The purpose of this study was to examine the effects of aerobic exercise on visceral fat and cardiac function. Furthermore we investigated the relationship between fat distribution and LV structure and function in obese adolescents. The subjects were randomly assigned to either the aerobic exercise training group (n=7) or served as controls (n=7). Aerobic training subjects exercised at 50-60% HRmax (1-4 weeks), 60-70% HRmax (5-24 weeks), for 60 minutes per day (duration), and 6 days per week (frequency). Abdominal fat volume measures consisted of subcutaneous fat volume (SFV), visceral fat volume (VFV), and VFV/SFV by CT (computed tomography). Subjects also underwent M-mode and doppler echocardiography to assess left ventricular size, mass and function. Paired t-tests were used to evaluate the difference in variables of interest at baseline and following 24 weeks of aerobic exercise. The 0.05 level of significance was the critical level for this study. Weight and body fat percentage (BF%) significantly decreased and lean body mass significantly increased in the aerobic exercise group. However, weight and BF% increased and lean body mass did not change in the control group. Abdominal fat tended to increase in the control group, while it significantly decreased in the aerobic exercise group. Insulin concentration was significantly decreased, but did not change in the control group. Most variables with regard to LV function were unchanged in the control group. However, whereas LVmass was not changed, FS and EF were significantly increased, and VO₂max (ml/kg/min) was significantly increased in the aerobic exercise group. In addition, the 24-week aerobic exercise subjects reduced both visceral and subcutaneous fat. However, although the cardiac function of obese adolescents was also significantly improved, there was no change in LVmass.

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In this cross-sectional study we investigated the association of walking characteristics with bone mineral density (BMD) in elderly women to examine the relationships between mobility, balance, body sway, and osteoporosis. Participants were 109 elderly Japanese women aged 62-89 years, ambulatory and voluntarily enrolled in the Fall Prevention Program. For each participant, bone mineral density in the femur and speed of sound, transmission index and osteo-sono index (OSI) in the calcaneus were estimated using a dual-energy x-ray absorptiometry (DEXA) and quantitative ultrasound (QUS) instrument, and they were grouped (osteoporosis, osteopenia, or normal) according to their BMD level.
Measurements were performed in the right femur and heel. We also examined waist girth, hip girth, 10-m walking speed, maximal step length, 40-cm step, one-legged balance time with eyes open, and postural sway. There were no significant differences in 40-cm step, body sway, and one-legged balance time among the groups.
In contrast, maximal step length, 10-m walking speed, total step during the 10m walk, and mean stride length during the 10-m walk were significantly associated with the higher BMD group (normal)(p<0.05). There were significant correlations between walking test parameters and femoral neck BMD (10-m walking speed: r=-0.23, total step: r=-0.24, mean stride length: r=0.24, maximal step length: r=0.19) and OSI (10-m walking speed: r=0.25, total step during 10-m walk: r=-0.18, mean stride length during 10-m walk: r=0.19, maximal step length: r=0.31).
Our results suggest that short maximal step length and slow 10-m walking speed are impaired with osteoporosis in elderly women. Femoral neck BMD and calcaneual OSI are correlated with these mobility parameters. Thus, the characteristics of this simple walker's test could be a useful instrument in the diagnosis of osteoporotic women.

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The objective of this study is to clarify conditions of daily living and physical function of elderly women who have a fear of falling.
From May 2002 to July 2002, we studied elderly women aged 65 or above living in Kitamimaki-Village in Nagano Prefecture. Of the 824 targeted population, 274 were studied, which accounted for 33.4%. The 10-m walking time, the maximal step length and the 40-cm step test were studied to measure the Good Walker's Index and the tandem gait test was used to detect balance capability. A questionnaire administered through an interview elicited information on the number of falls during the past year, presence of fear of falling, degree of satisfaction in daily life, physical activity, reason for living, and fall-related self-efficacy. Here the fear of falling is defined as anxiety and fear sufficient to suppress activity in order to avoid a fall, even when the subject is capable of maintaining a normal lifestyle. Based on this definition, the study sample was divided into two groups: a group having fear of falling (F group) and the other not having such fears (N group). Furthermore, we carried out discriminant analysis using fear of falling as an independent variable and 8 explanatory variables owning no multicollinearity.
The average age of the F group (77.2±6.6 yrs.) was significantly higher than that of the N group (74.3±6.3 yrs., p<0.001). Moving ability and balance capability of the F group were significantly lower than that of the N group in all survey items (p<0.001).
The frequency of falling during the past year was significantly higher in the F group (2.1±10.4 times) than in the N group (1.3±8.9 times). The F group also showed a significant lowness in both daily physical activity and satisfaction in daily life.
The 19 survey items for fall-related showed a significant difference in the two groups. Discriminant analysis resulted in a 75.2% apparent error rate and eigenvalues of 0.200 (p<0.001). The order of discriminant function coefficient was 1) sitting and standing, 2) airing sleeping mattress, and 3) taking a bath. These actions are characterized by large burdens on lower extremity muscles, the necessity to balance on one leg, the carrying of heavy objects and the vertical movement of the center of gravity. Any of these actions may cause a loss in balance.
As a result of the investigation of capabilities related to motion and balance, we extracted the following factors related to fear of falling: age, walking, standing up and sitting down, taking a bath and carrying heavy objects. In overall our study suggested that safely participating in such daily activities would contribute to the recovery and maintainance of confidence that a fall would not occur, and it would lead to appropriate repeated exercise considered as training to prevent a fall.

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With respect to prevention of bone fractures, we have been interested in the relationship between walking ability and bone mineral density (BMD) in the femoral neck. Since a decrease in walking ability is closely associated with falls as reported by Nevitt, we examined the relationship between the walking rate and BMD in the femoral neck.
Subjects were 178 of the 343 elderly people who voluntarily participated in a series of meetings, “Program for prevention of falls,” which were held at our hospital. Mean age was 69±5.0 years; height, 151.4±11.5 cm; weight, 49.6±5.9 kg and body mass index, 21.4±2.3. Based on the report of Kamioka that a median of 5.7 sec was needed for elderly people to walk 10m as fast as possible, we divided the subjects into two groups according to information collected at the first meeting of the “Program”. The F group included subjects who walked 10m within 5.7sec and the S group was comprised of those who needed more than 5.7sec to walk 10m. In addition, the BMD in the femoral neck was measured with QDR2000 (Hologic, Inc.) at the same meeting.
The BMD is routinely measured in ordinary health examinations at this hospital. The mean BMD value was 0.567±0.100 (YAM ratio, 74.7) in the S group, whereas it was 0.595±0.073 (YAM ratio, 77.9) in the F group. Differences in BMD and YAM were significant between the two groups (p<0.05). Dargent-Molina et al. predicted a risk of bone fracture on the basis of BMD in the femoral neck and walking velocity. They reported that because both walking velocity and BMD were low in persons with a prior history of fractures of the femoral neck, the risk of bone fracture was very high in elderly persons who walked slowly. Because of the finding that competence in walking is important to avoid falling, it would seem beneficial to provide the elderly with instructions on walking in the “Program” and to encourage them to form or maintain good walking habits.

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This study was designed to elucidate the physical features of tennis instructors and the relationship between those features and disorders that frequently occur among tennis instructors. For this purpose, we measured the range of motion of the shoulder and hip joints of tennis instructors as well as circumferences of their upper and lower extremities.
Subjects were 13 male tennis instructors (11 right-handers and 2 left-handers). Mean age was 34.2±8.4 years; height, 172.2±4.0 cm; body weight, 63.7±8.8kg; and BMI, 21.4±2.2. For statistical analysis, the paired, two-sided t-test was used. The range of motion of the shoulder joint on the dominant side was compared with that on the opposite side. The range of motion of the hip joint and circumferences of the upper and lower extremities were compared between the right and left sides. A P-value less than 0.05 was considered statistically significant.
Excursions of internal rotation and full rotation in the shoulder joint were restricted on the dominant side (P<0.05 and P<0.01, respectively). The excursion of external rotation of the hip joint was restricted on the left side (P<0.01). The circumference of the upper arm was larger on the dominant side than on the opposite side both in flexed and extended positions (P<0.001). The maximal circumference of the forearm was also larger on the dominant side (P<0.001).
The restriction of internal rotation of the arm on the dominant side seems to reflect a prodromal disorder that may progress to a clinically-significant disorder. The asymmetry of excursions of the hip joints is thought to be causally related to lumbago in some way. The larger arm circumference on the dominant side is obviously a result of the nature of tennis, in which the arm on the dominant side is consistently used. Periodic measurements of the range of motion of joints and the circumference of extremities may provide useful information in preventing the occurrence of disorders related to this sport.

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The purpose of this study was to investigate the comparison of physical fitness and leg extension power, between Japanese and Korean.
Two hundred and fifty five healthy (69 men and 186 women, aged 30-69 years) residents of Tokyo, three hundred and three healthy (86 men and 217 women, aged 30-69 years) residents of Seoul, participated in this study.
All participant performed the test included measuring height, weight, BMI (body mass index), % fat, PWC75%HR max and leg extension power.
As a result, the Korean participants showed relatively lower values of leg extension power (watt/kg) than that of Japanese subjects (p<0.01). Although Japanese showed the tendency for height and weight to decrease, Korean showed the tendency which weight increases with increasing aging.
These results suggest that the difference of physical fitness level was factor of different economy, culture and life style in aging.

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Taking care of elderly people and bed-ridden patients, a population that is expected to increase, is becoming more and more of a serious problem. To circumvent this problem, various measures are actively being taken for care prevention in many institutions. The term “care prevention” means actions taken to avoid degeneration of function in the elderly that would necessitate care by others. Numerous local governments have provided programs for care prevention on a commercial basis and are developing these measures according to the characteristics of districts and elderly people therein. At present, various systems are used to evaluate outcomes of these measures. In this communication, we discuss an indicator to evaluate care prevention business from easily understood concepts.
The life expectancy at birth (or life expectancy) has been used as an overall indicator of the level of health and welfare within a district. Although life expectancy accurately represents the situation directly related to death, this indicator does not necessarily represent the situation related to the need for care. In contrast, the concept of “health expectancy” recently has been proposed, and attempts have been made to calculate values of the new indicator representing the level of health of the population within certain districts. Methods of calculation have been examined and now made open. Health and welfare levels are being analyzed using the new indicator in individual prefectures and in smaller districts within prefectures, cities, towns and villages. Hereafter, this indicator will be widely accepted to evaluate measures for care prevention.
As another social indicator related to measures for care prevention, geriatric medical expenses (medical expenses per elderly person) are frequently used. Geriatric medical expenses are calculated yearly, taking each local goverment as a unit. This indicator does not directly represent the health and welfare level in districts, however, because the indicator increases or decreases depending on numerous variables, such as the social security system, infrastructure of the medical and welfare system, and the size of the local goverment.
As another indicator, the good walker's index (Kenkyakudo) is used to evaluate the ability of individual elderly persons, the objects of care prevention. This represents a reduction in function of the lower extremities with aging and is easily understood by elderly people, because the ability to move in daily life is measured for this index. This index has been scientifically supported through examinations of its statistical relationship to diseases and physiological functions. Based on this index, it is possible to provide every elderly person with instructions concerning exercise and daily life for care prevention, while the ability of each person can be evaluated cross-sectionally in comparison with standards for the gender and age group of the particular person and individually according to changes over time in comparison with his or her previous records. With this index, it is also possible to detect problems specific to individual districts on the basis of its distribution specificity for groups of elderly people within the district. The good walker's index was conceived to be useful as a common indicator to evaluate measures taken for care prevention because it is closely associated with the daily life of elderly people.

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In Japan, where the population is rapidly aging, it is considered important to positively intervene in the lives of independent elderly people to prevent their degenerating into a state whereby care by others is necessary for the activities of daily living. Such action is called “care prevention.” Although various places in Japan have undertaken measures for care prevention, at times total failure has been the result.
The main goal of Kitamimaki-village in Nagano prefecture has been to “construct a system in the village so as to prevent elderly people from becoming bed-ridden or demented.” In 2000, the village began a series of measures “to longitudinal comprehend the overall physical function of individual elderly people and to actively provide them with a care prevention program according to the need and health condition of each person comprehended as above”. Three years have passed since the beginning of this effort.
We previously began to assess the “Good Walker's Index” for care prevention in Kitamimaki-village. In relation to this effort, in the present study we examined the difficulties in efficiently and effectively implementing this program.
We found that in order to realize the target of the village “to prevent elderly people from becoming bed-ridden or demented,” priority should be given to directly appeal to elderly people, who are prone to remain indoors. To present a vivid and favorable impression of care prevention also was found to be necessary. For these purposes, we should accept the help of programs and activities in other institutions as an opportunity to distribute information on care prevention and continue to take measures for care prevention in collaboration with various groups and organizations.

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Disorders of ingestion and swallowing are dangerous and may lead to potentially fatal conditions, such as aspiration pneumonia. Few nursing homes make an effort to cope with ingestion and swallowing disturbances, probably because of lack of personnel for rehabilitation and equipment for diagnosis and therapy. It is impossible at present therefore to raise the level of ADL of residents in nursing homes in Japan The purpose of this communication is to describe activities in our institution as an example of how physicians, nurses, care workers, speech therapists, and physical and occupational therapists are grappling with ingestion and swallowing disturbances in a nursing home. In addition, I will describe in detail the roles and functions of individual specialist groups in our institution in order to provide you with information that may be applicable to other institutions.

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As medical trainers, we accompanied Japanese players who participated in the Paralympic Games in Sydney, Australia, and examined features of the disorders that occurred in Japanese players during the games. One year after the games, we determined changes in the disorders. During the games, we treated acute injuries under the direction of physicians. In addition, we treated players with various combinations of cryotherapy, thermotherapy, application of electrical current, ultrasonic therapy, stretching, massage and taping. The effects of these treatments were evaluated by comparing symptoms before and after treatment as expressed by the face scale (0~10).
Visiting the training room were 145 players; of these 36 were treated for pain (including one with dislocation of the hip joint a fall in an indoor shower in the player's village) and 109 were treated for exhaustion. As to the effect of treatments, mean intensities of pain were 7.67±1.9 and 5.92±2.0 on the face scale before and after treatment, respectively. The difference of 1.8±1.1 was significant. Mean magnitudes of exhaustion were 6.29±2.1 and 3.63±1.7 on the face scale before and after treatment, respectively. The difference of 2.7±1.3 was also significant. Thus, our treatments significantly ameliorated both pain and exhaustion.
One year after the games, a questionnaire was sent to players who had visited the trainer room to determine if there had been changes in symptoms during the 1-year period. In response to the questionnaire, 61% answered that their symptoms had persisted until the time of the survey or that they could not give an unequivocal answer. This result suggests the need for long-term support for such players.

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Features of vertigo, which occurs frequently in elderly persons, are described below. In this communication, the definition, symptoms, and classification (central and peripheral types) of vertigo are provided. In addition, the causes and symptoms of vertigo in cases representative of individual types are reported.
1.The frequency of complaints by elderly persons of vertigo and disequilibrium is increasing every year. The causes of such symptoms are cerebrovascular disorders, atrophy of the brain, and degeneration of the vertebral column (particularly degeneration of the cervical vertebra).
2.Central vertigo occurs more frequently in elderly persons than does peripheral vertigo. Since central vertigo is often “an alarm” warning of a threat to life, it should not be ignored thoughtlessly.
3.Among the several kinds of peripheral vertigo, benign paroxysmal positional vertigo occurs most often in elderly persons.
4.The severity of vertigo is not necessarily proportional to the probability of death. When diagnosing “dangerous vertigo,” namely central vertigo, a physician should be cautious in detecting signs reflecting disorders of the central nervous system.
5.The function of the central nervous system is generally decreased in the elderly, and central compensating activity to restore equilibrium is slow in elderly persons. Vertigo and disequilibrium tend to persist and are not quickly alleviated in elderly persons.

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In our country, epidemiological studies suggested that the prevalence of childhood obesity is increasing by 3 times in latest 30 years. Approximately 10% of 10 to 12 years schoolchildren are overweight in 2000. With the marked rise in the prevalence of obesity in childhood, obesity -linked risk factors are being expressed at young ages. Abdominal obesity is strongly linked to cardiovascular disease mainly through an increased risk of insulin resistance, hypertension and hyperlipidemia.
The mainstay of obesity treatment is alteration of energy balance through lifestyle change. The addition of behavioral modification to nutrition education and exercise is more effective in reduction of percent of overweight compared with nutrition education and exercise. To contribute to long-term weight maintenance, interventions should modify eating and exercise behaviors. When addressing physical activities with obese children, emphasis should to be placed on play and activities rather than “exercise.” We referred to the U.S. “The Kid’s Activity Pyramid”, and developed “The Kid’s Activity Mt.Fuji” for the purpose of emphasize physical activity in Japanese obese children. Maintenance of physical activities helps prevent the development of obesity and other cardiovascular disease risk factors that frequently are present as early as childhood.
In children, family based behavior modification is most successful, and it is important to engage the family in supporting lifestyle changes.

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