Exercise or sports in midlife and healthy life expectancy: an ecological study in all prefectures in Japan

Association between daily step counts and healthy life years: a national cross-sectional study in Japan

BACKGROUND

Despite accumulating evidence concerning the association between daily step counts and mortality or disease risks, it is unclear whether daily step counts are associated with healthy life years.

METHODS

We used the combined dataset of the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey conducted for a randomly sampled general population in Japan, 2019. Daily step counts were measured for 4957 adult participants. The associations of daily step counts with activity limitations in daily living and self-assessed health were evaluated using a multivariable logistic regression model. The bootstrap method was employed to mitigate uncertainties in estimating the threshold of daily step counts.

RESULTS

The median age was 60 (44-71) years, and 2592 (52.3%) were female. The median daily step counts were 5650 (3332-8452). The adjusted OR of activity limitations in daily living for the adjacent daily step counts was 0.27 (95% CI 0.26 to 0.27) for all ages and 0.25 (95% CI 0.25 to 0.26) for older adults at the lowest, with the thresholds of significant association at 9000 step counts. The OR of self-assessed unhealthy status was 0.45 (95% CI 0.44 to 0.46) for all ages and 0.42 (95% CI 0.41 to 0.43) for older adults at the lowest, with the thresholds at 11 000 step counts.

CONCLUSION

Daily step counts were significantly associated with activity limitations in daily living and self-assessed health as determinants of healthy life years, up to 9000 and 11 000 step counts, respectively. These results suggest a target of daily step counts to prolong healthy life years within health initiatives.

Impact of access to childhood health services on healthy life expectancy of the older population

Background

Life course theory provides new perspectives on the impact of early experiences on health in old age, where unfortunate childhood experiences can alter an individual's health trajectory. This study aims to calculate the healthy life expectancy of the older population in China under different childhood experiences, and to explore the influence of childhood medical and health services on the health level of older adults.

Methods

Differences in healthy life expectancy of the older population under different childhood experiences were analyzed using the multi-state life table method to calculate the healthy life expectancy by sex and place of birth, based on the cohort data of Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018.

Results

The probability of the transition risk from health to non-health gradually increased with age, while the probability of the transition risk from non-health to health decreased with age; In both urban and rural areas, on the probability of the transition risk from health to non-health, the older adults who were able to receive timely medical and health services in childhood were lower than those who failed to receive medical services in time (Z = -5.833, P < 0.05), but the probability of the transition risk from non-health to health was the opposite (Z = -5.334, P < 0.05); The probability of the transition risk from health to death is also higher in older adults who were unable to receive timely medical care in childhood (Z = -5.88, P < 0.05); The healthy life expectancy and its proportion in the remaining life expectancy of older people who received medical and health services in time during childhood were significantly higher than those of their peers (Z = -5.88, P < 0.05).

Conclusions

The lack of medical services in childhood has a negative effect on the health of older adults. The healthy life expectancy and its proportion of remaining life expectancy were higher for rural older adults than for urban older adults under the same health care conditions in childhood; the health benefits of good access to health care environment or conditions in childhood were greater for rural older females.

Ideal cardiovascular health metrics and life expectancy free of cardiovascular diseases: a prospective cohort study

Objectives

Whether cardiovascular health (CVH) metrics impact longevity with and without cardiovascular diseases (CVDs) has not been well established. This study aimed to investigate the association between CVH metrics and life expectancy in participants free of CVD events. We hypothesized that ideal CVH status was associated with increased life expectancy and assessed the effect of CVH status as a prevention target of longevity in the framework of predictive, preventive, and personalized medicine (PPPM/3PM).

Methods

A total of 92,795 participants in the Kailuan study were examined and thereafter followed up until 2020. We considered three transitions (from non-CVD events to incident CVD events, from non-CVD events to mortality, and from CVD events to mortality). The multistate lifetable method was applied to estimate the life expectancy.

Results

During a median follow-up of 13 years, 12,541 (13.51%) deaths occurred. Compared with poor CVH, ideal CVH attenuated the risk of incident CVD events and mortality without CVD events by approximately 58% and 27%, respectively. Women with ideal CVH at age 35 had a 5.00 (3.23-6.77) year longer life expectancy free of CVD events than did women with poor CVH metrics. Among men, ideal CVH was associated with a 6.74 (5.55-7.93) year longer life expectancy free of CVD events.

Conclusion

An ideal CVH status is associated with a lower risk of premature mortality and a longer life expectancy, either in the general population or in CVD patients, which are cost-effective ways for personalized medicine of potential CVD patients. Our findings suggest that the promotion of a higher CVH score or ideal CVH status would result in reduced burdens of CVD events and extended disease-free life expectancy, which offered an accurate prediction for primary care following the concept of PPPM/3PM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-023-00322-8.

Relationships among Physical Activity, Physical Function, and Food Intake in Older Japanese Adults Living in Urban Areas: A Cross-Sectional Study

Japan is experiencing a super-ageing society faster than anywhere else in the world. Consequently, extending healthy life expectancy is an urgent social issue. To realize a diet that can support the extension of healthy life expectancy, we studied the quantitative relationships among physical activities (number of steps and activity calculated using an accelerometer), physical functions (muscle strength, movement function, agility, static balance, dynamic balance, and walking function), and dietary intake among 469 older adults living in the Tokyo metropolitan area (65-75 years old; 303 women and 166 men) from 23 February 2017 to 31 March 2018. Physical activities and functions were instrumentally measured, and the dietary survey adopted the photographic record method. There was a significant positive association (p < 0.05) between physical activities (steps, medium-intensity activity, and high-intensity activity) and physical functions (movement function, static balance, and walking function), but no association with muscle strength. These three physical functions were significantly positively correlated with intake of vegetables, seeds, fruits, and milk; with magnesium, potassium, and vitamin B6; and with the dietary fibre/carbohydrate composition ratio (p < 0.05). Future intervention trials must verify if balancing diet and nutrition can improve physical activities in older adults through increased physical functions.

Sports activity participation and subjective health status of patients after total hip arthroplasty via the anterolateral-supine approach: a case series study

Background

No reports have been published about participation in sports activity and subjective health status after total hip arthroplasty via the anterolateral approach in the supine position (ALS-THA) in Japanese patients. This study assessed sports activity participation and subjective health status, as well as factors potential associated with these variables, in patients who underwent ALS-THA.

Methods

Of 698 patients who underwent total hip arthroplasty at our institution between 2013 and 2018, questionnaires were sent to 355 patients under 80 years old who had undergone ALS-THA and 242 responded. Patients were asked about their subjective health status, participation in sports activity, the EuroQol 5-dimensions 5-level (EQ-5D-5L), the University of California Los Angeles (UCLA) activity scale score and the Forgotten Joint Score (FJS). Patient characteristics and hospitalization information were also collected. Patients’ subjective health status was categorized as “healthy” or “unhealthy”. Univariate and multivariate logistic regression analyses were performed to determine factors associated with participation in sports activity after ALS-THA and a “healthy” status.

Results

The pre- and postoperative sports activity participation rates were 54.0% and 57.8%, respectively. Most patients (76.8%, n = 182) were considered “healthy”. Age (P = .019) and UCLA activity score (P < .001) were significantly associated with sports activity after ALS-THA. FJS (P = .002) and EQ-5D-5L (P = .004) were significantly associated with a “healthy” status.

Conclusion

Patients participating in sports activity after ALS-THA are older and have higher UCLA activity scores and patients considered “healthy” have higher FJS and EQ-5D-5L scores.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05886-6.

Age differences in the association of physical leisure activities with incident disability among community-dwelling older adults

Background

The relationship between leisure activities (LA) in old age and prevention of disability has not been fully investigated, and age and gender differences of these relationships are unknown. This study aimed to investigate whether physical and cognitive LA predicted incident disability among community-dwelling older adults by age and gender.

Methods

We prospectively observed 8,275 residents aged 65 or above without disability at baseline for 3 years. Incident disability was defined as a new certification of the public long-term care insurance system. LA were classified into two types: physical LA and cognitive LA. The frequency of LA was categorized into frequent (i.e., once a week or more), moderate (i.e., monthly or yearly), and non-engagement. Covariates included age, gender, family number, education, perceived economic situation, body mass index, chronic medical conditions, alcohol consumption, smoking status, regular dental visits, depression, cognitive functioning, and social participation. Multivariable Poisson regression models were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for incident disability. We performed stratified analyses by age groups (i.e., the young-old aged 65–74 and the old-old aged 75–97) and gender (i.e., men and women).

Results

The 3-year cumulative incidence of disability was 7.5%. After adjustment for covariates and mutual adjustment for both types of LA, a significant dose-response relationship between more frequent LA and lower risk of incident disability was found in young-old physical LA (P-trend < 0.001), in old-old cognitive LA (P-trend = 0.012), in male cognitive LA (P-trend = 0.006), and in female physical LA (P-trend = 0.030). Compared with people without LA, adjusted CIR (95% CI) of frequent LA was 0.47 (0.30–0.74) in young-old physical, 0.75 (0.58–0.96) in old-old cognitive, 0.65 (0.46–0.89) in male cognitive, and 0.70 (0.52–0.95) in female physical. Regarding the effect modification according to age and gender, only interaction between age and physical LA significantly prevented incident disability (P for interaction = 0.019).

Conclusion

We found age differences in the association of physical LA with incident disability among community-dwelling older adults. An effective measure to prevent long-term care in the community would be to recommend frequent physical LA for the young-old.

Supplementary information

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.21-00018.

Epidemiology of sudden death in organized school sports in Japan

Background

Nearly half of the sudden deaths documented in Japanese middle and high school occurred during school organized sport activities. However, no study to date has calculated the incidence rates of these deaths by sport. Therefore, this study aimed to describe the epidemiology of sudden death in organized school sports in Japan.

Methods

Data submitted to Japan Sport Council (JSC) Injury and Accident Mutual Aid Benefit System between 2005 and 2016 were retrieved from JSC website for analysis (n = 1137). Case information on fatal incidents that occurred during organized school sports in middle and high school students were extracted for analysis (n = 198). Descriptive statistics about activity type, sex, sport, cause of death, and presence of on-site trained medical personnel were calculated using frequencies and proportions. Sudden death incidence rates were expressed per 100,000 athlete-years with 95% confidence intervals (CI).

Results

The overall incidence rate of sports-related death was 0.38 deaths per 100,000 athlete-years (95%CI = 0.30, 0.45). Only three cases (2%) reported having trained medical personnel on-site at the time of death. Most deaths were in male student athletes (n = 149/162, 92%), with 7.5 times greater fatality rate in male compared to female student athletes (incidence rate ratio, 7.5; 95%CI = 4.43, 13.22). Baseball (n = 25/162, 15.4%), judo (n = 24/162, 14.8%), soccer/futsal (n = 20/162, 12.3%), and basketball (n = 18/162, 11.1%) accounted for 53.7% of deaths. Accounting for the number of participants in the respective sport, the three highest average incident rates of death were reported in rugby (4.59 deaths per 100,000 athlete-years, 95%CI = 2.43, 6.75), judo (3.76 deaths per 100,000 athlete-years, 95%CI = 1.58, 5.93), and baseball (0.59 deaths per 100,000 athlete-years, 95%CI = 0.38, 0.79). The top three causes of death were sudden cardiac arrest (n = 68/162, 42.0%), head trauma (n = 32/162, 19.8%), and heat related injury (n = 25/162, 15.4%).

Conclusions

In conclusion, the highest rates of sports-related death among Japanese student athletes were observed in the following: rugby, male athletes, and during practices. The leading cause of death was sudden cardiac arrest.

Financial Literacy and Exercise Behavior: Evidence from Japan

Lack of exercise, which increases the risk of many serious physical and mental illness, has been a common health issue in Japan. Recent studies confirm that financial literacy discourages irrational behavior like gambling and smoking. We therefore investigate how financial literacy, as a rational decision-making instrument, relates to peoples’ exercise behavior in Japan. We hypothesize that financial literacy encourages people to exercise regularly. Using Osaka University’s Preference Parameters Study (PPS) for 2010, we categorized respondents into two groups: those who exercise regularly or at least once a week and those who do not. Our probit estimation results show that financial literacy is positively related with exercise behavior, meaning that financially literate people are more likely to exercise regularly. As the COVID-19 health pandemic seems to exacerbate peoples’ physical inactivity, the results of our study show an alternative approach to encourage exercise. We therefore recommend that governments implement a financial literacy improvement policy to alleviate the lack of exercise.

Summary of the 9th Life Science Symposium: integration of nutrition and exercise sciences

The Life Science Symposium held by the Nutrition Research Committee of the International Life Sciences Institute (ILSI) Japan in 2018, "Fusion of Nutrition and Exercise Sciences Leading to Extension of Healthy Life Expectancy," covered current topics in the science of nutrition and exercise to address extending healthy life expectancy. Presentation topics included (1) lifestyle and gut microbiota; (2) how to use lipids in sports nutrition; (3) the effect and molecular mechanism of improvement of arteriosclerosis by exercise and nutrition; (4) physical activity and nutrition that support brain function; (5) skeletal muscles and food ingredients that support healthy longevity; (6) measures against sarcopenia by exercise and nutrient intake; (7) physical activity/exercise for disease prevention; (8) nutritional epidemiology research for the Japanese population; (9) new developments in health science in viewed from nutrition and intestinal flora; (10) why do Asians develop nonobese metabolic disease?; and (11) social implementation of the health promotion program by ILSI Japan. The speakers emphasized the promotion of research on exercise and nutrition interactions and encouraged social implementation of the research results in public and private sectors.

Declined Functional Status Prolonged Hospital Stay for Community-Acquired Pneumonia in Seniors

Purpose

Among senior community-acquired pneumonia (CAP) survivors, functional status after hospitalization is often decreased. This study investigated the change of functional status affecting delayed discharge.

Patients and Methods

This retrospective observational study was conducted in two medical facilities from January 2016 to December 2018. Hospitalized CAP patients >64 years old were divided into two groups: an early group discharged ≤1 week after ending antibiotic treatment and a delayed group discharged >1 week after ending antibiotic treatment. The primary outcome was decline in functional status.

Results

The early group comprised 170 patients and the delayed group comprised 155 patients (median age: 78 vs 82 years; p = 0.007). Distribution of the causative microorganisms and initial prescription of antibiotics showed no significant differences in the two groups (p=0.38; p=0.83, respectively) More patients showed decline in functional status in the delayed group than the early group (16 (9.4%) vs 49 (31.6%), p<0.001), even if rehabilitation was more frequently conducted (77 (45.3%) vs 118 (76.1%); p<0.001). Higher medical expenses were observed in the delayed group ($8631 vs $3817, respectively; p<0.001). Multivariable regression analysis of factors contributing delayed discharge revealed that decreased functional status, pneumonia severity index (PSI) categories, rehabilitation enrolled, aspiration and age were independently associated with delayed discharge (odds ratio 4.31, 95% confidence interval (CI) 2.32–7.98; 2.34, 95% CI 1.43–3.82; 15.96, 95% CI 4.56–55.82 (PSI V vs II); 2.48, 95% CI 1.11–5.98; and 1.03, 95% CI 1.01–1.06; respectively).

Conclusion

Functional status decline was independently associated with extended hospitalization.