Letter to the Editor: Recovery of Physical Activity among Older Japanese Adults since the First Wave of the COVID-19 Pandemic

Are Middle-Aged and Older Adult Users of Physical Activity Monitoring Systems More Physically Active and at a Lower Risk of Locomotive Syndrome? A Cross-Sectional Web-Based Online Survey

BACKGROUND

Physical inactivity is a risk factor for locomotive syndromes and functional limitations in middle-aged and older adults. Therefore, strategies to promote physical activity should be considered. This study investigated whether users of physical activity monitors were more physically active and exhibited a lower risk of locomotive syndrome, compared with non-users.

METHODS

We analyzed data from 742 Japanese adults aged 60-79 years. The participants were surveyed for their use of physical activity monitors in their daily lives. We also assessed the prevalence of locomotive syndrome.

RESULTS

We observed significantly higher physical activity levels in users compared with non-users. Moreover, the use of a physical activity monitor was significantly associated with decreased odds of locomotive syndrome (adjusted odds ratio [aOR]=0.48). Significantly lower risk of locomotive syndrome were observed in individuals who had used a monitor for >2 years (aOR=0.42) or had set a personal step goal (aOR=0.32).

CONCLUSION

Physical activity monitoring may increase engagement in physical activity-associated behavior. Therefore, monitoring could serve as a useful tool to promote physical health in middle-aged and older adults.

Association between Non-Face-to-Face Interactions and Incident Disability in Older Adults

OBJECTIVES

This observational prospective cohort study, conducted between September 2015 and February 2019, aimed to investigate the association between the incidence of disability and non-face-to-face interactions among community-dwelling older adults in Japan.

DESIGN

Participants reported their interaction status using a self-report questionnaire. Face-to-face interactions comprised in-person meetings, while virtual interactions (e.g., via phone calls or emails) were defined as non-face-to-face interactions. We examined the relationship between their interaction status at baseline and the risk of disability incidence at follow-up. We also considered several potential confounding variables, such as demographic characteristics.

SETTING

The National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes.

PARTICIPANTS

We included 1159 adults from Takahama City aged ≥75 years (mean age ± standard deviation = 79.5 ± 3.6 years).

MEASUREMENTS

Interaction status was assessed using a self-reported questionnaire consisting of two sections (face-to-face and non-face-to-face interactions), and four questionnaire items. Based on the responses we categorized study participants into four groups: "both interactions," "face-to-face only," "non-face-to-face only," and "no interactions."

RESULTS

Individuals with both kinds of interactions (49.3/1000 person-years) or only one kind of interaction (face-to-face = 57.7/1000 person-years; non-face-to-face = 41.2 person-years) had lower incidence of disability than those with no interactions (88.9/1000 person-years). Moreover, the hazard ratios adjusted for potential confounding factors for the incidence of disability in the both interaction, face-to-face-only, and non-face-to-face only groups were 0.57 (confidence interval = 0.39-0.82; p = 0.003), 0.66 (confidence interval = 0.44-0.98; p = 0.038), and 0.47 (confidence interval = 0.22-0.99; p = 0.048), respectively.

CONCLUSION

Considering the interaction status of older adults in their day-to-day practice, clinicians may be able to achieve better outcomes in the primary prevention of disease by encouraging older adults to engage in any form of interaction, including non-face-to-face interactions.

Gender-Related Differences in Social Participation Among Japanese Elderly Individuals During the COVID-19 Pandemic: A Cross-Sectional Survey

Introduction/Objectives:

The health of elderly individuals is known to benefit from maintaining societal involvement and relationships with other people, such as through social participation. We aimed to determine trends in the percentage of Japanese elderly people who engaged in social participation before and during the coronavirus disease 2019 (COVID-19) pandemic in one municipality in Japan, and compared differences in this status by gender.

Methods:

We conducted a cross-sectional questionnaire survey. Questionnaires were sent by mail to 3000 people aged 65 to 85 years who were randomly selected by the administrative staff of the city. Participant characteristics (age, gender, working status, residential status) and their economic status, daily physical activity, and social participation status were obtained at 3 time points: (1) before the COVID-19 pandemic in January 2020; (2) immediately prior to the declaration of a state of emergency in April 2020; and (3) in January 2021, 1 year after (1).

Results:

A total of 1301 people responded to the survey. The mean age was 73.3 (SD 5.5) years, and 690 (53.0%) were women. There were significant gender differences in terms of living alone, employment status, and amount of physical activity. The number of people reporting social participation gradually decreased from 543 respondents (41.7%) at (1) to 319 (24.5%) at (2) and 251 (19.3%) at (3). Women were more likely to demonstrate reduced social participation.

Conclusions:

Elderly individuals, particularly women, reported decreased social participation during the pandemic.

COVID-19-Related Lifestyle Changes among Community-Dwelling Older Adult Day-Care Users: A Qualitative Study

In Japan, the community-based comprehensive care system is an important initiative. The purpose of this study was to understand COVID-19-related lifestyle changes experienced by older adults who lived in communities and used day-care services. Using a qualitative inductive research method, semi-structured interviews were conducted with 13 older adults who used day-care services in Kyoto City, which assessed lifestyle changes before and after the spread of COVID-19 during March-April 2021. The extracted lifestyle change codes were classified into six categories and 16 subcategories. The data revealed that older adults felt socially isolated and experienced multiple changes in their lives, including limited leisure activities, changes in roles, decreased interpersonal interaction with family and acquaintances, poor diet and sleep quality, and reduced attention to personal appearance and grooming. The findings suggest that during COVID-19, older adults had difficulty adapting to the various changes in their lives and showed a decline in physical and mental functioning. Thus, it is important for day-care facilities to create sustainable spaces in response to the various care needs of community-dwelling older adults whose lifestyles have changed as a result of the COVID-19 situation.

Relationship between Psychological Distress and Prolonged Sedentary Bouts in the Elderly: Four Period Analysis

Background: Too much sitting is associated with low mental health in elderly individuals. We clarified the relationship between psychological distress and the rate of prolonged sedentary bouts (PSBs) among the elderly over four periods. Methods: In a secondary analysis, a sample population of 68 adults aged 65 years or older in Japan was used. The following proxy variables were used: PSB (mental health) and the Kessler 6 scale; K6 scores (psychological distress). Results: Using the cross-lagged effects models, from “2016 K6” to “2017 PSB” (p = 0.004), from “2017 K6” to “2018 PSB” (p < 0.001), and from “2018 K6” to “2019 PSB” (p = 0.021) were all significant; however, the reverse were not all significant in one period. In four periods, from “2016 PSB” to “2019 K6” (p = 0.025) was significant; however, the reverse was not significant. Fit indices were obtained: χ² = 7.641 (p = 0.182), goodness of fit index (GFI) = 0.891, comparative fit index (CFI) = 0.901, and root mean square error of approximation (RMSEA) = 0.121 in structural equation modelling. Conclusions: Psychological distress may affect the rate of PSB after one year, and the rate of PSB may affect the rate of psychological distress after three years in elderly individuals.

Physical Activity and Perceived Physical Fitness during the COVID-19 Epidemic: A Population of 40- to 69-Year-Olds in Japan

The COVID-19 pandemic has caused an abrupt change in lifestyle for many people with restrictions, often leading to a decrease in physical activity (PA), and thus contributing to a negative perception of health status. The purpose of this study was to examine the effects of the COVID-19 epidemic on physical activity and perceived physical fitness in Japanese adults aged 40 to 69 years. Data were collected from an online survey conducted between October 19 and 28, 2020. The analytic sample consisted of 1989 Japanese adults (mean age, 50.1 ± 6.9 years; women, 38.9%) who were aged between 40 and 69 years and completed the online survey. Overall, the PA time per week decreased by 32.4% between October 2019 and April 2020. A decrease in PA time was recorded in October 2020; however, a decline of 15.5% was observed. Compared to individuals who did not perceive a decline in physical fitness, individuals who perceived declining physical fitness during the COVID-19 state of emergency demonstrated a greater decrease in PA time in April 2020 (-50.5%), and this trend continued into October 2020 (-25.0%). These findings may indicate that Japanese adults aged 40 to 69 years who perceived declining physical fitness experienced a greater decrease in physical activity.

Participation in Social Activities and Relationship between Walking Habits and Disability Incidence

Identifying the relationship between physical and social activity and disability among community-dwelling older adults may provide important information for implementing tailored interventions to prevent disability progression. The aim of this study was to determine the effect of the number of social activities on the relationship between walking habits and disability incidence in older adults. We included 2873 older adults (mean age, 73.1 years; SD, ±5.9 years) from the National Center for Geriatrics and Gerontology—Study of Geriatric Syndromes. Baseline measurements, including frequencies of physical and social activities, health conditions, physical function, cognitive function, metabolic parameters, and other potential disability risk factors (for example, the number of years of education); monthly assessment for disability was monitored through long-term care insurance certification for at least 2 years from baseline. During a mean follow-up of 35.1 months (SD, 6.4 months), 133 participants developed disability. The disability incidence was 19.0 and 27.9 per 1000 person-years for participants who walked more (≥3 times per week) and less (≤3 times per week) frequently, respectively. The potential confounding factor-adjusted disability hazard ratio was 0.67 (95% confidence interval, 0.46 to 0.96; p = 0.030). The relationship between habitual walking and the number of social activities was statistically significant (p = 0.004). The reduction of disability risk by walking was greater among participants with fewer social activities. Habitual walking was associated with disability incidence, with a more pronounced effect among older adults who were less likely to engage in social activities.

The Influence of the COVID-19 Pandemic on Physical Activity and New Incidence of Frailty among Initially Non-Frail Older Adults in Japan: A Follow-Up Online Survey

OBJECTIVES

The objective of this study was to investigate the influence of the COVID-19 pandemic on physical activity (PA) and the incidence of frailty among initially non-frail older adults in Japan.

DESIGN

A follow-up online survey.

SETTING AND SUBJECTS

Among the 1,600 baseline online survey participants, 388 adults were already frail, and 275 older adults did not respond to the follow-up survey. Thus, the final number of participants in this study was 937 (follow-up rate: 77.3%).

METHODS

We assessed the total PA time at four time points according to the COVID-19 waves in Japan: January 2020 (before the pandemic), April 2020 (during the first wave), August 2020 (during the second wave), and January 2021 (during the third wave). We then investigated the incidence of frailty during a one-year follow-up period (during the pandemic).

RESULTS

The total PA time during the first, second, and third waves of the pandemic decreased from the pre-pandemic PA time by 33.3%, 28.3%, and 40.0%, respectively. In particular, the total PA time of older adults who were living alone and socially inactive decreased significantly: 42.9% (first wave), 50.0% (second wave), and 61.9% (third wave) less than before the pandemic, respectively. Additionally, they were at a significantly higher risk of incident frailty than those who were not living alone and were socially active (adjusted odds ratio: 2.04 [95% confidence interval: 1.01-4.10]).

CONCLUSION

Our findings suggest that older adults who live alone and are socially inactive are more likely to experience incident frailty/disability due to decreased PA during the pandemic. Understanding this mechanism may be crucial for maintaining the health status of older adults.

More Active Participation in Voluntary Exercise of Older Users of Information and Communicative Technology even during the COVID-19 Pandemic, Independent of Frailty Status

OBJECTIVES

The aim of this study was to examine whether older users of information and communicative technology (ICT) participate in active behaviors, such as voluntary exercise, to maintain health, even under community containment to suppress the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

Cross-sectional study.

SETTING

Community setting.

PARTICIPANTS

Independent community-dwelling older residents aged ≥75 years.

MEASUREMENTS

The municipality sent the Kihon Checklist (KCL) and Simplified Nutritional Appetite Questionnaire (SNAQ) with several questions on lifestyle and health conditions under social restriction.

RESULTS

Among 3199 responders (72.1%), we analyzed the data of 2304 residents who provided complete answers to the KCL and SNAQ and on ICT use, voluntary exercise, polypharmacy, and families. The mean age was 79.7 years (51.3% male). The percentages of frailty assessed by the KCL, voluntary exercise, and low SNAQ scores (≤14) were 16.0%, 61.4%, and 43.8% in 808 ICT users and 30.3%, 47.2%, and 54.1% in 1496 ICT non-users, respectively (p<0.001). ICT use was significantly associated with voluntary exercise even during social restriction, independent of age, sex, polypharmacy, low SNAQ scores, and frailty status (odds ratio, 1.503; 95% confidential interval, 1.246-1.813).

CONCLUSION

Older ICT users are more active to maintain health even during social restriction, independent of frailty status.