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OBJECTIVE: To characterize the interference of reactive stepping kinematics related to the increase or maintenance of the number of steps in response to a large perturbation during dual tasks among older adults. METHODS: This was a cross-sectional study that included 52 community-dwelling healthy older adults. Reactive stepping performance was analyzed after forward balance loss during a single task and a second cognitive task. The number of steps taken to recover balance and dual-task interference (DTI) for muscular onset latency, anteroposterior (AP) center of pressure (COP) displacement and velocity before step initiation, and step temporal and spatial variables were measured. The DTI of the variables was compared between the participants who increased versus those who maintained the number of steps taken during the dual task relative to the single task. RESULTS: Twenty-eight (53.8 %) participants increased their steps during dual tasks relative to a single task. In older adults, the AP COP peak velocity (P < 0.001) and step length (P < 0.001) were significantly worse during dual tasks than during a single task. However, this was not observed for older adults who did not increase their steps. The DTI for the AP COP peak velocity and step length were significantly larger for the older adults who increased their steps than those who did not (AP COP peak velocity; P = 0.044, step length; P = 0.003). Both groups showed a significant muscular onset delay during dual tasks than during a single task (P < 0.001), and no significant differences were found between the groups. CONCLUSIONS: Our findings suggest that reactive stepping strategies in older adults after a large external perturbation during secondary cognitive tasks can be attributed to interference with COP control before step initiation and step length.

DOI： 10.1016/j.humov.2024.103291

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BACKGROUND: Concern about falling is reportedly related to mobility and balance in older adults. While increased concern about falling may be directly related to balance deficits, establishing a causal relationship remains limited. This study aimed to investigate whether concern about falling affects threat-induced changes in emotions and postural control in older adults. RESEARCH QUESTION: How does concern about falling affect threat-induced changes in emotions and postural control among older adults? METHODS: Sixty-two older adults (age; 78.8 ± 5.7 years, height; 152.7 ± 6.3 cm) were exposed to height-related fear while standing, leaning forward, and leaning backward on the floor and a higher surface. The mean position, root mean square, and mean velocity of the center of pressure (COP) displacement were measured during the standing task, as well as the forward and backward limits of stability (LOS) tasks. The degree of self-reported fear of falling (FoF) was also obtained during the standing and LOS tasks. The participants were categorized into lower and higher concerns about falling based on the short form of the Falls Efficacy Scale International (FESI). RESULTS: Lower and higher concern about falling groups scored 10.2 ± 2.2 and 17.3 ± 3.3 in the short FESI. Both groups experienced increased FoF during the standing and forward LOS tasks on a higher surface. Leaning away from the edge of the surface resulted in increased COP velocity, decreased COP amplitude while standing, and decreased forward LOS. Participants with higher concern about falling had increased FoF during the backward LOS task and decreased backward LOS on a higher surface, while those with lower concern about falling did not. SIGNIFICANCE: Concern about falling can directly affect emotions and balance control owing to the occurrence of threat-related changes.

DOI： 10.1016/j.gaitpost.2024.10.020

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Korean Geriatrics Society  

BACKGROUND: The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated. METHODS: This cross-sectional study included from participants in the 2017-2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models. RESULTS: Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p&lt;0.001). The KCL scores were significantly associated with a lower QoL (p&lt;0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL. CONCLUSION: The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

DOI： 10.4235/agmr.24.0117

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This study aimed to determine the effects of walking-only intervention (walking was the only exercise in which people participated) on physical function, fall-related outcomes, and health-related quality of life in community-dwelling older adults. We conducted a systematic search across five electronic databases, assessing risk of bias using Minds Manual for Guideline Development. Meta-analyses were performed, and pooled standardized mean differences were calculated. Nine studies (a total of 1,309 participants) were included, showing that walking-only interventions improved walking endurance (standardized mean difference: 1.11, 95% confidence interval: [0.08, 2.15]) and health-related quality of life (standardized mean difference: 0.71, 95% confidence interval: [0.18, 1.25]). However, there were no significant improvements in other outcomes. The certainty of the evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for all outcomes was graded as very low, primarily due to significant inconsistency and imprecision. Our results suggest that walking-only intervention can be effective for enhancing walking endurance and health-related quality of life for community-dwelling older adults. Further studies are required to investigate the effects of walking-only intervention. This need stems from the limited number of randomized controlled trials, heterogeneous intervention settings and results, and the very low certainty of the evidence.

DOI： 10.1123/japa.2023-0183

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Several epidemiological studies have investigated the circulating levels of albumin, bilirubin, and uric acid (UA) in relation to cancer risk; however, they have provided equivocal evidence. In this prospective case-cohort study, we aimed to explore the association of plasma albumin, bilirubin, and UA levels with cancer incidence. We measured the plasma levels of albumin, bilirubin, and UA and investigated their association with cancer incidence in 3,584 cases and 4,270 randomly selected participants with a median follow-up of 15.8 years. The adjusted hazard ratios (HR) and 95% confidence intervals (CI) of total cancer for the highest (Q4) versus lowest quartile (Q1) was 0.77 (95% CI: 0.67-0.90, P for trend: <0.001) for albumin. This association was attenuated after excluding liver cancer cases with lower plasma albumin levels. Plasma bilirubin levels were positively related to liver cancer but inversely to total cancer after excluding liver cancer with adjusted HR Q4 vs. Q1 of 0.86 (95% CI: 0.74-0.99, P for trend = 0.015). Plasma UA levels were not dose-responsively associated with total cancer risk. Higher plasma bilirubin levels were associated with a decreased risk of total cancer after excluding liver cancer, which is likely attributed to the antioxidant properties of bilirubin.

DOI： 10.1093/aje/kwae092

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Self-disclosure is the attitude of communicating one’s experiences and condition to others and is an indicator of mental health and an open personality. Frailty, characterized by reduced physical and psychological resistance, predicts the incidence of dependency and mortality. Although low self-disclosure may be associated with frailty, there is no scale to measure older adults’ self-disclosure. This cross-sectional study assessed the validity of a self-assessment self-disclosure questionnaire and examined the association between the content of self-disclosures to friends and acquaintances and frailty among community-dwelling older adults. A total of 237 adults aged ≥65 in Japan were surveyed using a mailed self-administered questionnaire in 2021. The self-disclosure scale consisted of 10 items and showed adequate validity. Participants were classified into a robust group (n = 117, women 57.3%) and a frailty group (n = 120, women 73.3%) using the Kihon Checklist. After adjusting for covariates, multivariate-adjusted logistic regression models revealed frailty was associated with lower self-disclosure of recent positive events, motivation and strengths (indicating strong points) in life, relationships with family and relatives, experiences of work and social activities, and financial status. The proposed questionnaire must still be further tested in other populations, but our initial results may contribute to preventing frailty and improving mental health among community-dwelling older adults.

DOI： 10.3390/geriatrics9030067

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：IOS Press  

Background: As infrequent social interaction is a potential risk of dementia, oral malodor may increase the risk of dementia, including Alzheimer’s disease. Objective: This study investigated the association between malodor and dementia. Methods: We used the Japan Public Health Center-based Prospective Study data obtained at Yokote City. A total of 1,493 individuals aged 56 to 75 years underwent a dental examination and self-reported survey from May 2005 to January 2006. Follow-up for the onset of dementia was conducted using long-term care insurance data from 2006 to 2016. Hazard ratios of oral malodor on dementia were estimated by the Cox proportional hazards model. The inverse probability-weighted Cox model was used as a sensitivity analysis. Results: The study comprised 1493 participants (53.6% women) with a mean age of 65.6 (SD = 5.8) years old; at the end of the follow-up, 6.4% (n = 96) developed dementia, and the percentage was 20.7 in severe malodor group. Throughout 15274.133 person-years of follow-up, the average incidence rate for the onset of dementia per 1000 person-years was 6.29. The highest incidence rate was seen in participants with severe malodor (22.4 per 1000 person-years). After adjusting for confounders, compared to those with no malodor, there was a 3.8 (95% confidence interval: 1.5 to 9.4) times greater hazard of developing dementia in participants with severe malodor. The inverse probability weighted Cox model confirmed the same trend with an adjusted marginal hazard ratio of 4.4 (1.2 to 16.4). CONCLUSIONS: A significant association between oral malodor and the onset of dementia exists.

DOI： 10.3233/adr-240015

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BACKGROUND: We aimed to evaluate the validity of self-administered questionnaire surveys and face-to-face interview surveys for the detection of Helicobacter pylori eradication therapy. METHODS: Participants were a cohort, aged 40-74 years, living in three different locations of Japan, who took part in the baseline survey (2011-2012) of the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT). Five years after the baseline survey, a questionnaire and interview survey were independently conducted to determine the history of Helicobacter pylori eradication treatment over the 5-year period. Prescription of Helicobacter pylori eradication medications in national insurance claims data from the baseline survey to the 5-year survey was used as a reference standard. RESULTS: In total, 15,760 questionnaire surveys and 8,006 interview surveys were included in the analysis. There were 3,471 respondents to the questionnaire and 2,398 respondents to the interview who reported having received Helicobacter pylori eradication treatment within the past five years. Comparison of the questionnaire survey to national insurance claims data showed a sensitivity of 95.1% (2213/2328), specificity of 90.6% (12174/13432), positive predictive value of 63.8% (2213/3471), negative predictive value of 99.1% (12174/12289), and Cohen's Kappa value of 0.71. Respective values of the interview survey were 94.4% (1694/1795), 88.7% (5507/6211), 70.6% (1694/2398), 98.2% (5507/5608), and 0.74. CONCLUSION: Both the questionnaire and the interview showed high sensitivity, high specificity, and good agreement with the insurance claim prescriptions data. Some participants may have received eradication treatment without going through the public insurance claim database, resulting in a low positive predictive value.

DOI： 10.2188/jea.JE20230168

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PURPOSE: This study aims to investigate the relationships of moderate-to-vigorous physical activity (MVPA) with all-cause and disease-specific mortality. We also investigated how the association between MVPA at leisure time (LT-MVPA) and health outcomes differs at different MVPA at work (WT-MVPA) levels. METHODS: The 81,601 community-dwelling Japanese persons aged 50-79 years who responded to a questionnaire in 2000-2003 were followed until 2018. Cox proportional hazard model was used to examine the association of total MVPA with risks of all-cause, cancer, heart disease, stroke and respiratory disease mortality. Then, we compared the mortality risk according to the tertile of LT-MVPA, stratified by the tertile of WT-MVPA. RESULTS: During the 15.1 years of average follow-up, 16,951 deaths were identified. Even total MVPA below the recommended volume (i.e., 0.1-1.49 METs-h/day) was associated with 11% to 24% reductions in all-cause (hazard ratio [HR]: 0.89, 95% confidence interval [CI]: 0.82-0.96) and heart disease mortality (HR:0.76, CI: 0.61-0.94), compared to no MVPA at all. The further reduced risks were seen in MVPA up to 10 METs-h/day. The inverse association between LT-MVPA and mortality risks was more evident at lower WT-MVPA, which WT-MVPA was also inversely associated with the risks. CONCLUSIONS: Health benefits were observed at low levels of MVPA and up to 10 METs-h/day although the fine threshold for excessive MVPA was not clear. LT-MVPA had distinct health benefits especially for persons with lower WT-MVPA.

DOI： 10.1249/MSS.0000000000003331

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BACKGROUND: Divided attention is commonly required in daily life, and to prevent falls, balance must be recovered when a person experiences unexpected perturbations. Previous studies have shown that additional cognitive tasks in postural responses negatively affect automatic postural responses. However, the effect of dual-tasking on reactive stepping performance is still not clearly understood. This study investigated the effect of dual-tasking on reactive stepping induced by a large perturbation in older adults and characterized the effect of dual-tasking by comparison with young adults. RESEARCH QUESTION: How does the effect of dual-tasking on reactive stepping performance differ between young and older adults? METHODS: Twenty-nine older adults and twenty-two young adults were prospectively exposed to external perturbations to induce forward reactive steps. Perturbations were delivered under simple front fixed gaze (single-task condition) and modified Stroop task (dual-task condition). Measures of the time to foot-off and reach stability, step length, velocity, and number of steps were based on force plate data for both the single- and dual-task conditions. RESULTS: Young and older adults showed a delay in foot-off time during the dual-task condition compared with that during the single-task condition. The reach stability time, step length, and number of steps were worse in the dual-task condition than in the single-task condition for older adults, but not for young adults. The deficits in reactive stepping performance during dual-tasking could reflect the reactive balance capacity in real life. SIGNIFICANCE: The findings of this study highlight the increased risk of falls with age.

DOI： 10.1016/j.gaitpost.2023.10.018

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OBJECTIVE: The aim of this study was to determine whether physical activity (PA) is associated with periodontitis in the Japanese population. BACKGROUND: The potential association between PA and periodontitis has not been thoroughly investigated in the Japanese population. METHODS: We used cross-sectional data from the Japan Public Health Center-based Prospective Study for the Next-Generation Oral Health Study. Periodontitis was determined by a full-mouth periodontal examination. PA was assessed using a validated questionnaire. We performed multivariable ordinal logistic regression analyses to assess the association of total PA (the first quintile was set as the reference category) with periodontitis (three categories: no/mild, moderate, and severe), stratified by sex. The associations of periodontitis with domain- and intensity-specific PA were also studied in separate logistic regression models. RESULTS: This study included 2160 Japanese adults [1414 women and 746 men; mean (standard deviation) age 58.1 (9.6) years]. After adjusting for potential confounders, total PA was inversely associated with the presence and severity of periodontitis in women. The multivariable-adjusted odds ratios (95% confidence intervals) for periodontitis in the second to fifth quintiles (compared with the first quintile) of total PA were 0.81 (0.59-1.12), 0.74 (0.53-1.02), 0.77 (0.55-1.06), and 0.64 (0.46-0.89), respectively (p for trend = .01). We did not find different results when we further investigated the associations of periodontitis with domain- and intensity-specific PA. By contrast, PA was not associated with periodontitis in men. CONCLUSION: Total PA had an inverse, linear association with the presence and severity of periodontitis in Japanese women but not in Japanese men. Further prospective studies are required to determine the association between PA and periodontitis.

DOI： 10.1111/jre.13095

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BACKGROUND & AIMS: A balanced diet integrating several foods and nutrients may promote the maintenance of brain function. Previous studies have substantiated the above hypothesis in the regional population in Japan. This study aimed to investigate the potential effect of dietary diversity on the risk of disabling dementia in a nationwide large-scale cohort of the Japanese population. METHODS: A total of 38,797 participants (17,708 men and 21,089 women) aged 45-74 years were followed up for a median of 11.0 years. The daily frequencies of the consumption of each of the 133 food and beverage items listed on a food frequency questionnaire (excluding five alcoholic beverages) were measured. The dietary diversity score was calculated as the number of food items consumed per day. Multivariable adjusted Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of the dietary diversity score quintile groups. RESULTS: We documented 4302 participants with disabling dementia (11.1%) during the follow-up period. Among women, the dietary diversity score was inversely associated with disabling dementia (highest quintile HR [with the lowest quintile as the reference]: 0.67; 95% CI: 0.56-0.78; Q1-Q5 p for trend <0.001), but this was not true among men (highest quintile HR: 1.06; 95% CI: 0.87-1.29; Q1-Q5 p for trend = 0.415). These results did not change substantially when using disabling dementia with stroke as the outcome; the association remained significant among women but was absent among men. CONCLUSIONS: Our findings indicate that eating a variety of foods may prevent disabling dementia only among women. Thus, the habit of consuming a variety of food items has important public health implications for women.

DOI： 10.1016/j.clnu.2023.02.002

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OBJECTIVES: The association between alcohol consumption and dementia in Japanese is poorly understood, and use of single-point alcohol assessment may cause measurement error. We explored this association in Japanese using repeated alcohol assessments. METHODS: Participants in the Japan Public Health Center-based Prospective Study (JPHC Study) since 1990 and who were alive in 2006 were followed from 2006 until 2016 for dementia ascertainment. Disabling dementia was identified through long-term care insurance records. Alcohol consumption was assessed at the 5-year questionnaire survey (1995-1999) and drinking patterns were assessed on repeated follow-up (2000-2003). We performed Cox proportional hazards models with age as the time-scale with adjustment for various lifestyle factors and medical history using light consumption (<75 g ethanol/week, hereinafter "g") as reference. Analysis considering death as a competing risk was also conducted. RESULTS: Among 42,870 participants aged 54-84 years, 4802 cases of disabling dementia were newly diagnosed. Average years from alcohol assessment until dementia incidence was 14.9 years. Non-drinkers and regular drinkers with ≥450 g at 5 years had adjusted HRs (95% CI) of 1.29 (1.12-1.47) and 1.34 (1.12-1.60). Patterns of long-term abstinence, former drinking, and regular heavy weekly consumption of ≥450 g showed increased adjusted HRs of 1.61 (1.28-2.03), 2.54 (1.93-3.35), and 1.96 (1.49-2.59), respectively. Competing risk analysis yielded similar results. CONCLUSIONS: In Japanese, non-drinking and regular weekly consumption of ≥450 g from midlife were associated with high risk of disabling dementia compared with light drinking.

DOI： 10.1002/gps.5896

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The objective of this study was to identify the prevalence of family history of cancer using cohorts participating in the Japanese National Center Cohort Collaborative for Advancing Population Health (NC-CCAPH). We pooled data from seven eligible cohorts of the Collaborative with available data on family history of cancer. Prevalence of family history of cancer and corresponding 95% confidence intervals are presented for all cancers and selected site-specific cancers for the total population and stratified by sex, age, and birth cohort. Prevalence of family history of cancer increased with age ranging from 10.51% in the 15 to 39 year age category to 47.11% in 70-year-olds. Overall prevalence increased in birth cohorts from ≤ 1929 until 1960 and decreased for the next two decades. Gastric cancer (11.97%) was the most common site recorded for family members, followed by colorectal and lung (5.75%), prostate (4.37%), breast (3.43%) and liver (3.05%) cancer. Women consistently had a higher prevalence of family history of cancer (34.32%) versus men (28.75%). Almost one in three participants had a family history of cancer in this Japanese consortium study highlighting the importance of early and targeted cancer screening services.

DOI： 10.1038/s41598-023-30048-6

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

AIM: The purpose of this systematic review and meta-analysis was to investigate the effects of low-intensity resistance training on knee extension strength with respect to intensity, frequency, duration and training site in community-dwelling older adults. METHODS: A literature search was conducted for articles published up to December 2018 on PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), OTseeker and Ichushi-Web. Randomized controlled trials involving resistance training with <60 % one repetition maximum (1RM) in community-dwelling older adults aged 60 years and older were eligible. RESULTS: In total, 7 studies involving 275 participants were included in the meta-analysis. The results showed significant improvements in knee extension strength with low-intensity resistance training [standardized mean difference (SMD) 0.62, 95 % confidence interval (CI) 0.32 to 0.91]. In subgroup analyses, significant improvements were observed in the group with intensity at 50-60 % 1RM (0.83, 0.46 to 1.19), but not in the group at 40 % or less 1RM (0.30, 95%CI: -0.08 to 0.68). Concerning frequency, there were significant improvements in knee strength for those receiving training three times (0.90, 0.52 to 1.27) and two times (0.36, 0.03 to 0.69) per week, with a significant difference between the groups (p = 0.04). CONCLUSIONS: Low-intensity resistance training should be considered as an effective intervention to improve knee extension strength in community-dwelling older adults. Older adults may show more improvement in knee extension strength if intensity of the training is set at 50-60 % 1RM and frequency of training is three times per week.

DOI： 10.1016/j.exger.2022.112041

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OBJECTIVES: This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities. DATA SOURCES: PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018. STUDY SELECTION: Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes. DATA EXTRACTION: Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer. DATA SYNTHESIS: A total of 11 RCTs with 1,280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD] = 0. 22, 95% confidence interval [CI]: 0.02, 0.42, p = 0.03)]. Subgroup analyses indicated that interventions were conducted ≥ 3 days per week [SMD = 0.42, 95% CI 0.02, 0.82, p = 0.04]. For cognitive function, group exercise and ≥ 3 days/week of intervention had a significant benefit (group exercise: mean difference [MD] = 3.36, 95% CI 0.91, 5.80, p = 0.007; ≥ 3 days/week of intervention: MD = 2.28, 95% CI 0.07, 4.49, p = 0.04). CONCLUSIONS: Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

DOI： 10.1016/j.apmr.2022.11.002

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

The employment rate of older people in Japan is expected to increase in the future owing to the increase in the retirement age. Preventing frailty is imperative to maintaining productive roles of older adults. Therefore, this study aimed to examine the association between productive roles and frailty factors among community-dwelling older adults. A total of 135 older adults, enrolled in 2017, participated in the study. Productive roles and domains related to frailty were measured. We measured usual gait speed and grip strength for the physical domain; Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15) scores for the cognitive and mental domains; and social role and group activity for the social domain. Multivariate-adjusted logistic regression models revealed that having productive roles was associated with faster usual gait speed (odds ratios [OR] = 1.05; 95% confidence interval [CI], 1.01–1.08; p = 0.005) and lower GDS-15 score (OR = 0.79; 95% CI, 0.64–0.97; p = 0.023). These results suggest that health promotion to maintain gait speed and prevent depressive symptoms may contribute to maintaining productivity in community-dwelling older adults.

DOI： 10.3390/ijerph191710838

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It is unclear whether prediagnostic iron-related biomarkers in circulation are associated with cancer risk. We constructed a case-cohort of participants who had plasma samples available from the Japan Public Health Center-based Prospective Study and determined the incidence of cancer in these participants. We measured plasma concentrations of iron, ferritin, and hepcidin and assessed the association between each biomarker and cancer incidence using a weighted Cox regression model. There were 4,253 participants in the sub-cohort (the randomly selected participants from an eligible, at-risk population) and 3,596 incident cancer cases (499 cases occurred in the sub-cohort). Median follow-up was for 16.5 years. In the multivariable adjusted analysis, iron deficiency (plasma ferritin <30 ng/ml) was associated with a higher risk of total cancer (adjusted hazard ratio [HR]: 1.23, 95% confidence interval [CI]: 1.07-1.42) and the association was weaker after excluding those followed-up for <3 years. Iron overload was not significantly associated with total cancer (HR: 1.04, 95% CI: 0.82-1.33), but was associated with liver cancer (HR: 4.49, 95% CI: 2.71-7.43). Lower plasma levels of hepcidin and ferritin are associated with an increased gastrointestinal cancer risk. Meanwhile, lower plasma hepcidin and higher plasma ferritin levels were associated with an increased liver cancer risk. In conclusion, there was no association between iron overload and cancer risk, besides liver cancer.

DOI： 10.1158/1940-6207.CAPR-22-0151

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PURPOSE: This study determined the validity of claims-based definitions for identifying the incidence of total and site-specific cancers in a population-based cohort study. METHODS: Claims data were obtained for 21 946 participants aged 40-74 years enrolled in the Japan Public Health Center-based Prospective Study for the Next Generation. We defined total and site-specific cancer incidence using combinations of codes from claims data, including diagnosis and procedure codes for cancer therapy. Data from the cancer registry were used as the gold standard to evaluate validity. RESULTS: Among 21 946 participants, 454 total, 89 stomach, 67 colorectal, 51 lung, 39 breast and 99 prostate invasive cancer cases were newly diagnosed in the cancer registry. For invasive cancer, the sensitivity and specificity of the definition that combined codes for diagnosis and procedures for cancer therapy were 87.0% and 99.4% for total, 88.8% and 99.9% for stomach, 80.6% and 99.9% for colorectal, 86.3% and 99.9% for lung, 100% and 99.9% for breast and 91.9% and 99.9% for prostate cancer, respectively. Furthermore, for invasive and/or in situ cancer, the sensitivity and specificity of the definition were 84.5% and 99.5% for total, 66.7% and 99.9% for colorectal and 100% and 99.9% for breast cancer. CONCLUSIONS: Our findings suggest that claims-based definitions using diagnosis and procedure codes generally have high validity for total, stomach, lung, breast and prostate cancer incidence, but may underestimate colorectal cancer incidence.

DOI： 10.1002/pds.5494

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Importance: The associations of daily total physical activity and total moderate to vigorous physical activity (MVPA) with dementia are still unclear. Objective: To investigate the association between daily total physical activity and subsequent risk of disabling dementia in large-scale, extended follow-up prospective study. Design, Setting, and Participants: This prospective cohort study used data from questionnaires collected between 2000 and 2003 from 8 areas from the Japan Public Health Center-based Prospective Disabling Dementia Study. Participants included adults aged 50 to 79 years in with available follow-up data on disabling dementia. Data analysis was performed from February 1, 2019, to July 31, 2021. Exposures: Daily total physical activity, total MVPA, and leisure-time MVPA. Main Outcomes and Measures: The main outcome was incidence of disabling dementia during the dementia ascertainment period between 2006 and 2016, based on the national long-term care insurance system. Risks of dementia in association with daily total physical activity, total MVPA, and leisure time MVPA were calculated using multivariable adjusted hazard ratios (aHRs). Results: Among 43 896 participants (mean [SD] age, 61.0 [7.5] years; 23 659 [53.9%] women), 5010 participants were newly diagnosed with disabling dementia during a mean (SD) of 9.5 (2.8) years in the dementia ascertainment period. In the highest daily total physical activity group, compared with the lowest activity group, risk of dementia was lower in men (aHR, 0.75 [95% CI, 0.66-0.85]; P for trend < .001) and women (aHR, 0.75 [95% CI, 0.67-0.84]; P for trend < .001). Similar inverse associations were observed in men and women for total MVPA (men: aHR, 0.74 [95% CI, 0.65-0.84]; P for trend < .001; women: aHR, 0.74 [95% CI, 0.66-0.83]; P for trend < .001) and leisure-time MVPA (men: aHR, 0.59 [95% CI, 0.53-0.67]; P for trend < .001; women: aHR, 0.70 [95% CI, 0.63-0.78]; P for trend < .001). However, these inverse associations disappeared when participants diagnosed with disabling dementia within 7 years of the starting point were excluded in men (aHR, 0.93 [95%CI, 0.77-1.12]) and within 8 years were excluded in women (aHR, 0.86 [95%CI, 0.71-1.04]). The association remained significant among men in the highest vs lowest group of leisure-time MVPA, after excluding participants diagnosed within the first 9 years (aHR, 0.72 [95% CI, 0.56-0.92]; P for trend = .004). Conclusions and Relevance: This cohort study examined associations of daily total physical activity and total MVPA with risk of disabling dementia. The findings suggest that a high level of leisure-time MVPA was associated with decreased risk of disabling dementia in men.

DOI： 10.1001/jamanetworkopen.2022.4590

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BACKGROUND: Evidence of the association between chronic low-grade inflammation, as reflected by C-reactive protein (CRP) measurements, and cancer risk is equivocal. Specifically, few studies have examined this in uncommon cancers and Asian populations. METHODS: We utilised a case-cohort design consisting of multi-types of cancer (N = 3608), and a random subcohort (N = 4432) in a Japanese large population-based study, with a median follow-up time of 15.6 years, and measured baseline plasma CRP using high sensitivity assay. The hazard ratios (HRs) were estimated using weighted Cox proportional hazards methods. RESULTS: The multivariable-adjusted HR (95% confidence interval) for the top quartile of CRP was 1.28 (1.11‒1.48) (Ptrend < 0.001) for overall cancer compared to the bottom quartile of CRP. Among site-specific cancers, higher CRP levels were associated with an increased risk of colorectal, lung, breast, biliary tract, and kidney cancer, and leukaemia. These positive associations remained among participants after >3 years' follow-up. Furthermore, subgroup analyses for overall cancer robustly showed a positive association with CRP levels, regardless of sex and obesity. CONCLUSION: Our consistent findings suggested that chronic low-grade inflammation measured by CRP is associated with the risk of cancer.

DOI： 10.1038/s41416-022-01715-8

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Language：Japanese   Publisher：(一社)日本疫学会  

Ichushi

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Language：Japanese   Publisher：(有)科学評論社  

Ichushi

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BackgroundValidation studies on diabetes definitions using nationwide healthcare databases are scarce. We evaluated the validity of diabetes definitions using disease codes and antidiabetic drug prescriptions in the Japanese Diagnosis Procedure Combination (DPC) data via medical chart review.MethodsWe randomly selected 500 records among 15,334 patients who participated in the Japan Public Health Center-Based Prospective Study for the Next Generation in Yokote City and who had visited a general hospital in Akita between October 2011 and August 2018. Of the 500 patients, 98 were linked to DPC data; however, only 72 had sufficient information in the medical chart. Gold standard confirmation was performed by board-certified diabetologists. DPC-based diabetes definitions were based on the International Classification of Diseases, 10th Revision codes, and antidiabetic prescriptions. Sensitivity, specificity, and the positive and negative predictive values (PPV and NPV, respectively) of DPC-based diabetes definitions were evaluated.ResultsOf 72 patients, 23 were diagnosed with diabetes by chart review; 19 had a diabetes code, and 13 had both a diabetes code and antidiabetic prescriptions. The sensitivity, specificity, PPV, and NPV were 89.5% (95% confidence interval: 66.9-98.7), 96.2% (87.0-99.5), 89.5% (66.9-98.7), and 96.2% (87.0-99.5), respectively, for (i) diabetes codes alone; 89.5% (66.9-98.7), 94.3% (84.3-98.8), 85.0% (62.1-96.8), and 96.2 (86.8-99.5) for (ii) diabetes codes and/or prescriptions; 68.4% (43.4-87.4), 100% (93.3-100), 100% (75.3-100), and 89.8% (79.2-96.2) for (iii) both diabetes codes and prescriptions.ConclusionsOur results suggest that DPC data can accurately identify diabetes among inpatients using (i) diabetes codes alone or (ii) diabetes codes and/or prescriptions.

DOI： 10.2188/jea.JE20210024

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Smoking has been consistently associated with the risk of colorectal cancer (CRC) in Western populations; however, evidence is limited and inconsistent in Asian people. To assess the association of smoking status, smoking intensity and smoking cessation with colorectal risk in the Japanese population, we performed a pooled analysis of 10 population-based cohort studies. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox's proportional hazards model and then pooled using a random-effects model. Among 363 409 participants followed up for 2 666 004 person-years, 9232 incident CRCs were identified. In men, compared with never smokers, ever smokers showed higher risk of CRC. The HRs (95% CI) were 1.19 (1.10-1.29) for CRC, 1.19 (1.09-1.30) for colon cancer, 1.28 (1.13-1.46) for distal colon cancer and 1.21 (1.07-1.36) for rectal cancer. Smoking was associated with risk of CRC in a dose-response manner. In women, compared with never smokers, ever smokers showed increased risk of distal colon cancer (1.47 [1.19-1.82]). There was no evidence of a significant gender difference in the association of smoking and CRC risk. Our results confirm that smoking is associated with an increased risk of CRC, both overall and subsites, in Japanese men and distal colon cancer in Japanese women.

DOI： 10.1002/ijc.33248

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The Japan Public Health Center-based prospective study- physical activity questionnaire (JPHC-PAQ) was originally developed and validated for total physical activity (total PA). However, it is uncertain whether JPHC-PAQ could also estimate intensity-specific physical activity. The present study aims to evaluate the validity and reliability of intensity-specific physical activity by the JPHC-PAQ against 24-hour activity records (24 h-R). One-hundred and ten participants were chosen from those who had enrolled in the JPHC cohort. Time spent for total PA and intensity-specific physical activity, i.e. moderate (MPA), vigorous (VPA) and moderate-to-vigorous physical activity (MVPA) was estimated by JPHC-PAQ. In addition, the volume of PA was calculated by time of each activity multiplied by intensity of activity. For validity assessment, estimated physical activities were compared with 24 h-R. For reliability evaluation, a retest was conducted 3-6 months after the first survey was answered. Moderately strong correlation between JPHC-PAQ and 24 h-R was observed for total PA estimations (Spearman's rho = 0.672). In addition, moderate correlations were found for MPA (activity time: rho = 0.345, activity volume: rho = 0.300) and MVPA (activity time: rho = 0.563, activity volume: rho = 0.672). Whereas, little association was found for VPA time and volume. As for reliability, moderately strong correlation was found for both total and intensity-specific physical activity in the test-retest (rho = 0.482-0.745). In addition to total PA, the JPHC-PAQ showed acceptable validity and reliability for intensity-specific physical activity, especially in estimating MVPA and MPA.

DOI： 10.1016/j.pmedr.2020.101169

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Language：Japanese   Publisher：(公社)日本理学療法士協会  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01747&link_issn=&doc_id=20210115400015&doc_link_id=%2Fcb3physi%2F2020%2F004706%2F015%2F0624-0629%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcb3physi%2F2020%2F004706%2F015%2F0624-0629%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Although occupational sitting time has been associated with adverse health outcomes and mortality, the association with cancer incidence remains unknown. This study investigated the association between occupational sitting time and risk of total and site-specific cancer in a Japanese population. We evaluated 33 307 participants aged 50-79 years who responded to a questionnaire in 2000-2003 in the Japan Public Health Center-based Prospective Study and were followed until 2013. Participants were grouped by sitting time at work. Hazard ratio (HR) and 95% confidence interval (CI) of cancer incidence were calculated with adjustment for potential confounders including moderate-to-vigorous physical activity. During 10.2 years of follow-up, 3807 newly diagnosed cases of cancer were identified. Occupational sitting time was marginally associated with total cancer, with multivariable HRs for the ≥7 h/d vs 1 to <3 h/d category of 1.12 (95% CI, 0.99-1.26; P for trend = .071) in men, but not women. Among findings for cancers at specific sites, long occupational sitting time was associated with increased risk of pancreas cancer, with multivariable HRs for the ≥7 h/d vs 1 to <3 h/d category of 2.25 (95% CI, 1.17-4.34; P for trend = .021) in men, and lung cancer, with multivariable HRs for the ≥7 h/d vs 1 to <3 h/d category of 2.80 (95% CI, 1.33-5.90; P for trend = .013) in women. Extended sitting time at work was associated with an increased risk of pancreas cancer in men and lung cancer in women.

DOI： 10.1111/cas.14304

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

BACKGROUND: Although physical activity has been reported as a protective factor for kidney and bladder cancer in epidemiological studies, it is not clear. METHODS: In a population-based prospective study of 76,795 Japanese aged 45-74 years, participants were evaluated physical activity by self-administered questionnaire. Hazard ratios (HRs) and 95% confidence intervals (CIs) of the risk of urological cancer were calculated by the Cox proportional hazards models. RESULTS: During the 15.1-year follow-up, 202 kidney, 373 bladder and 83 upper urinary tract cancer cases were identified. Physical activity was not significantly associated with kidney, bladder and upper urinary tract cancer risks, with multivariate HRs in the highest versus lowest group of 1.05 (95% CI: 0.74-1.49), 1.06 (95% CI: 0.81-1.39) and 0.80 (95% CI: 0.48-1.35), respectively. CONCLUSIONS: Physical activity was not associated with the risk of urological cancer in the Japanese population.

Other Link： http://www.nature.com/articles/s41416-019-0392-y

DOI： 10.1038/s41416-019-0392-y

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Objectives The aim of this study was to investigate the effect of mail-based intervention using the TAKE10! Program to improve dietary habits in cases where direct intervention is not possible.Methods Subjects aged 70-91 years (77.6±5.0) were randomly assigned to two groups: 72 in the intervention group and 71 in the control group. The intervention group received monthly mail, which included self-check sheets (TAKE10! Check sheet and TAKE10! Calendar) and a letter with feedback and comments for 5 months. The outcome measures were changes in the intake frequency of 10 food groups, Dietary Variety Score (DVS), and Food Frequency Score (FFS).Results Compared to baseline, the post-intervention intake frequencies for 9 of 10 food groups, DVS, and FFS significantly increased in the intervention group. No significant differences were observed between baseline and post-intervention in the control group. In the subgroup analysis of the intervention group, post-intervention DVS and FFS of both subjects who cooked their own food and those who did not showed significant increases compared to baseline.Conclusion The mail-based TAKE10! Program resulted in improved dietary habits and could be shared with families in addition to direct interventions and could also be used in regions with inadequate transportation systems or frequent poor weather conditions.

DOI： 10.11236/jph.66.11_681

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J-GLOBAL

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AIM: The present study aimed to propose a structural model to explain the interaction of physical, cognitive and social domains of health status in the incidence of disability in community-dwelling people aged ≥75 years. METHODS: We analyzed 185 older adults (mean age 79.4 years, 58.4% female) who participated in a baseline assessment from 2012 to 2013. They were followed for incident certification of care needs in the national long-term care insurance certification system during the 2 years. Baseline assessments included several measurements related to the physical, cognitive and social domains of health status. We compared the model fit index between two hypothesis models - the parallel model and the hierarchical model - using structural equation modeling. RESULTS: During the follow-up period, 15 participants (8.1%) were newly certified as requiring personal support from the long-term care insurance system. The structural equation modeling showed that the hierarchical model, indicating that cognitive and social status were indirectly associated with disability through physical status, had a better fit with the data than the parallel model, indicating that physical, cognitive and social status each were directly associated with disability. CONCLUSIONS: The present results suggest that cognitive and social status might indirectly affect disability incidence through physical aging. Further research is required to examine the temporal relationship between physical, cognitive and social change using data over several time-periods. Geriatr Gerontol Int 2018; 18: 1614-1619.

DOI： 10.1111/ggi.13539

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[Purpose] The purpose of this study was to determine the change of allocation of attention caused by a difference in gait phase and gait speed. We also determined the relationship between attentional demand and gait automaticity change caused by the gait speed alteration. [Subjects and Methods] Ten male participated. Participants were instructed to perform the probe reaction time (RT) task during treadmill walking in four different gait speed conditions (60%, 80%, 100%, and 120% of preferred speed). Walking ratio in each gait speed conditions were calculated, and RTs and walking ratios were compared in each gait speed condition and in the single-support and double-support gait phase. [Results] RTs were significantly delayed with decline of gait speed. Walking ratio was significantly decreased in proportion of decrement of gait speed. There was no difference of gait phase between single-support and double-support phase. [Conclusion] This study showed that relationship between attentional load and deficit of gait automaticity. While gait phase didn't influence attentional demand, and this result showed the characteristics of treadmill gait.

DOI： 10.1589/jpts.30.419

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science  

DOI： 10.1371/journal.pone.0197164

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

<p>【はじめに，目的】</p><p></p><p>がん罹患の高齢化を背景に，高齢がん罹患者の運動機能に着目した報告が増加している。実際に，高齢がん罹患者の歩行機能や筋力が低下していることが示されており，この対象への改善策が課題となっている。これらの報告のなかで，がんの罹患を判断するために，基本的には調査時の自己報告によって得られた情報を採用する場合が多い。しかしながら，その自己報告が正確なものであるかどうかは検証が必要であり，特に高齢者のがん罹患に関する妥当性の検証はなされていない。本研究では，75歳以上の地域在住高齢者を対象に，がん罹患に関する自己報告の妥当性を検証し，自己報告の有無による縦断的な機能変化を明らかにすることを目的とした。</p><p></p><p></p><p>【方法】</p><p></p><p>対象は，測定調査会に参加した75歳以上の地域在住高齢者411名のうち，がん罹患に関する調査データに不備のあった1名を除外した410名（男性169名，女性241名，平均年齢80.0±4.1歳）とした。ベースライン時におけるがんの自己報告については，がん罹患の有無，罹患時期，がんの種類などを面接聴取した。また，がんの発症を同定するために，後期高齢者医療制度における診療報酬請求（レセプト）情報を活用した。さらに，機能指標として運動機能，認知機能，および健康関連指標を測定した。統計解析は，レセプト情報によってがん罹患を同定された者のうち，がんの罹患を自ら報告した高齢者の陽性的中率を算出し，自己報告による妥当性を検証した。また，がん罹患者を自己報告群と非自己報告群に分類し，2群間の各変数を比較した。さらに，2群間における各機能の縦断的変化についても検討した。</p><p></p><p></p><p>【結果】</p><p></p><p>レセプト情報によると，ベースライン調査の時点でがんに罹患していた者は51名だった。このうち，がんに罹患したことを自ら報告した高齢者は28名であり，陽性的中率は54.9%だった。報告群と非報告群の比較では，年齢（p=0.710）と性別（p=0.601）に有意な差は認められなかった。また，測定したすべての変数で有意な差は認められなかった。さらに，二元配置分散分析の結果からも，交互作用の見られた項目はなかった。</p><p></p><p></p><p>【結論】</p><p></p><p>国立がん研究センターによると，40～69歳を対象とした自己報告によるがん罹患の陽性的中率は53%であった。本研究においても同等の結果が得られ，がん罹患に関しては自己報告による調査だけでは正確に把握することが難しいことを示唆するものであった。理由として，高齢者のなかにはがんに対して誤った理解や病識を有している方がおり，自らをがん罹患者と表出することに抵抗感がある可能性が挙げられた。また，自己報告の有無によって諸機能の差異は認められず，将来的な機能低下に影響を及ぼすことも明らかにされなかった。今後は，がん罹患の陽性的中率を上げる工夫をするとともに，虚弱な高齢がん罹患者に対して機能向上を目的としたアプローチを検討する必要がある。</p>

DOI： 10.14900/cjpt.2016.1596

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DOI： 10.1519/JPT.0000000000000063

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Web of Science

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

【はじめに，目的】がんの早期発見と治療技術の向上により，がん治療後の患者に対する医療の充実や生活の質（Quality of Life；QOL）の向上が急務の課題となっている。がん治療のなかでも，近年，在宅での生活やQOL向上を目的とした外来化学療法を主体とする治療が増加している。しかしながら，がんと理学療法に関する研究のなかでは，体力向上や副作用軽減を目的とした介入研究は少ない。本研究では外来化学療法施行中の進行性がん患者に対して，在宅で実施可能な理学療法介入が身体機能およびQOLに及ぼす影響を明らかにすることを目的とした。【方法】対象は，2014年7月～2015年7月までに札幌医科大学附属病院で外来化学療法を施行した進行性がん患者24名とした。24名のがん患者は介入群12名と対照群12名にランダムに割り付けられ，ベースライン時と3ヵ月後に機能評価が実施された。ベースライン評価として，握力，膝伸展筋力，および開眼片脚立位時間を実測し，がん患者に対するQOL評価としてEORTC QLQ-C30による質問紙調査を実施した。本研究で実施した理学療法介入は，在宅での筋力増強運動と活動量モニタリングから構成された。筋力増強運動は，ブリッジ運動やスクワットなどを直接指導し，パンフレットを配布することで在宅での実施を促した。活動量モニタリングについては，活動記録器ライフコーダGS（スズケン社）を貸与し，毎日の歩数を運動実施カレンダーに記載させた。外来化学療法の実施ごとに，理学療法士が運動実施カレンダーを通して筋力増強運動と活動量モニタリングの実施状況を確認し，身体活動を促した。統計学的分析は，反復測定の二元配置分散分析を実施し，それぞれの評価項目について群（介入群－対照群）と期間（ベースライン－3ヵ月後）の交互作用を確認した。統計処理にはSPSS22.0を用い，危険率5％未満を有意とした。【結果】年齢，性別，および癌種について介入群（平均年齢63.6±11.2歳，男性7名）と対照群（平均年齢62.3±13.9歳，男性9名）の間に有意な差は認められなかった。介入群と対照群の運動機能をベースラインと3ヵ月後で比較したところ，握力，膝伸展トルク，および開眼片脚立位時間に有意な交互作用は認められなかった。一方で，がん患者のQOL指標であるEORTC QLQ-C30では，身体機能，疲労感，および食欲不振の項目について群と期間の有意な交互作用が認められた（p＜0.05）。【結論】本研究の結果から，筋力増強運動と活動量モニタリングを含む理学療法介入が，実測された運動機能に効果的であったことを示す知見を得ることは出来なかった。しかしながら，質問紙評価による身体機能や疲労感については，3ヵ月後の介入群で良好な値を示した。したがって，本研究の理学療法介入は，直接的には運動機能に影響を与えなかったが，主観的な身体機能や疲労感など一部の機能に対しては良好な影響を及ぼした可能性が示唆された。

DOI： 10.14900/cjpt.2015.1528

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

【はじめに，目的】身体活動量は加齢により低下することが報告されている。しかし，75歳以上の後期高齢者を対象に身体活動量を調査した報告は少なく，その多くが横断研究である。本研究の目的は，縦断調査によって地域在住後期高齢者における身体活動量の経時的変化と関連要因を明らかにすることであった。【方法】対象は，2012年11月～2013年11月のベースライン調査に参加した地域在住高齢者411名のうち，2015年9月の追跡調査に参加した188名からデータ欠損などの理由により29名を除外した159名（平均年齢82.1±3.7歳）とした。ベースライン調査と追跡調査時には，身体活動量（歩数，活動時間）の他，基本情報（年齢，性別等），身体機能指標（歩行速度，下肢筋力等），健康関連指標（ソーシャルサポート，運動習慣，主観的健康度等）の測定を行った。身体活動量の測定には，生活習慣記録器（ライフコーダ，スズケン社製）を用い，一週間の身体活動量を記録した。また，記録されたデータから，一日あたりの歩数（以下歩数）と一日あたりの活動時間を算出した。更に，一日あたりの活動時間を3METs以上の中強度活動時間と，3METs未満の低強度活動時間に分類した。統計解析は，身体活動量（歩数，中強度活動，低強度活動）の平均値をベースライン調査時と追跡調査時で比較した。また，ベースライン調査時と追跡調査時の身体活動量の変化により対象者を2群（低下群/維持向上群）に分類し，ベースライン調査時の各測定項目を比較した。さらに，身体活動量の変化（低下群/維持向上群）を従属変数とし，群間比較によってp＜0.25であった項目を独立変数として多重ロジスティック回帰分析を実施した。統計解析にはIBM SPSS Statistics 22.0を使用し，有意水準は5%とした。【結果】ベースライン調査時と比較して追跡調査時の低強度活動が有意に低下した（p＜0.05）。身体活動量の変化について，低下群は84名，維持向上群は75名であった。2群間で各測定項目を比較した結果，ソーシャルサポートのみに有意な差が認められた（p＜0.05）。また，多重ロジスティック回帰分析では，性別（p＜0.01，OR：0.311），ソーシャルサポート（p＜0.05，OR：1.435），および主観的健康度（p＜0.05，OR：1.946）が，身体活動量の変化に関連する有意な独立変数として抽出された。【結論】低強度活動時間は3METs未満の運動強度を示す指標とされ，歩行以下の日常生活の活動時間を反映していると報告されている。結果より，後期高齢者では歩数や中強度の活動時間ではなく，低強度の活動時間が減少することが示された。また，調査期間に低強度の活動時間が低下した要因としては，ベースライン調査時における周囲環境のサポートや心理的な健康感が影響を与えていることが示唆された。後期高齢者の周囲環境のサポートの充足や心理的な健康感の向上が，日常生活の活動時間を維持するために重要な役割を担う可能性があると考えられる。

DOI： 10.14900/cjpt.2015.1600

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Language：Japanese   Publisher：日本理学療法士学会  

Other Link： http://search.jamas.or.jp/link/ui/2016265125

DOI： 10.15063/rigaku.43_166

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

【はじめに，目的】筋肉量の低下は筋力低下を引き起こし，結果として日常生活動作や生活の質に影響を与えることは広く知られている。近年では高齢者における「活動」や「社会参加」が身体機能の維持にも重要であり，self-efficacyも関連することが明らかとされている。しかしながら高齢者における筋肉量低下と活動や社会参加，self-efficacyとの関連については詳細に明らかにされていない。そこで本研究は高齢者におけるself-efficacy，運動習慣や外出頻度などの活動能力に注目し，筋肉量の縦断的変化に対する影響を明らかにすることを目的とする。【方法】後期高齢者女性36名（平均年齢82.1±4.1歳）を対象とし，平成25年2月と平成27年9月の計二回の調査を実施した。筋肉量は生体インピーダンス法にて，50kMzの抵抗値を測定し，吉田らの方法に準拠し性別，身長，体重で補正した骨格筋量指表（Skeletal-Muscle-Mass-Index：以下SMI）を算出した。SMIは二回の調査間の変化量を算出し，低下群と維持・向上群の二群に分類した。self-efficacyは運動および活動のself-efficacy scale（以下，運動SEF，活動SEF）について質問紙留め置き法を用いて聴取し，活動能力については1週間の平均的な外出頻度と運動行動変容ステージを聴取した。なお調査期間中の運動習慣の変化を検討するため，運動行動変容ステージについては二回の調査期間内を比較し変化量を求めた。統計解析についてはSMIの低下群と維持・向上群の二群を従属変数，一回目調査時の運動SEF，活動SEFのそれぞれの合計点，外出頻度，および運動行動変容ステージの変化量を独立変数としたロジスティック回帰をステップワイズ法を用いた実施した。なお有意水準は5%とした。【結果】SMI変化量の平均値は-.035±1.64kgであった。またSMIの群分けについては低下群に分類された者が10名，維持・向上群に分類された者が26名であった。ステップワイズ法を用いたロジスティック回帰分析の結果，運動行動変容ステージの変化量（オッズ比=0.367，95%信頼区間；0.148-0.914，p＜0.031），外出頻度（オッズ比0.398=95%信頼区間；0.171-.0927，p=0.033）および活動SEF（オッズ比=2.430，95%信頼区間；1.141-5.176，p=0.033）が有意な項目として抽出された。【結論】本研究の結果より，外出頻度と活動を行う自信については，縦断的な筋肉量の低下との関係性が明らかとなり，外出頻度が多いことや自己効力感が高いこと筋肉量の維持に繋がる可能性が示唆された。また運動行動変容ステージについては，調査期間内に運動習慣に関する行動変容ステージが低下した者ほど期間内に筋肉量が低下した結果となり，筋肉量は習慣が変わることにより変化することが明らかとなり，高齢者における筋のトレーナビリティーの特徴の一部が示された。本研究で得られた知見は，高齢期の理学療法における在宅および地域での運動習慣や活動を促す上での一助となり得る。

DOI： 10.14900/cjpt.2015.1335

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

【はじめに，目的】高齢期における身体活動量の維持は，健康増進や介護予防において重要な役割を果たす。その中でも中強度（3METs）以上の身体活動は，身体機能や疾病リスクとの関連の強さから特に推奨されている。身体活動量に影響する因子の一つである季節変化について，寒冷積雪地域では冬期間に身体活動量が低下しやすいことや，冬期間の身体活動量低下が将来の運動機能に悪影響を及ぼすことが先行研究において報告されている。しかしながら，冬期間の身体活動量低下がその後の認知機能の変化にどのような影響を与えるのかについては明らかにされていない。そこで本研究では，積雪寒冷地域に住む後期高齢者を対象とし，冬期間の身体活動量低下がその後3年間の認知機能の変化に及ぼす影響について縦断的に検討した。【方法】対象は，2012年11月（初冬：第1回調査）と2013年2月（晩冬：第2回調査），2015年9月（第3回調査）の全3回の調査に参加した，積雪寒冷地域に住む75歳以上の高齢者93名（平均年齢79.5±3.3歳，男性41名/女性52名）とした。調査項目は，握力，快適歩行速度，全般的認知機能（Mini Mental State Examination：MMSE），外出頻度，活動セルフエフィカシー，中強度以上の身体活動時間とした。なお，中強度以上の身体活動時間は生活習慣記録機（ライフコーダ，スズケン社）を用いて測定し，装着1週間における1日あたりの平均活動時間を算出した。統計解析として，冬期間（第1回調査～第2回調査）における対象者全体の各変数の変化の有無を検討した。また，冬期間における中強度以上の身体活動時間低下の有無により対象者を2群化（維持向上群/低下群）した上で，年齢と性別を共変量とした二元配置分散分析を用い，その後3年間における各変数の変化を群間で比較した。なお，有意水準は5%とした。【結果】対象者全体における冬期間の変化として，外出頻度（p＜0.01）および快適歩行速度（p＜0.01）に有意な低下が認められた。身体活動時間の維持向上群は41名（44.1%），低下群は52名（55.9%）であり，群間で年齢と性別に有意差はなかった。分散分析の結果，MMSE得点（p＜0.01）および中強度以上の身体活動時間（p＜0.01）において群と時期による交互作用が認められ，冬期間に身体活動時間が低下した者はその後3年間において全般的な認知機能と身体活動時間が低下しやすいことが明らかになった。【結論】生活環境が大きく変化する冬期間において身体活動量を維持できない者は，その後の認知機能や身体活動量の長期的な低下を招くリスクが高いことが明らかとなり，冬期間に身体活動量を確保することの重要性が示された。また，身体活動量の低下と同時に認知機能の低下が生じていたことから，高齢者の身体活動を維持する上で認知機能を評価することの重要性が改めて確認されたと考える。

DOI： 10.14900/cjpt.2015.1495

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

【はじめに，目的】高齢者の転倒はしばしば重篤な障害を引き起こしQOLの低下につながる。転倒に関する要因は様々報告されているが，環境などの外的要因は転倒を引き起こす重要な要因の一つと考えられている。しかしながら，積雪寒冷地域において，転倒に関連する環境要因は冬期と非冬期で大きく異なる。そのため冬期に発生する転倒と非冬期に発生する転倒を同一のモデルで検討することは適切ではないと考えられる。そこで本研究では，積雪寒冷地域在住の後期高齢者を対象に，転倒時期の違いによる身体的特徴を縦断的調査によって明らかにすることを目的とした。【方法】対象は，2012年11月から2013年11月のベースライン調査と2015年9月のフォローアップ調査に参加した積雪寒冷地域在住の75歳以上の高齢者186名（平均年齢80.6±4.3歳，男性17名/女性23名）とした。調査項目は，基本情報の他に，転倒に関する情報と運動機能を測定した。転倒に関しては転倒回数と転倒時期を聴取した。運動機能は，最大歩行速度，TUG，坐骨歩き，握力，および膝伸展筋力を測定した。統計解析として，ベースライン調査における転倒の有無および時期により対象者を3群化（非転倒群，非冬期転倒群，冬期転倒群）した上で，群と調査時期を要因とする二元配置分散分析を用い，その後3年間における運動機能の変化を群間で比較した。なお，統計解析にはIBM SPSS Statics 21を用い，有意水準は5%とした。【結果】186名の後期高齢者のうち，BLの転倒経験者は54名（29.0％）であった。「非転倒群」に属したのが132名（71.0％），「非冬期転倒群」に属したのが35名（18.8％），「冬期転倒群」に属したのが19名（10.2％）であり，群間で年齢と性別に有意な差は認められなかった。分散分析の結果，有意な交互作用は認められなかった。膝伸展筋力（p＜0.01）に群および時期の主効果が認められ，最大歩行速度（p＜0.01），TUG（p＜0.01），坐骨歩き（p＜0.01），握力（p＜0.01）に群の主効果が認められた。【結論】本研究の結果から，ベースラインのみならず，その後3年間においても冬期以外に転倒を経験した後期高齢者はその他の高齢者と比較していくつかの運動機能が低下していることが明らかになった。積雪寒冷地域において，冬期は積雪や路面凍結といった環境の影響が大きく，そのような環境制約のない非冬期に転倒した高齢者は運動機能の低下が顕在化したものと推察される。また，虚弱高齢者をスクリーニングする上で，非冬期の転倒の有無は重要な因子であると考えられる。

DOI： 10.14900/cjpt.2015.1521

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/13607863.2014.967169

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DOI： 10.1589/jpts.27.2207

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DOI： 10.1186/s12877-015-0034-z

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Background. The aim of this study was to evaluate whether the decline of physical activity during winter influences physical performances (after 1 year) in old-old women. Methods. Fifty-three Japanese women (mean age: 78.4 ± 3.2 years) participated in this study. Data of physical activity was collected by using an accelerometer at baseline and 3-month follow-up, and participants who decreased step counts in this period were defined as declining groups. We measured grip strength, knee extensor strength, total length of the center of gravity, hip walking distance, and maximum walking speed to evaluate physical performances at baseline and 1-year follow-up. Repeated-measures analysis of variance determined the difference in physical performance between declining groups and maintenance group with maintained or improved step counts. Results. Daily step counts for 22 older women (41.5%) decreased during winter. A statistically significant interaction effect between group and time was found for maximum walking speed (F(1,50) = 5.23, p = 0.03). Post hoc comparisons revealed that walking speed in the maintenance group significantly increased compared with baseline (p = 0.01); the declining group showed no significant change (p = 0.44). Conclusion. Change of physical activity during winter influences the physical performance level after 1 year in community-dwelling old-old women, particularly its effect on maximum walking speed.

DOI： 10.1155/2015/253451

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DOI： 10.1537/ase.131026

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DOI： 10.7314/APJCP.2014.15.7.3305

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DOI： 10.1016/j.ijge.2013.01.014

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Language：Japanese  

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Language：English   Publisher：Japan Society of Physical Education, Health and Sport Sciences  

The present study sought to examine age-related differences in reaction time responses under simple- and dual-task conditions in active middle-aged males. Fifty healthy males aged 42 to 64 years who took part in public marathon events in 2010 or 2011, and who had participated in ski marathon events for more than 2 years were assessed, and whole body reaction times (WBRTs) were measured by under simple-task and dual-task conditions. In the dual-task condition, participants performed WBRTs measurements while they counted backwards aloud to 1, starting from 100. Although reaction times in the simple-task condition were not associated with age (<i>r</i>=0.21, <i>p</i>=0.14), a significant positive correlation was found between age and reaction times in a dual-task task condition involving concurrent cognitive tasks (<i>r</i>=0.45, <i>p</i><0.01). One-way analysis of variance revealed that older subjects (60 years and older) responded more slowly than two younger groups (aged <50 and 50-59 years) in dual-task conditions (<i>F</i>=7.87, p<0.01). However these age-related differences were not found in simple-task reaction times (<i>F</i>=1.74, <i>p</i>=0.19). The present findings suggest that attentional capacity assessed by reaction time in dual-task conditions declined with age in active middle-aged males.<br>

Other Link： http://search.jamas.or.jp/link/ui/2015032882

DOI： 10.5432/ijshs.201228

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DOI： 10.1589/jpts.24.205

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Society of Physical Therapy Science  

DOI： 10.1589/rika.27.411

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Language：Japanese   Publisher：公益社団法人日本理学療法士協会  

Purpose: The aim of this study was to determine the relationship between 5-m walking time and the need for long-term care among community-dwelling adults aged above 75 years. Methods: A total of 190 older individuals living aged&amp;ge;75 years (mean age, 80.1 [SD 4.2] years) and living at home participated in this study. Inpatients and current recipients of long-term care were excluded. In the baseline survey, participants performed the 5-m walking test and were followed-up for 39 months. Results: During the 39-month follow-up, 34 participants (17.9%) were certified for long-term care need. The log-rank test of survival curves indicated that the number of subjects certified for long-term care during the follow-up period was significantly higher in the slower walking speed group than in the faster walking speed group (p&lt;0.001). Cox&#039;s proportional hazard model revealed that the 5-m walking speed and body mass index were significantly associated with the need for long-term care during the 39 months follow-up period, and the hazard ratio of 5-m walking speed was 1.65 (p&lt;0.01). Discussion and Conclusion: These results suggested that the slow usual walking speed could relate to the future need for long-term care in community-dwelling older adults.

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DOI： 10.1589/jpts.22.405

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DOI： 10.3275/6763

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DOI： 10.1589/jpts.22.323

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Language：Japanese   Publisher：理学療法科学学会  

DOI： 10.1589/rika.24.727

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Language：Japanese   Publisher：(公社)日本理学療法士協会  

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Language：Japanese   Publisher：(公社)日本理学療法士協会  

Ichushi

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Language：Japanese   Publisher：(公社)日本理学療法士協会  

Ichushi

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Language：Japanese   Publisher：(一社)日本老年医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本老年医学会  

Ichushi

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DOI： 10.1080/13607863.2014.967169

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DOI： 10.14900/cjpt.2014.0525

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DOI： 10.14900/cjpt.2014.1912

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DOI： 10.14900/cjpt.2014.1913

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Language：Japanese   Publisher：Japanese Society of Physical Therapy  

DOI： 10.15063/rigaku.KJ00009930399

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DOI： 10.1589/rika.29.949

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DOI： 10.14900/cjpt.2013.0065

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DOI： 10.14900/cjpt.2013.0765

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DOI： 10.14900/cjpt.2013.0676

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DOI： 10.14900/cjpt.2013.0352

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DOI： 10.14900/cjpt.2013.0674

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DOI： 10.14900/cjpt.2012.0.48102066.0

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DOI： 10.14900/cjpt.2012.0.48100715.0

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

【はじめに、目的】姿勢制御は、日常生活の基本動作遂行にとって不可欠な機能の一つである。姿勢制御の構成要素としては筋骨格系や前庭系などのさまざまな機能が挙げられており、特に高齢期においては、転倒などへの影響から姿勢制御と注意機能との関連性を示唆する報告が多い。注意機能は、注意資源を能動的に配分する情報処理過程の注意過程と、意識下における自動的な情報処理過程の前注意過程に区別されている。ミスマッチ陰性電位（Mismatch Negativity; MMN）は、均一な刺激系列にまれに逸脱刺激を挿入する課題（Oddball課題）に対する意識下の脳反応として出現する前注意過程の自動処理関連電位である。本研究では、姿勢制御課題に対する注意資源の配分量を変化させた際のMMNを若年者と高齢者で測定することで、前注意過程における情報処理過程への加齢の影響について明らかにすることを目的とした。【方法】対象は、若年者20 名（男性15 名、女性5 名、平均年齢21.8 ± 1.0 歳）、高齢者20 名（男性15 名、女性5 名、平均年齢73.6 ± 4.5 歳）とした。本研究では、3 段階の異なる難易度の姿勢制御条件でそれぞれOddball課題を提示した。姿勢制御条件は座位条件、安定した支持基底面での立位保持条件および不安定な支持基底面での立位保持条件の3 条件とした。本研究で提示したOddball課題は標準刺激と逸脱刺激から構成され、標準刺激は周波数1000Hz、提示確率80%で提示され、逸脱刺激は周波数1100Hz、提示確率20%で提示された。音刺激の持続時間は50ms、強度は50dB、隣接する音刺激の刺激間時間間隔は500msとした。それぞれの姿勢保持条件における腰部加速度と下腿の筋活動を身体動揺の指標とし、MMN振幅とMMN潜時を前注意過程における情報処理過程の指標とした。統計解析は腰部加速度、下腿の筋活動、MMN振幅およびMMN潜時について、年齢と課題条件を要因とする反復測定分散分析を行い、交互作用と主効果について検討した。統計処理にはSPSS19.0 を用い、危険率5%未満を有意とした。【倫理的配慮、説明と同意】対象者にはヘルシンキ宣言の趣旨に沿い本研究の主旨および目的を口頭と書面にて説明し、書面にて同意を得た。なお、本研究は札幌医科大学倫理審査委員会の承認を受けて実施した。【結果】腰部加速度は、若年者と高齢者ともに座位条件、安定した立位保持条件、不安定な立位保持条件の順で有意に増大した。また両群の腰部加速度変化に有意な交互作用が認められ、高齢群でより身体動揺が増大したことが確認された（p&lt;0.01）。また、下腿の筋活動についても上記の課題順で増大し、高齢群で筋活動が増大するという交互作用が確認された（p&lt;0.01）。さらに、MMN成分に関して、MMN潜時には交互作用や主効果が認められなかったのに対して、MMN振幅では群間と課題条件に有意な交互作用が認められ、高齢群では上記の課題順でMMN振幅が減少したことが確認された（p&lt;0.01）。【考察】腰部加速度と下腿筋活動の結果から、座位条件と比較して立位条件で姿勢制御の難易度が高く、立位条件のなかでも支持基底面が不安定な条件で姿勢制御が困難であったことが確認された。また、この傾向は高齢群でより顕著にみられたことから、加齢に伴う姿勢調整機能の低下から、本研究で設定した課題では、高齢群は若年群に比べて姿勢制御がより困難であったことが示された。MMN成分に関して、姿勢制御の難易度が高い条件で高齢群でのみMMN振幅が減少した。このことは、姿勢制御の難易度が高くなった時に意識下の脳反応が高齢群で低下していたことを示唆するものであり、高齢者における姿勢制御時の外乱応答として、意識的に注意資源を配分する機能の低下に加えて無意識的な注意配分機能も低下していることが明らかになった。【理学療法学研究としての意義】姿勢制御の枠組みの中で、運動機能のみならず認知機能としての情報処理過程のメカニズムを明らかにすることは、姿勢制御を包含的に理解する上で重要であると考える。また、本研究では高齢者を対象として加齢の影響についても観察しており、今後は認知機能と転倒との関連性などについても明らかにできる可能性がある。

DOI： 10.14900/cjpt.2012.0.48101639.0

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DOI： 10.14900/cjpt.2012.0.48101639.0

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

【はじめに、目的】立位時に固定物に触ることで指先の皮膚を介して機械受容器が興奮し，体性感覚入力が増加することでCOP（Center of Pressure）の動揺が減少すると報告されている。特に，固定物に指先が加える力（コンタクトフォース）が1N以下であると，指先による力学的な支持の影響は小さいと報告されている。このようなタッチを用いた立位姿勢の安定化に関する研究の中で，触圧覚の重要性について報告されている一方で，固定物への荷重の加え方がCOP動揺の減少に影響するかについて明らかとされていない。先行研究のように固定物に触る時のコンタクトフォースを任意とした場合身体の動揺が大きくなると皮膚の変位が大きくなるが，コンタクトフォースを一定にする課題を与えた場合皮膚の変位が小さくなるために従来の方法に比べてCOP動揺が増加する可能性が予想される。本研究では，従来の方法によるタッチの場合とコンタクトフォースを一定とした場合のCOP動揺の比較を行うことで，固定物への荷重の加え方がタッチによる姿勢安定化に影響を与えるのかどうか検討することを目的とした。【方法】対象は健常成人男女16 名（平均年齢22.5 ± 1.3 歳，男8 名，女性8 名）とした。対象者には，床反力計（Kistler社製）の上で左足を前としたタンデム立位を取らせ，体側に垂らした右示指の位置に設置したピンチメータ（Biometrics社製）に示指の指腹を接触させた。被験者の前にはディスプレイを設置し，ピンチメータから得たコンタクトフォースをリアルタイムに掲示した。測定条件は，ピンチメータに触る条件を1）1N以下の任意の力で触るPrefer条件，2）0.2Nの一定の力で触る0.2N条件，3）0.5Nの一定の力で触る0.5N条件の3 条件に設定した。0.2 条件と0.5N条件では，ディスプレイ上の0.2Nおよび0.5Nの位置にターゲットとなるラインを掲示し，出来る限りそのラインにコンタクトフォースを合わせるよう教示した。試行はブロックランダマイズ化し，各4 試行測定した。床反力計およびピンチメータのサンプリング周波数は1000Hz とし，測定した30 秒間のうち最初と最後の2 秒間を除く20 秒間を解析区間とした。床半力データからCOPを算出し，COPおよびピンチメータのデータはフィルター処理後，COPデータから動揺速度および実効値面積，前後・左右方向の平均動揺振幅を算出し，ピンチメータデータから平均値および変動係数を算出した。統計学的分析として3 条件で得られた全ての変数に対し反復測定分散分析を行い，主効果の検討を行った。また，有意性が確認された場合Bonfferoniによる事後検定を行い有意性の検討を行った。統計解析にはSPSS19.0 を使用し，有意水準は5%未満とした。【倫理的配慮、説明と同意】対象者にはヘルシンキ宣言の趣旨に沿い本研究の主旨および目的を口頭と書面にて説明し，書面にて同意を得た。なお，本研究は札幌医科大学倫理審査委員会の承認を受けて実施した。【結果】コンタクトフォースの平均値は，Prefer条件が0.191 ± 0.020N，0.2N条件が0.215 ± 0.005N，0.5N条件が0.498 ± 0.004N であり，Prefer条件および0.2N条件に比べて0.5N条件で有意に大きい値であった（p&lt;0.05）。実効値面積および左右方向の平均動揺振幅は，Prefer条件に比べて0.2N条件および0.5N条件でそれぞれ有意な減少がみられ（p&lt;0.05），0.2N条件と0.5N 条件の間では有意差はみられなかった。動揺速度および前後方向の平均動揺振幅は，3条件の間で有意差はみられなかった。【考察】従来のタッチ課題に比べて一定の力で触る課題を課すことで，左右方向の動揺の大きさおよび重心動揺面積が有意に減少した。動揺速度については3 条件で有意な差がみられなかった。これらのことから，固定物への荷重の加え方の違いは，身体動揺の振幅の大きさに影響を与える一方で，身体動揺の速さには影響を与えない可能性が考えられた。先行研究では0.2-0.5N程度の力が指先に加わったときにCOP動揺が減少すると報告されており，指先に加わる力が変動せずに一定であっても0.2-0.5N程度の力が指先に加わるということが身体動揺の安定化に重要である可能性が示唆された。【理学療法学研究としての意義】感覚障害や加齢によるバランス機能低下に対してアプローチする際に，上肢からの体性感覚入力による姿勢安定化の有用性を考える上での基礎的な知見を得ることが出来る。

DOI： 10.14900/cjpt.2012.0.48100715.0

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

【はじめに、目的】高齢者における歩行能力の低下は、加齢に伴う身体機能低下の初期兆候として知られており、その重要性が広く認識されている。高齢者の歩行に関する先行研究では、歩行速度などの機能的変化についての検討が多く報告されているものの、歩行の耐久性などの活動に繋がる能力低下について縦断的に分析したものは散見される程度である。歩行能力低下を早期に発見し、加齢による活動制限に対する予防策を講じるためには、歩行の耐久性を含めてより多面的に身体機能の変化について検討する必要がある。本研究の目的は、地域在住高齢者における1年間の連続歩行距離低下と身体機能との関連について検討することとした。【方法】2009～2012年の間にS市にて年1回の頻度で毎年開催されている体力測定会において、上記の期間の内、連続した2年間のデータが揃っている65歳以上の地域在住高齢者47名（男性13名、女性34名、ベースライン平均年齢74.0±6.2歳）を対象とした。分析に用いた項目は、連続歩行距離、握力、開眼片脚立位時間、5m最大歩行速度、Functional Reach Testとした。連続歩行距離は質問紙を利用して、対象者の休まず歩ける距離を「1：10m未満」「2：10～50m未満」「3：50～100m未満」「4：100～500m未満」「5：500～1km未満」「6：1km以上」の6段階で聴取した。握力は、スメドレー式握力計を用いて測定し、2回の最大値を代表値として採用した。開眼片脚立位時間は、対象者の任意側の脚を拳上し続けることができる時間を計測した。5m最大歩行速度は、対象者に「できるだけ速く歩いてください」と教示し、直線11mの歩行路（加速路および減速路各3m、測定区間5m）上を歩行するのに要した時間を計測し、速度に換算した。Functional Reach Testは、安静立位にて基準線から最も前方に届いた手指先端の位置までの距離を計測し、2回の最大値を採用した。統計学的分析は、各変数の1年間の変化について、対応のあるt検定により検討した。また、対象者を1年後の連続歩行距離が低下した群と低下しなかった群の2群に分け、ベースラインにおける各身体機能の群間差を対応のないt検定を用いて検討した。統計処理にはSPSS19.0を使用し、有意水準は5%未満とした。【倫理的配慮、説明と同意】対象者には本研究の目的について口頭および案内文により説明を行い、書面にて測定参加の同意を得た。なお、本研究は札幌医科大学倫理審査委員会の承認を受けて実施した。【結果】連続歩行距離および各身体機能について、一年間で有意な変化は認められなかった。ベースラインの連続歩行距離は、段階1が1名、段階2が0名、段階3が2名、段階4が4名、段階5が7名、段階6が33名であり、1年後の変化は9名が低下、38名が維持または向上という結果であった。 1年後の連続歩行距離が低下した群は、低下しなかった群と比較してベースラインの5m最大歩行速度が有意に低く（p=0.04）、その他身体機能の指標である握力（p=0.86）、開眼片脚立位時間（p=0.26）、Functional Reach Test（p=0.14）においては有意差が認められなかった。【考察】地域在住高齢者の連続歩行距離は、身体機能が比較的高い高齢者であっても1年間で低下する可能性があることが示された。また、ベースラインの歩行速度低下がその後の連続歩行距離低下と関連していることが確認された。 一般的に加齢に伴う機能低下は、高次の社会的要素から低次の機能的要素へと低下が生じるとされている。本研究結果においても身体機能には1年間で変化が認められなかったが、連続歩行距離低下が低下した群、低下しなかった群に分けてみた場合、ベースラインの歩行速度が高い者が連続歩行距離を維持していたことが明らかとなった。 以上から、運動機能を高いレベルで維持することの重要性が改めて示唆されたと考える。【理学療法学研究としての意義】地域在住高齢者の連続歩行距離の縦断変化を考えるうえで、初期の歩行速度を評価する必要性が示された。今後さらなる研究を行うことで、高齢者の連続歩行距離低下のリスクを発見し、早期介入に繋げるための有用な知見が得られると考える。

DOI： 10.14900/cjpt.2012.0.48102066.0

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DOI： 10.14900/cjpt.2011.0.Eb1295.0

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DOI： 10.14900/cjpt.2011.0.Ed1477.0

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DOI： 10.14900/cjpt.2011.0.Eb1272.0

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DOI： 10.14900/cjpt.2011.0.Aa0880.0

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DOI： 10.14900/cjpt.2011.0.Ea0339.0

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DOI： 10.14900/cjpt.2010.0.EaOI2049.0

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DOI： 10.14900/cjpt.2010.0.EaOI1044.0

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：JAPANESE PHYSICAL THERAPY ASSOCIATION  

DOI： 10.14900/cjpt.2009.0.E2Se2079.0

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DOI： 10.14900/cjpt.2009.0.E2Se2081.0

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DOI： 10.14900/cjpt.2009.0.E3O2209.0

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DOI： 10.14900/cjpt.2008.0.A3P2067.0

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DOI： 10.1589/rika.24.727

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DOI： 10.1589/rika.24.727

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Language：Japanese   Publisher：JAPANESE PHYSICAL THERAPY ASSOCIATION  

DOI： 10.14900/cjpt.2008.0.A3P1083.0

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Language：Japanese   Publisher：JAPANESE PHYSICAL THERAPY ASSOCIATION  

【目的】&lt;BR&gt; 注意や認知機能の評価には，運動課題と認知課題を同時に行なう二重課題(dual task)が用いられ，単一課題(single task)時と比べて運動が稚拙になることが報告されている．しかし，運動の自動化と認知課題との注意量に関した報告は少なく，十分には明らかになっていない．そこで本研究では，認知課題が歩行に与える影響について検討すること，及び歩行と認知課題間の注意配分量の関連性について検討することを目的とした．&lt;BR&gt;【方法】&lt;BR&gt; 対象者は，健常成人8名(男性5名，女性3名，平均年齢22.1±1.1歳)とした．また，ヘルシンキ宣言に基づき実験リスクについて説明し，実験参加の同意を書面にて得たのち測定を行った．運動課題は歩行，認知課題はmental課題及び手作業課題とした．mental課題は，「コップの水をこぼさないように注意する」こととし，手作業課題は，「水と同量の重さの石が入ったコップを持つ」を用いた．歩行速度は，各課題ともに速い歩行(fast)，自然歩行(prefer)，遅い歩行(slow)とした．測定項目は，歩幅(step length；SL)，一歩ごとの時間(step time；ST)，こぼれた水の量とした．SLの計測方法は，上靴の底にパウダーを塗布し，歩行路上についた足跡を利用して，右(もしくは左)踵接地から左(もしくは右)踵接地までの距離を計測した．STの計測は，フットスイッチにて同定した．SL，STともに歩行開始後2歩目から連続する12歩目までの合計10歩とした． &lt;BR&gt;【結果】&lt;BR&gt; mental歩行のSLは手作業歩行のSLと比較して，有意にSLが減少し(p&lt;0.05)，mental歩行のSTは手作業歩行のSTと比較して，有意にSTが増加した(p&lt;0.05)．&lt;BR&gt; mental課題下における，水への内省報告と水をこぼした量に関しては，slow，prefer，fastのいずれの速度においても有意な相関は認められなかった(r=-0.30，p=0.17)．&lt;BR&gt;【考察】&lt;BR&gt; mental歩行のSLは，手作業歩行のSLと比較して，slow，prefer，fastの順に10.3%，14.6%，13.6%減少した．以下同様にmental歩行のSTは，手作業歩行のSTに比べ，23.0%，13.0%，4.8%増加した．これは，mental課題下では水をこぼさないように注意したことにより，歩行に対する注意配分量が減少したためだと考えられる． &lt;BR&gt;【まとめ】&lt;BR&gt; 健常成人8名を対象に，認知課題が歩行に及ぼす影響について検討した．その結果，いずれの速度においても，手作業歩行に比べてmental歩行での歩幅は減少し，一歩時間は増加した．また，両課題ともに歩行速度がprefer時に，最も一歩時間のばらつきが少ないことが認められ，自由歩行速度は歩行への注意配分量が最も少なかったということが示唆された．

DOI： 10.14900/cjpt.2008.0.A3P2067.0

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