of the Japanese elderly are not sufficiently active. Thus, examining the determinants is an important prerequisite for designing effective programs. The present study investigated the demographic, behavioral, psychosocial, and environmental determinants of meeting the national pedometer-determined physical activity recommendations for the elderly Japanese. Method: Data were analyzed for 137 community-dwelling elderly Japanese aged 70 to 89 years (47% male, mean age = 74.5 years), who completed a questionnaire and wore a pedometer. Demographic (gender, age, marital status), behavioral (BMI, smoking, alcohol consumption), psychosocial (self-efficacy, social support, health professional advice), and environmental (perceived neighborhood environment) variables were self-reported. Averaged daily steps were obtained using 1-year pedometer measurements. Based on the national physical activity recommendations in Japan (males: 6700 steps
females: 5900 steps), the participants were divided into two categories-sufficiently active and insufficiently active. An adjusted logistic regression model was utilized. Results: Totally, 47.4% of the participants (males: 51.5%
females: 43.8%) met the national recommendations. When adjusting for all other variables, a higher self-efficacy for exercise (AOR = 1.16
95% CI: 1.04-1.28) and positive perception of the neighborhood environment (AOR = 1.43
95% CI: 1.03-1.98) significantly influenced the meeting of the national recommendations. Conclusions: The findings clarified the need to identify effective intervention strategies to promote physical activity and suggest that an intervention design that accounts for these determinants may more effectively promote physical activity among the elderly Japanese. © 12 Bentham Science Publishers.

BACKGROUND:Exploring the detailed pattern and correlates of dog walking is crucial to designing effective interventions to increase the proportion of dog walkers. The current study examined the prevalence and pattern of dog walking, the association between dog walking and health-related physical activity, and the correlates of dog walking among dog owners in Japan.;METHODS:Japanese dog owners' (n=930) responses to an Internet-based cross-sectional survey were analyzed. A self-reported measure of physical activity, dog walking characteristics, and sociodemographic and dog-specific variables were obtained. Analyses of covariance and multivariate logistic regressions were used.;RESULTS:Overall, 64.4% of the surveyed dog owners walked their dogs. On an average, they walked their dogs 214.1±189.5 minutes per week. The dog walkers were 3.47 times more likely to meet physical activity recommendations, were significantly less likely to be unmarried (OR=0.61), and had higher levels of attachment with their dogs (OR=2.32) than the nondog walkers.;CONCLUSION:The findings confirmed that dog walking significantly helps dog owners meet physical activity recommendations for health and revealed that dog-specific factors such as dog attachment might be stronger correlates of dog walking than sociodemographic factors.

【目的】 心疾患患者や一般人を対象とした先行研究によれば, 運動耐容能が5 metabolic equivalents (METs)未満を下回る場合には生命予後不良であること, さらに, これは日常生活活動（ADL）低下の一要因となりうることが示されている.慢性心不全 (CHF) 患者を対象とした先行研究(2007)において我々は, 運動耐容能の一つとしての運動耐容能と上下肢筋力には正の相関関係があることを報告した. そこで, 本研究では,"慢性心不全患者の運動耐容能5METS未満とそれ以上では, 上下肢筋力には差がある'という仮説を立て, それを検証すべく, 以下の検討を行った. 本研究の目的は, CHF患者における運動耐容能5METsレベルの上下肢筋力について明らかにすることである.【方法】 対象者は, 当院の診療科に外来通院中で医師から心肺運動負荷試験（CPX）の依頼を受け, 上下肢筋力の測定に同意が得られた30歳以上のCHF男性患者148 例（平均年齢61.1歳）である． 除外基準は, 診療記録より各指標の調査不能例, 重篤な不整脈, 呼吸器疾患, 整形外科疾患を有する例であった. 運動耐容能は, 初回CPXで得られた最高酸素摂取量より5METs以上（A：85例）とそれ未満（B：63例）の2群に選別された. また, 上下肢筋力の指標は, 握力, 膝伸展および屈曲筋力とし, 我々は, 各指標の左右最高値の平均をそれらの指標とした. 解析には, AとB群の各指標の比較には患者背景を調整した共分散分析を用いた. また5METsレベルの各指標のカットオフ値の抽出には, 受信者動作特性（ROC）曲線を求め, 感度と特異度より判定した. 統計学的有意差判定の基準は5％未満とした.【倫理的配慮】 本研究を計画するにあたり当大学生命倫理委員会の承認を得た（承認番号340号）．実施に際しては,対象者に本研究の趣旨を説明した後, 全例書面にて同意を得た．【結果】 患者背景は, 年齢, brain natriuretic peptide (BNP)およびNew York Heart Association (NYHA) 心機能分類において両群で差を認めた. これら患者背景を調整した共分散分析を施行後において, A群はB群に比し, 握力（A: 40.90 vs. B: 33.97 kgf, P<0.01), 膝伸展筋力（A: 1.95 vs. B: 1.58 Nm/kg, P<0.01）および屈曲筋力（A: 1.09 vs. B: 0.85 Nm/kg, P<0.01）は全てにおいて高値を示した. また, 5METsレベルのカットオフ値は, 握力は35.2kgf（感度 0.78, 特異度 0.32,曲線下面積 0.81), 膝伸展筋力は1.70 Nm/kg (感度 0.77, 特異度 0.31, 曲線下面積 0.81), そして屈曲筋力は0.90Nm/kg (感度 0.78, 特異度 0.39, 曲線下面積 0.79)であった.【考察】 患者背景は, A群の年齢, BNPはB群に比し低い値を, またNYHA心機能分類は, B群においてより重度であった. また, 上下肢筋力は, A群はB群に比し高値を示した. 以上のことから, 運動耐容能の高低は, 年齢, 重症度に加え, 上下肢筋力の高低にも少なからず影響するという先行研究を支持する結果となった. 一方,心不全患者の生命予後に関する先行研究では, 握力32.2 kgf, 膝屈曲筋力0.68 Nm/kg未満において予後不良であることが示されている. 本研究で得られた, 運動耐容能5METsレベルのカットオフ値はそれらの値を上回る結果となった. また, 膝伸展筋力に関しては, 一般人男性における日常生活活動制限に関する膝伸展筋力からみたリスク層別の1.71 Nm/kgに近似していた. 以上より, 上下肢筋力はCHF男性患者の運動耐容能,リスクおよびADLを予測するための一助となる可能性がある. しかし本研究は, 横断的研究であるため, これらの指標が, 運動容能, 生命予後やADLの向上に直接寄与するのかについては言及できない. したがって今後更なる検討を要するものと思われる.【理学療法学研究としての意義】 本研究は, 上下肢筋力からみたCHF男性患者のリスク層別, 運動耐容能およびADL向上のための一つの目標値となる可能性がある. 以上より, 本研究の成果は, 理学療法学研究における運動指導方策への一助となるものと考えられる.

【はじめに、目的】 健康関連QOL(HRQOL)を向上させる因子の一つとして，身体活動セルフ・エフィカシー(SE)が注目されている。SEとはBanduraによると「ある結果を生み出すために必要な行動をどの程度うまく行うことができるかという個人の確信」と定義されている。特に運動や身体活動に関するSEは，身体活動や行動変容や運動の継続，更にはHRQOLに関係するとされている。しかしながら人工膝関節全置換術(TKA)患者に対して，身体活動SEが身体機能およびHRQOLに及ぼす影響について明らかにされていない。本研究の目的はTKA後のリハ介入における身体機能，HRQOLおよび身体活動SEの回復過程とその関連性について明らかにすることである。【方法】 対象は2010年10月から2011年7月までに当院でTKAを施行した変形性膝関節症患者44例48膝とした。手術時年齢は73.2±7.7歳，BMI26.1±3.5 kg/m2，術後在院日数25.2±5.3日，術後リハは当院プロトコールに準じて術後3ヶ月間外来リハを実施した。身体機能評価としてTimed Up and Go test(TUG)，開眼片脚起立時間，膝伸展筋力を測定した。HRQOLの評価指標としてSF-36の下位8尺度である身体機能(PF)，日常役割機能－身体(RP)，体の痛み(BP)，全体的健康感(GH)，活力(VT)，社会生活機能(SF)，日常役割機能－精神(RE)，心の健康(MH)と身体的サマリースコア(PCS)と精神的サマリースコア(MCS)を用いた。身体活動SEは虚弱高齢者の身体活動SE尺度（歩行，階段，重量物）とその総合得点を用いた。評価は術前，術後1ヶ月(退院時)と3ヶ月(外来通院時)とした。統計解析は回復過程を一元配置分散分析とBonferroni多重比較，身体機能およびHRQOLと身体活動SEとの関連性に関しては各変化量をpearsonの相関係数を用い，有意水準は5%未満とした。【倫理的配慮、説明と同意】 本研究は当院生命倫理委員会の承認(0826)を受け，対象者に研究内容の説明文書を用いて口頭による説明を行い，研究参加への同意を得て実施した。【結果】 各項目は術前(T1)→術後1ヶ月(T2)→術後3ヶ月(T3)の順に平均値±標準偏差で示した。TUGは11.8±3.8→11.7±3.8→10.5±3.3秒となりT1とT3，T2とT3で有意に改善した。開眼片脚起立時間は13.3±19.3→20.8±26.1→23.2±31.8秒となりT1とT3で有意に向上した。膝伸展筋力は0.5±0.2→0.5±0.1→0.6±0.1N・m／kgとなりT2とT3で有意に向上を認めた。SF-36の下位尺度のうち，PFは37.7±20.8→40.6±25.6→52.5±20.3点，BPは35.1±15.3→36.2±19.2→49.8±21.2点，SFは53.9±27.1→56.8±25.3→69.8±23.5点となりT1とT3，T2とT3で有意に改善を認めた。GHは48.8±13.6→53.5±14.5→54.1±16.5点となりT1とT3で有意に改善を示した。PCSは16.5±12.5→15.3±14.6→23.1±16.1点となりT1とT3，T2とT3で有意に改善した。身体活動SEのうち，歩行SEは12.4±5.0→14.9±6.4→15.9±5.3点，階段SEは8.9±5.2→10.4±5.2→12.5±5.1点，重量物SEは14.1±5.9→15.7±5.3→17.3±6.1点となりT1とT3で有意に向上した。身体活動SEの総合得点では35.4±12.5→41.1±13.1→45.6±12.8点となりT1とT2，T1とT3で有意に向上を認めた。身体活動SEの総合得点とHRQOLとの関連性はPF，RP，BP，RP，GH，REおよびPCSと有意な正の相関を示した(r＝0.307～0.508，p＜0.05)。身体活動SEの総合得点と身体機能の各項目とは有意な相関が見られなかった。【考察】 身体機能，HRQOLおよび身体活動SEは時間経過とともに有意に改善を示した。退院時では十分な改善が得られず，退院後もリハの継続が必要になると考える。身体機能と身体活動SEはHRQOLと関連性があり，身体機能とは関連性がないことが示唆された。HRQOLを向上させるためには，身体機能に加え，身体活動SEを高めるような方策を積極的にリハに組み入れていく必要があると考える。【理学療法学研究としての意義】 TKA後のリハは身体活動SEを高めるアプローチを加えることで，TKA患者のHRQOLを向上させることが可能になると考える。

Purpose: In a rapid developing Internet society, eHealth literacy becomes important to promote eHealth and aid in health care among individuals and groups. However, little is known about eHealth literacy in Japan. The present study reviewed the concept and issues of eHealth Literacy to promote eHealth effectively through recent trends of eHealth literacy.Methods: Medline, CINHAL, ERIC and "Igaku-chuo-zasshi" were searched for studies published in English and Japanese before September 30, 2011. "eHealth literacy", "e-Health literacy", "e- literacy", "eHEALS" and "Health literacy & Internet" were used as key words. A total of 161 publications were identified and 14 publications and 4 publications from reference lists met the inclusion criteria.Results: Twelve publications introduced the Lily model of eHealth literacy developed by Norman et al. in 2006 as follows: the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. Furthermore, one study advocated the concept of eHealth literacy, three studies developed the scale of eHealth literacy and five studies examined the effect of eHelath literacy interventions and the eHealth literacy levels on people needing eHealth literacy.Conclusion: Lily model of eHealth literacy is the most prevalent concept. It is necessary to revise the concept of eHealth literacy to include the skills of use Web 2.0 tools (e.g. Social Networking Service) in eHealth literacy and conduct the studies using the valid scale of eHealth literacy.

Objective: Environmental factors are related to physical activity among youth on a long-term. The purpose of the present study was to develop a neighborhood physical activity environment scale and to examine the relationship between neighborhood physical activity environment and out-side of school physical activity and school commuting among Japanese elementary students.Methods: Internet-based survey was administered to 1,074 Japanese guardians aged 20-59 years who had elementary school child. Sociodemographic attributes (gender and age of guardians, gender, age, hight and weight of children), neighborhood physical activity environment scale including 16 items and time of physical activity during out-side of school for leisure and walking to school commuting were assessed by the self-administered questionnaire.Results: Exploratory factor analyses identified 4 factors labeled "safety" with 5 items, "pleasing aesthetic" with 4 items, "crime safety" with 2 items and "uncomfortable aesthetic" with 2 items. Confirmatory factor analyses to examine the construct validity revealed acceptable fit indices (GFI = 0.969, AGFI = 0.949, RMSEA = 0.052, AIC = 288.360). The reliability of the subscale was found good internal consistency (r = 0.67-0.79) and moderately high inter-rater reliability (r = 0.55-0.68). Those who perceived good "safety", "pleasing aesthetic" and "uncomfortable aesthetic" environments were significantly more likely to spent of physical activity during out-side of school for leisure and school commuting.Conclusion: The valid and reliable neighborhood physical activity environment scale was developed and it is applicable to the assessment of neighborhood environmental perceptions relevant to physical activity in Japanese elementary school children.

Most researches on sports spectators have concentrated on how to increase spectating frequencies and they have conducted surveys only on sports spectators. The potential spectator market was reported to be 39.3%, which is equivalent to the actual Japan' s spectators' market. Therefore, it is necessary to conduct research on potential spectators. In the Behavioral Science domain one of the most effective models is the Transtheoretical Model of behavior change (TTM) , which can be applied to various behaviors. The present study examined the application of the TTM to sports spectating behavior, especially in the case of several ball games held in a top sports league. In particular, questionnaires were administered to adults aged 20-69 to assess the reliability and validity of the stages of change for the sports spectating behavior scale. In study I, (reliability test) , data collected from 166 adults through the internet showed a good reliability among the 2-week test-retest [Kappa Index (κ) =.67] . Then, in study II, (validity test) , the relationship between the stages of behavioral changes of sports spectating and the degree of self-reported sports spectating behavior (the annual length of spectating time, intention of spectating) was investigated among adults in A city. The results revealed that sports spectating behavior significantly differentiated among the stages of change. Specifically, participants in the post-adoption stages (preparation, action, and maintenance) reported a significantly greater amount of annual sports spectating time compared to those in pre-adoption stages (pre-contemplation and contemplation) . Moreover, participants in pre-contemplation stages reported a significantly lower score in intention of spectating compared to those in other stages. The TTM, originally developed for various behaviors such as healthy and unhealthy ones, can be generalized for use in evaluating sports spectating behavior.

Purpose: In a rapid developing Internet society, eHealth literacy becomes important to promote eHealth and aid in health care among individuals and groups. However, little is known about eHealth literacy in Japan. The present study reviewed the concept and issues of eHealth Literacy to promote eHealth effectively through recent trends of eHealth literacy.<br>Methods: Medline, CINHAL, ERIC and "Igaku-chuo-zasshi" were searched for studies published in English and Japanese before September 30, 2011. "eHealth literacy", "e-Health literacy", "e- literacy", "eHEALS" and "Health literacy & Internet" were used as key words. A total of 161 publications were identified and 14 publications and 4 publications from reference lists met the inclusion criteria.<br>Results: Twelve publications introduced the Lily model of eHealth literacy developed by Norman et al. in 2006 as follows: the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. Furthermore, one study advocated the concept of eHealth literacy, three studies developed the scale of eHealth literacy and five studies examined the effect of eHelath literacy interventions and the eHealth literacy levels on people needing eHealth literacy.<br>Conclusion: Lily model of eHealth literacy is the most prevalent concept. It is necessary to revise the concept of eHealth literacy to include the skills of use Web 2.0 tools (e.g. Social Networking Service) in eHealth literacy and conduct the studies using the valid scale of eHealth literacy.

Background: Previous studies have shown associations of sedentary behavior with cardiovascular risk, independent of moderate-to-vigorous physical activity (MVPA). However, few studies have focused on older adults. This study examined the joint associations of television (TV) viewing time and MVPA with overweight/obesity among Japanese older adults.
Methods: A population-based, cross-sectional mail survey was used to collect self-reported height, weight, time spent in TV viewing, and MVPA from 1806 older adults (age: 65-74 years, men: 51.1%). Participants were classified into 4 categories according to TV viewing time (dichotomized into high and low around the median) and MVPA level (dichotomized into sufficient and insufficient by the physical activity guideline level of &gt;= 150 minutes/week). Odds ratios (ORs) for overweight/obesity (body mass index &gt;= 25 kg/m(2)) were calculated according to the 4 TV/MVPA categories, adjusting for potential confounders.
Results: Of all participants, 20.1% were overweight/obese. The median TV viewing time (25th, 75th percentile) was 840 (420, 1400) minutes/week. As compared with the reference category (high TV/insufficient MVPA), the adjusted ORs (95% CI) of overweight/obesity were 0.93 (0.65, 1.34) for high TV/sufficient MVPA, 0.58 (0.37, 0.90) for low TV/insufficient MVPA, and 0.67 (0.47, 0.97) for low TV/sufficient MVPA.
Conclusions: In this sample of older adults, spending less time watching TV, a predominant sedentary behavior, was associated with lower risk of being overweight or obese, independent of meeting physical activity guidelines. Further studies using prospective and/or intervention designs are warranted to confirm the presently observed effects of sedentary behavior, independent of physical activity, on the health of older adults.

Purpose: Patients with exercise capacity of &lt;5 metabolic equivalents (METs) are considered to have a high risk of death. The aim of this study was to determine age-related differences in physical activity associated with an exercise capacity of &gt;= 5 METs in chronic heart failure (CHF) outpatients. Methods: We enrolled 157 stable CHF patients (79.6% men, age 60.3 +/- 11.5 years). Patients were divided into two age-based groups (middle-aged, &lt;65 years, n = 97) and (older-aged, &gt;= 65 years, n = 60). Peak oxygen uptake (peak VO2) was assessed by cardiopulmonary exercise testing. We further divided patients into groups according to exercise capacity: &gt;= 5 METs and &lt;5 METs. Physical activity was assessed by measuring the average number of steps/day for 1 week with an electronic pedometer. Results: Receiver-operating characteristic curves were used to select cutoff values for steps associated with an exercise capacity of &gt;= 5 METs in the middle- and older-aged patients. Cutoff values of 6045 steps in the middle-aged and 6070 steps in the older-aged patients were determined. Conclusions: Both middle-and older-aged CHF patients with exercise capacity of &gt;= 5 METs completed approximately 6000 steps/day. This could become a target amount for minimal physical activity that could contribute to increased exercise capacity in CHF patients.

Engaging in physical activity was proved to have positive effects on physical and mental health in children. Built environment is an important correlate of physical activity participation. School recess provides a daily opportunity for children to be active during school day. Therefore, the purpose of the present article was to review literatures regarding 1) physical activity during school recess, 2) the relationship between recess physical activity and school physical environment, 3) intervention for physical activity promotion during recess by changing school physical environment, and to explore trends of current researches and assignments of future research. A review was conducted and included studies published to May 31, 2011. Twenty-two studies were selected in 1) and showed boys often engaged in more physical activity than girls, but the results on differences in physical activity between ages were inconsistent. Six studies were selected in 2) and indicated recess physical activity was associated with playground environments such as equipments, marking, and surface situate. School environment intervention was observed to be a potential method for promoting physical activity in children by 8 studies in 3). Playground environment with marking, additional play equipments, and designated activity zones increased physical activity during recess. Most researches regarding recess physical activity was conducted in U.S., Australia, and Western countries, and confirmed the effectiveness of recess to promote physical activity. However, few studies on this topic were conducted in Japan. Further researches are needed to draw a conclusion about the possibility of recess to promote physical activity among Japanese children.

Background: Depression, a common mental illness, has a high global incidence. Regular physical activity at recommended levels is inversely associated with depression
however, this association has not yet been studied in the Japanese population. The present study examines the association between recommended physical activity criteria and depression, and depression score differences between physical activity groups and sociodemographic variables among Japanese adults. Methods: Sociodemographic data (gender, age, educational level, employment status, marital status, living conditions, and household income), the Japanese short version of the International Physical Activity Questionnaire (IPAQ), and the Center for Epidemiologic Studies Depression Scale were used to estimate the participants' physical activity and depression levels, respectively, via an Internet-based survey. A representative sample of 3000 Japanese adults answered the survey, stratified by gender and age. The present study followed current Japanese exercise guidelines to categorize respondents as "meeting" or "not meeting" the recommended criteria. Analysis of covariance, logistic regression, and two-way univariate analysis of covariance were performed. Results: Respondents not meeting the recommendations for physical activity had significantly higher depression scores than those meeting the recommendations. Individuals not meeting the recommended criteria had significantly higher depression scores than those meeting the criteria across the following variables: age, marital status, living conditions, and household income in men
and age, marital status, education level, employment status, and household income in women. Men who were unmarried and had low household income levels and women who were young, unmarried, and had lower household income levels had higher depression scores. Conclusion: The present study is one of the first studies to report on the cross-sectional associations among depression scores, physical activity levels, and various sociodemographic factors in the Japanese population. © 2011 Elsevier Ltd. All rights reserved.

Background: Although both insufficient physical activity (PA) and high screen time (ST) are independent risk factors for obesity, how the combination of sufficient/insufficient PA and high/low ST could increase obesity risk among the adult population of Japan is not known. This study examined joint associations of PA and ST with overweight among Japanese adults.
Methods: An Internet-based survey collected data on height, weight, self-reported time spent in PA and ST, and sociodemographic variables from 2832 adults. Respondents were categorized into sufficient PA/low ST, sufficient PA/high ST, insufficient PA/low ST, or insufficient PA/high ST categories as per public PA guidelines and the median of ST. Logistic regression analysis examined the odds ratios (OR) of being overweight (body mass index, &gt;= 25 kg/m(2)) according to the categories of PA and ST.
Results: In comparison with the sufficient PA/low ST category, participants in the insufficient PA/high ST category were significantly more likely overweight (OR, 1.48; 95% confidence interval [95%CI), 1.14, 1.93) after adjusting for sociodemographic variables. A significantly higher OR for overweight (including obesity) among insufficient PA/high ST category was also observed in men, but no significant association was found in women.
Conclusions: Both insufficient PA and prolonged ST contribute to overweight and obesity among Japanese adults. Public health initiatives addressing obesity in Japan need to consider both promoting PA and reducing ST, especially in men.

To determine self-reported sleep quality-related differences in physical activity (PA) and health-related quality of life (HRQOL) and target values of PA for high-quality sleep in chronic heart failure (CHF) outpatients, 149 CHF outpatients (mean age 58 years) were divided into two groups by sleep-quality level determined via self-reported questionnaire: shallow sleep (SS) group (n = 77) and deep sleep (DS) group (n = 72). Steps were assessed by electronic pedometer, HRQOL was assessed with the Short Form 36 (SF-36) survey, and data were compared between groups. PA resulting in high-quality sleep was determined by receiver-operating characteristics curves. All SF-36 subscale scores except that of bodily pain were significantly decreased in the SS versus DS group. A cutoff value of 5723.6 steps/day and 156.4 Kcal/day for 1 week were determined as target values for PA. Sleep quality may affect PA and HRQOL, and attaining target values of PA may improve sleep quality and HRQOL of CHF outpatients. Patents relevant to heart failure are also discussed in this article. © 2011 Bentham Science Publishers.

Background: Although physical activity is associated with a lower risk of colon cancer, few studies have described the physical activity required for colon cancer prevention in various sociodemographic subgroups. The current study examined the prevalence and sociodemographic correlates of attaining the 2 recommended physical activity criteria for colon cancer prevention among Japanese adults. Methods: The sample included 5322 Japanese adults aged 20 to 79 years. Seven sociodemographic attributes (eg, gender, age, education level, employment status) and the International Physical Activity Questionnaire were assessed via an Internet-based survey. The odds of meeting each physical activity criterion by sociodemographic variables were calculated. Results: Overall, 23.8% of the study population met the criterion of &gt;= 420 minutes of moderate-intensity activity, and 6.4% met the criterion of &gt;= 210 minutes of vigorous activity. Being male, highly educated, employed, living with another person, being married and having a higher household income were significantly correlated with the attainment of recommendations. Conclusions: Participants who met the 2 activity recommendations differed in gender, education level, employment status, marital status, living conditions, and household income. The findings of the current study imply that strategies to promote more intense physical activity in all demographic groups may be necessary.

Objective: The purpose of this study was to clarify the process of shaping partnerships for developing and implementing a system of walking groups as a health promotion effort.Methods: We conducted a semi-structured interview with two public health nurses who were responsible for the IC-Walk program implemented by the Department of Health Promotion in M City and also performed document analysis regarding the program. Qualitative analysis was used to capture perspectives related to partnership formation processes by extracting codes, subcategories, and categories from interview transcripts and the documents.Results: Eighteen identified codes for shaping partnerships were grouped into nine subcategories ("mayors," "parties," "conferences," "groups," budget from sections beyond health," "subsidy," "private sector," "intersectoral collaboration within the government," and "intersectoral collaboration without the government"). Four categories were then abstracted: "political decision," "programs," "organization," and "budget". Finally, a structured model showed the relationships among the categories, taking into consideration the process of shaping partnerships.Conclusions: This study presented a structured model of the process of shaping partnerships for a municipal health promotion program. The model indicated that administrators' awareness and behavior contributed to the shaping of partnerships.

The authors examined the relationship between strength-training behavior and perceived environment in older Japanese adults. An Internet-based survey was conducted of 293 adults age 68.2 +/- 2.8 yr. The dependent variable was regular strength-training behavior. The IPAQ environment module, access to facilities for strength training, and home equipment for strength training were environmental factors. Logistic-regression analysis was employed. After demographic variables (gender, age, educational background, household income, body-mass index, self-rated health status, smoking habit, and residential area) were adjusted for, home equipment for strength training (OR = 2.14, 95% CI = 1.50-3.06), access to facilities for strength training (OR = 2.53, 95% CI = 1.32-4.85), and observing active people (OR = 2.20, 95% CI = 1.06-4.58) were positively correlated with regular strength-training behavior. In conclusion, environmental factors associated with strength-training behavior were access to facilities for strength training, having home equipment for strength training, and observing active people.

To examine differences in objective and subjective outcomes in outpatients undergoing percutaneous coronary intervention (PCI) performed for acute myocardial infarction versus cardiac surgery (CS) following a phase II cardiac rehabilitation (CR). Longitudinal observational study of 437 consecutive cardiac outpatients after 8 weeks of phase II CR. Patients were divided into the PCI group (n = 281) and CS group (n = 156). Handgrip and knee extensor muscle strength, peak oxygen uptake (VO2), upper- and lower-body self-efficacy for physical activity (SEPA), and physical component summary (PCS) and mental component summary (MCS) scores as assessed by Short Form-36 were measured at 1 and 3 months after PCI or CS. All outcomes increased significantly between months 1 and 3 in both groups. However, increases were greater in the CS versus PCI group in handgrip strength (+12.3 % vs. +8.1%, P &lt
0.01), knee extensor muscle strength (+19.3% vs. +17.5%, P = 0.008), peak VO2 (+20.9% vs. +16.9%, P &lt
0.01), upper-body SEPA (+27.7% vs. +9.2%, P = 0.001), and PCS score (+6.5% vs. +4.1%, P = 0.001). Although this relatively short-term phase II CR increased all outcomes for both groups, outcomes showed the recovery process was different between the PCI and CS groups, slightly favoring CS patients. Furthermore, patents in the field of CR are presented. © 2011 Bentham Science Publishers.

Although it is crucial to examine the environmental correlates of physical activity (PA) for developing more effective interventions for overweight populations, limited studies have investigated differences in the environmental correlates on body mass index (BMI). The purpose of the present study was to examine the perceived environmental correlates of PA among normal-weight and overweight Japanese men. Data were analyzed for 1,420 men (aged 44.4 +/- 8.3 years), who responded to an internet-based cross-sectional survey of answering the short version of the International Physical Activity Questionnaire and its Environment Module. Binary logistic regression analyses were utilized to examine the environmental factors associated with meeting the PA recommendation (150 minutes/week) between the normal-weight and overweight men. After adjusting for socio-demographic variables, common and different environmental correlates of PA were observed among normal-weight and overweight men. Furthermore, significant interactions regarding PA were observed between BMI status and two environmental correlates: access to public transportation (P = 0.03) and crime safety during the day (P = 0.01). The results indicated that BMI status is a potential moderator between perceived environmental factors and PA and suggested that different environmental intervention approaches should be developed for overweight populations.

Background Psychological, social, and environmental factors are important determinants for physical activity promotion. There are numerous studies of the direct effects of these factors on physical activity. However, only a few studies have been examined the direct and mediated effects of these factors on physical activity.
Purpose The purpose of the present study was to examine the direct and indirect influences of psychological, social, and environmental factors on physical activity among Japanese adults.
Methods An internet-based cross-sectional survey was conducted to 2,000 Japanese adults aged 20-79 years. Seven sociodemographic attributes (e. g., gender, age, and marital status), self-efficacy, pros and cons, social support for exercise and environmental variables (home fitness equipment, access to facilities, neighborhood safety, aesthetics, seeing others exercising) were assessed by a self-administered questionnaire. The physical activity was estimated from the Japanese version of the short form of the International Physical Activity Questionnaire. Data were analyzed using structural equation modeling by gender.
Results The respondents&apos; mean (SD) age was 43.6(13.0). Environmental factors had indirect effects on physical activity through self-efficacy, social support and pros and cons. On both gender, the strongest indirect effects was the path of environmental factors on physical activity through pros to self-efficacy. The total effects of environmental factors on physical activity were 0.06 of males and 0.04 of females.
Conclusion The results indicate that environmental factors had indirect effects on physical activity through psychological and social factors among Japanese adults. These results could contribute to the development of physical activity promotion strategies in Japan. (Jpn. J. Phys. Fitness Sports Med. 2011, 60 89 similar to 97)

OBJECTIVES:With the rapid developing an internet society, ehealth literacy, defined as the ability to seek, find, understand, and appraise and apply the knowledge gained to addressing or solving a health problem, becomes important to promote and aid health care at the individual level. However, the eHealth Literacy Scale (eHEALS) was only a scale developed to assess the ehealth literacy. Thus, the present study was conducted to evaluated the validity and reliability of a Japanese version of the eHEALS (J-eHEALS), and examine the association of ehealth literacy with demographic attributes and characteristics on health information searching among Japanese adults.;METHODS:Data were analyzed for 3,000 Japanese adults (males: 50.0%,mean age: 39.6 + 10.9 years) who responded to an Internet-based cross-sectional survey. The J-eHEALS, 6 demographic attributes, resources for obtaining health information (health resources), and contents of health information obtained from internet (ehealth contents) were obtained with a questionnaire. Confirmatory factor analysis and correlation with the communicative and critical health literacy scale were utilized to assess construct validity and criterion validity. Cronbach alpha and correlation coefficients were computed for internal consistency and test-retest reliability. Also, differences in J-eHEALS scores with each demographic attribute were examined with ANOVA and the independent t-test. Finally, chi-square tests were used to determine differences in the proportions of ehealth literacy groups (high or low) classified with a median split within health resources and ehealth contents.;RESULTS:Principal components analysis produced a single factor solution and confirmatory factor analysis for the 8-items model demonstrated high indices (GFI = .988, CFI = .993, RMSEA= .056). A significant positive correlation was found between the J-eHEALS and communicative and critical health literacy scores. Cronbach alpha was 0.93 (P < .01), and test-retest reliability was r = 0.63 (P < .01). The J-eHEALS scores were significantly higher in women, the 40-and 50-year age group, those with high income, and individuals with a high frequency of internet searching. Furthermore, the high ehealth literacy group used many health resources and obtained a greater variety of ehealth contents as compared with the low literacy group. The most frequent resource was the internet in the high group, and television/radio in the low group. However, these results could be subject to bias because of the non-representative nature of the Internet population.;CONCLUSION:The results indicate the J-eHEALS to be a highly validated and reliable scale. The present study suggests that enhancement of ehealth literacy will be important to utilize the increasing amount of health information on the internet effectively and appropriately.

BACKGROUND:Although physical activity is associated with a lower risk of colon cancer, few studies have described the physical activity required for colon cancer prevention in various sociodemographic subgroups. The current study examined the prevalence and sociodemographic correlates of attaining the 2 recommended physical activity criteria for colon cancer prevention among Japanese adults.;METHODS:The sample included 5322 Japanese adults aged 20 to 79 years. Seven sociodemographic attributes (eg, gender, age, education level, employment status) and the International Physical Activity Questionnaire were assessed via an Internet-based survey. The odds of meeting each physical activity criterion by sociodemographic variables were calculated.;RESULTS:Overall, 23.8% of the study population met the criterion of ≥ 420 minutes of moderate-intensity activity, and 6.4% met the criterion of ≥ 210 minutes of vigorous activity. Being male, highly educated, employed, living with another person, being married and having a higher household income were significantly correlated with the attainment of recommendations.;CONCLUSIONS:Participants who met the 2 activity recommendations differed in gender, education level, employment status, marital status, living conditions, and household income. The findings of the current study imply that strategies to promote more intense physical activity in all demographic groups may be necessary.

OBJECTIVES:According to the interim report "National Health Promotion in the 21st Century (Healthy Japan 21)", the Exercise and Physical Activity Guide for Health Promotion 2006 (EPAGH2006) is an im-portant resource in the field of physical activity in Japan. A previous study (Higo & Nakamura, 2008) showed that although the awareness level of EPAGH2006 was lower than for other health pro-motion policies (e.g., Healthy Japan 21), the proportion of people who walked regularly was higher in the EPAGH2006 awareness group than in the no-awareness group. This result indicates that pro-motion of EPAGH2006 would contribute to increase in the number of physically active people. The purpose of the present study was to identify longitudinal change in awareness of EPAGH2006, and to examine the relationship with levels of physical activity.;METHODS:The subjects were 1,100 Japanese adults (mean [SD], 39.8 [10.1 years) recruited from among the registrants of a Japanese social research company. This longitudinal study was conducted using online questionnaires in surveys in November 2007 (T1) and December 2008 (T2). The awareness level of EPAGH2006 was assessed with 3 choices, i.e., good understanding, awareness and no-awareness. The International Physical Activity Questionnaire short Version (Craig et al., 2003; Murase et al., 2002) was used to estimate the amount of physical activity that the subjects engaged in. The Mann-Whitney test was utilized to assess inter-group differences in changes in the amount of physical activity between the understanding and no-awareness groups.;RESULTS:The proportion of those who fully understood EPAGH2006 was 1.4% at T1 and 2.2%0 at T2 and did not significantly increase. The physical activity level in the understanding group at T2 was significantly decreased compared with the no-awareness groups at both T1 and T2 (p=0.013).;CONCLUSION:The lack of increase in the awareness level between the two time points suggests that dissemination of EPAGH2006 has not been effective. A more strategic approach would appear to be required. However, the results also did not indicate that the awareness level of EPAGH2006 had a positive in-fluence on physical activity. Further studies, conducted when the awareness levels improve, may elucidate the relationship between the levels of EPAGH2006 awareness and physical activity.

【目 的】<BR> 身体活動(PA)は, 生命予後あるいは健康関連QOL(HRQL)に関与する. 先行研究(2005)にて我々は, 回復期心臓リハビリテーション(リハ)におけるself-monitoring(自己監視)が維持期におけるPAの促進に貢献することを報告した. 一方, 入院期の患者教育の強化は, 退院後の再発予防に寄与することが知られている. そこで本研究では, "入院期の心疾患患者に対するPA促進のためのself-monitoringは, 退院後のPAを促進させる'という仮説を立て, それを検証すべく以下の検討を行った. <BR>本研究の目的は, 心疾患患者に対する入院期のself-monitoringが退院後のPAに及ぼす影響について検討することである. <BR>【方 法】<BR>1. 対象<BR>対象は, 2008年から2010年の間に当院リハ部に心大血管疾患にて依頼のあった入院患者連続1061例中, 病棟から運動療法室でのプログラムに移行後, 入院期(T1)においてPAの測定に同意が得られた心疾患患者351例である. 除外基準は, 1）年齢30歳未満, 2）診療記録より各指標の調査不能例, 3）重篤不整脈, 大血管疾患, 高次能機能障害および整形外科疾患を有する例である. この351例をself-monitoring(A)群と対照(B)群の2群に割り付けした. また351例中, A群64例およびB群62例の計126例に対し, 退院後(T2)在宅でのPAの測定を試みた.なお T2でのPAの測定は, 外来診察時から8日間施行した. <BR>2. 患者背景に関する情報<BR>年齢, 性, 基礎疾患, Body mass index(BMI), 左室駆出率(LVEF), 投薬内容など患者背景に関する情報は, 診療記録より調査した. また病前運動習慣の有無に関しては, 先行研究(2004)の基準に基づき調査した. なお退院日からPA測定までの期間(日数)は, 後述するLifecorder返却後に検者にて算出(PA測定日－退院日)された. <BR>3. PA<BR>PAの指標は歩数とした. 測定にはLifecorderを用い, その装着部位は腰部とした. 患者はT1およびT2において, それを入浴, 就寝中を除く24時間, 8日間装着した. 測定終了後, 検者は, 初日を除く7日間の歩数の平均値(日歩数)を算出した. <BR>4．self-monitoring<BR>検者は, T1でのPA測定後, PAのフィードバックと退院後のPAの目標設定をA群に対し行った. 患者は, それに基づき, 在宅でのPAを促すべくself-monitoringを施行するよう求められた. <BR>5. 解析<BR>両群における患者背景およびPAの差の検定には, T検定およびχ²<BR>検定を用いた.介入の有無によるT1とT2 におけるPAの変化は, 群と時期による二元配置分散分析を用いた. 統計学的有意差判定の基準は5%とした. <BR>【説明と同意】<BR> 本研究を計画するにあたり当大学生命倫理委員会の承認を得た(承認番号1480号). 実施に際しては, 対象者に本研究の趣旨を説明した後, 同意を得た. <BR>【結 果】<BR>1. 最終対象者<BR>126例中23例は, PAの測定あるいは解析が不能であり対象から除外した. 従って最終対象者は, A群52例, B群51例の計103例(急性心筋梗塞47例, 開心術後24例, 心不全32例, 年齢59.1歳, 男性82.5%)であった. <BR>2. 患者背景は,年齢, 性, 基礎疾患, BMI, LVEFおよび投薬内容において2群間に差はなかった。また, 病前運動習慣の有無についても2群間で差はなかった. 退院日からPA測定までの期間(日数)は, A群28.0日, B群26.1日(p＝0.66)であり差はなかった. <BR>3. PA<BR>T1での日歩数は, A群は4588.0歩, B群は5155.2歩(p＝0.21)で2群間に差はなかった. T2での日歩数は, A群は8609.6歩, B群は5512.9歩(p＜0.0001)にてA群はB群に比し高値を示した. またAB群間で, PAの変化に差があるのかを検討すべく, 分散分析を施行した.その結果, A群のPAにおいて時期の主効果(p<0.0001)および群×時期の交互作用(p<0.0001)を認めた.<BR>【考 察】<BR>本研究は, 入院期の心疾患患者に対しPAを促進するためのself-monitoringが, 退院後のそれに対する影響について検討した. 患者背景は, 2群間に差を認めなかった. また病前運動習慣の有無とPAの測定時期について調査した結果, 双方ともに両群間で差はなかった. 以上より, T1およびT2に対するPAの差異にこれらが影響する可能性は少ないものと考えられる.<BR>T1でのPAの平均値は, 4588.0から5155.2歩であり2 群間に差はなかった.しかし分散分析の結果, A群はB群に比しT2におけるPAは高値を示した. 以上より入院期の心疾患患者に対するPAを促進するためのself-monitoringの導入は, 退院後のPAの向上に少なからず貢献する可能性があるものと考えられる. <BR>本研究結果は, それが再発やHRQLおよび生命予後に直接寄与するか？については言及できない. したがって今後更なる検討を要するものと思われる. <BR>【理学療法学研究としての意義】<BR>本研究結果は心疾患患者に対する退院時の患者教育の一つとして, 運動指導方策の一助となる可能性がある. <BR>

【目的】<BR> 変形性膝関節症(膝OA)患者は加齢や膝痛のため、立ちすわりや歩行などの機能的バランス能力が低下する。高齢者の機能的バランス能力を評価するために臨床で最も簡便な評価方法として、Timed Up and Go test(TUG)が用いられている。TUGの遅延は歩行、階段昇降、屋外活動などの日常生活動作能力の低下を示す。しかしながら人工膝関節全置換術(TKA)患者のTUGの遅延が健康関連QOL(HRQOL)の回復過程に及ぼす影響については報告されていない。本研究の目的はTKA後におけるHRQOLの回復過程について術前の機能的バランス能力の影響について検討することである。<BR>【方法】<BR> 2008年8月から2010年6月までに当院でTKAを施行した膝OA患者40例を対象にした。運動器不安定症の診断基準である11秒をカットオフ値としてTUG11秒未満(TUG良好群)と11秒以上(TUG遅延群)に分けた。内訳はTUG良好群19例(70.8±6.8歳)、TUG遅延群21例(76.8±7.3歳)であった。HRQOLの評価指標として、準WOMACの痛みと機能、SF-36の下位8尺度である身体機能(PF)、日常役割機能－身体(RP)、体の痛み(BP)、全体的健康感(GH)、活力(VT)、社会生活機能(SF)、日常役割機能－精神(RE)、心の健康(MH)を用いた。評価時期は術前、術後1ヶ月(退院時)と3ヶ月(外来通院時)とした。<BR>統計解析は、各群の経時的変化は一元配置分散分析とBonferroni多重比較を、両群における各指標の比較は二元配置分散分析とBonferroni多重比較を用いて分析した。SPSS 15.0を用い、危険率の判定は、5％未満を有意とした。<BR>【説明と同意】<BR> 対象者に研究内容の説明文書を用いて口頭による説明を行い、研究参加への同意を書面にて得た。なお、本研究は当院生命倫理委員会の承認(0826)を受けて実施した。<BR>【結果】<BR> 各項目は術前(T1)→術後1ヶ月(T2)→術後3ヶ月(T3)の順に平均値で示した。TUGではTUG良好群は9.4→9.7→8.6秒、TUG遅延群は15.6→14.5→12.2秒であり、各群間においてT1とT3、T2とT3で有意に改善した。TUG良好群とTUG遅延群の経時的変化の間では、交互作用を示した。TUG良好群とTUG遅延群に群間差を示し、T1からT3、T2からT3で測定時間が短縮した。<BR> 準WOMACの痛みではTUG良好群は50.3→59.2→75.0点、TUG遅延群は39.2→57.3→75.7点であり、TUG良好群ではT1とT3、T2とT3で有意に痛みが軽減し、TUG遅延群ではそれに加えてT1とT2においても有意に軽減した。準WOMACの機能ではTUG良好群は74.8→68.5→80.8点、TUG遅延群は52.7→62.0→72.6点であり、TUG良好群ではT2とT3で有意に機能が向上し、TUG遅延群ではそれに加えてT1とT3においても有意に向上した。TUG良好群とTUG遅延群の経時的変化の間では、交互作用を示した。TUG良好群とTUG遅延群に群間差を示し、T1からT3、T2からT3で機能が向上した。<BR> SF-36のPFではTUG良好群は39.9→54.6→54.6点、TUG遅延群は36.0→52.7→52.7点であり、両群においてT1と比較してT2とT3に有意な改善を示した。BPではTUG良好群は43.3→50.9→50.9点、TUG遅延群は29.5→55.1→55.1点であり、TUG良好群ではT1と比較してT2とT3で改善傾向を示したが、TUG遅延群では有意な向上を示した。GHではTUG良好群は53.0→63.7→63.7点、TUG遅延群は51.8→58.0→58.0点であり、TUG良好群ではT1と比較してT2とT3で有意な改善を示し、TUG遅延群では有意差を認めなかった。SFではTUG良好群は66.4→75.7→75.7点、TUG遅延群は49.4→67.3→67.3点であり、TUG良好群では有意差を認めなかったが、TUG遅延群ではT1と比較してT2とT3で有意な改善を示した。なお、SF-36でのRP、VT、RE、MHの下位尺度項目では、経時的な群間差を認めなかった。<BR><BR>【考察】<BR> 膝の痛みと機能に関しては、術前に機能的バランス能力が低い患者は、改善効果が高いことが示唆された。術前に機能的バランス能力が高い患者ではTKAと術後リハにより、自覚的にも健康を感じることができる。それに対して、術前に機能的バランス能力が低い患者ではTKAと術後リハにより、社会的交流が向上することが明らかとなった。<BR><BR>【理学療法学研究としての意義】<BR> 理学療法はHRQOLの向上に貢献したものと考える。TKA術前の機能的バランス能力の状態により、TKA術後の回復過程や改善項目が異なる。理学療法アプローチ方法を検討する必要があると考える。<BR>

[Purpose] This study aimed to evaluate patients' recovery process of physical function and Health-Related Quality of Life (HRQOL) after Total Knee Arthroplasty (TKA). [Subjects] The subjects were 40 knee osteoarthritis patients in TKA rehabilitation. [Methods] The Timed-Up-and-Go test (TUG), the knee extensor strength, and one-leg standing (OLS) time with open eyes were measured. The Modified-WOMAC and the SF-36 were used for evaluation of HRQOL. [Results] All the scores, including the Modified-WOMAC pain score and the SF-36 scores of physical functioning, bodily pain, general health perceptions and social functioning at one month post-TKA and the Modified-WOMAC knee function score at three months post-TKA, were significantly improved. All the scores regarding physical function and HRQOL were significantly negatively correlated in terms of changes and initial values, except the OLS time with open eyes. [Conclusion] These results suggest that HRQOL improves within one month following TKA, and that physical function improves within three months after TKA.

Objective:The present study examined physical activity(PA)levels and differences in PA by gender and grades during school recess periods. Method:PA levels of two hundred and thirty children(55% boys, 42%younger)from two elementary schools in Japan were measured with accelerometry for seven consecutive days. Time spent in sedentary, light PA, moderate PA, vigorous PA during break(25 minutes)and lunch recess(15 minutes), and total recess(40 minutes)was determined. Two-way analysis of variance was used to examine differences in PA variables by gender and grades. Results:Data of one hundred and eighty four children(52% boys, 56% younger)was available. Time spent in sedentary, light PA, moderate PA, and vigorous PA was 8.5±4.9, 12.9±3.8, 1.6±1.2, and 2.9±2.8 minutes during break, and 3.5±2.5, 9.5±2.2, 1.4±0.9, and 1.6±1.4 minutes during lunch recess, respectively. There were no significant interactions between gender and grades. Significant main effects of PA variables were found for gender and grades. Boys had fewer sedentary time(p=0.017)and higher vigorous PA time(p<0.001)than girls during total recess. Younger engaged in more sedentary(p=0.045)and less light(p=0.023)and moderate PA(p=0.006)than older at break. On the other hand, at lunch recess, younger had significantly longer light(p=0.015)and vigorous PA(p<0.001)and shorter sedentary time(p<0.001)than older. Conclusion:Overall, boys were less sedentary and engaged in PA at higher intensity levels than girls during school recess. Different pattern in PA was shown between break and lunch recess by grades.

The present case study evaluated an environment-focused project for promoting walking, which included the development of walking courses (using public spaces, parks, roads) with stations for smart cards in the community and an interfaced internet-based self-monitoring system. The project was started in 2008 in Misato City of Saitama Prefecture. In this project, individuals can participate by paying a registration fee (500 yen) and obtaining their own cards. If registrants walk the course, holding their cards over a scanner at 3-4 stations, the smart card records their data (e.g. distance and time spent in walking) from one to the other station and transfers these to a self-monitoring system. As a result, registrants could check their data online. From June 2008 to November 2009, a total of 631 individuals (62% female) who obtained the information from newspaper, magazines, website, or some local events, registered for this project. From walking data collected automatically in the database through the self-monitoring system, it was found that 445 registrants (63% female) used this system at least once, and most of the registrants were 40 years old or more. This suggests that the project in this study might have been effective in promoting walking only among older people. Also, most of the registrants lived around the courses. In particular, the courses in the area surrounded by beautiful nature and residential areas were often used. To expand this idea to other age groups, new attempts, including a point supplying system based on the distance of walking are under development.

&lt;B&gt;Purpose&lt;/B&gt; : To understand the factors associated with the initiation and maintenance of strength training among older people, a qualitative approach would be useful. The purpose of the present study was to explore the initiation processes involved in strength training, and the facilitators and barriers to maintain strength training among people aged 60-74 years.&lt;BR&gt;&lt;B&gt;Methods&lt;/B&gt; : Semi-structured interviews were conducted with 15 members of a sports club. The interview consisted of questions related to initiation processes, facilitators, and barriers of strength training. Transcripts of the interviews were reviewed and categorizations were conducted.&lt;BR&gt;&lt;B&gt;Results&lt;/B&gt; : The initiation processes consisted of &quot;coping with physical inactivity or health problems,&quot; &quot;encouragement from others,&quot; &quot;increase in leisure time,&quot; &quot;feeling good program,&quot; &quot;interests in physical activity,&quot; and &quot;enjoyment of other sports,&quot; The common categories between facilitators and barriers were &quot;physical factors,&quot; &quot;psychological factors,&quot; &quot;social factors,&quot; and &quot;environmental factors.&quot; In addition, &quot;daily life factors&quot; and &quot;other factors&quot; were categorized as facilitators, and &quot;unco

The purpose of this study was to develop a Social Support Scale for Sports and to clarify the differences in evaluations of social support according to differences in the frequency of participation in sports.<BR>    The survey was carried out by a questionnaire mailed to 5,000 people aged 18 and over, randomly selected from the Basic Resident Register in "city A" .<BR>    Using factor analysis, 2 factors were extracted : "instrumental support" and "emotional support." The results showed that both factors' social support scores showed higher values as the participation in sports became more frequent. <BR>    The results suggest that the Social Support Scale for Sports has validity for sports.

The present case study evaluated an environment-focused project for promoting walking, which included the development of walking courses (using public spaces, parks, roads) with stations for smart cards in the community and an interfaced internet-based self-monitoring system. The project was started in 2008 in Misato City of Saitama Prefecture. In this project, individuals can participate by paying a registration fee (500 yen) and obtaining their own cards. If registrants walk the course, holding their cards over a scanner at 3-4 stations, the smart card records their data (e.g. distance and time spent in walking) from one to the other station and transfers these to a self-monitoring system. As a result, registrants could check their data online. From June 2008 to November 2009, a total of 631 individuals (62% female) who obtained the information from newspaper, magazines, website, or some local events, registered for this project. From walking data collected automatically in the database through the self-monitoring system, it was found that 445 registrants (63% female) used this system at least once, and most of the registrants were 40 years old or more. This suggests that the project in this study might have been effective in promoting walking only among older people. Also, most of the registrants lived around the courses. In particular, the courses in the area surrounded by beautiful nature and residential areas were often used. To expand this idea to other age groups, new attempts, including a point supplying system based on the distance of walking are under development.

Purpose : To understand the factors associated with the initiation and maintenance of strength training among older people, a qualitative approach would be useful. The purpose of the present study was to explore the initiation processes involved in strength training, and the facilitators and barriers to maintain strength training among people aged 60-74 years.<BR>Methods : Semi-structured interviews were conducted with 15 members of a sports club. The interview consisted of questions related to initiation processes, facilitators, and barriers of strength training. Transcripts of the interviews were reviewed and categorizations were conducted.<BR>Results : The initiation processes consisted of "coping with physical inactivity or health problems," "encouragement from others," "increase in leisure time," "feeling good program," "interests in physical activity," and "enjoyment of other sports," The common categories between facilitators and barriers were "physical factors," "psychological factors," "social factors," and "environmental factors." In addition, "daily life factors" and "other factors" were categorized as facilitators, and "uncontrollable factors" were categorized as barriers.<BR>Discussion : These results indicate that 1) the initiation of strength training would be associated with interests in health problems and physical activity, increase of leisure time, encouragement from others, or presence of a good program, and that 2) the maintenance of strength training would be associated with environmental factors and daily life factors as well as physical and psychosocial factors.

Objectives According to the interim report "National Health Promotion in the 21st Century (Healthy Japan 21)", the Exercise and Physical Activity Guide for Health Promotion 2006 (EPAGH2006) is an important resource in the field of physical activity in Japan. A previous study (Higo & Nakamura, 2008) showed that although the awareness level of EPAGH2006 was lower than for other health promotion policies (e.g., Healthy Japan 21), the proportion of people who walked regularly was higher in the EPAGH2006 awareness group than in the no-awareness group. This result indicates that promotion of EPAGH2006 would contribute to increase in the number of physically active people. The purpose of the present study was to identify longitudinal change in awareness of EPAGH2006, and to examine the relationship with levels of physical activity.<br/>Methods The subjects were 1,100 Japanese adults (mean [SD], 39.8 [10.1] years) recruited from among the registrants of a Japanese social research company. This longitudinal study was conducted using online questionnaires in surveys in November 2007 (T1) and December 2008 (T2). The awareness level of EPAGH2006 was assessed with 3 choices, i.e., good understanding, awareness and no-awareness. The International Physical Activity Questionnaire short Version (Craig et al., 2003; Murase et al., 2002) was used to estimate the amount of physical activity that the subjects engaged in. The Mann-Whitney test was utilized to assess inter-group differences in changes in the amount of physical activity between the understanding and no-awareness groups.<br/>Results The proportion of those who fully understood EPAGH2006 was 1.4% at T1 and 2.2% at T2 and did not significantly increase. The physical activity level in the understanding group at T2 was significantly decreased compared with the no-awareness groups at both T1 and T2 (p=0.013).<br/>Conclusion The lack of increase in the awareness level between the two time points suggests that dissemination of EPAGH2006 has not been effective. A more strategic approach would appear to be required. However, the results also did not indicate that the awareness level of EPAGH2006 had a positive influence on physical activity. Further studies, conducted when the awareness levels improve, may elucidate the relationship between the levels of EPAGH2006 awareness and physical activity.

BACKGROUND: Recent research has revealed the importance of neighborhood environment as a determinant of physical activity. However, evidence among elderly adults is limited. This study examined the association between perceived neighborhood environment and walking for specific purposes among Japanese elderly adults. METHODS: This population-based, cross-sectional study enrolled 1921 participants (age: 65-74 years, men: 51.9%). Neighborhood environment (International Physical Activity Questionnaire Environmental Module) and walking for specific purposes (ie, transportation or recreation) were assessed by self-report. Multilevel logistic regression analyses with individuals at level 1 and neighborhoods at level 2 were conducted to examine the association between environment and walking, after adjustment for potential confounders. RESULTS: Access to exercise facilities, social environment, and aesthetics were associated with total neighborhood walking. Odds ratios (95% CI) were 1.23 (1.00-1.51), 1.39 (1.14-1.71), and 1.48 (1.21-1.81), respectively. Regarding walking for specific purposes, social environment and aesthetics were consistent correlates of both transportation walking and recreational walking. Environmental correlates differed by specific types of walking and by sex. Transportation walking significantly correlated with a greater variety of environmental attributes. Sex differences were observed, especially for transportation walking. Bicycle lanes, crime safety, traffic safety, aesthetics, and household motor vehicles were significant correlates among men, while access to shops, access to exercise facilities, and social environment were important among women. CONCLUSIONS: Specific environment-walking associations differed by walking purpose and sex among elderly adults. Social environment and aesthetics were consistent correlates of both transportation walking and recreational walking. Improving these environmental features might be effective in promoting physical activity among elderly Japanese.

The purpose of this study was to evaluate the effects of a group-based walking program on physical activity and mediators of activity in middle-aged and older adults. Fifty-six community residents (mean age = 60.3 years) participated in either a walking program (WP: n = 39) or health information program (IP: n = 17) for 2 months. The WP included: 1) instruction in walking technique; 2) participating in group walks; and 3) practicing behavioral skills. The IP consisted of: 1) information about the importance of diet and physical activity; 2) participating in easy exercise; and 3) practicing behavioral skills. After the programs, participants were provided a daily self monitoring and goal setting sheet to be completed over a 4-month period. Letters were sent to participants four times during the follow-up period. Physical activity and mediators of activity were assessed at baseline, 2 months, and 6 months. For the WP participants, daily step count and moderate and vigorous physical activity significantly increased during the 6-month period. There was a significant group-by-time interaction for physical activity, but no interaction for mediators of activity. These results suggest that the group-based walking program played an important role in increasing daily physical activity.<br>

[Purpose] This study aimed to evaluate patients' recovery process of physical function and Health-Related Quality of Life (HRQOL) after Total Knee Arthroplasty (TKA). [Subjects] The subjects were 40 knee osteoarthritis patients in TKA rehabilitation. [Methods] The Timed-Up-and-Go test (TUG), the knee extensor strength, and one-leg standing (OLS) time with open eyes were measured. The Modified-WOMAC and the SF-36 were used for evaluation of HRQOL. [Results] All the scores, including the Modified-WOMAC pain score and the SF-36 scores of physical functioning, bodily pain, general health perceptions and social functioning at one month post-TKA and the Modified-WOMAC knee function score at three months post-TKA, were significantly improved. All the scores regarding physical function and HRQOL were significantly negatively correlated in terms of changes and initial values, except the OLS time with open eyes. [Conclusion] These results suggest that HRQOL improves within one month following TKA, and that physical function improves within three months after TKA.

[Purpose] The aim of the present study was to examine the relationship between walking behavior and psychological and environmental factors among patients with severe diabetes mellitus. [Methods] Twenty-two people (mean age 55.3 years) completed a questionnaire during educational hospitalization. Measured variables included the stage of change for walking behavior, self-efficacy for walking behavior, time spent in walking behavior, the Problem Areas In Diabetes survey (PAID), hospital anxiety and depression scale (HADS), and the International Physical Activity Questionnaire Environmental module (IPAQ-E). [Results] The total time spent in walking showed a significant positive correlation with self-efficacy for walking behavior, and a significant negative correlation with depression mood. [Conclusion] The results indicate that intervention approaches enhancing self-efficacy for walking behavior and reducing depressive mood might be effective for walking promotion among patients with severe diabetes mellitus.

Background: An understanding of the contributing factors to be considered when examining how individuals engage in physical activity is important for promoting population-based physical activity. The environment influences long-term effects on population-based health behaviors. Personal variables, such as self-efficacy and social support, can act as mediators of the predictive relationship between the environment and physical activity. The present study examines the direct and indirect effects of environmental, psychological, and social factors on walking, moderate-intensity activity excluding walking, and vigorous-intensity activity among Japanese adults.
Methods: The participants included 1,928 Japanese adults aged 20-79 years. Seven sociodemographic attributes (e. g., gender, age, education level, employment status), psychological variables (self-efficacy, pros, and cons), social variables (social support), environmental variables (home fitness equipment, access to facilities, neighborhood safety, aesthetic sensibilities, and frequency of observing others exercising), and the International Physical Activity Questionnaire were assessed via an Internet-based survey. Structural equation modeling was conducted to determine associations between environmental, psychological, and social factors with physical activity.
Results: Environmental factors could be seen to have indirect effects on physical activity through their influence on psychological and social variables such as self-efficacy, pros and cons, and social support. The strongest indirect effects could be observed by examining the consequences of environmental factors on physical activity through cons to self-efficacy. The total effects of environmental factors on physical activity were 0.02 on walking, 0.02 on moderate-intensity activity excluding walking, and 0.05 on vigorous-intensity activity.
Conclusions: The present study indicates that environmental factors had indirect effects on walking, moderate-intensity activity excluding walking and vigorous-intensity activity among Japanese adults, especially through the effects on these factors of self-efficacy, social support, and pros and cons. The findings of the present study imply that intervention strategies to promote more engagement in physical activity for population-based health promotion may be necessary.

The purpose of this study was to explore patterns of lifestyle walking behavior among Japanese adults aged 30-49 and to identify their sociodemographic characteristics
A sample of 5,009 was collected from registrants of a social research company The study was a cross-sectional survey using the Internet Measured variables were walking behavior in five domains (commuting, working, shopping, exercising and other movement) and sociodemographic characteristics Hierarchical cluster analysis was utilized to identify walking patterns
Four walking behavior clusters were identified cluster 1 (N=1.089) walking while commuting, working and shopping, cluster 2 (N=381) walking while commuting. cluster 3 (N=1,257) walking for exercise. cluster 4 (N=1,161)walking while shopping Cluster I had the highest proportion of walkers who met physical activity recommendations Also it had a high proportion of women who were unmarried, employed, without children, or finished university or graduate school Cluster 2 showed a high proportion of men who were married, with children, with high household income, or finished university or graduate school, and women who were married. employed, without children, with high household income, or finished university or graduate school Cluster 3 had a high proportion of women aged 40-49 Cluster 4 showed a low proportion of men with high household income and a high proportion of women who were married. unemployed, or with children
This study indicated that walking behavior patterns in both genders was different depending on marital status, number of children, educational level and household income In addition, the employment status of women had apparent effects on these patterns (Jpn J Phys Fitness Sports Med 2010. 59 : 323 similar to 332)

Background: Understanding the long-term effects of environment on health behavior is important for the promotion of population-based physical activity.
Purpose: The purpose of this study was to examine the relationship between perceived environment and active commuting among Japanese adults.
Methods: Internet-based cross-sectional survey were conducted to 3,000 Japanese adults aged 30-59 years. Seven sociodemographic attributes (gender, age, marital status, employment status, living status, educational attainment and household income), type of commute and International Physical Activity Questionnaire Environment Module were assessed by self-administered questionnaire.
Results: Of all respondents to the survey, 2,032 (mean age: 43.8 +/- 9.2, male: 62.5%) were employed. Those who use an active commute were 1,401 (68.9%). In both genders, high residential density (male: OR=2.28, female: OR=3.08), good access to shops (OR=2.03, 3.06), public transportation (OR=1.65, 3.78), recreational facilities (OR=1.31, 1.44), presence of sidewalks (OR=1.42, 1.77), crossroads (OR=1.87, 1.76), having a destination (OR=1.84, 2.34), and not having household vehicles (OR=15.13, 41.24) were associated with an active commute. The results indicated some gender differences. Among male, the presence of a bicycle lane and good aesthetics was positively associated with the active commute, while traffic safety was negatively associated. On the-other hand, crime safety was associated with the active commute in female.
Conclusion: The results indicate that perceived environment was associated with the active commute among Japanese adults. (Jpn. J. Phys. Fitness Sports Med. 2010, 59: 215 similar to 224)

PURPOSE:Although a foot care program for long-term care prevention has been launched in Japan, few studies have examined its effectiveness. The purpose of the present investigation was to examine the association of foot problems with fall experience and fear of falling among Japanese community-dwelling elderly people.;METHODS:The participants were 10,581 community-dwelling elderly people (75.2 +/- 5.6 years) and the study design was cross-sectional using a questionnaire. Self-reported tinea pedis, skin problems (inflammation, swelling, or discoloration), nail problems (thickening or deformities), impairment (in function or blood flow), regular foot care, and wearing of appropriate shoes were selected as parameters of foot problems and their care. Logistic regression analysis was conducted to examine whether these were related to fall experience (in the past 1 year) and fear of falling adjusted for age, the Tokyo Metropolitan institute of gerontology index of competence, medical conditions, and lower limb functions.;RESULTS:Forty-six percents of males and 39.0% of females reported at least one foot problem. After adjusting for covariates, tinea pedis (male: adjusted odds ratio = 1.37[95% confidence interval= 1.15-1.63], female: 1.29[1.08-1.53]), skin problems (male: 1.66[1.32-2.101, female: 1.37[1.13-1.66]), nail problems (male: 1.72[1.45-2.051, female: 1.48[1.26-1.74]), and functional impairment (male: 2.42[1.91-3.05], female: 1.66[1.36-2.04]) were significantly associated with fall experience. Also, each problem was negatively associated with fear of falling (tinea pedis[male: 1.37 [1.15-1.62], female: 1.25[1.07-1.47]], skin problems[male: 1.42[1.13-1.801, female: 1.62[1.34-2.00]], nail problems[male: 1.41[1.19-1.68], female: 1.46[1.25-1.70]], functional impairment [male: 2.05[1.61-2.60], female: 2.10[1.69-2.60]]). In addition, regular foot care (0.81[0.71-0.921) was a significant correlate of fear of falling in females.;CONCLUSIONS:These results imply that focusing on foot problems (i.e., tinea pedis, skin problems, nail problems, functional impairment) would be one of means for fall preventions. Well-designed prospective studies evaluating foot problems objectively are now needed to confirm the relationships indicated by this study.

【目 的】<BR>睡眠の質の低下は,不安や抑うつに影響する要因として知られている.大学生を対象とした先行研究において荒井ら(2006)は,身体活動（PA)が主観的な睡眠の質と部分的に関連することを示した. また, Izawa et al(2004）は,日常生活におけるPAの高低は,心疾患患者の健康関連QOL(HRQOL)に関連することを報告している. 以上より睡眠の質の程度は,PAやHRQOLに少なからず影響を及ぼす可能性があるものの,慢性心不全(CHF)患者における睡眠の質の違いがそれらに及ぼす影響については明らかではない. 本研究の目的は,睡眠の質の相違がPAおよびHRQOLに及ぼす影響について検討し,CHF患者に対する生活指導のための方策を得ることである.<BR>【方 法】<BR>1.対象<BR>対象は,2004年11月から2009年5月の間に当院リハ部に心肺運動負荷試験(CPX)目的に来院した連続979件のうち,除外基準を除き, かつ睡眠の質に関する調査,PAおよびHRQOLの測定に同意が得られた外来通院中のCHF患者161例である. 除外基準は1）年齢30歳未満,2）NYHA心機能分類 IV度,3）診療記録より各指標の調査不能例,4）重篤不整脈,残存大動脈瘤,高次能機能障害,呼吸器疾患を有する例である. <BR>2.患者背景<BR>年齢, 性, 基礎疾患, 最近のアルコール摂取の有無および投薬内容など患者背景に関する情報および左室駆出率など各指標は, 診療記録より調査した。<BR>3.睡眠の質に関する調査<BR>睡眠の質に関する調査は,自己記入式にて行った. その内容は1）「どちらかというと浅い眠り」, 2）「どちらかというと深い眠り」である. 判定方法は二者択一である. 調査終了後,全対象者は,睡眠が浅い群(A群)と睡眠が深い群(B群)の2群に選別された. <BR>4.PA<BR>本研究におけるPAの指標は歩数と消費カロリーとした. 測定にはLifecorderを用い, その装着部位は腰部とした. <BR>患者はそれを入浴，就寝中を除く24時間，連続8日間装着した。測定終了後検者は, 初日を除く7日間の歩数および消費カロリーの平均値(日歩数およびkcal)を算出した. <BR>5HRQOL<BR>HRQOLの指標には, SF-36日本語版を用いた. 本研究では, SF-36の身体的側面(PCS)と精神的側面(MCS)のサマリースコアをHRQOLの指標とした.<BR>6.解析<BR>各指標は平均値±標準偏差で示した. 両群における患者背景および睡眠の質の違いによるPAとHRQOLの差の検定には, 正規性を確認した後, T検定およびカイ二乗検定を用いた. 睡眠の質の相違によるPAとHRQOLのカットオフ値の算出にはROC曲線を用いた. なお統計学的判定の有意水準は5%とした.<BR>【説明と同意】<BR>本研究を計画するにあたり当大学生命倫理委員会の承認を得た(承認番号340号). 実施に際しては,全対象者に本研究の趣旨を説明した後,書面にて同意を得た.<BR>【結 果】<BR>1.最終対象者<BR>161例中12例は,PAの連続測定あるいはHRQOLの解析が不能であり対象から除外した. 従って最終対象者は,149例(年齢57.7歳,男性85%)であった. <BR>2.患者背景は,アルコール摂取のみA群 はB群 に比し高い割合を示した(59% vs.40%,カイ二乗=6.18,p=0.01). なお, その他の指標に差は認めなかった.<BR>3.PA <BR>日歩数は, A群は5543.6±2410.3, B群は6815.0±2794.7日歩数(t=-2.97,p<0.001)であった. 消費カロリーは,A群は161.7±101.1, B群は199.9±113.4 kcal(t=-2.09,p=0.03)であり,PAは両指標ともにA 群はB群に比し低値を示した.<BR>4.HRQOL<BR>PCSは,A群は46.2±8.0, B群は45.9±7.2(t=0.22,p=0.82)であった. MCSは A群は46.1±10.0, B群は52.6±8.4(t=-4.21,p<0.001)であり,HRQOLのMCSにおいてA群はB群に比し低い値を示した. <BR>5.各指標のカットオフ値<BR>睡眠の質(どちらかというと深い眠り)をアウトカム, 日歩数, 消費エネルギーおよびMCSを独立変数とした場合の各指標のカットオフ値は, 日歩数(5723.6 歩), 消費エネルギー(156.4kcal)およびMCS(48.9)であった. <BR>【考 察】<BR>患者背景に関しては, 睡眠の質の相違はアルコール摂取の有無を除く各指標において差を認めなかった. 以上よりCHF患者におけるアルコール摂取の有無は, 睡眠の質に関わる一要因となりうるものと考えられる. <BR>また, 睡眠の質の相違はPAやHRQOLのMCSに差異を生じることが明らかとなった. すなわち,睡眠の質の低下は患者のPAに加え, HRQOLのうち精神的側面の低下に影響する可能性がある. さらに,睡眠の質からみたCHF患者のPAおよびHRQOLの目標値は, それぞれ日歩数(5723.6歩),消費エネルギー(156.4kcal)およびMCS(48.9)が望ましいと考えられた. <BR>【理学療法学研究としての意義】<BR>睡眠の質はCHF患者のPAおよび精神的側面の低下にも影響する可能性がある. 本研究結果は,睡眠の質の相違がアルコール摂取, PAおよびHRQOLの精神的側面に少なからず影響を及ぼすことを示した. 以上より,CHF患者に対する生活指導方策の一助となるものと思われる. <BR>

【目的】人工膝関節置換術(Total Knee Arthroplasty;以下TKA)後は,筋力など身体機能の回復だけでなく,術後の疼痛の程度に左右される印象を持つ.我々は「自分自身で痛みをうまく管理する」といった痛み対処方略(pain coping strategy)に着目した.入院生活とは異なる自宅生活での機能改善と痛み対処方略の関連を把握することは退院時指導のヒントとなる.そこで我々は、TKA後3カ月の身体機能および患者の痛み対処方略がどのように変化し,痛み対処方略の変化が及ぼす術後の身体機能との関連を検討した.<BR>【方法】対象は当院にて変形性膝関節症に対しTKAを施行した患者22名23脚(平均年齢72.8±6.8歳, BMI27.8±4.6kg/m²)であった.測定項目は等尺性膝伸展筋力体重比(機器:アニマ社製μ-tas), Timed up and go test(以下TUG),10m歩行時間であった.調査項目は日本版変形性膝関節患者機能評価表（Japanese Knee Osteoarthritis Measure:以下JKOM ),痛みの評価はVisual Analogue Scale(以下VAS)とした.痛み対処方略の評価はCoping Strategy Questionnaire日本版(以下CSQ),認知面からみた身体活動の評価に,歩行に関するself efficacy(以下歩行SE),疼痛がどの程度軽減できるかという対処方略の全体評価に,痛みに対するself efficacy(以下疼痛SE)を採用した.CSQのうち認知的対処方略には,「注意の転換」,「思考回避」,「自己教示」,「無視」,「願望思考」,「破滅思考」の下位尺度があり,行動的対処方略には,「痛み行動の活性化」と「他の行動の活性化」の下位尺度がある.得点が高いほどその対処方略を採用していることを示す (最高12点,最低0点) .測定時期は術前と術後約3ヶ月であった.統計学的解析は,各項目の前後の差の検定にはWilcoxonの符号付き順位検定を,各項目の変化量と痛み対処方略の変化との関連には単回帰分析を使用し,有意水準は5％未満とした.<BR>【説明と同意】本研究は聖マリアンナ医科大学倫理委員会の承認を得て実施された.（承認番号第1313号）<BR>【結果】術前→術後の順に中央値(四分位偏差)で示す.術側膝伸展筋力体重比は0.26(0.09)→0.27(0.06)kgf/kg,非術側は0.35(0.08)→0.36（0.06）kgf/kgであった.TUGは10.98(2.33)→9.84(2.13)秒,10m歩行時間は9.28(2.29)→7.98(1.08)秒であった.JKOMは46(17)→27(9)であった. VASは59.5(17.75)→13.5(19)であった.有意な改善は10m歩行時間,JKOM，VASでみられた (p＜0.01) . CSQは「注意の転換」4(2.5)→3(2.5),「思考回避」6(2.5)→3(2.5),「自己教示」10(3.5)→5(2.5),「無視」6(1.5)→3(2.5),「願望思考」8(4)→5(3.5),「破滅思考」4(2)→2(2),「痛み行動の活性化」5(2)→5(3),「他の行動の活性化」9(2)→4(2)となり,CSQの各下位項目のうち注意の転換,思考回避,自己教示,無視,願望思考,他の行動の活性化で術前後に有意な変化がみられた.歩行SEは14(3.5)→19.5(3.25）、疼痛SEは6(0.5)→8(1.5)となり,有意に改善した(p＜0.05).歩行SEおよび疼痛SE,JKOMを従属変数とし,各身体機能,VAS,CSQ下位項目の変化量を独立変数とした単回帰分析では有意差を認めなかった.<BR>【考察】術後3カ月ではVASや10m歩行時間,JKOMの改善とともに痛み対処方略の採用そのものが減少していた.TKAによる疼痛軽減、術後の疼痛コントロールがなされ,身体機能や日常生活動作の改善が示された.一方,膝伸展筋力やバランス評価では術前後で有意な変化はみられなかった.TKA後の経過は,身体機能の改善よりも疼痛の程度が生活の改善に関与していることが示唆された.更に,改善に影響を及ぼした因子を検討するため解析を行ったが,特徴的なものは示されなかった.CSQ下位項目は個人ごとに傾向が異なるため,さらに因子内でのグループ化など詳細な検討が必要である.<BR>【理学療法学研究としての意義】臨床の疼痛管理では,患者自身の疼痛に対する認知の把握やその活用はほぼ行われていない.早期退院が推奨される現状において,患者自身の自己管理は重要となり,術後の身体機能や痛み対処の変化,患者のself efficacyが退院後の機能回復にどのような影響を及ぼすのかということは,患者指導における有用な情報となると思われる.

【目的】<BR>外乱刺激により体幹が不意に不安定になる場合、多裂筋や脊柱起立筋は同時に活動させるが、予測される場合では、多裂筋と脊柱起立筋は異なった活動をするといわれている。しかし、物体挙上動作時に質量予測の有無が体幹筋全体に対してどのような影響を与えているかの報告は見当たらない。本研究では予測よりも重い重量物を挙上したときの体幹筋の筋活動にどのような影響を与えるのかを分析し比較検討した。<BR><BR>【方法】<BR>被検者は特記する既往および腰痛の訴えがなく、本研究への同意を示した成人男性11名を被検者とした。動作課題は、テーブル上に提示された物体を、光刺激を合図に右上肢で挙上するよう指示した。挙上動作は物体を10回挙上させ重さを認識させた場合の1.0kg（予測1.0kg）、4.0kg（予測4.0kg）、重さ1.0kgと認識させたあとに、分からないようにすり替え4.0kgを挙上させた場合（予測外4.0kg）の計3種類でおこなった。被検筋はワイヤ電極にて腹横筋、多裂筋、表面電極にて腹直筋、外腹斜筋、脊柱起立筋の左右5筋、計10筋とした。物体が床から離れた時点を0msecと定め、‐200から+200msecを解析区間とし，区間内を100msecごとに4相に分けた。記録されたデータはモーションアーチファクトを除去し整流化後にRoot Mean Squareにより平滑化し、各相の筋活動量の平均値を算出した。次に、その値を予測4.0kgにおける解析区間内の最大活動量の値で除すことで正規化し％筋活動量とした。％筋活動量を用い各相および各条件間での比較検討をおこなった。統計処理は一元配置の分散分析をおこない、有意差があったものに対してTukeyによる多重比較検定をおこなった。<BR><BR>【説明と同意】<BR>被検者には研究内容を理解してもらった上で同意を得、整形外科医立会いのもと実施した。なお、本研究は早稲田大学スポーツ科学学術院、人を対象とする研究等倫理委員会の承認を得て実施した。<BR><BR>【結果】<BR>・条件ごとの各相による筋比較<BR>予測1.0kgでは左右多裂筋が1相（-200～-100msec）より2相（-100～0msec）で有意に高くなっていた（p＜0.01）。3相（0～100msec）、4相（100～200msec）では2相に対し有意に低くなっていた（p＜0.01）。その他の筋には有意差が認められなかった。予測外4.0kgでは右多裂筋が1相より2相で有意に高くなっていた（p＜0.05）。また、左多裂筋が1相や3相に対し4相で有意に高くなっていた（p＜0.05）。その他の筋には有意差が認められなかった。予測4.0kgでは右脊柱起立筋、右多裂筋が1相より2相、3相、4相で有意に高くなっていた（p＜0.01）。また、左脊柱起立筋、左多裂筋が1相より2相、3相で有意に高くなっていた(p＜0.05）。その他の筋には有意差が認められなかった。<BR>・相ごとの条件による筋比較<BR>1相および2相ではすべての筋において有意差が認められなかった。3相では左右脊柱起立筋が予測1kg、予測外4kgに対し予測4kgで有意に高くなっていた（p＜0.05）。また、左右多裂筋も同様に予測4kgで有意に高くなっていた（p＜0.01）。その他の筋には有意差が認められなかった。4相では左右多裂筋が予測1kgに対し予測外4kgで有意に高くなっていた（p＜0.05）。その他の筋には有意差が認められなかった。<BR><BR>【考察】<BR>予測1kgの挙上動作において、左右多裂筋は挙上直前から筋活動を高めていた。挙上直後（0～100msec）には筋活動が低下し挙上前と有意差は認められなくなった。予測4kgでは左右脊柱起立筋は左右多裂筋と同時に挙上直前（-100～0msec）から筋活動を高め、挙上後（100～200msec）も高めた筋活動を維持していた。予測外4kgでは、右多裂筋が挙上直前から筋活動を高めていた。左多裂筋は挙上後に遅れて筋活動を高めていた。予測1kg、予測外4kgと予測4kgを比較すると、予測4kgでは脊柱起立筋と多裂筋が挙上直後に筋活動を有意に高めていた。挙上後では予測外4kgが予測1kgに対し、左右多裂筋の筋活動を有意に高めていた。今回の結果より、1kgの質量と誤認して4kgの質量を挙上する場合には、挙上（-200～100msec）まで1kgと同様の体幹筋の筋活動をおこない、挙上後（100～200msec）に両側多裂筋の筋活動が高くなっていた。つまり、予測よりも重い物体を挙上した場合には、挙上直前や直後に負荷に適応した体幹筋の筋活動がおこなえていないため、腰部・体幹の安定性に何らかの影響を与えている可能性が示唆された。<BR><BR>【理学療法学研究としての意義】<BR>物体を挙上する際、質量を誤認して発症する急性腰痛の一要因を解明し、不意の動作においても腰椎の安定性を高めておくことができる、腰痛予防のためのリハビリテーションへと応用していく。

Objective The objective of this study was to examine the relationship between perceived environment and achieving recommended level of walking, moderate to vigorous physical activity excluding walking or moderate to vigorous physical activity among Japanese adults.Methods Internet-based cross-sectional survey was conducted using the sample of 3,000 Japanese adults aged 30-59 years. Physical activity and neighbourhood environment were assessed by the short version of International Physical Activity Questionnaire (IPAQ) and IPAQ Environment Module. Participants were assigned to either "meeting recommendation" or "not meeting recommendation" according to criteria; ≥150 minutes per week of walking, moderate to vigorous intensity activity excluding walking or moderate to vigorous physical activity. Odds ratio of meeting physical activity recommendation was calculated in relation to environmental variables by gender, adjusted for sociodemographic attributes (gender, age, marital status, employment status, living status, educational attainment and household income). Results Convenient access to shops (male: OR=1.44, female: OR=1.73), public transportation (OR=1.75, 1.88), recreational facilities (OR=1.51, 1.37), good street connectivity (OR=1.32, 1.44), having destinations (OR=1.62, 1.44), and having household motor vehicles (OR=1.66, 1.85) were significantly related to meet the recommended level of walking. Access to recreational facilities (OR=1.33, 1.47), social environment (OR=1.48, 1.35) and aesthetics (OR=1.30, 1.39) were significantly related to meeting the recommended level of moderate to vigorous physical activity excluding walking. Convenient access to shops(OR=1.46, 1.36), public transportation (OR=1.60, 2.03), recreational facilities (OR=1.54, 1.41), having a destination (OR=1.54, 1.33), and good aesthetics (OR=1.41, 1.43) were significantly related to meet the recommended level of moderate to vigorous physical activity. Conclusion The moderate to vigorous physical activity excluding walking were associated with environment for exercising such as recreational facilities and social environment. The walking and moderate to vigorous physical activity including walking were associated with environment for lifestyle physical activity such as convenient access to shop and public transportation. Perceived environment influence was different depending on types of physical activities among Japanese adults.

Purpose : The purpose of the present study was to explore the perception of strength training among older adults who engaged in strength training.<BR>Methods : Semi-structured interviews were conducted with 15 participants aged 60-74 years who engaged in strength training in a sports facility. The questions of the interview included those regarding the mode of exercises they perceived as strength training, and perception about typical people engaged in strength training. Interviews were audio-taped and transcribed verbatim. The three interviewers reviewed the transcripts and categorized the perceptions.<BR>Results : Nine categories of current perceptions of strength training were identified: structured exercises (n=15) , exercises for particular people (n=9) , exercises which those with positive outlook participated in (n=7) , easy exercises (n=6) , lifestyle activities (n=5) , exercises in which healthy people participated (n=5) exercises done in particular place (n=3) , vigorous-intensity exercises (n=2) , and unconcerned exercise (n=2) . Thirteen of participants mentioned the previous perceptions to strength training: unconcerned exercise (n=9) , exercises for particular people (n=7) , structured exercises (n=4) , vigorous-intensity exercises (n=3) , exercises done in particular place (n=1) , and others (n=4) .<BR>Discussions : These results indicate that some older adults who engaged in strength training perceived strength training as an easy and lifestyle-based exercise, and that the perceptions might have been changed in the process of behavioral change for strength training.

Built environment is an important correlate of physical activity participation. Understanding the long-term effects of environment on health behavior is necessary for the promotion of population-based physical activity. However, most studies assessing the relationships between physical activity and environment have been conducted in the United States and Australia. The present study reviews Japanese researches on built environment and physical activity, and discusses the applicability of the built environment on promoting physical activity among Japanese adults. A review was conducted by searching the PubMed and Ichushi electronic database from inception to Sept 24, 2009. Eligible articles were identified as follows : 2 studies that developed the environment scale ; 10 studies that assessed the relationships with physical activity and built environment. There have been only a limited number of studies which were conducted with Japanese adults, thus more researches are needed to draw conclusions about the built environment associated with physical activity.

Purpose : The purpose of the present study was to explore the perception of strength training among older adults who engaged in strength training.<BR>Methods : Semi-structured interviews were conducted with 15 participants aged 60-74 years who engaged in strength training in a sports facility. The questions of the interview included those regarding the mode of exercises they perceived as strength training, and perception about typical people engaged in strength training. Interviews were audio-taped and transcribed verbatim. The three interviewers reviewed the transcripts and categorized the perceptions.<BR>Results : Nine categories of current perceptions of strength training were identified: structured exercises (n=15) , exercises for particular people (n=9) , exercises which those with positive outlook participated in (n=7) , easy exercises (n=6) , lifestyle activities (n=5) , exercises in which healthy people participated (n=5) exercises done in particular place (n=3) , vigorous-intensity exercises (n=2) , and unconcerned exercise (n=2) . Thirteen of participants mentioned the previous perceptions to strength training: unconcerned exercise (n=9) , exercises for particular people (n=7) , structured exercises (n=4) , vigorous-intensity exercises (n=3) , exercises done in particular place (n=1) , and others (n=4) .<BR>Discussions : These results indicate that some older adults who engaged in strength training perceived strength training as an easy and lifestyle-based exercise, and that the perceptions might have been changed in the process of behavioral change for strength training.