Objective: The present study investigated 1) prevalence of low back pain (LBP) by intensity, 2) the association between LBP intensity and depressive symptom, 3) the joint association of LBP intensity and exercise habit with depressive symptom among community-dwelling older adults.

Methods: The participants were 1,051 men and women aged 65 to 84 years old who were living in Matsudo city, Chiba, Japan. Intensity of LBP, depressive symptom, exercise habit, sociodemographic attributes, lifestyles, and biological variables were obtained by a self-administered questionnaire. The associations of LBP with depressive symptom as well as joint associations of LBP intensity and exercise habit on the odds of being depression were examined using multivariate logistic regressions.

Results: Prevalence of LBP was 47.7% (mild: 35.2%, moderate: 10.0%, severe: 2.5%). After adjusting for potential confounders, mild pain (odd ratio [OR]: 1.85), moderate to severe pain (OR: 2.03) were significantly associated with depressive symptom. There was no significant interaction between LBP intensity and exercise habit on the association with depressive symptom. As a joint association, participants with mild pain (OR: 2.85), with moderate to severe pain (OR: 2.92) with no exercise habit were significantly associated with depressive symptom, compared to pain-free participants having exercise habit.

Conclusion: Almost half of community-dwelling older adults have LBP and one-quarter of them have moderate to severe pain. Participants with more severe pain were more likely to have depressive symptoms, suggesting that reduction of pain can alleviate depressive symptom. Inactive people with LBP have a tendency to show depressive symptom compared to active people.

Objectives: Community-based projects or population approaches undertaken by municipalities to promote physical activity comprise multistage dimensions, such as disseminating information about the project, enhancing its recognition, evaluating its effectiveness, and sustaining it. However, few comprehensive assessment tools have been utilized for such projects. This study aimed to develop a comprehensive assessment tool for municipal projects that promote physical activity.

Methods: Seventeen researchers reviewed the literature and constructed a model to assess the process and effectiveness of projects. The model divided the projects into multistage dimensions. Measurement items were developed for each dimension. The model was applied to existing projects in 6 municipalities.

Results: The RE-AIM model was adopted as the basis of the new model. A sixth dimension - Plan - was then added before Adoption (to form a modified RE-AIM model: PAIREM). The main items in the 6 dimensions were as follows: health goal and target population [Plan]; the proportion of administrative units adopting the project in a municipality [Adoption]; information, education, and support deliveries [Implementation]; the proportion of the target population that received information and education and recognized the project [Reach]; the status of achievement of the health goal [Effectiveness]; and long-term adoption and effectiveness [Maintenance]. The model and its items successfully assessed the projects conducted by the 6 municipalities.

Conclusion: A comprehensive assessment tool was developed for population approaches that promote physical activity. The model and its items will enable public health sectors to regularly evaluate the process and effectiveness of their projects.

Background: Regular physical activity (PA) reduces the risks of various chronic diseases; however, the majority of the Japanese population, as well as the populations in many other countries, is inactive. In recent years, multicomponent strategies for promoting PA, such as community-wide campaigns (CWCs), have been recommended; although there is not enough evidence about the effects of the community-wide promotion of PA. The Ministry of Health, Labour, and Welfare in Japan published PA guidelines for the health promotion in 2013 called the Active Guide. It is important to examine whether the Active Guide can be utilized in the community.

Purpose: The aim of this study was to evaluate the effectiveness of CWC utilizing the Active Guide for promoting PA in Japanese adults.

Methods: This study was a non-randomized controlled trial, allocating four communities into the intervention group and nine into the control group from Fujisawa city, Kanagawa, Japan. The intervention used a CWC from 2013 until 2015 to promote PA, and was comprised of information, education, and the delivery of community support. The primary outcome was a PA time. The secondary outcomes included awareness of CWC and the Active Guide, and knowledge of Active Guide. To evaluate overall the intervention, the RE-AIM framework was used. Two independent, population-based, random-sample, self-administered questionnaires obtained from 3,000 adults (20 years old or older) living in communities in Fujisawa were used to evaluate the difference between the status at the baseline and at the 2-year follow-up.

We conducted a randomized controlled trial to investigate the effectiveness of a multimodal exercise program for improving cognitive function and brain activation efficiency in community-dwelling older adults. This article responds to a research project approved by the Japanese Association of Exercise Epidemiology “to promote the creation, communication, and utilization of evidence from intervention studies in Japan”. We aimed to demonstrate evidence for the effectiveness of a multimodal exercise program for improving cognitive function and brain activation efficiency, and discuss its generalizability through the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Participants in this program were limited because of small sample size. However, participant’s characteristics were relatively average level (“reach”). The “effectiveness” of this program was validated by the improvement of the efficiency of brain activation during cognitive tasks and increase of physical activity, which is associated with improvements in memory and executive function. The “adoption”appears to be good as the equipment and location of the intervention were relatively common. However, we have not evaluated it scientifically. Furthermore, future study is required to verify the “implementation” and “maintenance”of this program. Although challenges remain to be addressed, this was verified as an effective and practicable shortterm exercise program for cognitive improvement, which is expected to be actively utilized for care prevention practice.

I have developed a novel exercise form named Square-Stepping Exercise (SSE) with colleagues. Through several investigations, including randomized controlled trials, we found that SSE is effective in preventing falls and improving cognitive function in older adults. A 5-year implementation of a project to disseminate SSE in a local municipality introduced the program to 11.3% older adults of the target population. Older adults who performed SSE obtained satisfaction from successful stepping and perceived activation of brain function. One of our previous studies found high long-term adherence to SSE; 63% of the original participants have continued SSE for 4 years. Their functional fitness level is maintained or significantly improved compared to that at baseline. Other researchers interested in SSE have investigated its effects on children or with music. Therefore, we established a non-profit organization (NPO) in 2007 to disseminate SSE efficiently, and have trained SSE instructors and leaders. By the end of 2015, 4,490 SSE instructors and leaders have been certified. Many municipalities have adopted SSE for preventive health projects in Japan. The SSE program has been introduced in 7 countries and regions. In response, we established a branch NPO office in 4 countries and regions, which also use SSE for preventive health projects. Research on SSE has been conducted in three countries. In conclusion, SSE can prevent falls and improve cognitive function in older adults. Long-term adherence is high and SSE can be implemented in real-world settings.

Background: Concern over the health risks of sedentary behavior has highlighted the need to examine factors associated with screen-based (television/computer) sedentary behavior. The present study examined the association of screen-based sedentary behavior with body weight and sociodemographic attributes among Japanese adults.

Methods: A population-based cross-sectional study enrolled 1034 Japanese adults aged 40 to 69 years who lived in 2 Japanese cities. Sociodemographic variables, height, weight, and time spent on screen-based sedentary behavior were collected by self-administered questionnaire. Differences in screen time in relation to body mass index and weight gain since age 20 years were assessed by the Mann-Whitney U test. Independent associations of each variable with screen time were examined by forced-entry logistic regression analyses.

Results: Mean (SD) age and median (interquartile range) duration of screen time per week were 55.6 (8.4) years and 832.0 (368.8–1263.1) minutes, respectively, for men, and 55.3 (8.4) years and 852.6 (426.0–1307.5) minutes, respectively, for women. Screen time among participants with weight gain was longer than among those with a weight gain of less than 10 kg (P = 0.08). Unmarried and unemployed participants had longer screen times. Participants aged 40 to 49 years were less likely than older age groups to spend time on screen-based sedentary behavior during leisure hours.

Conclusions: The present findings imply that strategies are necessary to discourage screen-based sedentary behavior among all demographic groups, especially among adults who are elderly, unmarried, or unemployed.

Background: Participation in a sports group is key for the prevention of incident functional disability. Little is known about the correlates of older adults’ participation in sports groups, although this could assist with the development of effective health strategies. The purpose of this study was to identify the demographic and biological, psychosocial, behavioral, social and cultural, and environmental correlates of sports group participation among Japanese older adults.

Methods: Data were obtained from the Japan Gerontological Evaluation study, which was a population-based cohort of people aged ≥ 65 years without disability enrolled from 31 municipalities across Japan (n = 78,002). Poisson regression analysis was used to determine the associations between the factors and participation in sports groups.

Results: Non-regular participation in sports groups was associated with lower educational level, being employed, and working the longest in the agricultural/forestry/fishery industry among the demographic and biological factors and poor self-rated health and depression among the psychosocial factors. Of the behavioral factors, current smoking was negatively associated and current drinking was positively associated with regular participation in sports groups. Among the social and cultural factors, having emotional social support and participating in hobby clubs, senior citizen clubs, or volunteer groups were associated with a high prevalence of participation in sports groups. Perceptions of the presence of parks or sidewalks, good access to shops, and good accessibility to facilities were positively associated with participation in sports groups among the environmental factors.

Conclusions: Our study suggests that the promotion of activities that could increase older adults’ participation in sports groups should consider a broad range of demographic and biological, psychosocial, behavioral, social and cultural, and environmental factors. Although future longitudinal studies to elucidate the causal associations are needed, encouraging participation in community groups through social networks might be effective for participation in sports groups.