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The purpose of this study was to determine both an association between mortality and physical activity (PA) objectively measured by accelerometer and cutoff values for PA in Japanese outpatients with heart failure (HF). This prospective observational study comprised 170 HF outpatients (mean age, 65.2 years; 77% men). Peak oxygen uptake (VO 2 ) and the relation between ventilation and carbon dioxide production (VE/VCO 2 slope) as indices of exercise capacity were measured during cardiopulmonary exercise testing with a cycle ergometer. PA was assessed by accelerometer-measured average step count (steps) per day for 1 week. Study endpoint was cardiovascular-related death. Over an average follow-up of 1,377.1 (median, 1,335) days, 31 cardiovascular-related deaths occurred. Patients were then divided into survivor (n = 139) and nonsurvivor (n = 31) groups. Brain natriuretic peptide level was significantly different between groups. Peak VO 2 and steps were also significantly lower and VE/VCO 2 slope higher in the nonsurvivors versus survivors. Univariate Cox proportional hazards analysis showed brain natriuretic peptide, peak VO 2 , VE/VCO 2 slope, and steps to be significant prognostic indicators of survival. Multivariate analysis showed PA of ≤4,889.4 steps/day to be a strong and independent predictor of prognosis (hazard ratio: 2.28, 95% confidence interval: 1.31–6.30; p = 0.008). Kaplan-Meier curves after log-rank test showed significant prognostic difference between PA of ≤4,889.4 and >4,889.4 steps/day in the 2 groups (log-rank: 12.19; p = 0.0005). In conclusion, step count as objectively measured by accelerometer may be a prognostic indicator of mortality in Japanese outpatients with HF.

In Reply: We thank Stabler and colleagues for their valuable comments1 on our work. We agree that the analytical approach used in our study does not necessarily support the conclusion that TV viewing time is associated with overweight/obesity, independent of moderate-to-vigorous physical activity (MVPA). Our intention was to examine whether TV viewing time was detrimentally associated with adiposity even among those who met physical activity guidelines. However, as Stabler and colleagues point out, it is misleading to use the term “independent” to characterize these associations, given how we originally approached our analyses. It is also appropriate to query our rather colloquial use of the term “risk”. Strictly speaking, “odds” is what is statistically and epidemiologically correct for a cross-sectional study using logistic regression. Following this helpful advice, we conducted an additional analysis in which TV viewing time, MVPA, and their interaction term were included (along with the same covariates used in the original adjusted models). The TV time/MVPA interaction term was found to be nonsignificant (P = 0.408), which suggests that the relationship between TV time and the odds of being overweight or obese is not significantly moderated by MVPA levels and can be interpreted as consistent with our original conclusion. Nevertheless, we must agree that the analytic approach recommended by Stabler and colleagues is formally correct and appropriate in this case. We appreciate their thoughtful attention to our work and are grateful for the opportunity to re-examine our data and more appropriately state our conclusion.

Background: In rapidly developing Internet-user societies, eHealth literacy has become important in promoting wellness. Although previous studies have observed that poor health literacy is associated with less knowledge and screening practice of colorectal cancer (CRC), little is known about whether eHealth literacy is associated with these variables. Objective: The present study examined associations between eHealth literacy, knowledge of CRC, and CRC screening practices. Methods: Data were analyzed for 2970 Japanese adults (men, 49.9%; mean age ± SD, 39.7 ± 10.9 years) who responded to an Internet-based cross-sectional survey. Knowledge of the definition of CRC, its risk factors and screening practice, previous experience of CRC screening, score on the Japanese version of the eHEALS (J-eHEALS), sociodemographic attributes (sex, age, marital status, educational attainment, and household income level), and frequency of Internet usage were obtained. Sociodemographic attributes and frequency of Internet usage were used as control variables in the multiple regression and logistic regression models. Results: eHealth literacy was positively associated with CRC knowledge (β = .116, < .001), when the covariables of both eHealth literacy and CRC knowledge were used in the multiple regression model. Moreover, after controlling for sociodemographic factors, which were significantly associated with eHealth literacy and CRC screening practice, an increase of 1 point in the eHEALS score signified that participants were 1.03 times (95% CI = 1.01–1.05) more likely to undergo CRC screening. Conclusions: Internet users with high eHealth literacy are more likely to have knowledge and previous screening practice related to CRC compared to those with low eHealth literacy. [J Med Internet Res 2012;14(6):e153]

Background:Exploring the detailed pattern and correlates of dog walking is crucial to designing effective interventions to increase the proportion of dog walkers. The current study examined the prevalence and pattern of dog walking, the association between dog walking and health-related physical activity, and the correlates of dog walking among dog owners in Japan.Methods:Japanese dog owners’ (n = 930) responses to an Internet-based cross-sectional survey were analyzed. A self-reported measure of physical activity, dog walking characteristics, and sociodemographic and dog-specific variables were obtained. Analyses of covariance and multivariate logistic regressions were used.Results:Overall, 64.4% of the surveyed dog owners walked their dogs. On an average, they walked their dogs 214.1 ± 189.5 minutes per week. The dog walkers were 3.47 times more likely to meet physical activity recommendations, were significantly less likely to be unmarried (OR = 0.61), and had higher levels of attachment with their dogs (OR = 2.32) than the nondog walkers.Conclusion:The findings confirmed that dog walking significantly helps dog owners meet physical activity recommendations for health and revealed that dog-specific factors such as dog attachment might be stronger correlates of dog walking than sociodemographic factors.

Patients with exercise capacity of5 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.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 (V)O(2)) was assessed by cardiopulmonary exercise testing. We further divided patients into groups according to exercise capacity: ≥5 METs and5 METs. Physical activity was assessed by measuring the average number of steps/day for 1 week with an electronic pedometer.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.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.• Middle-aged and older-aged chronic heart failure (CHF) patients with a measured exercise capacity of ≥5 METs completed approximately 6000 steps/day as measured by electronic pedometer. • This amount of steps could become a target amount for minimal physical activity that could contribute to increased exercise capacity in CHF patients.

Izawa KP, Watanabe S, Hiraki K, Morio Y, Kasahara Y, Takeichi N, Oka K, Osada N, Omiya K. Determination of the effectiveness of accelerometer use in the promotion of physical activity in cardiac patients: a randomized controlled trial. Objective To investigate the effect of the self-monitoring of physical activity by hospitalized cardiac patients attending phase I cardiac rehabilitation (CR). Design Randomized controlled trial. Setting University hospital CR program. Participants CR patients (N=126) with a mean age of 59.1 years. Interventions Patients were randomly assigned to the self-monitoring group (group A, n=63) or the control group (group B, n=63). Along with CR, group A patients performed self-monitoring of their physical activity at the beginning of a phase I CR program (acute in-hospital phase for inpatients) and ending just before they began a phase II CR program (postdischarge recovery phase for outpatients). Main Outcome Measures Physical activity (averages of daily number of steps taken and daily energy expenditure for 1wk) as measured by accelerometer was assessed in both groups at baseline (t1) and before the beginning of phase II CR (t2). Results Although there were no significant differences in physical activity values between groups A and B at t1, values of group A at t2 were significantly higher than those of group B (8609.6 vs 5512.9 steps, P P Conclusions Self-monitoring of patient physical activity from phase I CR might effectively increase the physical activity level in preparation for entering a phase II CR program. Results of the present study could contribute to the development of new strategies for the promotion of physical activity in cardiac patients.

Physical activity is beneficial for adolescent health. The physical activity patterns of Japanese adolescents are relatively unknown. Therefore, this study aimed to describe the current patterns of physical activity and to identify sex and grade differences among them.The participants comprised 714 Japanese adolescents aged 12 to 15 years old (boys N = 372, girls N = 342) from a public junior high school in Okayama, Japan. Physical activity at school, outside of school after hours, and during lunch recess as well as the total leisure time in a usual week was assessed with a 5-item questionnaire. To assess the differences in the physical activity patterns by sex and grade, independent t tests and analysis of variance (ANOVA) were conducted, respectively.Boys spent significantly more time in physical activity both inside and outside of school settings than girls (p .05). Higher grade students were significantly less active than lower grade students (p .05). Furthermore, the physical activity patterns across the grades differed between settings (at school, outside of school during the after-school period, lunchtime recess, and at home).To increase physical activity levels among Japanese adolescents, implementation of after-school programs or environmental modifications developed within the school setting could be effective strategies.

Background Although both insufficient physical activity (PA) and high screen time (ST) are independent risk factors for obesity, how the combination of sufficient/insufficient PA and high/low ST could increase obesity risk among the adult population of Japan is not known. This study examined joint associations of PA and ST with overweight among Japanese adults. Methods An Internet-based survey collected data on height, weight, self-reported time spent in PA and ST, and sociodemographic variables from 2832 adults. Respondents were categorized into sufficient PA/low ST, sufficient PA/high ST, insufficient PA/low ST, or insufficient PA/high ST categories as per public PA guidelines and the median of ST. Logistic regression analysis examined the odds ratios (OR) of being overweight (body mass index, ≥ 25 kg/m2) according to the categories of PA and ST. Results In comparison with the sufficient PA/low ST category, participants in the insufficient PA/high ST category were significantly more likely overweight (OR, 1.48; 95% confidence interval [95%CI), 1.14, 1.93) after adjusting for sociodemographic variables. A significantly higher OR for overweight (including obesity) among insufficient PA/high ST category was also observed in men, but no significant association was found in women. Conclusions Both insufficient PA and prolonged ST contribute to overweight and obesity among Japanese adults. Public health initiatives addressing obesity in Japan need to consider both promoting PA and reducing ST, especially in men.

Objectives Although physical activity reduces the risk of diseases such as cancer, diabetes and cardiovascular disease, a large proportion of the population is not sufficiently physically active. Therefore, the present study examined the environmental, social, and psychological correlates for meeting the 2 recommended physical activity criteria: ≥420 min per week of at least moderate-intensity activity (MPA criterion) and ≥210 min per week of vigorous activity (VPA criterion) for colon cancer prevention among Japanese adults. Design Cross-sectional study. Methods The sample included 2000 Japanese adults aged 20–79 years. An Internet-based survey was used to assess seven sociodemographic variables (e.g., education level, employment status), environmental variables (home fitness equipment, access to facilities, neighborhood safety, aesthetic sensibilities, and frequency of observing others exercising, residential area), social variables (social support), psychological variables (self-efficacy, perceived positive (pros) and negative (cons) aspects of exercise), and physical activity. The adjusted odds of meeting each physical activity criterion by these variables were calculated. Results Overall, 22.3% of the study population met the criterion of MPA, and 7.3% met the criterion of VPA. Having high self-efficacy, fewer perceived cons, possessing home fitness equipment, reporting enjoyable scenery, and living in a rural area were significantly associated with meeting the recommended criteria. Conclusions Participants who met the 2 activity recommendations differed by self-efficacy, cons, possession of home fitness equipment, reporting of enjoyable scenery, and residential area. These findings imply that strategies to promote more intense physical activities specifically in terms of these variables may be necessary for colon cancer prevention.

With the rapid developing an internet society, ehealth literacy, defined as the ability to seek, find, understand, and appraise and apply the knowledge gained to addressing or solving a health problem, becomes important to promote and aid health care at the individual level. However, the eHealth Literacy Scale (eHEALS) was only a scale developed to assess the ehealth literacy. Thus, the present study was conducted to evaluated the validity and reliability of a Japanese version of the eHEALS (J-eHEALS), and examine the association of ehealth literacy with demographic attributes and characteristics on health information searching among Japanese adults.Data were analyzed for 3,000 Japanese adults (males: 50.0%,mean age: 39.6 + 10.9 years) who responded to an Internet-based cross-sectional survey. The J-eHEALS, 6 demographic attributes, resources for obtaining health information (health resources), and contents of health information obtained from internet (ehealth contents) were obtained with a questionnaire. Confirmatory factor analysis and correlation with the communicative and critical health literacy scale were utilized to assess construct validity and criterion validity. Cronbach alpha and correlation coefficients were computed for internal consistency and test-retest reliability. Also, differences in J-eHEALS scores with each demographic attribute were examined with ANOVA and the independent t-test. Finally, chi-square tests were used to determine differences in the proportions of ehealth literacy groups (high or low) classified with a median split within health resources and ehealth contents.Principal components analysis produced a single factor solution and confirmatory factor analysis for the 8-items model demonstrated high indices (GFI = .988, CFI = .993, RMSEA= .056). A significant positive correlation was found between the J-eHEALS and communicative and critical health literacy scores. Cronbach alpha was 0.93 (P.01), and test-retest reliability was r = 0.63 (P.01). The J-eHEALS scores were significantly higher in women, the 40-and 50-year age group, those with high income, and individuals with a high frequency of internet searching. Furthermore, the high ehealth literacy group used many health resources and obtained a greater variety of ehealth contents as compared with the low literacy group. The most frequent resource was the internet in the high group, and television/radio in the low group. However, these results could be subject to bias because of the non-representative nature of the Internet population.The results indicate the J-eHEALS to be a highly validated and reliable scale. The present study suggests that enhancement of ehealth literacy will be important to utilize the increasing amount of health information on the internet effectively and appropriately.

Background:Although physical activity is associated with a lower risk of colon cancer, few studies have described the physical activity required for colon cancer prevention in various sociodemographic subgroups. The current study examined the prevalence and sociodemographic correlates of attaining the 2 recommended physical activity criteria for colon cancer prevention among Japanese adults.Methods:The sample included 5322 Japanese adults aged 20 to 79 years. Seven sociodemographic attributes (eg, gender, age, education level, employment status) and the International Physical Activity Questionnaire were assessed via an Internet-based survey. The odds of meeting each physical activity criterion by sociodemographic variables were calculated.Results:Overall, 23.8% of the study population met the criterion of ≥ 420 minutes of moderate-intensity activity, and 6.4% met the criterion of ≥ 210 minutes of vigorous activity. Being male, highly educated, employed, living with another person, being married and having a higher household income were significantly correlated with the attainment of recommendations.Conclusions:Participants who met the 2 activity recommendations differed in gender, education level, employment status, marital status, living conditions, and household income. The findings of the current study imply that strategies to promote more intense physical activity in all demographic groups may be necessary.

According to the interim report "National Health Promotion in the 21st Century (Healthy Japan 21)", the Exercise and Physical Activity Guide for Health Promotion 2006 (EPAGH2006) is an im-portant resource in the field of physical activity in Japan. A previous study (HigoNakamura, 2008) showed that although the awareness level of EPAGH2006 was lower than for other health pro-motion policies (e.g., Healthy Japan 21), the proportion of people who walked regularly was higher in the EPAGH2006 awareness group than in the no-awareness group. This result indicates that pro-motion of EPAGH2006 would contribute to increase in the number of physically active people. The purpose of the present study was to identify longitudinal change in awareness of EPAGH2006, and to examine the relationship with levels of physical activity.The subjects were 1,100 Japanese adults (mean [SD], 39.8 [10.1 years) recruited from among the registrants of a Japanese social research company. This longitudinal study was conducted using online questionnaires in surveys in November 2007 (T1) and December 2008 (T2). The awareness level of EPAGH2006 was assessed with 3 choices, i.e., good understanding, awareness and no-awareness. The International Physical Activity Questionnaire short Version (Craig et al., 2003; Murase et al., 2002) was used to estimate the amount of physical activity that the subjects engaged in. The Mann-Whitney test was utilized to assess inter-group differences in changes in the amount of physical activity between the understanding and no-awareness groups.The proportion of those who fully understood EPAGH2006 was 1.4% at T1 and 2.2%0 at T2 and did not significantly increase. The physical activity level in the understanding group at T2 was significantly decreased compared with the no-awareness groups at both T1 and T2 (p=0.013).The lack of increase in the awareness level between the two time points suggests that dissemination of EPAGH2006 has not been effective. A more strategic approach would appear to be required. However, the results also did not indicate that the awareness level of EPAGH2006 had a positive in-fluence on physical activity. Further studies, conducted when the awareness levels improve, may elucidate the relationship between the levels of EPAGH2006 awareness and physical activity.

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.

Although it is crucial to examine the environmental correlates of physical activity (PA) for developing more effective interventions for overweight populations, limited studies have investigated differences in the environmental correlates on body mass index (BMI). The purpose of the present study was to examine the perceived environmental correlates of PA among normal-weight and overweight Japanese men. Data were analyzed for 1,420 men (aged 44.4 ± 8.3 years), who responded to an internet-based cross-sectional survey of answering the short version of the International Physical Activity Questionnaire and its Environment Module. Binary logistic regression analyses were utilized to examine the environmental factors associated with meeting the PA recommendation (150 minutes/week) between the normal-weight and overweight men. After adjusting for socio-demographic variables, common and different environmental correlates of PA were observed among normal-weight and overweight men. Furthermore, significant interactions regarding PA were observed between BMI status and two environmental correlates: access to public transportation (P = 0.03) and crime safety during the day (P = 0.01). The results indicated that BMI status is a potential moderator between perceived environmental factors and PA and suggested that different environmental intervention approaches should be developed for overweight populations.

a Graduate School of Health Sciences, Kobe University, Kobe, Japan b Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan c Department of Physical Therapy, Tokushima Bunri University, Tokushima, Japan d Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan e Division of Cardiology, St. Marianna University Toyoko Hospital, Kawasaki, Japan f Department of Cardiology, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan g Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA h Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan i Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

heart failure patients Kazuhiro P. Izawa ⁎, Satoshi Watanabe , Shinobu Tochimoto , Koichiro Oka , Yuhei Otobe , Shinji Nemoto , Yasuyuki Hirano , Naohiko Osada , Kazuto Omiya , Peter H. Brubaker , Hiroyuki Shimizu g a Graduate School of Health Sciences, Kobe University 7-10-2 Tomogaoka, Suma-ku, Kobe 654-0142, Japan b Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kanagawa, Japan c Faculty of Sport Sciences, Waseda University, Saitama, Japan d Department of Physical Therapy, Tokushima Bunri University, Tokushima, Japan e Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan f Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA g Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan

Although a foot care program for long-term care prevention has been launched in Japan, few studies have examined its effectiveness. The purpose of the present investigation was to examine the association of foot problems with fall experience and fear of falling among Japanese community-dwelling elderly people.The participants were 10,581 community-dwelling elderly people (75.2 +/- 5.6 years) and the study design was cross-sectional using a questionnaire. Self-reported tinea pedis, skin problems (inflammation, swelling, or discoloration), nail problems (thickening or deformities), impairment (in function or blood flow), regular foot care, and wearing of appropriate shoes were selected as parameters of foot problems and their care. Logistic regression analysis was conducted to examine whether these were related to fall experience (in the past 1 year) and fear of falling adjusted for age, the Tokyo Metropolitan institute of gerontology index of competence, medical conditions, and lower limb functions.Forty-six percents of males and 39.0% of females reported at least one foot problem. After adjusting for covariates, tinea pedis (male: adjusted odds ratio = 1.37[95% confidence interval= 1.15-1.63], female: 1.29[1.08-1.53]), skin problems (male: 1.66[1.32-2.101, female: 1.37[1.13-1.66]), nail problems (male: 1.72[1.45-2.051, female: 1.48[1.26-1.74]), and functional impairment (male: 2.42[1.91-3.05], female: 1.66[1.36-2.04]) were significantly associated with fall experience. Also, each problem was negatively associated with fear of falling (tinea pedis[male: 1.37 [1.15-1.62], female: 1.25[1.07-1.47]], skin problems[male: 1.42[1.13-1.801, female: 1.62[1.34-2.00]], nail problems[male: 1.41[1.19-1.68], female: 1.46[1.25-1.70]], functional impairment [male: 2.05[1.61-2.60], female: 2.10[1.69-2.60]]). In addition, regular foot care (0.81[0.71-0.921) was a significant correlate of fear of falling in females.These results imply that focusing on foot problems (i.e., tinea pedis, skin problems, nail problems, functional impairment) would be one of means for fall preventions. Well-designed prospective studies evaluating foot problems objectively are now needed to confirm the relationships indicated by this study.

Objective: To examine differences in physiologic and psychosocial outcomes between age groups after an exercise-based supervised-recovery phase II cardiac rehabilitation outpatient program. Design: This is a longitudinal observational study. The study assessed 442 consecutive cardiac patients. Patients were divided into the middle-aged group (

According to the interim report of Healthy Japan 21, promoting Exercise Guideline 2006 is one important issue in the fields of physical activity and exercise. However, a previous study indicated that Japanese people rarely were aware of Exercise Guideline 2006 (HigoNakamura, 2008). The purpose of the present study was to identify characteristics of those who were aware of the guideline.The subjects were 1,613 Japanese adults (40.2 +/- 12.2 years) recruited by a Japanese social research company. The study designwas cross-sectional, using an internet questionnaire. Regarding the research items, the dependent variable was awareness of Exercise Guideline 2006, and the independent variables included awareness of other health promotion policies such as Healthy Japan 21, the Japanese Nutrition Balance Guide, and the Japanese national policy for preventing metabolic syndrome, as well as demographic variables (e.g., gender, age, BMI, hours per day spent watching TV watching and hours per day with internet usage). Logistic regression analysis was used for this research.Of all subjects, 12.3% answered that they were aware of Exercise Guideline 2006. Those over 50 years old (OR = 2.17; 95% CI = 1.11-4.22), having over 10 million household income (OR = 1.94; 99% CI = 1.05-3.61), an exercise habit (OR = 1.75; 95% CI = 1.07-2.86), an awareness of Healthy Japan 21 (OR = 23.60; 95% CI = 15.26-36.52), the Japanese Nutrition Balance Guide (OR = 5.52; 95% GCI = 3.01-10.13), and the Japanese national policy for preventing metabolic syndrome (OR = 3.41; 95% CI = 2.12-5.48) were significantly more likely to be aware of the guideline.Major findings of this study were: 1) older people are more aware of Exercise Guideline 2006 than their younger counterparts, although level of awareness was generally low; 2) for promotion of Exercise Guideline 2006, targeting those with a low educational background might not be a critical issue; and 3) awareness levels for Exercise Guideline 2006 and HealthyJapan 21 are similar. Development of effective and specific ways for promoting Exercise Guideline 2006 are a high priority.

Background:Dog ownership appears to have associated health benefits as a result of increased physical activity through dog walking. This study examined the association between dog ownership and health-related physical activity among Japanese adults.Methods:Male and female respondents to an Internet-based cross-sectional survey were divided into the following groups: dog owner (DOG), nondog pet owner (NDOG), and nonpet owner (NPOG). Moderate and vigorous physical activity amount (MVPA), walking amount (Walking), and sedentary behavior time (SB) were estimated from the International Physical Activity Questionnaire. Analyses of covariance and logistic regression analysis were used.Results:The differences in MVPA, Walking, and SB were statistically significant among the three groups. DOG had a significantly greater amount of MVPA than NDOG and NPOG. DOG also had a significantly greater amount of Walking and less SB time than NPOG, and DOG was 1.5 times more likely to meet the physical activity recommendation than NDOG and NPOG.Conclusions:The dog owners had higher physical activity levels than owners of other kinds of pets and those without any pets, suggesting that dogs may play a major role in promoting physical activity. However, only 30% of the dog owners met the recommended criteria for physical activity.

Whether upper-extremity and lower-extremity muscle strength can predict a prognosis of congestive heart failure (CHF) patients is unclear. This study evaluated the impact of muscle strength on long-term mortality in patients with CHF.Prospective observational study of male Japanese CHF patients.Clinical characteristics (age, body mass index, left ventricular ejection fraction, heart failure etiology, and medications) were obtained from hospital records of 148 male outpatients with stable CHF. Brain natriuretic peptide was determined as an index of disease severity. Peak oxygen uptake ((Equation is included in full-text article.)), handgrip, and knee extensor muscle strength were also determined.After 1331.9+/-700.3 days of follow-up, 13 cardiovascular-related deaths occurred, and the patients were divided into two groups: survival (n=135) and nonsurvival (n=13). No significant differences were found between the groups in clinical characteristics, brain natriuretic peptide levels, and knee extensor muscle strength. Peak(Equation is included in full-text article.)(P=0.011) and handgrip strength (P=0.008) were significantly lower in the nonsurvival versus survival group. Left ventricular ejection fraction, peak(Equation is included in full-text article.), and handgrip strength were found by univariate Cox proportional hazards analysis to be significant prognostic indexes of survival. Multivariate analysis, however, revealed handgrip strength to be an independent predictor of prognosis. A handgrip strength cutoff value of 32.2 kgf was determined by the analysis of receiver-operating characteristics and was assessed. Kaplan-Meier survival curves after log-rank test showed significant prognostic difference between the two groups (P=0.008).Handgrip strength may be useful for forecasting prognosis in patients with CHF.

Background:Although engaging in the recommended amount of physical activity provides disease-prevention benefits, few studies have examined the proportion and correlates of meeting the Japanese physical activity recommendation. This study investigated the prevalence and demographic correlates of attaining the recommended value on the Exercise and Physical Activity Reference for Health Promotion 2006.Methods:Data were analyzed for 5177 Japanese adults who took an Internet-based cross-sectional survey. The International Physical Activity Questionnaire and 6 possible demographic correlates were obtained. Respondents were divided into 3 groups—recommended, insufficient, and inactive—according to their estimated weekly physical activity level. A multivariate logistic regression analysis was used.Results:Overall, 26.6% of respondents were physically active according to the recommendation criterion. Gender, employment status, age, marital status, and educational level were statistically significant. In men, being employed and in women, being 30 to 39 years of age were negatively associated with the attainment of the recommendation. Being male, being a married woman, and having a college education or higher for women were positively correlated with the attainment of the recommendation.Conclusions:Different associations of demographic correlates with the physical activity recommendation for men and women were found, suggesting that gender-specific strategies for targeting the population or specific interventions might be more effective in promoting physical activity among Japanese adults.

AIM The present study examined the association of pain coping strategy with pain and activity restriction among middle-aged and elderly women with the knee pain. METHODS The participants were 134 female community residents (62.1+/-8.2 years) with knee pain. The pain and activity restriction were assessed with the Japanese Knee Osteoarthritis Measure (JKOM). The pain coping strategy was evaluated using the Japanese short version of the Coping Strategy Questionnaire (CSQ). A theoretical model was developed to explain the relationships among age, pain, activity restriction, and pain coping strategy. This model was then tested using structural equation modeling (SEM). RESULTS The overall fit index was adequate for the final model (GFI=.980, AGFI=.946, CFI=.995, RMSEA=.022). SEM indicated that increasing age had a significant association with increasing pain, and indirect influence on progressive activity restriction. Also, aggravating pain was significantly associated with adopting more "praying or hoping", "catastrophizing", and "increasing pain behavior" as pain coping strategy, and indirectly affected progress in activity restriction. CONCLUSIONS The results indicate that reducing the use of maladaptive coping strategy would be important to promote the ability of pain self-management among middle-aged and elderly women with knee pain. The present study suggests that it would be necessary to incorporate the cognitive-behavioral approaches in order to modify the use of maladaptive coping strategy in existing therapeutic exercise intervention for knee pain.

Background The benefits of a recommended level of physical activity on physiological health indicators such as morbidity and mortality are well-accepted, but less research has addressed whether or not the association between the recommended level of physical activity and a health-related quality of life (HRQOL) exists in the Japanese population. Thus, the present study examined whether the recommended physical activity would be associated with HRQOL in the general Japanese middle-aged population. Methods Data were obtained from 1211 male and female respondents (39.4 ± 10.9 year, mean ± SD) from an Internet-based survey of registrants of an Internet research service. Physical activity level was estimated from the short form of the International Physical Activity Questionnaire. HRQOL was assessed with the Medical Outcomes Survey Short Form-8 questionnaire (SF-8). Based on the current national guidelines for exercise in Japan, respondents were divided into a recommended group, an insufficient group, and an inactive group according to their estimated weekly physical activity level. Multivariate analyses of covariance were utilized. Results Across both genders, the recommended group had significantly higher physical functioning (PF) scores than the inactive group (p < .05). Additionally, across both genders, the recommended group had significantly higher general health perception scores than the insufficient and inactive groups (p < .05). The recommended group had significantly higher vitality scores than the insufficient and inactive groups in males, and higher than only the inactive group in females (p < .05). The insufficient group had significantly higher PF scores than the inactive group across both genders (p < .05). The recommended group had significantly higher physical component scores than the inactive group (p = .001). Conclusion Individuals who attained the recommended level of physical activity had better scores on some dimensions of HRQOL than those who did not, suggesting that the recommended level of physical activity may be applicable not only to the physiological objective outcomes but also to some dimensions in both the physical and mental aspects of HRQOL.

Maximum gait speed and physical activity (PA) relate to mortality and morbidity, but little is known about gender-related differences in these factors in elderly hospitalized cardiac inpatients. This study aimed to determine differences in maximum gait speed and daily measured PA based on sex and the relationship between these measures in elderly cardiac inpatients.A consecutive 268 elderly Japanese cardiac inpatients (mean age, 73.3 years) were enrolled and divided by sex into female (n = 75, 28%) and male (n = 193, 72%) groups. Patient characteristics and maximum gait speed, average step count, and PA energy expenditure (PAEE) in kilocalorie per day for 2 days assessed by accelerometer were compared between groups.Gait speed correlated positively with in-hospital PA measured by average daily step count (r = 0.46, P < 0.001) and average daily PAEE (r = 0.47, P < 0.001) in all patients. After adjustment for left ventricular ejection fraction, step counts and PAEE were significantly lower in females than males (2651.35 ± 1889.92 vs 4037.33 ± 1866.81 steps, P < 0.001; 52.74 ± 51.98 vs 99.33 ± 51.40 kcal, P < 0.001), respectively.Maximum gait speed was slower and PA lower in elderly female versus male inpatients. Minimum gait speed and step count values in this study might be minimum target values for elderly male and female Japanese cardiac inpatients.

Exercise maintenance after supervised cardiac rehabilitation is important in maintaining both physical activity and physiological factors, such as peak and muscle strength (MS), associated with reduced mortality. However, there is no evidence of the effects of unsupervised exercise training and MS training on physical activity and physiological factors after supervised cardiac rehabilitation of Japanese cardiac patients. We conducted a randomized, controlled trial to evaluate the effect of unsupervised exercise training on physical activity and selected physiological factors after supervised cardiac rehabilitation. Eighteen myocardial infarction (MI) patients (16 men, 2 women; mean age 66.3 years) were recruited following completion of a supervised recovery-phase cardiac rehabilitation program. Patients were randomly assigned to a MS training (n=10) or control group (n=8). Baseline measurements of physical activity, peak , and MS were performed at the end of supervised recovery-phase cardiac rehabilitation (6 months after the onset of MI: T1). Six months later, after going through an unsupervised exercise program (12 months after the onset of MI: T2) exercise maintenance, peak , MS, and physical activity were remeasured. The MS training group performed low-intensity MS training and walking over the second 6-month period; the control group performed walking exercise only. All patients maintained their exercise training. At T2, there were no significant differences in peak values between the MS training and control groups. There was also no significant difference in physical activity (mean number of steps per week) between the MS training and control groups. However, MS was significantly higher in the MS training group than in the control group. We concluded that unsupervised exercise training and low-level MS training performed after supervised cardiac rehabilitation may effectively maintain not only physical activity and peak but increase MS.

To evaluate the effect of the self-monitoring approach (SMA) on self-efficacy for physical activity (SEPA), exercise maintenance, and objective physical activity level over a 6-mo period after a supervised 6-mo cardiac rehabilitation (CR) program.We conducted a randomized, controlled trial with 45 myocardial infarction patients (38 men, seven women; mean age, 64.2 yrs) recruited after completion of an acute-phase, exercise-based CR program. Patients were randomly assigned to an SMA group (n = 24) or control group (n = 21). Along with CR, the subjects in the SMA group self-monitored their weight and physical activity for 6 mos. The SMA used in this study was based on Bandura's self-efficacy theory and was designed to enhance confidence for exercise maintenance. The control group participated in CR only. All patients were evaluated with the SEPA assessment tool. Exercise maintenance, SEPA scores, and objective physical activity (average steps per week) as a caloric expenditure were assessed at baseline and during a 6-mo period after the supervised CR program.Mean period from myocardial infarction onset did not differ significantly between the SMA and control groups (12.1 +/- 1.3 vs. 12.2 +/- 1.2 mos, P = 0.692). All patients maintained their exercise routine in the SMA group. Mean SEPA score (90.5 vs. 72.7 points, P0.001) and mean objective physical activity (10,458.7 vs. 6922.5 steps/wk, P0.001) at 12 mos after myocardial infarction onset were significantly higher in the SMA than control group. SEPA showed significant positive correlation with objective physical activity (r = 0.642, P0.001).SMA during supervised CR may effectively increase exercise maintenance, SEPA, and objective physical activity at 12 mos after myocardial infarction onset.

We investigated the changes of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQL) in Japanese cardiac surgery patients. Subjects were 47 consecutive outpatients (32 men, 15 women; mean age 59.4 ± 12.6 years) recovering from cardiac surgery. Patients performed both aerobic exercise on a treadmill at anaerobic threshold intensity and moderate resistance training 2 days per week, 60 min per session, from 1 to 3 months after cardiac surgery. Differences in the eight SF-36 subscale scores and physiological outcomes within the patient group at 1 month and at 3 months after cardiac surgery were analyzed. Peak oxygen uptake, handgrip strength, and knee extension strength were used as physiological outcome measures. HRQL was assessed with the Japanese version Medical Outcome Study Short Form 36 (SF-36). Significant change in overall physiological outcome from 1 month to 3 months was observed. There was also significant change in seven of the eight SF-36 health status subscale scores (physical functioning, role-physical, bodily pain, general health, vitality, role-emotional, and mental health). However, with the exception of physical functioning and mental health scores, values did not reach those of the average healthy Japanese. In conclusion, we found that CR exercise training for Japanese cardiac surgery patients during the recovery phase changes not only physiological outcomes but also HRQL as assessed by the SF-36.

failure patients Kazuhiro P. Izawa ⁎, Satoshi Watanabe , Koichiro Oka , Naohiko Osada , Kazuto Omiya , Peter H. Brubaker , Hiroyuki Shimizu e a Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kanagawa 216-8511, Japan b Faculty of Sport Sciences, Waseda University, Saitama, Japan c Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan d Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States e Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan

Objective The purpose of this study was to determine exercise maintenance rate, leisure-time objective physical activity level, and health-related quality of life in relation to exercise maintenance over the 6-mo period after a supervised 5-mo recovery-phase cardiac rehabilitation program in acute myocardial infarction patients. The study also investigated whether exercise maintenance resulted in reproducible health-related quality-of-life outcomes comparable with those of the Japanese normal population. Design This observational study comprised 109 acute myocardial infarction patients (89 men, 20 women; mean age, 63.5 +/- 10.1 yrs). Physiologic outcomes (peak oxygen uptake, handgrip, and knee-extension strength) measured at 1 and 6 mos after acute myocardial infarction onset were compared. Completed exercise maintenance and health-related quality-of-life questionnaires and results of electronic pedometer recordings to evaluate leisure-time objective physical activity level were assessed 6 mos after cardiac rehabilitation. Results The mean period from acute myocardial infarction to evaluation of outcomes was 18.8 +/- 3.4 mos. Ninety of 109 patients (82.6%) continued exercise for >6 mos after cardiac rehabilitation (exercise group); 19 patients (17.4%) quit exercise after cardiac rehabilitation (nonexercise group). Improvement in physiologic outcomes was noted at 6 mos vs. those at 1 mo, but outcomes were not significantly different between groups. The exercise group performed significantly better than the nonexercise group for leisure-time objective physical activity level and scored significantly higher than the nonexercise group for seven of eight health-related quality of life measures, attaining scores similar to those of the Japanese normal population. Conclusions At >18 mos after acute myocardial infarction, the exercise maintenance rate in our patients remains high, and exercise maintenance may be one of the factors contributing to improvement of health-related quality of life and leisure-time objective physical activity level.

Background The present study examined the impact of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQOL) of patients with acute myocardial infarction (AMI). Methods and Results A total of 124 consecutive AMI patients were divided into a supervised outpatient CR group (n=82) and a non-CR group as a control (n=42). Peak oxygen uptake, handgrip strength, and knee extension muscular strength were used as physiological outcome measures. HRQOL outcomes were assessed by the Medical Outcome Study Short Form 36 (SF-36). CR group patients performed both aerobic exercise and moderate resistance training from 1 month (T1) to 3 months (T2) after AMI onset. Age, sex, body mass index, medications, and ejection fraction were similar in both groups. Significantly greater increases in overall physiological outcomes from T1 to T2 were measured in the CR group compared with those of the non-CR group. There were also significantly greater improvements in 4 of the 8 SF-36 health status subscales (physical functioning, role-physical, general health, and vitality) in the CR group compared with the non-CR group. Conclusions Eight weeks of exercise training have specific effects on improvement in HRQOL and physiological outcomes in Japanese patients. (Circ J 2004; 68: 315 - 320)

To develop a measure for disease-specific health-related quality of life in patients with heart failure and examine its reliability and validity.One hundred and four patients with stable chronic heart failure (74 males, 30 females, mean age 64.2 +/- 10.0 years) with left ventricular ejection fractions of less than 40% were enrolled in this study. Each patient responded to the Medical Outcomes Study Short Form 36 (SF-36) and a disease specific questionnaire comprising four categories (dyspnea, sleep, appetite and fatigue), each consisting of five to six questions. A stepwise exploratory factor analysis was applied to the disease-specific measure to consider categorical fitness. In 25 of the 104 patients, the data in the questionnaire were compared with peak oxygen uptake, anaerobic threshold, slope of the regression line relating the ventilatory equivalent to carbon dioxide output (VE/VCO2 slope) and peak work rate. Correlations between the questionnaire and eight components of SF-36 were evaluated.The appetite category proved unreliable and was excluded from consideration, so 12 questions were adopted from the other three categories. Cronbach's a values ranged from 0.68 to 0.89 and the coefficients of test-retest were from 0.84 to 0.94, so both internal consistency and reproducibility of these questions were considered excellent. The scores of three categories well reflected the severity of heart failure based in New York Heart Association functional class. The anaerobic threshold (r = 0.53), peak oxygen uptake (r = 0.66), VE/VCO2 slope (r = -0.48) and peak work rate (r = 0.41) correlated with the total score of the 12 questions. The total scores were closely correlated with the eight components of SF-36.This study suggests that the disease-specific questionnaire is applicable to evaluation of the health-related quality of life in patients with heart failure.

The transtheoretical model of behavior change (TTM) has been used to account for how people change their health behavior. It was originally developed to explain or predict change in unhealthy addictive behavior (e.g., smoking), but recently the use of the TTM within the physical activity and exercise behavior domain has been proposed. In the present study, we examined its structure in this regard among middle-aged Japanese adults. In particular, the relationship between the stages of change for exercise behavior and self-efficacy was investigated. Firstly, a scale was developed to assess self-efficacy for exercise. Four hundred and sixty seven middle-aged adults completed questionnaires. As a result of stepwise variable selection procedure in exploratory factor analysis, a scale comprising 1 factor with 5 items was developed. Psychometric analyses revealed that this scale had high reliability and validity. Secondly, a cross-sectional investigation was conducted to examine the relationship between stage of change and self-efficacy among middle-aged adults (n = 808) using a questionnaire approach. Significant associations were found between stage of change for exercise behavior classification and self-efficacy for exercise. Specifically, scores on self-efficacy of the subjects in the present study were less for those in a precontemplation stage and greater for those in maintenance compared to all other stages, and generally followed a linear pattern of change across the stages. Although the use of a cross-sectional research design and nonrandom sampling methods in the present study limit interpretation, the similarity of these results to those in the previous literature suggests that the relationship between stages of change for exercise behavior and self-efficacy for exercise holds across different age groups and cultures. By accurately understanding these relationships, health promotion professionals may be able to improve physical activity and exercise promotion efforts.