Effect of Exercising with Others on Incident Functional Disability and All-Cause Mortality in Community-Dwelling Older Adults: A Five-Year Follow-Up Survey

Utilization of Japanese long-term care-related data including Kaigo-DB: An analysis of current trends and future directions

Despite high expectations from the government and researchers regarding data utilization, comprehensive analysis of long-term care (LTC)-related data use has been limited. This study reviewed the use of LTC-related data, including Kaigo-DB, in Japan after 2020. There was an increase in studies using LTC-related data in Japan between 2020 and 2021, followed by a stabilization period. The national government provided 13.5% of this data (6.5% from Kaigo-DB), while prefectures and municipalities contributed 85.2%, and facilities provided 1.3%. The linked data used in 90.4% of the studies primarily consisted of original questionnaire or interview surveys (34.6%) and medical claims (34.0%). None of the studies based on Kaigo-DB utilized linked data. In terms of study design, cohort studies were the most common (84.6%), followed by descriptive (5.1%), cross-sectional (3.2%), and case-control studies (1.3%). Among the 138 individual-based analytical descriptive studies, the most frequently used LTC-related data as an exposure was LTC services (26.8%), and the most common data used as an outcome was LTC certification or care need level (43.5%), followed by the independence degree of daily living for the older adults with dementia (18.1%). To enhance the use of LTC-related data, especially the valuable national Kaigo-DB, insights can be gleaned from how researchers effectively utilize municipal and prefectural data. Streamlining access to Kaigo-DB and enabling its linkage with other datasets are promising for future research in this field.

Impact of exercising alone and exercising with others on the risk of cognitive impairment among older Japanese adults

PURPOSE

This longitudinal study investigates the influence of the stratified frequency of exercising alone and exercising with others on the prevention of cognitive impairment among older Japanese adults.

METHODS

This four-year follow-up study targeted 4,358 individuals (mean age: 76.9 ± 5.6 years, female: 51.8%) who participated in an inventory mail survey in one region of Japan. The exercise forms surveyed involved the frequency of exercising alone and with others. Cognitive impairment was assessed using the nationally standardized dementia scale proposed by the Ministry of Health, Labour and Welfare of Japan. Adjusted Cox proportional-hazard models were used to examine the association between the exercise forms and the development of cognitive impairment, and calculate population-attributable fractions (PAFs).

RESULTS

The cumulative incidence of cognitive impairment throughout the study was 7.7%. Participants who exercised ≥ 2 times/week alone (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.61-0.998) had a lower risk of developing cognitive impairment than those who did not exercise alone. Similarly, participants who exercised ≥ 2 times/week with others (HR = 0.66; 95% CI = 0.47-0.94) showed a lower risk of developing cognitive impairment than those who did not exercise with others. The scenarios involving PAFs demonstrated that, if all participants exercised alone or with others ≥ 2 times/week, the risk of cognitive impairment decreased by 15.1% and 29.2%, respectively.

CONCLUSION

Both forms of exercise reduced the development of cognitive impairment, with exercising with others potentially being highly effective in preventing cognitive impairment.

Does laughing with others lower the risk of functional disability among older Japanese adults? The JAGES prospective cohort study

While laughter is evoked mainly in social contexts, the potential link between laughter in daily life and health benefits is unclear. This study aimed to examine the association between laughter in daily life and the onset of functional disability among older adults in Japan. Data were obtained from a 6-year follow-up cohort of 12,571 participants (46.1% male) in the Japan Gerontological Evaluation Study, aged ≥65 years, who could independently perform daily activities. We evaluated their laughter in daily life from three perspectives: the types of situations in which people laugh, the number of situations in which people laugh with others, and the persons with whom people laugh. Using the Cox proportional hazards model, the risk of functional disability was estimated. A total of 1420 functional disabilities were observed during follow-up. After adjusting for potential confounders, participants who laughed with others (e.g., during conversations with friends) were at a reduced risk of functional disability (hazard ratio, 0.77; 95% confidence interval, 0.65-0.92) than those who laughed alone (e.g., during watching television). Similarly, the number of situations to laugh with others was inversely associated with the risk of functional disability (P_trend < 0.001). Laughing in a conversation with friends reduced the risk of functional disability by approximately 30% compared to laughing alone. Overall, laughing with others was associated with a reduced risk of functional disability. Having more situations to laugh with others or at least the situation to laugh with friends might contribute to reducing the risk of functional disability later in life.

Combined effect of daily physical activity and social relationships on sleep disorder among older adults: cross-sectional and longitudinal study based on data from the Kasama study

Background

This study investigated whether daily physical activity of older adults, combined with social relationships, is associated with the risk of sleep disorder. Further, it determined whether a high level of one variable with a low level of the other, leads to a significantly lower risk of sleep disorder than low levels of both.

Methods

The sample comprised 1339 community-dwelling older Japanese adults: 988 in Study 1 and 351 in Study 2. The level of daily physical activity and range of social relationships were assessed using the Physical Activity Scale for the Elderly and the Lubben Social Network Scale, respectively. The Pittsburgh Sleep Quality Index was used to assess sleep disorder. To test the combined relationships and effects in Studies 1 and 2, the medians for the respective scores of each of the following four groups that the participants were categorized into, were calculated: (1) low activity group with low social relationships, (2) low activity group with high social relationships, (3) high activity group with low social relationships, and (4) high activity group with high social relationships. After adjusting for potential confounders, a logistic regression analysis was conducted in Study 1. After adjusting for potential confounders, a Cox proportional hazards regression analysis was conducted in Study 2.

Results

Study 1 revealed that the high activity group with high social relationships showed a significantly lower risk of sleep disorder (ORs: 0.585, 95% CI: 0.404–0.847) than the low activity group with low social relationships. Study 2 also revealed that the high activity group with high social relationships showed a significantly lower prevalence of sleep disorder (HRs: 0.564, 95% CI: 0.327–0.974) than the low activity group with low social relationships.

Conclusions

Our findings suggest that for older adults with high social relationships, being physically active is favorably associated with sleep quality. However, a high level of one variable with a low level of the other has not been confirmed in improving sleep quality among older adults.

Perceived declining physical and cognitive fitness during the COVID-19 state of emergency among community-dwelling Japanese old-old adults

Aim

Perceived health status, including physical and cognitive fitness, will be negatively associated with future health conditions among old‐old adults. The coronavirus disease 2019 (COVID‐19) pandemic has caused sudden changes in lifestyle. Thus, this study examined the associations of participation in an exercise class before the COVID‐19 pandemic and the exercise habits and disruption to the rhythms of daily life during the COVID‐19 state of emergency with perceived declining physical and cognitive fitness among community‐dwelling old‐old adults.

Methods

In July 2020, we carried out a mail survey of community‐dwelling old‐old adults aged between 77 and 99 years in Bibai, Hokkaido, Japan, to determine their perceived declining physical and cognitive fitness during the COVID‐19 state of emergency.

Results

Of the 774 responders, 339 (43.8%) participants reported a decline in physical fitness, whereas 259 (33.5%) perceived declining cognitive fitness during the COVID‐19 state of emergency. In a multivariate logistic regression model adjusted for potential confounders, exercise habits during the COVID‐19 state of emergency were significantly associated with a lower perception of declining physical fitness. Disruption to the rhythms of daily life during the COVID‐19 state of emergency was significantly associated with a higher perception of declining physical and cognitive fitness.

Conclusions

Approximately half and more than one‐third of community‐dwelling old‐old adults perceived declining physical and cognitive fitness, respectively, during the COVID‐19 state of emergency. During this period, exercise habits were positively correlated with perceived health status among old‐old adults, whereas disruption to the rhythms of daily life was negatively correlated. Geriatr Gerontol Int 2021; 21: 364–369.

Associations between exercising in a group and physical and cognitive functions in community-dwelling older adults: a cross-sectional study using data from the Kasama Study

[Purpose] To examine the associations of exercise habits, particularly exercising in a group, with physical and cognitive functions in community-dwelling older adults. [Participants and Methods] A total of 615 older adults participated in this cross-sectional study. We conducted three physical performance tests (grip strength, five times sit-to-stand, and 5-meter walk tests) and the Five-Cog test (attention, memory, visuospatial, language, and reasoning). We investigated exercise habits using questionnaires and classified the participants into three groups as follows: those who did not exercise (n=86), those who exercised alone (n=168), and those who exercised in a group (n=362). To clarify the associations of exercise habits with physical and cognitive functions, we used the analysis of covariance with adjustment for potential confounders. [Results] The participants who exercised in a group had better lower limb strength than those who exercised alone and better scores for all the variables than the non-exercisers. Furthermore, those who exercised in a group scored significantly higher on the attention, memory, visuospatial, and overall cognitive function tests than those who exercised alone. [Conclusion] Our results highlight the importance of the social aspects associated with exercising, such as the presence of exercise peers, to improve the physical and cognitive health of older adults.

A Bowling Exergame to Improve Functional Capacity in Older Adults: Co-Design, Development, and Testing to Compare the Progress of Playing Alone Versus Playing With Peers

Background

Older people often do not meet the recommended levels of exercise required to reduce functional decline. Social interaction is mentioned by this cohort as a reason for joining group-based exercises, which does not occur when exercising alone. This perspective shows that exergames can be used as motivational resources. However, most available exergames are generic, obtained from commercial sources, and usually not specifically designed or adapted for older people.

Objective

In this study, we aim to co-design and develop a new exergame alongside older participants to (1) tailor the game mechanics and optimize participants’ adherence to and enjoyment of exercise; (2) test the participants’ functional capacity, motivation, and adherence to the exergaming program; and (3) compare these scores between those who played alone and those who played with peers.

Methods

We conducted a co-design process to develop a new exergame adapted to older people. For user testing, 23 participants were divided into 2 groups to play individually (alone group) or to compete in pairs (with peers group). They played the game twice a week, resulting in 21 exergaming sessions. We assessed the participants’ General Physical Fitness Index (GPFI) before and after the user testing. We also administered questionnaires about the gaming experience and exercise adherence with its motivators and barriers.

Results

We introduced a new bowling exergame for Xbox with a Kinect motion sensor that can be played in single or multiplayer mode. For the GPFI measurements, the sample was homogeneous in the pretest (with peers group: mean 40.5 [SD 9.6], alone group: mean 33.9 [SD 7.8]; P=.11). After the exergame testing sessions, both groups had significant gains (with peers group: mean 57.5 [SD 8.7], P=.005; alone group: mean 44.7 [SD 10.6]; P=.02). Comparing the posttest between groups, it was found that the group in which participants played with peers had better outcomes than the group in which participants played alone (P=.02). Regarding the gaming experience and exercise adherence, both groups recognized the benefits and expressed enthusiasm toward the exergame.

Conclusions

The findings suggest that the developed exergame helps in improving the functional capacity and adherence to physical exercise among older people, with even better results for those who played with peers. In addition to leading to more appropriate products, a co-design approach may positively influence the motivation and adherence of participants.