In order to establish a health promotion program for Taiyo Village in Ibaragi Prefecture, we initiated a research project at University of Tsukuba in 1996. The purpose of this research project are as follows : 1) Examine health promotion in the independent elderly, who make up the majority of the elderly population ; 2) Develop measures to prevent strokes, falls and fractures, which account for about half of the cases in which the elderly become bedridden ; 3) Establish a safe and effective exercise program according to scientifically proven health guidelines ; 4) Assess the efficacy of strength training, which has not been incorporated into most elderly exercise programs, in preventing the elderly from becoming bedridden due to falls and fractures ; 5) Develop a program that can be easily adapted by different municipalities ; and 6) Accumulate success stories at Taiyo Village and disseminate them throughout Japan. The results of this 7-year Taiyo Village project have yielded several important points: 1) Establishment of guidelines to improve life functions; 2) Development of an exercise program to improve and maintain functional ability for life ; and 3) Reduction in medical costs. The results of the present study suggest that when promoting the health of the elderly, it is important to not only study the efficacy of an exercise program, but to also establish a regional program that effectively utilizes research findings.

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The purpose of the present study is to observe the effect of aging on life fitness in Japanese. Life fitness consists of such parameters as body composition, joint torque (JT), leg extension power (LP) and run power (RP) . Subjects were 719 males and 859 females, from 20 to 80yrs old. The “aged” groups (over 70 years) indicated a higher percentage of body fat, compared to the younger groups. The subcutaneous fat thickness at the arms and legs measured by ultrasonography, was independent of age, while that at the abdomen and back was higher among aged groups. It is therefore considered that the higher percentage body fat observed in the aged groups is due mainly to accumulated subcutaneous fat at the abdomen and back. Muscle volume (MV) at the upper extremity indicated no significant difference among age groups; while that at the lower extremity (especially knee extensor muscle) was significantly lower in the aged groups compared to the younger groups. The ratio of JT to MV, considered as the index of specific tension, was lower for the aged groups than younger groups. Mechanical power performed during ergometer running and leg extension power were significantly lower for the aged groups. It is concluded that aged peoples due to low muscle volume of the knee extensor, experience deterioration in leg extension power, resulting in lower mechanical power for runnine.

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The ability to walk is just as important for the elderly as it is for young people. In fact, in the elderly, decreased mobility limits function in daily life and can lead to more serious situations (e.g., becoming bedridden) . The elderly population has increased over the last decade, and many researchers have studied the mobility of the elderly. However, the focus of most studies has been to facilitate recovery of bedridden individuals and prevent the elderly from becoming bedridden, and particularly to prevent fall-induced fractures, which often cause the elderly to become bedridden. However, about 70-80% of the elderly population do not require care, and it is necessary to conduct research on the maintenance of activities of daily living to make it possible for the elderly to work or volunteer. From this perspective, mobility is an important physical factor. Mobility is dependent on muscle activity and it has long been known that aging reduces muscle mass. Therefore, it is feasible to assume that reduced muscle mass leads to decreased ability to walk, and we have proven that there is a close correlation between the two. When presenting the idea of strength training to the elderly, it is appropriate to focus on the maintenance and improvement of mobility, not on the training itself. The results of our research can be summarized as follows:
Muscle mass decreases with age, with the legs being affected to a greater degree than the arms. Moreover, muscle atrophy is dependent on weakening of muscle fibers, especially fast-twitch (Type II) fibers. Reduced lower limb muscle mass increases the risk of falling and can decrease walking ability to a degree that can affect daily living activities.
In order to improve reduced muscle mass in aging, it is important to use an exercise program that is designed to strengthen fast-twitch fibers, which can be followed even by the elderly. Since walking therapy mostly mobilizes slow twitch fibers, it is not effective in preventing and improving muscle atrophy. It is important to have an exercise program that is designed to mobilize fast-twitch fibers.

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Central arterial distensibility decreases with age-related changes in the arterial wall, and as a result, systolic blood pressure and/or pulse pressure (difference of systolic pressure and diastolic pressure) may increase in the elderly. Systolic hypertension and increased pulse pressure are known to be independent risk factors of cardiovascular and cerebrovascular diseases. Decreased distensibility of the central arteries may also cause the deterioration of circulatory function and physical ability in the elderly. Several studies have shown that central arterial distensibility is increased in athletes, and that daily physical activity is positively related to central arterial distensi bility in not only young but also elderly people. It has also been shown that relatively short-term and low-intensity exercise training could improve central arterial distensibility even in the elderly. Thus, physical exercise may have an effect on retarding age-related changes of the central arteries. To establish higher quality of life by preventing cardiovascular and cerebrovascular diseases and by improving circulatory function and physical ability in the elderly, further studies are needed to investigate the detailed mechanism and the appropriate amount and or intensity of exercise in improving central arterial distensibility.

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The purpose of this study is to discuss the effects of aging and exercise on aerobic capacity in the elderly and the procedure for encouraging sedentary elderly to engage in a health promotion program based on aerobic exercise. Regular proper aerobic exercise training, even when started as an elder, induces an increase in maximal oxygen intake and lactate threshold (or ventilatory threshold) by enhancing ventricular diastolic function and oxidative capacity in muscle ; and reduces the risk factors of lifestyle related diseases. There was a need for a simple test for determining aerobic capacity and exercise prescriptions in community-dwelling elderly. We recommended two methods for this purpose : one is to determine DPBP and the other is to estimate work rate at a certain concentration (rest plus 0.1 mmol /l ) of the blood lactate based on it just after 2 A stage step exercise. Both work rate can be used not only for evaluation of the aerobic fitness level, but also a safer and effective exercise intensity to elucidate the benefit of aerobic exercise. These tests were very simple and can determine 5 to 10 people simultaneously.

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This review describes age-related changes in muscle work capacity and muscle blood flow as an indicator of oxygen transport capacity. Maximal endurance time, measured using a given relative load, did not differ between younger and older people ; and the strength decline ratio, as a percent of maximal voluntary contraction, remained constant across the middle- and old age groups, or slightly increased with age. A likely explanation would be the agerelated modification of muscle fiber composition. In contrast, the recently proposed submaximal test indicated that the breaking point of blood pressure regulation (BP_critical), during progressively increasing exercise, significantly decreased in the elderly in their 70 s. Concerning muscle blood flow in the elderly, the results are inconsistent. Some studies indicated the muscle blood flow during leg or handgrip exercise can be preserved in the elderly ; other studies reported it decreases in older people both at baseline and during exercise. Longitudinal studies on elderly people show that training can reverse age-related peripheral circulatory changes in healthy older people. In addition, daily physical activity is related to muscle work capacity and gradually decreases with age. Thus, further studies are needed concerning whether the decline of muscle work capacity or the reduction of muscle blood flow with age is due to aging or inactivity in older people.

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Although regular physical activity has many beneficial health-related effects for the elderly, inappropriate or excessive exercise has been known to exaggerate or be associated with risk of cardiovascular events. Therefore, appropriate initial health screening, including medical evaluation and risk stratification, is vital to ensure or increase exercise safety.
In the elderly, medical evaluation needs to focus on identifying the coronary risk factors or signs suggestive of cardiovascular disease, since coronary artery disease has been demonstrated to be the most common cause responsible for cardiovascular events during physical activity in the elderly. It is noteworthy that variability of physical fitness is high in the elderly and cardiovascular risk during exercise is greater in subjects with lower physical fitness. In risk stratification, there-fore, pre-assessment of physical fitness in addition to routine medical evaluation is pivotal.
Exercise prescription must be based on risk stratification and/or complicating cardiovascular disease severity. Low-level exercise, for example, 40% of VO₂max is recommended for high-risk subjects such as those with two or more coronary risk factors, suggestive cardiovascular disease, lower physical fitness, or flail order adults. Since most subjects have reported at least one prodromal symptom within one week of sudden death, it is very important to check the physical condition before exercise on each day. Although various arrhythmias are likely to be responsible for cardiac events during exercise, their complete prediction is seldom possible. Therefore, monitoring EGG during exercise contributes greatly to exercise safety.
Further investigation is required for improvement of exercise safety for the elderly.

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Infection is the major cause of health impairment in elderly persons. Immune function declines with age. In order to keep the elderly in good health, it is necessary to control the age-associated decline of their immune function. Components of a non-specific immune system arc neutrophils, macrophages and NK cells. A specific immune system is composed of T lymphocytes and B lymphocytes. T lymphocytes differentiate in the thymus. Age-associated atrophy of the thymus causes a decline in T lymphocyte function. It is essential in aging of the immune system. B lymphocytes produce immunoglobulin to act as antibodies. With aging, abnormal antibodies such as autoantibodies and monoclonal immunoglobulin increase, and the number of normal antibodies compared to foreign antigens decrease. Exercise influences the autonomic nervous system, hypothalamo-hypophyseal system, and immune system. Moderate exercise enhances immune function, and severe exercise causes immune function decline. Immune function declines after a severe single bout of exercise, and an “open window” of infections occurs. Appropriate exercise training may improve immune function. Recently, it was shown that exercise training for one year increased the contents of secretory immunoglobulin A in saliva in elderly persons. This result suggests that long-term exercise training improves immune function in elderly persons.

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Oxidation produces free radicals, which cause peroxidation, enzyme inhibition and genetic damage in muscle cells. Genetic damage to cells and tissues caused by free radicals facilitates aging. Therefore, the functional capacity of the antioxidant system against free radicals is important to protect cells and tissues. The health benefits of regular exercise are well documented in a large number of reports. Moderate exercise can result in greater health benefits than vigorous exercise, because intense activity may generate free radicals. This is evidenced by an increase in effects such as lipid peroxidation, glutathione oxidation, and oxidative protein damage. These are regarded as an indirect sign of muscle cell damage. During exercise, increased aerobic metabolism is a potential source of free radicals (oxidative stress) in mitochondria. In muscle cells, mitochondria are one important source of reactive intermediates that include superoxides, hydrogen peroxide, and possibly hydroxyl radicals. Unfortunately, because research focusing on oxidative stress and antioxidants following exercise has up to now been narrow in scope, the mechanism linking oxidative stress and antioxidants in muscle tissue during exercise, is not fully understood. Knowledge of the mechanism of free radical formation during exercise will be useful and may lead to the prevention of oxidative stress and damage associated with physical activity. Although the capability of an antioxidant system can be estimated by measuring the content or activity of cellular superoxide dismutase isozymes, catalase and glutathione peroxidase, scavenger capacity against free radicals in muscle cells has not been investigated. Recent progress in electronics has made it possible, using electron spin resonance and a spin-trapping technique, to determine and quantify the reactive oxygen species involved in chemical reactions. Biological applications of electron spin resonance include detecting the production of free radicals and radical scavenging activity in living specimens. This review paper provides a brief account of how exercise leads to oxidative stress and the link with antioxidants, and suggests future paths of research.

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It is well known that individual differences exist in exercise capacity or trainability. Several studies have shown that these individual differences are brought about by environmental effects such as life-style, diet and genetics. The potential of several specific genes to cause individual differences in endurance capacity or trainability has been investigated. The angiotensin-converting enzyme (ACE) gene, which has insertion (I) /deletion (D) polymorphism, is one of the most studied genes. Montgomery et al. reported that elite high-altitude mountaineers had higher I allele frequency of the ACE gene than did sedentary males. Moreover, they reported that subjects with II homozygotes showed higher trainability during a 10-week endurance training program than did individuals with ID heterozygotes or DD homozygotes. However, the results reported by Rankinen et al. did not support their results in terms of the relation between ACE genotype and cardiorespiratory endurance. Although numerous studies have reported a relationship between these two items, it remains controversial. Furthermore, mitochondrial DNA (mtDNA), the creative kinase and the Na⁺-K⁺-ATPase ∂2 genes have been studied as genes that may dictate individual differences in endurance capacity or trainability. We are going to report about the relation between these genes and exercise capacity and trainability.

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The health service system in Japan has changed remarkably in the past 20 years. One feature of the changes is the introduction of evidence-based medicine (EBM) and another is medical economics. These approaches were not taken into account in the health services though they were very common in economic work. The rapidly aging population and economic crisis call for a new evaluation system in the health service field in Japan.
There are some studies on medical economics in clinical services at present; however few studies have been reported in preventive medicine. Especially, studies on medical economics in prim ary prevention in the community are very few in our country.
The activity of primary prevention is very important not only for medical economics but also for health promotion which is represented by The Healthy Japan 21. This article introduces some studies on medical economics for prevention in the United States and European Countries as well as some reports in the fields of industrial health in Japan.
Regretfully, only one study on medical economics has been found in the community; however this study did not show enough reliability and validity epidemiologically.
Kuno and his group conducted a new primary prevention study for aged people in a community. And medical economic evaluation programs are induced from the beginning in each project. These results may have a strong influence on primary prevention work in the community in Japan.

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As safety of testing was the highest priority for physical ability measurement in elderly people, their motor ability was evaluated by means of test performance of walking. The purpose of this study was to review existing research on walking tests assessing motor ability of elderly people. Motor ability exerted to perform walking was assumed to be divided into three domains of speed, coordination, and endurance. The maximum and normal speed walking tests were used to measure walking speed in elderly people. The principal determinant of walking speed was stride that was affected by strength of lower limbs. Hurdle walking and the 8-figure walking were used to measure coordination including balance and agility required in walking. Distance walking for 6 and or 12 min was used to measure walking endurance. The 6 min distance walking was the most useful test item to assess the aerobic fitness level of elderly people. The 10 m hurdle walking test and the 6 min distance walking test were selected in Japan Fitness Test for 65-79 years of age.

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[in Japanese]

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The influences of age on muscle architectural characteristics, i. e., muscle thickness, pennation angle, fascicle length, were studied in 121 men and 229 women aged 17 to 85 yrs. The subjects were divided into three age groups (younger : 17-39 yrs, middle-aged : 40-59 yrs, elderly : 60-85 yrs) for both genders. Muscle thickness and pennation angle of the vastus lateralis (VL), medial gastrocnemius (MG), and long head of triceps brachii (TB) muscles were measured using B-mode ultraso-nography, and fascicle length was estimated. In all age groups, men had significantly greater relative muscle thickness (to limb length) in VI, and TB than women, but not in MG. Relative muscle thickness of VL was significantly lower in elderly than in younger and middle-aged subjects. Ilowever, the corresponding differences in MG and TB were insignificant. The pennation angle of VL was significantly lower in elderly than in younger and middle-aged subjects, although there were no significant differences in pennation angles of MG and TB among the three groups. These results suggest that the decrease in thickness of vastus lateralis muscle with aging is significant, but not significant for medial gastrocnemius and triceps hrachii muscles.

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Walking is the most basic movement in daily life, and is a popular exercise for eloerly individuals to keep their health. However, it is not clear how walking is effective in keeping or increasing the muscle mass and bone intensity of the lower limbs. This study aimed to investigate the relationships between walking steps per day during daily life and either the muscle thickness values of lower leg anterior and posterior or the bone intensity of calcaneus. The subjects were 116 healthy men (n=31) and women (n=85) aged from 60 to 78 yrs, Walking steps per day were deter-mined using a pedometer. Muscle thickness values at the lower leg anterior and posterior sites and the osteo sono assessment index (OSI) of calcaneus were determined using ultrasonographic apparatuses. In women, OSI correlated significantly with walking steps (r=0.265, p<0.05) and the product of walking steps and weight (r=0.369, p<0.05) . In both genders, however, no significant correlations were found between walking steps and muscle thickness values at the two sites. The findings here suggest that increasing the number of walking steps during daily life will improve the intensity of calcaneus for elderly women, but is not effective for inducing hypertrophic change in the muscles located in the lower limbs for elderly individuals of both genders.

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This study aimed to investigate the influence of aging on muscle thickness in lower limbs, with specific emphasis on the site- and gender-related differences. Subjects were a total of 191 healthy young and elderly persons of both genders : 51 young men (24.2±3.6 yrs), 45 young women (23.1±3.2yrs), 51 elderly males, and 44 elderly females. Lower leg anterior, and lower leg posterior muscle thickness was determined using a brightness mode ultrasonographic apparatus. At all sites except for the thigh posterior, the muscle thickness values were significantly greater in the young than in the elderly groups of both genders, even in terms of the ratio of muscle thickness to body mass^1/3 (Mt/Wt^1/3 ratio), calculated to normalize the morphological differences. The relative difference in muscle thickness between the two age groups was the greatest at the thigh anterior and the least at the thigh posterior in both genders. Between young men and women, the men showed significantly greater muscle thickness and Mt/Wt^1/3 ratio at every site than the women. Between the elderly groups, however, Mt/Wt^1/3 ratios at all sites, except for the thigh anterior, did not show significant gender-related differences. Relative differences in both muscle thickness and Mt/Wt^1/3 ratio between the young men and women were similar among the sites, but between the elderly groups the corresponding values at the thigh anterior were greater than at the other sites. These results indicate that 1) the influence of aging on muscle thickness differs between the muscle groups located in the anterior and posterior sited within the same segment, 2) for women, the age-related loss of muscle thickness at the thigh anterior is relatively greater as compared to those at the other sites of the lower limb.

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This study was aimed to investigate the influences of age and gender on isometric muscle torque and explosive muscle power output with reference to muscle volume. A total of 177 healthy subjects of both genders were divided into four groups according to their age and gender : 46 young men (22.0±3.2yrs), 43 young women (22.7±3.3yrs), 46 elderly men (71.2±4.3yrs) and 42 elderly women (72.7±4.5 yrs) . The maximal voluntary isometric knee extension torque of the right leg (hip and knee angle at 90 degrees) and the power of bilateral leg extension in sitting position were mea sured. The ratios of both torque and power to muscle volume, estimated using ultrasonograph measurement, was calculated (torque/MV and power/MV respectively) . Torque was significantly less among the elderly than among the young for both genders, and among women than among the men for both age groups. Significant age-related differences were evident even in terms of torque/ MV, but the corresponding differences between men and women disappeared. On the other hand, power MV showed significant age- and gender-related differences, and the age-related difference was larger than that for torque MV. These results suggest that age- and gender-related differences in power are more noticeable than differences in torque and that these differences are not simply explained by differences in muscle volume.

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The factors influencing ankle range of motion were investigated for 185 middle-aged and elderly subjects (116 women and 69 men, aged 48-86 years) . Each subject was seated with the right knee extended, and the ankle joint was passively dorsiflexed by a dynamometer with torque just tolerable for each subject, to measure the maximal dorsiflexion angle. During passive loading, elongation of muscle fibers in the gastrocnemius and Achilles tendon was determined in vivo by ultrasonography. There was a difference between women and men for the passive dorsiflexion angle (men smaller than women), which negatively correlated with muscle thickness of the posterior portion of the leg determined by ultrasonography. Both in women and men, the passive dorsiflexion angle negatively correlated with age, even after normalizing for maximal voluntary plantar flexion torque. Both elongation of muscle fibers and tendon was related to the passive dorsiflexion angle, and the ratio of tendon elongation to muscle fiber elongation positively correlated with the passive dorsiflexion angle. The active dorsiflexion angle, measured separately with the subject maximally dorsiflexing the ankle with no load, correlated with the passive dorsiflexion angle but not with age, and there was no gender difference. From the results it was suggested 1) that the mobility of the ankle joint is affected by elongation of both muscle fibers and tendon, but with the effect of the tendon being greater than that of muscle fibers, and 2) that muscle mass negatively affects passively-induced joint range of motion. Actively performed joint range of motion would be affected by elongation of the muscle-tendon corn plex and force-generating capability of the ankle. Gender difference in joint range of motion and the aging effect are related to these factors.

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According to cross-sectional studies, decreased postural stability, assessed by center of pressure (COP) sway, has been remarkable over the past 60 years, and has become one of the impairment factors for quality of life in the elderly. In the present study, in order to determine whether exercise training, consisting of bicycle ergometer and strength training inhibits decreased postural stability for elderly individuals (60 years of age or more), we investigated changes in COP sway and plantar flexors muscle volume. Healthy male (n=9) and female (n=8) subjects aged 62 to 76 yrs participated in the present study. Subjects were requested to maintain a quiet standing barefoot position on a force platform (type 9281B, Kistler) with their eyes opened or closed. Mean velocity of COP (COP sway length/time) was calculated from anterior-posterior COP sway from force platform data. From the spectral analysis of COP sway, low (0-1 Hz) and high (1 -10 Hz) frequency components of COP series were extracted. The muscle volume of the plantar flexors muscle group was estimated from multi-regression analysis based on measured muscle thickness at the lower leg posterior site using an ultrasonographic apparatus (SSD-500, Aloka) . Mean velocity of COP significantly (P< 0.05) decreased due to training, and this was accompanied by a decrease in COP sway high frequency components. On the other hand, COP sway low frequency components and muscle volume did not change. These findings suggest that an inhibition of decreased postural stability in the elderly is not mainly related to muscle volume, but to improvement of a feedback system from somatosensory function. With respect to the elderly, who have a larger mean velocity of COP, however, postural stability could be related to muscle volume.

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Arterial compliance progressively decreases with aging. This aging-induced reduction of arterial compliance causes an increase of systolic blood pressure (SBP), whereas regular exercise increases arterial compliance. We hypothesized that an increase in daily physical activity (DPA) produces a beneficial effect on systemic arterial compliance (SAC ; an index of central arterial compliance) and this phenomenon could decrease SBP in the elderly. We investigated the relationship among DPA, SAC, SBP, diastolic blood pressure (DBP), and some other risk factors for cardiovascular and/or cerebrovascular events (total cholesterol, HDL-cholesterol, and HOMA-R) cross-sectionally in 127 elderly persons (42 male, 85 female : aged 74±4 years) . The DPA was estimated by expended calories using an accelerometer. The SAC was calculated from a finger pulse pressure waveform recorded by using PORTAPRES ; and stroke volume obtained from the same pressure waveform based on the volume-clump method. The analyses demonstrated that SBP was directly and decreasingly affected by SAC, and that DPA had an increasing effect on SAC. Furthermore, SBP was directly and increasingly affected by DBP, and DBP was directly and decreasingly affected by both SAC and DPA. Therefore, it is considered that DPA may have suppressive effects on the rise of SBP through the indirect effects of changing SAC and DBP. These findings suggest that an increase in DPA could improve the age-induced reduction of arterial compliance and rise of SBP in elderly humans.

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Double product (DP, heart rate × systolic blood pressure) during an incremental exercise test has been known to start to increase steeply at a workload, i. e. double product break point (DPBP), which corresponds to the blood lactate threshold. The study was to investigate the relationship between DP transition and ST segment depression in electrocardiogram during exercise. Thirty-one patients of angina pectoris of effort and 140 elderly persons performed a continuous incremental exercise test using a stationary bicycle ergometer. During the entire test, HR and blood pressure were measured every 15 seconds and an electrocardiogram was recorded continuously. DPBP was then calculated. In ten of the 31 patients, ST level depression above -0.1 mV with a typical ischemic form in lead V 5 was observed during the test. However, workload at the DPBP was significantly lower than that of the ischemic threshold on the electrocardiogram (i. e. -0.1mV of ST depression) in relation to work load (46+/-16 vs. 78+/-20 watts), HR (96+/-13 vs. 117+/-13 bpm), SBP (160+ /-20 vs. 199+/-31 mmHg) and DP (15400+/-3400 vs. 23400+/-4900 bpm × mmHg) . In elderly persons, DPBP could be determined without the ischemic ST depression in 96% of 327 tests. This study indicated that the DPBP would be an objective index of exercise intensity with lower risk for exercise prescription in cardiac patients and elderly persons.

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Resistance exercise in the elderly and patients with a cardiovascular disorder has been thought to have a high cardiovascular risk, because it has the tendency to cause an excessive rise in blood pressure and induce serious arrhythmia. But recently, resistance exercise has been introduced into physical therapy because the safety of such exercise has been confirmed in subjects without a cardiovascular disorder.
The purpose of this study was to investigate the safety of lower extremity resistance exercise in middle-aged or elderly subjects with hypertension and receiving medical treatment (n=24), and those without hypertension (n=40), by measuring cardiovascular response during resistance exercise of different loads (40% and 60% 1 RM), and usefulness of respiratory guidance during such exercise.
As a result, there was no difference in diastolic blood pressure between those with and without hypertension ; but systolic blood pressure and rate pressure product both at rest and during exercise were significantly greater in patients with hypertension. However, neither group showed symptoms of angina, ischemic signs in ECG, or serious arrhythmia ; and there was no difference in the frequency of excessive rise in blood pressure between the groups (2 subjects with hypertension and 1 subject without hypertension) . Blood pressure during exercise was significantly lowered by respiratory guidance.
These results show that it is important to measure blood pressure during exercise before resistance exercise training regardless of the presence of hypertension, although an excessive rise in blood pressure occurred in only a few subjects. Furthermore, it is important to exhale slowly and not hold one's breath during exercise.

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The purpose of the present study was to investigate the effects of long-term exercise training on immune function in elderly individuals. This study was conducted on 27 sedentary subjects including 7 males and 20 females aged 66.1±4.2 yrs. (range of 60 to 77 yrs.) who participated in a 12-month exercise program. The subjects attended the exercise program 4.4 ± 1.7 times per month. Peripheral blood samples were taken prior to, and at 5 and 12 months during the exercise training program. Each lymphocyte subset (natural killer: NE, T, cytotoxic T: Tc, helper T: Th, memory-Th and NKT) count in the samples was measured using flow cytometry. Results indicated that NE and Tc cell counts were not significantly altered. Whereas, T and Th cell counts were significantly elevated after 12 months, and memory-Th and NET cell counts were significantly elevated after 5 and 12 months of exercise training. These results suggest that long-term exercise training may be a stimu lus to increase and or maintain immune function in elderly individuals.

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The purpose of this study was to confirm the causal effect model of strength on walking ability development as a result of exercise participation among elderly people in a community, utilizing the latent curve model (LCM) in structural equation modeling (SEM) . Twenty-six male and 57 female subjects, 83 in total, aged 67.8±5.7, 63.9±7.1 and 65.1±6.9 in a pooled sample participated in the exercise program which lasted for two years. Grip strength and sit-ups used in the Japan Fitness Test were measured for muscular strength, 10-m hurdle walk and 6-min walk for walking ability, and the fitness test score for physical ability. The data analysis procedures were as follows : a) analysis of test-retest reliability and construct validity of measurement items, b) analysis of causal structure model of aging, muscular strength and walking ability, c) analysis of variance for repeated measurement of walking performance by sex, age and year, d) analysis of LCM for walking performance development. The highest goodness-of-fit indices of SEM were obtained in the LCM of 10-m hurdle walk performance development (GFI=0.989, AGFI=0.920, CFI=0.998, RMSEA=0.038) . The path coefficient of sit-ups at pre-test effect on the intercept of 10-m hurdle walk performance development was significant (p<0.05) . The path coefficients of age to intercept and slope of 10-m hurdle walk development were also significant (p<0.05) . It was concluded that walking ability development through participation in exercise age and strength level was more effective for maintaining walking ability in older age.

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The purpose of this study was to confirm the causal structure model of muscle, motor and living functions utilizing structural equation modeling (SEM) . As subjects, 103 community-dwelling older men and women, aged 65.7±6.9years of age, participated in the study to measure muscle cross-sectional area, maximum voluntary contractions, muscle power, 4 physical performance tests, and 16 questionnaires regarding ability of activities of daily living. The causal structure model of muscle, motor and living functions was hypothesized to be a hierarchical causal structure. The causal structure model of muscle function was hypothesized to be a hierarchical causal structure consisting of 3 sub-domains of muscle mass, muscle strength, and muscle power. Data analysis procedures were as follows : a) testing of construct validity of muscle function variables using confirmatory factor analysis (CFA) in SEM ; b) testing of causal structure using SEM ; c) testing of factor invariance using multi-group analysis for gender. The highest goodness of fit indices was obtained in the causal structure model of muscle, motor and living functions (NFI= .928, CFI= .978, RMSEA =.061) . The causal coefficient of muscle function to motor function was .98 (p<.05), followed by.34 for motor function to living function. From the results of multi-group analysis, the measurement invariance model indicated the highest goodness of fit indices (TLI=.968, CFI .977) . It was concluded that the hierarchical causal relation was among muscle, motor and living functions, and in which muscle function was consisted of 3 sub-domains.

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The purpose of this study was to confirm the reliability and validity of a physical fitness questionnaire (PFQ) with self-rating for elderly people applying structural equation modeling (SEM) . As subjects, 105 community-dwelling older men and women aged 67.1±6.1 years participated in the study to measure 13 PFQ items and 13 performance tests. The data analysis procedures were as follows : a) testing reliability of PFQ ; b) testing of construct validity of PFQ using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) ; c) testing of criterion-related validity of PFQ to the performance tests using SEM ; d) testing of correlations of the PFQ to walking ability using SEM. Cronbaeh's alpha coefficient for consistency reliability of the PFQ was .83. Four common factors of muscle strength-power, endurance, coordination, and flexibility were extracted in EFA. The high and enough goodness of fit indices were obtained in the confirmatory factor structure model, and in each sub-domain of criterion-related validity to performance tests and correlation to walking ability models. The criterion-related validity coefficient of muscle strength and power was .77, followed by .66 for endurance, .59 for coordination and .82 for flexibility. The correlation coefficient of muscle strength and power to walking ability was -.51, followed by -.58 for coordination, - .43 for endurance and - . 28 for flexibility. These results indicated that the PFQ consisting of 13 items and 4 sub-domains satisfied reliability and construct validity although criterion related validity to performance tests was insufficient. It was concluded that the PFQ is of useful for physical fitness checking of elderly people.

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The purpose of this study was to examine the relationship between housebound (defined as elderly who go outside less than once a week) and physical fitness test (6 items of grip strength, situps, trunk flexion, foot balance, 10 m hurdle walk, 6 min walk), fitness test score, Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence (3 factors of instrumental self-maintenance, intellectual activity, and social role), and General Health Questionnaire (GHQ) (4 categories of somatic symptoms, anxietynsomnia, social dysfunction, severe depression), considering the differences among gender and age.
The subjects were 296 community-dwelling elderly aged≥65 (mean age ; 75.5±4.9) . Of the subjects, 32% were male, and 57% were elderly aged≥75. Seventy-nine (27.2%) were housebound. The rate of housebound subjects with a full score for intellectual activity, social role on the TMIG sub-scales, 10m-hurdle walk and 6 minute walk was significantly worse than non-housebound subjects. The scores for social dysfunction and severe depression on the GHQ sub-scales for housebound were significantly higher than those for non-housebound ; and few housebound exercised more than 2 times per week or 30 minutes a day. The mental health of male housebound and housebound aged under 75 was the worst among all groups. On the other hand, female housebound and those aged≥75 had lower TMIG and physical fitness results. The characteristics of the housebound were different between genders. Among the housebound aged≥75, grip strength correlated with TMIG and GHQ-28 ; the 10 m hurdle walk correlated with severe depression, instrumental selfmaintenance and intellectual activity ; and the physical fitness score correlated with GHQ-28 after adjusted for age and gender.
Physical fitness correlated with TMIG and GHQ among the housebound; and few housebound exercised in daily life. Improving grip strength and walking ability may reduce the number of housebound.

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The purpose of this research was to study the effects of exercise program participation on the personal factors of exercise adherence promotion in the middle-aged and elderly by comparing a group and individual exercise program. The personal factors for promoting exercise adherence, the four domains (i, e. initiative attitude, achievement satisfaction, self-recognition, and intrinsic motivation), were hypothesized. Two groups of middle-aged and elderly subjects, who volunteered to participate in different 6-month exercise programs, were examined. Group 1, 33 subjects (aged 67.7 ±4.3 years : mean±SD), participated in a program consisting of an individual exercise program (combination of endurance and resistance exercise, e. g. cycling exercise, dumbbell and machine exercise, once a week) and group exercise program (e, g. dance and ball game, once a week) . Group 2, 27 subjects (aged 65.2±4.Ovears), participated in the same individual exercise program twice a week. After the 6-month exercise program, significant improvements in group 1 were found in the selfassessment of activity score of the initiative attitude domain, the achievement satisfaction score including enjoyment, achievement and satisfaction, and the self-recognition score representing competence. In group 2, the mastery score in the intrinsic motivation domain was reduced, and the curiosity score in the same domain and the achievement score in the achievement satisfaction domain tended to decrease. These results show that a group program might have a more significant effect on the personal factors hypothesized to promote exercise adherence in this study. Hut there should be follow-up study on the subjects to determine the effectiveness of the program over the long term.

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