Effects of Changes in Frequency of Going Out during the COVID-19 Pandemic on ikigai (Sense of Purpose in Life) and Mental Health in Middle-Aged and Older Adults in Japan.

To clarify whether changes in frequency of going out due to the COVID-19 pandemic affect ikigai (sense of purpose in life) and mental health in Japanese middle-aged and older adults. In a questionnaire survey mailed to 16,866 adults aged > 40 years in Japan in September 2020, 7,973 responses were received (response rate, 47.3%) in October 2020. Following exclusions, data from 6,978 individuals (50.6% female, mean age 67.8 ± 12.2 years) were available for analysis. Respondents were categorized based on changes in frequency of going out, reflecting changes in social and/or physical activity, during the pandemic compared with before it: the previously active group went out often before but less often during the pandemic; the remained active group continued going out often; and the inactive group continued not going out often. Whether these changes affected the respondents' ikigai and mental health was investigated. The previously active group had a significantly higher proportion of individuals with decreased ikigai during the pandemic than the other groups. Mental health score decreased in all groups during the pandemic, but more so in the previously active group (-3.21), followed by the inactive and then the remained active groups (-1.45 and -1.28, respectively). Previously active individuals showed the greatest decline in ikigai and mental health among the three groups. These findings suggest that continuing to engage in appropriate physical and social activities, including going out, while following appropriate infection control measures, even under restrictions, can help people maintain ikigai and mental health.

Impact of subjective well-being on physical frailty in middle-aged and elderly Japanese with high social isolation.

Social isolation exacerbates physical frailty and is associated with subjective well-being. Even those with high levels of social isolation may have different health statuses depending on the type of isolation and their subjective well-being. However, the effect of subjective well-being on the relationship between social isolation and physical frailty remains unclear. This study examined whether the risk of physical frailty was the same for individuals with social isolation according to high and low subjective well-being. The study participants included 1,953 middle-aged Japanese adults aged 45 years and older. Physical frailty was assessed using a modified version of the Fried phenotype criteria. Probabilistic Latent Semantic Analysis was used to classify participants according to social isolation indicators. Subsequently, we focused on the groups with high social isolation and classified them according to whether their subjective well-being was high or low. Subjective well-being was evaluated using the Shiawase and Ikigai scales, which are concepts used in Japan. Finally, we used survival time analysis to examine the relationship between Shiawase or Ikigai and physical frailty in groups with high social isolation. The participants were classified into four groups based on their social isolation status. The physical frailty rate of the high social isolation class was 37.0%, which was significantly higher than that of the other classes. Survival time analysis revealed that among people with high social isolation, those with high Shiawase and Ikigai had a significantly lower risk of physical frailty than those with low Shiawase and Ikigai. All individuals with high social isolation are not at a high risk of physical frailty. The findings reveal that even those with high level of social isolation may have a lower risk of physical frailty if their subjective well-being is high. These results will contribute to promoting the prevention of frailty in middle-aged and older adults.

Does participation in municipality-initiated incentivized health promotion programs promote physical activity among the physically inactive? Verification in six Japanese municipalities.

Background: Physical activity can prevent lifestyle-related diseases, such as hypertension and diabetes. However, many people in society are physically inactive, especially middle-aged and older adults over 40. Therefore, this study examined the effects of a municipality-led incentivized health promotion program to clarify: (1) whether the average number of steps increased from the preparticipation period to the 18th month following the program; and (2) whether such increases were influenced by financial incentives. Design and methods: This study analyzed gender, age, step, and incentive type data from 5688 middle-aged and elderly participants in an incentivized health promotion program. The incentives were regional gift certificates that could only be used in local areas, national gift certificates, common points that could be used in department and convenience stores nationwide, and donations. The incentives were worth a maximum of 24,000 yen per year. Results: Both the physically active group and the physically inactive group had increased the step count markedly 18 months post-participation; however those participants chosing financial incentives showed significantly higher steps after 18 months than those who opted for non-financial incentives (time: p < 0.05, time × group: p < 0.05). Conclusions: Municipality-led financially incentivized health promotion programs could motivate increases in the average number of steps taken by those physically inactive residents.

A Structural Analysis of the Effects on the Lifestyle and Health Status of Exercise Class Participants Owing to COVID-19 Prevention Measures.

Objectives: In this study, we aimed to clarify and measure the interrelationships among decrease in communication, exercise, and physical and mental health under COVID-19 prevention measures, restricting individuals from going out of the house. Methods: Participants included 540 middle-aged and older adults who are regular exercise class members. The survey was conducted between April 15 and May 10, 2020. For the self- administered questionnaire survey, a municipal employee of City A and an exercise instructor visited the home of each participant to collect the survey data. The survey items were sex, age, limitation of going out, feeling of inactivity, interaction with others, health status, and forgetfulness; a covariance structural analysis was performed to clarify the interrelationship between lifestyle and health status. Results: Restrictions on going out due to the COVID-19 prevention measures were associated with the physical and mental health of middle-aged and older adults who regularly attended exercise classes because they enforced inactivity and decreased the frequency of conversation. Conclusions: Several waves of COVID-19 may arrive in Japan in the future. Therefore, it is necessary to implement measures to prevent secondary health damage and not focus only on infection prevention.

Daily steps and healthcare costs in Japanese communities.

Physical inactivity is a pandemic that requires intensive, usually costly efforts for risk reduction of related chronic diseases. Nevertheless, it is challenging to determine the effectiveness of physical activity in healthcare cost reduction based on existing literature. Therefore, this study aimed to investigate the impact of physical activity (daily steps) on healthcare costs utilising the data retrieved from a health promotion project (the e-wellness Project, held in three municipalities in Japan). Evaluating the effects of daily steps, measured by pedometers, on healthcare costs by a quasi-experimental approach among participants aged 40-75 years (about 4000 person-years of observation, between 2009 and 2013), we found that a one-step-increase in the annual average daily step reduced outpatient healthcare costs by 16.26 JPY (≒ 0.11 GBD) in the short run. Based on the assumption of a dynamic relationship between the health statuses in multiple years, the long-run effects of daily steps on healthcare costs were estimated at 28.24 JPY (≒ 0.20 GBD). We determined the health benefits of walking in a sample of middle-aged and older Japanese adults by our findings that an increase in step counts reduced healthcare costs.

Who opts out of a project for health promotion with incentives?: Empirical research on the effect of rewards to motivate persistence.

Objectives　Although providing incentives for a better lifestyle has been of increasing concern, there is insufficient evidence about its effect. Therefore, this research aims to discover new insights by verifying the effect of rewards to motivate persistence in a project for health promotion.Methods　A total of 7,622 participants of an incentivized project for health promotion (Wellness Point Project) were recruited from 6 municipalities in Japan, namely Tohoku, Chubu, Kanto, Kinki, and Chugoku, of which the 4,291 individuals who had the necessary information for estimation were analyzed. Persistence in the project was judged by whether there was information about daily steps and/or participation in some fitness classes every month for one year at most. In addition, we used the reason participants chose certain rewards in order to categorize the characteristic of rewards, and estimated opt-out hazard ratios from the project using survival time analysis. Furthermore, the estimation in the model included individual features such as age, education, status of physical activity before joining the project, lifestyles such as smoking, drinking, and so on.Results　A multivariate analysis reveals that those who had chosen a reward for regional contribution were more likely to opt out than those who had chosen a certain reward because it is close to cash. The opt-out hazard ratio was 1.63 (95% CI: 1.18-2.25) among men and 1.40 (95% CI: 1.08-1.81) among women. In addition, insufficient physical activity, smoking, working for men, and physical condition for women were associated with opt-out.Conclusions　This research verified that a reward that participants felt was close to cash, compared to the internal motivation of regional contribution, could enhance the persistence rate of the project. Moreover, it was found that not only giving incentives but also considering participants' conditions is necessary to enhance persistence.