The objective of this study is to clarify the validity of the Good Walker's Index (Kenkyakudo) on screening the fall of the community-dwelling elderly.
The survey was carried out on 559 elderly between 60-79 years old, who underwent local checkups at village A (Shimane 1995), village B (Nagano 1997), city C (Hokkaido 1998). The Good Walker's Index was measured along with an interview on their fall experience in the past year. Based on this data, people who had less than one fall experience was classified as control group and those with more than two as the fall group. There were 188 male and 311 female in the control group and 23 and 37 in the fall group respectively.
Even after the elderly were adjusted for age, significant differences between the two groups were found only in the men's 10m walking time (p<0.05), maximum length of a step (p<0.01), 40cm-staircase stepping (p<0.05), and the women's 40cm-staircase stepping (p<0.05). By using the quartile as a reference, the screening level was set for each of the items with significant differences. For the women's 40cm-staircase stepping, the original 3 grades evaluation was used. The sensitivity was between 65.2-91.3% and the specificity 27.7-62.4% for the men, and 56.8% and 62.6% for the women respectively. The combined sensitivity and specificity (10m walking time, maximum length of a step, and 40cm-staircase stepping) for the men was 91.3% and 27.7%. Although the case of falling is quite complex, the Good Walker's Index is effective in fall prediction. Improving the effectiveness of the screening test by adding dynamic balance measurements to the mobility test is an issue for the future.

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We previously reported the importance of exercise in elderly people living in a barrier-free nursing home, to prevent the decline in physical activity. In this study, we attempted to obtain basic data for the purpose of training elderly people to perform age-appropriate exercises in daily life, by studying the age-dependent decline in physical activity.
The subjects were 11 elderly people (5 males, 6 females; mean age: 77.7 yr, range 64-84 yr) who lived in a barrier-free nursing home. (The subjects were generally healthy, and could live independently in the nursing home setting) We evaluated the physical activity and the ability to avoid falling in each subject in November 1998 and in November 1999. The 11 subjects did not undergo any interventions during that period. The main outcomes measured were the Good Walker's Index, which was calculated based on the 10m walking time, maximum width of steps, and ability to climb up and down a 40cm-staircase physical measurements; and shaking of the center of balance on stabilometry. The paired t-test or the McNemar test was used to analyze the differences between the parameters in November 1998 and November 1999.
The Good Walker's Index in the 11 subjects tended to decrease over the one-year period. The time and the number of steps taken in the 10-m free gait with their full ability in November 1999 were higher than the respective value in November 1998. However, the differences were not significant. The actual length of the maximum width of a step and the ratio of the maximum length of a step to the length of the lower limbs, in November 1998 and in November 1999 did not significantly differ. On the test to climb up and down a 40cm-staircase, in November 1998, 3 cases had difficulty and the remaining 8 cases could not climb up and down the stairs by themselves; whereas in November 1999, one case had difficulty and the remaining 10 cases could not climb up and down the stairs by themselves. On stabilometry, the Romberg ratio of the total length (cm) of deviation from the center of gravity (the relation between eyes closed and eyes open), the ratio of length/area (of total length (cm) by record times (second)) (1/cm), the Y-axis maximum deviation and the ratio of X/Y maximum deviation ratio in November 1999 were all significantly poorer in comparison with those in November 1998.
These results suggest that in elderly people living in a barrier-free nursing home, there is more prominent reduction in neurological function such as the shaking of the center of balance, than muscle strength such as the degree of good walking with aging. Therefore, it is necessary to guide the physical exercises of elderly people to maintain the balance function, such as by training them to wear shoes and giving them appropriate training in walking in consideration of their lower function.

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Taking a village with an aging society like Kitamimaki as an example, mobility and balance ability along with relating factors of a farming village elderly were examined.
A measurement of figure, balance ability, and Good Walker's Index (Kenkyakudo) as a measure of mobility was taken from 786 citizens above the age of 65. Moreover, a survey was taken on exercise habits, frequency of falls, and fear of falls. On each topic, the data was classified by sex and age, for it to be examined in relation to age and how mobility and balance ability factors relate to the other measurements.
As a result, change in relation to aging was found in both men's and women's mobility and balance ability measurement, which suggests its effectiveness as a measuring/evaluating method for the decline in lower limbs function due to aging. As for the items related to the decline in the mobility and the balance ability, exercise habits needed more consideration with general physical activities in everyday life. It was pointed out that although the number of falls is an important factor, it is equally essential to consider the susceptibility subject to an environment that causes falls (hours of activity in daily life). Active people are more likely to fall than inactive people. Furthermore, it was also pointed out that the fear of falling relates to motion and balance ability.

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The objective of this study is to examine the relation between the changes of the local sport festival, which Kitamimaki Village (Nagano) has been involved for 94 years since 1906, and the social background.
First of all, literature on this Outdoor Games was examined. Then a survey from 16 seniors deeply involved in the festival was taken by telephone or interview on how the festival is organized and run.
As a result, it became obvious that Outdoor Games began as an important means for training imperialists for the war. As times past, it gradually changed to be a means of building a community. At present; however, only few citizens participate, due to changes in social background and it lacks in excitement. In such atmosphere, Kitamimaki Village is organizing many events to meet the various needs of the citizens. A further study on such government-organized event is suggested for the future, along with an examination on local sport events as a means of rebuilding the community.

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The purpose of this study is to comment on the fall prevention program that is focused on Bandura's self-efficacy theory and scale for fall-related self-efficacy. Fall-related self-efficacy is the confidence to carry on the activities of daily living without falling. There are four sources of information that influence a fall-related self-efficacy. These are “inactive mastery experience”, “vicarious experience”, “verbal persuasion” and “physiological and affective states.”
In our fall prevention program, the following devices were included: (1) reinforcement of a success experience as a inactive mastery experience; (2) interchange between participants as a vicarious experience; (3) a detailed physical examination, measurements of walking ability and explanation from a doctor, as “verbal persuasion”; and (4) the device to let the participants be aware how they progressed in “physiological and affective states”.
We developed a fall-related self-efficacy scale on the basis of the Falls Efficacy Scale by Tinetti et al (1991), and measured the fear of falling at the fall prevention program. No difference of the Fall-related Self-Efficacy was found either between the intervention group and the control group, or between the beginning and the end of the program.

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Preventing the serious event during the exercise, adequate screening and evaluation are important to identify and counsel persons with underlying cardiovascular disease before they begin exercising, especially in the Elderly. The purpose of preparticipation screenig is to identify both those not known to be at risk and those known to be at risk for cardiovscular event during exercise. We tried to identify the participant based on the history and physical examination. We here present four cases who should not participate the exercise program.
case 1: male 65 years old
He had diabetes mellitus more than 10 years and had established triopathy. Physical examination shows equilibrim disturbance and he could not read a newspaper, he was not allowed to begin the exercise program.
case 2: male 86 years old
13 years before he sufferd acute myocardial infarction and there after there was no accident without regular examination. Just after extensive cardiac examination, he had pneumonia and admitted other hospital.
case 3: male 71 years old
He had diabetes mellitus more than 30 years, but without any management. Laboratory data shows his blood glucose was 315mg/dl. He was advised to control diabetes before beginning exercising.
case 4: male 75 years old
10 years before he had angina pectoris and said no any angina attack during daily life. But careful history shows he had several mild angina attack. Nuclear myocardial imaging revealed large reversible defect, but coronary angiography was rejected. After change of medication, he became asymptomatic and visited outpatient office regulary. 3 years after his first visiet he had frequent angina attack, emergent coronary angiography shows severe coronary artery disease. Percutaneous coronary angioplasty was performed and thereafter he had no any attack.

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