Long-term effects of home-based bench-stepping exercise training on healthcare expenditure for elderly Japanese

Socioeconomic Disparities in Health Care Consumption: Using the 2018-China Family Panel Studies

The existing research on residents’ health care consumption mostly covers medical care consumption and seldom regards residents’ health care consumption as an independent research object. This article takes residents’ healthcare consumption as the research object and aims to explore the impact of socioeconomic status on healthcare consumption and its mechanisms. The data of this study came from the 2018-China Family Panel Studies (CFPS). The binary probit regression model and the Tobit model explored the impact mechanism of residents’ income, education, occupation, and physical activity on health care consumption decision-making and health care expenditure, respectively. The research results showed that, from the perspective of the direct influence mechanism, residents’ work income (0.029, p < 0.01) and education level (811.149, p < 0.01) had a significant positive impact on health care consumption. Residents whose occupations (−99.697, p < 0.01) tend to be more skilled and also have higher health care consumption. From the perspective of the mediating mechanism, residents’ physical exercise duration had a significant positive impact on their participation in healthcare consumption (0.005, p < 0.01) but had a weaker impact on healthcare consumption expenditure (21.678, p < 0.1). In general, socioeconomic status represented by income, education, and occupation had a significant positive impact on residents’ health care consumption. The duration of physical exercise also played an important mediating role.

Effects of acute moderate-intensity aerobic exercise on executive function and prefrontal cortex activity in community-dwelling older adults: A single-blind, randomized controlled trial

AIM

To date, there is a controversy regarding the effects of acute aerobic exercise of moderate intensity on executive function and prefrontal cortex activity in community-dwelling older adults. This study aimed to investigate the effects of acute aerobic exercise of moderate intensity in healthy older adults.

METHODS

Fifty-six healthy older adults were randomly assigned to the experimental group (EG) that performed moderate-intensity aerobic exercise or the wait-list control group (CG) for a total of 15 sessions. To compare the two groups, the Stroop Color-Word Task (SCWT) and the Trail-Making Test Part B (TMT-B) were implemented for executive function and prefrontal cortex activity during executive function testing.

RESULTS

After the intervention, the EG achieved a significant improvement in the SCWT (P < 0.001; η²  = 0.196) and the TMT-B (P < 0.001; η²  = 0.245) compared with the CG. In addition, the EG showed a lower HbO2 concentration in the prefrontal cortex than the CG during the SCWT (P < 0.05; η²  = 0.076) and the TMT-B (P < 0.05; η²  = 0.090).

CONCLUSIONS

These findings shed new light on the clinical effectiveness of acute moderate-intensity aerobic exercise on executive function and prefrontal cortex activity in healthy older adults. Geriatr Gerontol Int 2022; ••: ••-••.

Association between single limb standing test results and healthcare costs among community-dwelling older adults

BACKGROUND AND OBJECTIVE

Identifying risks for older adults who will require healthcare resources is critical for the government, healthcare providers, and consumers. The objective of this study was to examine the relationship between the results of the single limb standing (SLS) test and healthcare costs among community-dwelling older adults.

METHODS

We used data obtained from a population-based prospective cohort study of the residents of Tadami town in Fukushima Prefecture, Japan. The participants were above 60 years of age and had undergone annual health check-ups, and data on their healthcare costs over the two-year study period were available. A censored regression model adjusted for potential confounders was used to estimate the mean difference in total healthcare costs between participants who could remain standing on a single limb for at least 30 s and those who could not.

RESULTS

Healthcare costs of participants who passed the SLS test were significantly lower than those who did not. The mean difference between the two groups' healthcare costs was 4064 USD (95 % confidence interval: 2661-5467 USD, p < 0.05). After adjusting for potential confounders, the mean difference between the two groups was smaller (1686 USD) but remained statistically significant (95 % confidence interval: 125-3246 USD, p < 0.05).

CONCLUSIONS

Among community-dwelling older adults, limited static balance (SLS time <30 s) was found to be associated with high healthcare costs in the two years after the SLS test. The SLS test may help identify individuals at high risk of becoming frequent users of healthcare services in the future.

Internet of Things (IoT) System and Field Sensors for Exercise Intensity Measurements

Although exercise training according to individual peak aerobic capacity ( V ˙ o_2peak ) has been recommended at all ages, sensors available in the field are limited. The most popular sensors in the field are pedometers, but they cannot be used to monitor exercise intensity. Instead, although heart rate (HR) monitors are broadly available in the field to estimate exercise intensity, HR responses to exercise vary by individual according to physical fitness and environmental conditions, which hinders the precise measurement of energy expenditure. These issues make it difficult for exercise physiologists to collaborate with geneticists, nutritionists, and clinicians using the internet of things (IoT). To conquer these problems, we have developed a device that is equipped with a triaxial accelerometer and a barometer to measure energy expenditure during interval walking training (IWT) in the field with inclines. IWT is a training regimen to repeat fast and slow walking for 3 min each, equivalent to greater than 70% and approximately 40% of individual V ˙ o_2peak , respectively. Additionally, we developed an IoT system that enables users to receive instructions from trainers according to their walking records even if they live far away. Since the system is available at low cost with minimum personnel, we can investigate any factors affecting the adherence to and effects of IWT in a large population for a long period. This system was also used to verify any effects of nutritional supplements during IWT and to examine the value of applying IWT to clinical medicine. © 2020 American Physiological Society. Compr Physiol 10:1207-1240, 2020.

Effects of a moderate-intensity aerobic exercise programme on the cognitive function and quality of life of community-dwelling elderly people with mild cognitive impairment: A randomised controlled trial

BACKGROUND

Individuals with mild cognitive impairment have a heightened risk of developing dementia. Physical exercise, especially moderate-intensity aerobic exercise, is a promising lifestyle intervention to improve the cognitive function of this patient group. However, the mechanisms underlying the exercise-cognition relationship are not fully understood. Whether the cognitive benefits of physical exercise can improve the overall well-being of this group remains unknown. This study aims to address these research gaps in the under-researched Chinese population.

OBJECTIVES

This study aimed to evaluate the effects of a moderate-intensity aerobic exercise programme on the cognitive function and health-related quality of life of Chinese elderly with mild cognitive impairment and to explore the mediating roles of depressive mood and sleep quality in the exercise-cognition relationship.

DESIGN

A single-blinded randomised controlled trial.

SETTINGS AND PARTICIPANTS

This study was conducted in two urban community healthcare centres in Hangzhou City, China. Elderly people aged over 60 years screened with mild cognitive impairment were included.

METHODS

A total of 120 eligible participants were randomly assigned to receive either the group-based moderate-intensity aerobic exercise programme or the health education programme (as attention-placebo control). Montreal Cognitive Assessment, Quality of Life-Alzheimer's Disease, Geriatric Depression Scale and Pittsburgh Sleep Quality Index were administered at baseline before randomisation and immediately after the completion of the interventions. Analysis followed the intention-to-treat principle. Generalised estimating equation was used to compare the changes in the cognitive function and health-related quality of life over the pre-test and post-test periods between the groups. The mediating roles of depressive mood and sleep quality in the exercise-cognition relationship were examined with the PROCESS macro.

RESULTS

Participants in the intervention group had a significantly greater improvement in terms of cognitive function (β = 1.895; 95% confidential interval [CI] = 1.421, 2.368; p <  0.001) and health-related quality of life (β= 0.605; 95% CI= 0.295, 0.914; p <  0.001) compared with the control group over the pre-test and post-test periods. The exercise-cognition relationship was significantly mediated by reduced depressive symptoms (indirect effect: β= -0.705; 95% CI: -1.028, -0.382) and improved sleep quality (indirect effect: β=-0.205; 95% CI: -0.122, 0.831).

CONCLUSIONS

This study revealed the benefits and outlined the underlying mediating mechanism of an aerobic exercise programme to the cognitive function and health-related quality of life of Chinese elderly people with mild cognitive impairment. The findings provided insights into the development of public health initiatives to promote brain health amongst the elderly with mild cognitive impairment.

Interval Walking Training Can Increase Physical Fitness in Middle-Aged and Older People

No long-term exercise training regimen with high adherence and effectiveness for middle-aged and older individuals is currently broadly available in the field. To address this problem, we developed an exercise training system comprising interval walking training and an information technology network that requires only minimal staff support. We hypothesized that our training system could increase physical fitness in older people.

Peroxisome proliferator-activated receptor gamma co-activator 1 gene Gly482Ser polymorphism is associated with the response of low-density lipoprotein cholesterol concentrations to exercise training in elderly Japanese

Muscle peroxisome proliferator-activated receptor gamma co-activator 1 (PGC-1)α gene expression is influenced by the Gly482Ser gene polymorphism, which is a candidate genetic risk factor for diabetes mellitus and obesity. This study investigated the effects of PGC-1 gene Gly482Ser polymorphisms on alterations in glucose and lipid metabolism induced by exercise training. A 12-week intervention study was performed for 119 participants who were more than 65 years of age and completed exercise training at lactate threshold intensity. Total cholesterol and low-density lipoprotein cholesterol were significantly reduced in Gly/Gly but not in Gly/Ser and Ser/Ser participants after exercise. The Gly/Gly genotype of the PGC-1 gene Gly482Ser polymorphism influences the effects of moderate-intensity exercise training on low-density lipoprotein cholesterol and total cholesterol concentrations in older people.

Do healthier lifestyles lead to less utilization of healthcare resources?

Background

Governments are urged to determine methods to control the use of medical resources and curb the rise of healthcare costs. The question is, do health behaviors have an impact on the use of medical resources? This study aims to identify and understand the difference in the number of outpatient visits and health examinations based on various health behaviors and to determine whether patients seek medical care for illness from the same physicians.

Methods

This study used the dataset derived from the Department of Budget, Accounting and Statistics of Kaohsiung, Taiwan in 2005. Persons older than 15 years were surveyed using an on-site questionnaire. A total of 2911 persons were enrolled in this study. Independent t-tests, chi-square tests, one-way ANOVA, multiple linear regression and binominal logistic regression were used in the data analysis.

Results

The regression model for the frequency of doctor visits, health examinations, and whether the same physician is sought for medical care has demonstrated significant correlations with gender, age and education-level variables. Four health behaviors (i.e., exercise habits, dietary habits, regular blood pressure measurement, drinking habits) exhibited a significant correlation with healthcare utilization (P <0.05).

Conclusions

Healthy lifestyles lead to an increase in the utilization of preventive health services. However, there is not much significantly reducing the number of outpatient visits in people with health behaviors. Specifically, people with regular exercise habits and who take their blood pressure measurement regularly have an increased number of outpatient visits. It is suggested that more available and accessible health consultation services be provided to inculcate in the general public the importance of maintaining a healthy lifestyle.

Views and Expectations of Community-Dwelling Thai Elderly in Reporting Falls to Their Primary Care Physicians

Fall among older adults is a concern in Thailand. The challenge for primary care physicians is to deliver effective interventions potentially adhered to by older people. This research employed a mixed-methods design to understand factors leading to fall reporting by community-dwelling Thai elders and their expectations regarding fall prevention education. Participants ( N = 305) who had fallen in the last year completed a questionnaire in the quantitative phase, and 50 of these were interviewed in-depth in the qualitative phase. Results revealed that only 39% reported their fall. Participants with comorbidities were 1.6 times more likely to report falling than those without (odds ratio = 1.61, confidence interval = [1.01, 2.58]). Post-fall pain (84%) was the strongest reason for reporting. Some participants believed that falling is an inevitable life event. It is crucial to encourage older adults to report falling, to provide targeted education, and to focus on improving the overall health status of older adults.

Effects of home-based bench step exercise on inflammatory cytokines and lipid profiles in elderly Japanese females: A randomized controlled trial

PURPOSE

The purpose of the current study was to investigate the effects of a 12-week home-based bench step exercise program on inflammatory cytokines and lipid profiles in elderly females.

METHODS

Sixty-two postmenopausal females (65-85 years of age) were randomized to either the bench step exercise group (n=31) or the control group (n=31). The subjects in the bench step exercise group were instructed to perform bench step exercises at the exercise intensity corresponding to lactate threshold (LT), three times per day 10-20 min each session, for a goal of ≥140 min/week at home for 12 weeks. At baseline and 12 weeks, circulating levels of nine inflammatory cytokines (high-molecular-weight adiponectin, interleukin-4 [IL-4], IL-5, IL-6, IL-8, IL-15, tumor necrosis factor-α [TNF-α], TNF-β and interferon-γ [IFN-γ]) and serum lipids including high-density lipoprotein cholesterol (HDL-C) were measured.

RESULTS

The bench step training at the LT significantly increased HDL-C levels and decreased IFN-γ concentrations in the subjects with lower (< 63 mg/dL) baseline HDL-C levels (p<0.05). The change in IFN-γ inversely correlated with the change in HDL-C in the exercise group (ρ=-0.56, p<0.01), whereas this association was not observed in the control group. Additionally, principal component analysis-derived index of what we called "inflammatory status factor" was inversely associated with the changes in HDL-C in the exercise group.

CONCLUSION

The bench step exercise-induced reduction in the IFN-γ levels may partially explain the degree of improvement in the HDL-C levels with the exercise program.