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>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>

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: 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: 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.

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.

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.

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.

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.

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.

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.

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.

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: 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.

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.

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.

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.

: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 < 0.001) and average daily PAEE (r = 0.47, P < 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 < 0.001; 52.74 ± 51.98 vs 99.33 ± 51.40 kcal, P < 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.

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>

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 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 ((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.

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.

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. (C) 2014 Elsevier Inc. All rights reserved.

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. (C) 2014 Elsevier Inc. All rights reserved.

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.

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 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.

: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 > 34 (VE/VCO2 > 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 < 0.001). After adjustment for clinical characteristics, MPT was significantly higher in the VE/VCO2 ≤ 34 group vs VE/VCO2 > 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.

: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.

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.

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.

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: &gt;= 420 min per week of at least moderate-intensity activity (MPA criterion) and &gt;= 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 73% 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. Crown Copyright (C) 2013 Published by Elsevier Ltd on behalf of Sports Medicine Australia. All rights reserved.

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.

BACKGROUNDPhysical 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.
METHODSThe 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.
RESULTSBoys 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).
CONCLUSIONTo increase physical activity levels among Japanese adolescents, implementation of after-school programs or environmental modifications developed within the school setting could be effective strategies.

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.

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.

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.

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<.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: 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.

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. (Am J Prev Med 2012;43(4):429-433) (c) 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.

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.

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.

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: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 (β=.116, <.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.

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<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<0.05). Dog walkers were more likely to be sufficiently active than both non-dog walkers and non-dog owners (p<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.

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.

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.

【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.

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.

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.

[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.

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.

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' 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.

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.

: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.

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>

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.<br/>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.<br/>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.<br/>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.

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.

[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.

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.

[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.

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.

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.<br/>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 thepast 1 year) and fear of falling adjusted for age, the Tokyo Metropolitan institute of gerontology index of competence, medical conditions, and lower limb functions.<br/>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[1.32-2.10], female: 1.37[1.13-1.66]), nail problems (male: 1.72[1.45-2.05], 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[1.13-1.80], 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[0.71-0.92]) was a significant correlate of fear of falling in females.<br/>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.

[Purpose] The purpose of the present study was to clarify the factors associated with the persistence rate of home exercise (HE) to promote an improvement in treatment results post-operation. [Method] The participants were 17 people who had received single intervertebral laminotomy due to lumbar spinal disease. They were divided into two groups based on the persistence rate of HE in the investigation period (high group vs. low group). Self-efficacy, pre-onset physical activity level, and recognition of motor task were investigated. [Result] There were significant differences in pre-onset physical activity level, self-efficacy, and recognition of motor task between the two groups. [Conclusion] The factor that influenced the HE persistence rate of post-laminotomy patients was able to be determined, suggesting a plan for an HE guidance method to improve treatment results.

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 1 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.

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.

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.

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 1 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.

Objective: To examine differences in physiologic and psychosocial outcomes between age groups after an exercise-based supervised-recovery phase 11 cardiac rehabilitation outpatient program.
Design: This is a longitudinal observational study. The study assessed 442 consecutive cardiac patients. Patients were divided into the middle-aged group (&lt;65 yrs, n = 242) and older-age group (&gt;= 65 yrs, n = 200). Peak oxygen uptake, handgrip and knee extensor muscle strength, upper- and lower-body self-efficacy for physical activity, and physical component summary and mental component summary scores as assessed by SF-36 were measured at 1 and 3 mos after the onset of acute myocardial infarction or cardiac surgery and were compared.
Results: All physiologic and psychosocial outcomes increased significantly between months 1 and 3 in both groups. However, increases were greater in the middle-aged vs. older-aged group in peak oxygen uptake (+13.1% vs. +8.7%, P &lt; 0.01), knee extensor muscle strength (+17.6% vs. +13.3%, P = 0.01), lower-body self-efficacy for physical activity (+17.3% vs. +12.7%, P = 0.02), and physical component summary score (+5.4% vs. +2.7%, P = 0.02).
Conclusions: Age-related differences in various physiologic and psychosocial measures indicated greater improvement from an exercise-based supervised recovery-phase II cardiac rehabilitation outpatient program in middle-aged vs. older-aged patients. Older adults may derive equal mental or emotional benefit from such a cardiac rehabilitation program but do not experience as much improvement in physiologic outcomes as middle-aged adults.

Background: Dog ownership appears to have associated health benefits as a result of increased physical activity through dog walking. This study examined the association between dog ownership and health-related physical activity among Japanese adults. Methods: Male and female respondents to an Internet-based cross-sectional survey were divided into the following groups: dog owner (DOG), nondog pet owner (NDOG), and nonpet owner (NPOG). Moderate and vigorous physical activity amount (MVPA), walking amount (Walking), and sedentary behavior time (SB) were estimated from the International Physical Activity Questionnaire. Analyses of covariance and logistic regression analysis were used. Results: The differences in MVPA, Walking, and SB were statistically significant among the three groups. DOG had a significantly greater amount of MVPA than NDOG and NPOG. DOG also had a significantly greater amount of Walking and less SB time than NPOG, and DOG was 1.5 times more likely to meet the physical activity recommendation than NDOG and NPOG. Conclusions: The dog owners had higher physical activity levels than owners of other kinds of pets and those without any pets, suggesting that dogs may play a major role in promoting physical activity. However, only 30% of the dog owners met the recommended criteria for physical activity.

Background Whether upper-extremity and lower-extremity muscle strength can predict a prognosis of congestive heart failure (CHF) patients is unclear. This study evaluated the impact of muscle strength on long-term mortality in patients with CHF.
Design Prospective observational study of male Japanese CHF patients.
Methods Clinical characteristics (age, body mass index, left ventricular ejection fraction, heart failure etiology, and medications) were obtained from hospital records of 148 male outpatients with stable CHF. Brain natriuretic peptide was determined as an index of disease severity. Peak oxygen uptake (V) over dot(O2), handgrip, and knee extensor muscle strength were also determined.
Results After 1331.9 +/- 700.3 days of follow-up, 13 cardiovascular-related deaths occurred, and the patients were divided into two groups: survival (n = 135) and nonsurvival (n = 13). No significant differences were found between the groups in clinical characteristics, brain natriuretic peptide levels, and knee extensor muscle strength. Peak (V) over dot(O2) (P= 0.011) and handgrip strength (P=0.008) were significantly lower in the (V) over dot(O2) nonsurvival versus survival group. Left ventricular ejection fraction, peak , and handgrip strength were found by univariate Cox proportional hazards analysis to be significant prognostic indexes of survival. Multivariate analysis, however, revealed handgrip strength to be an independent predictor of prognosis. A handgrip strength cutoff value of 32.2 kgf was determined by the analysis of receiver-operating characteristics and was assessed. Kaplan-Meier survival curves after log-rank test showed significant prognostic difference between the two groups (P=0.008).
Conclusion Handgrip strength may be useful for forecasting prognosis in patients with CHF. Eur J Cardiovasc Prev Rehabil 16:21-27 (C) 2009 The European Society of Cardiology

Background: Although engaging in the recommended amount of physical activity provides disease-prevention benefits, few studies have examined the proportion and correlates of meeting the Japanese physical activity recommendation. This study investigated the prevalence and demographic correlates of attaining the recommended value on the Exercise and Physical Activity Reference for Health Promotion 2006. Methods: Data were analyzed for 5177 Japanese adults who took an Internet-based cross-sectional survey. The International Physical Activity Questionnaire and 6 possible demographic correlates were obtained. Respondents were divided into 3 groups recommended, insufficient, and inactive according to their estimated weekly physical activity level. A multivariate logistic regression analysis was used. Results: Overall, 26.6% of respondents were physically active according to the recommendation criterion. Gender, employment status, age, marital status, and educational level were statistically significant. In men, being employed and in women, being 30 to 39 years of age were negatively associated with the attainment of the recommendation. Being male, being a married woman, and having a college education or higher for women were positively correlated with the attainment of the recommendation. Conclusions: Different associations of demographic correlates with the physical activity recommendation for men and women were found, suggesting that gender-specific strategies for targeting the population or specific interventions might be more effective in promoting physical activity among Japanese adults.

Objective: To examine gender differences in clinical characteristics and physiological and psychosocial outcomes at entry into phase II cardiac rehabilitation.
Design: Cross-sectional study.
Subjects: The study comprised 442 consecutive patients with cardiac diseases assessed at entry into a phase II cardiac rehabilitation programme.
Methods: Clinical characteristics of the patients, such as age, education, marital status, employment and body mass index, were obtained from hospital records. Oxygen uptake, handgrip and knee extensor muscle strength were measured to assess physiological outcomes. Self-efficacy for physical activity, hospital anxiety depression scale and health-related quality of life assessed by Short Form-36 were evaluated to assess psychosocial outcomes.
Results: The number of married women and their levels of education, employment and body mass index were significantly lower, and their ages higher, than those of the men. Measures of physiological outcome in women were significantly lower than those in men. Measures of self-efficacy for physical activity and Short Form-36 physical and emotional subscale scores were lower and anxiety levels higher in women than in men.
Conclusion: Cardiac rehabilitation programmes exclusively for women focusing on physiological outcomes, group counselling, and training to enhance physical and emotional domains may encourage increased participation by women in cardiac rehabilitation.

Objective: Indices of exercise capacity such as peak oxygen uptake (VO2peak) and muscle strength are important In association with reduced mortality. The present study compared differences in V02peak and muscle strength indices (grip strength and knee extensor and flexor muscle strength) with disease severity and investigated the relation of these variables in congestive heart failure (CHF) patients.
Design: The study comprised 102 patients with stable CHIF (93 men, age 61.4 +/- 10.2 yrs) with left ventricular ejection fraction (LVEF) &lt;40% by echocardiography. We used New York Heart Association (NYHA) functional class to index disease severity. VO2peak, grip strength, knee extensor, and flexor muscle strength were determined. Patients were divided into three groups by NYHA class: class I (n = 39), class 11 (n 49), and class III (n = 14).
Results: Age, sex, and LVEF did not differ according to NYHA class. VO2peak and all muscle strength indices decreased with increases in NYHA class (P &lt; 0.05). VO2peak correlated positively with all muscle strengths (P &lt; 0.05). Stepwise linear regression analysis revealed that grip and knee extensor strength were important in predicting VO2peak center dot
Conclusions: Exercise capacity and disease severity in CHIF patients may be influenced not only by lower-limb but also upper-limb muscle strength.

Objective: To evaluate the effect of the self-monitoring approach (SMA) on self-efficacy for physical activity (SEPA), exercise maintenance, and objective physical activity level over a 6-mo period after a supervised 6-mo cardiac rehabilitation (CR) program.
Objective: To evaluate the effect of the self-monitoring approach (SMA) on self-efficacy for physical activity (SEPA), exercise maintenance, and objective physical activity level over a 6-mo period after a supervised 6-mo cardiac rehabilitation (CR) program.
Design: We conducted a randomized, controlled trial with 45 myocardial infarction patients (38 men, seven women; mean age, 64.2 yrs) recruited after completion of an acute-phase, exercise-based CR program. Patients were randomly assigned to an SMA group (n = 24) or control group (n = 2 1). Along with CR, the subjects in the SMA group self-monitored their weight and physical activity for 6 mos. The SMA used in this study was based on Bandura's self-efficacy theory and was designed to enhance confidence for exercise maintenance. The control group participated in CR only. All patients were evaluated with the SEPA assessment tool. Exercise maintenance, SEPA scores, and objective physical activity (average steps per week) as a caloric expenditure were assessed at baseline and during a 6-mo period after the supervised CR program.
Results: Mean period from myocardial infarction onset did not differ significantly between the SMA and control groups (12.1 +/- 1.3 vs. 12.2 +/- 1.2 mos, P = 0.692). All patients maintained their exercise routine in the SMA group. Mean SEPA score (90.5 vs. 72.7 points, P &lt; 0.001) and mean objective physical activity (10,458.7 vs. 6922.5 steps/wk, P &lt; 0.001) at 12 mos after myocardial infarction onset were significantly higher in the SMA than control group. SEPA showed significant positive correlation with objective physical activity (r = 0.642, P &lt; 0.001).
Conclusions: SMA during supervised CR may effectively increase exercise maintenance, SEPA, and objective physical activity at 12 mos after myocardial infarction onset.

The purpose of the present study was to compare differences in physiological outcomes and health-related quality of life (HRQOL) in relation to degree of illness in patients with chronic heart failure (CHF) and to compare HRQOL in CHF patients with that of a normal Japanese population. One hundred and twenty-five patients with stable CHF (93 men, 32 women, mean age 63.3 ± 12.4 years) with left ventricular ejection fraction (LVEF) of less than 40% were enrolled in the present study. We used New York Heart Association (NYHA) functional class as an index of degree of illness. In 64 of the 125 patients, physiological outcome measures included peak oxygen uptake (peak V̇O 2) and V̇E/V̇CO2 slope. HRQOL was assessed with the medical outcome study short form-36 (SF-36) Japanese version. In addition, SF-36 scores of CHF patients were compared against Japanese standard values. Age and LVEF did not differ according to NYHA functional class. The eight SF-36 subscale scores and peak V̇O2 decreased with increases in the NYHA functional classes, whereas V̇E/ V̇CO2 slope increased with increases in NYHA functional class (p&lt
0.05). Of the 8 SF-36 subscales measured in CHF patients, only the bodily pain score attained that of the normal Japanese population. These findings suggest that HRQOL decreases as NYHA functional class increases and other physiological measures worsen. In addition, HRQOL values of CHF patients were low in comparison with standard values of a normal Japanese population.

We investigated the changes of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQL) in Japanese cardiac surgery patients. Subjects were 47 consecutive outpatients (32 men, 15 women
mean age 59.4 ± 12.6 years) recovering from cardiac surgery. Patients performed both aerobic exercise on a treadmill at anaerobic threshold intensity and moderate resistance training 2 days per week, 60 min per session, from 1 to 3 months after cardiac surgery. Differences in the eight SF-36 subscale scores and physiological outcomes within the patient group at 1 month and at 3 months after cardiac surgery were analyzed. Peak oxygen uptake, handgrip strength, and knee extension strength were used as physiological outcome measures. HRQL was assessed with the Japanese version Medical Outcome Study Short Form 36 (SF-36). Significant change in overall physiological outcome from 1 month to 3 months was observed. There was also significant change in seven of the eight SF-36 health status subscale scores (physical functioning, role-physical, bodily pain, general health, vitality, role-emotional, and mental health). However, with the exception of physical functioning and mental health scores, values did not reach those of the average healthy Japanese. In conclusion, we found that CR exercise training for Japanese cardiac surgery patients during the recovery phase changes not only physiological outcomes but also HRQL as assessed by the SF-36.

Objective: The purpose of this study was to determine exercise maintenance rate, leisure-time objective physical activity level, and health-related quality of life in relation to exercise maintenance over the 6-mo period after a supervised 5-mo recovery-phase cardiac rehabilitation program in acute myocardial infarction patients. The study also investigated whether exercise maintenance resulted in reproducible health-related quality-of-life outcomes comparable with those of the Japanese normal population.
Design: This observational study comprised 109 acute myocardial infarction patients (89 men, 20 women; mean age, 63.5 +/- 10.1 yrs). Physiologic outcomes (peak oxygen uptake, handgrip, and knee-extension strength) measured at 1 and 6 mos after acute myocardial infarction onset were compared. Completed exercise maintenance and health-related quality-of-life questionnaires and results of electronic pedometer recordings to evaluate leisure-time objective physical activity level were assessed 6 mos after cardiac rehabilitation.
Results: The mean period from acute myocardial infarction to evaluation of outcomes was 18.8 +/- 3.4 mos. Ninety of 109 patients (82.6%) continued exercise for &gt;6 mos after cardiac rehabilitation (exercise group); 19 patients (17.4%) quit exercise after cardiac rehabilitation (nonexercise group). Improvement in physiologic outcomes was noted at 6 mos vs. those at 1 mo, but outcomes were not significantly different between groups. The exercise group performed significantly better than the nonexercise group for leisure-time objective physical activity level and scored significantly higher than the nonexercise group for seven of eight health-related quality of life measures, attaining scores similar to those of the Japanese normal population.
Conclusions: At &gt;18 mos after acute myocardial infarction, the exercise maintenance rate in our patients remains high, and exercise maintenance may be one of the factors contributing to improvement of health-related quality of life and leisure-time objective physical activity level.

Background The present study examined the impact of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQOL) of patients with acute myocardial infarction (AMI).
Methods and Results A total of 124 consecutive AMI patients were divided into a supervised outpatient CR group (n=82) and a non-CR group as a control (n=42). Peak oxygen uptake, handgrip strength, and knee extension muscular strength were used as physiological outcome measures. HRQOL outcomes were assessed by the Medical Outcome Study Short Form 36 (SF-36). CR group patients performed both aerobic exercise and moderate resistance training from 1 month (T1) to 3 months (T2) after AMI onset. Age, sex, body mass index, medications, and ejection fraction were similar in both groups. Significantly greater increases in overall physiological outcomes from T1 to T2 were measured in the CR group compared with those of the non-CR group. There were also significantly greater improvements in 4 of the 8 SF-36 health status subscales (physical functioning, role-physical, general health, and vitality) in the CR group compared with the non-CR group.
Conclusions Eight weeks of exercise training have specific effects on improvement in HRQOL and physiological outcomes in Japanese patients.

A study was conducted to clarify the effects of exercise habits on cardiovascular reactivity to a psychological stressor in healthy Type A individuals. Ninety male and 88 female undergraduate students were initially recruited to complete the student version of the Jenkins Activity Survey as a measure of their Type A behavior pattern (TABP). Subjects were identified as Type A or Type B based on their TABP scores. They were then assigned to an exercise (E) or non-exercise (NE) group according to their exercise habits. Six females and six males each made up the 4 condition groups (Type A-E, Type A-NE, Type B-E and Type B-NE). Cardiovascular reactivity (heart rate:HR and skin temperature:ST) was assessed during the time periods of baseline, mirror drawing test (MDT) and recovery for all subjects. Results revealed that Type A individuals had greater and more rapid HR reactivity than Type B individuals and that male Type A subjects showed significantly greater ST reactivity relative to female Type A and Type B subjects. Only males showed a significant main effect of exercise habits on HR reactivity during the MDT. The E group demonstrated more rapid HR recovery following the task than the NE group. During the MDT, Type A individuals showed significantly greater ST reactivity than Type B subjects in the NE group, while there was no difference of TABP type in ST reactivity in the E group. Also, no significant main effect and interaction was shown in the MDT performance. These results suggest that exercise habits contribute to the lowering of cardiovascular reactivity to a psychological stressor and indirectly to the prevention of cardiovascular diseases for Type A individuals.

This study was designed to examine the psychological benefits of anaerobic exercise for older adults. Specifically, strength training was employed to examine the effects on mood and anxiety in a group of healthy but sedentary older women. 36 women (mean age=68.5 yr.) were randomly assigned to groups given high intensity or moderate intensity strength training or to a control group. Strength training was conducted three days a meek for 12 weeks. After the training period, both high and moderate strength-training programs produced marked improvements in muscle strength and body composition compared to the control subjects. The average improvements in the high and moderate intensity strength-training groups for muscle strength were 40.5 and 35.5%, respectively, and for percent body fat 1.52 and 2.50%, respectively. As for psychological changes, both training groups significantly improved positive mood (vigor), and the moderate intensity group significantly reduced trait anxiety compared to means of the control group. Also, both training groups showed some decrease in tension and state anxiety after the training period. These findings provide evidence for the effectiveness of anaerobic training to enhance perception of psychological well-being in older women. ii moderate intensity rather than high intensity of training regimen map be more beneficial for sedentary older women to improve psychological health.

Promotion of physical activity (PA) is a public health priority. We conducted a cluster randomized trial to promote PA among residents. Randomly selected 12 communities in Unnan city, Japan, were allocated to either intervention or control. In addition, randomly selected residents aged 40 to 79 years who responded to the baseline survey (n=4414; 74%) were followed to examine primary outcome, PA after 5 years and secondary outcomes, certification of long-term care need and all-cause mortality after 7 years. The intervention was a communitywide interventions using social marketing. As the results, adults achieving recommended levels of PA increased in intervention communities [adjusted change difference: 4.6 percentage points (95% confidence interval: 0.4, 8.8)]. No significant favorable changes in secondary outcomes were observed. We also started a dissemination and implementation study to spread the interventions all over Unnan city using a single arm trial in 2016

The purpose of this study is to clarify the impact on the environment on the amount of physical activity and what kind of environmental factors are affecting the amount of physical activity.Firstly, we made a map for spatial visualization of the physical activity amount by prefectures using a spatial epidemiology technique. We observed that there is a greater number of steps in the denser prefectures. Secondly, we examined the relationship between the social and natural environment and the number of steps using an ecological study. We observed a significant relationship between the number of steps with a number of city parks, private cars, and snow days a year, annual mean temperature, and increased rate of private cars. In addition, we find a relationship between physical activity related work environment and the incidence of non-communicable diseases such as diabetes, low back pain, or kidney stones among workers using a cohort study

The aim of this study was to clarify sedentary time assessed using an accelerometer, to examine the associations of objectively-assessed sedentary time with demographic factors and various health outcomes, and to develop an intervention strategy for reducing sedentary time in older population. Our findings indicated that decreasing sedentary time and increasing daily habitual physical activity contribute to improvements in physical function and mental health. An intervention strategy to give the knowledge related to sedentary behavior was effective to reduce sedentary time of older people

Participants (n = 297) wore an accelerometer and completed a survey and physical functions performance test. Sedentary behavior(SB) accounted for 8.7hrs a day (58 % of wear time), with 7.7 breaks per sedentary hour, and 4.4 prolonged SB bouts per day (42% of total SB). Men, those aged over 75 years, and those with BMI over 25 had significantly more ST than the counterparts. The highest proportion of ST in 6 different domains were TV viewing (46.9%).TV viewing was significantly associated with higher proportion of prolonged bouts and less breaks. Replacing 10minutes-SB to moderate-to vigorous physical activity (MVPA) was significantly and favorably associated with most of physical function measures and health-related QOL(SF-8). For improving the health and functional well-being of Japanese older adults, there may be benefit from replacing at least 10-minutes SB to MVPA with more frequent breaks, especially during TV viewing, particularly for those who are older and overweight/obese

We investigated preventive behaviors and related factors in stroke patients and constructed a nursing support model applying behavioral science theory. The recurrence prevention behavior of stroke patients was four disease management behaviors and six lifestyle improvement behaviors. Stroke patients felt four benefits and four burdens in the recurrence prevention behavior. For the prevention of reoccurrence, there were four methods of support "information support," "instrumental support," "emotional support," and "evaluation support". Social support was another factor which was associated with medication, exercise, self-efficacy, behavioral change.We also implemented classroom-type recurrence prevention education applying behavior change theory. Improvement was seen in medication behavior, dietary behavior, exercise, and self-efficacy

The present study developed the long-term care prevention program combined with exercise therapy and cognitive-behavioral therapy (pain coping skills training) among elderly with chronic knee pain, and examined the effectiveness of a newly-developed program. The program was effective in the improvement of pain self-management skills, physical function, and physical activity. In order to disseminate an effective program for community-dwelling older adults with knee pain, we discussed with staffs in target municipality, and carried out the dissemination trial. We found the development of participants’ recruitment strategies to be the most important issue for dissemination of this newly-developed program

A cluster randomized trial with community as unit of randomization were conducted to evaluate a 5-year community wide campaign (CWC) to promote physical activity. Randomly-sampled 4414 residents (40-79 years) responded to the baseline survey (74 %) and were followed from 2009 to 2014. As the results, CWC did not significantly increase proportion of active adults (adjusted change difference = +4.5 % [95 % Confidence interval: 0.3, 9.3], P=0.066). However, in the analyses using secondary outcomes, adults doing flexibility activity significantly increased in intervention communities (P=0.049), and adults doing walking tended to increase in intervention communities (P=0.058). In conclusion, CWC did not achieve significant increase in active adults at population level. However, the results of borderline significance and analyses of secondary outcomes suggested its potential effectiveness

A longitudinal study of randomized sample of community-dwelling adult was conducted for 4 years, and the prevalence and incidence of disabling foot pain (DFP) and foot pain were analyzed. As a result, the prevalence of foot pain was 22.5% and the prevalence rate of DFP was 19.6%, and the population-equivalent prevalence number of DFP reached 5.57 million in Japan. As a result of follow-up survey for 4 years, the foot pain incidence rate was 15.5% and DFP incidence rate was 3.5%. Risk factors for DFP were age, exercise habits, falling history, falling self-efficacy feeling, osteoporosis, gout, superficial sensory abnormalities, flat foot, concave foot

本研究では、「身体活動の恩恵」に対して反応性の低い運動無関心者の行動準備性を高めることを企図して、携帯メールマガジン(ML)によって「趣味・余暇活動」に関する情報を開発・提供し、その効果を検証した。社会調査会社のモニタから抽出された運動無関心者に対して上記MLを8週間にわたって配信したところ、介入群の55%(対照群では26%)の行動準備性が向上(前熟後期から熟考期以上に行動変容ステージが移行)し(p<0.001)、「趣味・余暇活動ゲートウェイ」の有効性が検証された。

In order to investigate the economic evaluation of exercise programs for long-term care prevention, the present study conducted to examine 1) the cost and benefit of community-based water-based exercise program among the elderly with lower-limb pain, 2) the impact of its water-based exercise program on medical expenditure and consultation behavior, 3) the effect of body-weighted strength training on the cost of long-term care among the frail elderly. From the results, the exercise programs implemented in the present study were cost-effective and seemed to have a small but positive impact of the medical expenditure and cost for long-term care.

The present study examined the short-and long-term effect of water-based exercise program on functional fitness, health-related QOL among frail elderly women with lower-limb pain. Elderly women aged 65 years or older with confirmed knee and/or low back pain participated in a 12-week water-based exercise program. The findings indicate that the water-based exercise program can not only improve functional mobility and lower muscular strength, but also enhance general health perception and reduce bodily pain perception on health-related QOL among elderly women with lower-limb pain.

In this research project, we had run five subgroups for stress management education system, i.e., (1)Developing Evaluation Methods, (2)Cancer patients, (3)Dementia, (4)Heart Rehabilitation, (5)Incurable disease.(1)Developing Evaluation Methods : We established psychological scales of Stress Management Self-efficacy Scale(SMSE) and tried to assess the educational effect of stress management for patients with severe disease. Also psychophysiological and psychoneuroimmunological indices were established.(2)Cancer patients : We have established psycho-social intervention with stress management education for lung cancer patients.(3)Dementia : We tried to apply the relaxation and activation training for dementia patients and to assess the effect by using physiological index.(4)Heart Rehabilitation: With using SF-36, we recognized the good effects of stress management education on the quality of life of the patients with heart disease at least 6-months after heart attack.(5)Incurable disease : Basic research using over 600 patients indicated that patients group showed smaller scores of both SF-36 and SMSE-20, especially the group of nerve-muscle diseases showed more important severity. On this fundamental research, we made a 5-days/3-months program of stress management education seminar for patients groups. Results showed that the estimated self-efficacy of relaxation was increased by means of our program

本研究は、我が国の中年者および高齢者を対象に、生活習慣病予防あるいは介護予防を目的として、行動科学に基づく身体活動・運動促進プログラムに活用するための教材開発を行い、その有用性を確認することを目的とした。初期には、中年者および高齢者における身体活動・運動習慣の関連要因を明らかにするための大規模な調査研究を行った。その結果、性や年齢を問わず、運動を継続するための自信(セルフ・エフィカシー)や、運動することに伴うメリットとデメリットの自覚(意思決定バランス)などが、身体活動・運動の習慣化にとって重要な関連要因となっていることが明らかになった。また、介護予防において特に注目されている筋力トレーニングのような特定の活動についても関連要因の検討を行っている。以上の基礎研究の結果を基に、中期には中年者および高齢者における身体活動・運動促進プログラムで活用するための教材(コンテンツ)開発を行った。特に、行動科学の考え方を活かし、印刷教材、ビデオ教材、携帯電話のメール機能などを利用した教材のコンテンツを提案する際に、目標設定やセルフ・モニタリング等に代表される行動変容技法を盛り込んだものに工夫した。後期には、これらの教材を用いて、対面式、非対面式の身体活動・運動促進プログラムの効果検証を試みている。プログラム参加者による様々な教材を用いた身体活動介入に対する評価は、おおむね良好であることが分かった。また、これら教材を用いた介入によって、日常生活における身体活動量(特に、歩行)が増加するとともに、介入のターゲットである修正可能な関連要因(特に、セルフ・エフィカシー)の高まりも確認されている。本研究で提案したコンテンツを応用し、様々な伝達手段によって身体活動・運動の促進プログラムを展開していくことが可能になると考えられる

There are increasing attentions to neighborhood environment as physical activity determinants. This study examined the association between environmental attributes and physical activity among older adults (age : 65-74 years, N=1921) by cross sectional mail survey. The results showed the association of walking time with environmental attributes including access to exercise facilities, social environment and aesthetics. Patterns of associations differed by gender and type of physical activity. Also the results showed different patterns of associations from previous studies using young to middle aged adult sample. Results of this study suggest the importance of intervening environmental attributes for health promotion among older adults

In rapid developing an internet society, ehealth literacy, defined as the ability to seek, find, understand, and appraise them and apply the knowledge gained to addressing or solving a health problem, becomes important to promote health and aid in health care among individuals. However, the eHealth Literacy Scale(eHEALS) was only a scale developed to assess the ehealth literacy. Thus, the present study developed the Japanese version of the eHEALS(J-eHEALS), evaluated its validity and reliability, and examined the association of the ehealth literacy with demographic attributes and characteristics on health information searching among Japanese adults

We examined whether objectively-measured built environment (street layout) is associated with walking and sedentarybehaviors in the context of a non-Western country; and whether suchassociations differ between urban and rural areas.&nbsp;Adultsliving in urban and rural areas in Japan (n=1,076) reported their walking (for commuting; for errands; and, for exercise) andsedentary behaviors (TV viewing and car driving). Two street layout measures (intersection density andstreet integration) were objectively calculated. Participants living in areas with more connected streetlayout weremore likely to walk for commuting and for errands, and less likely to drive. These relationshipsdiffered urban and rural areas. Our study confirms that previous findings from Westerncountries, i.e., the association of street connectivity with travel behaviors,are also applicable to Japan.

本研究では、犬の飼い主の身体活動不足の実態を明らかにした。対象者は、地域在住成人4231名であった。ペットの飼育状況によるドメイン別の中高強度身体活動時間（仕事、余暇、移動）および座位行動時間（車移動、公共交通機関移動、仕事、テレビ視聴、PC利用、その他）の差異について検討した。その結果、犬の飼育群は他の群と比較して、仕事および移動に関する中高強度身体活動時間が有意に長いことが分かった。また、犬の飼育群は非ペット飼育群に比べてPC利用に伴う座位行動時間が有意に長かった。本研究から、犬の飼い主の身体活動を増進させ、座位行動を減らす効果的な介入戦略の開発に向けた重要な知見が得られた。

本研究は日本人中高齢者701名を対象に、犬の所有と客観的に測定された座位行動パターンとの関連について検討した。ペットの所有状況は、犬の所有群17.3%、犬以外のペットの所有群13.0%、ペットの非所有群69.7%に分類された。加速度計評価による座位行動パターンは、装着時間内における総座位時間および20分以上の座位行動バウトの割合、座位行動の中断頻度を算出した。交絡因子を調整したマルチレベル線形回帰分析の結果、犬の所有群はペットの非所有群と比べて、総座位時間割合および20分以上の座位行動バウト割合が有意に少なかった。犬を所有することによる飼育や散歩が、座りすぎを防止する可能性がある。

　これまでペットを飼うことが人間の健康にもたらす恩恵について盛んに研究が行われ、成果が蓄積されつつある。特に、犬の飼育や犬の散歩に関しては、子供の過体重・肥満者の割合の低さ、高齢者における歩行速度の維持、心疾患患者の良好な予後など、健康の維持・増進にとって好影響を及ぼすことが明らかにされている。そのため、最近は人間の健康や体力を維持・向上させるための効果的な戦略として、犬の飼育や犬の散歩に注目が集まっている。犬の飼い主の身体活動を促進させるための第一歩として、犬の散歩を含む飼い主の身体活動がどの程度行われているのかといった実態を把握することが重要であると考えられるが、先行研究では身体活動の評価が調査票等による主観的なものに依存しており、バイアスを多く含んでいる。本研究ではこれらの問題点を解消するため、わが国における犬の飼い主の身体活動状況について加速度計を用いて客観的に評価し、その実態を明らかにすることを目的とした。　犬の散歩の実態調査に参加した犬の飼育者48名（52.2±10.4歳）を分析対象とした。7日間の犬の散歩日誌およびスズケン社製ライフコーダによる犬の散歩行動の測定、質問紙による犬の飼育者の属性（性別、年齢、婚姻状況、教育歴、住居形態、同居の有無）および飼い犬の特性（サイズ、犬種、年齢、頭数）の調査を行った。日誌をもとに、犬の散歩時間に該当するライフコーダデータを抽出した。1日および週あたりの犬の散歩回数、散歩時間、中等度強度以上の散歩時間、散歩中の静止時間、散歩強度、週あたりの散歩時間における中等度強度以上の散歩時間および制止時間の割合、週あたり中強度以上の散歩時間が150分以上の飼育者（推奨身体活動充足者）の割合を算出し、犬の特性の影響について検討した。　毎日犬の散歩を実施している者が47.9%と最も多く、6日（18.8%）、4日（12.5%）の順であった。91.9%が1日1回または2回散歩を実施していた。また、平均で1日1.6±0.5回で計63.4±35.0分、週5.7±1.7日で計363.6±230.9分の散歩を実施していた。週あたりの散歩時間のうち、43.2%は中等度強度以上で散歩を実施していたが、10.3%は立ち止っている時間であった。犬の散歩の平均強度は3.2±0.8であり、41.7%が推奨身体活動充足者であった。中・大型犬は小型犬と比較して有意に1日の散歩回数が多く、中等度強度以上での散歩時間が長かった。また、愛玩犬（1.39±0.4回）は他の犬種（1.69±0.4回）と比較して、1日の散歩回数が有意に少なかった（p=.019）。　犬の飼育者はおおよそ毎日1時間、そのうち45%程度を疾病予防や健康増進に有益である強度で犬と散歩していた。また、犬のサイズは中等度強度での散歩回数や散歩時間に影響を及ぼすことが明らかになった。これらの知見を犬の飼い主の身体活動を促進させる効果的な支援方法の開発につなげていく必要がある。

　本研究の目的は、わが国の成人における客観的・主観的に評価した身体活動および座位行動と抑うつ症状との関連を検討し、効果的なうつ予防対策の指針作成に向けて、より焦点を当てるべき身体活動・座位行動の介入場面や活動内容の目安等を明らかにすることであった。　対象者は、住民基本台帳より無作為抽出した40～69歳の地域住民3,000名のうち、研究参加に同意し、各種調査・測定に協力した410名であった。身体活動・座位行動に関しては、加速度計（オムロンヘルスケアActive Style Pro HJA-350IT）および調査票（Global Physical Activity Questionnaire：GPAQ；Workforce Sitting Questionnaire改良版）により評価した。また、抑うつ症状の評価には、抑うつ状態自己評価尺度日本語版（Center for Epidemiologic Studies Depression Scale：CES-D）を用いた。さらに、個人的属性として、性、年齢、教育歴、世帯収入、婚姻状況、就業状況、同居の有無、喫煙状況、飲酒状況、現病歴、BMI（身長、体重より算出）についても調べた。これらのデータについて欠損等がなかった343名を最終的な分析対象者とした。多変量ロジスティック回帰分析により、客観的評価による中等度の強度以上の身体活動および座位行動、生活場面ごとの中等度の強度以上の身体活動・座位行動指標と抑うつ症状との関連について検討した。すべての統計処理には統計解析ソフトSTATA12.0を用いた。　客観的評価による総身体活動について、全ての予測される交絡要因および客観的評価による総座位時間を調整しても、中等度の強度以上の身体活動時間の長い群は、短い群と比較して、抑うつ症状と有意な負の関連が認められた。生活場面別の身体活動については、仕事中における中等度の強度以上の身体活動時間の長い群は、低い群と比較して、約2.1倍抑うつ症状を示す割合が高かった。一方で、余暇時間における中等度の強度以上の身体活動時間が長い群は短い群と比べて、抑うつ症状と有意な負の関連がみられた。　客観的評価による総座位行動に関して、全ての予測される交絡要因および客観的評価による総身体活動時間を調整した結果、総座位時間と抑うつ症状に有意な関連は認められなかった。生活場面別の座位行動では、仕事や移動中以外での座位でのPCやスマートフォン利用時間の長い群は、短い群と比較して、約2倍抑うつ症状を示す者の割合が高かった。その他の生活場面別座位行動指標と抑うつ症状には有意な関連はみられなかった。　今後、うつ予防対策の指針作成に向けては、中等度の強度以上の総身体活動に加えて、仕事および余暇場面における中等度の強度以上の身体活動に着目すべきである。一方、座位行動に関しては、余暇でのPCやスマートフォン利用に伴う座位時間（移動中や仕事中を除く）を減らす取り組みが重要であることが分かった。

　本研究は、わが国の女性における身体活動・運動実施による乳がん予防効果の認知度を調査し、認知度を高める必要のある対象者を特定するとともに、効果的な普及方策を検討する手がかりを得るために、認知に関連する要因を解明することを目的とした。　対象者は、20～69歳までの成人女性1,000名を対象とした横断調査を実施した。調査項目は、社会人口統計学的要因（年齢、婚姻状況、子どもの有無、職業分類、教育歴、世帯収入）、閉経の有無、乳がん既往歴・家族歴、乳がんに関する知識、身体活動・運動実施とがんに関する情報取得の有無、身体活動・運動実施状況であった。乳がんのリスク要因に関する「運動不足」に関する質問項目において「原因である」と回答した者を身体活動・運動実施による乳がん予防効果の「認知者」、「原因ではない」と回答した者を「非認知者」と分類した。この認知に関連する要因を検討するために、強制投入法によるロジスティック回帰分析を行った。　対象者の平均年齢は44歳、既婚者は74％、子どものいる者は63％、大学・大学院卒の者は35％、フルタイム就労者が30％、閉経者は35％、乳がん既往歴・家族歴を有する者は5％であった。現状では、対象者の32％が身体活動・運動実施による乳がん予防効果を認知していた。40歳代（OR=0.57）、子どもを持つ者（OR=0.61）、大学・大学院卒（OR=1.51）、身体活動・運動実施とがんに関する情報を取得している者（OR=2.30）および乳がんに関する知識（症状）の高い者（OR=2.6）が、認知度に有意に関連していた。　身体活動・運動による乳がん予防効果に対する認知を向上させることは、身体活動・運動実施への動機づけを高め、態度を変容させる乳がん予防の重要な第一歩であると考えられる。今後は、ヘルスコミュニケーションの理論に基づいて、本研究で明らかとなった認知に関連する要因を考慮に入れた具体的な普及戦略を構築していくことが必要である。

　わが国では5世帯に1世帯の割合で犬を飼っていることが知られている。近年、犬の飼い主における犬の散歩を通じた心身の健康づくりが注目されている。しかしながら、現状では成人を対象にした研究は比較的行われているものの、子どもや高齢者に注目した研究は、国内外を問わず十分に行われているとは言い難い。　研究1は、自宅で犬を飼うことが児童の余暇身体活動時間に及ぼす影響について検討することを目的とした。6～12歳までの児童978名およびその保護者を対象に、犬の飼育状況、余暇の総身体活動時間および自宅での余暇身体活動時間について調査を行った。その結果、対象児童の14%が自宅で犬を飼っており、飼育率は高学年の方が低学年の児童より有意に高かった。また、週あたりの平均余暇総身体活動時間および自宅での余暇身体活動時間はそれぞれ、244分、66分であった。自宅で犬を飼っている児童は飼っていない児童に比べ、週あたりの総余暇活動時間が40分、自宅での余暇身体活動時間が23分多いことが明らかになった。　一方、研究2の目的は、高齢者における犬の飼育が日常身体活動量に及ぼす影響について検討することであった。対象となった65～74歳の地域在住高齢者1,926名から、犬の飼育状況および犬の散歩の頻度や時間、IPAQ-Sにより日常身体活動時間に関するデータを取得した。結果として、対象となった高齢者の14%が犬を飼っており、そのうちの71%が犬の散歩を実施していた。また、週あたりの犬の散歩の実施時間は303分間であった。犬の散歩実施者は非実施者および犬の非飼育者に比べて、中高強度の身体活動時間および総身体活動時間が有意に長く、非飼育者よりも推奨身体活動量を満たす者が3.4倍も多かった。　以上の結果から、成人だけでなく児童や高齢者の身体活動の促進にとっても、犬を飼うことや犬の散歩が大きな貢献をしている可能性が示唆された。

本研究の目的は、行動科学の理論とeテクノロジー（インターネット等に関連した様々なネットワーク技術）を応用した身体活動推進プログラムを開発し、その有効性について検討することを目的とした。本研究で開発した身体活動推進プログラムに採用したeテクノロジーとして、Felica（非接触ICカード技術）を応用した身体活動モニタリングシステムの構築、人と人とのつながりを促進・支援するコミュニティ型Webサイト（ソーシャルネットワーキングサービス：SNS）の完備、実行した身体活動量に応じた報酬としてのポイント制の導入に焦点を当て、それらを効果的に組み合わせたプログラムを開発した。このようなeテクノロジーを有効に組み合わせた内容にすることにより、多くの対象者が行動変容の知識・スキルを効果的・効率的に獲得できるよう配慮した。このプログラムを実施した3ヶ月間の前後で身体活動量データが得られた924名を対象に、アウトカム評価としての身体活動量（日歩数）、プロセス評価として、対象者の内省報告からユーザビリティに関して分析を行った。その結果、プログラム参加前の平均日歩数が6,946歩であったのに対し、プログラム参加後には8,182歩まで有意に増加し、特にeヘルスリテラシー（インターネット上で健康情報を検索し、内容を評価し、取得した健康情報を自分の健康問題解決に向けて活用する能力）が高い参加者ほど、大きな身体活動量の増進効果が認められた。また、ユーザビリティに関しては、身体活動量のモニタリングが容易で操作性も高く、Webサイトの構成・見やすさ等も多くの対象者から優れているという評価が得られた。特に、SNSに対する反響が大きく、仲間のアドバイスや励まし合いが、このプログラムを継続していくことの動機付けを高め、健康づくりを見直す大きなきっかけになっていることが伺えた。実際に、このプログラムへの参加がきっかけとなり、3ヶ月の利用により大きな体重減少（6kg）が認められた参加者も存在した。今後の課題としては、新たな研究デザイン（ランダム化比較試験）を用いたプログラムの有効性検証が必要だと考えられる。

本年度は、我が国の子どもの身体活動を推進させるための効果的・効率的な支援方法を検討するために、学校の休み時間における児童の身体活動に着目した研究を実施した。具体的には、小学生の休み時間に実施している身体活動を測定機器により客観的に評価し、その活動強度に関する男女差および学年差を明らかにすることにより、介入ターゲットを決定することを目的とした。本研究の対象者は、埼玉県内の2つの小学校に在籍する小学生230名(男子55％、低学年42％)であった。身体活動の測定には、加速度センサー付歩数計(スズケン社製ライフコーダ)を用い、7日間連続装着することにより、業間(25分)と昼休み(15分)における身体活動強度(座位活動、低強度、中等度強度、高強度、中高強度)を評価した。有効データが2日以下の者は分析から除外し、各強度の身体活動における男女差および学年差について、ｔ検定を用いて分析を行った。本研究で分析対象者となったのは、業間の身体活動については192名、昼休みに関しては195名であった。中高強度の身体活動の実施割合は、業間においては男子が17.8％、女子は9.7％、一方、昼休みに関しては男子が16.2％、女子は11.3％となり、健康への恩恵を得る水準での身体活動強度を維持している児童の割合が、比較的少ないことが明らかになった。ｔ検定の結果、業間および昼休みにおいて、座位活動時間は女子の方が有意に長く、高強度および中高強度の身体活動時間は、男子の方が有意に長いことが分かった。また、昼休みの時間は、高強度および中高強度の身体活動時間が低学年において有意に長かった。本研究の結果から、男子および低学年の児童が、休み時間における中高強度の身体活動時間が有意に長く、諸外国における先行研究の結果と同様の傾向を示していることが明らかになった。今後は、女子および高学年の児童をターゲットにした効果的・効率的な身体活動支援が必要だと考えられる。

本研究の目的は、虚弱高齢者を対象に、自宅でも実施可能な抗重力筋を鍛えるための筋力向上トレーニングと、目標設定やセルフモニタリングなどの行動変容支援を組み合わせたプログラムを開発・実施し、その効果を身体的側面、心理的側面、行動的側面および転倒関連の側面から検討することであった。介護予防健診を受診し、老年症候群のリスクを保有する65歳以上の虚弱高齢者で、プログラムへの参加に同意した35名を、性、年齢、老年症候群リスクを調整しながら、自重負荷筋力トレーニング群（筋トレ群：18名）、介護予防教育講座群（講座群：17名）にランダムに割り付けた。両介入プログラムとも、週1回、1回90分のセッションを12回（初回および最終回は効果測定）実施した。その結果、身体的側面では握力、椅子立ち座りが筋トレ群で、移動能力（TUG、通常および最大歩行速度）は両群ともにプログラム終了後に有意な改善が認められた。心理的側面では、両群ともにSF-36日本語版の8つの下位尺度のうち、心の健康を除く全ての項目（身体機能、役割機能－身体、身体の痛み、全体的健康感、活力、社会生活機能、役割機能－精神）が有意に改善した。行動的側面は、自己報告による一日平均歩行時間について、筋トレ群で有意な改善が認められた。転倒関連指標は、両群ともにすべての指標において有意な改善はみられなかった。以上のことから、本研究で実施した筋力向上トレーニングプログラムは、短期的ではあるが身体的側面、心理的、行動的側面に効果をもたらしたと考えられる。一方、プログラム開始から1年後まで追跡調査を行った結果、各側面において有意に改善していた多くの指標において、効果の維持が認められなかった。これらの結果から、長期的な効果の維持をもたらすような支援、特に運動習慣の定着をさらに促すような働きかけを介入プログラムに積極的に導入していくことの必要性が示唆された。

本研究は、心身の機能低下が認められる高齢者の介護予防を目的として、マシンを使用した筋力向上トレーニングが身体諸機能および手段的ADLや健康関連QOLにどのような効果をもたらすかについて検討した。対象者は、老年症候群をスクリーニングするための介護予防健診（おたっしゃ21）を実施し、リスクが3つ以上（たとえば、虚弱、転倒、尿失禁）あると判定された65歳以上の高齢者46名で、参加者の大半が女性であった。3ヵ月間のトレーニングは、包括的高齢者運動トレーニングに基づいて、コンディショニング期、高負荷筋力増強トレーニング期、機能的トレーニング期と期分けして進められたが、対象者の状況に合わせて個別対応を重視した。測定項目は、身体的側面として移動能力（最大歩行速度、Timed Up & Goテスト）、柔軟性（長座位体前屈)、バランス能力(開眼片足立ち、閉眼片足立ち、ファンクショナルリーチ)、筋力（握力、膝伸展筋力）であった。一方、心理・行動的側面の測定には、手段的ADL（老研式活動能力指標）および健康関連QOL（SF-36日本語版）を用いた。トレーニングの結果、移動能力の指標である最大歩行速度およびTimed Up & Goテスト、筋力の指標である握力および膝伸展筋力に有意な変化が認められた。すなわち、上肢および下肢の筋力が強くなるとともに、移動能力にも向上がみられた。また、老研式活動能力指標およびSF-36日本語版の「役割機能－身体」、「役割機能－精神」においても有意な変化が認められた。すなわち、手段的ADLや日常的な役割機能についても改善することが分かった。また、トレーニング前のレベルが低い人ほどこれらの指標について大きな改善を示すことが明らかになった。以上のことから、虚弱高齢者にとってマシンを利用した筋力向上トレーニングの有用性が示されるとともに、トレーニング前の機能レベルを考慮する必要性があることが示唆された。

　本研究は、中高年者の身体活動・運動への参加、継続 (アドヒレンス) に関わる要因を、行動変容のトランスセオレティカル・モデル (TTM) に基づいて検討した。また、これら基礎研究の知見に基づいて、行動変容のTTMに基づく身体活動介入を行う際に利用するための印刷教材「今のあなたに合った身体活動や運動は？」の作成を試みた。以上の研究成果は、次の3つにまとめられる。　①行動変容のTTMの構成要素を測定するための尺度の構成：行動変容のTTMを構成する5つの概念 (運動行動変容の段階、運動行動変容の過程、運動セルフ・エフィカシー、運動意思決定のバランス (運動の恩恵・負担の知覚)、運動ソーシャル・サポート) を測定するための尺度を作成した。各尺度に関して、信頼性および妥当性が確認された。　②行動変容のTTMに基づく中高年者の身体活動・運動へのアドヒレンスに関わる要因の検討：横断的、縦断的な調査から、運動行動変容の5つの段階 (無関心期、関心期、準備期、実行期、維持期) に属する人によって、運動行動変容の過程、運動セルフ・エフィカシー、運動意思決定のバランス (運動の恩恵・負担の知覚)、運動ソーシャル・サポートに対する評価が異なることが明らかになった。これらの結果は、運動行動変容の各段階ごとに関わる要因が異なり、各段階に応じた運動アドヒレンス強化のための介入を行うことが重要であることを示している。すなわち、無関心期に属する人には、運動の負担感を軽減すること、関心期の人には運動の恩恵に対する知覚を強化することが重要である。また、準備期ではセルフ・エフィカシーを強化するような介入、実行期、維持期に属する人には逆戻りを予防するような行動的スキルを習得させる介入が有効である可能性が示唆された。　③行動変容のTTMに基づく身体活動介入に利用する印刷媒体の作成：以上の基礎研究の知見に基づいて、運動行動変容の段階に応じた介入を行う際に利用する印刷教材「今のあなたに合った身体活動や運動は？」の作成を試みた。