[Reasons for older adults independently continuing exercise after a supervised Square-Stepping Exercise intervention]

OBJECTIVE

Square-Stepping Exercise (SSE), composed of movements similar to walking, involves varied movements in multiple directions and is performed on a thin mat (100 x 250 cm) that is partitioned into 40 squares (25 cm each). We introduced SSE to a group of older adults for three months as a supervised intervention. After this intervention period, the participants continued SSE without supervision for four years. The current study was conducted to determine why the participants independently continued SSE.

METHODS

Among 52 older adults who attended the SSE intervention, 40 continued SSE (continued group) and 12 discontinued (discontinued group). Seven in the continued group were excluded from analyses because of low attendance rates. Each of the remainder (n = 33) was independently interviewed and asked why he/she had continued SSE. The average interview time for the continued group was 12 minutes. Twelve in the discontinued group were investigated for exercise habits by postal questionnaire.

RESULTS

The participants in the continued group noted two to six reasons for continuation of SSE. After analyzing data inductively, the answers were categorized as follows: (1) friends and social communication; (2) equitable management of group activity; (3) expectation of health from exercise; (4) simple-easy exercise; and (5) family support for exercise. The participants in the discontinued group reported that 89% of them continually did walking, muscular strength exercise, and calisthenics.

CONCLUSION

We found that reasons why adoption of SSE as an intervention program for older adults enhance their exercise adherence in the long term.

[Association of the physical activity of community-dwelling older adults with transportation modes, depression and social networks]

AIM

The purpose of this study was to cross-sectionally examine the relationships among leisure, household and occupational physical activity with the frequency of going out by various transportation modes, depression and social networks in older adults.

METHODS

We randomly selected a total of 2,100 community-dwelling adults aged 65 to 85 years of age from the Basic Resident Register. Of these, 340 people were the subjects of this study. The scales of measurement used were the Physical Activity Scale for the Elderly, the Lubben Social Network Scale (LSNS) and the Geriatric Depression Scale (GDS).

RESULTS

In a regression model, leisure-time physical activity significantly correlated with frequency of going out by bicycle (β=0.17) and LSNS score (β=0.17). Household physical activity and occupational physical activity were significantly correlated with LSNS score (β=0.21) and frequency of going out by motor vehicle (β=0.25), respectively. For total physical activity, in the 3 above-mentioned activities a significant correlation was observed among frequency of going out by bicycle (β=0.10), by motor vehicle (β=0.23), GDS score (β=-0.16) and LSNS score (β=0.23).

CONCLUSION

These results indicate that the frequency of going out by bicycle and by motor vehicle were significant factors to predict leisure and occupational physical activity. Furthermore, social networks appear to be important determiners in leisure and household physical activity in community-dwelling older adults.

Angiotensin II receptor blockade with valsartan decreases plasma osteopontin levels in patients with essential hypertension

Osteopontin (OPN) has recently emerged as a key factor in both vascular remodelling and development of atherosclerosis. It has been reported that OPN is regulated by the renin-angiotensin-aldosterone system (RAAS). The aim of this study was to clarify the effect of angiotensin II receptor blockade with valsartan on plasma OPN levels in patients with essential hypertension (EHT). Forty-six patients (mean age, 64±11 years) with EHT were randomly assigned to treatment with amlodipine or valsartan. There were no significant differences in baseline clinical characteristics between the two groups. Blood sampling and blood pressure evaluation were performed before and after 24 weeks of treatment. After 24 weeks, both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were decreased significantly and by the same degree in each treatment group. However, valsartan but not amlodipine decreased plasma OPN levels (baseline and 24-week data-valsartan: 614±224 ng ml(-1), 472±268 ng ml(-1), P=0.006; amlodipine: 680±151 ng ml(-1), 687±234 ng ml(-1), P>0.999). A positive correlation between the reduction in OPN and the log natural (ln) C-reactive protein (CRP) was seen in the valsartan-treated group. Stepwise regression analysis showed that treatment with valsartan and the reduction of ln CRP were associated with the reduction in OPN levels, and this association was independent of the reduction in SBP or aldosterone levels (valsartan: β=0.332, P=0.026; ln CRP reduction: β=0.366, P=0.015). These results suggest that suppression of the RAAS and inflammation may decrease plasma OPN levels.

[Effects of a community-based weight loss program, jointly established by local government and university faculty, on weight loss and metabolic syndrome components: the Sodegaura Weight Management Study]

PURPOSE

Sodegaura City (Chiba, Japan) and the University of Tsukuba (Ibaraki, Japan) have jointly established a community-based weight loss program named the Sodegaura SMART Diet (SSD). The purpose of this study was to investigate the effects of the SSD on weight loss and metabolic syndrome (MS) components.

METHODS

The study period spanned 2004 to 2008 with 192 women who satisfied the following two study criteria: (1) age from 40 to 64 years; and (2) BMI > or =25 kg/m2 or abdominal circumference (AC) > or =90 cm. A total of 184 (95.8%) women completed the entire study program of 12 lectures in 14 weeks regarding an appropriate diet and physical activity. We measured and analyzed changes in body weight and MS components before and after the SSD. Furthermore, we compared changes in body weight and MS componenfs between an intervention group (32 participants in 2008) and a control group (16 women who participated in a one-time lecture on MS and pre- and post-measurement sessions). Between 2004 and 2006, 122 women participated in the SSD, 96 of which (78.7%) consented to a 2 year follow-up measurement session.

RESULTS

Analysis of the 184 subjects who completed the study program showed significant decreases in body weight (66.9 +/- 8.2 kg to 59.4 +/- 7.5 kg), BMJ (27.7 +/- 2.7 kg/m2 to 24.6 +/- 2.6kg/m2), AC (95.2 +/- 7.4 cm to 87.8 +/- 7.6 cm), and the number of MS components (2.1 +/- 1.1 to 1.1 +/- 1.0). At baseline, the prevalence of MS and pre-MS as determined by the Japanese MS definitions was 33.2 00 (61 subjects) and 27.700 (51 subjects), respectively. After the intervention, the prevalence decreased significantly to 6.0% (11 subjects) and 15.2% (28 subjects), respectively. We observed significant group differences between the SSD and control groups in changes for several variables, i.e., body weight, BMI, percent fat mass, AC, triglycerides, fasting plasma glucose, and number of MS components. After the 2 year follow-up, body weight (-6.2 +/- 3.7 kg) and AC (-5.9 +/- 5.0 cm) were still significantly decreased compared to pre-intervention measurements.

CONCLUSIONS

Our study showed that the SSD may affect weight loss and improve MS components among middle-aged Sodegaura citizens. The local government will use these data to plan a city-wide promotion of the program to improve the health of its citizens.

Validation of lower extremity performance tests for determining the mobility limitation levels in community-dwelling older women

BACKGROUND AND AIMS

Assessment of mobility status among community-dwelling older people is important for preventing further deterioration of mobility and identifying changes in mobility as early as possible. We attempted to identify the optimal cut-off values for eight lower extremity performance (LEP) tests in community-dwelling older women with mobility limitation (ML) levels.

METHODS

The ML levels of 433 community-dwelling older women, mean age 73.2 years (SD 5.7, range 65-93) were classified according to selfreports. ML levels were identified by face-to-face interviews and according to self-reported difficulty in walking one-quarter of a mile or climbing 10 steps without resting. The LEP tests comprised one-legged stance, tandem stance, functional reach, tandem walk, alternate step, five chair sit-to-stands, timed up-and-go (TUG) and usual gait speed. Receiver-operating characteristic curves were obtained for all scales to assess optimal cut-off values.

RESULTS

The optimal cut-off value of 6.52 (s) for the TUG test was shown by the highest sensitivity (74%) and specificity (71%) in the discrimination of no ML from moderate ML, whereas the optimal cut-off value of 1.05 (m/s) in the usual gait speed test showed the highest sensitivity (73%) and specificity (67%) in the discrimination of moderate ML from severe ML.

CONCLUSIONS

Among community-dwelling older women, TUG and usual gait speed had the highest sensitivity and specificity in discriminating ML levels.

PPARG genotype accounts for part of individual variation in body weight reduction in response to calorie restriction

Several studies indicate that expression of the peroxisome proliferator-activated receptor gamma (PPARG) gene is influenced by calorie restriction. The aim of this study was to investigate whether PPARG gene variations are associated with weight reduction and changes in coronary heart disease (CHD) risk factors in response to a 14-week calorie restriction. In total, 95 middle-aged, Japanese women (BMI>or=25 kg/m2) enrolled as subjects for 14 weeks and attended weekly dietary lectures instructing them on how to consume a nutritionally balanced diet of 1,200 kcal/day. Eight single-nucleotide polymorphisms (SNPs) in the PPARG gene (rs1801282 (Pro/Ala), rs2292101, rs2959272, rs1386835, rs709158, rs1175540, rs1175544, and rs1797912) were analyzed. Body weight decreased significantly (-7.7+/-3.1 kg; -11.3+/-4.4%) during the intervention. Six PPARG SNPs (rs2959272, rs1386835, rs709158, rs1175540, rs1175544, and rs1797912) were significantly associated with the weight reduction, with rs1175544 having the strongest association (P=0.004). No differences across the rs1175544 genotypes were observed in any of the blood analyses or in blood pressure. In a multiple regression analysis, the rs1175544 genotypes accounted for 7% of the total weight reduction variance. These data suggest that one SNP of the PPARG genotype accounted for a significant portion of the total body weight reduction variance in response to a short-term intervention consisting of calorie restriction; however, no relationship was found between these SNPs and the changes in CHD risk factors which accompanied weight loss.

[A functional fitness test battery for pre-frail older adults (so-called "specified elderly individuals")]

BACKGROUND

In Japan, an exercise program for pre-frail older adults (so-called "specified elderly individuals") (SEIs) has been prescribed under the newly developed long-term care insurance system. Three functional fitness measures (grip strength, one-leg balance with eyes open, and 5-m habitual walk) are used in the system; however, it has yet to be determined if applying these measures to SEIs is appropriate.

PURPOSE

The purpose of this study was to develop a new test battery assessing functional fitness for SEIs, and to determine cross-validity and responsiveness of these measures.

METHODS

One hundred and twenty seven SEIs (76.6 +/- 5.9 yr) and 315 healthy older adults (HOAs) (72.2 +/- 5.8 yr) completed twelve functional fitness tests related to activities of daily living (ADL) and mobility. The SEI was defined by the Japanese Ministry of Health, Labour and Welfare in 2005. The test battery items were selected by logistic regression analysis. A functional fitness score (FFS) equation was developed by principal component analysis. The cross-validity of the FFS equation was then tested using a different set of 28 SEIs (77.5 +/- 6.5 yr) and 143 HOAs (71.5 +/- 4.7 yr). Responsiveness of the FFS was also assessed in 62 SEIs (76.7 +/- 5.9 yr) after a 3-month exercise program.

RESULTS

The following 4 test items were selected for assessment of functional fitness in SEIs: tandem stance, 5-repetition sit-to-stand, alternate step, and timed up and go. Applying principal component analysis to the 4 selected functional fitness items, the first principal component was interpreted as total functional fitness. The following equation was developed to estimate FFS based on the first principal component coefficient of each variable: FFS = 0.031X1-0.106X2-0.192X3-0.096X4 + 1.672, X1 = tandem stance(s), X2 = 5-repetition sit-to-stand (s), X3 = alternate step(s), X4 = timed up and go(s). The cut-off value to distinguish SEIs from HOAs using receiver operating characteristic ROC) curve was 0.065 (sensitivity 82.2%, specificity 81.9%). The cross-validity and responsiveness of the FFS equation was considered acceptable. CONCLUSION This newly developed test battery should be a useful tool for comprehensively evaluating functional fitness in SEIs.

Weight reduction can decrease circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 levels in overweight middle-aged men

Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) has been reported to be associated with acute coronary syndrome, but its association with obesity has not been elucidated. In this study, we examined whether weight reduction would reduce the serum levels of sLOX-1 in a 12-week weight reduction intervention. Thirty-eight overweight middle-aged men were enrolled in the study, and 32 completed the intervention. The serum level of sLOX-1 was measured using a chemiluminescent enzyme-linked immunoassay. After the intervention program, body weight and the serum level of sLOX-1 decreased significantly (-7.5% +/- 4.8% and -72.1% +/- 35.9%, respectively). Changes in serum levels of sLOX-1 were positively correlated with changes in body weight (r = 0.54, P = .003), body mass index (r = 0.57, P = .001), body fat mass (r = 0.57, P = .002), total cholesterol (r = 0.41, P = .03), subcutaneous fat area (r = 0.50, P = .007), high-sensitivity C-reactive protein (r = 0.56, P = .002), leptin (r = 0.47, P = .01), and tumor necrosis factor-alpha (r = 0.32, P = .09); but no correlations were observed with fasting glycemic-related factors (blood glucose, hemoglobin A(1c), and insulin). Changes in body mass index and high-sensitivity C-reactive protein were selected as significant predictors of sLOX-1 changes by multiple regression analyses. These results suggest that LOX-1 induction may be related to adipocyte metabolism, inflammation, and immune response associated with obesity.

Factors alleviating metabolic syndrome via diet-induced weight loss with or without exercise in overweight Japanese women

OBJECTIVE

Although a 5%-10% loss in the baseline weight has been associated with improvement in obesity-related disorders, only a few studies have explored the factors to alleviate metabolic syndrome (MS). This study aimed to determine the factors that alter MS components in overweight Japanese women.

METHODS

Between 1999 and 2006, 323 Japanese women aged 24-67 with body mass indices of 25-40 kg/m(2) and the presence of at least 1 component of MS were recruited from Ibaraki and Chiba. The participants were enrolled in a 3-month weight-loss program with a low-calorie diet with or without exercise. The factors to alleviate MS components were explored using classification and regression tree (CART) analyses.

RESULTS

Of the 323 participants, 309 completed the weight-loss program and were included in the analyses. The CART analyses revealed that a weight reduction of 8.1% in baseline body weight was sufficient to improve at least 1 component of MS. Similarly, classification trees were generated for improvement in abdominal obesity (essential factor: > or =13.0% weight loss), hypertension (essential factor: baseline age, < or =41.5 years), and hyperglycemia (essential factor: > or =13.2% weight loss).

CONCLUSION

These results suggest that moderate weight loss of 8%-13% contributes to improving the MS components in overweight Japanese women.

Effects of serum 25-hydroxyvitamin D(3) levels on physical fitness in community-dwelling frail women

The aim of this study was to evaluate the effects of a combination of serum 25-hydroxyvitamin D(3) (25(OH)D(3)) levels and exercise on physical fitness in community-dwelling frail elderly in Japan. A longitudinal survey was conducted in a town (latitude 36 degrees north). Eighty women aged 65 years and over attended a 3-month exercise class. A face-to-face interview was conducted based on a questionnaire. The serum levels of 25(OH)D(3), intact parathyroid hormone (iPTH), were measured. Nine physical fitness tests were performed at baseline and at the end of a 3-month follow-up period. Among 80 subjects, 56.3% experienced falls, and 71.3% experienced stumbling more than once during the past year. The prevalence of 25(OH)D(3)<50 nmol/l or 25(OH)D(3)<75 nmol/l was 27.5% and 88.8%, respectively. Significantly greater improvements in alternate step, functional reach (FR), "timed up & go" (TUG), and 5-m walk, and superior functional capacity for the subjects with 25(OH)D(3) levels greater than 67.5 nmol/l (highest quartile) was observed at the end of the class. In contrast, the subjects with 25(OH)D(3) levels <47.5 nmol/l (lowest quartile) did not improve their physical fitness. A serum 25(OH)D(3) level of greater than 47.5 nmol/l may therefore be necessary to maintain walking ability and balance. Greater than 67.5 nmol/l appears to be preferable for lower extremity strength in Japanese frail elderly women.

[Evaluation of the association between impaired renal function and physical function among community-dwelling Japanese frail elderly based on the estimated glomerular filtration rate (eGFR)]

AIM

Falls are major risk factors in nursing care and reported to be associated with low vitamin D levels or impaired renal function. It is unknown whether physical function is associated with impaired renal function. The aim of this study was to examine the association between estimated glomerular filtration rate (eGFR) (ml/min/1.73 m(2)), vitamin D, and physical function in Japanese frail elderly.

METHODS

A cross-sectional survey was conducted in two towns (latitude 36 degrees north) from June 2006 to January 2008. Subjects counted of 109 community-dwelling frail elderly, aged 65 years and over (mean+/-SD: 75.8+/-5.2 yr) who attended a program for nursing care prevention. An interview was conducted based on a questionnaire. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25 (OH) D), 1,25-dihydroxyvitamin D (1,25 (OH)(2)D), and creatinine were measured. eGFR (ml/min/1.73 m(2)) was calculated using the Modification of Diet in Renal Disease formula. The following functional fitness tests were performed: timed up and go (TUG), a 5-meter walk, functional reach (FR), one leg stance, tandem stance, and grip strength.

RESULTS

Of the subjects, 59.6% experienced falls, 75.2% experienced stumbling at least once during the past year. eGFR was 68.0+/-14.1 ml/min/1.73 m(2) in the subjects. The prevalence of eGFR<60.0 ml/min/1.73 m(2) was 30%. The subjects with eGFR> or =60 ml/min/1.73 m(2) showed significantly better results for FR, one leg stance, and tandem stance than those with eGFR<60 ml/min/1.73 m(2). Multiple liner regression analysis suggested that FR and tandem stance were significantly affected by eGFR.

CONCLUSIONS

Our data suggest that assessment of renal function seems to be significant when we consider balance ability in the frail elderly.

Square-stepping exercise and fall risk factors in older adults: a single-blind, randomized controlled trial

BACKGROUND

Decreased fitness of the lower extremities is a potentially modifiable fall risk factor. This study aimed to compare two exercise programs--square-stepping exercise (SSE), which is a low-cost indoor program, and walking--for improving the fitness of the lower extremities.

METHODS

We randomly allocated 68 community-dwelling older adults (age 65-74 years) to either the SSE or walking group (W group). During the 12-week regimen, the SSE group participated in 70-minute exercise sessions conducted twice a week at a local health center, and the W group participated in outdoor supervised walking sessions conducted weekly. The W group was instructed to increase the number of daily steps. Prior to and after the program, we obtained information on 11 physical performance tests for known fall risk factors and 3 self-reported scales. The fall incidence was followed-up for 8 months.

RESULTS

At 12 weeks postregimen, significant differences were observed between the two exercise groups with respect to leg power (1 item), balance (2 items), agility (2 items), reaction time (2 items), and a self-reported scale (1 item); the SSE group demonstrated a marked improvement in the above-mentioned items with Group x Time interactions. Significant time effects were observed in the tests involving chair stands, functional reach, and standing up from a lying-down position without Group x Time interactions. During the follow-up period, the fall rates per person-year in the SSE and W groups were 23.4% and 33.3%, respectively (p =.31).

CONCLUSION

Although further studies are required, SSE is apparently more effective than walking in reducing fall risk factors, and it appears that it may be recommended as a health promotion exercise in older adults.

Square-stepping exercise versus strength and balance training for fall risk factors

BACKGROUND AND AIMS

Feasible and lowcost exercise programmes targeting fall risk factors may decrease the risk of falling in older adults. The purpose of this study was to compare the effects of square-stepping exercise (SSE) training, which is a new and low-cost method designed to improve lower-extremity functional fitness, with strength and balance (SB) training.

METHODS

The study included 39 community-dwelling adults aged 65 to 74 years. The participants were randomized to either group SSE (n=20) or SB (n=19). They engaged in 70- min group exercise sessions twice a week for 12 weeks. The efficacy of the program was measured with both a 9- item test battery for assessment of physical performance and self-reported scales (fear of falling, pleasure in exercise, perceived health status). Fall incidence was followed up for 14 months.

RESULTS

The results of a 2-way ANOVA revealed that the time effect in 7 of the 9 performance tests was significant, although group-by-time interactions were not. No significant changes were observed in the self reported scales. During the 14-month follow-up period, 7 falls in 6 participants in the SSE group and 12 falls in 11 participants in the SB group were reported. The incidence rate per person in the SSE group (30.0%) was not significantly different from that in the SB group (57.9%). The rate of falls per trip [falls/(falls + trips)] in the SSE group (17.1%) was significantly lower than in the SB group (50.0%).

CONCLUSIONS

SSE is as equally effective as SB training in improving lower-extremity functional fitness. SSE may also be recommended for older adults, due to its low cost and effectiveness.

Effects of additional resistance training during diet-induced weight loss on bone mineral density in overweight premenopausal women

Bone loss accompanies a diet-induced weight loss and could be prevented with a combination of exercises. This study was conducted to examine the effects of additional resistance training during diet-induced weight loss on whole-body and selected regional bone mineral density (BMD). The participants of a 14-week weight-loss study were 42 overweight premenopausal Japanese women who were randomly placed in either a diet-only group (D; n = 21) or a diet plus resistance training group (DR; n = 21). Whole-body BMD and body composition, lumbar spine BMD, and 1/3 radial BMD were measured by dual-energy X-ray absorptiometry before and after the intervention. Bone formation and resorption markers were also measured. Thirty-five participants (83%) completed the study. Individuals in groups D (n = 17) and DR (n = 18) lost 6.2 +/- 3.5 kg and 8.6 +/- 3.6 kg body weight, respectively. Reductions in percentage fat mass and fat mass in group DR were significantly greater than in group D; lean mass decreased significantly in both groups. The effect of time on whole-body BMD was significant (-0.3%); however, whole-body bone mineral content, lumbar spine BMD, and 1/3 radial BMD remained unchanged. There were no significant timeby-group interactions in the whole-body and regional BMD and bone markers. These results suggest that additional resistance training during weight loss has no effect on BMD in overweight premenopausal Japanese women. Further long-term studies with large numbers of subjects are needed.

Effects of aerobic exercise on metabolic syndrome improvement in response to weight reduction

OBJECTIVE

The objective was to test effects of aerobic exercise training on metabolic syndrome (MetSyn) improvement in response to weight reduction.

RESEARCH METHODS AND PROCEDURES

A total of 459 overweight and obese women (age, 49 +/- 9 years; BMI, 28 +/- 3 kg/m(2)) were recruited for a baseline examination to test the relationship between cardiorespiratory fitness and metabolic syndrome prevalence; among these, 67 subjects with MetSyn were treated with 14-week weight-loss programs, which included low-calorie diet and aerobic exercise. The MetSyn was defined according to the Examination Committee of Criteria for "Metabolic Syndrome" in Japan. Maximal oxygen uptake (Vo(2max)) during a maximal cycling test was measured as an index of cardiorespiratory fitness at baseline and after the intervention.

RESULTS

In the baseline examination, age- and BMI-adjusted odds ratios for MetSyn prevalence in the low, middle, and upper thirds of Vo(2max) were 1.0 (referent), 0.50 (95% confidence interval, 0.26 to 0.95), and 0.39 (95% confidence interval, 0.14 to 0.96), respectively (linear trend, p = 0.02). The adjusted odds ratios for MetSyn improvement in the two interventions with diet alone and diet plus exercise were 1.0 and 3.68 (95% confidence interval, 1.02 to 17.6; p = 0.04), respectively.

DISCUSSION

These results suggest that adding aerobic exercise training to a dietary weight-reduction program further improves MetSyn (adjusted odds ratio, 3.68) in obese women, compared with diet alone. Further studies on an association between Vo(2max) change and MetSyn improvement are needed.

Effects of the interaction between lean tissue mass and estrogen receptor alpha gene polymorphism on bone mineral density in middle-aged and elderly Japanese

Because both genetic and environmental factors influence bone mass, it is important to examine the effect of gene-environment interactions on bone mineral density (BMD) for the prevention of osteoporosis at an individual level. Estrogen receptor alpha (ER alpha) plays an important role in increasing BMD via mechanical strain and muscle mass is a reflection of the forces the muscle applies to the bone. The aim of this study is to investigate the effect of the interaction between lean tissue mass (LTM) and the ER alpha polymorphisms T-->C (PvuII) [dbSNP: rs2234693] and A-->G (XbaI) [dbSNP: rs9340799] on BMD in middle-aged and elderly individuals. Subjects were 2209 community-dwelling Japanese men and women, ages 40 to 79 years. ER alpha polymorphisms in the first intron, T-->C and A-->G were identified and lumbar spine and femoral neck BMD and LTM were measured by dual-energy X-ray absorptiometry. Both T-->C and A-->G polymorphisms were divided into two genotype groups (TT vs. TC/CC; AA vs. AG/GG). In postmenopausal women, the effect of LTM on femoral neck BMD was significantly larger for those with the TC/CC genotype than for those with the TT genotype for the T-->C polymorphism, and larger for those with the AG/GG genotype than for those with the AA genotype for the A-->G polymorphism. This gene-LTM interaction was observed at the femoral neck, but not at the lumbar spine. For men and premenopausal women, no gene-LTM interaction was found. In conclusion, there was an interaction between LTM and the ER alpha T-->C and A-->G polymorphisms with respect to their effect on femoral neck BMD in postmenopausal women and those with the TC/CC and AG/GG genotypes had larger effects of LTM than those with TT and AA genotypes.

Response of Japan to the introduction of exotic animal diseases

The response of Japan to the introduction of exotic animal diseases is used as an example of methods used to control these diseases. Japan had been free from the major animal exotic diseases for many years until outbreaks of foot and mouth disease (FMD) occurred in 2000, highly pathogenic avian influenza (HPAI) in 2004 and bovine spongiform encephalopathy (BSE) was detected in 2001. In spring 2000, four outbreaks of FMD were recorded. In early 2004, four outbreaks of HPAI were recorded. Without resorting to vaccination, both diseases were eradicated in several months through depopulation of infected farms, movement controls, surveillance and other measures. The first case of BSE was detected in September 2001. Since then, 23 additional cases were detected by the end of March 2006, despite a strict ban on the use of meat-and-bone meal for feed and other eradication measures. The authors describe how these diseases occurred or were detected in Japan and discuss how Japan responded to them. Details are given on how they were introduced into Japan, the impact on Japanese farming and society and the lessons learned.

Effect of regular exercise on homocysteine concentrations: the HERITAGE Family Study

We investigated whether regular aerobic exercise could affect plasma total homocysteine (tHcy), and whether there were sex-related or racial differences in tHcy changes. Data were available for 816 black and white men and women, aged 17-65 years, 711 of whom completed a 20 week aerobic exercise training program. The tHcy concentration was measured in frozen plasma samples by an HPLC method. In Blacks, tHcy did not change with exercise training [men -0.5 (SD 3.7) micromol/l, women 0.0 (2.2) micromol/l) but increased significantly in Whites (men +0.3 (1.7) micromol/l, women +0.2 (1.6) micromol/l). No sex-related differences were found in either racial group. Changes in tHcy correlated negatively with baseline homocysteine (r = -0.40, P < 0.0001). Homocysteine levels of the "High" (hyperhomocysteinemia) (>or=15 micromol/l) group (n = 30) decreased significantly with regular aerobic exercise from 23.1 (12.1) to 19.6 (7.6) micromol/l. Homocysteine levels of the "Normal" group increased slightly from 8.2 +/- 2.2 to 8.5 +/- 2.4 micromol/l. Men exhibit racial differences for tHcy responses to exercise training. Regular aerobic exercise has favorable effects on individuals with hyperhomocysteinemia, but tHcy slightly increased in individuals within the normal range.

A novel exercise for improving lower-extremity functional fitness in the elderly

BACKGROUND AND AIMS

Many falls in the elderly are caused by tripping. After tripping, a certain level of lower-extremity functional fitness is necessary, in order to make protective responses and to avoid falling. The purpose of this study was to test whether our new exercise program (a square-stepping exercise: SSE) would improve lower-extremity functional fitness in the elderly.

METHODS

Fifty-two individuals aged 60-80 years were divided into two groups (non-randomized control design); SSE (n=26) and controls (n=26). Lower-extremity functional fitness was defined as standing up from a lying position (agility), chair-stand in ten seconds (leg power), walking round two cones (locomotion speed), sit-and-reach (flexibility) and single-leg balance with eyes closed (balance). The SSE group participated in a six-month regimen of SSE once a week. SSE was performed on a thin mat of 250 cm by 100 cm, partitioned into 40 small squares (25 cm each side). SSE included not only forward steps but also backward, lateral and oblique steps, and step patterns were progressively made more complicated. Controls maintained their usual lifestyles.

RESULTS

In the SSE group, significant improvements were observed in agility, leg power, locomotion speed, flexibility and balance. No significant changes were detected in any tests in the control group.

CONCLUSIONS

The SSE program improved lower-extremity functional fitness, lack of which constitutes a risk factor for falls in the elderly. This program should be tested further to determine if it can effectively reduce the incidence of falls in the elderly.

Cutoff and Target Values for Intra-Abdominal Fat Area for Prevention of Metabolic Disorders in Pre- and Post-Menopausal Obese Women Before and After Weight Reduction

BACKGROUND

The Japan Society for the Study of Obesity originally proposed a cutoff value of >100 cm(2) for the intra-abdominal fat area (IFA) as a definition for "visceral fat obesity" in Japanese adults. There are no studies on the cutoff or target values after weight reduction in pre- and post-menopausal women.

METHODS AND RESULTS

In the present study 149 pre-menopausal obese women (PreM, 43.3 years, 27.3 kg/m(2)) and 58 post-menopausal women (PostM, 53.9 years, 27.7 kg/m(2)) participated in a 14-week weight reduction program. The IFA was measured by computed tomography. The program induced significant reductions in body weight (8.6 kg in PreM and 7.8 kg in PostM). The IFA decreased significantly from 80.4 +/- 41.3 to 50.7 +/- 23.8 (PreM) and from 115.4 +/- 38.0 to 75.7 +/- 30.5 (PostM).

CONCLUSIONS

The receiver-operating characteristic curve analyses revealed that the appropriate cutoff values were 80 cm(2) (PreM) and 110 cm(2) (PostM) before the program, and after the program the appropriate target values were determined as 60 and 70 cm(2), respectively.

Association between carotid haemodynamics and inflammation in patients with essential hypertension

Previous studies have shown that high blood pressure causes chronic inflammation. Hypertensive patients are reported to have high-circulating levels of proinflammatory cytokines such as interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP). The pulsatility index (PI) and resistive index (RI) are used as markers of peripheral vascular resistance. In the present study, we evaluated the relationship between carotid haemodynamics and the proinflammatory cytokines, IL-6 and hs-CRP. In all, 41 patients with essential hypertension participated. The intima-media thickness (IMT), peak systolic velocity (pVs), peak diastolic velocity (pVd) and mean velocity (mV) in the common carotid artery were measured using ultrasound Doppler flow methods, and PI [(pVs-pVd)/mV] and RI [(pVs-pVd)/pVs] were calculated. Serum IL-6 and hs-CRP concentrations were measured by an enzyme-linked immunosorbent assay. IMT was positively correlated with age and pulse pressure. Both PI and RI were positively correlated with pulse pressure, IL-6 and hs-CRP. A multiple regression analysis revealed that PI and RI were independently associated with hs-CRP. These results suggested that carotid haemodynamic parameters such as PI and RI are associated with atherosclerosis and inflammation in hypertensive patients.

Effects of aerobic exercise and obesity phenotype on abdominal fat reduction in response to weight loss

OBJECTIVE

To test the effects on abdominal fat reduction of adding aerobic exercise training to a diet program and obesity phenotype in response to weight loss.

DESIGN

A prospective clinical trial with a 14-week weight-loss intervention design.

SETTING AND PARTICIPANTS

In total, 209 overweight and obese women were assigned to four subgroups depending on type of treatment and the subject's obesity phenotype: diet alone (DA) with intra-abdominal fat (IF) obesity (> or =mean IF area), diet plus exercise (DE) with IF obesity, DA with abdominal subcutaneous fat (ASF) obesity (<mean IF area) and DE with ASF obesity. Abdominal fat areas were evaluated by CT scans, with values adjusted for selected variables.

RESULTS

Values were adjusted for age, menopausal status and change in body weight and total fat mass. The IF reductions were significantly (P<0.0001) greater in subjects with IF obesity phenotype (-45.1 cm2) compared to the ASF obesity phenotype (-22.2 cm2). The ASF reductions were significantly (P<0.001) greater for subjects with ASF obesity (-74.5 cm2) compared to IF obesity (-55.5 cm2). For IF obesity, the IF reduction was significantly (P<0.01) greater in the DE group (-49.3 cm2) than in the DA group (-37.8 cm2).

CONCLUSION

These results suggest that for individuals with IF obesity, the efficacy on reducing IF of adding aerobic exercise training to a diet-alone weight-reduction program is more prominent (-49.3 cm2/-37.8 cm2=1.3 times) compared with DA. Moreover, abdominal fat reduction was found to be modified by obesity phenotype in response to weight loss.

Target value of intraabdominal fat area for improving coronary heart disease risk factors

OBJECTIVE

The goal of this study was to determine an intraabdominal fat (IF) area target value for improving coronary heart disease (CHD) risk factors in response to weight reduction.

RESEARCH METHODS AND PROCEDURES

Subjects were 279 obese Japanese women, 21 to 66 years old, who were divided into diet-alone and diet-plus-exercise groups and participated in a 14-week weight reduction program. The IF area was measured by computerized tomography scans. Systolic blood pressure > or = 140 mm Hg, diastolic blood pressure > or = 90 mm Hg, total cholesterol > or = 5.70 mM, triglycerides > or = 1.70 mM, and fasting plasma glucose > or = 6.99 mM were defined as CHD risk factors.

RESULTS

The best trade-off between sensitivity (probability of correctly detecting true positive) and specificity (probability of correctly detecting true negative) was found at 100 cm2 pretreatment in combined data of the two groups. At posttreatment, although a slight difference was found in the target value between the treatment groups (60 cm2 for diet alone and 50 cm2 for diet plus exercise), the combined data showed that the best trade-off occurred at 60 cm2 (sensitivity and specificity were 0.55 and 0.63, respectively). The percentage of subjects having no CHD risk factors was significantly lower in the group that had large IF areas (> or = 60 cm2) (46%) compared with the group that had normal IF areas (<60 cm2) (65%). However, the percentage of subjects having multiple CHD risk factors was significantly greater in the group that had large IF areas (16%) compared with the group with normal IF areas (7%) at posttreatment.

DISCUSSION

Our longitudinal data suggest that obese Japanese women should reduce their IF areas to < 60 cm2 through weight reduction to improve CHD risk factors independent of treatment.

Regional body composition changes exhibit opposing effects on coronary heart disease risk factors

OBJECTIVE

We investigated how regional body composition measured by dual-energy X-ray absorptiometry (DXA) is associated with risk factors for coronary heart disease (CHD) during weight reduction in obese women.

METHODS AND RESULTS

Data were gathered from 128 overweight and obese women, aged 34 to 66 years, during a 14-week intervention study with diet and exercise. Regional (arms, legs, and trunk) fat tissue (FT) and lean soft tissue (LST) were measured by DXA. The FT change in legs correlated negatively with changes in diastolic blood pressure, low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), and the number of CHD risk factors per subject (r=-0.17, P<0.05 to -0.26, P<0.01) in response to weight reduction, whereas truncal FT change had positive correlations with changes in triglycerides, LDL-C, FPG, and the number of CHD risk factors per subject (r=0.17, P<0.05 to 0.25, P<0.01). LST change in legs correlated negatively with changes in systolic blood pressure, FPG, and the number of risk factors (r=-0.20 to -0.21, P<0.05).

CONCLUSIONS

Regional body composition information is important for evaluating improvement of CHD risk factors during weight-reduction treatment for obesity; differential FTs had opposing effects on CHD risk factors during weight reduction in obese women.

Health benefits associated with exercise habituation in older Japanese men

BACKGROUND AND AIMS

The purpose of this study was to compare the effects of exercise habituation (3-32 years, mean 13.2 years) on physical vitality among five different groups.

METHODS

One hundred and two independent, community-dwelling elderly Japanese men, aged 64.6 +/- 6.6 years, were recruited as subjects. The vital age test battery consisted of various coronary heart disease risk factors and physical fitness elements.

RESULTS

The results of analysis of variance revealed that vital age as an index of physical vitality was youngest in joggers (47.9 yr, N=18), intermediate in trekkers (55.8 yr, N=20) and walkers (59.1 yr, N=18), and oldest (69.6 yr, N=20) in patients with ischemic heart disease (IHD). The difference between chronological age and vital age was approximately 15 years (p<0.05) in joggers, and 8 years (p<0.05) in trekkers and walkers. The vital age of sedentary persons (N=26) was only 1.9 years (NS) younger than their chronological age, which was similar to the difference (vital age of 64.1 +/- 8.5 yr vs chronological age of 65.7 +/- 5.4 yr) previously observed in similarly aged exercising IHD patients.

CONCLUSIONS

These results indicate that exercise habituation significantly affects the overall health status of most individuals, irrespective of mode of exercise. Among the three modes of exercise, jogging may be most beneficial. Furthermore, regularly exercising coronary patients may have physical vitality similar to that of sedentary men.

Association of the mitochondrial DNA 15497G/A polymorphism with obesity in a middle-aged and elderly Japanese population

Although polymorphism of the mitochondrial DNA 15497guanine/adenine (Mt15497G-->A) leads to the Gly251Ser amino acid replacement on human cytochrome b, it is unknown whether functional alteration of the mitochondrion is induced by the Gly251Ser replacement. To see if an association exists between the Mt15497G-->A polymorphism and obesity, we examined differences in body size, body composition, and regional body fat distribution between the two genotypes in middle-aged and elderly Japanese individuals (825 women and 906 men). The Mt15497 genotype was determined with an automated colorimetric allele-specific DNA probe assay system using the polymerase chain reaction (PCR) method. The Mt15497G-->A polymorphism was detected in 3.5% ( n=60) of all subjects: 2.8% ( n=23) among women and 4.1% ( n=37) among men. After adjusting for age and smoking, we found that body weight, body mass index, waist and hip circumferences, fat mass, fat-free mass, intra-abdominal fat and triglycerides were significantly greater in women with the A allele compared with the G allele ( p=0.001-0.025). For men, waist to hip ratio was significantly greater ( p=0.032), and waist circumference, intra-abdominal fat and triglycerides had a trend to be significantly greater ( p=0.062-0.087) in subjects with the A allele compared with the G allele. These data suggest that the Mt15497 polymorphism may be associated with obesity-related variables and lipid metabolism.

Effects of exercise intensity on physical fitness and risk factors for coronary heart disease

OBJECTIVE

To determine whether "low-intensity" exercise (walking) and "high-intensity" exercise (aerobic dance), when added to a weight loss diet, have different effects on coronary heart disease (CHD) risk factors and physical fitness.

RESEARCH METHODS AND PROCEDURES

Ninety obese women were divided into diet only (DO), diet plus walking (DW), and diet plus aerobic dance (DA) groups. DXA was used to evaluate segmental body composition. Leg-extension strength and maximal oxygen uptake (VO2max) were the indicators of physical fitness. Blood pressure, lipoproteins, and fasting glucose were used as indices for CHD risk factors. These items were measured before and after a 14-week intervention period.

RESULTS

Whole-body plus all segmental fat masses were significantly reduced (p < 0.001). Reductions in whole-body and lower-limb fat- and bone-free masses were significantly less (p < 0.01) in the DA group (-1.5 and -0.1 kg, respectively) compared with the DO (-2.1 and -0.4 kg, respectively) and DW (-2.5 and -0.5 kg, respectively) groups. Improvements in leg-extension strength and VO2max were significantly greater (p < 0.05) in the DA group compared with the DO group. The CHD risk factors clearly improved (p < 0.05) within each group. Reductions in low density lipoprotein-cholesterol and fasting glucose were significantly greater (p < 0.05) in the DA group compared with the DO and DW groups.

DISCUSSION

Adding higher intensity aerobic dance to a weight-loss diet program may help maintain fat- and bone-free mass and may be more effective in improving CHD risk factors compared with low-intensity walking.

Association of polymorphisms in the estrogen receptor alpha gene with body fat distribution

OBJECTIVE

To examine whether polymorphisms of the estrogen receptor (ER) alpha gene are associated with body fat distribution.

DESIGN

Cross-sectional, epidemiological study of two single-nucleotide polymorphisms, a T --> C (PvuII) and an A --> G (XbaI), in the first intron of the ERalpha gene.

SUBJECTS

A total of 2238 community-dwelling middle-aged and elderly Japanese population (age: 40-79 y).

MEASUREMENTS

The ERalpha genotypes (by automated fluorescent allele-specific DNA primer assay system), anthropometric variables, fat mass (FM) and percentage FM (%FM) (by dual-energy X-ray absorptiometry).

RESULTS

FM and waist were inversely associated with age (r=-0.630 and -0.504, respectively) in women with the GG genotype. On the other hand, waist circumference of the AA genotype was positively correlated with age (r=0.231). Thus, for middle-aged women (40-59 y) with the AG or GG genotype body mass index (BMI), %FM, FM, waist, hip and waist-to-hip ratio (WHR) were larger than those with the AA genotype. In particular, FM and waist were greater by 20% and 9%, respectively, for the GG genotype, compared to the AA genotype. Alternatively, FM and waist were smaller by 18% and 6%, respectively, in older women with the GG genotype, compared to the AA genotype. No effect was found among the A --> G polymorphisms for men. For both genders, no difference was found in any variables among the TT, TC and CC genotypes with the exception of BMI of older men (60-79 y).

CONCLUSION

No association was found between the ERalpha gene polymorphisms and body fat distribution in men. For women, the A --> G polymorphism, in particular the GG genotype, may contribute to the development of upper-body obesity in middle-aged individuals, but may serve to decrease the whole-body and abdominal fat tissue of older individuals.

Relationships of resting energy expenditure with body fat distribution and abdominal fatness in Japanese population

Body fat distribution and abdominal fatness are indicators of risks for coronary heart disease. However, the relationships between resting energy expenditure (REE) and the body fat distribution or the abdominal fatness are unclear. We examined the relationships of REE with whole-body fat distribution (waist, hip and waist-to-hip ratio: WHR) and abdominal fatness (intra-abdominal fat: IF and subcutaneous fat: SF) after adjustment for body composition. 451 men and 471 women were subdivided into two groups, 40-59 years: middle-aged group and 60-79 years: elderly group. REE was measured by an indirect calorimetry system. Percentage of fat mass (%FM), fat mass (FM) and fat-free mass (FFM) were assessed by a dual-energy x-ray absorptiometry method. The IF area (IFA) and SF area (SFA) at the level of the umbilicus were measured using computed tomography. Circumference of waist and hip were measured in a standing position. The WHR, waist circumference and SFA did not significantly (p>0.05) associate with the REE after adjusting for FM, FFM and age in any of the groups. The adjusted REE was significantly and inversely correlated with hip (r=-0.159, p<0.05) and IFA (r=-0.131, p<0.05) in the elderly men. These results suggest that lower REE may contribute to greater hip and IFA rather than WHR and waist in elderly men.

Effects of obesity phenotype on coronary heart disease risk factors in response to weight loss

OBJECTIVE

To determine whether there is a difference in risk-factor improvement for coronary heart disease (CHD) between the intra-abdominal fat (IF) and subcutaneous fat (SF) obesity phenotypes after weight loss.

RESEARCH METHODS AND PROCEDURES

Subjects included 55 mildly obese women (body mass index, 25 to 36 kg/m(2); age range, 34 to 63 years) who had at least two of three CHD risk factors [systolic blood pressure (SBP), >140 mm Hg; total cholesterol (TC), >220 mg/dL; fasting plasma glucose, >110 mg/dL). Using computed tomography, IF obesity was classified as > or =110 cm(2) of the IF area measured; subjects with <110 cm(2) were classified as having SF obesity. The IF and SF obesity groups were divided into diet-only and diet-plus-exercise groups. Assays and measurements were performed before and after a 14-week (98-day) intervention.

RESULTS

Weight was reduced by 7 to 10 kg in each group. The IF and SF areas, SBP, diastolic blood pressure, TC, and low-density lipoprotein-cholesterol were significantly reduced in all groups (p < 0.01). Reduction in IF area was greater in IF obesity than in SF obesity, whereas no differences were observed in the improvement of CHD risk factors. Sample sizes needed for observing a significant difference for SBP, TC, triglycerides, and fasting plasma glucose were greater than the number of subjects in this study.

DISCUSSION

Our results suggest that the influence of the obesity phenotype on improving CHD risk factors is not apparent. A larger study is needed to prove the validity of this finding.

Selective and sustained occupancy of prostatic alpha1-adrenoceptors by oral administration of KMD-3213 and its plasma concentration in rats

This study examined the ex-vivo occupancy by KMD-3213 of alpha1-adrenoceptors in the prostate and other tissues of rats in terms of tissue selectivity and duration of occupancy in relation to plasma concentration. Oral administration of KMD-3213 (0.2-20.2 micromol kg(-1), 0.5 h) dose-dependently decreased [3H]prazosin binding sites (Bmax) in the prostate (42-74%) and submaxillary gland (54-88%) compared with the control value. In contrast, there was only a slight change in the Bmax values in the spleen and cerebral cortex of KMD-3213-treated rats. The alpha1-adrenoceptor occupancy in the prostate and submaxillary gland was increased, with plasma free concentration of KMD-3213 at 0.5 h after oral administration of KMD-3213 (0.6-20.2 micromol kg(-1)). The receptor occupancy in these tissues was much greater than that in the spleen, heart or cerebral cortex. After oral administration of KMD-3213 (6.1 micromol kg(-1)), the alpha1-adrenoceptor occupancy in the prostate and submaxillary gland occurred rapidly, in parallel with the rise in the plasma concentration of the drug, and it lasted for at least 24 h, despite a remarkable decrease in the plasma concentration. It is concluded that KMD-3213 may produce fairly selective and sustained occupancy of alpha1-adrenoceptors in the prostate, a target organ for treatment of bladder outlet obstruction in patients with benign prostatic hyperplasia.

Targeted overexpression of CCAAT/enhancer-binding protein-delta evokes enhanced gene transcription of platelet-derived growth factor alpha-receptor in vascular smooth muscle cells

Platelet-derived growth factor (PDGF) is thought to play a significant role in various models of vascular remodeling, particularly in the early process of vascular diseases. Its action is mediated by its specific receptor, the PDGF receptor. The PDGF alpha-receptor (PDGFalphaR) plays an important role in the growth and proliferation of vascular smooth muscle cells (VSMCs), and its gene expression is thought to be regulated by several potential transcriptional nuclear factors. However, the detailed mechanisms of tissue-specific transactivation of the PDGFalphaR gene in VSMCs remain to be clarified. We have previously demonstrated that the rat PDGFalphaR gene contains an enhancer core sequence for CCAAT/enhancer-binding proteins (C/EBPs) in its promoter region, and we have also suggested that C/EBP-delta is the principal factor involved in the induction of tissue-specific transcriptional activity of the PDGFalphaR gene in VSMCs. To explore the definitive roles of C/EBP-delta protein on PDGFalphaR gene transcription in VSMCs, we developed C/EBP-delta transgenic rats by using a chimeric fusion gene of the mouse smooth muscle alpha-actin promoter and an entire coding region of rat C/EBP-delta cDNA. This report describes the first successful targeted overexpression of C/EBP-delta capable of inducing PDGFalphaR gene transcription and modifying cell proliferative activity to PDGFs. Targeted overexpression of C/EBP-delta evokes high levels of PDGFalphaR gene expression, susceptibility to VSMC growth, and proliferation of VSMCs to PDGFs. The results obtained reveal evidence of a new role and new functional significance of C/EBP-delta on VSMC growth via the PDGFalphaR during the process of vascular remodeling and atherosclerosis.