Abstract

Background

Awareness, knowledge, beliefs, and behavioral intentions of physical activity (PA) guidelines may be important mediating factors for promoting PA. However, these pathways of the psychological process to PA behavior have not been examined. These pathways may differ depending on health literacy levels. This study investigated the pathways to PA, from guideline awareness to behavior, and further examined whether they differed by health literacy.

Methods

A cross-sectional study was conducted with 7,000 Japanese participants aged 20–69 years. The participants were registered with an Internet survey company. Participants’ awareness, knowledge, beliefs, and behavioral intentions regarding the PA guidelines of Japan, the volume of moderate-to-vigorous intensity PA, activity level, and health literacy were examined through a questionnaire. The PA pathways, from guideline awareness to behavior, were examined by structural equation modeling (SEM), with PA behavior as the dependent variable. Multi-group SEM was conducted to examine the moderating effect of health literacy on PA pathways. Health literacy scores were dichotomized into high and low groups in multi-group modeling by the median split.

Results

SEM revealed that PA guideline awareness directly affects PA behavior and has certain indirect effects through the mediation of knowledge, beliefs, and behavioral intentions. Furthermore, the multi-group SEM showed that the proportion of indirect effects (path coefficient [PC]: 0.11, 95% confidence interval [CI]: 0.10–0.13) was higher than direct effects (PC: 0.07, 95%CI: 0.03–0.11) in the high-health literacy group. In contrast, the proportion of direct effects (PC: 0.22, 95%CI: 0.15–0.30) was higher than indirect effects (PC: 0.06, 95%CI: 0.05–0.07) in the low-health literacy group.

Conclusions

PA guideline awareness is both directly and indirectly associated with PA behavior, mediated by psychological pathways of knowledge, beliefs, and behavioral intentions, and influenced by health literacy. These results suggest that health literacy should be considered when implementing PA guideline-based interventions.

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

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

OBJECTIVE: To quantify the associations between muscle-strengthening activities and the risk of non-communicable diseases and mortality in adults independent of aerobic activities. DESIGN: Systematic review and meta-analysis of prospective cohort studies. DATA SOURCES: MEDLINE and Embase were searched from inception to June 2021 and the reference lists of all related articles were reviewed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective cohort studies that examined the association between muscle-strengthening activities and health outcomes in adults aged ≥18 years without severe health conditions. RESULTS: Sixteen studies met the eligibility criteria. Muscle-strengthening activities were associated with a 10-17% lower risk of all-cause mortality, cardiovascular disease (CVD), total cancer, diabetes and lung cancer. No association was found between muscle-strengthening activities and the risk of some site-specific cancers (colon, kidney, bladder and pancreatic cancers). J-shaped associations with the maximum risk reduction (approximately 10-20%) at approximately 30-60 min/week of muscle-strengthening activities were found for all-cause mortality, CVD and total cancer, whereas an L-shaped association showing a large risk reduction at up to 60 min/week of muscle-strengthening activities was observed for diabetes. Combined muscle-strengthening and aerobic activities (versus none) were associated with a lower risk of all-cause, CVD and total cancer mortality. CONCLUSION: Muscle-strengthening activities were inversely associated with the risk of all-cause mortality and major non-communicable diseases including CVD, total cancer, diabetes and lung cancer; however, the influence of a higher volume of muscle-strengthening activities on all-cause mortality, CVD and total cancer is unclear when considering the observed J-shaped associations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020219808.

OBJECTIVE: To prospectively investigate the association between personal activity intelligence (PAI) - a novel metabolic metric which translates heart rate during physical activity into a simple weekly score - and mortality in relatively healthy participants in China whose levels and patterns of physical activity in addition to other lifestyle factors are different from those in high-income countries. PATIENTS AND METHODS: From the population-based China Kadoorie Biobank study, 443,792 healthy adults were recruited between June 2004 and July 2008. Participant's weekly PAI score was estimated and divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Using Cox proportional hazard analyses, we calculated adjusted hazard ratios (AHRs) for cardiovascular disease (CVD) and all-cause mortality related to PAI scores. RESULTS: During a median follow-up of 8.2 (interquartile range, 7.3 to 9.1) years, there were 21,901 deaths, including 9466 CVD deaths. Compared with the inactive group (0 PAI score), a baseline weekly PAI score greater than or equal to 100 was associated with a lower risk of CVD mortality, an AHR of 0.87 (95% CI, 0.81 to 0.94) in men, and an AHR of 0.84 (95% CI, 0.78 to 0.92) in women, after adjusting for multiple confounders. Participants with a weekly PAI score greater than or equal to 100 also had a lower risk of all-cause mortality (AHR, 0.93; 95% CI, 0.89 to 0.97 in men, and AHR, 0.93; 95%, 0.88 to 0.98 in women). Moreover, this subgroup gained 2.7 (95% CI, 2.4 to 3.0) years of life, compared with the inactive cohort. CONCLUSION: Among relatively healthy Chinese adults, the PAI metric was inversely associated with CVD and all-cause mortality, highlighting the generalizability of the score in different races, ethnicities, and socioeconomic strata.

Cardiorespiratory fitness (CRF) is an independent predictor of morbidity and mortality. In Japan, annual physical exams are mandatory in workplace settings, and most healthcare settings have electronic medical records (EMRs). However, in both settings, CRF is not usually determined, thereby limiting the potential for epidemiological investigations using EMR data. PURPOSE: To estimate CRF (mL/kg/min) using variables commonly recorded in EMRs. METHODS: Participants were 5293 Japanese adults (11.7% women) who completed an annual physical exam at a large gas company in Tokyo, Japan, in 2004. The mean age was 48.3 ± 8.0 years. Estimated CRF (eCRF) was based on age, measured body mass index, resting heart rate, systolic and diastolic blood pressure, and smoking. Measured CRF was determined by a submaximal cycle ergometer graded exercise test. RESULTS: Regression models were used for males and females to calculate Pearson's correlation and regression coefficients. Cross-classification of measured CRF and eCRF was conducted using the lowest quintile, quartile, and tertile as the unfit categories. R's for eCRF were 0.61 (MD 4.41) for men and 0.64 (MD 4.22) for women. The overall accuracy level was reasonable and consistent across models, yet the unfit lower tertile model provided the best overall model when considering the positive predictive value and sensitivity. CONCLUSION: eCRF may provide a useful method for conducting investigations using data derived from EMRs or datasets devoid of CRF or physical activity measures.

Previous cohort study reported that high physical activity was associated with a low risk of self-reported hearing loss in women. However, no studies have examined the association between physical activity and the development of hearing loss as measured using an objective assessment of hearing loss in men and women. Here, we used cohort data to examine the association between leisure-time physical activity and incidence of objectively assessed hearing loss in men and women. Participants included 27 537 Japanese adults aged 20-80 years without hearing loss, who completed a self-administered physical activity questionnaire between April 2001 and March 2002. The participants were followed up for the development of hearing loss as measured by audiometry between April 2002 and March 2008. During follow-up, 3691 participants developed hearing loss. Compared with the none physical activity group, multivariable adjusted hazard ratios (HRs) for developing hearing loss were 0.93 (95% confidence interval (CI), 0.86-1.01) and 0.87 (0.81-0.95) for the medium (<525 MET-min/week) and high (≥525 MET-min/week) physical activity groups, respectively (p for trend = 0.001). The magnitude of risk reduction was slightly greater in vigorous-intensity activity than in moderate-intensity activity (p for interaction = 0.01). Analysis by sound frequency showed that the amount of physical activity was inversely associated with high frequency hearing loss development (p for trend <0.001), but not with low frequency hearing loss development (p for trend = 0.19). Higher level of leisure-time physical activity was associated with lower incidence of hearing loss, particularly for vigorous-intensity activities and high sound frequencies.

身体活動が健康の維持向上に寄与することは広く受け入れられており,国内外のガイドラインで身体活動の促進が推奨されている。一方,近年では,海外のガイドラインにおいて有酸素性の身体活動だけではなく筋力トレーニングの実施についても言及されるようになってきており,週2回以上実施することが推奨されている。このように,筋力トレーニングに関する研究は,スポーツ科学やトレーニング分野だけではなく公衆衛生分野にも広がり,健康アウトカムに対する筋力トレーニングの影響をテーマとした研究を中心に筋力トレーニングに関する疫学研究が報告されるようになってきている。そこで本レビューでは,新たな運動疫学研究の分野である筋力トレーニングに関する疫学研究について概説する。最初に,筋力トレーニングに関する用語の定義と整理を行う。次に,筋力トレーニングに関する歴史を紹介する。その後,死亡や疾病の罹患をアウトカムとした筋力トレーニングの研究を中心に解説し,最後に,筋力トレーニングの実施割合および関連要因について述べる。本レビューで紹介する研究の多くは海外からの報告である。日本で実施されている筋力トレーニングに関する疫学研究は,主に実施者の割合に関するものであり,特に,健康リスクとの関連に関する疫学研究は非常に限られている。今後,日本人を対象とした研究が数多く報告されることが期待される。(著者抄録)

The purpose of this study was to examine the associations of cardiorespiratory fitness, general adiposity, and central adiposity with incident intermediate hyperglycemia (IH) in women. We conducted a prospective cohort study of 1534 women aged 20-79 years old who had an annual health check-up with no history of major chronic diseases. At baseline, fitness was assessed by a Balke graded exercise test, and the estimated metabolic equivalents were used to create quartile groups. Women were also grouped based on their body mass index ( 25 kg/ m2, 25-29.9 kg/m2, and 30 kg/m2) and waist-to-height ratio (>0.50 or < 0.50). Cox proportional hazards models were conducted to assess the association of fitness and fatness variables with incident IH defined as fasting glucose of 5.6-6.9 mmol/L. Overall, 18.1% (n = 277) of the women developed IH during an average follow-up of 5.06 years. Fitness, body mass index, and waist-to-height ratio at baseline were the independent predictors of the IH incidence in separate age-adjusted models; yet when all three variables were included in the same model along with confounding variables, only fitness remained significant and demonstrated a clear inverse association with incident IH (P-for-trend <0.001). Health promotion efforts should focus on improving fitness for the prevention of IH in women.

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

Previous studies have not investigated the determinants of resting oxidative stress, including physical fitness, as it relates to redox regulation. The present study therefore was aimed at identifying lifestyle and biological factors that determine resting oxidative stress, including objectively measured physical fitness. In 873 middle-aged and elderly men and women, age and anthropometric parameters, lifestyle-related parameters, medication and supplementation status, physical fitness, biochemical parameters, and nutritional intake status, as well as three plasma oxidative stress markers: protein carbonyl (PC), F-2-isoprostane (F-2-IsoP), and thiobarbituric acid reactive substances (TBARS), were surveyed and measured. The determinants of PC, F-2-IsoP, and TBARS in all participants were investigated using stepwise multiple regression analysis. In PC, age (beta=-0.11, P=0.002), leg extension power (beta=-0.12, P=0.008), BMI (beta=0.12, P=0.004), and HDL-C (beta=0.08, P=0.040) were included in the regression model (adjusted R2=0.018). In the F-2-IsoP, smoking status (beta=0.07, P=0.060), BMI (beta=0.07, P=0.054), and HbA1c (beta=-0.06, P=0.089) were included in the regression model (adjusted R2=0.006). In TBARS, glucose (beta=0.18, P<0.001), CRF (beta=0.16, P<0.001), age (beta=0.15, P<0.001), TG (beta=0.11, P=0.001), antioxidant supplementation (beta=0.10, P=0.002), and HbA1c (beta=-0.13, P=0.004) were included in the regression model (adjusted R2=0.071). In conclusion, the present study showed that age, anthropometric index, lifestyle-related parameters, medication and supplementation status, objectively measured physical fitness, biochemical parameters, and nutritional intake status explain less than 10% of oxidative stress at rest.

目的 本研究の目的は、地域在住自立高齢者に対する膝痛改善教室(教室)が医療費の推移へ与える効果を検討することであった。方法 2015年1月から2月の間に山梨県都留市A地区在住の自立高齢者を対象に非ランダム化比較試験として4週間の教室を実施した。本研究の分析対象者は、教室の介入群で教室のすべての回と最終評価に参加した28人と、教室の非介入群で再調査にも回答のあった70人のうち、死亡・転出者と対象期間に社会保険に加入していた者を除外し、医療費データの利用に同意が得られた49人(介入群20人、非介入群29人)とした。医療費データは、2014年1月から2018年12月の傷病名に関節症のコードを含む医科入院外レセプトとそれに関連する調剤レセプトの合計を用いた。教室開催前の2014年を基準とする2015年から2018年までの各年の医療費の変化量を算出し、その間の医療費の推移に及ぼす介入の効果を線形混合効果モデルで分析した。結果 医療費の変化量の推移に対する教室の効果(調整平均値の群間差:介入群-非介入群)は、対象全期間を通じて有意差は認められなかった(全期間-5.6千円/人、95%CI:-39.2-28.0)。各年では、2015年9.3千円/人(95%CI:-39.6-58.3)、2016年-2.0千円/人(95%CI:-44.4-40.5)、2017年-10.3千円/人(95%CI:-42.5-21.9)、2018年8.2千円/人(95%CI:-39.1-55.4)であり、介入による有意な医療費抑制効果は確認されなかった。結論 今後は介入プログラムや対象人数を増やすなどの改善を行ったうえで、引き続き検証する必要がある。(著者抄録)

Objectives Approximately 40% of new fitness club (FC) members drop out within the first six months; however, the factors associated with FC membership resignation are largely unknown. This study aimed to identify the association between psychological attitudes toward exercise and FC membership resignation.Methods We conducted a cohort study enrolling participants from 17 FCs. All individuals who became members at FCs between April 1st, 2015 and March 31st, 2016 (n=5,421) were invited to participate in the study, and those who agreed to participate completed a self-administered baseline questionnaire (n=2,934). We excluded participants aged <20 years (n=167) and those with missing values (n=702). Psychological factors were evaluated using the short version of the perceived benefit and barriers to exercise scale. Participants were followed until September 30th, 2016, at which time we assessed the FC membership drop-out rate. Cox proportional-hazards models were used to evaluate the association between perceived benefits/barriers of exercise and FC membership resignation. Sub-analyses were then conducted, stratifying by gender and age group.Results A total of 2,065 participants were included in the analyses. The mean (standard deviation) age was 39.0 (15.0) years and 28.8% were male. Over 10.1 (4.4) months of newly-joined member follow-up, the FC membership drop-out rate was 24.6 instances per 1000 person-months. Multivariable analyses revealed no significant factors associated with FC membership drop-out. However, men aged 40-59 years who had a high physical benefit score and who perceived improving physical fitness as a benefit, were less likely to resign their memberships (hazard ratio [HR], 95% confidence interval [CI], 0.72 [0.52-1.00]). However, women aged <40 years with a high discomfort score and who saw discomfort as a barrier were more likely to resign membership (HR, 1.10 [1.01-1.19]). Women aged 40-59 years with high social benefit scores and who perceived social interaction as a benefit were less likely to resign their memberships, as were women with higher lack of motivation to exercise scores and who perceived lack of motivation as a barrier to exercise (HR for social benefit, 0.84 [0.74-0.97]; HR for lack of motivation, 0.85 [0.73-0.99]). Among both male and female participants aged ≥60 years, higher self-improvement scores, indicating that peer recognition was perceived as a benefit of exercise, was associated with higher HR for drop-out (men, 2.52 [1.10-5.81]; women, 1.31 [1.00-1.72]).Conclusions The results revealed gender and age differences in the association between the perceived benefits/barriers of exercise and FC membership dropout. Implementing programs based on enrollees' characteristics and psychological factors may contribute to preventing FC dropout in the future.

目的 健康増進施設であるフィットネスクラブ(fitness club:FC)では、約4割以上の新規入会者が6ヵ月以内に退会する。運動の習慣化に心理行動医学的アプローチが重要とされるが、民間FCの退会と関連する心理的要因を検討した報告は極めて少ない。そこで、本研究の目的はFC新規入会者における運動習慣の促進要因・阻害要因と退会との関連を明らかにすることである。方法 単一の経営母体である民間FC(17施設)の協力を得てコホート研究を実施した。2015年4月1日から2016年3月31日までのすべての新規入会者(5,421人)に自記式質問紙調査を依頼し、2,934人より回答を得た。未成年者(n=167)および回答欠損者(n=702)は解析から除外した。運動習慣の心理的要因は「簡易版運動習慣の促進要因・阻害要因尺度」で評価した。2016年9月30日まで追跡し退会の有無を把握した。Cox比例ハザードモデルにより全体および性・年齢階級別に検討した。結果 最終的な分析対象者は2,065人(平均年齢[標準偏差]、39.0[15.0]歳、男性28.8%)で、追跡不能者はいなかった。平均追跡期間は10.1(4.4)ヵ月で、退会率は24.6人/1,000人月であった。全体の分析では心理的要因と退会に有意な関連は認めなかった。層別解析において40-59歳の男性では「健康体力(促進要因)」得点が高い者ほど退会率が低かった(HR、0.72[0.52-1.00])。39歳以下の女性では、「身体的・心理的阻害(阻害要因)」得点が高い者では退会率が高かった(HR、1.10[1.01-1.19])。40-59歳の女性では「対人関係(促進要因)」得点が高い者ほど退会率が低く(HR、0.84[0.74-0.97])、「怠惰性(阻害要因)」得点が高い者ほど退会率が低かった(HR、0.85[0.73-0.99])。男女とも60歳以上では「自己の向上(促進要因)」得点が高い者ほど退会率が高かった(男性HR、2.52[1.10-5.81]、女性HR、1.31[1.00-1.72])。結論 退会と関連する入会時の心理的要因は性・年齢階級により異なった。退会予防には入会者の属性や心理的要因に即した運動プログラムの提供が必要と考えられた。(著者抄録)

Background: Grip strength reflects systemic muscle strength and mass and is reportedly associated with various metabolic variables. However, its prognostic association with dyslipidemia is unknown. We examined the association of grip strength and other physical fitness markers with the incidence of dyslipidemia among Japanese adults.Methods: A total of 16,149 Japanese (6,208 women) individuals aged 20-92 years who underwent a physical fitness test between April 2001 and March 2002 were included in this cohort study. Grip strength, vertical jump, single-leg balance with eyes closed, forward bending, and whole-body reaction time were evaluated at baseline. Dyslipidemia was annually determined based on fasting serum lipid profiles and self-reported dyslipidemia from April 2001 to March 2008.Results: During the follow-up period, 4,458 (44.9%) men and 2,461 (39.6%) women developed dyslipidemia. A higher relative grip strength (grip strength/body mass index) was associated with a lower incidence of dyslipidemia among both men and women (P for trend <0.001). Compared with those for the first septile, the hazards ratios and 95% confidence intervals (CIs) for the seventh septile were 0.56 (95% CI, 0.50-0.63) for men and 0.69 (95% CI, 0.58-0.81) for women. Moreover, relative vertical jump (vertical jump strength/body mass index) was also inversely associated with the incidence of dyslipidemia among both men and women (P for trend <0.001). There was no association between other physical fitness and dyslipidemia among both men and women.Conclusion: Relative grip strength and vertical jump may be useful risk markers of the incidence of dyslipidemia.

A high level of physical fitness, especially cardiorespiratory fitness, is associated with lower incidence of hypertension. However, the relationship between flexibility, which is a component of physical fitness, and the incidence of hypertension is unknown. The purpose of this study was to investigate the relationship between flexibility and the incidence of hypertension in a cohort study. A total of 22,972 (14,805 men and 8167 women; median age 49 years) normotensive participants were included in this study. Between April 2001 and March 2002, flexibility (standing forward bending) was measured using a standing trunk flexion meter. The participants were divided into quartiles of flexibility by sex and age group. Hypertension was defined as systolic blood pressure >= 140 mm Hg, diastolic blood pressure >= 90 mm Hg, or a self-reported history of previously diagnosed hypertension or current medication for hypertension at a health examination between April 2002 and March 2008. Hazard ratios and 95% confidence intervals (95% CI) for the incidence of hypertension were estimated using Cox proportional hazards models after adjusting for age, sex, body mass index, exercise habits, smoking status, and drinking status. During 102,948 person years of follow-up (median 5.6 years), 4235 participants developed hypertension. Compared with the lowest flexibility (quartile 1), hazard ratios and 95% CI were 0.96 (0.88 - 1.04) for quartile 2, 0.94 (0.86 - 1.03) for quartile 3, and 0.83 (0.76 - 0.91) for quartile 4. A high level of flexibility was associated with lower incidence of hypertension, independent of other confounding factors.

BACKGROUND: Several cross-sectional studies have linked higher physical fitness with better hearing sensitivity but have not established a causal relation; none have used a prospective design that is less susceptible to bias. We used a prospective cohort study to investigate the association between muscular and performance fitness and the incidence of hearing loss.METHODS: A total of 21,907 participants without hearing loss received physical fitness assessments between April 2001 and March 2002. Muscular and performance fitness index, an age- and sex-specific summed z-score based on grip strength, vertical jump height, single-leg balance, forward bending, and whole-body reaction time was calculated. Participants were classified into quartiles according to the muscular and performance fitness index and each physical fitness test. They were followed up for the development of hearing loss, assessed by pure-tone audiometry at annual health examinations between April 2002 and March 2008. Hazard ratios and 95% confidence intervals for hearing loss incidence were estimated using Cox proportional hazards regression models.RESULTS: During follow-up, 2765 participants developed hearing loss. The hazard ratios (95% confidence intervals) for developing hearing loss across the muscular and performance fitness index quartiles (lowest to highest) were 1.00 (reference), 0.88 (0.79-0.97), 0.83 (0.75-0.93), and 0.79 (0.71-0.88) (P-trend < .001). Among the various physical fitness components, a clear dose-response association with hearing loss incidence was observed for vertical jump height and single-leg balance (P-trend < .001 for both).CONCLUSION: Higher muscular and performance fitness is associated with a lower incidence of hearing loss. (C) 2020 The Authors. Published by Elsevier Inc.

Background: While physical activity has been reported to positively affect stress and sleep quality, less is known about the potential relationships among them. The present study aimed to investigate the mediating effect of stress on the association between physical activity and sleep quality in Chinese college students, after controlling for age, nationality, and tobacco and alcohol use. Participants: The sample comprised 6973 college students representing three Chinese universities. Methods: Physical activity, perceived stress, and sleep quality were respectively measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), Perceived Stress Scale-10 Items (PSS-10), and Pittsburgh Sleep Quality Index (PSQI). Results: Mediating effects of perceived stress on the association between physical activity and sleep quality were observed in males and females, with 42.4% (partial mediating effect) and 306.3% (complete mediating effect) as percentages of mediation, respectively. Conclusion: The results of this study may provide some suggestions that physical activity could improve sleep by aiding individuals in coping with stress and indicate that stress management might be an effective non-pharmaceutical therapy for sleep improvement.

Background: To examine the association between muscular and performance fitness (MPF) and the incidence of glaucoma. Methods: Atotal of 27,051 glaucoma-free participants aged 20-87 years underwent physical fitness tests between April 2001 and March 2002. The MPF index was calculated using an age- and sex-specific summed z-score from grip strength, vertical jump, single-leg balance, forward bending, and whole-body reaction time. The participants were divided into quartiles according to the MPF index and each physical fitness test. Participants were followed up for the development of glaucoma, which was defined based on physician-diagnosed glaucoma at an annual health examination between April 2002 and March 2008. Hazard ratios for the incidence of glaucoma were estimated using Cox proportional hazards models. Results: During follow-up, 303 participants developed glaucoma. Compared with the lowest MPF index group, hazard ratio (95% confidence interval) of developing glaucoma was 0.64 (0.46-0.89) for the highest MPF index group (P for trend = .001). Vertical jump and whole-body reaction time were associated with incident glaucoma (P for trend = .01 and < .001, respectively). There were no associations between the other physical fitness tests and the incidence of glaucoma. Conclusion: Higher MPF is associated with lower incidence of glaucoma.

Aim To re-evaluate the suitability of calf circumference as a surrogate marker of low muscle mass measured by both bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). We also examined the effects of obesity and age on low muscle mass screening using calf circumference. Methods In total, 1239 adults participated in this cross-sectional study. We measured the maximum calf circumference in a standing position and appendicular skeletal muscle mass (ASM) using BIA and DXA. We defined low muscle mass based on the Asian Working Group for Sarcopenia 2019 consensus. Results Calf circumference was positively correlated with BIA-measured ASM/height(2)(men:r= 0.81, women:r= 0.73) and DXA-measured ASM/height(2)(men:r= 0.78, women:r= 0.76). In the subgroup analyses by obesity and age, calf circumference was also positively correlated with ASM/height(2). The optimal calf circumference cut-offs for low muscle mass screening measured by BIA and DXA were 35 cm (sensitivity 91%, specificity 84%) and 36 cm (sensitivity 82%, specificity 80%) for men, and 33 cm (sensitivity 82%, specificity 84%) and 34 cm (sensitivity 85%, specificity 72%) for women, respectively. Conclusions Calf circumference is positively correlated with BIA- and DXA-measured muscle mass regardless of obesity and age and is a simple and accurate surrogate marker of muscle mass for diagnosing sarcopenia.Geriatr Gerontol Int 2020; center dot center dot: center dot center dot-center dot center dot.

The relationships between cardiorespiratory fitness (CRF) measurements not confounded by adiposity and the prevalence of pre-diabetes mellitus (pre-DM) and diabetes mellitus (DM) are not well known. Thus, we aimed to investigate the associations of visceral fat (VF) and CRF with the prevalence of pre-DM/DM among Japanese adults. The study included 970 individuals (327 women and 643 men) who were 40-87 years old and had complete health examinations, abdominal fat area, and fitness data from WASEDA'S Health Study during 2015-2018. The VF area was measured using magnetic resonance imaging. CRF was measured using a cycle ergometer and was defined as VO(2)peak divided by fat free mass. The pre-DM/DM was identified based on the questionnaire and fasting blood tests. The odds ratios (ORs) and 95% confidence intervals (CIs) for prevalence of pre-DM/DM were calculated. Seventy-three participants had pre-DM and 48 participants had DM. Compared to the low VF group, the high VF group had a higher prevalence of pre-DM/DM (OR: 1.87, 95% CI: 1.18-2.96), although no significant relationship was observed between CRF and pre-DM/DM prevalence (Pfor trend = 0.239). The sub-group analyses also revealed no significant relationship between CRF and pre-DM/DM prevalence in the low VF group (Pfor trend = 0.979), although CRF values were inversely related to the prevalence of pre-DM/DM in the high VF group (Pfor trend = 0.024). Although CRF was not independently related to the prevalence of pre-DM/DM after adjusting for adiposity, higher VF values were related to a higher prevalence of pre-DM/DM. In addition, CRF levels were inversely associated with the prevalence of pre-DM/DM only among high VF individuals.

Objectives: To examine the independent, joint, and fully combined associations of sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA), and cardiorespiratory fitness (CRF) with the odds of poor sleep quality (SQ). Methods: We performed a secondary data analysis on 757 working adults (male = 345) in Singapore, with an average age of 35.2 years. The Pittsburgh Sleep Quality Index was used to assess SQ. Objectively measured MVPA and SB were each obtained using an accelerometer. A non-exercise prediction equation was used to estimate CRF. Logistic regression models were used to determine associations. Results: In total, 13.2% of the sample (n = 100) was identified as having poor SQ. After adjusting for study covariates, independent analyses revealed a clear inverse association for higher CRF and lower odds of poor SQ (OR = 0.50; 95% CI = 0.28-0.91). SB and MVPA demonstrated no independent associations. Joint associations revealed that odds of having poor SQ for those with low CRF was higher regardless of SB level and was further deteriorated by lower MVPA in the fully combined model. The fully combined model also demonstrated that those with lower SB, higher MVPA, and higher CRF had the lowest odds of having poor SQ (OR = 0.28; 95% CI = 0.10-0.78). Conclusions: Physical activity/exercise training programs that aim to improve CRF may be useful in lowering the odds or poor SQ in working adults.

[Purpose] The aim of this study was to investigate the relationship between leg muscle strength, measured by a very simple one-leg stand-up test, and the prevalence of diabetes among Japanese males to raise awareness of diabetes prevention. [Participants and Methods] This cross-sectional analysis was conducted in 1,800 Japanese males (median [interquartile range] age, 61 [56-67] years) who completed health examinations and a one-leg stand-up test. The prevalence of diabetes was defined if any of the following conditions applied: 1) fasting blood glucose level more than 126 mg/dl, 2) two-hour blood glucose level more than 200 mg/dl (75-g oral glucose tolerance test), 3) HbA1c more than 6.5%, 4) diagnosed with diabetes by a physician, and/or 5) treated for diabetes. [Results] There were 490 participants with diabetes, and 517 participants were unable to complete the sit-to-stand task. When males, who could stand up, were used as a reference, the odds ratio for the prevalence of diabetes was significantly higher among those who were unable to stand up on neither leg than those who successfully stood up on both right and left legs after adjustment for covariates. [Conclusion] Low leg muscle strength, as measured by the one-leg stand-up test, was associated with a higher prevalence of diabetes among Japanese males. Because of its simplicity, this test could be useful detecting individuals who are at increased risk of developing diabetes.

Aim Watching sports at stadiums can have a favorable impact on health-related outcomes in older adults. We examined the effect of watching professional baseball at a ballpark on older adults' health-related outcomes. Methods A total fo 58 participants aged 65-85 years were randomized into a spectator group (n = 29) and waiting-list group (n = 29). During the 2-month intervention, there were 21 games. The spectator group watched games at the ballpark, and the waiting-list group maintained their daily routines. The health-related outcomes were executive and cognitive functions, health-related quality of life, depression symptoms, subjective happiness and physical activity. Results The median days watching baseball games in the spectator group was 6 days (interquartile range 4-10 days). Executive function using the reverse Stroop interference rate showed a non-significant trend of improvement in the spectator group compared with the waiting-list group (P = 0.063). The spectator group showed a significant reduction in depressive symptoms compared with the waiting-list group (P = 0.016). Conclusions Regularly watching professional baseball at a ballpark reduced older adults' depression symptoms. Geriatr Gerontol Int 2019; 19: 717-722.

Aims/Introduction To investigate the relationship between combined aerobic and resistance training, and the incidence of type 2 diabetes mellitus. Materials and Methods The present study included 10,680 Japanese women. Participants enrolled between 2005 and 2010, and were followed up until 2014. The frequency of combined training was counted for the first 3 months, the 6th month and the 9th month. In 2014, women reported whether or not they had diabetes, as well as the year of developing diabetes. Hazard ratios and 95% confidence intervals (CI) for the incidence of type 2 diabetes were obtained using Cox proportional hazard models. Results The median duration of follow up was 5 years, with 166 women developing type 2 diabetes. Using the lowest frequency of training group (1st quartile) as the reference, the hazard ratios for the second through fourth quartiles was as follows: 0.95 (95% CI 0.64-1.41), 0.73 (95% CI 0.48-1.13) and 0.69 (95% CI 0.44-1.07), respectively (P for trend = 0.116). After adjustment for age, body mass index and thigh circumference, the hazard ratios were: 0.84 (95% CI 0.56-1.26), 0.69 (95% CI 0.45-1.06) and 0.61 (95% CI 0.39-0.95), respectively (P for trend = 0.040). Conclusions A higher frequency of combined aerobic and resistance training is associated with a lower risk of developing type 2 diabetes in Japanese women.

Background: Simple physical fitness test can be a useful potential predictor of type 2 diabetes (T2DM). We examined the association between performances on simple physical fitness tests and the incidence of T2DM.Methods: This longitudinal study was conducted in 21,802 nondiabetic Japanese (6,649 women) aged 20 to 92 years, who underwent all physical fitness tests at baseline (April 2001 to March 2002). From April 2001 to March 2008, physical fitness tests, including grip strength, vertical jump, single-leg balance with eyes closed, forward bending, whole-body reaction time, and supine legs-up, were performed every year. Participants had physical fitness tests at least two times during the period. T2DM was also annually determined based on fasting blood glucose, glycated hemoglobin, and self-reported diabetes during the period. Discrete-time logit models were used to examine the influence of the serial level of each physical fitness test on the incidence of T2DM.Results: During the entire study period, 972 participants developed diabetes. Lower relative grip strength (grip strength/body weight) and single-leg balance performance were associated with a higher incidence of T2DM. For relative grip strength, as compared with the fourth quartile group, the odds ratios for other groups ranged from 1.16 to 1.56 (P for trend < 0.001). For single-leg balance, the odds ratios ranged from 1.03 to 1.49 (P for trend < 0.001).Conclusion: The performance of a simple single-leg balance test as well as that of a grip strength test were negatively associated with the risk of T2DM among Japanese.

Objectives: Although maintaining cardiorespiratory fitness is encouraged to reduce the risk of hypertension, the level at, and length of time for which, individuals need to maintain fitness remains unclear. We examined the association between the frequency of achieving the recommended fitness levels of the 'Physical Activity Reference for Health Promotion 2013' and the risk of hypertension among Japanese men.Methods: This cohort study was conducted in 6653 men without hypertension enrolled in 1986. Whether the participants' fitness level was equal to or exceeded the reference value (fit) or not (unfit) was determined. The frequency of achieving the recommended fitness level was calculated by counting the number of times the fitness level was achieved in 1980 through 1986. Incident hypertension was defined as the first visit with a SBP/DBP of at least 140/90 mmHg or self-reported antihypertensive medication use and was evaluated during annual health examinations from 1986 until 2009.Results: During the follow-up period, 3630 men developed hypertension. The multivariable-adjusted hazard ratios (95% confidence interval) for incident hypertension comparing men with fit versus unfit at baseline was 0.79 (0.74-0.85). Moreover, the frequency of achieving the recommended fitness level was inversely associated with the incidence of hypertension. The risk of hypertension was lower among those who achieved three or more of the recommended levels (0.72 for three times to 0.62 for seven times).Conclusion: Achieving the fitness level recommended in the Japanese guideline three or more times during a 6-year period can be beneficial for the risk reduction of hypertension.

OBJECTIVES: Although maintaining cardiorespiratory fitness is encouraged to reduce the risk of hypertension, the level at, and length of time for which, individuals need to maintain fitness remains unclear. We examined the association between the frequency of achieving the recommended fitness levels of the 'Physical Activity Reference for Health Promotion 2013' and the risk of hypertension among Japanese men. METHODS: This cohort study was conducted in 6653 men without hypertension enrolled in 1986. Whether the participants' fitness level was equal to or exceeded the reference value (fit) or not (unfit) was determined. The frequency of achieving the recommended fitness level was calculated by counting the number of times the fitness level was achieved in 1980 through 1986. Incident hypertension was defined as the first visit with a SBP/DBP of at least 140/90 mmHg or self-reported antihypertensive medication use and was evaluated during annual health examinations from 1986 until 2009. RESULTS: During the follow-up period, 3630 men developed hypertension. The multivariable-adjusted hazard ratios (95% confidence interval) for incident hypertension comparing men with fit versus unfit at baseline was 0.79 (0.74-0.85). Moreover, the frequency of achieving the recommended fitness level was inversely associated with the incidence of hypertension. The risk of hypertension was lower among those who achieved three or more of the recommended levels (0.72 for three times to 0.62 for seven times). CONCLUSION: Achieving the fitness level recommended in the Japanese guideline three or more times during a 6-year period can be beneficial for the risk reduction of hypertension.

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

目的:座位行動や身体活動の日内パターンの解明を主目的とした研究についてシステマティックレビューを行い、これまでの知見を整理し、今後の課題を明らかにすることを目的とした。方法:5つの文献データベースで検索した論文について、採択基準(成人、時間帯別の座位行動または身体活動に関する内容を含むなど)を基に該当論文を選定し、1)座位行動および身体活動の日内パターンの分布・傾向、2)座位行動および身体活動の日内パターンに関連する要因、3)座位行動および身体活動の日内パターンと健康アウトカムの関連という3つの観点から整理した。結果:採択論文27編のうち、2015年以降欧米や豪州の高齢者層を中心に、加速度計法で評価した座位行動や身体活動を1時間ごと、あるいは1日を3つに区分して検討した研究が主流であった。分布・傾向を検討した12編の主な傾向として、日内の遅い時間帯で座位行動レベルの上昇と身体活動レベルの低下がみられた。また、関連要因を検討した21編の多くで、性別や年齢、肥満度と座位行動や身体活動パターンに関連がみられた。健康アウトカムとの関連を検討した研究は1編のみであった。結論:座位行動や身体活動の日内パターンを検討した論文は少なく、対象者の居住地域や年齢、扱われた関連要因や健康アウトカムに偏りがあった。セグメント化した介入のため、今後は対象者の特性別、特に我が国の壮年・中年層を含めた研究成果の蓄積が必要である。(著者抄録)

Family history of hypertension (FH) is a nonmodifiable risk factor for hypertension. However, cardiorespiratory fitness (CRF) is a modifiable risk factor and might be important for preventing hypertension in both people with and without FH. The purpose of this study was to investigate the combined association of CRF and FH on the incidence of hypertension in normotensive male Japanese workers. A total of 6890 workers were included in this study. CRF was determined using a submaximal exercise test. A self-reported questionnaire was used to determine FH. Six groups were established, combining the two groups with and without FH (Yes, No) and the three CRF groups (Low, Moderate, High). The incidence of hypertension, defined as systolic blood pressure of >= 140 mmHg or diastolic blood pressure of >= 90 mmHg, or self-reported physician-diagnosed hypertension was evaluated. During the observation period of 101,212 man-years (median 17 years, minimum 1 year, maximum 23 years), 2210 workers developed hypertension. There were 3860 participants who had FH (56%). Compared with the Yes-Low CRF group, the HRs (95% CI) for hypertension were 66% lower in the No-High CRF group (0.34 [0.28-0.40]), 47% lower in the No-Low CRF group (0.53 [0.46-0.61]), and 24% lower in the Yes-High CRF group (0.76 [0.67-0.86]). FH and CRF did not show a significant interaction (p for interaction = 0.181). The combination of FH and CRF showed a clear association with the risk of incident hypertension, and moderate to high levels of CRF might be equally beneficial for preventing hypertension for both people with and without FH.

Background: There are several studies on the relationship between low back pain and physical activity. However, the results of these studies vary, and the relationship between them remains unclear. Therefore, we conducted a cross-sectional study to evaluate the association between objectively measured physical activity and low back pain in Japanese men. Methods: The study included 4022 Japanese men [average age: 47 (10) y]. Daily amount of moderate to vigorous physical activity and step counts were measured using an accelerometer. Low back pain, drinking and smoking, and lifestyle-related diseases were surveyed using a self-administered questionnaire A logistic regression model was used to evaluate the relationship between physical activity and step counts with persistent low back pain after adjusting for confounders. Results: Persistent low back pain was reported in 428 participants. The multivariable-adjusted odds ratios of presenting persistent low back pain across quartiles of amount of moderate to vigorous physical activity were 1.00 (reference); 0.93 (95% confidence interval, 0.70-1.22); 0.97 (95% confidence interval, 0.74-1.28); and 0.67 (95% confidence interval, 0.50-0.90); P for linearity = .012. Conclusion: We found a significant inverse relationship between objectively measured physical activity and persistent low back pain.

Background: This study aimed to examine the relationship between pedometer-assessed daily step count and all-cause mortality in a sample of elderly Japanese people.Methods: Participants included 419 (228 males and 191 females) physically independent, community-dwelling 71-year-old Japanese people. The number of steps per day was measured by a waist-mounted pedometer for seven consecutive days at baseline. Participants were divided into quartiles based on their average number of steps/day (first quartile, <4503 steps/day; second quartile, 4503-6110 steps/day; third quartile, 6111-7971 steps/day; fourth quartile, > 7972 steps/day) and were followed up over a mean period of 9.8 years (1999-2010) for mortality.Results: Seventy-six participants (18.1%) died during the follow-up period. The hazard ratios (adjusted for sex, body mass index, cigarette smoking, alcohol intake, and medication use) for mortality across the quartiles of daily step count (lowest to highest) were 1.00 (reference), 0.81 (95%Cl, 0.43-1.54), 1.26 (95%Cl, 0.70-2.26), and 0.46 (95%Cl, 0.22-0.96) (P for trend = 0.149). Participants in the highest quartile had a significantly lower risk of death compared with participants in the lowest quartile.Conclusion: This study suggested that a high daily step count is associated with a lower risk of all-cause mortality in physically independent Japanese elderly people.

Background: The relationship between the combination of physical activity (PA) and body mass index ( BMI) with low back pain (LBP) is unclear. The present study offers a cross-sectional assessment of how combinations of PA and BMI are related to LBP in Japanese men.Methods: Participants were 4022 Japanese men (mean age = 47) who underwent regular clinical examinations. PA was measured using a uniaxial accelerometer and divided into tertiles (PA(high), PA(middle), PA(low)). A self-administered questionnaire was used to report on persistent LBP experience, drinking and smoking habits, and any existing lifestyle diseases. After covariance adjustment, a logistic regression model was used to assess how combinations of PA and BMI are related to persistent LBP.Results: 428 of the participants had persistent LBP. A clear negative dose-response relationship was found between PA levels and persistent LBP (P for linearity = 0.012). Regarding BMI, odd ratios were shown to be higher in the overweight/obese category (BMI = 25 kg/m(2)) than for the normal weight category (BMI < 25 kg/m(2)). When the PAhigh was taken as the reference in the normal weight category, odds ratios for PAlow and PAmiddle in the normal weight category were shown to be high. Moreover, in the overweight/obese category, odd ratios for every fitness level were also high as for the normal weight category.Conclusion: The present study showed that both PA and BMI are related to persistent LBP. Also, the prevalence of persistent LBP became higher when PAlow and high BMI are combined rather than the group of PAhigh and low BMI combination.

Background: The "Physical Activity Reference for Health Promotion 2013" provides "fit" reference values for cardiorespiratory fitness (CRF) for good health. The importance of achieving a fit CRF level for several years on the subsequent prevention of type 2 diabetes mellitus (T2DM) remains to be clarified.Methods: This cohort study was conducted in 2,235 nondiabetic males aged 21 to 59 years, enrolled in April 1986 through March 1987. We calculated the ratio of the area under the curve (AUC(ratio)) for actual measured values and the AUC for the reference values of CRF in each individual during an 8-year measurement period before the baseline. According to whether they met a fit CRF level or not, participants were categorized into groups based on the AUCratio (Fit(AUC) or Unfit(AUC)) and initial CRF (Fit(initial) or Unfit(initial)), respectively. T2DM was evaluated on health checkups until March 2010.Results: During the follow-up period, 400 men developed T2DM. After adjustment for confounders, as compared with those in the Fit(AUC) group, the hazard ratio (HR) for those in the Unfit(AUC) group was 1.33 (95% confidence interval [CI], 1.06-1.65). A combined analysis with the categories of initial value and AUC(ratio) showed that, compared with the Fit(initial) and Fit(AUC) group, the HRs of Fit(initial) and Unfit(AUC), Unfit(initial) and Fit(AUC), and Unfit(initial) and Unfit(AUC) groups were 1.41 (95% CI, 0.99-2.00), 1.18 (95% CI, 0.81-1.70), and 1.40 (95% CI, 1.08-1.83), respectively.Conclusion: Achievement of a fit CRF level established in the Japan physical activity guideline for several years was associated with lower subsequent risk of T2DM.

Type 2 diabetes is increasing globally and in Asia. The purpose of this study was to examine the association of a fit-fat index (FFI) with diabetes incidence among Japanese men. In total 5,014 men aged 18-64 years old, who had an annual health check up with no history of major chronic disease at baseline from 2002 to 2009 were observed. CRF was estimated via cycle ergometry. Overall, 7.6% of the men developed diabetes. The mean follow-up period was 5.3 years. Hazard ratios, 95% confidence intervals and P trend for diabetes incidence were obtained using the Cox proportional hazards model while adjusting for confounding variables. High FFI demonstrated lower risk 0.54 (0.36-0.82) compared to low BMI 0.63 (0.44-0.90), low WHtR 0.64 (0.41-1.02), and High CRF 0.72 (0.51-1.03). FFI showed a marginally stronger dose response relationship across quartiles (P (trend)=0.001) compared to BMI (P (trend)=0.002), WHtR (P (trend)=0.055), and CRF (P (trend)=0.005). Overall, both fitness and fatness play independent roles in determining diabetes incidence in Japanese men. FFI may be a more advantageous physical fitness measure because it can account for changes in fitness and/or fatness.

Aim: Recent studies have suggested that non-high-density lipoprotein cholesterol (non-HDL-C) may be a good marker of coronary heart disease and cardiovascular disease risk. Therefore, we investigated the relationship between cardiorespiratory fitness (CRF) and non-HDL-C.Methods: We evaluated CRF and the incidence of high level of non-HDL-C in 4,067 Japanese men without dyslipidemia. The participants were given a submaximal exercise test, a medical examination, and questionnaires on their health habits in 1986. A cycle ergometer was used to measure the CRF and maximal oxygen uptake was estimated. The incidence of a high level of non-HDL -C (>= 170 mg/dL) from 1986 to 2006 was ascertained based on the fasting blood levels. A high level of non-HDL-C was found in 1,482 participants during the follow-up. Cox proportional hazard models were used to obtain the hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of a high level of non-HDL-C.Results: Following age adjustment, and using the lowest CRF group (quartile I) as reference, the HRs and 95% CIs for quartiles II through IV were: 1.00 (95% CI: 0.87-1.15), 0.87 (95% CI: 0.76-1.00), and 0.70 (95% CI: 0.60-0.81), respectively (P for trend <0.001). After additional adjustment for body mass index, systolic blood pressure, smoking, alcohol intake, and family history of dyslipidemia, the HRs and 95% CIs were: 1.05 (95% CI: 0.92-1.21), 0.94 (95% CI: 0.81-1.08), and 0.79 (95% CI: 0.67-0.92), respectively (P for trend=0.001).Conclusions: These results suggest that there is an inverse relationship between CRF levels and the incidence of a high level of non-HDL-C in Japanese men.

Background: We sought to examine the association between cardiorespiratory fitness (CRF) and incidence of type 2 diabetes considering the follow-up period in a cohort of Japanese men with a maximum follow-up period of 23 years.Methods: This study enrolled 7,804 male workers free of diabetes in 1986. CRF was measured using a cycle ergometer, and maximal oxygen uptake was estimated. During 1986-2009, participants were followed for development of type 2 diabetes, which was diagnosed using fasting blood tests, self-administered questionnaires, or oral glucose tolerance tests after urinary tests from annual health checkups. Hazard ratios for the incidence of type 2 diabetes were estimated using Cox proportional hazards models.Results: During the follow-up period, 1,047 men developed type 2 diabetes. In analyses by follow-up periods (1986-1993, 1994-2001, and 2002-2009), there was an inverse dose-response relationship between CRF and the development of type 2 diabetes for all three follow-up periods (P for trend 0.019, <0.001, and 0.001, respectively), and the association between CRF at baseline and the incidence of type 2 diabetes did not weaken with longer follow-up period. Compared with the lowest CRF group, hazard ratios of developing type 2 diabetes were 0.69 (95% confidence interval [CI], 0.49-0.97) for the highest CRF group in 1986-1993, 0.57 (95% CI, 0.42-0.79) for the highest CRF in 1994-2001, and 0.47 (95% CI, 0.30-0.74) for the highest CRF in 2002-2009.Conclusion: High CRF is associated with a lower risk of the incidence of type 2 diabetes over an extended period of >20 years among men.

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Purpose: Although the benefit of high cardiorespiratory fitness (CRF) for the prevention of type 2 diabetes mellitus (T2DM) is widely accepted, whether consistently high CRF is necessary or transiently high CRF is sufficient is unclear. The present study was conducted to examine the hypothesis that consistently high level of CRF is more beneficial than transiently high CRF for the prevention of T2DM. Methods: This cohort study was conducted in nondiabetic 7158 men age 20 to 60 yr, enrolled from 1986 to 1987. The area under the curve with respect to ground (AUC(G)) for CRF measurements during an 8-yr measurement period (1979-1987) was calculated as an index of integrated CRF level during the period. The differences (Delta AUC(P)) between AUC(G) and peak AUC (peak CRF-measurement period) was also calculated as an index of the presence and the size of a "spike'' in CRF. T2DM was defined by fasting blood glucose and a self-reported diagnosis of diabetes for participants with blood tests. For participants without blood tests, T2DM was defined by the result of oral glucose test after a nonfasting urinary test and a self-reported diagnosis of diabetes. T2DM was determined on health checkups until 2009. Results: During the follow-up period, 1495 men developed T2DM. After adjustment for confounders, as compared with the first quartile of AUC(G) for CRF, the hazard ratio (95% confidence interval) for the second, third, and fourth quartiles were 0.87 (0.76 to 1.00), 0.80 (0.68 to 0.95), and 0.72 (0.58 to 0.89), respectively. For CRF spike, there was no association between Delta AUC(P) in CRF and the incidence of T2DM. Conclusions: Consistently higher level of CRF over time was associated with lower risk of T2DM.

Purpose: Having a low level of physical fitness, especially cardiorespiratory fitness, appears to accelerate age-related aortic stiffening. Whereas, some studies have reported that trunk flexibility is a component of physical fitness, it is also negatively associated with arterial stiffening independent of cardiorespiratory fitness in cross-sectional studies. However, no long-term longitudinal study has determined whether poor trunk flexibility accelerates the progression of age-related aortic stiffening. We examined trunk flexibility and aortic stiffness progression in a 5-year longitudinal study.Methods and Results: A total of 305 apparently healthy men and women participated in this study (49.6 +/- 9.5 years of age). Trunk flexibility was measured using a sit-and-reach test. Aortic stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV) at baseline and after 5 years. Analysis of covariance (ANCOVA) was used to assess the association of the annual rate of cfPWV across flexibility levels (low, middle, high). There were no significant differences in baseline cfPWV among the three groups (835 164, 853 +/- 140, 855 +/- 2.68 cm/s; P = 0.577). Annual AcfPWV was significantly higher in the low-flexibility group than in the high-flexibility group (P = 0.009). ANCOVA revealed an inverse relationship between flexibility level and annual AcfPWV (14.41 +/- 2.73, 9.79 +/- 2.59, 2.62 +/- 2.68 cm/s/year: P for trend = 0.011). Multiple regression analysis revealed that baseline sit and reach (beta = 0.12, -0.70 to -0.01) was independently correlated with AcfPWV following adjustment for baseline peak oxygen uptake, age, sex, body fat, heart rate, and cfPWV. The 5-year change in cfPWV was not significantly correlated with 5-year change in sit-and-reach performance (P = 0.859).Conclusion: Poor trunk flexibility is associated with greater progression of age-related aortic stiffening in healthy adults. However, we failed to confirm a significant association between 5-year change in aortic stiffness and 5-year change in trunk flexibility. The association between increased age-related increase in aortic stiffness and deterioration in flexibility due to age may require observation for more than 5 years.

[Purpose] This study evaluated whether obesity is a risk factor for low back pain, by using body fat percentage (%FAT) and body mass index (BMI) as indices of obesity among Japanese males. [Subjects and Methods] This study included 1,152 males (average age: 28.0 ± 4.6 years). BMI was calculated from subject's height and weight, and %FAT was estimated by the thickness of two parts of skin. Low back pain, drinking and smoking were surveyed using a self-administered questionnaire, and maximal oxygen uptake was measured by a submaximal exercise test using a cycle ergometer. [Results] A significant positive dose-response relationship was shown between %FAT and persistent low back pain prevalence. Similarly, a significant positive dose-response relationship was confirmed between BMI and persistent low back pain. [Conclusion] This study suggests that both high %FAT and BMI are risk factors for persistent low back pain.

Objective: Using a fitness club is one of the forms of leisure activity. The benefits individuals seek in using their free time are related to their choices of activities during leisure time. For the purpose of obtaining data which are useful for the promotion of the utilization of fitness clubs, we aimed to investigate the relationship between the benefit factors sought in leisure time and the fitness club experiences of individuals. &lt;BR&gt;Methods: Data from a &amp;ldquo;survey for the purpose of ensuring that the value of fitness clubs is correctly communicated to consumers&amp;rdquo; was utilized. The subjects of the analysis comprised 1,023 people, among whom 506 had no experience using fitness clubs, and 517 had experience using fitness clubs. Benefits sought during leisure time were measured using a leisure-time-benefit scale. A logistic regression analysis was conducted with the presence or absence of fitness club membership experience as the object variable and items measuring awareness regarding leisure-related benefits as the explanatory variables.&lt;BR&gt;Results: Among those who responded to a question that enquired about &amp;ldquo;engaging in activities for the sake of one&amp;rsquo; s health&amp;rdquo; and the benefits of leisure time, the multivariable adjusted odds ratio regarding whether people who had fitness club experience for those who answered &amp;ldquo;this applies to me,&amp;rdquo; taking the people who answered either &amp;ldquo;this does not apply to me&amp;rdquo; or &amp;ldquo;this neither particularly applies nor particularly does not apply to me&amp;rdquo; as a reference, was 2.13. Additionally, the adjusted odds ratio in relation to a question about &amp;ldquo;engaging in activities along with other people&amp;rdquo; was 1.37.&lt;BR&gt;Conclusion: There is a higher tendency for people who have used a fitness club to seek &amp;ldquo;engaging in activities to maintain one&amp;rsquo; s health&amp;rdquo; and &amp;ldquo;engaging in activities with people&amp;rdquo; as a benefit of their leisure time, compared with people who have not used a fitness club.

We examined the relationship between frequency of watching baseball games and thephysical, social, and psychological characteristics among elderly people who participated in anintervention study titled effects of spectating professional baseball at the stadium on healthrelatedoutcomes in middle-aged and older adults. We used self-administered questionnaires andsurveys to determine physical, social, and psychological characteristics. During the study period, weprovided participants with free tickets to professional baseball games. We recommended that eachparticipant attend at least two games per month, but to avoid excessive attendance. Following thestudy period, we used questionnaires to determine the characteristics associated with attendance atprofessional baseball games. Whether or not a participant attended games frequently was used asthe objective variable, and other characteristics were used as explanatory variables in a stepwisemultiple regression or multiple logistic regression analysis, to determine which physical, social, andpsychological characteristics correlated with attendance frequency.There were 57 participants in this study, with a mean age of 74 years. The mean attendancefrequency was 3.3 times per month. Attendance frequency had a significant negative correlationwith the presence of an orthopedic disorder. There was a significant positive correlation with thefrequency of attendance at social outings. There was also a significant negative correlation withsubjective happiness and a positive correlation with physical quality of life. This study showed thatelderly participants who frequently attended professional baseball games did not have orthopedicdiseases, tended to go on frequent, regular outings, had a low level of subjective happiness, and had a high physical quality of life. Further study is needed to clarify the factors correlated with attendance at sporting events by the elderly. The information can be used to provide an environment conducive to attendance by the elderly at sporting events in stadiums.

【目的】椅子片脚立ち上がりテストと筋量および筋力との関連を検討することにより,サルコペニア簡易評価法としての椅子片脚立ち上がりテストの有用性を明らかにすることを目的とした.【方法】30歳から89歳の中高齢者575人を対象とした.座面の高さが40cmの椅子に座った状態から片脚で立ち上がることができるかを評価した.DXA法を用いて四肢除脂肪軟組織量を測定し,身長の2乗で除した骨格筋指数を用いて筋量を評価した.また,握力と脚伸展パワーの測定を行った.【結果】椅子から片脚で立ち上がることができなかった者では握力や脚伸展パワーが有意に低く(P<0.05),低筋量(オッズ比:2.79)や低筋力(オッズ比:3.07)に該当する者が多かった(P<0.05).また,低筋量と低筋力の各評価における椅子片脚立ち上がりテストの感度は48〜56%,特異度は72〜74%であった.【結論】椅子片脚立ち上がりテストによってサルコペニアをある程度推定できる可能性が示唆された.(著者抄録)

Wearable products or biosensors require conformability to a complex curved surface or stretching and moving shapes such as parts of the human body. However, it is difficult to apply conventional printed wiring boards (PWBs) or flexible printed circuits (FPCs) to these applications. This situation prompted us to develop a novel wiring structure suitable for 3D-conformable devices. Our structure is composed of spiral-shaped metal wiring and a polymeric insulating layer that has a similar shape. This wiring structure has the following key features: (1) 3D conformability that combines deformability with robustness, (2) low and unchanging electrical resistance during stretching, and (3) a process applicability that allows solder mounting processes or photo processes to be employed to manufacture this device. In this paper, we show the advantages of this structure compared to other conventional types. We also demonstrate a conformable LED matrix display in which LED chips are mounted at the center of each spiral in the array.

Context: Although metabolic abnormalities are often developed in Asians with body mass index (BMI) of 23-25 kg/m(2), the characteristics of the nonobese Asians with metabolic abnormality have not been fully understood.Objective: The aim of this study was to investigate the clinical significance of insulin sensitivity in Japanese men with BMI of 23-25 kg/m(2).Design and Participants: In this study, we defined hypertension, hyperglycemia, and dyslipidemia as cardiometabolic risk factors (CMRFs). We recruited subjects who met the following selection criteria: men with BMI of 21-23 kg/m(2) and no CMRF (n = 24); men with BMI of 23-25 kg/m(2) and no CMRF (n = 28), or one CMRF (n = 28), or at least two CMRFs (n = 14); and overweight men with metabolic syndrome (n = 20). Insulin sensitivity (IS) and ectopic fat content in muscle and liver were measured by two-step hyperinsulinemic-euglycemic clamp and H-1-magnetic resonance spectroscopy, respectively.Results: Among subjects with BMI of 23-25 kg/m(2), impaired IS in muscle, but not in liver, was found in those with even one CMRF, whereas impaired IS in both muscle and liver was observed in overweight men with metabolic syndrome. Liver fat accumulation and elevated liver enzymes were associated with impaired IS in both muscle and liver in those subjects.Conclusions: Among Japanese men with BMI of 23-25 kg/m(2), muscle insulin resistance was present in those with even one CMRF. In this population, liver fat accumulation and/or elevated liver enzymes could be a good marker for impaired IS in both muscle and liver.

Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.

BackgroundThe purpose of this study was to examine the impact of combined cardiorespiratory fitness and waist-to-height ratio in the form of a fit-fat index on incident diabetes risk. Additionally, the independent predictive performance of cardiorespiratory fitness, waist-to-height ratio, and body mass index also were estimated and compared.MethodsThis was a prospective cohort study of 10,381 men who had a normal electrocardiogram and no history of major chronic disease at baseline from 1979 to 2005. Random survival forest models and traditional Cox proportional hazards models were used to predict diabetes at 5-, 10-, and 15-year incidence horizons.ResultsOverall, 4.8% of the participants developed diabetes. Receiver operating characteristic curve analyses for incidence risk demonstrated good discrimination using random survival forest models across fitness and fatness measures; Cox models were poor to fair. The differences between fitness and fatness measures across horizons were clinically negligible. Smoothed random survival forest estimates demonstrated the impact of each fitness and fatness measure on incident diabetes was intuitive and graded.ConclusionsAlthough fitness and fatness measures showed a similar discriminative ability in predicting incident diabetes, unique to the study was the ability of the fit-fat index to demonstrate a better indication of incident risk when compared to fitness or fatness alone. A single index combining cardiorespiratory fitness and waist-to-height ratio may be more useful because it can indicate improvements in either or both of the measures.

Cardiorespiratory fitness is negatively associated with arterial stiffness, although it is unclear whether it is associated with prospective arterial stiffness changes. The authors examined cardiorespiratory fitness and arterial stiffness progression in a 2-year follow-up study of 470 healthy men and women aged 26 to 69 years. Peak oxygen uptake (VO2peak) was measured at baseline using a graded cycle exercise test. Arterial stiffness was assessed using brachialankle pulse wave velocity (baPWV) at baseline and after 2 years. Two-year changes in baPWV were significantly higher in patients in the lowest VO2peak tertile (28.8 +/- 7.6 cm/ s) compared with those in the highest VO2peak tertile (-1.4 +/- 7.5 cm/ s) (P=.024) and were inversely correlated with VO2peak (r=-.112, P=.015). Stepwise multiple regression analysis revealed that age, glucose, baPWV, VO2peak, and sex were independent correlates of 2-year changes in baPWV, suggesting that higher cardiorespiratory fitness is associated with age-related arterial stiffening suppression. J Clin Hypertens (Greenwich). 2016; 18: 292-298. (C) 2015 Wiley Periodicals, Inc.

Physical activity has multiple health benefits but may also increase the risk of developing musculoskeletal pain (MSP). However, the relationship between physical activity and MSP has not been well characterized. This study examined the dose-response relationship between sports activity and MSP among adolescents. Two school-based serial surveys were conducted 1 year apart in adolescents aged 12 to 18 years in Unnan, Japan. Self-administered questionnaires were completed by 2403 students. Associations between time spent in organized sports activity and MSP were analyzed cross-sectionally (n=2403) and longitudinally (n=374, students free of pain and in seventh or 10th grade at baseline) with repeated-measures Poisson regression and restricted cubic splines, with adjustment for potential confounders. The prevalence of overall pain, defined as having pain recently at least several times a week in at least one part of the body, was 27.4%. In the cross-sectional analysis, sports activity was significantly associated with pain prevalence. Each additional 1 h/wk of sports activity was associated with a 3% higher probability of having pain (prevalence ratio=1.03, 95% confidence interval=1.02-1.04). Similar trends were found across causes (traumatic and nontraumatic pain) and anatomic locations (upper limbs, lower back, and lower limbs). In longitudinal analysis, the risk ratio for developing pain at 1-year follow-up per 1 h/wk increase in baseline sports activity was 1.03 (95% confidence interval = 1.02-1.05). Spline models indicated a linear association (P<0.001) but not a nonlinear association (P >= 0.45). The more the adolescents played sports, the more likely they were to have and develop pain.

Background: In Japan, the incidence of kidney stones has increased markedly in recent decades. Major causes of kidney stones remain unclear, and limited data are available on the relationship between overweight/obesity and the incidence of kidney stones. We therefore evaluated body mass index (BMI) and the incidence of kidney stones in Japanese men.Methods: Of the workers at a gas company, 5984 males aged 20-40 years underwent a medical examination in 1985 (baseline). This study includes 4074 of the men, who were free of kidney stones at baseline and underwent a second medical examination performed between April 2004 and March 2005. BMI was calculated from measured height and weight in 1985, and men were categorized into tertiles. The development of kidney stones during follow-up was based on self-reports from questionnaires at the second medical examination.Results: The average duration of follow-up was 19 years, with 258 participants developing kidney stones during this period. Using the lowest BMI (1st tertile) group as a reference, the hazard ratios (95% confidence intervals [CIs]) for the 2nd and 3rd BMI tertiles were: 1.26 (95% CI, 0.92-1.73) and 1.44 (95% CI, 1.06-1.96), respectively (P for trend = 0.019). After additionally adjusting for potential confounders, such as age, systolic blood pressure, cardiorespiratory fitness, cigarette smoking, and alcohol consumption, the hazard ratios were 1.28 (95% CI, 0.93-1.76) and 1.41 (95% CI, 1.02-1.97), respectively (P for trend = 0.041).Conclusions: These results suggest that increased BMI is a risk factor for kidney stones in Japanese men.

Background While heavier weight is known to increase the incidence of dyslipidemia, limited data are available on the relationship between weight gain and its development. Methods A total of 2647 males were categorized into the following four groups according to the difference between their self-reported weight at 20 years of age and their measured weight in 1994-95: a loss of 5% (decrease), loss of ,5% or gain of ,5% (no change), gain of 5 to ,15% (increase) and gain of 15% (sizable increase). They were followed up until their 2002-03 health examination. Using the 'no change' group as reference, the multivariable-adjusted odds ratio (adjusted for age, body mass index at 20 years of age, physical activity, smoking and alcohol intake) and 95% confidence interval (95% CI) for the incidence of dyslipidemia were determined using logistic regression models. Results A total of 1342 participants developed dyslipidemia during the follow-up period. The 'increase' and 'sizable increase' groups had odds ratios for the incidence of dyslipidemia of 1.97 (95% CI, 1.59-2.45) and 2.68 (2.15-3.34), respectively, demonstrating that there was a significant dose-response association between weight gain since 20 years of age and the incidence of dyslipidemia (P, 0.001 for trend). Conclusion These results suggest that dyslipidemia could be prevented by avoiding weight gain in adulthood.

Background: There is limited data examining the association of combined fitness and central obesity with health related quality of life (HRQoL) in adults. We examined the association of combined cardiorespiratory fitness (CRF) and waist-to-height ratio (WHtR) in the form of a fit-fat index (FFI) with the Physical Component Summary (PCS) and Mental Component Summary (MCS) HRQoL scores in United States Navy servicemen.Methods: As part of a health fitness assessment, a total of 709 healthy males aged 18-49 years completed a submaximal exercise test, WHtR measurement, and HRQoL survey (SF-12v2) between 2004 and 2006. FFI level was classified into thirds with the lowest FFI tertile serving as the referent group. PCS and MCS scores >= 50 were taken to indicate average or better. Logistic regression was used to obtain odds ratios (OR) and 95 % confidence intervals (CI).Results: The prevalence of average or better HRQoL scores was lowest in the referent FFI tertile, PCS 60.2 % and MCS 57.6 %. Compared with the lowest FFI group in multivariate analyses, the OR (95 % CI) of having average or better PCS was 1.63 (1.09-2.42) and 3.12 (1.95-4.99) for moderate and high FFI groups respectively; MCS was 1.70 (1.13-2.55) and 4.89 (3.03-7.89) for moderate and high FFI groups respectively (all P < 0.001). Consistent and progressive independent associations were observed between age and MCS, and also between CRF and MCS.Conclusion: Among males in the United States Navy, higher levels of FFI were independently and more consistently associated with having average or better HRQoL (physical and mental) than other known predictors of HRQoL.

Background: Tracking refers to the tendency for an individual to maintain their rank within a group over time. This study longitudinally investigated the 8-year tracking of pedometer-determined physical activity among physically independent elderly Japanese people aged 72 to 80 years. Methods: Steps/day were measured when participants were aged 72 and assessed again after 2, 5, and 8 years. The number of participants with a 2-year follow-up (72 to 74 years) was 177 (101 males, 76 females), with a 5-year follow-up (72 to 77 years) was 183 people (110 males, 73 females), and with an 8-year follow-up (72 to 80 years) was 145 people (91 males, 54 females). Step counts were continuously measured for 1 week in January, April, July, and October during each year of assessment. Results: A high rank correlation coefficient for steps/day exceeding 0.60 was obtained at the 2-, 5- and 8-year follow-up examinations for both males and females. Conclusion: This study suggests that the rank within a group of pedometer-determined steps/day remains stable over up to 8 years in healthy Japanese people aged between 72 to 80 years old.

AimTo examine the relationship between calf circumference and muscle mass, and to evaluate the suitability of calf circumference as a surrogate marker of muscle mass for the diagnosis of sarcopenia among middle-aged and older Japanese men and women.MethodsA total of 526 adults aged 40-89 years participated in the present cross-sectional study. The maximum calf circumference was measured in a standing position. Appendicular skeletal muscle mass was measured using dual-energy X-ray absorptiometry, and the skeletal muscle index was calculated as appendicular skeletal muscle mass divided by the square of the height (kg/m(2)). The cut-off values for sarcopenia were defined as a skeletal muscle index of less than -2 standard deviations of the mean value for Japanese young adults, as defined previously.ResultsCalf circumference was positively correlated with appendicular skeletal muscle (r=0.81 in men, r=0.73 in women) and skeletal muscle index (r=0.80 in men, r=0.69 in women). In receiver operating characteristic analysis, the optimal calf circumference cut-off values for predicting sarcopenia were 34cm (sensitivity 88%, specificity 91%) in men and 33cm (sensitivity 76%, specificity 73%) in women.ConclusionsCalf circumference was positively correlated with appendicular skeletal muscle mass and skeletal muscle index, and could be used as a surrogate marker of muscle mass for diagnosing sarcopenia. The suggested cut-off values of calf circumference for predicting low muscle mass are <34cm in men and <33cm in women. Geriatr Gerontol Int 2015; 15: 969-976.

Background: The independent and combined associations of muscle strength and obesity on the prevalence of type 2 diabetes in Japanese men remain unclear.Methods: Hand grip strength was cross-sectionally evaluated between 2011 and 2013 to assess muscle strength in 5039 male workers aged 40 to 64 years. Weight and height were measured, and overweight/obesity was defined as a body mass index >= 25 kg/m(2). The prevalence of type 2 diabetes, defined as fasting plasma glucose >= 126 mg/dL and/or hemoglobin A1c >= 6.5% and/or self-reported physician-diagnosed diabetes, was evaluated. Odds ratios (OR) and 95% confidence intervals (95% CI) for the prevalence of type 2 diabetes were obtained using a logistic regression model.Results: In total, 611 participants had type 2 diabetes, and 1763 participants were overweight/obese. After adjustment for covariates, we found an inverse association between muscle strength and the prevalence of type 2 diabetes (P for trend <0.01). In addition, when the analyses were stratified by obesity status, the multivariable-adjusted OR per 2-standard-deviation increase in muscle strength was 0.64 (95% CI, 0.49-0.83) in the overweight/obese group, compared to a weaker relationship in the normal-weight group (OR 0.79 per 2-standard-deviation increase; 95% CI, 0.60-1.06).Conclusions: Dynapenia, an age-related decrease in muscle strength, is associated with increased prevalence of type 2 diabetes, and this relationship is stronger in overweight/obese middle-aged Japanese men than in normal-weight men.

Background: In "Physical Activity Reference for Health Promotion 2013" the Japan Ministry of Health, Labour and Welfare publication gives reference values for cardiorespiratory fitness (CRF) required for good health. We examined the associations between the CRF reference values and incidence of type 2 diabetes.Methods: This prospective cohort study enrolled 4633 nondiabetic Japanese men aged 20 to 39 years at baseline. CRF was measured using the cycle ergometer test, and maximal oxygen uptake was estimated. On the basis of the CRF reference value, participants were classified into 2 groups: those with values less than the reference value (under-RV) and those with values equal to or greater than reference value (over-RV). Hazard ratios (HRs) and 95% CIs for incident type 2 diabetes were estimated using a Cox proportional hazards model.Results: A total of 266 participants developed type 2 diabetes during the 14 years of follow-up. As compared with the under-RV group, the over-RV group had a significantly lower multivariable-adjusted HR for type 2 diabetes (HR 0.67; 95% CI, 0.51-0.89). In receiver operating characteristic analysis, the optimal CRF cut-off value for predicting incident type 2 diabetes was 10.8 metabolic equivalents (sensitivity, 0.64; specificity, 0.64), which was close to the CRF reference value of 11.0 metabolic equivalents.Conclusions: The reference CRF value appears to be reasonably valid for prevention of type 2 diabetes, especially among Japanese men younger than 40 years. Development of type 2 diabetes can be prevented by maintaining a CRF level above the reference value.

OBJECTIVES: The mean number of steps measured in the National Health and Nutrition Survey is employed for the assessment of physical activity/exercise in "Health Japan 21," and is used to represent the amount of physical activity/exercise that citizens engage in. In this study, we clarified the characteristics of the data on the number of steps, drawn from the National Health and Nutrition Survey. METHODS: Among the data from the National Health and Nutrition Surveys conducted from 2008 to 2010, data from 21,914 participants on daily number of steps and pedometer attachment were analyzed. On a nutritional intake questionnaire, subjects who responded on the physical status item that they had attached the pedometer all day long were assigned to the "Whole-day-attached" group. Their means, medians, outliers, and frequency distribution were then compared with those in a "Non- whole-day-attached" group. RESULTS: Subjects assigned to the "Non- whole-day-attached" group accounted for about 8% of cases in 2008, 2009, and 2010. In all three years, the mean number of steps in the "Whole-day-attached" group was 1,076 to 1,472 higher than that in the "Non-whole-day-attached" group. In both groups, outliers were present, and the frequency distribution showed a broad range on the side indicating a higher number of steps. Accordingly, the mean value was higher than the median value by approximately 600 steps. CONCLUSION: As data on the number of steps measured in the National Health and Nutrition Survey includes individuals not attaching the pedometer all day (approximately 8% of cases), the data are not normally distributed. Therefore, when utilizing these data as representative of citizens' physical activity/exercise, their characteristics should be taken into consideration.

Background: The aim of this study is to investigate the independent and joint effects of cardiorespiratory fitness (CRF) and body mass index (BMI) on cancer mortality in a low body mass index population.Methods: We evaluated CRF and BMI in relation to cancer mortality in 8760 Japanese men. The median BMI was 22.6 kg/m(2) (IQR: 21.0-24.3). The mean follow-up period was more than 20 years. Hazard ratios and 95% CI were obtained using a Cox proportional hazards model while adjusting for several confounding factors.Results: Using the 2nd tertile of BMI (21.6-23.6 kg/m(2)) as reference, hazard ratios and 95% CI for the lowest tertile of BMI (18.5-21.5) were 1.26 (0.87-1.81), and 0.92 (0.64-1.34) for the highest tertile (23.7-37.4). Using the lowest tertile of CRF as reference, hazard ratios and 95% CIs for 2nd and highest tertiles of CRF were 0.78 (0.55-1.10) and 0.59 (0.40-0.88). We further calculated hazard ratios according to groups of men cross-tabulated by tertiles of CRF and BMI. Among men in the second tertile of BMI, those belonging to the lowest CRF tertile had a 53% lower risk of cancer mortality compared to those in the lowest CRF tertile (hazard ratio: 0.47, 95% CI: 0.23-0.97). Among those in the highest BMI tertile, the corresponding hazard ratio was 0.54 (0.25-1.17).Conclusion: These results suggest that high CRF is associated with lower cancer mortality in a Japanese population of men with low average BMI.

Several studies have shown that low cardiorespiratory fitness (CRF) or heavy alcohol consumption is risks of total or certain types of cancer death. However, the combined influence of CRF and drinking habits on total cancer mortality is not clear. The purpose of this study was to investigate the joint effect of CRF and drinking habits on total cancer mortality among Japanese men. We evaluated the CRF and drinking habits on risk of total cancer mortality in 8,760 Japanese men (age: 19-59 yr) who were given a submaximal exercise test, a medical examination test, and questionnaires on their health habits. CRF was measured using a cycle ergometer test, and the men were classified into two categories by CRF levels based on the reference value of CRF (R-CRF) in "Physical Activity Reference for Health Promotion 2013" (Under R-CRF and Over R-CRF). Also, the men were assigned to Non Drinking, Moderate Drinking, and Heavy Drinking categories. There were 178 cancer deaths during the 20-yr follow-up period. Relative risk and 95% confidence intervals for total cancer mortality were obtained using the Cox proportional hazards model while adjusting for age, body mass index, systolic blood pressure, and smoking habits. Using the Under R-CRF & Heavy Drinking group as reference, the relative risk and 95% confidence intervals were 0.37 (0.16–0.85) for the Over R-CRF & Non Drinking group. This result suggests that Japanese male with a high CRF and a low drinking habit have a lower risk of total cancer mortality.

過去の身体活動疫学に関する研究を網羅的に収集・精読するシステマティックレビュー、ならびに生活習慣病予防、癌予防、運動器障害や認知症の予防と身体活動・運動・体力との関係を客観的に分析したメタ解析の成果を紹介した。この研究成果を基に、厚生労働省の「運動基準・運動指針の改定に関する検討会」において、新しい基準・指針のあり方について方向性が示されたので、その論点と今後の活用のあり方について概説した。

Objectives: This study was a cross-sectional survey of Japanese workers regarding the relationship between touching the eyes or nose and susceptibility to URTI in workers. Methods: The survey respondents were 4,663 Japanese workers. Subjects were surveyed via a self-administered questionnaire regarding their susceptibility to URTI and how often they touched their eyes or nose. In addition, subjects were surveyed regarding their preventive behaviors and routine behaviors thought to be associated with URTIs. A multiple logistic regression model was used to assess the relationship between susceptibility to URTI and how often the eyes or nose are touched. Results: Responses from 3,663 individuals who answered the self-administered questionnaire were analyzed. There were 1,590 individuals (42.9%) with a "frequent incidence of URTIs", defined as URTIs more than once a year. In terms of how often the eyes or nose are touched, the odds ratios (95% Cl) for a frequent incidence of URTIs among the groups responding "sometimes" and "often" were 1.41 (1.21-1.63) and 1.96 (1.59-2.42) (trend test: p<0.001) compared with the groups responding "never" and "almost never". Multivariate-adjusted odds ratios adjusted for confounding factors, i.e., behaviors to prevent URTIs, routine behaviors associated with URTIs, age, sex and BMI, were 1.33 (1.14-1.54) and 1.69 (1.36-2.09) (trend test: p<0.001). Conclusions: The present cross-sectional study indicates that susceptibility to URTI and how often the eyes or nose are touched are significantly associated in Japanese workers, independent of preventive behaviors and routine behaviors associated with URTIs.

Background: Emerging evidence suggests the adverse association between sedentary behavior (SB) and physical with mental health, but few studies have investigated the relationship between volume of physical activity and psychological distress. The present study examined the independent and interactive associations of daily SB and weekly level of moderate to vigorous physical activity (MVPA) with psychological distress in a multi-ethnic Asian population.Methods: De-identified data of 4,337 adults (18-79 years old) on sedentary behaviors, physical activity patterns, psychological distresses, and other relevant variables were obtained from the Singapore Ministry of Health's 2010 National Health Survey. Psychological distress was assessed using General Health Questionnaire-12 (GHQ-12), whereas total daily SB and total weekly volume (MET/minutes) of MVPA were estimated using the Global Physical Activity Questionnaire version 2 (GPAQ v2). Multivariate logistic regression analyses were carried out to estimate the odds ratios (95% confidence intervals) of the independent and interactive relationships of SB and MVPA with prevalence of psychological distress.Results: The category of high SB was positively associated with increased odds (OR = 1.29, 1.04-1.59) for psychological distress, whereas the category of active was inversely associated with lower odds (OR = 0.73, 0.62-0.86) for psychological distress. Multivariate analyses for psychological distress by combined daily SB and weekly MVPA levels showed inverse associations between middle SB and active categories (OR = 0.58, 0.45 - 0.74) along with low SB and active categories (OR = 0.61, 0.47-0.80).Conclusions: The present population-based cross-sectional study indicated that in the multi-ethnic Asian society of Singapore, a high level of SB was independently associated with psychological distress and meeting the recommended guidelines for physical activity along with <= 5 h/day of SB was associated with the lowest odds of psychological distress.

Several studies have shown that low cardiorespiratory fitness (CRF) or heavy alcohol consumption is risks of total or certain types of cancer death. However, the combined influence of CRF and drinking habits on total cancer mortality is not clear. The purpose of this study was to investigate the joint effect of CRF and drinking habits on total cancer mortality among Japanese men. We evaluated the CRF and drinking habits on risk of total cancer mortality in 8,760 Japanese men (age: 19-59 yr) who were given a submaximal exercise test, a medical examination test, and questionnaires on their health habits. CRF was measured using a cycle ergometer test, and the men were classified into two categories by CRF levels based on the reference value of CRF (R-CRF) in "Physical Activity Reference for Health Promotion 2013" (Under R-CRF and Over R-CRF). Also, the men were assigned to Non Drinking, Moderate Drinking, and Heavy Drinking categories. There were 178 cancer deaths during the 20-yr follow-up period. Relative risk and 95% confidence intervals for total cancer mortality were obtained using the Cox proportional hazards model while adjusting for age, body mass index, systolic blood pressure, and smoking habits. Using the Under R-CRF & Heavy Drinking group as reference, the relative risk and 95% confidence intervals were 0.37 (0.16–0.85) for the Over R-CRF & Non Drinking group. This result suggests that Japanese male with a high CRF and a low drinking habit have a lower risk of total cancer mortality.

Tokyo Gas is a gas company in Japan. The average age of employees in this company is increasing year by year. The Tokyo Gas Health Promotion Program began in 1978 to prevent the aging effects of the employees and company. Tokyo Gas has several health examinations, including a cardiorespiratory fitness test. The basic purpose of the health promotion program is to increase physical activity in daily life (especially walking). The company strongly recommends daily walking during commuting time, working time, and lunch time. Although the average age is increasing, the Tokyo Gas Health Promotion Program seems to have stopped the increase in the number of days absent due to illness and the aerobic capacity (maximal oxygen uptake) of employees has also been increasing. In addition, the trend in the number of people who require medical care for cardiovascular disease has decreased. The Tokyo Gas Health Promotion program has had several potential effects for the employees and the company.

The aim of this study was to pathologically investigate the developmental pattern of undifferentiated mucosal gastric cancer and to determine safe surgical margins for curative resection by endoscopic resection.Intramucosal cancer spread, or the width of the proliferative zone, was pathologically investigated in 47 cases of undifferentiated mucosal gastric cancer of size 20 mm or smaller without ulceration (scars). The 47 cases comprised 40 IIc and 7 IIb cases. The IIc cases consisted of 5 (12.5%) of intermediate-layer type (cancer localized at the intermediate layer of the mucosa), 31 (77.5%) of superficial type, and 4 of whole-layer type (10%). The IIb cases consisted of six of intermediate-layer type (85.7%) and one of superficial type (14.3%). The width of the proliferative zone in the 40 IIc cases ranged from 0 to 2,390 mu m (average 605.5 mu m). There was no significant correlation between width of proliferative zone and background mucosa. With regard to lesion size, average width was 243.6 mu m in cases with longest diameter a parts per thousand currency sign5 mm, while it was significantly larger (617.1 mu m) in cases with diameter > 5 mm.In endoscopic treatment of undifferentiated mucosal gastric cancer of size 20 mm or smaller without ulceration (scars), the lateral safety margin should be 3 mm or more.

Background: Limited data are available on the relationship between muscular and performance fitness (MPF) and the incidence of type 2 diabetes. Methods: A cohort of 3792 Japanese men completed a medical examination that included MPF and cardiorespiratory fitness tests MPF index composite score was calculated using. Z-scores from vertical jump, sit-ups, side step, and functional reach tests. Results: The mean follow-up period was 187 months (15.6 years). There were 240 patients who developed type 2 diabetes during follow-up Relative risks and 95% confidence intervals (CI) for incidence of diabetes across baseline quartiles of MPF index composite score were obtained using the Cox proportional hazards model while adjusting for age, BMI, diastolic blood pressure. cigarette smoking, alcohol intake, and family history of diabetes The relative risks for developing diabetes across quartiles of MPF index composite scores (lowest to highest) were 1.0 (referent), 1.15 (95% CI 0.83-1 60), 1.10 (0.78-1.55), and 0.57 (0.37-0.90) (P for trend = 061) These results were attenuated after adjustment for cardiorespiratory fitness (P for trend = 125). Conclusions: This prospective study suggests that MPF is a predictor of type 2 diabetes, although its predictive ability was attenuated after adjusting for cardiorespiratory fitness.

OBJECTIVE - Whereas single assessments of cardiorespiratory fitness have been shown to predict lower incidence of type 2 diabetes, there are no data on long-term trends in fitness and risk. We investigated the relationship between long-term trends in fitness and the incidence of type 2 diabetes.RESEARCH DESIGN AND METHODS - A cohort of 4,187 Japanese men free of diabetes completed annual health checkups and fitness tests for estimated maximal oxygen uptake at least four times over 7 years (1979-1985). We modeled the trend in fitness over 7 years for each man using simple linear regression. Men were then divided into quartiles based on the regression coefficient (slope) from the model. During the follow-up period (1985-1999), 274 men developed diabetes. Hazard ratios (HRs) and 95% Cls for the incidence of diabetes were obtained using the Cox proportional hazards model.RESULTS - Men in the lowest quartile of the distribution decreased in fitness over the 7 years (median slope -1.25 ml/kg/min), whereas men in the highest quartile increased in Fitness (median slope 1.33 ml/kg/min). With adjustment for age, initial fitness level, BMI, systolic blood pressure, cigarette smoking, alcohol intake, and a family history of diabetes and use of the lowest quartile, the HRs (95% Cl) for the second through fourth quartiles were 0.64 (0.46-0.89), 0.40 (0.27-0.58), and 0.33 (0.21-0.50), respectively (P-trend < 0.001).CONCLUSIONS - These results indicate that the long-term trend in fitness is a strong predictor of the incidence of type 2 diabetes in Japanese men.

Background: There is limited data examining the association between cardiorespiratory fitness (CRF) and health related quality of life (HRQOL) in healthy young adults. We examined the association between CRF and the HRQOL Physical Component Summary (PCS) and Mental Component Summary (MCS) scores in apparently healthy males in the United States Navy.Methods: A total of 709 males (18-49 yr) performed a submaximal exercise test and HRQOL assessment (SF-12v2 (TM)) between 2004-2006. CRF level was classified into fourths depending on age distribution with the lowest fitness quartile serving as the referent group. PCS and MCS scores >= 50 were defined as above the norm. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI). Results The age-standardized prevalence of above the norm scores was lowest in the referent CRF quartile, PCS 56.6% and MCS 45.1%. After adjusting for age, systolic blood pressure, body mass index, smoking habit, alcohol habit and using the lowest CRF group as the reference, the OR (95% CI) for PCS scores above the norm across the fitness quartiles (P < 0.003 for trend) were 1.51(0.94-2.41), 2.24(1.29-3.90), and 2.44 (1.30-4.57); For MCS the OR (95% CI) were across the fitness quartiles (P trend < 0.001) 2.03(1.27-3.24), 4.53(2.60-7.90), 3.59(1.95-6.60).Conclusion: Among males in the United States Navy relative higher levels of CRF are associated with higher levels of HRQOL.

OBJECTIVE: To investigate the association between cardiorespiratory fitness and the incidence of type 2 diabetes among Japanese men. RESEARCH DESIGN AND METHODS: This prospective cohort study was conducted in 4747 nondiabetic Japanese men, aged 20-40 years at baseline, enrolled in 1985 with follow-up to June 1999. Cardiorespiratory fitness was measured using a cycle ergometer test, and Vo(2max) was estimated. During a 14-year follow-up, 280 men developed type 2 diabetes. RESULTS: The age-adjusted relative risks of developing type 2 diabetes across quartiles of cardiorespiratory fitness (lowest to highest) were 1.0 (referent), 0.56 (95% CI 0.42-0.75), 0.35 (0.25-0.50), and 0.25 (0.17-0.37) (for trend, P < 0.001). After further adjustment for BMI, systolic blood pressure, family history of diabetes, smoking status, and alcohol intake, the association between type 2 diabetes risk and cardiorespiratory fitness was attenuated but remained significant (1.0, 0.78, 0.63, and 0.56, respectively; for trend, P = 0.001). CONCLUSIONS: These results indicate that a low cardiorespiratory fitness level is an important risk factor for incidence of type 2 diabetes among Japanese men.

PURPOSE: Limited data are available on the relationship between cardiorespiratory fitness and cancer mortality. We evaluated the cardiorespiratory fitness and risk of cancer mortality in Japanese men. METHODS: A total of 9039 men (19-59 yr) who were given a submaximal exercise test and a health examination between 1982 and 1988 and were followed for mortality up to 1999. Cardiorespiratory fitness was measured using a cycle ergometer test, and maximal oxygen uptake was estimated. RESULTS: The mean follow-up period was slightly more than 16 yr, producing a total of 148,491 person-years of observation. There were 231 deaths, with 123 deaths due to cancer. Relative risk (RR) and 95% confidence interval (95%CI) for cancer mortality were obtained using the Cox proportional hazards model. Taking into consideration age, systolic blood pressure, body mass index, smoking habit, and alcohol habit and using the lowest physical fitness group as the reference, the RR (95% CI) for increasing quartiles of fitness were 0.75(0.48-1.16), 0.43(0.25-0.74) and 0.41(0.23-0.74); P < 0.001 for trend. CONCLUSION: Low cardiorespiratory fitness is associated with cancer mortality in Japanese men.

1. The relationship between physical fitness (maximal oxygen uptake VO2(max)) and incidence of hypertension was investigated through a prospective study for a total of 16525 human-years of observation.
2. This study involved 3305 Japanese males whose blood pressure (BP) was normal when they received their first physical examination before the age of 50. They were monitored from 1983 to 1988. The BP of 425 subjects was diagnosed as hypertension in the fifth year.
3. Fitness levels were divided into quintiles according to VO2(max) levels, and were compared with the changes of BP and relative risk of hypertension after adjustment for age, initial percentage of body fat (PFAT), initial BP, alcohol consumption, cigarette smoking status and familial history of hypertension. The increase in BP of subjects in the least fit group was higher than in any other group. Relative risk was calculated using a multiple logistic regression and was 1.9 X higher in the least fit group compared with the fittest group.
4. The subjects were classified into three groups: the improved VO2(max) group, the deteriorated VO2(max) group and the unchanged VO2(max) group. The increase in BP of the improved VO2(max) group was significantly lower than the other two groups after adjustment for changes in PFAT, age, initial PFAT, initial BP, fitness level, alcohol consumption, cigarette smoking status and familial history of hypertension.
5. It is concluded that low VO2(max) level is related to higher incidence of hypertension. An improved VO2(max) would therefore be able to prevent hypertension.