Convenience of “Loco-check” Combination in Quick Screening of Latent Preliminary Group of Locomotive Syndrome by Measurement of Handgrip Strength: Secondary Analysis of the Previous Report / 社会薬学

As a screening tool for detecting latent pre-locomotive syndrome (latent pre-LS) in women over the age of 40, measuring handgrip strength with a cut-off value of 26 kg was proposed in a previous report. However, this screening method missed 22% of latent pre-LS. It would be beneficial to screen almost persons with latent pre-LS in community pharmacies. In this study, it was investigated whether screening using the combination of measuring handgrip strength and the questionnaire, “Loco-check,” which was proposed by the Japanese Orthopaedic Association, improved the detection of latent pre-LS in the same group mentioned above. Combining only one of the “Loco-check” questions, “I cannot put on a pair of socks while standing on one leg,” with the measurement of handgrip strength with the cut-off value of 26 kg, the detection of latent pre-LS was increased to 90.2%. The odds ratio was 9.72 in logistic regression analysis. Using the combination of the measurement of handgrip strength and the response to one question is both rapid and convenient. Therefore, in this study, this screening combination is proposed to be a useful tool in community pharmacies for detecting early latent pre-LS.

Engagement in different sport disciplines during university years and risk of locomotive syndrome in older age: J-Fit

BACKGROUND@#Among former Olympic-level athletes, engagement in different sport disciplines has been associated with mortality risk in subsequent years. However, limited evidence is available on whether engagement in different sport disciplines at a young age is associated with locomotive syndrome (LS) risk later in life. This study examined the relationship between engagement in different sport disciplines during university years and LS risk in older age among former university athletes.@*METHODS@#Participants were 274 middle-aged and 294 older men alumni who graduated from a school of physical education in Japan. LS risk was defined as answering "yes" to any of the Loco-check questions. Data on university sports club membership were collected using questionnaires. University clubs were classified into three groups of cardiovascular intensity (low, moderate, high), following the classification system of sport disciplines by the American College of Cardiology. This classification considers the static and dynamic components of an activity, which correspond to the estimated percent of maximal voluntary contraction reached and maximal oxygen uptake achieved, respectively. University clubs were grouped based on the risk of bodily collision (no, yes) and extent of physical contact (low, moderate, high). Relationships between engagement in different sport disciplines and LS risk were analyzed using Cox proportional hazards models, and adjusted for age, height, weight, joint disease, habitual exercise, and smoking and drinking status.@*RESULTS@#Adjusted hazard ratios and 95% confidence intervals associated with the low, moderate, and high cardiovascular intensity sports were 1.00 (reference), 0.48 (0.22-1.06, P = 0.070), and 0.44 (0.20-0.97, P = 0.042) in older men, respectively; however, there was no significant association between these parameters among middle-aged men. Engagement in sports associated with physical contact and collision did not affect LS risk in either group.@*CONCLUSIONS@#Engagement in sports associated with high cardiovascular intensity during university years may reduce the risk of LS in later life. Encouraging young people to participate in such activities might help reduce LS prevalence among older populations.

Assessment of lower extremity muscle mass, muscle strength, and exercise therapy in elderly patients with diabetes mellitus

The increase in the proportion of elderly people in the population is one of the most remarkable sociodemographic phenomena of the twenty-first century. The number of patients with diabetes is also increasing worldwide with this demographic change. Given these facts, consideration of the problems the general elderly population is facing in the management of diabetes is essential. In this review article, we focus on sarcopenia, which is the decrease in lower extremity muscle mass and muscle strength accompanying aging, describe the relationship between sarcopenia and diabetes, and highlight the specific factors through which diabetes contributes to loss of muscle strength. The quantitative methods for evaluating lower extremity muscle strength will also be described. These methods hold the key to assessing the effectiveness of exercise therapy and optimizing the assessment of the degree of autonomy in the activities of daily living. Exercise is one of the basic treatments for type 2 diabetes and may also prevent and improve sarcopenia. This review discusses the aspects common to the two health conditions and elucidates the effectiveness and necessity of exercise as a preventive measure against diabetes among the elderly.

Locomotive syndrome in Japan

The present aging rate in Japan of some 28% will continue to increase along with the advancing age of elderly persons. Therefore, the demand for care will also increase. Approximately 25% of the need for nursing-care defined by the Japanese long-term care insurance system is associated with disorders or deterioration of locomotive organs. Therefore, the prevention and treatment of diseases in the locomotor system and maintenance of motor function are important for extended healthy life span and to decrease the demand for long-term care. Based on this background, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, which is defined as reduced mobility due to impaired locomotive organs. Changes in locomotion must be noticed early to ensure the timely implementation of appropriate checks and measures of locomotion can uncover risk of acquiring LS. The acquisition of an exercise habit, appropriate nutrition, being active and evaluating and treating locomotion-related diseases are important to delay or avoid LS. The JOA recommends locomotion training consisting of four exercises to prevent and improve LS. Countermeasures against LS should become a meaningful precedent not only for Japan, but for other countries with rapidly aging populations.

Locomotive syndrome in the elderly: translation, cultural adaptation, and Brazilian validation of the tool 25-Question Geriatric Locomotive Function Scale / Síndrome locomotora em idosos: tradução, adaptação cultural e validação brasileira do instrumento 25-Question Geriatric Locomotive Function Scale

ABSTRACT Objective: The term Locomotive Syndrome refers to conditions in which the elderly are at high risk of inability to ambulate due to problems in locomotor system. For Locomotive Syndrome screening, the 25-Question Geriatric Locomotive Function Scale was created. The objective here was to translate, adapt culturally to Brazil, and study the psychometric properties of 25-Question Geriatric Locomotive Function Scale. Method: The translation and cultural adaptation of 25-Question Geriatric Locomotive Function Scale were carried out, thus resulting in GLFS 25-P, whose psychometric properties were analyzed in a sample of 100 elderly subjects. Sociodemographic data on pain, falls, self-perceived health and basic and instrumental functionalities were determined. GLFS 25-P was applied three times: in one same day by two interviewers, and after 15 days, again by the first interviewer. Result: GLFS 25-P showed a high internal consistency value according to Cronbach's alpha coefficient (0.942), and excellent reproducibility, according to intraclass correlation, with interobserver and intraobserver values of 97.6% and 98.4%, respectively (p < 0.01). Agreements for each item of the instrument were considerable (between 0.248 and 0.673), according to Kappa statistic. In its validation, according to the Pearson's coefficient, regular and good correlations were obtained for the basic (BADL) and instrumental (IADL) activities of daily living, respectively (p < 0.01). Statistically significant associations with chronic pain (p < 0.001), falls (p = 0.02) and self-perceived health (p < 0.001) were found. A multivariate analysis showed a significantly higher risk of Locomotive Syndrome in the presence of chronic pain (OR 15.92, 95% CI 3.08–82.27) and with a worse self-perceived health (OR 0.23, 95% CI 0.07–0.79). Conclusion: GLFS 25-P proved to be a reliable and valid tool in Locomotive Syndrome screening for the elderly population.

RESUMO Objetivo: O termo síndrome locomotora (SL) designa condições nas quais os idosos apresentam alto risco de incapacidade para deambulação em decorrência de problemas em órgãos locomotores. Para seu rastreio foi criado o 25-Question Geriatric Locomotive Function Scale (GLFS-25). Objetivou-se aqui, traduzir, adaptar transculturalmente para o Brasil e estudar as propriedades psicométricas do GLFS-25. Método: Feitas tradução e adaptação transcultural do GLFS-25 que originaram o GLFS 25-P, cujas propriedades psicométricas foram analisadas numa amostra de 100 idosos. Apurados dados sociodemográficos relativos a dor, queda, autopercepção da saúde e funcionalidades básica e instrumental. O GLFS 25-P foi aplicado em três momentos: num mesmo dia por dois entrevistadores e após 15 dias novamente pelo primeiro entrevistador. Resultado: O GLFS 25-P apresentou alto valor de consistência interna, segundo o coeficiente Alfa de Cronbach (0,942); e reprodutibilidade ótima, segundo a correlação intraclasses: valores de 97,6% e 98,4%, interobservador e intraobservador, respectivamente (p < 0,01). As concordâncias para cada item do instrumento foram consideráveis (entre 0,248 e 0,673), segundo a estatística Kappa. Na validação, segundo o coeficiente de Pearson, foram obtidas correlações regular e boa para as atividades de vida diária básicas (AVDB) e instrumentais (AIVD), respectivamente (p < 0,01). Encontradas associações estatisticamente significantes com dor crônica (p < 0,001), queda (p = 0,02) e autopercepção de saúde (p < 0,001). A análise multivariada evidenciou risco de SL significativamente maior na presença de dor crônica (OR 15,92, IC 95% 3,08-82,27) e pior autopercepção de saúde (OR 0,23, IC 95% 0,07-0,79). Conclusão: O GLFS 25-P demonstrou ser confiável e válido no rastreio da SL em idosos.

An Outpatient-based Survey on the Recognition of Locomotive Syndrome in Japan: The Results of three Years of Surveys.

Background: In 2007, the Japanese Orthopaedic Association (JOA) proposed the term locomotive syndrome (LS) and the Japan Locomo Challenge Promotion Conference (JLCPC) began to carry out continuous campaigns to increase the LS recognition. LS awareness and prevention activities have been considered to be critical health promotion activities in the orthopedic field. The JLCPC surveyed the LS recognition rate with an Internet-based questionnaire since 2012. However, there have not been any outpatient cohort studies. Thus, since 2014, we have surveyed the outpatients who were treated at Juntendo University Hospital, Tokyo. Methods: To investigate LS recognition, we conducted an annual questionnaire survey of the approximately 1000 orthopedic outpatients who were treated each year at Juntendo University Hospital (Tokyo, Japan) from March to June (a 3-month period) in the 3 years from 2013 to 2015. Results: We created three classifications of LS recognition: “Known”, “Heard of” and “Unknown.” The results of the survey revealed that the LS recognition rate was 24.6% in 2013, 26.4% in 2014 and 27.9% in 2015. The outpatient survey results indicated that there has been a stable increase in the LS recognition rate over the past 3 years. Conclusion: This study demonstrated that the LS recognition rate in 2015 was 27.9%, which amounts to a 3.3% increase in comparison to the in 2013 survey. We therefore consider that our outpatient-based survey has been a health promotion activity that has helped to promote a better understanding of the effects of the promotion of LS awareness and trends in awareness promotion activities.

Locomotive syndrome presents a risk for falls and fractures in the elderly Japanese population

"Locomotive syndrome" is used to designate the condition of individuals with musculoskeletal disease who are highly likely to require nursing care. This article reviews screening, prevalence, causal and related factors, and the relationship between locomotive syndrome and falls and fractures in older adults with this syndrome. A few self-administered questionnaire tools are available to assess individuals for locomotive syndrome. Additionally, screening methods, including a physical functioning assessment, are appropriate for detailed discrimination of locomotive syndrome. The prevalence of locomotive syndrome is significantly higher in women than in men, and tends to increase markedly from 70 years of age. More severe locomotive syndrome is related to knee pain, osteoporosis, sarcopenia, and lumbar disease. The incidence of falling in locomotive syndrome is higher than the incidence for the older population in general. Locomotive training including squats and a unipedal standing exercise has been recommending to prevent locomotive syndrome. This training improves muscle strength and balance function for older people who have a risk for locomotive syndrome.

The Recognition of Locomotive Syndrome in 2014: A Cross-Sectional Study in the Orthopeadic Outpatients in Tokyo.

Background: To prevent locomotor dysfunction, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, and has carried out numerous campaigns to increase the awareness of LS. We previously surveyed the recognition of LS and reported that 24.6% of outpatients knew about it in 2013. Were surveyed the recognition of LS and the prevalence of LS in 2014 to elucidate the effects and trends of the recognition of LS and the promotion campaigns. Methods: To investigate the recognition of LS and the prevalence of LS, we conducted a questionnaire survey including both the 25-question Geriatric Locomotive Function Scale (GLFS- 25) and the “loco-check” in 1,027 (450 male and 577 female) orthopaedic outpatients. This survey was performed at Juntendo University Hospital (Tokyo, Japan), from March to June 2014. Results: The concept about LS was known to 26.4% of the patients, which was increased 1.8% in comparison to our survey in 2013. And, the most common media source to obtain information about LS was TV. Newspapers and magazines were also common media sources. In terms of the prevalence of LS in orthopaedic outpatients, 60.5% (734 of 1,027 people who answered the questions) were classified into the LS high-risk group as determined using the GLFS-25. The prevalence of LS was 54.9% in males and 64.3% in females. Conclusion: We investigated the recognition of LS and the prevalence of LS using an outpatient cohort from the Tokyo area. This study demonstrated that the recognition of LS in 2014 was 26.4%, which increased by 1.8% compared to our survey in 2013. Our outpatient-based survey is therefore considered to positively help obtain a better understanding of the effects and trends of promoting the concept of LS.

An Outpatient-based Survey about the Recognition of Locomotive Syndrome and the Results of the Loco-check at a University Hospital in Tokyo.

Background: To prevent locomotor dysfunction, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, and has carried out many campaigns to increase the awareness of LS. Recently, the JOA reported that 26.6% of people recognized LS in internet based surveys. However, a survey of the recognition of LS using outpatient (hospital-based) cohorts has never been performed. Therefore, we surveyed the recognition of LS, the prevalence of LS and any correlations between LS andthe clinical data in the outpatient cohort. Methods: To investigate the recognition of LS and prevalence of LS, we conducted a questionnaire survey including the “loco-check” in 1010 (429 male and 581 female) orthopaedic outpatients at Juntendo University Hospital (Tokyo, Japan) from April to June 2013. Results: Only 24.6% of the patients knew about the concept of LS. In terms of the media sources from which the patients had received information about LS, 49.5% received LS information from TV. With regard to the prevalence of LS, 43.8% was classified into the LS group. The prevalence of LS was 32.9% in males and 51.8% in females. When the relationship between LS and orthopaedic disease was examined, 50 of 55 (90.9%) knee osteoarthritis (OA) patients, 21 of 26 (80.8%) hip OA patients and 98 of 151 (64.9%) lumbar spondylosis patients had statistically significant correlations with LS (p<0.0001). Conclusion: This study confirmed the rate of recognition of LS indicated by the JOA survey. Our studies also revealed that LS score was related to orthopaedic disorders. Our outpatient-based surveys may help provide a better understanding of the effects and trends of the campaigns to promote the recognition of LS.

Locomotive Syndrome, Musculoskeletal Ambulation Disorder Symptom Complex, Frailty and Sarcopenia / The Japanese Journal of Rehabilitation Medicine

As Japan has become a super-aging society a new focus has been placed on locomotive syndrome (Locomo), musculoskeletal ambulation disorder symptom complex (MADS), frailty and sarcopenia. Locomo is a condition whereby long-term care or support is needed or may be needed in the future due to weakness of the locomotive organs. MADS is a condition presenting with unstable balance or walking difficulty, which leads to a high risk of the patient falling down or giving up excursions outside the home. In a broad sense, MADS patients also belong in the Locomo category. The prevention and treatment of Locomo and MADS are very important, because these conditions typically result in deterioration of the exercise function and loss of mental and physical health. The aim of Locomotive syndrome exercises is to reduce pain, and to restore and improve joint function. We need to take a comprehensive approach to Locomotive syndrome, including lifestyle modification, muscle exercise, stretching and therapeutic exercise. Two basic, simple and commonly used exercises are single-leg standing and squats exercises.