The purpose of this study was to develop and evaluate a new physical activity questionnaire (PA-questionnaire) for the assessment of daily energy expenditure (DEE) in Japanese workers. The study subjects were workers and college students of 38 males and 14 females in the age range of 18-69 years. The values of DEE estimated from the PA-questionnaire were statistically analyzed with those of DEE calculated by the calorie counter method (CC-method) and the activity records method (AR-method) . The DEE mean of PA-questionnaire in males and females was significantly larger than those of CC-method, 25.2 (p < 0.001) and 12.5% (p < 0.05), respectively. A similar relationship was also recognized between the DEE mean of PA-questionnaire and AR-method, with a larger extents in males of 6.4 (p < 0.001), but there was no significant difference in females (3.3%) . Additionally, the values of DEE by PA-questionnaire strongly correlated with those of CC-method (r = 0.711 in males and 0.921 in females) and AR-method (r = 0.893 in males and 0.918 in females) . Furthermore, the comparison was also made with the working energy expenditure (WEE) of PA-questionnaire and AR-method. A strong correlation (r = 0.876) was found between the values of two methods and no significant difference was recognized between the WEE means of two methods. From these findings, we concluded that the new proposal method of PA-questionnaire was adequate for the estimation of the DEE in Japanese workers.
Health examinations specified for metabolic syndrome are introduced in health services in April 2008. The stakeholders of medical insurance are required to offer every insured and dependent subject aged 40 to 74 years. This examinations include abdominal circumference, blood pressure, triglyceride and high-density lipoprotein (HDL) cholesterol, fasting blood sugar or HbA1c, AST, ALT, γ-GTP. Blood chemistry analyses are required under the designated total quality control. The judgments for metabolic syndrome are conducted on the basis of these medical examinations. The stratified health educational programs are provided from medical stakeholders. This health services are expected to reduce future medical expense regarding lifestyle-related diseases.
The medical care reformation of the prevention of the lifestyle disease starts in April, 2008. The concept of Metaboric-syndrom is introduced, the health guidance becomes important more than before. And the evaluation of the checkup and the health guidance is not the frequencies, as a result, what effect went up is evaluated. ⌈Effective health guidance to attain good results⌋is an important theme for the health leader now. According to a standard checkup and the health guidance program of the Ministry of Health, Labour and Welfare, it is assumed ⌈The health guidance is to support it for the patient to notice the problem in the lifestyle from own life, and to derive the directionality of a voluntarily healthy action transformation.⌋ The condition that people change the lifestyle is Desire, Knowledge, Technology, Confidence, Environment. It is important that the health leader appeal to these five elements. There is “Behavioral science (behavior therapy) ” as an effective, scientific technique for supporting these. There are 1 ⌈Goal setting⌋, 2 ⌈Self monitoring⌋, 3 ⌈Stage theory⌋ as a behavior therapy often used for the health guidance. Moreover, “Coaching” is often used. The target of the specific health guidance to aim at the improvement of Metaboric-syndrom is to decrease weight and the abdominal circumference, and to decrease the fat of internal organs. The target of the loss in weight is to decrease from weight and the abdominal circumference at the beginning by about 5% for six months from three months, and to maintain it at a long term. It is important to show the patient the target by the numerical value concretely as much as possible while advancing the discussion with the patient. In addition, person's lifestyle has received a big influence from a surrounding environment. Therefore, the population approach is also important for improving the effect of the health guidance.
A new health check-up system focused on the metabolic syndrome will be introduced under the reform of health care system, which will start from 2008. In comparison with the past health check-up, a new system emphasizes on health counseling. There are several points which lead to effective health behavior change among health examinees; 1) health counseling based on behavioral science, 2) lifestyle intervention on the health check-up day, 3) effective use of IT-based behavior change program, 4) smoking cessation intervention to all smoking examinees, 5) combination of high risk strategy and population strategy.
The national program of health examination about the population of 40 to 74 years of age is supposed to be altered largely from 2008, focusing on metabolic syndrome. The circumference of the waist and body mass index (BMI) is measured in the first step of screening. If the value of these measurements is less than the criteria, subjects are excluded from the subsequent health guidance program, even if they have hypertension, diabetes mellitus or dyslipidemia. Using our data of 2006, we investigated the prevalence of those diseases among the subjects who were excluded from the health guidance program in the first step of screening. In 7, 859 subjects who received the screening, 2, 784 subjects were selected for health guidance program (target subjects) . On the other hand, 5, 075 subjects were excluded from the program (excluded subjects), being 64.6% of the examinee. In the excluded subjects, 2, 030 subjects without treatment were diagnosed as hypertension, diabetes mellitus, dyslipidemia or the combination of these diseases (subjects with disease), being 40.0% of the excluded subjects. The same prevalence was 38.7% in the target subjects. Moderate to severe hypertension, definite diabetes mellitus, and dyslipidemia with moderate risk were defined according to the criteria of each scientific society (subjects with definite disease) . Prevalence of total subjects with definite disease was 21.4% in the excluded subjects, and 53.6% in the subjects with disease. Incidence of smokers in the male subjects with disease were higher than men in the target subjects (p < 0.005) . Our data suggest that not a few subjects with hypertension, diabetes mellitus or dyslipidemia exist in the subjects who are excluded from the health guidance program in the newly starting health examination system, and some countermeasures should be taken to deal with the subjects with these diseases.