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Objectives: We are responsible for answering the research question, "Does a return-to-work program improve the returning outcome?" This is one of the six research questions in the evidence-based "Return-to-work Guidance in Occupational Health 2017" developed by the Kanto branch of the Japanese Society of Occupational Health. This study aimed to integrate the effectiveness of the return-to-work program to improve the state of sick-listed employees suffering from cardiovascular disease, cancer, and musculoskeletal and mental health problems., Methods: Three different databases, PubMed, Cochrane Library, and Ichushi-Web were searched. Based on the results of a systematic review, the guidance developing group created the draft of the recommendations with evidence to decision framework and used a poll to determine the recommendations. We integrated the evidence from a systematic review and meta-analysis at the disease level. This study protocol was registered with PROSPERO (the registration number is: CRD42016048937)., Results: A total of five articles on musculoskeletal diseases and six on mental health problems were retrieved. No articles in the cardiovascular and cancer areas matched the eligibility criteria. When workers suffered from musculoskeletal disorders, the rehabilitation group statistically returned to work earlier than the usual care group did [HR 1.58 (95% CI 1.26-1.97), -40.71days (95% CI -60.69--20.72) ]. In the mental health problems group, the psychological intervention program group had statistically less days of sick leaves as compared to that in the usual care group [-18.64 days (95% CI -27.98--9.30) ]., Conclusions: It might be suggested that work environment management, work management, tackling psychological problems, cognitive behavioral approach, and several meetings with supervisors and occupational health staff, in addition to a direct focus on backache contributed to the early return-to-work of workers suffering from musculoskeletal disease. Regarding mental health problems, interviews with a psychological approach and consultations with psychologists and psychiatrists might be effective in reducing the days of sick leaves. However, because these methods were investigated in Europe, we need to be careful when introducing these practises in Japan due to the differences in the occupational health support systems. Further, high quality evidence level studies are needed in Japan.

Objective: We conducted a systematic review to determine whether work accommodation at the time of return-to-work (RTW) following a period of sick leave would improve work-related outcomes. Using a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, we developed recommendations applicable to the field of occupational health in Japan., Method: We approached our review question for "Evidence-based Return-to-work Guidance in Occupational Health 2017 (RTW 2017) " using a PICO framework (P: workers on sick leave; I: work accommodation; C: usual care; O: improvement of work-related outcomes, such as shortened sick leave period or lower rate of sick leave recurrence). To identify relevant intervention studies about work accommodation at the time of RTW, for example, modified work or partial RTW, we searched Cochrane Library, PubMed, and ICHUSHI Web using keywords/phrases such as workplace accommodation, partial RTW, rehabilitation, and modified work. Although we found no systematic reviews, we did identify 632 randomized controlled trials and cohort studies. Two researchers screened them independently using selection and exclusion criteria defined by the RTW guidance committee in the scope. For intervention studies, we extracted PICO and evaluated risk of bias using RevMan 5.3. For cohort studies, we applied the Newcastle-Ottawa scale for evaluation of risk of bias. We then evaluated the body of evidence based on risk of bias, indirectness, inconsistency, imprecision, and publication bias using GRADEPro GDT. Finally, we adopted Evidence to Decision from GRADE and developed recommendations based on anonymous panels' votes., Result: We identified three relevant studies, which were one randomized controlled trial and two cohort studies, on Partial RTW or modified work for musculoskeletal disorders. Although we could not conduct a meta-analysis, our qualitative systematic review of these studies led us to conclude that partial RTW could shorten the period of sick leave and modified work could lower the recurrence rates of sick leave. Therefore, "Work accommodation at the time of RTW could be provided for workers on sick leave for musculoskeletal disorders" was weakly recommended on the basis of low evidence., Conclusions: Our recommendation, though plausible, is weak, as it is based on evidence from a small number of studies of foreign occupational health systems. Development of robust recommendations will require accumulation of additional information on diverse factors, such as cost-effectiveness, and on other diseases, for example, mental health disorders or malignant diseases, in Japan.

The assembly of the Japanese Experiment Module "Kibo" to international space station was completed in 2009 and Koichi Wakata became the first Japanese station astronaut who spent more than 4 months in the station. Bone and muscle losses are significant medical concerns for long duration human space flight. Effective countermeasure program for bone loss and muscle atrophy is necessary to avoid post flight bone fracture and joint sprain after landing. The musculoskeletal response to human space flight and current physical countermeasure program for station astronauts are described.

In accordance with the increase of elderly population in Japan, the number of the elderly requiring care services is also increasing. Musculoskeletal conditions account for 24% of the causes for requiring care services. These backgrounds lead to the advocacy of the term "Locomotive Syndrome" by the Japanese Orthopaedic Association in 2007. This means such conditions that an elderly person necessitates or is at risk of necessitating care services due to the decreased ambulation caused mainly by aging-related musculoskeletal disorders, and judged with seven check items at this point of time. This syndrome requires intervention with exercise training, and two kinds of "Locomotion Trainings" are recommended as easily performable ones at home.

Horseback riding therapy is popularly used as one of the physiotherapy in Europe. Dr. Kimura hit upon Horseback Riding Robot, which can precisely simulate horseback motion ; as a result, he has developed and completed the Horseback Riding Robot, which can be worked by six motors. The Horseback Riding Robot, however, is very expensive. For that reason we have decided to turn over a new leaf and have developed a home machine by realizing one motor type. We proved the muscle strength trainings by use of Horse Riding Robot and a home machine, unlike a existing monotonous and boring muscle training, to be worthwhile and effective.

There is an urgent need to establish measures for dealing with reduced life function in the elderly. Fractures caused by falls are one of the factors that prevent elderly people from living independently, and there is a need for exercises that provide superior balance and more effectively prevent falls. However, although several meta-analyses have been conducted regarding balance, there are few clear guidelines for balance exercises. In the present study, we clarified the development of balance ability by examining the motor development process, and discuss herein the significance of acquisition and maintenance of static balance. We also conducted a literature search regarding effective exercises for static balance impairment, and include a discussion of the effectiveness and limitations of static balance exercises.

Weightless environments such as prolonged bed rest and spaceflight are associated with dramatic losses of muscle volume and bone mass that hinder patients' or astronauts' health and reintegration into daily life. It is important that the countermeasure is effective for slow twitch fiber, and adds mechanical stress to a bone. So, we developed the hybrid training method (HYB) as a countermeasure of this musculoskeletal atrophy, which uses the contraction produced in a muscle by electrical stimulation of antagonist to resist the volitional contraction of agonist. HYB has several features. These include ; 1) simple device, 2) simultaneous contractions both agonist and antagonist musculature, 3) volitional contraction of deep layers of muscle, 4) longitudinal bone force loads. Several studies reported that, this HYB was tested successfully for increasing muscles strength and hypertrophy in the upper and lower extremities. And, a wearable HYB apparatus with a virtual reality control system was developed. Now, we are developing the hybrid ergometer with virtual reality system, which training can play while playing a game at home.

Muscle weakness and fall of ability for balance occur as becoming old. It is the worst results to fall down, and to break their bones. It is easy to have fracture elder people so that there is osteoporosis, and therefore they cannot walk, and become bedridden For a purpose to prevent that a senior citizen becomes a care state required by fall, we define "the state that fall of ability for balance and locomotive system result from aging and shut ourselves up, and a fall risk rose" as Musculoskeletal Ambulation Disability Syndrome (MADS) . A diagnosis of MADS is performed by criteria. The criteria of MADS is that a person with a history of 11 disorders has the particular degree of ADL independence and motor function. It is important to prevent falling down and do injury of fractures in persons with MADS by performing rehabilitation mainly on dynamic flamingo treatment.

Selection and application of the exercise programs for rehabilitation of the elderly should not only be based on a short-term efficiency, but also be based on the self- determination and motivation of the participants themselves. In this paper, we will review the functional improvement of the elderly by Tai Chi, Hula, Ball Exercise, and Arcade Games, and will discuss about the motivation theory to apply in practice. The intrinsic motivation is the essential element of the theory and is composed of enjoyment, interest and satisfaction.

Declined anabolic and gonadal steroid hormones with age affect the development of age-related musculoskeletal disorders, including osteoporosis and sarcopenia. Exercises could have an influence on hormones affecting bone and muscle metabolism. Studies have shown that a combination of physical exercise and hormone replacement therapy (HRT) has a significantly better effect on bone and muscle than either of these interventions alone. Recent studies provide possible mechanisms for HRT effects in augmenting skeletal muscle repair and retention of muscle mass in older woman. Vitamin D improves musculoskeletal functions and prevents falls. However, it is not known whether exercise and bisphosphonates are able to interact in improving musculoskeletal functions.

Physical disability in older people is characterized by declines in multiple domains including strength, balance, flexibility, reaction time, coordination, and muscular endurance. Evidence that therapeutic exercises can reduce physical disability is accumulating. Muscle strength can be improved in older people, particularly if their muscles are significantly overloaded by training exercises. Progressive resistance strength training (PRT) improves muscle strength and aerobic capacity in older people. However, the effect of PRT on their overall physical disability is still unclear. In Japan, power rehabilitation program is believed to be effective in improving their physical activities.

Aging is typically accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness in any organs. Musculoskeltal system is one of the most involved organs in geriatric patients. Appropriate roles in geriatric rehabilitation for musculoskeltal disorders should be emphasized not only to treat the disorders, but also to prevent many complications cause by specific disease or injury. Representative management methods in geriatric rehabilitation are introduced in this section. Rest is often effective, especially in the acute phase of illness or injury. However, cautions should be paid in disuse syndrome which may be produced by prolonged bed rest. Major manifestations in this syndrome includes muscle weakness and atrophy, joint contracture, decubitus, osteoporosis, ectopic ossification, cardiovascular impairment, pneumonia, urological and mental problems. Physical agents such as heat, cold, light and pressure have been used as therapeutic agents. Electrical stimulation is often effective in the treatment of low-back pain syndrome. Traction is the act of drawing, or a pulling force. Its mechanism to relieve pain seems to immobilize the injured parts, to increase peripheral circulation by massage effect and to improve muscle spasm. Brace is very effective to control acute pain in musculoskeltal system. However, long-term wear of brace should be avoided to prevent the disuse syndrome. Exercise is one of the most important rehabilitation modalities. This includes stretching and muscle strengthening programs. Education of body mechanism in activity of daily living is essential in rehabilitation of geriatric patients.