Search

PURPOSE: Limited data are available on the relationship between cardiorespiratory fitness and cancer mortality. We evaluated the cardiorespiratory fitness and risk of cancer mortality in Japanese men. METHODS: A total of 9039 men (19-59 yr) who were given a submaximal exercise test and a health examination between 1982 and 1988 and were followed for mortality up to 1999. Cardiorespiratory fitness was measured using a cycle ergometer test, and maximal oxygen uptake was estimated. RESULTS: The mean follow-up period was slightly more than 16 yr, producing a total of 148,491 person-years of observation. There were 231 deaths, with 123 deaths due to cancer. Relative risk (RR) and 95% confidence interval (95%CI) for cancer mortality were obtained using the Cox proportional hazards model. Taking into consideration age, systolic blood pressure, body mass index, smoking habit, and alcohol habit and using the lowest physical fitness group as the reference, the RR (95% CI) for increasing quartiles of fitness were 0.75(0.48-1.16), 0.43(0.25-0.74) and 0.41(0.23-0.74); P < 0.001 for trend. CONCLUSION: Low cardiorespiratory fitness is associated with cancer mortality in Japanese men. [ABSTRACT FROM AUTHOR]

Objectives: Poor cardiorespiratory fitness (CRF) and high body mass index (BMI) increased the risk of developing metabolic Syndrome (MetS) mostly in Caucasians. However, the sex-specific combined association of CRF and BMI on MetS considering health-related behaviors has yet to be thoroughly examined in Japanese. This study aims to investigate the sex-specific independent and combined associations of CRF and BMI with MetS in middle-aged Japanese adults., Methods: 421 participants were included in this cross-sectional study. CRF was estimated using a submaximal cycle ergometer. CRF and BMI were respectively divided into three categories according to tertile distribution. MetS was diagnosed based on five risk factors: waist circumference, triglycerides, high-density lipoprotein cholesterol, blood pressure, and fasting glucose. Multivariable logistic regression models were used to estimate independent and combined association of CRF and BMI with MetS., Results: Results showed that 154 (57.5%) and 70 (45.8%) of men and women had MetS, respectively. Compared to men with lower CRF or higher BMI, men with middle and higher CRF or middle and lower BMI were less likely to have MetS. Compared with 'unfit and higher BMI' group, 'unfit and lower BMI', 'fit and higher BMI', and 'fit and lower BMI' groups in men showed statistically significant decreased prevalences of MetS. However, no significant associations were found in women., Conclusions: This study found significant independent and combined associations of CRF and BMI with MetS only in men, but not in women. However, prospective studies are warranted to confirm sex-specific associations of CRF and BMI with MetS., (© 2024. The Author(s).)

Purpose: To explore the impact of COVID-19 pandemic lockdown (CoPL) on body mass index (BMI) and physical fitness among college students., Methods: Two one-year cohorts, one with no pandemic lockdown (NoPL) exposure and one with CoPL exposure, were included. Baseline measurements were performed in October 2018 (NoPL) and October 2019 (CoPL), and follow-up data were collected one year later. Participants were divided into "deterioration", "no-change", and "improvement" groups based on their quartile distribution of one-year differences (follow-up-baseline) for lower 25%, middle 50%, and upper 25%. Baseline-category logit regression models were used to determine the odds ratios of deterioration and improvement in BMI and physical fitness, with "no-change" used as baseline., Results: A total of 2,594 and 2,525 students were included in NoPL and CoPL cohorts, respectively. CoPL was associated with higher odds for deterioration in BMI (male), explosive strength, upper-limb muscle strength, abdominal muscle strength, and cardiorespiratory fitness, but lower odds for deterioration in BMI (female) and flexibility. CoPL was associated with lower odds for improvement in BMI (male), explosive strength, lower-limb and upper-limb muscle strength, and cardiorespiratory fitness, but higher odds for improvement in BMI (female) and flexibility., Discussion: Not all dimensions of health outcomes were negatively impacted by the lockdown, as deterioration in BMI in males, muscle strength, and cardiorespiratory fitness following the CoPL were more than that in the absence of the lockdown, while deterioration in BMI in females and flexibility were less than that in the absence of the lockdown., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The current Japanese hypertension management guidelines (2019) recommend regular exercise for all patients with hypertension. However, limited evidence is available regarding the prevalence of exercise habits in these patients. Therefore, we examined the proportion of participants who met the recommendations on exercise in the Japanese hypertension management guidelines (2019) using a nationally representative sample., Methods: Participants aged ≥20 years from the Japanese National Health and Nutrition Examination Survey conducted from 2013 to 2018 were included. Participants with hypertension were defined as those with blood pressure level ≥140/90 mmHg or those who used antihypertensive drugs. Adherence to the guideline recommendations, stratified by gender, age category, blood pressure level, and medication status, was examined., Results: This study included 13,414 participants with hypertension (age 68.2 ± 11.7 years, 48.1% men). Among them, 31.8% of participants with hypertension (36.8% of men and 27.3% of women) met the guidelines. Regarding age, the 20-64 years age group had the lowest proportion of patients who met the guidelines (22.4%), followed by those in the 65-74 (37.7%) and ≥75 years age groups (34.5%). Adherence to the guidelines did not significantly differ according to blood pressure levels (<120/<80, 120-129/<80, 130-139/80-89, 140-159/90-99, and 160-179/100-109 mmHg) and presence of antihypertensive medications., Conclusion: One-third of participants with hypertension engaged in exercise as recommended by the current hypertension management guidelines. Promotion of exercise therapy and monitoring exercise habits among participants with hypertension is warranted., Competing Interests: Authors declare no Conflict of Interests for this article., (© 2024 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

Objectives: To examine the dose-response relationship between physical activity (PA) and all-cause and cardiovascular disease (CVD) mortality, specifically among older adults., Design: Umbrella review., Setting and Participants: Eligible studies included systematic reviews with meta-analyses that investigated the association of aerobic PA, muscle-strengthening activity, and multicomponent PA, including exercise programs (such as aerobic, muscle strengthening, and balance training), with all-cause and CVD mortality among older adults aged ≥60 years., Methods: We performed a literature search in PubMed, CINAHL, and the Cochrane Library for eligible studies published between January 2017 and March 2023 to update an umbrella review initially conducted by the United States 2018 PA Guidelines Advisory Committee. Studies included in the 2018 US PA and 2020 World Health Organization (WHO) Guidelines were also reviewed. In addition, meta-analyses that reported effect sizes stratified by age and recruiting older adults (aged ≥60 years) were included., Results: Overall, 16 relevant systematic reviews (10 from our review and 6 from the US and WHO guidelines) met the inclusion criteria. All these reviews showed that 7.5 to 15.0 metabolic equivalents (METs)-hours/week (around the recommended PA levels outlined in the US and WHO guidelines) substantially reduced mortality risks among older adults (approximately 19%-30% for all-cause mortality and 25%-34% for CVD mortality). Moreover, 15.0 to 22.5 MET-hours/week, exceeding the guideline-recommended PA levels, resulted in greater reductions in mortality risks by 35% to 37% and 38% to 40%, respectively., Conclusions and Implications: PA substantially reduced all-cause and CVD mortality risks among older adults. Larger risk reductions may be achieved by engaging in PA levels higher than those recommended by the current international PA guidelines. Our findings suggest that recommending higher PA levels beyond the current guidelines may benefit older adults when developing future international PA guidelines., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Cardiorespiratory fitness (CRF) is a predictor of chronic disease that is impractical to routinely measure in primary care settings. We used a new estimated cardiorespiratory fitness (eCRF) algorithm that uses information routinely documented in electronic health care records to predict abnormal blood glucose incidence., Methods: Participants were adults (17.8% female) 20-81 years old at baseline from the Aerobics Center Longitudinal Study between 1979 and 2006. eCRF was based on sex, age, body mass index, resting heart rate, resting blood pressure, and smoking status. CRF was measured by maximal treadmill testing. Cox proportional hazards regression models were established using eCRF and CRF as independent variables predicting the abnormal blood glucose incidence while adjusting for covariates (age, sex, exam year, waist girth, heavy drinking, smoking, and family history of diabetes mellitus and lipids)., Results: Of 8602 participants at risk at baseline, 3580 (41.6%) developed abnormal blood glucose during an average of 4.9 years follow-up. The average eCRF of 12.03 ± 1.75 METs was equivalent to the CRF of 12.15 ± 2.40 METs within the 10% equivalence limit. In fully adjusted models, the estimated risks were the same (HRs = 0.96), eCRF (95% CIs = 0.93-0.99), and CRF (95% CI of 0.94-0.98). Each 1-MET increase was associated with a 4% reduced risk., Conclusions: Higher eCRF is associated with a lower risk of abnormal glucose. eCRF can be a vital sign used for research and prevention.

Background: Awareness, knowledge, beliefs, and behavioral intentions of physical activity (PA) guidelines may be important mediating factors for promoting PA. However, these pathways of the psychological process to PA behavior have not been examined. These pathways may differ depending on health literacy levels. This study investigated the pathways to PA, from guideline awareness to behavior, and further examined whether they differed by health literacy., Methods: A cross-sectional study was conducted with 7,000 Japanese participants aged 20-69 years. The participants were registered with an Internet survey company. Participants' awareness, knowledge, beliefs, and behavioral intentions regarding the PA guidelines of Japan, the volume of moderate-to-vigorous intensity PA, activity level, and health literacy were examined through a questionnaire. The PA pathways, from guideline awareness to behavior, were examined by structural equation modeling (SEM), with PA behavior as the dependent variable. Multi-group SEM was conducted to examine the moderating effect of health literacy on PA pathways. Health literacy scores were dichotomized into high and low groups in multi-group modeling by the median split., Results: SEM revealed that PA guideline awareness directly affects PA behavior and has certain indirect effects through the mediation of knowledge, beliefs, and behavioral intentions. Furthermore, the multi-group SEM showed that the proportion of indirect effects (path coefficient [PC]: 0.11, 95% confidence interval [CI]: 0.10-0.13) was higher than direct effects (PC: 0.07, 95%CI: 0.03-0.11) in the high-health literacy group. In contrast, the proportion of direct effects (PC: 0.22, 95%CI: 0.15-0.30) was higher than indirect effects (PC: 0.06, 95%CI: 0.05-0.07) in the low-health literacy group., Conclusions: PA guideline awareness is both directly and indirectly associated with PA behavior, mediated by psychological pathways of knowledge, beliefs, and behavioral intentions, and influenced by health literacy. These results suggest that health literacy should be considered when implementing PA guideline-based interventions., (© 2023. The Author(s).)

Objective　This study clarified the current status of awareness, knowledge, beliefs, and behavioral intentions regarding the Japanese physical activity guidelines (Active Guide) and their relationship with physical activity, sedentary behavior, and the participants' characteristics.Methods　A cross-sectional study was conducted with 7,000 participants aged 20-69 years registered with an online survey company. Awareness, knowledge, beliefs, and behavioral intentions regarding the Active Guide were examined. Awareness was assessed by unprompted and prompted recall. Knowledge was assessed by numerical responses to "the recommended daily activity time (18-64 years/65 years and older)" and "physical activity time to be increased (plus-ten)," respectively. To survey the beliefs and behavioral intentions, we created a 5-point scale for the Active Guide. For physical activity, the amount of moderate-to-vigorous intensity physical activity was calculated from the Japan Public Health Center-based prospective Study (JPHC study) questionnaire. Physical activity level was calculated from the standard specific medical checkup and health guidance questionnaire. For sedentary behavior, the Japanese version of the International Physical Activity Questionnaire (IPAQ) was used. The dependent variables were awareness, knowledge, beliefs, and behavioral intentions. The independent variables were physical activity, sedentary behavior, and the participants' characteristics (gender, age, body mass index, marital status, educational background, work status, and household income). After descriptive statistics were measured, a logistic regression analysis was performed to examine the associations.Results　Unprompted and prompted recall of the Active Guide were 1.7% and 5.3-13.4%, respectively. Those with knowledge of it scored 37.2%, 7.0%, 24.8%, and 2.6% for recommended daily activity time (18-64 years), daily physical activity time (65 years and older), plus-ten, and all three items answered correctly, respectively. The median (interquartile range) score of the beliefs was 21 (16-25) points (32-point scale). Those with behavioral intentions scored 51.4% for "recommended daily activity" and 66.9% for "plus-ten." Logistic regression analysis showed that awareness, knowledge, beliefs, and behavioral intentions were positively associated with moderate-to-vigorous intensity physical activity and level. The results were inconsistent for sedentary behavior. Although personal characteristics differed based on assessment item, they were mainly associated with age, education level, employment, and household income.Conclusions　This study revealed that the number of people who had awareness and knowledge of the Active Guide remained low. Those with awareness, knowledge, beliefs, and behavioral intentions were more physically active. However, the results for sedentary behavior were not consistent. Hence, further research is required to understand this tendency. A future longitudinal study is also required.

Objective: To quantify the associations between muscle-strengthening activities and the risk of non-communicable diseases and mortality in adults independent of aerobic activities., Design: Systematic review and meta-analysis of prospective cohort studies., Data Sources: MEDLINE and Embase were searched from inception to June 2021 and the reference lists of all related articles were reviewed., Eligibility Criteria for Selecting Studies: Prospective cohort studies that examined the association between muscle-strengthening activities and health outcomes in adults aged ≥18 years without severe health conditions., Results: Sixteen studies met the eligibility criteria. Muscle-strengthening activities were associated with a 10-17% lower risk of all-cause mortality, cardiovascular disease (CVD), total cancer, diabetes and lung cancer. No association was found between muscle-strengthening activities and the risk of some site-specific cancers (colon, kidney, bladder and pancreatic cancers). J-shaped associations with the maximum risk reduction (approximately 10-20%) at approximately 30-60 min/week of muscle-strengthening activities were found for all-cause mortality, CVD and total cancer, whereas an L-shaped association showing a large risk reduction at up to 60 min/week of muscle-strengthening activities was observed for diabetes. Combined muscle-strengthening and aerobic activities (versus none) were associated with a lower risk of all-cause, CVD and total cancer mortality., Conclusion: Muscle-strengthening activities were inversely associated with the risk of all-cause mortality and major non-communicable diseases including CVD, total cancer, diabetes and lung cancer; however, the influence of a higher volume of muscle-strengthening activities on all-cause mortality, CVD and total cancer is unclear when considering the observed J-shaped associations., Systematic Review Registration: PROSPERO CRD42020219808., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Objective: To prospectively investigate the association between personal activity intelligence (PAI) - a novel metabolic metric which translates heart rate during physical activity into a simple weekly score - and mortality in relatively healthy participants in China whose levels and patterns of physical activity in addition to other lifestyle factors are different from those in high-income countries., Patients and Methods: From the population-based China Kadoorie Biobank study, 443,792 healthy adults were recruited between June 2004 and July 2008. Participant's weekly PAI score was estimated and divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Using Cox proportional hazard analyses, we calculated adjusted hazard ratios (AHRs) for cardiovascular disease (CVD) and all-cause mortality related to PAI scores., Results: During a median follow-up of 8.2 (interquartile range, 7.3 to 9.1) years, there were 21,901 deaths, including 9466 CVD deaths. Compared with the inactive group (0 PAI score), a baseline weekly PAI score greater than or equal to 100 was associated with a lower risk of CVD mortality, an AHR of 0.87 (95% CI, 0.81 to 0.94) in men, and an AHR of 0.84 (95% CI, 0.78 to 0.92) in women, after adjusting for multiple confounders. Participants with a weekly PAI score greater than or equal to 100 also had a lower risk of all-cause mortality (AHR, 0.93; 95% CI, 0.89 to 0.97 in men, and AHR, 0.93; 95%, 0.88 to 0.98 in women). Moreover, this subgroup gained 2.7 (95% CI, 2.4 to 3.0) years of life, compared with the inactive cohort., Conclusion: Among relatively healthy Chinese adults, the PAI metric was inversely associated with CVD and all-cause mortality, highlighting the generalizability of the score in different races, ethnicities, and socioeconomic strata., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Although the negative relationship between cardiorespiratory fitness (CRF) or muscular fitness and diabetes mellitus were respectively observed in many previous studies, there is still a lack of studies that include CRF and muscular fitness simultaneously. Therefore, this study aimed to investigate the relationship between the combination of CRF and muscular fitness and diabetes through a cross-sectional study.  METHODS: This study was part of WASEDA'S Health Study, a cohort study launched in 2014. We used a part of the baseline data collected for this study. Maximal exercise test using a cycle ergometer and leg extension power (LEP) test were respectively used to evaluate CRF and muscular fitness. Since LEP is affected by body weight, relative LEP (rLEP) which is LEP per body weight, was used as an index of muscular fitness. 796 men (56.5 ± 10.4 years old) who completed a medical examination and fitness tests, were divided into two groups based on CRF and rLEP, respectively. The prevalence of diabetes was collected based on a self-reported questionnaire or blood test. Odds ratios and 95% confidence intervals (CIs) for the prevalence of diabetes were obtained using logistic regression models while adjusting for age, body mass index, exercise habits, family history of diabetes, smoking habits, and drinking habits., Results: 55 (7%) participants had diabetes. Compared to participants with lower CRF or rLEP, the odds ratio (95% CIs) of diabetes in those with higher CRF or rLEP was 0.46 (0.21-0.98) or 0.34 (0.16-0.74), respectively. Furthermore, using the lower CRF and lower rLEP group as the reference, the odds ratio (95% CIs) for the lower CRF and higher rLEP group was 0.32 (0.12-0.88), and higher CRF and higher rLEP group was 0.21 (0.07-0.63), after adjusting for potential confounding factors., Conclusions: CRF and rLEP have independent and joint inverse associations with diabetes prevalence. In addition, participants with high CRF and high rLEP had a lower prevalence of diabetes compared to those with only high CRF or only high rLEP., (© 2022. The Author(s).)

Objectives: To clarify the association between moderate-to-vigorous physical activity (MVPA) and/or sedentary behaviour (SB) and the incidence of functional disability (FD) in older adults., Design: Prospective cohort study., Setting: Local municipality of Tsuru, Yamanashi, Japan. We conducted a baseline survey in January 2016. Follow-up was commenced on 1 February 2016 and completed on 31 October 2018., Participants: All individuals (6661 people) aged >65 years who were independently living in the community were eligible., Methods and Outcome Measures: MVPA (min/week) and SB (min/day) were measured using self-administered questionnaires in 5311 independently living older adults who participated in this study. The follow-up period was 33 months, and the incidence of FD was objectively determined by experts. The participants were divided into three groups based on MVPA distribution (non-MVPA, 0 min; short-MVPA, 1-299 min and long-MVPA, ≥300 min/week) and into two groups based on the median value of SB (short-SB,<190 min; and long-SB, ≥190 min/day). The participants were also classified into six categories based on different combinations of MVPA and SB. Cox proportional hazards model was used to calculate the HR and 95% CI for FD development with MVPA, SB and a combination of these behaviours., Results: Among the included participants, 2415 were male and 2896 were female. The mean ages (SD) of the male and female participants were 74.5 (6.8) and 74.9 (6.9) years, respectively. The total number of participants with chronic conditions was 3489 (65.7%). Using the non-MVPA group as the reference, the multivariable-adjusted HR (95% CI) was 0.68 (0.54 to 0.84) in the short-MVPA group and 0.53 (0.41 to 0.69) in the long-MVPA group. Regarding SB, the short-SB group had an HR of 0.86 (0.71 to 1.03) compared with the long-SB group. The combined behaviour showed the lowest HR in the long-MVPA and short-SB group 0.49 (0.34 to 0.72) and the long-MVPA and long-SB group 0.49 (0.34 to 0.68), respectively., Conclusions: Long-MVPA had a robust association with FD development, whereas short-SB had a modest association. Moreover, a combination of these behaviours had a stronger association than individual behaviours. If the identified associations are assumed to be causal in nature, these findings suggest that encouraging older adults to engage in MVPA and reduce SB in their daily lives could be effective to prevent or delay FD development., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The negative impact of COVID-19 on physical activity has been improved, while the research on changes in physical fitness that may be caused by physical inactivity is still scarce. This study aims to explore the impact of the COVID-19 pandemic lockdown on physical fitness, and the impact of initial physical fitness indicators on their changes during the lockdown in adolescents. A longitudinal study including 265 adolescents aged 14.1 ± 0.4 years old was conducted in China. Physical fitness measurement at baseline and follow-up were respectively measured before (November 2019) and after the lockdown (July 2020). Several physical fitness indicators including aerobic fitness (i.e., 800-m or 1000-m run) and explosive force (i.e., 50-m sprint) deteriorated during the lockdown. Whereas the performances of vital capacity, flexibility (i.e., sit and reach), and muscular strength (i.e., pull-ups) were significantly improved during the lockdown. Furthermore, the reduction in physical fitness for adolescents with higher physical fitness before the lockdown was greater than that for others. These findings may contribute to the development of targeted intervention strategies for physical fitness promotion during the lockdown caused by the public health emergency.

Previous cohort study reported that high physical activity was associated with a low risk of self-reported hearing loss in women. However, no studies have examined the association between physical activity and the development of hearing loss as measured using an objective assessment of hearing loss in men and women. Here, we used cohort data to examine the association between leisure-time physical activity and incidence of objectively assessed hearing loss in men and women. Participants included 27 537 Japanese adults aged 20-80 years without hearing loss, who completed a self-administered physical activity questionnaire between April 2001 and March 2002. The participants were followed up for the development of hearing loss as measured by audiometry between April 2002 and March 2008. During follow-up, 3691 participants developed hearing loss. Compared with the none physical activity group, multivariable adjusted hazard ratios (HRs) for developing hearing loss were 0.93 (95% confidence interval (CI), 0.86-1.01) and 0.87 (0.81-0.95) for the medium (<525 MET-min/week) and high (≥525 MET-min/week) physical activity groups, respectively (p for trend = 0.001). The magnitude of risk reduction was slightly greater in vigorous-intensity activity than in moderate-intensity activity (p for interaction = 0.01). Analysis by sound frequency showed that the amount of physical activity was inversely associated with high frequency hearing loss development (p for trend <0.001), but not with low frequency hearing loss development (p for trend = 0.19). Higher level of leisure-time physical activity was associated with lower incidence of hearing loss, particularly for vigorous-intensity activities and high sound frequencies., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Cardiorespiratory fitness (CRF) is an independent predictor of morbidity and mortality. In Japan, annual physical exams are mandatory in workplace settings, and most healthcare settings have electronic medical records (EMRs). However, in both settings, CRF is not usually determined, thereby limiting the potential for epidemiological investigations using EMR data., Purpose: To estimate CRF (mL/kg/min) using variables commonly recorded in EMRs., Methods: Participants were 5293 Japanese adults (11.7% women) who completed an annual physical exam at a large gas company in Tokyo, Japan, in 2004. The mean age was 48.3 ± 8.0 years. Estimated CRF (eCRF) was based on age, measured body mass index, resting heart rate, systolic and diastolic blood pressure, and smoking. Measured CRF was determined by a submaximal cycle ergometer graded exercise test., Results: Regression models were used for males and females to calculate Pearson's correlation and regression coefficients. Cross-classification of measured CRF and eCRF was conducted using the lowest quintile, quartile, and tertile as the unfit categories. R's for eCRF were 0.61 (MD 4.41) for men and 0.64 (MD 4.22) for women. The overall accuracy level was reasonable and consistent across models, yet the unfit lower tertile model provided the best overall model when considering the positive predictive value and sensitivity., Conclusion: eCRF may provide a useful method for conducting investigations using data derived from EMRs or datasets devoid of CRF or physical activity measures.

The purpose of this study was to examine the associations of cardiorespiratory fitness, general adiposity, and central adiposity with incident intermediate hyperglycemia (IH) in women. We conducted a prospective cohort study of 1534 women aged 20-79 years old who had an annual health check-up with no history of major chronic diseases. At baseline, fitness was assessed by a Balke graded exercise test, and the estimated metabolic equivalents were used to create quartile groups. Women were also grouped based on their body mass index (<25 kg/m 2 , 25-29.9 kg/m 2 , and ≥ 30 kg/m 2 ) and waist-to-height ratio (≥0.50 or < 0.50). Cox proportional hazards models were conducted to assess the association of fitness and fatness variables with incident IH defined as fasting glucose of 5.6-6.9 mmol/L. Overall, 18.1% (n = 277) of the women developed IH during an average follow-up of 5.06 years. Fitness, body mass index, and waist-to-height ratio at baseline were the independent predictors of the IH incidence in separate age-adjusted models; yet when all three variables were included in the same model along with confounding variables, only fitness remained significant and demonstrated a clear inverse association with incident IH (P-for-trend <0.001). Health promotion efforts should focus on improving fitness for the prevention of IH in women., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Previous studies have not investigated the determinants of resting oxidative stress, including physical fitness, as it relates to redox regulation. The present study therefore was aimed at identifying lifestyle and biological factors that determine resting oxidative stress, including objectively measured physical fitness. In 873 middle-aged and elderly men and women, age and anthropometric parameters, lifestyle-related parameters, medication and supplementation status, physical fitness, biochemical parameters, and nutritional intake status, as well as three plasma oxidative stress markers: protein carbonyl (PC), F 2 -isoprostane (F 2 -IsoP), and thiobarbituric acid reactive substances (TBARS), were surveyed and measured. The determinants of PC, F 2 -IsoP, and TBARS in all participants were investigated using stepwise multiple regression analysis. In PC, age ( β = -0.11, P = 0.002), leg extension power ( β = -0.12, P = 0.008), BMI ( β = 0.12, P = 0.004), and HDL-C ( β = 0.08, P = 0.040) were included in the regression model (adjusted R 2 = 0.018). In the F 2 -IsoP, smoking status ( β = 0.07, P = 0.060), BMI ( β = 0.07, P = 0.054), and HbA1c ( β = -0.06, P = 0.089) were included in the regression model (adjusted R 2 = 0.006). In TBARS, glucose ( β = 0.18, P < 0.001), CRF ( β = 0.16, P < 0.001), age ( β = 0.15, P < 0.001), TG ( β = 0.11, P = 0.001), antioxidant supplementation ( β = 0.10, P = 0.002), and HbA1c ( β = -0.13, P = 0.004) were included in the regression model (adjusted R 2 = 0.071). In conclusion, the present study showed that age, anthropometric index, lifestyle-related parameters, medication and supplementation status, objectively measured physical fitness, biochemical parameters, and nutritional intake status explain less than 10% of oxidative stress at rest., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Takuji Kawamura et al.)

Background: Grip strength reflects systemic muscle strength and mass and is reportedly associated with various metabolic variables. However, its prognostic association with dyslipidemia is unknown. We examined the association of grip strength and other physical fitness markers with the incidence of dyslipidemia among Japanese adults., Methods: A total of 16,149 Japanese (6,208 women) individuals aged 20-92 years who underwent a physical fitness test between April 2001 and March 2002 were included in this cohort study. Grip strength, vertical jump, single-leg balance with eyes closed, forward bending, and whole-body reaction time were evaluated at baseline. Dyslipidemia was annually determined based on fasting serum lipid profiles and self-reported dyslipidemia from April 2001 to March 2008., Results: During the follow-up period, 4,458 (44.9%) men and 2,461 (39.6%) women developed dyslipidemia. A higher relative grip strength (grip strength/body mass index) was associated with a lower incidence of dyslipidemia among both men and women (P for trend <0.001). Compared with those for the first septile, the hazards ratios and 95% confidence intervals (CIs) for the seventh septile were 0.56 (95% CI, 0.50-0.63) for men and 0.69 (95% CI, 0.58-0.81) for women. Moreover, relative vertical jump (vertical jump strength/body mass index) was also inversely associated with the incidence of dyslipidemia among both men and women (P for trend <0.001). There was no association between other physical fitness and dyslipidemia among both men and women., Conclusion: Relative grip strength and vertical jump may be useful risk markers of the incidence of dyslipidemia.

A high level of physical fitness, especially cardiorespiratory fitness, is associated with lower incidence of hypertension. However, the relationship between flexibility, which is a component of physical fitness, and the incidence of hypertension is unknown. The purpose of this study was to investigate the relationship between flexibility and the incidence of hypertension in a cohort study. A total of 22,972 (14,805 men and 8167 women; median age 49 years) normotensive participants were included in this study. Between April 2001 and March 2002, flexibility (standing forward bending) was measured using a standing trunk flexion meter. The participants were divided into quartiles of flexibility by sex and age group. Hypertension was defined as systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, or a self-reported history of previously diagnosed hypertension or current medication for hypertension at a health examination between April 2002 and March 2008. Hazard ratios and 95% confidence intervals (95% CI) for the incidence of hypertension were estimated using Cox proportional hazards models after adjusting for age, sex, body mass index, exercise habits, smoking status, and drinking status. During 102,948 person years of follow-up (median 5.6 years), 4235 participants developed hypertension. Compared with the lowest flexibility (quartile 1), hazard ratios and 95% CI were 0.96 (0.88 - 1.04) for quartile 2, 0.94 (0.86 - 1.03) for quartile 3, and 0.83 (0.76 - 0.91) for quartile 4. A high level of flexibility was associated with lower incidence of hypertension, independent of other confounding factors., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Several cross-sectional studies have linked higher physical fitness with better hearing sensitivity but have not established a causal relation; none have used a prospective design that is less susceptible to bias. We used a prospective cohort study to investigate the association between muscular and performance fitness and the incidence of hearing loss., Methods: A total of 21,907 participants without hearing loss received physical fitness assessments between April 2001 and March 2002. Muscular and performance fitness index, an age- and sex-specific summed z-score based on grip strength, vertical jump height, single-leg balance, forward bending, and whole-body reaction time was calculated. Participants were classified into quartiles according to the muscular and performance fitness index and each physical fitness test. They were followed up for the development of hearing loss, assessed by pure-tone audiometry at annual health examinations between April 2002 and March 2008. Hazard ratios and 95% confidence intervals for hearing loss incidence were estimated using Cox proportional hazards regression models., Results: During follow-up, 2765 participants developed hearing loss. The hazard ratios (95% confidence intervals) for developing hearing loss across the muscular and performance fitness index quartiles (lowest to highest) were 1.00 (reference), 0.88 (0.79-0.97), 0.83 (0.75-0.93), and 0.79 (0.71-0.88) (P trend <.001). Among the various physical fitness components, a clear dose-response association with hearing loss incidence was observed for vertical jump height and single-leg balance (P trend <.001 for both)., Conclusion: Higher muscular and performance fitness is associated with a lower incidence of hearing loss., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: While physical activity has been reported to positively affect stress and sleep quality, less is known about the potential relationships among them. The present study aimed to investigate the mediating effect of stress on the association between physical activity and sleep quality in Chinese college students, after controlling for age, nationality, and tobacco and alcohol use., Participants: The sample comprised 6973 college students representing three Chinese universities., Methods: Physical activity, perceived stress, and sleep quality were respectively measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), Perceived Stress Scale-10 Items (PSS-10), and Pittsburgh Sleep Quality Index (PSQI)., Results: Mediating effects of perceived stress on the association between physical activity and sleep quality were observed in males and females, with 42.4% (partial mediating effect) and 306.3% (complete mediating effect) as percentages of mediation, respectively., Conclusion: The results of this study may provide some suggestions that physical activity could improve sleep by aiding individuals in coping with stress and indicate that stress management might be an effective non-pharmaceutical therapy for sleep improvement.

The relationships between cardiorespiratory fitness (CRF) measurements not confounded by adiposity and the prevalence of pre-diabetes mellitus (pre-DM) and diabetes mellitus (DM) are not well known. Thus, we aimed to investigate the associations of visceral fat (VF) and CRF with the prevalence of pre-DM/DM among Japanese adults. The study included 970 individuals (327 women and 643 men) who were 40-87 years old and had complete health examinations, abdominal fat area, and fitness data from WASEDA'S Health Study during 2015-2018. The VF area was measured using magnetic resonance imaging. CRF was measured using a cycle ergometer and was defined as VO2peak divided by fat free mass. The pre-DM/DM was identified based on the questionnaire and fasting blood tests. The odds ratios (ORs) and 95% confidence intervals (CIs) for prevalence of pre-DM/DM were calculated. Seventy-three participants had pre-DM and 48 participants had DM. Compared to the low VF group, the high VF group had a higher prevalence of pre-DM/DM (OR: 1.87, 95% CI: 1.18-2.96), although no significant relationship was observed between CRF and pre-DM/DM prevalence (P for trend = 0.239). The sub-group analyses also revealed no significant relationship between CRF and pre-DM/DM prevalence in the low VF group (P for trend = 0.979), although CRF values were inversely related to the prevalence of pre-DM/DM in the high VF group (P for trend = 0.024). Although CRF was not independently related to the prevalence of pre-DM/DM after adjusting for adiposity, higher VF values were related to a higher prevalence of pre-DM/DM. In addition, CRF levels were inversely associated with the prevalence of pre-DM/DM only among high VF individuals., Competing Interests: The authors have declared that no competing interests exist.

Background: To examine the association between muscular and performance fitness (MPF) and the incidence of glaucoma., Methods: A total of 27,051 glaucoma-free participants aged 20-87 years underwent physical fitness tests between April 2001 and March 2002. The MPF index was calculated using an age- and sex-specific summed z-score from grip strength, vertical jump, single-leg balance, forward bending, and whole-body reaction time. The participants were divided into quartiles according to the MPF index and each physical fitness test. Participants were followed up for the development of glaucoma, which was defined based on physician-diagnosed glaucoma at an annual health examination between April 2002 and March 2008. Hazard ratios for the incidence of glaucoma were estimated using Cox proportional hazards models., Results: During follow-up, 303 participants developed glaucoma. Compared with the lowest MPF index group, hazard ratio (95% confidence interval) of developing glaucoma was 0.64 (0.46-0.89) for the highest MPF index group (P for trend = .001). Vertical jump and whole-body reaction time were associated with incident glaucoma (P for trend = .01 and <.001, respectively). There were no associations between the other physical fitness tests and the incidence of glaucoma., Conclusion: Higher MPF is associated with lower incidence of glaucoma.

Aim: To re-evaluate the suitability of calf circumference as a surrogate marker of low muscle mass measured by both bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). We also examined the effects of obesity and age on low muscle mass screening using calf circumference., Methods: In total, 1239 adults participated in this cross-sectional study. We measured the maximum calf circumference in a standing position and appendicular skeletal muscle mass (ASM) using BIA and DXA. We defined low muscle mass based on the Asian Working Group for Sarcopenia 2019 consensus., Results: Calf circumference was positively correlated with BIA-measured ASM/height 2 (men: r = 0.81, women: r = 0.73) and DXA-measured ASM/height 2 (men: r = 0.78, women: r = 0.76). In the subgroup analyses by obesity and age, calf circumference was also positively correlated with ASM/height 2 . The optimal calf circumference cut-offs for low muscle mass screening measured by BIA and DXA were 35 cm (sensitivity 91%, specificity 84%) and 36 cm (sensitivity 82%, specificity 80%) for men, and 33 cm (sensitivity 82%, specificity 84%) and 34 cm (sensitivity 85%, specificity 72%) for women, respectively., Conclusions: Calf circumference is positively correlated with BIA- and DXA-measured muscle mass regardless of obesity and age and is a simple and accurate surrogate marker of muscle mass for diagnosing sarcopenia. Geriatr Gerontol Int 2020; 20: 943-950., (© 2020 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Objectives: To examine the independent, joint, and fully combined associations of sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA), and cardiorespiratory fitness (CRF) with the odds of poor sleep quality (SQ)., Methods: We performed a secondary data analysis on 757 working adults (male = 345) in Singapore, with an average age of 35.2 years. The Pittsburgh Sleep Quality Index was used to assess SQ. Objectively measured MVPA and SB were each obtained using an accelerometer. A non-exercise prediction equation was used to estimate CRF. Logistic regression models were used to determine associations., Results: In total, 13.2% of the sample (n = 100) was identified as having poor SQ. After adjusting for study covariates, independent analyses revealed a clear inverse association for higher CRF and lower odds of poor SQ (OR = 0.50; 95% CI = 0.28-0.91). SB and MVPA demonstrated no independent associations. Joint associations revealed that odds of having poor SQ for those with low CRF was higher regardless of SB level and was further deteriorated by lower MVPA in the fully combined model. The fully combined model also demonstrated that those with lower SB, higher MVPA, and higher CRF had the lowest odds of having poor SQ (OR = 0.28; 95% CI = 0.10-0.78)., Conclusions: Physical activity/exercise training programs that aim to improve CRF may be useful in lowering the odds or poor SQ in working adults.

[Purpose] The aim of this study was to investigate the relationship between leg muscle strength, measured by a very simple one-leg stand-up test, and the prevalence of diabetes among Japanese males to raise awareness of diabetes prevention. [Participants and Methods] This cross-sectional analysis was conducted in 1,800 Japanese males (median [interquartile range] age, 61 [56-67] years) who completed health examinations and a one-leg stand-up test. The prevalence of diabetes was defined if any of the following conditions applied: 1) fasting blood glucose level more than 126 mg/dl, 2) two-hour blood glucose level more than 200 mg/dl (75-g oral glucose tolerance test), 3) HbA1c more than 6.5%, 4) diagnosed with diabetes by a physician, and/or 5) treated for diabetes. [Results] There were 490 participants with diabetes, and 517 participants were unable to complete the sit-to-stand task. When males, who could stand up, were used as a reference, the odds ratio for the prevalence of diabetes was significantly higher among those who were unable to stand up on neither leg than those who successfully stood up on both right and left legs after adjustment for covariates. [Conclusion] Low leg muscle strength, as measured by the one-leg stand-up test, was associated with a higher prevalence of diabetes among Japanese males. Because of its simplicity, this test could be useful detecting individuals who are at increased risk of developing diabetes., Competing Interests: The authors declare that they have no conflict of interest., (2020©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Aim: Watching sports at stadiums can have a favorable impact on health-related outcomes in older adults. We examined the effect of watching professional baseball at a ballpark on older adults' health-related outcomes., Methods: A total fo 58 participants aged 65-85 years were randomized into a spectator group (n = 29) and waiting-list group (n = 29). During the 2-month intervention, there were 21 games. The spectator group watched games at the ballpark, and the waiting-list group maintained their daily routines. The health-related outcomes were executive and cognitive functions, health-related quality of life, depression symptoms, subjective happiness and physical activity., Results: The median days watching baseball games in the spectator group was 6 days (interquartile range 4-10 days). Executive function using the reverse Stroop interference rate showed a non-significant trend of improvement in the spectator group compared with the waiting-list group (P = 0.063). The spectator group showed a significant reduction in depressive symptoms compared with the waiting-list group (P = 0.016)., Conclusions: Regularly watching professional baseball at a ballpark reduced older adults' depression symptoms. Geriatr Gerontol Int 2019; 19: 717-722., (© 2019 Japan Geriatrics Society.)

Aims/introduction: To investigate the relationship between combined aerobic and resistance training, and the incidence of type 2 diabetes mellitus., Materials and Methods: The present study included 10,680 Japanese women. Participants enrolled between 2005 and 2010, and were followed up until 2014. The frequency of combined training was counted for the first 3 months, the 6th month and the 9th month. In 2014, women reported whether or not they had diabetes, as well as the year of developing diabetes. Hazard ratios and 95% confidence intervals (CI) for the incidence of type 2 diabetes were obtained using Cox proportional hazard models., Results: The median duration of follow up was 5 years, with 166 women developing type 2 diabetes. Using the lowest frequency of training group (1st quartile) as the reference, the hazard ratios for the second through fourth quartiles was as follows: 0.95 (95% CI 0.64-1.41), 0.73 (95% CI 0.48-1.13) and 0.69 (95% CI 0.44-1.07), respectively (P for trend = 0.116). After adjustment for age, body mass index and thigh circumference, the hazard ratios were: 0.84 (95% CI 0.56-1.26), 0.69 (95% CI 0.45-1.06) and 0.61 (95% CI 0.39-0.95), respectively (P for trend = 0.040)., Conclusions: A higher frequency of combined aerobic and resistance training is associated with a lower risk of developing type 2 diabetes in Japanese women., (© 2018 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Background: Simple physical fitness test can be a useful potential predictor of type 2 diabetes (T2DM). We examined the association between performances on simple physical fitness tests and the incidence of T2DM., Methods: This longitudinal study was conducted in 21,802 nondiabetic Japanese (6,649 women) aged 20 to 92 years, who underwent all physical fitness tests at baseline (April 2001 to March 2002). From April 2001 to March 2008, physical fitness tests, including grip strength, vertical jump, single-leg balance with eyes closed, forward bending, whole-body reaction time, and supine legs-up, were performed every year. Participants had physical fitness tests at least two times during the period. T2DM was also annually determined based on fasting blood glucose, glycated hemoglobin, and self-reported diabetes during the period. Discrete-time logit models were used to examine the influence of the serial level of each physical fitness test on the incidence of T2DM., Results: During the entire study period, 972 participants developed diabetes. Lower relative grip strength (grip strength/body weight) and single-leg balance performance were associated with a higher incidence of T2DM. For relative grip strength, as compared with the fourth quartile group, the odds ratios for other groups ranged from 1.16 to 1.56 (P for trend < 0.001). For single-leg balance, the odds ratios ranged from 1.03 to 1.49 (P for trend < 0.001)., Conclusion: The performance of a simple single-leg balance test as well as that of a grip strength test were negatively associated with the risk of T2DM among Japanese.

Objectives: Although maintaining cardiorespiratory fitness is encouraged to reduce the risk of hypertension, the level at, and length of time for which, individuals need to maintain fitness remains unclear. We examined the association between the frequency of achieving the recommended fitness levels of the 'Physical Activity Reference for Health Promotion 2013' and the risk of hypertension among Japanese men., Methods: This cohort study was conducted in 6653 men without hypertension enrolled in 1986. Whether the participants' fitness level was equal to or exceeded the reference value (fit) or not (unfit) was determined. The frequency of achieving the recommended fitness level was calculated by counting the number of times the fitness level was achieved in 1980 through 1986. Incident hypertension was defined as the first visit with a SBP/DBP of at least 140/90 mmHg or self-reported antihypertensive medication use and was evaluated during annual health examinations from 1986 until 2009., Results: During the follow-up period, 3630 men developed hypertension. The multivariable-adjusted hazard ratios (95% confidence interval) for incident hypertension comparing men with fit versus unfit at baseline was 0.79 (0.74-0.85). Moreover, the frequency of achieving the recommended fitness level was inversely associated with the incidence of hypertension. The risk of hypertension was lower among those who achieved three or more of the recommended levels (0.72 for three times to 0.62 for seven times)., Conclusion: Achieving the fitness level recommended in the Japanese guideline three or more times during a 6-year period can be beneficial for the risk reduction of hypertension.

[Purpose] The purpose of this study was to identify which physical attribute could influence each outcome in the Stand-up test and the Two-step test and the degree of their involvement. [Participants and Methods] The participants were 2,476 people (1,674 males and 802 females), who underwent a two-day health checkup and were requested to take the Locomotive Syndrome Risk Test (Locomo Test). Participants were divided into groups under the Locomo level based on the result of Locomo Test by gender. Furthermore, the relationship between each physical attributes (quartile) based on the result of Locomo Test and the Locomo level was evaluated. [Results] According to the relationship between each physical attributes and Locomo level 1 in the Stand-up test, height showed a positive relationship and the multivariable adjusted odds ratio significantly increased with taller height in both genders. Body weight and BMI showed a negative relationship, although rather weak positive relationship, it was identified in waist circumference. On the other hand, there was no clear correlation between each physical attribute and Locomo level 1 in the Two-step test. [Conclusion] The findings indicate The Stand-up test would overestimate the decline of locomotor function in taller people and would underestimate it in shorter individuals.

Family history of hypertension (FH) is a nonmodifiable risk factor for hypertension. However, cardiorespiratory fitness (CRF) is a modifiable risk factor and might be important for preventing hypertension in both people with and without FH. The purpose of this study was to investigate the combined association of CRF and FH on the incidence of hypertension in normotensive male Japanese workers. A total of 6890 workers were included in this study. CRF was determined using a submaximal exercise test. A self-reported questionnaire was used to determine FH. Six groups were established, combining the two groups with and without FH (Yes, No) and the three CRF groups (Low, Moderate, High). The incidence of hypertension, defined as systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg, or self-reported physician-diagnosed hypertension was evaluated. During the observation period of 101,212 man-years (median 17 years, minimum 1 year, maximum 23 years), 2210 workers developed hypertension. There were 3860 participants who had FH (56%). Compared with the Yes-Low CRF group, the HRs (95% CI) for hypertension were 66% lower in the No-High CRF group (0.34 [0.28-0.40]), 47% lower in the No-Low CRF group (0.53 [0.46-0.61]), and 24% lower in the Yes-High CRF group (0.76 [0.67-0.86]). FH and CRF did not show a significant interaction (p for interaction = 0.181). The combination of FH and CRF showed a clear association with the risk of incident hypertension, and moderate to high levels of CRF might be equally beneficial for preventing hypertension for both people with and without FH.

Background: There are several studies on the relationship between low back pain and physical activity. However, the results of these studies vary, and the relationship between them remains unclear. Therefore, we conducted a cross-sectional study to evaluate the association between objectively measured physical activity and low back pain in Japanese men., Methods: The study included 4022 Japanese men [average age: 47 (10) y]. Daily amount of moderate to vigorous physical activity and step counts were measured using an accelerometer. Low back pain, drinking and smoking, and lifestyle-related diseases were surveyed using a self-administered questionnaire. A logistic regression model was used to evaluate the relationship between physical activity and step counts with persistent low back pain after adjusting for confounders., Results: Persistent low back pain was reported in 428 participants. The multivariable-adjusted odds ratios of presenting persistent low back pain across quartiles of amount of moderate to vigorous physical activity were 1.00 (reference); 0.93 (95% confidence interval, 0.70-1.22); 0.97 (95% confidence interval, 0.74-1.28); and 0.67 (95% confidence interval, 0.50-0.90); P for linearity = .012., Conclusion: We found a significant inverse relationship between objectively measured physical activity and persistent low back pain.

Background: We sought to examine the association between cardiorespiratory fitness (CRF) and incidence of type 2 diabetes considering the follow-up period in a cohort of Japanese men with a maximum follow-up period of 23 years., Methods: This study enrolled 7,804 male workers free of diabetes in 1986. CRF was measured using a cycle ergometer, and maximal oxygen uptake was estimated. During 1986-2009, participants were followed for development of type 2 diabetes, which was diagnosed using fasting blood tests, self-administered questionnaires, or oral glucose tolerance tests after urinary tests from annual health checkups. Hazard ratios for the incidence of type 2 diabetes were estimated using Cox proportional hazards models., Results: During the follow-up period, 1,047 men developed type 2 diabetes. In analyses by follow-up periods (1986-1993, 1994-2001, and 2002-2009), there was an inverse dose-response relationship between CRF and the development of type 2 diabetes for all three follow-up periods (P for trend 0.019, <0.001, and 0.001, respectively), and the association between CRF at baseline and the incidence of type 2 diabetes did not weaken with longer follow-up period. Compared with the lowest CRF group, hazard ratios of developing type 2 diabetes were 0.69 (95% confidence interval [CI], 0.49-0.97) for the highest CRF group in 1986-1993, 0.57 (95% CI, 0.42-0.79) for the highest CRF in 1994-2001, and 0.47 (95% CI, 0.30-0.74) for the highest CRF in 2002-2009., Conclusion: High CRF is associated with a lower risk of the incidence of type 2 diabetes over an extended period of >20 years among men.

Background: The "Physical Activity Reference for Health Promotion 2013" provides "fit" reference values for cardiorespiratory fitness (CRF) for good health. The importance of achieving a fit CRF level for several years on the subsequent prevention of type 2 diabetes mellitus (T2DM) remains to be clarified., Methods: This cohort study was conducted in 2,235 nondiabetic males aged 21 to 59 years, enrolled in April 1986 through March 1987. We calculated the ratio of the area under the curve (AUC ratio ) for actual measured values and the AUC for the reference values of CRF in each individual during an 8-year measurement period before the baseline. According to whether they met a fit CRF level or not, participants were categorized into groups based on the AUC ratio (Fit AUC or Unfit AUC ) and initial CRF (Fit initial or Unfit initial ), respectively. T2DM was evaluated on health checkups until March 2010., Results: During the follow-up period, 400 men developed T2DM. After adjustment for confounders, as compared with those in the Fit AUC group, the hazard ratio (HR) for those in the Unfit AUC group was 1.33 (95% confidence interval [CI], 1.06-1.65). A combined analysis with the categories of initial value and AUC ratio showed that, compared with the Fit initial and Fit AUC group, the HRs of Fit initial and Unfit AUC , Unfit initial and Fit AUC , and Unfit initial and Unfit AUC groups were 1.41 (95% CI, 0.99-2.00), 1.18 (95% CI, 0.81-1.70), and 1.40 (95% CI, 1.08-1.83), respectively., Conclusion: Achievement of a fit CRF level established in the Japan physical activity guideline for several years was associated with lower subsequent risk of T2DM.

Background: This study aimed to examine the relationship between pedometer-assessed daily step count and all-cause mortality in a sample of elderly Japanese people., Methods: Participants included 419 (228 males and 191 females) physically independent, community-dwelling 71-year-old Japanese people. The number of steps per day was measured by a waist-mounted pedometer for seven consecutive days at baseline. Participants were divided into quartiles based on their average number of steps/day (first quartile, < 4503 steps/day; second quartile, 4503-6110 steps/day; third quartile, 6111-7971 steps/day; fourth quartile, > 7972 steps/day) and were followed up over a mean period of 9.8 years (1999-2010) for mortality., Results: Seventy-six participants (18.1%) died during the follow-up period. The hazard ratios (adjusted for sex, body mass index, cigarette smoking, alcohol intake, and medication use) for mortality across the quartiles of daily step count (lowest to highest) were 1.00 (reference), 0.81 (95%CI, 0.43-1.54), 1.26 (95%CI, 0.70-2.26), and 0.46 (95%CI, 0.22-0.96) (P for trend = 0.149). Participants in the highest quartile had a significantly lower risk of death compared with participants in the lowest quartile., Conclusion: This study suggested that a high daily step count is associated with a lower risk of all-cause mortality in physically independent Japanese elderly people.

Background: The relationship between the combination of physical activity (PA) and body mass index (BMI) with low back pain (LBP) is unclear. The present study offers a cross-sectional assessment of how combinations of PA and BMI are related to LBP in Japanese men., Methods: Participants were 4022 Japanese men (mean age = 47) who underwent regular clinical examinations. PA was measured using a uniaxial accelerometer and divided into tertiles (PA high , PA middle , PA low ). A self-administered questionnaire was used to report on persistent LBP experience, drinking and smoking habits, and any existing lifestyle diseases. After covariance adjustment, a logistic regression model was used to assess how combinations of PA and BMI are related to persistent LBP., Results: 428 of the participants had persistent LBP. A clear negative dose-response relationship was found between PA levels and persistent LBP (P for linearity = 0.012). Regarding BMI, odd ratios were shown to be higher in the overweight/obese category (BMI ≥ 25 kg/m 2 ) than for the normal weight category (BMI < 25 kg/m 2 ). When the PA high was taken as the reference in the normal weight category, odds ratios for PA low and PA middle in the normal weight category were shown to be high. Moreover, in the overweight/obese category, odd ratios for every fitness level were also high as for the normal weight category., Conclusion: The present study showed that both PA and BMI are related to persistent LBP. Also, the prevalence of persistent LBP became higher when PA low and high BMI are combined rather than the group of PA high and low BMI combination.

Type 2 diabetes is increasing globally and in Asia. The purpose of this study was to examine the association of a fit-fat index (FFI) with diabetes incidence among Japanese men. In total 5,014 men aged 18-64 years old, who had an annual health check up with no history of major chronic disease at baseline from 2002 to 2009 were observed. CRF was estimated via cycle ergometry. Overall, 7.6% of the men developed diabetes. The mean follow-up period was 5.3 years. Hazard ratios, 95% confidence intervals and P trend for diabetes incidence were obtained using the Cox proportional hazards model while adjusting for confounding variables. High FFI demonstrated lower risk 0.54 (0.36-0.82) compared to low BMI 0.63 (0.44-0.90), low WHtR 0.64 (0.41-1.02), and High CRF 0.72 (0.51-1.03). FFI showed a marginally stronger dose response relationship across quartiles (P (trend) =0.001) compared to BMI (P (trend) =0.002), WHtR (P (trend) =0.055), and CRF (P (trend) =0.005). Overall, both fitness and fatness play independent roles in determining diabetes incidence in Japanese men. FFI may be a more advantageous physical fitness measure because it can account for changes in fitness and/or fatness.

Purpose: Although the benefit of high cardiorespiratory fitness (CRF) for the prevention of type 2 diabetes mellitus (T2DM) is widely accepted, whether consistently high CRF is necessary or transiently high CRF is sufficient is unclear. The present study was conducted to examine the hypothesis that consistently high level of CRF is more beneficial than transiently high CRF for the prevention of T2DM., Methods: This cohort study was conducted in nondiabetic 7158 men age 20 to 60 yr, enrolled from 1986 to 1987. The area under the curve with respect to ground (AUCG) for CRF measurements during an 8-yr measurement period (1979-1987) was calculated as an index of integrated CRF level during the period. The differences (ΔAUCP) between AUCG and peak AUC (peak CRF-measurement period) was also calculated as an index of the presence and the size of a "spike" in CRF. T2DM was defined by fasting blood glucose and a self-reported diagnosis of diabetes for participants with blood tests. For participants without blood tests, T2DM was defined by the result of oral glucose test after a nonfasting urinary test and a self-reported diagnosis of diabetes. T2DM was determined on health checkups until 2009., Results: During the follow-up period, 1495 men developed T2DM. After adjustment for confounders, as compared with the first quartile of AUCG for CRF, the hazard ratio (95% confidence interval) for the second, third, and fourth quartiles were 0.87 (0.76 to 1.00), 0.80 (0.68 to 0.95), and 0.72 (0.58 to 0.89), respectively. For CRF spike, there was no association between ΔAUCP in CRF and the incidence of T2DM., Conclusions: Consistently higher level of CRF over time was associated with lower risk of T2DM.

Objective: To determine the effects of watching a professional baseball game on the affect and subjective happiness of elders without a specific team to support. Method: Elderly Japanese ( n = 16) were instructed to watch baseball games at a ballpark. They answered a questionnaire several weeks before (baseline) and, on the day of the game, before and after watching the game. Participants' affect and happiness were assessed using the General Affect Scale and Subjective Happiness Scale, respectively. Results: Calmness had a tendency to increase from baseline to before watching the game ( p = .052). Furthermore, subjective happiness significantly increased after watching the game, compared with baseline ( p = .017). Discussion: Visiting a ballpark to watch a professional baseball game increased elders' subjective happiness after they had finished watching it., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Having a low level of physical fitness, especially cardiorespiratory fitness, appears to accelerate age-related aortic stiffening. Whereas, some studies have reported that trunk flexibility is a component of physical fitness, it is also negatively associated with arterial stiffening independent of cardiorespiratory fitness in cross-sectional studies. However, no long-term longitudinal study has determined whether poor trunk flexibility accelerates the progression of age-related aortic stiffening. We examined trunk flexibility and aortic stiffness progression in a 5-year longitudinal study. Methods and Results: A total of 305 apparently healthy men and women participated in this study (49.6 ± 9.5 years of age). Trunk flexibility was measured using a sit-and-reach test. Aortic stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV) at baseline and after 5 years. Analysis of covariance (ANCOVA) was used to assess the association of the annual rate of cfPWV across flexibility levels (low, middle, high). There were no significant differences in baseline cfPWV among the three groups (835 ± 164, 853 ± 140, 855 ± 2.68 cm/s; P = 0.577). Annual ΔcfPWV was significantly higher in the low-flexibility group than in the high-flexibility group ( P = 0.009). ANCOVA revealed an inverse relationship between flexibility level and annual ΔcfPWV (14.41 ± 2.73, 9.79 ± 2.59, 2.62 ± 2.68 cm/s/year; P for trend = 0.011). Multiple regression analysis revealed that baseline sit and reach (β = -0.12, -0.70 to -0.01) was independently correlated with ΔcfPWV following adjustment for baseline peak oxygen uptake, age, sex, body fat, heart rate, and cfPWV. The 5-year change in cfPWV was not significantly correlated with 5-year change in sit-and-reach performance ( P = 0.859). Conclusion: Poor trunk flexibility is associated with greater progression of age-related aortic stiffening in healthy adults. However, we failed to confirm a significant association between 5-year change in aortic stiffness and 5-year change in trunk flexibility. The association between increased age-related increase in aortic stiffness and deterioration in flexibility due to age may require observation for more than 5 years.

[Purpose] This study evaluated whether obesity is a risk factor for low back pain, by using body fat percentage (%FAT) and body mass index (BMI) as indices of obesity among Japanese males. [Subjects and Methods] This study included 1,152 males (average age: 28.0 ± 4.6 years). BMI was calculated from subject's height and weight, and %FAT was estimated by the thickness of two parts of skin. Low back pain, drinking and smoking were surveyed using a self-administered questionnaire, and maximal oxygen uptake was measured by a submaximal exercise test using a cycle ergometer. [Results] A significant positive dose-response relationship was shown between %FAT and persistent low back pain prevalence. Similarly, a significant positive dose-response relationship was confirmed between BMI and persistent low back pain. [Conclusion] This study suggests that both high %FAT and BMI are risk factors for persistent low back pain.

Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals., (© 2016 American Heart Association, Inc.)

Context: Although metabolic abnormalities are often developed in Asians with body mass index (BMI) of 23-25 kg/m 2 , the characteristics of the nonobese Asians with metabolic abnormality have not been fully understood., Objective: The aim of this study was to investigate the clinical significance of insulin sensitivity in Japanese men with BMI of 23-25 kg/m 2 ., Design and Participants: In this study, we defined hypertension, hyperglycemia, and dyslipidemia as cardiometabolic risk factors (CMRFs). We recruited subjects who met the following selection criteria: men with BMI of 21-23 kg/m 2 and no CMRF (n = 24); men with BMI of 23-25 kg/m 2 and no CMRF (n = 28), or one CMRF (n = 28), or at least two CMRFs (n = 14); and overweight men with metabolic syndrome (n = 20). Insulin sensitivity (IS) and ectopic fat content in muscle and liver were measured by two-step hyperinsulinemic-euglycemic clamp and 1 H-magnetic resonance spectroscopy, respectively., Results: Among subjects with BMI of 23-25 kg/m 2 , impaired IS in muscle, but not in liver, was found in those with even one CMRF, whereas impaired IS in both muscle and liver was observed in overweight men with metabolic syndrome. Liver fat accumulation and elevated liver enzymes were associated with impaired IS in both muscle and liver in those subjects., Conclusions: Among Japanese men with BMI of 23-25 kg/m 2 , muscle insulin resistance was present in those with even one CMRF. In this population, liver fat accumulation and/or elevated liver enzymes could be a good marker for impaired IS in both muscle and liver.

Background: The purpose of this study was to examine the impact of combined cardiorespiratory fitness and waist-to-height ratio in the form of a fit-fat index on incident diabetes risk. Additionally, the independent predictive performance of cardiorespiratory fitness, waist-to-height ratio, and body mass index also were estimated and compared., Methods: This was a prospective cohort study of 10,381 men who had a normal electrocardiogram and no history of major chronic disease at baseline from 1979 to 2005. Random survival forest models and traditional Cox proportional hazards models were used to predict diabetes at 5-, 10-, and 15-year incidence horizons., Results: Overall, 4.8% of the participants developed diabetes. Receiver operating characteristic curve analyses for incidence risk demonstrated good discrimination using random survival forest models across fitness and fatness measures; Cox models were poor to fair. The differences between fitness and fatness measures across horizons were clinically negligible. Smoothed random survival forest estimates demonstrated the impact of each fitness and fatness measure on incident diabetes was intuitive and graded., Conclusions: Although fitness and fatness measures showed a similar discriminative ability in predicting incident diabetes, unique to the study was the ability of the fit-fat index to demonstrate a better indication of incident risk when compared to fitness or fatness alone. A single index combining cardiorespiratory fitness and waist-to-height ratio may be more useful because it can indicate improvements in either or both of the measures.

Physical activity has multiple health benefits but may also increase the risk of developing musculoskeletal pain (MSP). However, the relationship between physical activity and MSP has not been well characterized. This study examined the dose-response relationship between sports activity and MSP among adolescents. Two school-based serial surveys were conducted 1 year apart in adolescents aged 12 to 18 years in Unnan, Japan. Self-administered questionnaires were completed by 2403 students. Associations between time spent in organized sports activity and MSP were analyzed cross-sectionally (n = 2403) and longitudinally (n = 374, students free of pain and in seventh or 10th grade at baseline) with repeated-measures Poisson regression and restricted cubic splines, with adjustment for potential confounders. The prevalence of overall pain, defined as having pain recently at least several times a week in at least one part of the body, was 27.4%. In the cross-sectional analysis, sports activity was significantly associated with pain prevalence. Each additional 1 h/wk of sports activity was associated with a 3% higher probability of having pain (prevalence ratio = 1.03, 95% confidence interval = 1.02-1.04). Similar trends were found across causes (traumatic and nontraumatic pain) and anatomic locations (upper limbs, lower back, and lower limbs). In longitudinal analysis, the risk ratio for developing pain at 1-year follow-up per 1 h/wk increase in baseline sports activity was 1.03 (95% confidence interval = 1.02-1.05). Spline models indicated a linear association (P < 0.001) but not a nonlinear association (P ≥ 0.45). The more the adolescents played sports, the more likely they were to have and develop pain.

Background: While heavier weight is known to increase the incidence of dyslipidemia, limited data are available on the relationship between weight gain and its development., Methods: A total of 2647 males were categorized into the following four groups according to the difference between their self-reported weight at 20 years of age and their measured weight in 1994-95: a loss of ≥5% (decrease), loss of <5% or gain of <5% (no change), gain of ≥5 to <15% (increase) and gain of ≥15% (sizable increase). They were followed up until their 2002-03 health examination. Using the 'no change' group as reference, the multivariable-adjusted odds ratio (adjusted for age, body mass index at 20 years of age, physical activity, smoking and alcohol intake) and 95% confidence interval (95% CI) for the incidence of dyslipidemia were determined using logistic regression models., Results: A total of 1342 participants developed dyslipidemia during the follow-up period. The 'increase' and 'sizable increase' groups had odds ratios for the incidence of dyslipidemia of 1.97 (95% CI, 1.59-2.45) and 2.68 (2.15-3.34), respectively, demonstrating that there was a significant dose-response association between weight gain since 20 years of age and the incidence of dyslipidemia (P < 0.001 for trend)., Conclusion: These results suggest that dyslipidemia could be prevented by avoiding weight gain in adulthood., (© The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Cardiorespiratory fitness is negatively associated with arterial stiffness, although it is unclear whether it is associated with prospective arterial stiffness changes. The authors examined cardiorespiratory fitness and arterial stiffness progression in a 2-year follow-up study of 470 healthy men and women aged 26 to 69 years. Peak oxygen uptake (V˙O2peak) was measured at baseline using a graded cycle exercise test. Arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV) at baseline and after 2 years. Two-year changes in baPWV were significantly higher in patients in the lowest V˙O2peak tertile (28.8±7.6 cm/s) compared with those in the highest V˙O2peak tertile (-1.4±7.5 cm/s) (P=.024) and were inversely correlated with V˙O2peak (r=-.112, P=.015). Stepwise multiple regression analysis revealed that age, glucose, baPWV, V˙O2peak, and sex were independent correlates of 2-year changes in baPWV, suggesting that higher cardiorespiratory fitness is associated with age-related arterial stiffening suppression., (© 2015 Wiley Periodicals, Inc.)

Background: In Japan, the incidence of kidney stones has increased markedly in recent decades. Major causes of kidney stones remain unclear, and limited data are available on the relationship between overweight/obesity and the incidence of kidney stones. We therefore evaluated body mass index (BMI) and the incidence of kidney stones in Japanese men., Methods: Of the workers at a gas company, 5984 males aged 20-40 years underwent a medical examination in 1985 (baseline). This study includes 4074 of the men, who were free of kidney stones at baseline and underwent a second medical examination performed between April 2004 and March 2005. BMI was calculated from measured height and weight in 1985, and men were categorized into tertiles. The development of kidney stones during follow-up was based on self-reports from questionnaires at the second medical examination., Results: The average duration of follow-up was 19 years, with 258 participants developing kidney stones during this period. Using the lowest BMI (1st tertile) group as a reference, the hazard ratios (95% confidence intervals [CIs]) for the 2nd and 3rd BMI tertiles were: 1.26 (95% CI, 0.92-1.73) and 1.44 (95% CI, 1.06-1.96), respectively (P for trend = 0.019). After additionally adjusting for potential confounders, such as age, systolic blood pressure, cardiorespiratory fitness, cigarette smoking, and alcohol consumption, the hazard ratios were 1.28 (95% CI, 0.93-1.76) and 1.41 (95% CI, 1.02-1.97), respectively (P for trend = 0.041)., Conclusions: These results suggest that increased BMI is a risk factor for kidney stones in Japanese men.