Objectives: Physical activity is a relevant factor for the locomotive syndrome (LS); however, the association between intensity of physical activity and LS is unclear. This study aimed to investigate the associations among different intensities of physical activity (vigorous, moderate, and light), sedentary time, and LS. Methods: A cross-sectional analysis of records from 2890 Japanese community residents (mean age: 57.5 years) was conducted. LS was assessed using the stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale. Physical activity and sedentary time were assessed by self-administered questionnaires. The associations among physical activity, sedentary time, and LS were examined by logistic regression analysis stratified by age (<65 years and ≥65 years) and sex. Results: Vigorous physical activity in men aged ≥65 years, and moderate and vigorous physical activities in women aged <65 years were significantly associated with lower odds of LS. By contrast, no significant association was found between physical activity and LS in men <65 years and women ≥65 years of age. No association between light physical activity and the LS was found in either group. The association between sedentary time and LS was observed in women aged <65 years. Conclusions: Physical activity and sedentary time were associated with the LS but in an age- and sex-dependent manner. This study highlights the importance of engaging individuals in high-intensity physical activity to prevent or address LS.

Objectives: Inpatient cardiac rehabilitation (CR) and pharmacotherapy are important for better in-hospital outcomes in elderly heart failure (HF) patients. We aimed to examine whether conventional CR combined with Waon therapy (Waon-CR) improves exercise capacity compared to CR alone in elderly HF patients. Methods: Decompensated and hospitalized HF patients who could not walk independently over 200 m were recruited. Patients admitted from May 2020 to March 2021 and from April 2021 to March 2024 were included in the CR and Waon-CR groups, respectively. Participants underwent a 5-session program during hospitalization. The main outcome measure was a 6-minute walk distance (6MWD) at the completion of the program. We also investigated exercise-related adverse events. Results: A total of 34 patients (mean age 79.5 years, 13 males) were enrolled, including 18 patients in the CR group and 16 patients in the Waon-CR group. The 6MWD after the 5-session program was longer in the Waon-CR group than in the CR group (362.2 ± 103.7 vs. 286.3 ± 100.6 m, p = 0.038). Significant improvement of the 6MWD was demonstrated in the Waon-CR group after adjusting for confounding factors (adjusted B, 147.0 m; 95% confidence interval, 41.3–252.8 m, p = 0.012). There were no adverse events during the hospital stay. Conclusions: Inpatient Waon-CR was feasible and led to improved 6MWD in elderly HF patients at the completion of the 5-session program.

Objectives: This study aimed to investigate the effect of the number of days from surgery to ambulation on activities of daily living (ADL) at discharge in postoperative patients with type A aortic dissection (TAAD). Methods: It included patients with a diagnosis of TAAD who were independent in ADL before the onset of symptoms. ADL was assessed using the Katz Index (KI), with a KI score of 6 points at discharge defining independence and less than 6 points classified as dependence. Patients were divided into 2 groups based on independence in ADL at discharge. Logistic regression analysis was performed with independence in ADL at discharge as the object variable and the number of days from surgery to ambulation as the explanatory variable. A receiver operating characteristic curve was constructed to calculate the cutoff value. Results: A total of 100 patients were included in the analysis. There was a significant difference in the number of days to ambulation between the 2 groups. Multiple logistic regression analysis revealed that the probability of being independent in ADL at discharge was significantly lower with more days to ambulation (odds ratio: 0.93, 95% confidence interval: 0.86–0.99, P < 0.035). The cutoff value for the number of days from surgery to ambulation for independence in ADL at discharge was 8 days (area under the curve: 0.64). Conclusions: In postoperative patients with TAAD, the longer the postoperative days to start ambulation, the more difficult ADL recovery may be, but the cutoff values need further validation.

Objectives: Recently, rehabilitation professionals in Japan have become increasingly involved in Kayoi-no-ba for long-term care prevention. However, there are significant differences in the quality and content of professional rehabilitation support. This study aimed to develop a competency scale for rehabilitation professionals who support Kayoi-no-ba. Methods: A survey was mailed to rehabilitation supervisors at 440 facilities selected from a nationwide Internet search of facilities that implement the “community-based rehabilitation activity support project,” and rehabilitation professionals involved in supporting Kayoi-no-ba were asked to respond to the survey. The questionnaire was self-administered, and responses were sought via a 6-point scale for the 50 proposed competency items. For statistical analysis, exploratory factor analysis was conducted to examine the factor structure of the scale. Covariance structure analysis was used to assess model fit and to evaluate the reliability and internal consistency of the scale. Results: Among the 260 facilities that responded (59.1%), 607 participants provided valid responses. The final competency scale had a 3-factor structure (knowledge and attitude, ability to coordinate groups, and clinical practice skills) comprising 20 items. Model fit and internal consistency were good. Conclusions: Our findings indicate that rehabilitation professionals who support Kayoi-no-ba should have the attitude and knowledge of supporters, the ability to coordinate groups, and the clinical practice skills of rehabilitation therapists. This competency scale could be used as a guideline to improve the quality of support.

Objectives: The effect of the co-occurrence of whole-body muscle wasting and respiratory muscle weakness on the clinical characteristics of patients with chronic obstructive pulmonary disease (COPD) is unclear. We investigated this association in patients with chronic respiratory diseases. Methods: 47 outpatients with mild to very severe COPD were classified into four groups according to their fat-free mass index and respiratory muscle strength: 19 without muscle wasting and respiratory muscle weakness (normal), 6 with muscle wasting only (MW), 11 with respiratory weakness only (RW), and 11 with muscle wasting and respiratory weakness (MW + RW). We measured their body composition, pulmonary function, lower muscle strength, submaximal exercise capacity, physical activity in daily life, nutritional status, frailty status, and health-related quality of life (QOL). Multiple linear regression analyses examined the association of muscle wasting and/or respiratory muscle weakness with participant characteristics, using each participant’s characteristics as an explained variable adjusted for confounding variables (Normal as the reference). Results: The regression analysis revealed that the percentage of vital capacity, lower muscle strength, submaximal exercise capacity, nutritional status, and frailty status were worse in the MW + RW group than in the Normal group. The MR + RW group had the largest number of variables with significant differences compared to the Normal group. Conclusions: These data suggest that the co-occurrence of whole-body muscle wasting and respiratory muscle weakness was significantly associated with deteriorating clinical characteristics in patients with COPD.

Objectives: In recent years, the number of elderly heart failure patients with multiorgan failure has been increasing. Furthermore, the combination of heart failure and decreased hepatic reserve can cause severe skeletal muscle impairment and decreased survival rates. This study investigated whether the degree of improvement in the five repetitions of sit-to-stand (5STS) and walking speed (WS) differs depending on hepatic reserve in elderly heart failure patients. Methods: The patients were divided into the following two groups: good hepatic reserve (albumin–bilirubin score [ALBI score] ≤−2.25) and poor hepatic reserve (ALBI score >−2.25). Propensity score matching was performed using the brain natriuretic peptide level. A two-way analysis of variance (ANOVA) was performed to examine the main effects of the hepatic reserve and time points (admission or discharge). Results: After propensity score matching, 28 out of the 33 (84.8%) patients in the good hepatic reserve (age, 83.74 ± 9.25 years and ALBI score, −2.55 ± 0.19 points) and 27 out of 40 (67.5%)patients in the poor hepatic reserve (age, 85.85 ± 7.53 years and ALBI score, −1.93 ± 0.26 points) were analyzed. Two-way ANOVA showed that the 5STS (p = 0.04) and WS (p = 0.01) in poor hepatic reserve tended to be worse than in good hepatic reserve. Furthermore, the 5STS (p = 0.04) and WS tended to improve at discharge in both groups. However, the improvement in WS was not significant (p = 0.15). Conclusions: Our study suggests that the hepatic reserve in elderly heart failure patients may be an important factor in the assessment of physical functions.

Objective: This study aimed to clarify the association between frailty and the self-reported inability to immediately open a polyethylene terephthalate (PET) bottle cap. Methods: This cross-sectional study included 427 participants aged 73 and 78 years in City A, Japan. Frailty was assessed using the Kihon Checklist (KCL), and PET bottle cap opening ability was surveyed using a mailed questionnaire. The participants were divided into Immediately Open and Cannot-Immediately Open groups. The frailty status and KCL scores were compared between the groups. Multivariate analysis was used to investigate the association between frailty and the PET bottle cap-opening pattern. The possibility of screening frailty based on the Immediately/Cannot-Immediately Open classification was analyzed using a receiver operating characteristic (ROC) curve. Results: The number of frailty in the Cannot-Immediately Open group was significantly greater than the expected count compared to the robust and pre-frailty groups (P <0.001). Total KCL scores differed significantly between the Immediately Open group (3.2 ± 3.1) and the Cannot-Immediately Open group (5.7 ± 4.1) (P <0.001). The Cannot-Immediately Open group showed significantly higher scores in 5 of the 7 domains and a higher proportion of 1-point scores in 15 of the 25 KCL items. Individuals in the Cannot-Immediately Open group were associated with frailty (β = 2.03; odds ratio = 7.62; P <0.001). The ROC analysis revealed a sensitivity and specificity of 50.0% and 81.0%, respectively (area under the curve = 0.65; P <0.001). Conclusions: The self-reported inability to open a PET bottle cap immediately may be a moderate screening tool for frailty and is associated with many frailty factors.

Objective: This study investigated the factors that influence Ikigai among people aged 75 years and older using home medical and nursing care with home-visit rehabilitation. Methods: This cross-sectional study involved 66 home-visit rehabilitation users aged 75 years or older who received home medical and nursing care at 2 home-care nursing stations. The following attributes were evaluated: Ikigai-9, life-space assessment (LSA), home-based LSA (Hb-LSA), Frenchay activities index (FAI), functional independence measure (FIM), self-efficacy for activities of daily living (SEADL), self-efficacy scale for going out among community-dwelling elderly (SEGE), and physical function. The correlation between Ikigai-9 scores and each assessment was examined. Multiple regression analysis was performed using the Ikigai-9 as the dependent variable and the correlated items as independent variables. Results: The Hb-LSA, FAI, FIM, SEADL, and SEGE were correlated with Ikigai-9. Among the correlated items, the FAI was selected for multiple regression analysis. Conclusion: Home-visit rehabilitation users aged 75 and over may be more likely to feel Ikigai if they have higher instrumental ADLs.

Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual’s lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual’s behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan—which encourages residents to engage in the local society by participating in community places or groups that are referred to as ”Kayoi-no-ba”—and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.

Objective: This preliminary study aimed to explore the reference values of spatiotemporal and kinematic parameters in the lower extremities and trunk during gait for the healthy older adults. Methods: Walking speed, stride length and time, cadence, walk ratio, and step width were calculated as spatiotemporal parameters of gait. Forward tilting of the trunk (FTT), hip flexion and extension, knee flexion and extension, and their laterality were measured as peak angles during one-gait cycle. The bootstrap method was conducted to estimate the 95% confidence interval (CI). Results: This study included 334 healthy older adults (255 women). The following gait parameters were estimated with 95%CI: walking speed (95%CI 1.21–1.30), cadence (95%CI 116.35–121.20), walk ratio (95%CI 0.0055–0.0060), step width (95%CI 0.15–0.17), FTT (95%CI 1.91–4.19), hip flexion (95%CI 28.54–31.01), hip extension (95%CI 19.30–22.27), knee extension (95%CI 0.09–0.14), laterality of hip flexion (95%CI 1.31–2.02), laterality of hip extension (95%CI 1.32–1.97), laterality of knee flexion (95%CI 3.41–4.77), and laterality of knee extension (95%CI 0.07–0.13) in men, and walking speed (95%CI 1.28–1.34), walk ratio (95%CI 0.0050–0.0054), FTT (95%CI 2.54–3.73), hip flexion (95%CI 32.80–34.28), laterality of hip flexion (95%CI 1.65–2.05), laterality of hip extension (95%CI 2.06–2.57), and laterality of knee flexion (95%CI 3.04–3.89) in women. Conclusion: This study suggested provisional reference values of spatiotemporal and kinematic parameters in the lower extremities and trunk during gait for the healthy older adults.

Objective: This study aimed to compare the effects of the standing low-frequency vibration exercise device (SLVED) and walking training on balance ability on an unstable surface in community-dwelling elderly people. Methods: Thirty-eight older adults were randomly allocated to the SLVED sessions: the intervention group (n = 19), and the walking sessions: the control group (n = 19). Each group session lasted 20 min and was performed twice a week for 12 weeks. Standing balance was assessed by the change in center-of-gravity sway of the participant standing on foam rubber with eyes open (EO) and eyes closed (EC). The primary outcome measures were the root mean square (RMS) values of the center of foot pressure in the mediolateral and anteroposterior directions and the RMS area. Secondary outcome measures were the results of the 10-m walking time test (10 MWT), five-times sit-to-stand (5T-STS) test, and timed up-and-go (TUG) test. Results: Analysis of variance showed a significant group × time interaction for the TUG test. Significant improvements were observed in Y-RMS for EO condition; RMS, X-RMS, Y-RMS, and RMS area for EC condition; and 10 MWT, 5T-STS test, and TUG test for the main effect of the time factor. Conclusion: SLVED for intervention in community-dwelling older adults showed a greater improvement than walking training in the TUG test. In addition, SLVED improved the Y-RMS for the EO condition on foam rubber; RMS, X-RMS, Y-RMS, and RMS area for the EC condition on foam rubber in standing balance; and the 10 MWT and 5T-STS test, suggesting that it has similar effects to walking training.

Objective: Social participation is an essential component of active aging. Physical dysfunction is restriction of social participation, but it is inconclusive that improvement of physical function contributes to promote social participation. Therefore, understanding the other factor that moderates the association between physical dysfunction and social participation is important, and social network (i.e., ties with family and friends) may be a key factor. The aims of this study were to investigate the association between physical function and frequency of social participation, with social network as a moderator, and to examine the gender differences on the relationships. Methods: We conducted a cross-sectional study among 287 community-dwelling older adults. We asked how often they participated in social groups in a week to measure frequency of social participation. Physical function and social network were measured by using the modified version of Short Physical Performance Battery for community-dwelling older adults and the abbreviated Lubben Social Network Scale, respectively. To investigate the association, we performed a linear regression analysis. Results: After adjustment, a linear regression analysis showed interactions between physical function and social network on frequent social participation (β: −0.20, 95% confidence interval [CI]: −0.40 to −0.01). Furthermore, the same association was observed only in women (adjusted β: −0.33, 95% CI: −0.65 to −0.02). Conclusion: Our results suggested that social network moderates the association between physical function and social participation, and observed gender differences on the relationships. The findings of this study indicated the importance of multidimensional assessment and measures for improving social participation, not only physical function but also social network.

Objective: This study aims to estimate the cost-effectiveness of combined physical and cognitive programs designed to prevent community-dwelling healthy young-old adults from developing dementia. Methods: The analysis was conducted from a public healthcare and long-term care payer’s perspective. Quality-adjusted life years (QALYs) and expenses for health services and long-term care services were described in terms of effectiveness and cost, respectively. A thousand community-dwelling healthy adults aged 65 years were generated through simulation and analyzed. The incremental cost-effectiveness ratio (ICER) of adults with preventive program intervention compared to those with nonintervention was simulated with a 10-year cycle Markov model. The data sources for the parameters to build the Markov models were selected with priority given to higher levels of evidence. The threshold for assessing cost-effectiveness was set as less than 5,000,000 Japanese yen/QALY. Results: The ICER was estimated as −5,740,083 Japanese yen (US$−57,400)/QALY. Conclusion: A program targeting community-dwelling healthy young-old adults could be cost-effective.

Objective: The maximum phonation time (MPT) is used to assess simple respiratory functions and can be performed anywhere without special instruments. We investigated the association between MPT and respiration, considering the future utilization of simple respiratory assessments during home-based physical therapy. Method: This cross-sectional study included 140 older adults enrolled in Japanese long-term care insurance (77 men, 63 women; mean age, 77.9±8.0 years). The participants performed the MPT, followed by spirometry. We analyzed the MPT of the three age groups, relative reliability of the MPT values, and the association between MPT and respiratory function. Results: We found that the MPT of older men requiring long-term care or support was related to age. The intraclass correlation coefficient of MPT was >0.8 for all groups. Only forced vital capacity was associated with MPT in the partial correlation and multiple regression analyses. Conclusion: MPT could be an alternative assessment of respiratory function in home-based physical therapy for older adults requiring long-term care or support.

In older adults, social participation is an important component of rehabilitation and health promotion. Several studies have attempted to describe the definition and concepts of social participation, and there were many outcomes to measure social participation. This overview provides information about representative social participation and related concepts that have been defined in the literature. A standardized definition of social participation has not been developed; commonly, recognition for social participation was proposed as focused on involvement in social activities that provide interaction with others in a society or community. Many instruments assess the various aspects of social participation. Because of operational definition and diversity in social participation, performance in social participation was adopted as an aspect of assessment. Further discussions are needed to clarify the definition of social participation and evaluate the instruments used to assess social participation for it to be useful for rehabilitation and health promotion. In doing so, determining and developing assessment and intervention based on the purpose or perspective of social participation in older adults with and without disabilities is important.

Objective: The purpose of this study is to investigate the effect of an intervention combining exercise and cognitive activity on cognitive function in healthy older adults. Methods: This pilot randomized controlled trial recruited 33 eligible, healthy communitydwelling older adults (mean age, 77.1 years old; women, 51.5%), who were divided into intervention and waitlist control groups. The intervention group was engaged weekly in a group activity comprising exercise and discussions of homework, which included reading aloud, simple arithmetic, and simple activities, like spotting differences, for cognitive stimulation. They were also required to complete cognitive activity homework twice a week. The waitlist control group received no intervention. The main outcomes were cognitive function assessed using the Mini-Mental State Examination, delayed recall score on the Logical Memory IIA of the Wechsler Memory Scale Revised, Trail Making Test, and digit symbol substitution test. Results: According to the results, Mini-Mental State Examination scores were maintained in the intervention group but declined in the control group [Mean change in outcomes in control group (95% confidence interval): -1.68 (-2.89 to -0.48) ]. Additional mean change in outcomes in intervention group were found [1.68 (0.02 to 3.35) ]. Conclusions: Interventions combining exercise and cognitive activity can be helpful for preserving cognitive function in healthy older adults.

Objective: We examined the association between social frailty and subjective sleep quality among community-dwelling adults. Methods: This cross-sectional study recruited Japanese adults over the age of 60 years from health check-ups held in a public townhall in a suburban area between 2018 and 2019. Social frailty was evaluated using five criteria (living alone, not visiting friends sometimes, going out less frequently than the last year, not feeling helpful to friends or family, and not talking to someone every day) and categorized into three groups: non-frailty, pre-frailty, and frailty. Sleep quality was assessed according to the Pittsburgh Sleep Quality Index (PSQI) by giving participants a self-reported questionnaire. We performed multivariable linear regression analysis, denoting social frailty as an independent variable, and the global PSQI score as a dependent variable. Results: Data from 300 older adults were analyzed, 51.0% of whom were female. The participants' mean age was 73.0 years (standard deviation = 5.8). Multivariable analysis revealed the notable association between social frailty and a high global PSQI score (compared with non-frailty, frailty: β = 0.94, 95% CI = 0.08 to 1.80, p = 0.033). Of the five determiners of social frailty, not talking with someone every day was especially associated with a high global PSQI score (β = 1.57, 95% CI = 0.49 to 2.66, p = 0.005). Conclusion: The present study suggests that social frailty is associated with poor sleep quality among community-dwelling older adults. Our findings indicate the importance of social frailty on sleep quality among older adults.

Objectives: To reveal self-rated changes of health status during stay-at-home orders among older adults and to verify whether decrease in frequency of going outdoors during these orders was related to self-rated changes in health status.

Method: A self-completed questionnaire for older adults was provided in 2 dayservice facilities and a nursing station. We operationally defined health status with 4 domains (motor function, oral and swallowing function, depression, and social networks) and designed the questionnaire to determine self-rated changes in health status using factor analysis. After factor analysis, regression analyses were conducted.

Dependent variable was each factor score (self-rated changes of health status), and independent variable was decrease in frequency of going outdoors.

Results: Approximately 80% of participants answered that their health status had "worsened" in motor function (75.0%-87.2%). Moreover, more than 70% of participants answered "worsened" in "Feeling energy" and "Getting together and speaking with friends" (72.3% and 75.7%, respectively). Regression analyses demonstrated that, after adjusting for covariates, the decrease in frequency of going outdoors was related to self-rated changes of motor function and friend network.

Conclusion: During stay-at-home orders, older adults felt deterioration in their motor function, in feeling energy, and in their friend network, especially people who had decreased their frequency of going outdoors felt more deterioration in their motor function and in their friend network.

Objective: To examine the changes in postural alignment and kyphosis-correlated factors after 6 months of back extensor strengthening exercise in a group of community-dwelling older adults aged ≥65 years. Methods: We quasi-randomized 29 subjects into an intervention group treated with a back extensor strengthening program and a control group treated with a full-body exercise program. These groups completed 20-30 minutes of exercise directed by a physical therapist one or more times per week and were instructed to exercise at home as well. The participants were assessed prior to and after the intervention using the following criteria: postural alignment of "usual" and "best" posture, physical function, physical performance, self-efficacy, and quality of life. The differences between two factors (group and period) were compared for each of the measurement variables. Results: Subjects who adequately completed the exercises were analyzed. A reduced knee flexion angle was noted in the "best" posture of both groups, as were improved physical function and performance with the exception of one-leg standing time. Verifying the effect size in the post-hoc analysis, the body parts that showed changes to postural alignment after the intervention differed between groups. Conclusions: Back extensor strengthening exercises improved physical function and performance, but did not improve spinal alignment. The changes due to these interventions were not significantly different from changes observed in the full-body exercise group. However, post-hoc analysis revealed that the effect size of posture change was different, possible indicating that the two groups experienced different changes in the postural alignment.

Objective: Many studies have demonstrated that the loss of muscle mass (LMM) poses a risk of postural instability in the elderly; however, few studies have shown how LMM decreases proprioception. In this study, we investigated the changes in postural sway among older individuals with LMM induced by application of a local vibratory stimulus. Method: We enrolled 64 older adults (mean age). Postural sway was measured while applying vibration stimuli of 30, 60, and 240 Hz to both the gastrocnemius and lumbar multifidus muscles. We also measured the relative proprioceptive weighting ratio (RPW) of postural sway. The patients were divided into LMM and non-LMM (NLMM) groups. The study subjects were compared in terms of their age, height, weight, body mass index (BMI), lower leg skeletal muscle mass index (LSMI), L4/5 lumbar multifidus cross-sectional area ratio, and RPW at 30, 60, and 240 Hz. Results: Subjects in the LMM group showed a significantly lower RPW at 60 Hz, LSMI, and BMI than did those in the NLMM group. Conclusions: Decrease in RPW with 60-Hz stimulation concerning the lower leg proprioception is a risk factor for LMM-associated postural instability in the elderly. Consequently, with respect to the gastrocnemius muscles proprioception in LMM, it is necessary to perform assessments using muscle spindle stimuli.