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

Regional Difference in the Impact of COVID-19 Pandemic on Domain-Specific Physical Activity, Sedentary Behavior, Sleeping Time, and Step Count: Web-Based Cross-sectional Nationwide Survey and Accelerometer-Based Observational Study

BACKGROUND

Physical activity (PA) and sedentary behavior (SB) have been affected by the COVID-19 pandemic and its restrictive environments, such as social distancing and lockdown measures. However, regional differences in the changes in domain-specific PA and SB in response to the COVID-19 pandemic are not clearly understood.

OBJECTIVE

This study aimed to examine regional differences in domain-specific PA and SB, as well as sleeping time in response to the COVID-19 pandemic in Japan.

METHODS

A web-based cross-sectional nationwide survey and an accelerometer-based longitudinal observation were conducted. In the web-based survey, we recruited 150 Japanese men and 150 Japanese women for each of the following age groups: 20s, 30s, 40s, 50s, 60s, and 70s (n=1800). A total of 1627 adults provided valid responses to web-based surveillance from June to July 2020. Participants were recruited from urban (Greater Tokyo Area, n=1028), urban-rural (regional core cities, n=459), or rural (regional small and medium cities, n=140) areas. They answered sociodemographic and health-related questions and retrospectively registered the PA data of their average day before and during the COVID-19 pandemic in a web-based PA record system. In the accelerometer-based observation, PA and step count data were obtained using a triaxial accelerometer on people living in urban (n=370) and rural (n=308) areas.

RESULTS

Before the COVID-19 pandemic, there were no significant differences between these 3 regions in the time spent sleeping, staying at home, working or studying, and exercising (P>.05). By contrast, people living in urban areas had a longer duration of SB and transportation and a shorter duration of moderate-to-vigorous PA and lying or napping time compared with people living in rural areas (P>.05). During the COVID-19 pandemic, a significant decrease was observed in transportation time in urban (-7.2 min/day, P<.001) and urban-rural (-2.0 min/day, P=.009) areas but not in rural (-0.4 min/day, P=.52) areas. The moderate-to-vigorous PA was decreased in urban (-31.3 min/day, P<.001) and urban-rural (-30.0 min/day, P<.001) areas but not in rural areas (-17.3 min/day, P=.08). A significant increase was observed in time spent sleeping in urban (+22.4 min/day, P<.001) and urban-rural (+24.2 min/day, P<.001) but not in rural areas (+3.9 min/day, P=.74). Lying or napping was increased in urban (+14.9 min/day, P<.001) but not in rural areas (-6.9 min/day, P=.68). PA and step count obtained using an accelerometer significantly decreased in urban (P<.05) but not in rural areas (P>.05).

CONCLUSIONS

The effect of the COVID-19 pandemic on PA and SB was significantly dependent on living area, even in a single country. The effects of PA and SB were greater in the Greater Tokyo Area and regional core cities but were not observed in regional small and medium cities in Japan.

Locomotive syndrome in rheumatoid arthritis patients during the COVID-19 pandemic

This study aimed to longitudinally evaluate the development of locomotive syndrome (LS) in rheumatoid arthritis (RA) patients during the COVID-19 pandemic using the 25-question Geriatric Locomotive Function Scale (GLFS-25). Subjects were 286 RA patients (female, 70.6%; mean age, 64.2 years) who had GLFS-25 and Clinical Disease Activity Index (CDAI) data available for a 1-year period during the COVID-19 pandemic and who did not have LS at baseline. Associations between subject characteristics and development of LS were determined using logistic regression analysis. Among the 286 patients, 38 (13.3%, LS group) developed LS at 1 year after baseline. In the LS group, scores of the GLFS-25 categories "GLFS-5" and "Social activities" were significantly increased at 1 year relative to baseline. GLFS-5 is a quick 5-item version of the GLFS-25, including questions regarding the difficulty of going up and down stairs, walking briskly, distance able to walk without rest, difficulty carrying objects weighing 2 kg, and ability to carry out load-bearing tasks and housework. A significant correlation was also observed between changes in "Social activities" and that of "GLFS-5." Multivariable logistic regression analysis revealed that the development of LS was significantly associated with BMI (OR: 1.11 [95% confidence interval (CI): 1.00-1.22]) and CDAI (OR: 1.08 [95%CI: 1.00-1.16]) at baseline. Adequate exercise and tight control of RA disease activity are important for preventing the development of LS in view of restrictions on going out imposed during the COVID-19 pandemic. GLFS-5 is useful for evaluating the physical function of RA patients.

Effect of Home-Based Training with a Daily Calendar on Preventing Frailty in Community-Dwelling Older People during the COVID-19 Pandemic

It has been reported that marked decreases in physical activity including social activities, deterioration in eating habits and mental health, and an increase in frailty have occurred during the COVID-19 pandemic. This study aimed to devise a method to prevent the onset and progression of frailty during the COVID-19 pandemic and to verify its effect. The subjects were 111 community-dwelling older people who answered questionnaires before and after the intervention. A calendar incorporating 31 different tasks, one for each day, was created as an intervention tool with the aim of improving motor, oral, and cognitive functions. The intervention group (n = 49) participants performed these tasks every day for 3 months. The primary outcome was the Kihon checklist (KCL) score. When the amount of change in the KCL score before and after 3 months was compared between the two groups, no difference in the total score was observed between the two groups; however, the intervention group showed significantly improved cognitive function in the KCL sub-domain. In the intervention group, the number of pre-frailty and frailty patients decreased significantly after the intervention compared to before the intervention. These results suggest that the use of the calendar created in this study during the COVID-19 pandemic could prevent decreased cognitive function in the KCL sub-domain and could help prevent the onset and progression of pre-frailty and frailty.

Impact of Daycare Service Interruption during COVID-19 Pandemic on Physical and Mental Functions and Nutrition in Older People with Dementia

This study evaluated changes of cognitive, physical, and nutritional status before and after the interruption and resumption of daycare services during the COVID-19 pandemic in older dementia people in a daycare center. Comprehensive geriatric assessment data were analyzed before and after the lockdown of daycare center services, including mini-mental state examination, activities of daily living (ADL) scores, mini-nutritional assessment-short forms (MNA-SF), and timed up-and-go (TUG) tests. Among 19 dementia people participating in daycare services, 17 participants were enrolled in the study with, finally, two excluded because of incomplete follow-ups. They had a median age of 81 years; their MNA-SF scores and TUG values deteriorated significantly after a 3-month closure of daycare services (p < 0.05), and after resumption of daycare services the MNA-SF scores and TUG values recovered to near the pre-lockdown levels (p < 0.05). Besides, baseline ADL scores predicted a decline and recovery of TUG and MNA-SF values. Our findings suggest that planning continuous support for older dementia adults is important for daycare facilities during COVID-19 pandemic confinement.

Internet use and physical activity of older adults during the COVID-19 pandemic: a cross-sectional study in a northern Japanese City

Background

Little is known of whether Internet use is associated with physical activity among socially isolated older adults during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated the association between Internet use and physical activity, and whether this association differs depending on social isolation among community-dwelling Japanese older adults.

Methods

A cross-sectional study was conducted with 1048 community-dwelling residents aged 65–90 years. Data were obtained using a self-reported questionnaire in August 2020. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form. Multivariable logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between Internet use and moderate-to-vigorous physical activity (MVPA).

Results

Internet use showed a significant association with MVPA (OR = 1.42, 95% CI: 1.06–1.90) after adjusting for age, sex, self-reported socioeconomic status, and other health-related characteristics. When the results were stratified by social participation and living status, Internet use was associated with a significantly higher likelihood of MVPA among participants with no social participation (OR = 1.81, 95% CI: 1.03–3.17) and living with family (OR = 1.40, 95% CI: 1.02–1.93).

Conclusion

Internet use was associated with sufficient physical activity, and this association may differ depending on the social isolation among community-dwelling older adults in Japan.

Factors Related to Preventive Behaviors against a Decline in Physical Fitness among Community-Dwelling Older Adults during the COVID-19 Pandemic: A Qualitative Study

Older adults face the concern of developing frailty and sarcopenia due to an inactive lifestyle during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to reveal the preventive behaviors taken by older adults who perceived a decline in physical fitness during COVID-19 and analyze the background factors which promoted such behaviors using a qualitative study design in 2020. The participants were recruited through the cohort study of Japanese older adults who were aged 79–81 and had not been diagnosed with sarcopenia previously in 2019 and perceived their physical fitness to have declined during the pandemic. The interviews of 19 participants were analyzed using thematic analysis. The participants engaged in five types of preventive behaviors to counter declining physical fitness: “walking”, “exercising at home”, “improving daily diet”, “maintaining a daily routine”, and “taking a good rest”. Four themes were extracted pertaining to backgrounds of such preventive behaviors: “feeling anxiety and mental pressure”, “available networks with family and neighbors”, “prior experiences of behaviors”, and “access to information”. Anxiety due to lifestyle changes during the pandemic was the primary reason for the behaviors. This study can be a useful guide for undertaking possible measures to prevent frailty during future pandemics.

Behavior changes and functional capacity Physical, social, and dietary behavioral changes during the COVID-19 crisis and their effects on functional capacity in older adults

Background

This two-year follow-up study aimed to identify factors associated with unhealthy behaviors during the COVID-19 pandemic and examine their impact on functional capacity in older adults.

Methods

Altogether, 536 adults aged ≥65 years participated in this study. The frequency of going out, exercise habits, face-to-face and non-face-to-face interactions, social participation, and eating habits were examined as behavioral factors before and after the first declaration of a state of emergency in Japan. Functional capacity was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence.

Results

Using latent class analysis considering changes in the six behaviors, the participants were divided into healthy (n = 289) and unhealthy (n = 247) behavior groups. The male sex was associated with 2.36 times higher odds, diabetes with 2.19 times higher odds, depressive mood with 1.83 times higher odds, poor subjective economic status with 2.62 times higher odds, and living alone with 44% lower odds of being unhealthy. The unhealthy behavior group showed significantly decreased functional capacity (B =−1.56 [−1.98, −1.14]) than the healthy behavior group. For each behavior, negative changes in going out (B =−0.99 [−1.60, −0.37]), face-to-face interaction (B =−0.65 [−1.16, −0.13]), and non-face-to-face interactions (B =−0.80 [−1.36, −0.25]) were associated with a decline in functional capacity.

Conclusion

Our results showed four factors associated with engaging in unhealthy lifestyle behaviors and how behavioral changes affect functional capacity decline during the COVID-19 pandemic, which will help to develop public health approaches

How Has the Nationwide Public Health Emergency of the COVID-19 Pandemic Affected Older Chinese Adults' Health Literacy, Health Behaviors and Practices, and Social Connectedness? Qualitative Evidence From Urban China

Older Chinese adults' daily lives have been affected significantly during the outbreak phase of the COVID-19 pandemic since January 2020. They were confronted with activity restrictions due to strict pandemic prevention. The older population also had to get accustomed to widely-used modern technologies in community management, such as health codes and WeChat groups. By late 2021, mainland China had reduced the prevalence of COVID-19, and people's daily lives had primarily returned to pre-pandemic normality. Under China's systematic health management during the pandemic, older Chinese adults' responses to this nationwide public health emergency may have influenced their health in the long run. However, it remains unclear what specific health changes or improvements have occurred. Such a void in the literature is worrying, given that older adults are at high health risks due to the pandemic which, might still be with humankind for a while. Thus, it is of necessity to explore and report their health changes after this official, large-scale health intervention. In this study, 17 adults aged 55 and above were recruited as interviewees. All interviewees reside in a community located in Q district, N city of the People's Republic of China. According to the findings, many interviewees now have better literacy in health risk prevention. Information and Communication Technologies (ICTs) play a significant role in getting access to health information. Specifically, television, WeChat chatting groups, and TikTok could be valuable information sources for older adults. As for the understanding and evaluation of health information, although older participants can distinguish COVID-19 rumors, they may sometimes feel confused about the underlying scientific logic. Regarding changes in health behaviors and practices, many older adults can integrate health information and knowledge into their daily lives. Additionally, although interviewees can keep important social connections, not all of them are familiar with using new ICTs, such as online chatting group, for social participation and engagement. The empirical evidence suggests that both the communities and the local governments can offer specific training programs to older residents for the sake of enhancing their health literacy, health behaviors and practices, and social connectedness during and after the pandemic.

[Factors influencing changes in daily life due to the state of emergency among older adults living in Akita Prefecture]

The present study is assessed the effects of COVID-19 on the mental and physical function after the declaration of an emergency situation, which included the request that residents refrain from going out, in order to prevent the spread of COVID-19 infection. The investigation was conducted from 2019 to 2020. Our samples consisted of 506 older adults (332 people in 2019 and 174 people in 2020), whose physical, cognitive, depression, and independence in daily and social activities were measured annually. Furthermore, a questionnaire survey (COVID-19 questionnaire) on the impact of the spread of COVID-19 infection on respondents' daily lives (reduction in social interaction, going out, exercise, and sleep time) was conducted among participants in 2020. According to a statistical analysis, the UWS (Usual Walking Speed) was significantly faster in 2020 than it had been in 2019 (p<0.000). However, no significant differences were found in other items. A correlation analysis, revealed a significant association between the reduction in sleep time and GDS-15 (Geriatric Depression Scale) score (r=0.200, p=0.019) and between the COVID-19 questionnaire total score and body mass index (r=0.282, p=0.001).These results suggest that the decline in the physical and mental function might not have been evident in older adults in Akita Prefecture, where the number of infected people is small, although a more detailed long-term follow-up is needed. Even in such areas, there might be a significant relationship between depression and sleep or between changes in daily life due to self-imposed restraint and obesity as an effect of self-imposed restraint among 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.

Challenges and Opportunities for Osteoporosis Care During the COVID-19 Pandemic

PURPOSE

The coronavirus disease 2019 (COVID-19) has both directly and indirectly affected osteoporosis diagnosis and treatment throughout the world.

METHODS

This mini-review summarizes the available evidence regarding the effects of COVID-19, its treatment, and the consequences of the pandemic itself on bone health. Additionally, we review evidence and expert recommendations regarding putative effects of osteoporosis medications on COVID-19 outcomes and vaccine efficacy and summarize recommendations for continuation of osteoporosis treatment during the pandemic.

RESULTS

The use of standard screening procedures to assess for osteoporosis and fracture risk declined dramatically early in the pandemic, while rates of fragility fractures were largely unchanged. COVID-19, its treatments, and public health measures to prevent viral spread are each likely to negatively affect bone health. Osteoporosis treatments are not known to increase risk of adverse events from COVID-19, and preclinical data suggest possible beneficial effects of some therapies. Vitamin D deficiency is clearly associated with adverse outcomes from COVID-19, but it remains unclear whether vitamin D supplementation may improve outcomes. Osteoporosis treatment should be continued whenever possible, and recommendations for substituting therapies, if required, are available.

CONCLUSION

The COVID-19 pandemic has decreased screening and disrupted treatment for osteoporosis. Osteoporosis medications are safe and effective during the pandemic and should be continued whenever possible. Further studies are needed to fully understand the impact of the COVID-19 pandemic on long-term bone health.

Are non-face-to-face interactions an effective strategy for maintaining mental and physical health?

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has led to social isolation measures, forcing many people to stay indoors, stop daily outdoor activities, and limit face-to-face social interactions with friends, colleagues, and family. This study aimed to identify if non-face-to-face interaction affects depressive symptoms and frailty in older adults.

METHODS

We included 3834 older adults (age: 71.1 ± 6.9 [mean ± standard deviation] years; range: 60-96 years; 2153 women) from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Interaction status was assessed using a self-reported questionnaire. Participants were categorized into: "both interactions" (both face-to-face and non-face-to-face interactions), "face-to-face only" (only face-to-face interactions), "non-face-to-face only" (only non-face-to-face interactions), "no interactions" (neither face-to-face nor non-face-to-face interactions) groups. Depressive symptoms and frailty were measured using the 15-item Geriatric Depression Scale and Kihon Checklist, respectively.

RESULTS

Potential confounding factors-adjusted odds ratios for both, face-to-face only and non-face-to-face only groups for developing depressive symptoms were 0.39 (95%CI, 0.26-0.57; p<0.001), 0.56 (95%CI, 0.38-0.84; p=0.004), and 0.51 (95%CI, 0.27-0.96; p=0.038), respectively, and those for development of frailty were 0.44 (95%CI, 0.30-0.65; p<0.001), 0.59 (95%CI, 0.39-0.87; p=0.008), and 0.63 (95%CI, 0.34-1.15; p=0.128), respectively.

CONCLUSIONS

Our findings indicate that non-face-to-face interactions are also important in preventing the deterioration of mental health, which is a concern during the COVID-19 pandemic. However, non-face-to-face interactions alone may not be sufficient to maintain physical health, and it is important to maintain opportunities for face-to-face interaction among older adults, particularly during the COVID-19 pandemic.

Change in subjective health status among frail older Japanese people owing to the coronavirus disease pandemic and characteristics of their responses

Aim

The coronavirus disease 2019 (COVID‐19) pandemic remains a major global public health issue, and it has led to restrictions in physical and social activities among community‐dwelling people, including frail older adults. This study aimed to determine the impact of the pandemic on the subjective health status and characteristics of community‐dwelling frail older adults by assessing their knowledge of infection, behaviors and negative psychological response.

Methods

During October 2019, 720 older adults participated in “The Otassha Study.” A year after the COVID‐19 outbreak, between June 29 and July 31, 2020, a health status questionnaire, comprising questions concerning knowledge about infection, behaviors and psychological responses during the pandemic, was sent to all participants of the health examination in 2019. Respondents were divided into the robust and frail groups, and their responses were compared.

Results

Although the self‐reported health status of the older adults in both groups was worse in 2020 than in 2019, differences were not observed in the degree of deterioration between the groups. Those in the frail group had fewer resources of information related to COVID‐19 and had fewer coping behaviors for health maintenance compared with the robust group.

Conclusion

Information gathering and actions aimed at health maintenance tended to be weaker among older adults with frailty, although the influence of COVID‐19 on subjective health status did not differ significantly between robust and frail adults. Therefore, robust and frail older adults may need to adopt different countermeasures to prevent worse health during this pandemic. Geriatr Gerontol Int 2021; 21: 1053–1059.

Trajectories of frailty, physical function, and physical activity levels in elderly patients with heart failure: impacts of interruption and resumption of outpatient cardiac rehabilitation due to COVID-19

During the nationwide state of emergency, many hospitals could not provide outpatient cardiac rehabilitation for cardiac disease patients in order to minimize coronavirus disease 2019 (COVID-19) incidence. The purpose of this study was to examine the trajectories of frailty, physical function and physical activity levels due to interruption and resumption of outpatient cardiac rehabilitation by COVID-19 in elderly heart failure patients. Fifteen patients who did not attend outpatient cardiac rehabilitation during the state of emergency but resumed it after the state of emergency were included. Frailty, physical function and physical activity levels were assessed with the Kihon checklist (KCL), various tests including short physical performance battery (SPPB), and life space assessment (LSA), respectively. Objective parameters were measured at three points; before and after the nationwide state of emergency in Japan and 3 months after resuming outpatient cardiac rehabilitation. The post-state of emergency KCL score was significantly higher than the pre-state of emergency score (P = 0.03), whereas there was no significant difference in KCL between post-state of emergency and 3 months after cardiac rehabilitation resumption. SPPB and LSA scores did not change significantly between pre- and post-state of emergency. The changes in LSA from post-state of emergency to 3 months after cardiac rehabilitation resumption tended to correlate with changes in KCL (r = -0.71, P = 0.11). We demonstrated that frailty status deteriorated significantly in elderly heart failure patients whose outpatient cardiac rehabilitation was interrupted due to COVID-19. In addition, the frailty status showed no significant improvement after 3 months of resuming cardiac rehabilitation.

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.

Change in walking steps and association with built environments during the COVID-19 state of emergency: A longitudinal comparison with the first half of 2019 in Yokohama, Japan

In Japan, a state of emergency (SoE) was declared in early April 2020 until late May in response to the first wave of the coronavirus disease (COVID-19). This longitudinal study analyzed the step counts of 18,817 citizens in Yokohama city in the first half of 2020 compared to the previous year, and investigated the association between the change in step counts and the individuals' neighborhood environment by sex and age using generalized linear mixed models. Step counts decreased especially in women and non-elderly people during the SoE. Older women were more susceptible to the neighborhood environment: high walkability (i.e., high population density, proximity to railway stations) adversely affected their step counts, whereas proximity to large parks came to have a positive effect during the SoE.

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.