Objectives: Square-stepping exercise (SSE) is a preventive program that reduces the risk of falls and improves physical function and agility in community-dwelling older adults. Although SSE has shown benefits in community-dwelling older adults, its feasibility in Japanese daycare service facilities, where physical and cognitive conditions may differ, remains unclear. This study aimed to assess its implementation and acceptability among older adults in daycare service facilities. Methods: A single-arm, 4-week intervention was conducted at Daycare Service Facility A in Kagoshima, Japan. Participants performed SSE once weekly for 4 weeks, with each session lasting 60 min. Safety (absence of injuries or illnesses), program completion rates, and session attendance rates were monitored throughout the intervention, and one-on-one semi-structured interviews were conducted to assess acceptability. Results: The participants were 21 older adults (mean age 87.4 ± 4.6 years). Adherence was high, with a 95.2% completion rate and 100% attendance rate. No injuries were observed. All participants completed the exercises by following the step patterns, as instructed. Interviews revealed positive psychological changes, such as enjoyment and a sense of accomplishment, and physical improvements, including better lower-limb conditions and overall health. Conclusions: The findings suggest that SSE may be safely implemented with high adherence in older females with care levels of 3 or below in daycare service facilities and may also promote positive psychological changes. It is necessary to conduct a more detailed evaluation of its effectiveness.

Objectives: Physical therapists (PTs) face various psychosocial risks that affect their mental health; however, profession-specific reports on organizational exposures remain limited. This study aimed to examine total overtime, workplace harassment, and workplace consultation availability and their associations with current mental distress among PTs in Japan. Methods: A nationwide cross-sectional web survey of PTs, conducted from August 12 to September 20, 2025, was analyzed. The primary outcome was current mental distress (yes/no). The main exposures were total overtime in the past 3 months (per 10 h/3 months), workplace harassment (yes/no), and workplace consultation availability (yes/no). Separate multivariable logistic models were fit for each exposure with a common adjustment set (sex, age, tenure in current workplace [midpoint, years], employment status, hospital bed size, and number of PTs). Missing covariates were handled via multiple imputation (multiple imputation by chained equations, m = 15) with pooling by Rubin’s rules. Results: Of the 718 PTs surveyed, 312 (43.5%) were classified as distress present. Mean total overtime was 16.7 ± 15.0 h over 3 months and was higher in the distress-present group. Adjusted associations were total overtime adjusted odds ratio (aOR) 1.13 (95% confidence interval [CI] 0.98–1.31) per additional 10 h, harassment aOR 2.29 (95% CI 1.67–3.14), and workplace consultation availability aOR 0.60 (95% CI 0.43–0.84). Conclusions: Workplace harassment was associated with higher rates of mental distress, whereas workplace consultation availability was inversely associated. Total overtime showed a positive trend in the adjusted model. These findings point to organizational targets, including overtime management, harassment prevention, and accessible consultation routes.

Objectives: Physical activity levels vary seasonally, but the short-term impact of intensity-specific activity changes on older adults’ physical function remains unclear. This study aimed to examine seasonal changes in physical activity and their effects on physical function among older adults in a rural, snowy region. Methods: Thirty-nine older adults from Tobetsu-cho, Hokkaido, Japan, were included. Body composition and physical function were assessed during the non-snowfall season (June–September 2023) and 1 year later (June–September 2024). Accelerometers measured step counts and activity levels during both the non-snowfall and snowfall seasons (January–February 2024). Participants were grouped by the extent of change in activity levels (greater-change vs. smaller-change). Two-way analysis of variance (ANOVA) assessed differences in 1-year changes in physical function. Results: Repeated-measures 2-way ANOVA showed a significant main effect of season on body fat percentage, appendicular skeletal muscle mass index, grip strength, and walking speed in the light-intensity physical activity (LPA) category. A significant interaction was observed for the Five Times Sit-to-Stand Test (FTSST). Bonferroni’s test revealed a significant worsening of FTSST scores (p <0.01) after 1 year, but only in the group with a greater LPA decline. Conclusions: A greater decrease in LPA during the snowfall was associated with short-term declines in lower-limb function, as measured by FTSST. Given its link to fall risk and loss of independence, maintaining LPA during snowy seasons may be essential for maintaining lower-limb function in older adults.

Japan’s primary care system is evolving from a specialist-dominated model to one incorporating board-certified family physicians and generalist training pathways. However, the system remains fragmented, with limited integration of multi-professional teams. Primary care due to legal and systemic barriers, including the requirement for physician referrals and limited training for autonomous practice. Drawing on international evidence, this paper examines the potential role of physiotherapists as first-contact practitioners (FCPs) and advanced practice physiotherapists (APPs) within Japan’s evolving primary care system, with particular attention to system integration, workforce capacity, and care for musculoskeletal and chronic conditions. Studies demonstrate improved clinical outcomes, patient satisfaction, operational efficiency, and cost-effectiveness with physiotherapy-led models. FCPs reduce physician workload, medication use, and diagnostic imaging, while enhancing patient self-management and adherence to guidelines. However, challenges such as role ambiguity, diagnostic uncertainty, and inadequate funding hinder effective integration. Addressing these barriers requires legislative reform, comprehensive training, role clarity, and improved inter-professional collaboration. For Japan, embedding physiotherapists in multidisciplinary primary health care could support integrated community care, addressing the needs of an aging population and fragmented services. This transition necessitates redefining physiotherapy roles, expanding the scope of practice, and aligning with chronic care models. Coordinated policy initiatives on funding, training, and regulation are essential to develop multi-professional primary care teams and optimize patient outcomes. Lessons from international models provide valuable insights for advancing physiotherapy’s role in Japan’s primary care system.