日足P&Fの状況：（11月24日）～（11月28日）

This study examined whether a walking program encouraged using the e-mail function of participants' cellular phones promotes behavior changes. Study participants were persons who wanted to join a walking program for their health. The experimental group had 1,111 members (male: n=554, female: n=557, 30-49 yrs) and the control group had 1,190 members (male: n=598, female: n=592, 30-49 yrs). The participants in the experimental group were encouraged to execute a walk behavior with e-mails using their cellular phones twice a week for one month . The contents of the e-mails depended on the level of walking as determined before the study for each participant. The main points studied were the time (in minutes) of walking per week and the extent of changes in the walking behavior. The analysis of results after receiving encouraging e-mail messages for one month showed more time spent walking for the experimental group in comparison with the time of the control group [Mean inter-group difference in change: 70.1 min/week, (p<0.05)]. The extent of changes in walking behavior (expressed as a percentage) was higher in the experimental group (38.5%) than in the control group (22.3%) (χ2=61.19, p<0.05). These results indicates that the walking program, encouraged by e-mail messages received on a cellular phone, promotes walking behavior in people.

Workplace settings-both internal and external-can influence how workers are physically active or sedentary. Although research has identified some indoor environmental attributes associated with sitting at work, few studies have examined associations of workplace neighbourhood built-environment attributes with workplace sitting time. We examined the cross-sectional associations of perceived and objective workplace neighbourhood built-environment attributes with sitting time at work and for transport among desk-based workers in Japan. Data were collected from a nationwide online survey. The Abbreviated Neighborhood Environment Walkability Scale (n = 2137) and Walk Score® (for a subsample of participants; n = 1163) were used to assess perceived and objective built-environment attributes of workplace neighbourhoods. Self-reported daily average sitting time at work, in cars and in public transport was measured using a Japanese validated questionnaire. Linear regression models estimated the associations of workplace neighbourhood built-environment attributes with sitting time. All perceived workplace neighbourhood built-environment attributes were positively correlated with Walk Score®. However, statistically significant associations with Walk Score® were found for sitting for transport but not for sitting at work. Workers who perceived their workplace neighbourhoods to be more walkable reported a longer time sitting at work and in public transport but a shorter sitting time in cars. Our findings suggest that walkable workplace neighbourhoods may discourage longer car use but have workplaces where workers spend a long time sitting at work. The latter finding further suggests that there may be missed opportunities for desk-based workers to reduce sitting time. Future workplace interventions to reduce sitting time may be developed, taking advantage of the opportunities to take time away from work in workplace neighbourhoods.

OBJECTIVES: Reducing sedentary behaviour (SB) and increasing physical activity (PA) have been shown to be associated with decreased depression. However, there are yet few studies examining the potential benefits on older adults' depression, when SB is replaced with PA. This study aimed to examine the associations of objectively assessed SB, light-intensity PA (LPA) and moderate-to-vigorous PA (MVPA) with depression among a sample of Japanese older adults, and to explore impacts of substituting SB with PA on older adults' depression. DESIGN: Cross-sectional analysis. SETTING: General community. PARTICIPANTS: A total of 276 older adults aged 65-85 years living in Japan. MAIN OUTCOME MEASURES: Three behaviours including the average daily time spent in SB (≤1.5 METs); LPA (>1.5 to <3.0 METs) and MVPA (≥3.0 METs) per day were calculated by accelerometers. Depression was assessed using the Japanese version of the 15-item Geriatric Depression Scale (GDS-15). RESULTS: Less SB (β=0.129, 95% CI 0.015 to 0.243) and more LPA (β=-0.138, 95% CI -0.265 to -0.011) were found to be significantly and negatively associated with the GDS-15 score in the single-activity model. The isotemporal substitution model found that replacing only 30 min per day of SB with the same amount of LPA to be significantly and negatively associated with the GDS-15 score (β=-0.131, 95% CI -0.260 to -0.002). CONCLUSIONS: These findings indicated that substituting even small amounts of SB with LPA may contribute to less depression in older adults. Potential favourable effects can be observed for replacing only 30 min per day of SB with LPA.

Background: Although considerable evidence has demonstrated that physical activity is associated with breast cancer prevention, few studies have assessed the level of awareness of this association. Awareness is a key first step to successful of behavior change. Increasing awareness may contribute to promote physical activity and prevent breast cancer at the population level. The present study examined the prevalence and correlates of awareness about the role of physical activity in breast cancer prevention among Japanese women.Methods: 1,000 Japanese women aged 20-69 years (mean age: 44.3 +/- 13.4 years) who responded to an internet-based cross-sectional survey. Awareness of the role of physical activity in breast cancer prevention, knowledge of breast cancer (symptom, risk factor, screening), exposure to information about physical activity and cancer, a self-reported physical activity, and sociodemographic variables (age, marital status, having a child, education level, employment status, and household income) were obtained. Force-entry logistic regression analysis was used.Results: The prevalence of awareness was 31.5% (95% CI: 28.6-34.4). Factors significantly associated with awareness included sociodemographic variables, exposure to information, and knowledge of breast cancer. Being married (AOR, 95% CI: 1.75, 1.05-2.92) was positively related to awareness, while having children (0.65, 0.36-0.86) was negatively related. College graduates or those with higher levels of education (1.50, 1.01-2.22) were significantly more likely to be aware than those who had not graduated high school. Moreover, exposure to information (2.11, 1.51-2.95), and high knowledge of symptoms (2.43, 1.75-3.36) were positively associated with awareness. Finally, low knowledge of risk factors (0.30, 0.22-0.40) was negatively associated with awareness.Conclusions: Japanese women through internet-based study were poorly aware of the role of physical activity in breast cancer prevention. Awareness was especially low among individuals with children and higher knowledge of risk factors whereas high in married women, those with higher educational level, exposure to information, and greater knowledge of symptoms. The findings suggest that strategies to increase the awareness about the preventive role of physical activity are needed for breast cancer prevention in consideration of subgroups with low awareness.

Background: In the rapidly developing use of the Internet in society, eHealth literacy-having the skills to utilize health information on the Internet-has become an important prerequisite for promoting healthy behavior. However, little is known about whether eHealth literacy is associated with health behavior in a representative sample of adult Internet users.Objective: The aim of this study was to examine the association between eHealth literacy and general health behavior (cigarette smoking, physical exercise, alcohol consumption, sleeping hours, eating breakfast, eating between meals, and balanced nutrition) among adult Internet users in Japan.Methods: The participants were recruited among registrants of a Japanese Internet research service company and asked to answer a cross-sectional Internet-based survey in 2012. The potential respondents (N= 10,178) were randomly and blindly invited via email from the registrants in accordance with the set sample size and other attributes. eHealth literacy was assessed using the Japanese version of the eHealth Literacy Scale. The self-reported health behaviors investigated included never smoking cigarettes, physical exercise, alcohol consumption, sleeping hours, eating breakfast, not eating between meals, and balanced nutrition. We obtained details of sociodemographic attributes (sex, age, marital status, educational attainment, and household income level) and frequency of conducting Internet searches. To determine the association of each health behavior with eHealth literacy, we performed a logistic regression analysis; we adjusted for sociodemographic attributes and frequency of Internet searching as well as for other health behaviors that were statistically significant with respect to eHealth literacy in univariate analyses.Results: We analyzed the data of 2115 adults (response rate: 24.04%, 2142/10,178; male: 49.74%, 1052/2115; age: mean 39.7, SD 10.9 years) who responded to the survey. Logistic regression analysis showed that individuals with high eHealth literacy were significantly more likely to exhibit the good health behaviors of physical exercise (adjusted odds ratio [AOR] 1.377, 95% CI 1.131-1.678) and eating a balanced diet (AOR 1.572, 95% CI 1.274-1.940) than individuals with low eHealth literacy.Conclusions: We found that some health behaviors, including exercise and balanced nutrition, were independently associated with eHealth literacy among Japanese adult Internet users.

To examine differences in objective and subjective outcomes in outpatients undergoing percutaneous coronary intervention (PCI) performed for acute myocardial infarction versus cardiac surgery (CS) following a phase II cardiac rehabilitation (CR). Longitudinal observational study of 437 consecutive cardiac outpatients after 8 weeks of phase II CR. Patients were divided into the PCI group (n = 281) and CS group (n = 156). Handgrip and knee extensor muscle strength, peak oxygen uptake (VO2), upper- and lower-body self-efficacy for physical activity (SEPA), and physical component summary (PCS) and mental component summary (MCS) scores as assessed by Short Form-36 were measured at 1 and 3 months after PCI or CS. All outcomes increased significantly between months 1 and 3 in both groups. However, increases were greater in the CS versus PCI group in handgrip strength (+12.3 % vs. +8.1%, P < 0.01), knee extensor muscle strength (+19.3% vs. +17.5%, P = 0.008), peak VO2 (+20.9% vs. +16.9%, P < 0.01), upper-body SEPA (+27.7% vs. +9.2%, P = 0.001), and PCS score (+6.5% vs. +4.1%, P = 0.001). Although this relatively short-term phase II CR increased all outcomes for both groups, outcomes showed the recovery process was different between the PCI and CS groups, slightly favoring CS patients. Furthermore, patents in the field of CR are presented. © 2011 Bentham Science Publishers.

【はじめに、目的】 健康関連QOL(HRQOL)を向上させる因子の一つとして、身体活動セルフ・エフィカシー(SE)が注目されている。SEとはBanduraによると「ある結果を生み出すために必要な行動をどの程度うまく行うことができるかという個人の確信」と定義されている。特に運動や身体活動に関するSEは、身体活動や行動変容や運動の継続、更にはHRQOLに関係するとされている。しかしながら人工膝関節全置換術(TKA)患者に対して、身体活動SEが身体機能およびHRQOLに及ぼす影響について明らかにされていない。本研究の目的はTKA後のリハ介入における身体機能、HRQOLおよび身体活動SEの回復過程とその関連性について明らかにすることである。【方法】 対象は2010年10月から2011年7月までに当院でTKAを施行した変形性膝関節症患者44例48膝とした。手術時年齢は73.2±7.7歳、BMI26.1±3.5 kg/m2，術後在院日数25.2±5.3日、術後リハは当院プロトコールに準じて術後3ヶ月間外来リハを実施した。身体機能評価としてTimed Up and Go test(TUG)、開眼片脚起立時間、膝伸展筋力を測定した。HRQOLの評価指標としてSF-36の下位8尺度である身体機能(PF)、日常役割機能－身体(RP)、体の痛み(BP)、全体的健康感(GH)、活力(VT)、社会生活機能(SF)、日常役割機能－精神(RE)、心の健康(MH)と身体的サマリースコア(PCS)と精神的サマリースコア(MCS)を用いた。身体活動SEは虚弱高齢者の身体活動SE尺度（歩行、階段、重量物）とその総合得点を用いた。評価は術前、術後1ヶ月(退院時)と3ヶ月(外来通院時)とした。統計解析は回復過程を一元配置分散分析とBonferroni多重比較、身体機能およびHRQOLと身体活動SEとの関連性に関しては各変化量をpearsonの相関係数を用い、有意水準は5%未満とした。【倫理的配慮、説明と同意】 本研究は当院生命倫理委員会の承認(0826)を受け、対象者に研究内容の説明文書を用いて口頭による説明を行い、研究参加への同意を得て実施した。【結果】 各項目は術前(T1)→術後1ヶ月(T2)→術後3ヶ月(T3)の順に平均値±標準偏差で示した。TUGは11.8±3.8→11.7±3.8→10.5±3.3秒となりT1とT3，T2とT3で有意に改善した。開眼片脚起立時間は13.3±19.3→20.8±26.1→23.2±31.8秒となりT1とT3で有意に向上した。膝伸展筋力は0.5±0.2→0.5±0.1→0.6±0.1N・m／kgとなりT2とT3で有意に向上を認めた。SF-36の下位尺度のうち、PFは37.7±20.8→40.6±25.6→52.5±20.3点、BPは35.1±15.3→36.2±19.2→49.8±21.2点、SFは53.9±27.1→56.8±25.3→69.8±23.5点となりT1とT3，T2とT3で有意に改善を認めた。GHは48.8±13.6→53.5±14.5→54.1±16.5点となりT1とT3で有意に改善を示した。PCSは16.5±12.5→15.3±14.6→23.1±16.1点となりT1とT3，T2とT3で有意に改善した。身体活動SEのうち、歩行SEは12.4±5.0→14.9±6.4→15.9±5.3点、階段SEは8.9±5.2→10.4±5.2→12.5±5.1点、重量物SEは14.1±5.9→15.7±5.3→17.3±6.1点となりT1とT3で有意に向上した。身体活動SEの総合得点では35.4±12.5→41.1±13.1→45.6±12.8点となりT1とT2，T1とT3で有意に向上を認めた。身体活動SEの総合得点とHRQOLとの関連性はPF、RP、BP、RP、GH、REおよびPCSと有意な正の相関を示した(r＝0.307～0.508，p＜0.05)。身体活動SEの総合得点と身体機能の各項目とは有意な相関が見られなかった。【考察】 身体機能、HRQOLおよび身体活動SEは時間経過とともに有意に改善を示した。退院時では十分な改善が得られず、退院後もリハの継続が必要になると考える。身体機能と身体活動SEはHRQOLと関連性があり、身体機能とは関連性がないことが示唆された。HRQOLを向上させるためには、身体機能に加え、身体活動SEを高めるような方策を積極的にリハに組み入れていく必要があると考える。【理学療法学研究としての意義】 TKA後のリハは身体活動SEを高めるアプローチを加えることで、TKA患者のHRQOLを向上させることが可能になると考える。

To determine self-reported sleep quality-related differences in physical activity (PA) and health-related quality of life (HRQOL) and target values of PA for high-quality sleep in chronic heart failure (CHF) outpatients, 149 CHF outpatients (mean age 58 years) were divided into two groups by sleep-quality level determined via self-reported questionnaire: shallow sleep (SS) group (n = 77) and deep sleep (DS) group (n = 72). Steps were assessed by electronic pedometer, HRQOL was assessed with the Short Form 36 (SF-36) survey, and data were compared between groups. PA resulting in high-quality sleep was determined by receiver-operating characteristics curves. All SF-36 subscale scores except that of bodily pain were significantly decreased in the SS versus DS group. A cutoff value of 5723.6 steps/day and 156.4 Kcal/day for 1 week were determined as target values for PA. Sleep quality may affect PA and HRQOL, and attaining target values of PA may improve sleep quality and HRQOL of CHF outpatients. Patents relevant to heart failure are also discussed in this article. © 2011 Bentham Science Publishers.

Objective: Indices of exercise capacity such as peak oxygen uptake (VO2peak) and muscle strength are important In association with reduced mortality. The present study compared differences in V02peak and muscle strength indices (grip strength and knee extensor and flexor muscle strength) with disease severity and investigated the relation of these variables in congestive heart failure (CHF) patients.Design: The study comprised 102 patients with stable CHIF (93 men, age 61.4 +/- 10.2 yrs) with left ventricular ejection fraction (LVEF) 40% by echocardiography. We used New York Heart Association (NYHA) functional class to index disease severity. VO2peak, grip strength, knee extensor, and flexor muscle strength were determined. Patients were divided into three groups by NYHA class: class I (n = 39), class 11 (n 49), and class III (n = 14).Results: Age, sex, and LVEF did not differ according to NYHA class. VO2peak and all muscle strength indices decreased with increases in NYHA class (P 0.05). VO2peak correlated positively with all muscle strengths (P 0.05). Stepwise linear regression analysis revealed that grip and knee extensor strength were important in predicting VO2peak center dotConclusions: Exercise capacity and disease severity in CHIF patients may be influenced not only by lower-limb but also upper-limb muscle strength.

Engaging in physical activity was proved to have positive effects on physical and mental health in children. Built environment is an important correlate of physical activity participation. School recess provides a daily opportunity for children to be active during school day. Therefore, the purpose of the present article was to review literatures regarding 1) physical activity during school recess, 2) the relationship between recess physical activity and school physical environment, 3) intervention for physical activity promotion during recess by changing school physical environment, and to explore trends of current researches and assignments of future research. A review was conducted and included studies published to May 31, 2011. Twenty-two studies were selected in 1) and showed boys often engaged in more physical activity than girls, but the results on differences in physical activity between ages were inconsistent. Six studies were selected in 2) and indicated recess physical activity was associated with playground environments such as equipments, marking, and surface situate. School environment intervention was observed to be a potential method for promoting physical activity in children by 8 studies in 3). Playground environment with marking, additional play equipments, and designated activity zones increased physical activity during recess. Most researches regarding recess physical activity was conducted in U.S., Australia, and Western countries, and confirmed the effectiveness of recess to promote physical activity. However, few studies on this topic were conducted in Japan. Further researches are needed to draw a conclusion about the possibility of recess to promote physical activity among Japanese children.

Purpose: Patients with exercise capacity of 5 metabolic equivalents (METs) are considered to have a high risk of death. The aim of this study was to determine age-related differences in physical activity associated with an exercise capacity of = 5 METs in chronic heart failure (CHF) outpatients. Methods: We enrolled 157 stable CHF patients (79.6% men, age 60.3 +/- 11.5 years). Patients were divided into two age-based groups (middle-aged, 65 years, n = 97) and (older-aged, = 65 years, n = 60). Peak oxygen uptake (peak VO2) was assessed by cardiopulmonary exercise testing. We further divided patients into groups according to exercise capacity: = 5 METs and 5 METs. Physical activity was assessed by measuring the average number of steps/day for 1 week with an electronic pedometer. Results: Receiver-operating characteristic curves were used to select cutoff values for steps associated with an exercise capacity of = 5 METs in the middle- and older-aged patients. Cutoff values of 6045 steps in the middle-aged and 6070 steps in the older-aged patients were determined. Conclusions: Both middle-and older-aged CHF patients with exercise capacity of = 5 METs completed approximately 6000 steps/day. This could become a target amount for minimal physical activity that could contribute to increased exercise capacity in CHF patients.

We examined whether street layout a key urban design element is associated with walking and sedentary behaviors in the context of a non-Western country; and, whether such associations differ between an urban and a rural area. In 2011, 1076 middle-to-older aged adults living in an urban and a rural area of Japan reported their walking and sedentary (sitting) behaviors. Two objective measures of street layout (intersection density and street integration) were calculated. Participants exposed to more-connected street layouts were more likely to walk for commuting and for errands, to meet physical activity recommendations through walking for commuting, and less likely to drive. These relationships differed between the urban and the rural area. This shows that previous findings from Western countries on associations of street connectivity with travel behaviors may also be applicable to Japan.

Evidence about the impacts of the physical activity environment on adults' weight in the context of Asian countries is scarce. Likewise, no study exists in Asia examining whether Walk Score a free online walkability tool is related to obesity. This study aimed to examine associations between multiple physical activity environment measures and Walk Score ratings with Japanese adults' body mass index (BMI). Data from 1073 adults in the Healthy Built Environment in Japan study were used. In 2011, participants reported their height and weight. Environmental attributes, including population density, intersection density, density of physical activity facilities, access to public transportation, and availability of sidewalks, were calculated using Geographic Information Systems. Walk Scores ratings were obtained from the website. Multiple linear regression analysis was conducted to examine the association between each environmental attribute and BMI. Adjusting for covariates, all physical activity environmental attributes were negatively associated with BMI. Similarly, an increase of one standard deviation of Walk Score was associated with a 0.29 (95% confidence interval (CI) of-0.49--0.09) decrease in BMI. An activity-friendly built environment was associated with lower adults' BMI in Japan. Investing in healthy community design may positively impact weight status in non-Western contexts.

BACKGROUND: Physical inactivity and sedentary behaviour (too much sitting) can contribute to renal dysfunction. However, the potential benefits of behavioural change (e.g. replacing sedentary behaviour with physical activity) on renal function are not well understood. We used isotemporal substitution to model potential impacts of behaviours on renal function by replacing time spent in one behaviour to another. METHODS: In 174 older Japanese adults (age, 50-83 years; females, 76%), the time spent in sedentary behaviour, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were assessed using an uniaxial accelerometer. Renal function was evaluated by the estimated glomerular filtration rate (eGFR) from serum creatinine and cystatin C levels. RESULTS: In univariate analyses, eGFR was significantly, albeit weakly, correlated with time spent in sedentary behaviour (rs = - 0.229), LPA (rs = 0.265), and MVPA (rs = 0.353). In the isotemporal substitution models, replacement of 30 min/day of sedentary behaviour with an equivalent LPA time was not significantly associated with eGFR (β = 2.26, p = 0.112); however, replacement with an equivalent time of MVPA was beneficially associated with eGFR (β = 5.49, p < 0.05). CONCLUSIONS: These cross-sectional findings suggest that sedentary behaviour (detrimentally) and physical activity (beneficially) may affect renal function and that replacing sedentary behaviour with MVPA may benefit renal health in older adults.

Background: Dog ownership is emerging as an important correlate of sufficient physical activity and therefore has the potential to positively affect a portion of the population. A growing body of literature indicates that dog-walking contributes to increased physical activity. However, most of the previous studies have been conducted in Australia or the U.S. and have sampled from the general adult population. Purpose: This study examined the association between dog ownership, dog-walking, and physical activity in older Japanese adults. Methods: Participants were community-dwelling residents aged 65-74 years who responded to a population-based cross-sectional survey (N=1926). Physical activity, dog ownership, dog-walking, and sociodemographic attributes were self-reported (collected in 2010 analyzed in 2011). ANCOVAs and multivariate logistic regressions were used. Results: Overall, 14.0% of older adults were dog owners, with 71% reporting that they walked their dog for an average of 308.5±300.7 minutes/week. Dog walkers reported more minutes/week of moderate-to-vigorous physical activity (M±SE: 241.7±27.0) and total physical activity (M±SE: 698.6±40.6) than both non-dog walkers (M±SE: 110.7±41.8 M±SE: 527.2±62.9) and non-dog owners (M±SE: 164.7±9.1 M±SE: 519.2±13.7), respectively (p<0.05). Dog walkers also walked more minutes per week (M±SE: 508.0±33.4) than non-dog owners (M±SE: 384.5±11.3 p<0.05). Dog walkers were more likely to be sufficiently active than both non-dog walkers and non-dog owners (p<0.001). Conclusions: Use of dog-walking may be a potentially viable means of intervention for increasing walking and overall physical activity in older Japanese adults. © 2012 American Journal of Preventive Medicine.