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The purpose of this study was to examine the effects of an exercise intervention for older married couples on exercise adherence and physical fitness. Thirty-six older married couples and 61 older adults participated in the study as couple and non-couple groups (CG, NCG, respectively). Participants attended an exercise class once a week and performed a home-based exercise program consisting of walking and strength exercise over eight weeks. Exercise adherence was assessed by the rate of non-absentee, walking habits (≥ 2 times/week), and strength exercise habits (≥ 6 items*2 sets/week). Physical fitness was assessed by the Senior Fitness Tests. Logistic regression analyses were conducted to obtain the CG's odds ratios (ORs) and 95% confidence interval (CI) for non-absentee, walking habits, and strength exercise habits (reference: NCG). Analyses of covariance were used to examine the statistical difference in the degree of change (⊿) for physical fitness between CG and NCG. CG had significantly higher ORs for non-absentee and walking habits compared with NCG but there was no significant difference in the rate of strength exercise habits between the two groups. In regards to ⊿ for physical fitness, significantly higher ⊿ for upper extremity strength was observed in CG than in NCG, while there were no significant differences in ⊿ for other physical fitness items between the two groups. These results suggest that an exercise intervention for older married couples would be more useful to maintain higher participation in exercise program and walking and improving upper extremity strength. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effects of weekly or bi-weekly dietary sessions with the same number of total lecture hours, periods, and lecture contents on weight loss, dropouts during the intervention, and the weight loss maintenance after 1 year., Methods: The study included 52 middle-aged women with at least 1 risk factor for cardiovascular disease (i.e., obesity, hypertension, dyslipidemia, and hyperglycemia) who were encouraged to lose weight. Thirty-seven women were assigned to the weekly class (self-selected weekly class group: n=26) or the bi-weekly class (self-selected bi-weekly class group: n=11) based on their preference. Fifteen women were assigned to the bi-weekly class against their will (bi-weekly class group). All groups participated in the same number of sessions (total, 26 h), and were instructed to reduce their dietary intakes to 1200 kcal/day for 13 weeks. The self-selected weekly class group attended a 2-h instructional session every week, whereas both the bi-weekly class groups received 1-h sessions twice a week. Data on the body weight of the participants was collected 1 year after the intervention using a self-administered questionnaire via mail., Results: The self-selected bi-weekly class group had significantly fewer dropouts (self-selected weekly class group: 5 persons, 19.2%; self-selected bi-weekly class group: 1 person, 9.0%; bi-weekly class group: 8 persons, 53.3%; P<0.05). There was a significant decrease in weight (P<0.05) in all 3 groups during the intervention (self-selected weekly class group: -4.3±2.7 kg, self-selected bi-weekly class group: -6.7±3.0 kg, bi-weekly class group: -6.0±3.4 kg). However, weight loss in the self-selected bi-weekly class group was significantly greater than that in the other 2 groups. A significant change in body weight at the 1-year follow-up was not observed in any group (self-selected weekly class group: +0.4±1.3 kg, self-selected bi-weekly class group: -0.1±2.3 kg, bi-weekly class group: +0.5±0.6 kg). Repeated-measures ANOVA (time×group) revealed no significant interactions in weight loss., Conclusion: These results suggest that a greater frequency of dietary sessions contributes to weight loss, while a lesser frequency of dietary sessions contributed to a decrease in questionnaire recovery rates. The dropout rate in the self-selected weekly and bi-weekly class groups was lesser than that in the bi-weekly class group. Therefore, dietary sessions tailored to the needs of the participants might decrease the dropout rate.

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

Objectives: The purpose of this study was to examine intervention effects of a community-based prevention program for pre-frail elderly individuals by comparing an intervention group (exercise with nutritional care) with a control group (exercise without nutritional care)., Methods: The study was conducted in Y town and S city in Ibaraki Prefecture in Japan. The subjects comprised 161 pre-frail elderly individuals in the community-based prevention program, who were divided into two groups, the intervention group (N = 81, Y town, mean age : 76.2 +/- 5.7 years), and the control group (N = 81, S city, mean age 76.2 +/- 4.7 years). The items surveyed included age, gender, activities of daily living, functional capacity, and dietary variety score (DVS). Functional fitness measurement items (grip strength, alternate step, 5-repetition sit-to-stand, one-leg balance with eyes open, tandem stance, functional reach (FR), sit and reach, 5-m habitual walk, and timed up and go (TUG)) and blood data were assessed at the beginning and end of the intervention., Results: The DVS of the intervention group was significantly improved compared to that of the control group (P < 0.01). In particular, the food frequencies of fish and shellfish, meat, eggs, milk, fruits, and fat and oil (P < 0.01) were significantly increased in the intervention group, as were those of soybean products, seaweed, and potatoes (P < 0.05). On the other hand, significant increases were seen only in the frequencies of fish and shellfish, meat, and milk in the control group. The intervention group showed significant improvement in five-repetition sit-to-stand, tandem stance, FR, sit and reach, and TUG by the end of the intervention. In addition, the intervention group's performance on one-leg balance with eyes open (P < 0.05) was significantly improved even after adjusting for age, gender, and the functional fitness measurement items which were different at the beginning of the study., Conclusion: This study suggests that a combined exercise and nutrition program for pre-frail elderly individuals improves their food intake and functional fitness.

Aim: A characteristic condition of pre-frail elderly people is decreased mobility, which is associated with vitamin D levels and renal function. The aim of this study was to examine the association between physical fitness improvement and vitamin D levels, vitamin D supplements, and renal function in pre-frail elderly people., Methods: We conducted a longitudinal study in 2 towns from June 2006 to December 2009. Subjects consisted of 177 community-dwelling pre-frail elderly people aged 65 years and over (mean±standard deviation [SD]: 76.4±5.5 yrs) who attended a nursing care prevention program for 3 months. An interview was conducted based on a questionnaire. Serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D(25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), creatinine, and calcium were measured. eGFR (ml/min/1.73 m(2)) was calculated using a new formula. Alfacalcidol 1 µg/day was administered to subjects for 3 months, and we assumed that the elderly who took vitamin D (VD) of more than 80% of the recommended daily allowance to be the VD group. Walking ability, balance, and muscle strength physical fitness tests were performed., Results: The prevalence of eGFR <60.0 ml/min/1.73 m(2) was about 24.3%, and that of 25(OH)D <75 nmol/L was 86.4%. Pre-eGFR level and vitamin D supplementation with FR, pre-eGFR and pre 25(OH)D ≥45 nmol/L were associated with improvement in the timed up and go (TUG) test, pre-25(OH)D level (<50 nmol/L, ≥50 nmol/L) was associated with the tandem stance test, pre 25(OH)D level (<67.5 nmol/L, ≥67.5 nmol/L) was associated with the alternate step and 5 chair sit-to-stands tests, and post 1,25(OH)(2)D (<44 pg/ml, ≥44 pg/ml) was associated with the tandem walk tests., Conclusions: These results suggest that the assessment of renal function and maintenance of appropriate vitamin D levels are important for the independent living of pre-frail elderly people. Ideally, a 25(OH)D level greater than 67.5 nmol/L is preferable.

Objective: To evaluate exercise intervention efficacy for the prevention and treatment of sarcopenia in the elderly., Methods: We conducted a systematic literature search of randomized controlled trials in the Physical Activity Guidelines Advisory Committee Report (before 2007), Pubmed, the Cochrane database, and Igaku Chuo Zasshi (January 2006 to August 2009)., Data Extraction: Two authors independently extracted relevant data. A total of 951 articles were found by search engines, and 9 studies were finally selected after a review by 2 experts. The content of these studies, especially duration, sets, periods, frequency, and intensity of exercise intervention were extracted and summarized in a results table. Five of 6 articles concluded that high-intensity resistance training significantly increased soft lean tissue and muscle mass. The remaining 3 articles indicated that moderate-intensity resistance training did not affect soft lean tissue or muscle mass., Conclusion: This systematic review suggested that high-intensity resistance training with sufficient periods, frequency, repetitions, and sets is effective to counteract the loss of muscle mass associated with advancing age.

Objective: Square-Stepping Exercise (SSE), composed of movements similar to walking, involves varied movements in multiple directions and is performed on a thin mat (100 x 250 cm) that is partitioned into 40 squares (25 cm each). We introduced SSE to a group of older adults for three months as a supervised intervention. After this intervention period, the participants continued SSE without supervision for four years. The current study was conducted to determine why the participants independently continued SSE., Methods: Among 52 older adults who attended the SSE intervention, 40 continued SSE (continued group) and 12 discontinued (discontinued group). Seven in the continued group were excluded from analyses because of low attendance rates. Each of the remainder (n = 33) was independently interviewed and asked why he/she had continued SSE. The average interview time for the continued group was 12 minutes. Twelve in the discontinued group were investigated for exercise habits by postal questionnaire., Results: The participants in the continued group noted two to six reasons for continuation of SSE. After analyzing data inductively, the answers were categorized as follows: (1) friends and social communication; (2) equitable management of group activity; (3) expectation of health from exercise; (4) simple-easy exercise; and (5) family support for exercise. The participants in the discontinued group reported that 89% of them continually did walking, muscular strength exercise, and calisthenics., Conclusion: We found that reasons why adoption of SSE as an intervention program for older adults enhance their exercise adherence in the long term.

Purpose: Sodegaura City (Chiba, Japan) and the University of Tsukuba (Ibaraki, Japan) have jointly established a community-based weight loss program named the Sodegaura SMART Diet (SSD). The purpose of this study was to investigate the effects of the SSD on weight loss and metabolic syndrome (MS) components., Methods: The study period spanned 2004 to 2008 with 192 women who satisfied the following two study criteria: (1) age from 40 to 64 years; and (2) BMI > or =25 kg/m2 or abdominal circumference (AC) > or =90 cm. A total of 184 (95.8%) women completed the entire study program of 12 lectures in 14 weeks regarding an appropriate diet and physical activity. We measured and analyzed changes in body weight and MS components before and after the SSD. Furthermore, we compared changes in body weight and MS componenfs between an intervention group (32 participants in 2008) and a control group (16 women who participated in a one-time lecture on MS and pre- and post-measurement sessions). Between 2004 and 2006, 122 women participated in the SSD, 96 of which (78.7%) consented to a 2 year follow-up measurement session., Results: Analysis of the 184 subjects who completed the study program showed significant decreases in body weight (66.9 +/- 8.2 kg to 59.4 +/- 7.5 kg), BMJ (27.7 +/- 2.7 kg/m2 to 24.6 +/- 2.6kg/m2), AC (95.2 +/- 7.4 cm to 87.8 +/- 7.6 cm), and the number of MS components (2.1 +/- 1.1 to 1.1 +/- 1.0). At baseline, the prevalence of MS and pre-MS as determined by the Japanese MS definitions was 33.2 00 (61 subjects) and 27.700 (51 subjects), respectively. After the intervention, the prevalence decreased significantly to 6.0% (11 subjects) and 15.2% (28 subjects), respectively. We observed significant group differences between the SSD and control groups in changes for several variables, i.e., body weight, BMI, percent fat mass, AC, triglycerides, fasting plasma glucose, and number of MS components. After the 2 year follow-up, body weight (-6.2 +/- 3.7 kg) and AC (-5.9 +/- 5.0 cm) were still significantly decreased compared to pre-intervention measurements., Conclusions: Our study showed that the SSD may affect weight loss and improve MS components among middle-aged Sodegaura citizens. The local government will use these data to plan a city-wide promotion of the program to improve the health of its citizens.

Background: In Japan, an exercise program for pre-frail older adults (so-called "specified elderly individuals") (SEIs) has been prescribed under the newly developed long-term care insurance system. Three functional fitness measures (grip strength, one-leg balance with eyes open, and 5-m habitual walk) are used in the system; however, it has yet to be determined if applying these measures to SEIs is appropriate., Purpose: The purpose of this study was to develop a new test battery assessing functional fitness for SEIs, and to determine cross-validity and responsiveness of these measures., Methods: One hundred and twenty seven SEIs (76.6 +/- 5.9 yr) and 315 healthy older adults (HOAs) (72.2 +/- 5.8 yr) completed twelve functional fitness tests related to activities of daily living (ADL) and mobility. The SEI was defined by the Japanese Ministry of Health, Labour and Welfare in 2005. The test battery items were selected by logistic regression analysis. A functional fitness score (FFS) equation was developed by principal component analysis. The cross-validity of the FFS equation was then tested using a different set of 28 SEIs (77.5 +/- 6.5 yr) and 143 HOAs (71.5 +/- 4.7 yr). Responsiveness of the FFS was also assessed in 62 SEIs (76.7 +/- 5.9 yr) after a 3-month exercise program., Results: The following 4 test items were selected for assessment of functional fitness in SEIs: tandem stance, 5-repetition sit-to-stand, alternate step, and timed up and go. Applying principal component analysis to the 4 selected functional fitness items, the first principal component was interpreted as total functional fitness. The following equation was developed to estimate FFS based on the first principal component coefficient of each variable: FFS = 0.031X1-0.106X2-0.192X3-0.096X4 + 1.672, X1 = tandem stance(s), X2 = 5-repetition sit-to-stand (s), X3 = alternate step(s), X4 = timed up and go(s). The cut-off value to distinguish SEIs from HOAs using receiver operating characteristic ROC) curve was 0.065 (sensitivity 82.2%, specificity 81.9%). The cross-validity and responsiveness of the FFS equation was considered acceptable. CONCLUSION This newly developed test battery should be a useful tool for comprehensively evaluating functional fitness in SEIs.

Advances in medical care have enabled many middle-aged and older adults to live for long periods of time. However, considerable variability is present among those people with regards to both longevity and physical health status. Physical inactivity is a significant risk factor for many chronic diseases, while exercise habituation is beneficial for the maintenance of good health and high vitality. The authors have developed the concept of so-called vital age for the assessment of health and functional status in middle-aged and older adults. The vital age is estimated using a variety of bio-medical, primarily cardiovascular risk factor parameters. Previous research has compared vital age between sedentary persons and those with obesity and chronic diseases and between sedentary persons and those with exercise habituation, and found that exercise habituation can certainly contribute to better physical vitality in previously sedentary persons as well as diseased persons.

Aim: Falls are major risk factors in nursing care and reported to be associated with low vitamin D levels or impaired renal function. It is unknown whether physical function is associated with impaired renal function. The aim of this study was to examine the association between estimated glomerular filtration rate (eGFR) (ml/min/1.73 m(2)), vitamin D, and physical function in Japanese frail elderly., Methods: A cross-sectional survey was conducted in two towns (latitude 36 degrees north) from June 2006 to January 2008. Subjects counted of 109 community-dwelling frail elderly, aged 65 years and over (mean+/-SD: 75.8+/-5.2 yr) who attended a program for nursing care prevention. An interview was conducted based on a questionnaire. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25 (OH) D), 1,25-dihydroxyvitamin D (1,25 (OH)(2)D), and creatinine were measured. eGFR (ml/min/1.73 m(2)) was calculated using the Modification of Diet in Renal Disease formula. The following functional fitness tests were performed: timed up and go (TUG), a 5-meter walk, functional reach (FR), one leg stance, tandem stance, and grip strength., Results: Of the subjects, 59.6% experienced falls, 75.2% experienced stumbling at least once during the past year. eGFR was 68.0+/-14.1 ml/min/1.73 m(2) in the subjects. The prevalence of eGFR<60.0 ml/min/1.73 m(2) was 30%. The subjects with eGFR> or =60 ml/min/1.73 m(2) showed significantly better results for FR, one leg stance, and tandem stance than those with eGFR<60 ml/min/1.73 m(2). Multiple liner regression analysis suggested that FR and tandem stance were significantly affected by eGFR., Conclusions: Our data suggest that assessment of renal function seems to be significant when we consider balance ability in the frail elderly.

Objective: To develop diabetes risk scores and to produce a diabetes risk prediction sheet that can be used throughout Japan as a tool for health guidance., Research Design and Methods: A total of 16,289 men and 37,099 women aged 40-69 years who had underwent health check-ups in Ibaraki prefecture, Japan, in 1993, were followed through 2003 (mean follow-up duration; 5.0 yr in men, 5.5 yr in women). Relative risk (RR) of newly developed diabetes (determined by fasting blood glucose > / = 126 mg/dL, resting blood glucose > / = 200 mg/dL, or treatment of diabetes) was calculated according to blood glucose, triglycerides (log-transformed), systolic blood pressure, body mass index (BMI), treatment for hypertension, dyslipidemia, smoking habits, alcohol consumption, and fasting status using Cox's proportional hazards model. Diabetes risk scores were calculated by multiplying RRs of individual variables. In addition, we attempted to develop a diabetes risk prediction sheets for specific health guidance of the larger general Japanese population., Results: During the follow-up, there were 3,654 new cases of diabetes in 1,667 men and 1,987 women. In both men and women, the significant factors included in the risk scores were BMI, blood glucose, systolic blood pressure, treatment for hypertension, triglycerides and smoking habits. Based on the computed risk scores, a 12-page diabetes risk prediction sheet was produced. The sheet includes a scoring protocol for diabetes risk scores consisting of a representative value and RR for each risk factor as well as advice for achieving a healthy lifestyle., Conclusion: The diabetes risk prediction sheet developed in this study may be an effective tool to guide individuals at high risk for lifestyle-related disease such as diabetes.

Objective: We aimed to evaluate the effect of a community-based health educational program for overweight or obesity persons, as the Kokuho Health-up model Program in Kyowa area of Chikusei-shi., Methods: The subjects were men and women aged 35 to 60 years who participated in annual health check-ups from 1998 to 2003 and were living in Chikusei-shi (Former Kyowa town) Ibaraki prefecture, had a body mass index > or = 25.0 kg/m2 at baseline, and agreed to a 6-month intervention. The participants were divided into 59 persons for the intense intervention group (health checkups, dietary advice, monthly individual health education, and exercise in sports facilities three times/ week), 62 persons for the moderate intervention group (health checkups, dietary advice, monthly individual health education, and exercise in sports facilities or at home once/week), and 34 persons for the control group (only health checkups). Criteria for the metabolic syndrome were those published by the Japanese 8 committee., Result: During the 6-month intervention, the follow-up rate was 86%. At the baseline, there were no differences in physical status or lifestyles among the intervention and control groups. The frequency of use of sports facilities was 6.4 times/month for the intense intervention group and 1.9 times/month for the moderate intervention group. Mean body weight did not change in the control group (70.6 kg to 70.9 kg, P = 0.84) but decreased in the intense intervention group (71.4 kg to 69.5 kg, P < 0.001) and moderate intervention group (69.5 kg to 66.7 kg, P < 0.001). Mean abdominal circumference increased in the control group (91.0 cm to 93.9 cm, P = 0.001) but did not change in intense intervention group (90.1 cm to 90.0 cm, P = 0.29) or moderate intervention group (90.4 cm to 88.7 cm, P = 0.39). The prevalence of metabolic syndrome increased in the control group (18.2% to 40.0%, P = 0.01) but did not change in either of the intervention groups., Conclusions: We found a significant reduction of body weight and an attenuation of the increase of metabolic syndrome in both intensive and moderate intervention groups. The present community-based educational program may be effective for health promotion with overweight or obese middle-aged adults.