The preventive approach in the Long-Term Care Insurance was started with the Long-Term Care Insurance in Japan in 1999. It is defined as helping the elderly to independent and active lives. It was implemented not only to prevent diseases, but also to help independent life in the elderly by focusing on physical and mental frailty in the elderly. The first review of Long-Term Care Insurance in Japan reported a rapid significant increase in the number of persons requiring light assistance, being 1.7 times the number at the beginning. Although the Long-Term Care Insurance provides physical help for such persons, other preventive approaches to dependency are important. Physical therapists who are well versed in the care of physical and mentally disabled persons have an important role in the preventive approach as well.

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In 2000, the Long-term Care Insurance System was started in Japan. It provides various care services to persons who are bedridden or senile and require constant care in daily life, or who need assistance in daily life. However, needless to say, an independent and healthy life with no need for care is the ideal for all, particularly for aged people. Thus, the prevention of dependence on long-term care has become the most important and urgent issue in Japan as well as other countries facing an aging population. Among elderly persons, a variety of aging-specific physical and mental ailments easily lead to dependence on long-term care. These include falls, incontinence, malnutrition, decline of functional capacity, cognitive impairment (dementia), poor oral hygiene, and foot troubles. They are collectively called the "geriatric syndrome". Rather than diseases, the "geriatric syndrome" is a state of impaired health accompanied by restriction of ADL and impairment of QOL. Due to the multifactorial nature of the geriatric syndrome, research for its prevention requires multi-faceted approaches, from not only physical but also psychological and social viewpoints. In this context, we put into practice a new mass health examination system targeting the elderly in Japan, aimed at early detection of persons at high risk of geriatric syndrome and early intervention for these persons. In this comprehensive mass health examination for maintenance of independence and health of the elderly ("Otasha-Kenshin"), the elderly at high risk of various health problems such as falls, incontinence, malnutrition, cognitive impairment, and functional decline are effectively screened, then they are offered various safe and effective training programs.

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The purpose of this study was to examine the influence of kiphosis posture on cardiopulmonary response and exercise tolerance. Exercise testing was carried out under two conditions: kiphosis posture and natural posture. Kiphosis posture was that to which kiphosis patients are susceptible. That is trunk alignment changes with change of muscle contraction type. The subject were nine healty young females. In kiphosis posture and natural posture, we measured subjects' pulmonary function, mobility of thorax, respiratory response, blood pressure and rating of perceived exertion during graded exercise testing. In the kiphosis posture trial, oxygen pulse (O₂pulse), tidal volume (TV), and oxygen consumption (VO₂ and VO₂/kg) were significantly higher than in the natural posture trial at rest (p<0.05), but conversely VO₂ and VO₂/kg were lower at peak exercise (p<0.05). Most parameters rose during exercise (p<0.05). However diastolic blood pressure (DBP) and rate pressure product (RPP) did not change in the natural posture trial, whereas they increased significantly in the kiphosis posture trial (p<0.01). From these results, we speculate that in kiphosis posture oxygen demand is increased at rest and thus disadvantages aerobic metabolism during exercise. Hence we consider that improvement of kiphosis posture would be effective for prevention of exercise tolerance deterioration.

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The purpose of this study was to investigate the relationships between physical activity, measured by pedometric measurement and oxygen uptake (VO₂) kinetics, and exercise endurance of DM patients. Subjects were 10 DM patients (7 male and 3 female: 65 ± 7 years old) with no complications, living at home. The physical activity was assessed by measuring the daily gait steps using a pedometric caloriecounter (CAL-D; Suzuken, Ltd, Japan) for 18 ± 7 days. To evaluate the physical fitness by exercise capacity, a graded cycling exercise test was performed, and gas exchange, maximal oxygen uptake (VO₂max, in ml/min) and maximal work rate (maxWR, in watts) were monitored. The following results were obtained. (1) The average of walking steps, exercise energy expenditure and total energy expenditure were 8202 ± 1966 steps/day, 231 ± 70 kcal/day and 1789 ± 191 kcal/day, respectivery. (2) VO₂max and maxWR were 1282 ± 222 ml/min and 118 ± 25 watts, respectively. (3) There was a positive correlation between the walking steps and VO₂max (r=0.44, p<0.05). These results suggest that pedometric physical activity is related with exercise endurance in DM patients. Therefore it is expected that the measurement of exercise therapy by caloriecounter in DM patients would be effective.

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Aim: The aim of this study was to create a model with the added measure of independence of ADL in order to measure the physical activity of aged people with dyskinesia. Method: The subjects were 60 institutionalized aged persons with dyskinesia. The dependent variable was the physical activity estimated by heart rate (HRPA) during 24-hour monitoring. The independent variables were the items of ADL, communication level, feeding, toilet, movement, dressing, bathing and getting into and out of bed, as well as inclination to exercise before disability (PAEXL), inclination to exercise after disability (POEXL), and regularity of toilet and daily living activities. With these 5 items as independent variables multiple regression was performed with the dependent variable, HRPA, and the variables contributing to physical activity were determined. Result: The model equation was determined as
HRPA=1344.341-63.011*PAEXL+52.802*POEXL-62.150* Movement
ADL was not a significant variable, but inclination to exercise both before and after disabilty were significant variables. The multiple regression coefficient was 0.443. The 95% confidence limits of PAEXL, POEXL and movement were -108.209/-17.812, 6.504/99.100 and -124.461/0.161, respectively. Conclusion: POEXL was related positively to HRPA. When PAEXL was high it related negatively to HRPA. It is considered that the measure derived from these variables could be used in a test battery as a measure of physical activity of aged people with dyskinesia.

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The purpose of this study was to sample the factors influencing foot-gripping force by measuring the height, weight, muscle strength of legs, and the shape and flexibility of the toes and feet of 53 healthy women and then to project the foot-gripping force based on these factors. Foot flexibility, arch height of the foot, and body weight were sampled as the factors influencing foot-gripping force. These three variables provided a projection formula of foot-gripping force: foot-gripping force = -6.265 + 0.795 ´ foot flexibility + 0.320 ´ arch height of the foot + 0.111 ´ weight. The multiple correlation coefficient of this regression formula is 0.78 (p<0.0001), which shows significance in terms of the goodness-of-fit for projecting the foot-gripping force. Moreover, the correlation coefficient between the projected value of the foot-gripping force obtained by the projection formula and the actual value for an additional 26 healthy women who were tested was 0.82 (p<0.0001), which indicates the validity of using the three explanatory variables for projecting foot-gripping force: foot flexibility, arch height of the foot, and weight.

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The purpose of this study was to explore the possibility of evaluating postural control based on the changes in the center of foot pressure (hereinafter referred to as COP) after doing exercises. After doing treadmill exercise at a variety of velocities, forward-moving distances by running in place and changes of COP over time were measured using normal healthy young subjects. The healthy young subjects showed high values of forward-moving distances by running in place and COP just after treadmill exercise, which gradually decreased. It was found that the procedure varied according to the velocity of treadmill. It was also suggested that the COP value has a different implications from that of usual values. Consequently, it was considered that it is important to evaluate postural control just after exercise.

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The purpose of this study was to verify the reliability of the flexible-electrogoniometer measurement of the knee joint, as compared with photo measurements. Pearson product-moment correlation coefficient was used to analyze the data. The result showed that there was a strong reliability between the two measurements. The flexible-electrogoniometer thus provides reliable data in measurement of knee joint movement.

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The purpose of this study was to clarify the relationship between cognitive impairment and activities of daily living (ADL) of the elderly with dementia. We therefore investigated the degree of dementia and ADL, and the degree of dementia and the Independence of ADL items. Subjects were the 18 elderly persons with dementia who could walk in an institution. We based the degree of dementia on Nishimura's Dementia Scale and the Functional Independence Measure (FIM) on ADL. As a result, FIM scores of the severe dementia group were significantly lower than those of the moderate dementia group in all items except locomotion. The "Independence of the FIM items" showed significant differences for each item between both moderate and severe dementia group. These results suggest that remarkable deterioration of ADL is seen as the cognitive impairment gets more serious.

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The method of using leg propulsion for a wheelchair was adopted in order to study whether a pedometer can accurately measure exercise levels when attached to various parts of the leg. The subjects of this study were five healthy males (mean age: 29.4 years). A pedometer was attached to the top of the malleolus lateralis, the max crus circumference and the top of the caput fibula (on the right side in all cases). Then each subject performed the task of moving in a wheelchair with their legs at a rate of 120 steps / min for fifteen minutes. Measurements were repeated eight times at an interval of one week between each measurement. From the data obtained, the 95% confidence interval of each attachment was calculated. The analysis of variance and post-hoc test were also carried out using each part as a factor (p<0.05). The values measured with a pedometer attached to the max crus circumference were the nearest to the target steps (1,800 steps), while the values measured at the top of malleolus lateralis were significantly higher than those at the other two attached parts. These results assumed that a relatively accurate measurement could be achieved by attaching a pedometer to the max crus circumference or the top of the caput fibula and that the pedometer was an effective method for estimating exercise levels when both legs were used for wheelchair propulsion.

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This is a case report of a chronic stroke patient who showed improvement in the performance of activities of daily living by visiting physical therapy. A 75-year-old, right hemiplegic man with aphasia was discharged from a hospital nine months after the onset of the stroke. He continued to take rehabilitation service as an outpatient twice a week after discharge from hospital. When he started our visiting physical therapy once a week at 18 months after onset, he required moderate help in daily living. Our visiting physical therapy included a training program to improve muscle strength and to increase physical endurance in the nonparetic lower limb. Three months after the intervention of the physical therapy, he was able to stand up and transfer from a wheelchair without any assistance. One year after our intervention, he was able to walk with minimum assistance. These remarkable changes in his performance may indicate that visiting physical therapy is very effective in cases like this, to improve the performance of home care patients with chronic stroke.

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The aim of this study was to assess by the time study method, the effect of a physical therapy program drawn up with the objective of increasing the physical activity of a chronic rheumatoid arthritis patient who was visiting a day-care center. The subject was a 63-year-old male, height 155 cm, and was ranked 4 according to the ACR classification. He could move independently inside the center by moving a wheelchair with his legs, and he was attending the center 3 times a week. The time study method recorded the subject's activities in minutes during each visit to the day-care center from the start until the end of care, and his physical activity time as a percentage of total time available for physical activity was computed. As a result, it was found that physical activity time lengthened and rest time shortened within the total time available for physical activity. From the present result, we consider that in day-care rehabilitation, the construction of a physical therapy program which takes into consideration daily living activities is important, and the assessment of physical activity in the field of physical therapy is essential.

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