Effects of small community walking intervention on physical activity, well-being, and social capital among older patients with cardiovascular disease in the maintenance phase: a randomized controlled trial

[Purpose] Older patients with cardiovascular disease should increase their physical activity and prioritize positive psychological and social approaches in the maintenance phase of their cardiac rehabilitation. This study aimed to clarify the effect of small community walking on physical activity, well-being, and social capital in older patients with cardiovascular disease in the maintenance phase. [Participants and Methods] We conducted a multicenter study in Kumamoto, Japan. We randomly divided 55 patients with cardiovascular disease into two groups: small community walking and walking alone. For three months, a registered cardiac rehabilitation instructor provided walking guidance to both groups using a wearable device. We measured physical activity, social capital, and subjective happiness before and after the intervention. [Results] Results revealed a statistically significant main effect of time on physical activity and social participation. In the subjective happiness scale, there was an association between group and time. [Conclusion] Our results suggest that walking guidance using a wearable device was beneficial in improving overall physical activity, regardless of whether the individual did small community walking or walking alone. Furthermore, small community walking intervention may effectively enhance well-being. The relationship between physical activity and social participation needs to be further investigated.

Effects of social network incentives and financial incentives on physical activity and social capital among older women: a randomized controlled trial

Background

Financial incentives have been used to increase physical activity. However, the benefit of financial incentives is lost when an intervention ends. Thus, for this study, we combined social network incentives that leverage the power of peer pressure with financial incentives. Few reports have examined the impact of physical activity on social capital. Therefore, the main goal of this study was to ascertain whether a combination of two incentives could lead to more significant changes in physical activity and social capital during and after an intervention.

Methods

The participants were 39 older women over 65 years of age in Kumamoto, Japan. The participants were randomly divided into a financial incentive group (FI group) and a social network incentive plus financial incentive group (SNI + FI group). Both groups underwent a three-month intervention. Measurements of physical activity and social capital were performed before and after the intervention. Additionally, the effects of the incentives on physical activity and social capital maintenance were measured 6 months postintervention. The financial incentive group received a payment ranging from US$4.40 to US$6.20 per month, depending on the number of steps taken during the intervention. For the other group, we provided a social network incentive in addition to the financial incentive. The SNI + FI group walked in groups of three people to use the power of peer pressure.

Results

A two-way ANOVA revealed that in terms of physical activity, there was a statistically significant interaction between group and time (p = 0.017). The FI group showed no statistically significant improvement in physical activity during the observation period. In terms of the value of social capital, there was no significant interaction between group and time.

Conclusion

Our results suggest that social network incentives, in combination with financial incentives, are more effective for promoting physical activity than financial incentives alone among older women and that these effects can continue after an intervention. In the meantime, further studies should be conducted on the effect of physical activity on social capital.

Trial registration

UMIN000038080, registered on 09/22/2019 (Retrospectively registered).

Prolonged effectiveness of 12-month exercise-plus-diet intervention in Japanese adults at risk of impaired glucose or lipid metabolism

BACKGROUND AND OBJECTIVES

To investigate the prolonged effects of a 12-month exercise-plus-diet intervention in Japanese adults at risk of impaired glucose or lipid metabolism.

METHODS AND STUDY DESIGN

A total of 180 participants were randomly divided into an intervention group (n=94), and a control group (n=86). An exercise-plus- diet intervention was conducted on the intervention group for 12 months. The effects were evaluated by questionnaire, physical examinations, and blood tests at baseline, 3 months, 12 months (the end of intervention), and 24 months (one year after the end of intervention). The control group took only the same examinations as the intervention group.

RESULTS

At the end of the 12-month intervention, body weight, waist circumference, fasting glucose, HbA1c, triglycerides, and LDL-cholesterol were improved in the intervention group compared to the control group (all p<0.05). One year after the end of the intervention, body weight, waist circumference, fasting glucose, triglycerides, and LDL-cholesterol were still decreased in the intervention group compared to the control group (all p<0.05), especially among non-overweight participants. Among overweight persons, only body weight in the intervention group was lower than the control group. The personal behaviours of physical activity and diet in the intervention group were also improved.

CONCLUSIONS

The 12-month exercise-plus-diet programs were found to be effective in improving glucose and lipid metabolism, as well as personal behaviour one year after completion of the intervention.

Slow movement resistance training using body weight improves muscle mass in the elderly: A randomized controlled trial

To examine the effect of a 12-week slow movement resistance training using body weight as a load (SRT-BW) on muscle mass, strength, and fat distribution in healthy elderly people. Fifty-three men and 35 women aged 70 years old or older without experience in resistance training participated, and they were randomly assigned to a SRT-BW group or control group. The control group did not receive any intervention, but participants in this group underwent a repeat measurement 12 weeks later. The SRT-BW program consisted of 3 different exercises (squat, tabletop push-up, and sit-up), which were designed to stimulate anterior major muscles. Initially, these exercises were performed by 2 sets of 10 repetitions, and subsequently, the number of repetitions was increased progressively by 2 repetitions every 4 weeks. Participants were instructed to perform each eccentric and concentric phase of movement slowly (spending 4 seconds on each movement), covering the full range of motion. We evaluated muscle mass, strength, and fat distribution at baseline and after 12 weeks of training. Changes over 12 weeks were significantly greater in the SRT-BW group than in the control group, with a decrease in waist circumference, hip circumference, and abdominal preperitoneal and subcutaneous fat thickness, and an increase in thigh muscle thickness, knee extension strength, and hip flexion strength. In conclusion, relatively short-term SRT-BW was effective in improving muscle mass, strength, and fat distribution in healthy elderly people.

Pedometer-determined physical activity and indicators of health in Japanese adults

Recently, many cross-sectional studies observed that body mass index (BMI) and percentage of body fat (%BF) were inversely associated with pedometer-determined physical activities, but studies on Asian populations, including the Japanese, are sparse. Height, weight, body fat percentage (%BF, bioelectrical impedance analyzer), and waist circumference were measured on 117 women (62.8+/-4.5 years, 22.2+/-2.2 kg/m(2)) and 62 men (64.0+/-4.6 years, 23.6+/-2.5 kg/m(2)). Pearson correlations and partial correlation coefficients after controlling for age were calculated between steps/day and variables. Furthermore, participants were classified into four groups as follows: <5,000, 5,000-7,499, 7,500-9,999, and >or=10,000 steps/day, and analyzed using ANOVA across activity groups. In women, a significant correlation was found between steps/day and BMI (r=-0.217, p=0.018), %BF (r=-0.292, p=0.0014), and the relationship was still significant after controlling for age. The relationship between steps/day and waist circumference was not significant. In men, a significant relationship was not observed between steps/day and obesity indices. The correlations between steps/day and both BMI and %BF were significant in Japanese women, but weak compared with Caucasian and African-American women as reported previously. A possible cause is racial difference in degree of obesity and body shape. The effects of physical activity on body shape and composition may differ according to race.

Favorable effects of non-instrumental resistance training on fat distribution and metabolic profiles in healthy elderly people

This study examined the effect of a 12-week non-instrumental resistance training program using body weight as a load (RT-BW) on body composition, fat distribution and metabolic profiles in elderly males and females. Healthy, non-diabetic, elderly volunteers (22 males and 30 females) aged 65-82 years were non-randomly divided into RT-BW (12 males and 20 females) and control (10 males and 10 females) groups. The RT-BW subjects were trained three times per week for 12 weeks according to a specified protocol involving a combination of upper and lower body weight and rubber tubing exercises. We evaluated body composition and fat distribution using anthropometry, dual energy X-ray absorptiometry and ultrasonography, and measured serum lipid levels and HbA(1c) at baseline and after 12 weeks of training. Changes over 12 weeks were significantly greater in the RT-BW group compared with the control group, with a decrease in waist circumference, pre-peritoneal (visceral) fat thickness and thigh fat thickness, and an increase in thigh muscle thickness. On the other hand, the changes in body weight, fat mass and fat free mass were no different between the groups. Further, there were significantly greater changes of metabolic profiles in the RT-BW group with an increase in HDL cholesterol and a decrease in triglyceride and HbA(1c). There was a significant between-group difference in diastolic blood pressure. Relatively short-term, non-instrumental resistance training using body weight as a load was effective in improving fat distribution and metabolic profiles in healthy elderly people without weight loss.

Accuracy of body fat assessment by bioelectrical impedance in Japanese middle-aged and older people

Bioelectrical impedance analysis (BIA) is commonly used to measure the percentage of body fat (%BF), but its accuracy is controversial. In addition, the equations are specific to the group for which they were established. As far as we know, there is no study examining the accuracy of BIA in Japanese middle-aged and older people. We compared %BF assessed using BIA with that of dual-energy X-ray absorptiometry (DEXA) in 102 female and 51 male local residents aged 40 to 78 y. Simple correlation coefficients were 0.79 for females and 0.69 for males, which are statistically significant (p<0.001). However, BIA tended to overestimate %BF in the lower BF group and underestimate it in the BF higher group, and only 45.1% for female and 47.1% for male subjects were measured accurately, i.e., within 10% of the measurement by DEXA. This result suggests that this model of BIA is an alternative for estimating %BF in Japanese middle-aged and older people as well as when subjects are within a normal body fat range, but greater accuracy is needed for lean and overweight subjects.

Effects of intentional weight cycling on non-obese young women

This study investigated the effects of intentional weight cycling in non-obese, young women (n = 5; mean age, 24.6 years; mean body mass index [BMI], 20.5 kg/m(2)). During the first 30 days, the subjects lost more than 4 kg with energy restriction alone (first diet period). In the following 14 days, they regained more than the weight they had lost by eating ad libitum (free-living period). In the subsequent 30 days, they once again lost more than 4 kg with only energy restriction (second diet period). Height, weight, waist and hip circumferences, body composition, lipid profiles, thyroid hormones, systolic and diastolic blood pressures (SBP, DBP), and resting energy expenditure (REE) were examined. Measurements were taken at the beginning of the study (day 0), at the end of each diet period (day 30 and day 74), the end of the free-living period (day 44), and on day 180. The mean change in each variable from baseline (day 0) was used and controlled for the baseline value, baseline weight, and change in weight (Delta weight). Statistical tests were performed to determine the significance of the mean changes in the variables. By day 180, there were significant decreases in the subjects' lean body mass (P <.01), serum triiodothyronine (T(3)) (P <.001), serum total thyroxine (T(4)) (P <.001), and REE (P <.001), and significant elevations of SBP (P <.05) and DBP (P <.001). The lipid profiles had not changed except for increased triglycerides (TG). These results suggest that weight cycling through energy restriction alone may have negative health consequences in non-obese, young women.

Effects of high versus low-intensity resistance training on bone mineral density in young males

The purpose of this study was to investigate the effect of high-intensity and low-intensity resistance training upon bone mineral density (BMD) by comparing the BMD of young male powerlifters (n = 5), recreational trainees (n = 5), and controls (n = 5). Lumbar spine (L2-L4), proximal femur, and whole body BMDs were measured using dual-energy X-ray absorptiometry (DXA). The high-intensity group showed a significantly greater BMD when the whole body and trochanter regions were measured than the low-intensity and control group. The BMD of the lumbar spine, femoral neck, and Ward's triangle was greater in the high-intensity group compared with the control group. There was no significant BMD difference between the low-intensity and control group except at the trochanter region. These results suggest that high-intensity resistance training is effective for increasing BMD, but low-intensity resistance training is not.

Comparison between the air displacement method and dual energy x-ray absorptiometry for estimation of body fat

Air displacement plethysmography (ADP) is a method for the determining percent body fat (%BF) using the two-compartment model, in which the body is partitioned into body-fat mass and fat-free mass (FFM). Although this model assumes a constant density of FFM as 1.10 g/ml, its density may depend upon the bone mineral content (BMC) and total body water (TBW) which vary with age, gender, and race/ethnicity. This study compared %BF determined from ADP (ADP%BF) with %BF obtained by dual-energy x-ray absorptiometry (DXA%BF), and also investigated the effects of BMC, TBW, and other factors on its value. The subjects were 721 female and male Japanese aged 40 to 79 years. Body density was measured by ADP and %BF was calculated using Brozek et al's equation. BMC and body-fat volume were measured using DXA, and TBW was measured by multifrequency bioelectrical impedance. A series of anthropometric measurements was taken. Although ADP%BF was highly correlated with DXA%BF (female: r = 0.89, male: r = 0.90) (p < 0.001), ADP%BF differed significantly from DXA%BF (female: -1.30 +/- 0.14% (mean +/- s.e.m.), male: 1.22 +/- 0.13%) (p < 0.001). The difference in %BF (ADP%BF-DXA%BF) was negatively associated with BMC/FFM but not with TBW/FFM in both genders. The difference in %BF was also positively correlated with waist circumference. Considering previous studies, this result may be explained by the underestimation of DXA%BF, rather than by the overestimation of ADP%BF. In conclusion, ADP may be a useful method to measure %BF. However, BMC should be taken into consideration. Furthermore, DXA%BF may be underestimated in people with large waists.

Frequencies and circumstances of falls in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA)

Frequencies and circumstances of falls were assessed among 1030 middle-aged and elderly people who participated in the NILS-LSA (National Institute for Longevity Sciences, Longitudinal Study of Aging) from November, 1997 to March, 1999 and responded to the questionnaires. The variables analyzed in the present study were demography and history of falls in the past one year. Circumstances of falls, e.g. time, location, activities associated with falls, cause of falls and degree of injury due to falls were asked when the subjects experienced a fall. Fear of falling was also investigated in all subjects. The prevalence of falls was 12.9% in the middle-aged group (40-59 yr.) and 16.5% in the elderly group (60-79 yr.). The distribution of time, location, activity associated with falls, cause and injury due to falls corresponded with previous fall studies among community-dwelling elderly people. The incidence of falls was extremely high during the daytime and outdoors. Falls occurred most frequently while walking. The majority of falls were due to extrinsic factors. About 40% of all falls caused no injury. As to the fear of falling, about 30% of the middle-aged subjects and about 60% of the elderly subjects reported that they were fearful. Our results suggested that fall accidents are not rare, even in middle-aged people.

Bone mineral density obtained by peripheral quantitative computed tomography (pQCT) in middle-aged and elderly Japanese

To clarify age-related changes in bone mineral density (BMD) by peripheral quantitative computed tomography (pQCT), 1,124 Japanese middle-aged and elderly community-dwelling people were examined. The BMD of the trabecular bone was assessed at the distal part of the radius (D50), and the BMD of the cortical bone was assessed at the diaphysis of the radius (P100). P100 during age 40 to 49 was significantly higher in females (1359.6 +/- 10.7 mg/cm3, mean +/- SE) than in males (1253.5 +/- 9.5 mg/cm3), while there was no difference in D50, 245.3 +/- 5.1 mg/cm3 in females and 293.0 +/- 5.5 mg/cm3 in males. Females and males aged 50 to 59 lost 8.09 +/- 2.08 (mean +/- SE) mg/cm3 and 3.80 +/- 1.77 mg/cm3 of D50 every year, respectively. As for P100, females lost 25.1 +/- 4.48 mg/cm3, and males lost 6.37 +/- 3.89 mg/cm3 every year. Because of these gender differences, both D50 and P100 were significantly higher in males than in females aged 50 and over. Assuming that the average BMD between ages 40 and 44 was the maximum bone mineral density (BMD max), the percentage change from the BMD max with age was examined. Females aged 60 to 69 whose BMD were under 70% of the BMD max made up 73.9% in D50 and 23.2% in P100. Only 21.1% of males aged 60 to 69 showed less than 70% of the BMD max in D50 and only 3.8% in P100. The percentage decrease in BMD by age was larger in D50 than in P100 in both males and females. The individual difference in BMD was larger in D50 than in P100. These results suggest that pQCT may be useful to independently assess aging effects on cortical and trabecular bone density.

Age-related changes in gait velocity and leg extension power in middle-aged and elderly people

To prevent a decline in gait with age, it is necessary to investigate age-related changes in gait performance and detect related factors. The purpose of this study was to assess the association between gait ability and leg extension power among middle-aged and elderly people. Height, weight, maximum gait velocity (MGV) and leg extension power (LEP) were measured in 752 males and females who participated in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA). Age-related changes in MGV and LEP and the association between MGV and LEP were assessed. There were significant decline trends in height, weight, MGV and LEP with advancing age (p < 0.001). MGV showed a significantly positive correlation with LEP (in males: r = 0.48 p < 0.001, in females: r = 0.47; p < 0.001). Subjects aged 60 yrs and over showed a significantly higher correlation than those under 60 yrs in males, but not in females, after adjustment for height and weight. Although the relationships between MGV and LEP were different by age and gender, LEP may be one of the important factors in maintaining gait ability.

Bone mineral density differences between paraplegic and quadriplegic patients: a cross-sectional study

STUDY DESIGN

This cross-sectional study was conducted by comparing bone mineral density (BMD) of paraplegic and quadriplegic patients.

OBJECTIVES

The purpose of this study was to investigate the relationship between the bone mineral loss and injury level in spinal cord injury patients.

SETTINGS

Experiments were conducted at Yoneda Hospital and Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan.

METHODS

Lumbar spine (L2-4), proximal femur (femoral neck, trochanter region and Ward's triangle) and whole body BMD were measured in ten paraplegic and ten quadriplegic patients using dual-energy X-ray absorptiometry (DXA, HITACHI BMD-IX).

RESULTS

Significant differences were observed in the lumbar spine, trochanter region and upper extremities BMD between paraplegic and quadriplegic patients (P<0.05, P<0.05 and P<0.01, respectively), but not in the femoral neck, Ward's triangle, head, pelvis, lower extremities or whole body BMD.

CONCLUSION

These results suggest that the injury level influences on the lumbar spine, upper extremities and trochanter region BMD. From a biomechanical standpoint, it is possible to explain that the differences in mechanical loading exerted on bones also affected the difference of lumbar spine BMD in the two groups.

Effects of high-intensity resistance training on bone mineral density in young male powerlifters

The effects of high-intensity resistance training on bone mineral density (BMD) and its relationship to strength were investigated. Lumbar spine (L2-L4), proximal femur, and whole body BMD were measured in 10 male powerlifters and 11 controls using dual-energy X-ray absorptiometry (DXA). There were significant differences in lumbar spine and whole body BMD between powerlifters and controls, but not in proximal femur BMD. A significant correlation was found between lumbar spine BMD and powerlifting performance. These results suggest that high-intensity resistance training is effective in increasing the lumbar spine and whole body BMD.