Preventive Effect of an Intervention Program with Increased Physical Activity on the Development of Musculoskeletal Pain in Community-Dwelling Older Adults: A Randomized Controlled Trial.

OBJECTIVE: To examine whether compared with a program without increased physical activity, an intervention program with increased physical activity can prevent the development of musculoskeletal pain in community-dwelling older adults. DESIGN: Randomized controlled trial. SETTING: Japanese community. SUBJECTS: Seventy-nine older adults without musculoskeletal pain were randomized into two groups: an intervention group (n = 40) that engaged in increased physical activity and an exercise class and a control group (n = 39) that participated only in the exercise class. METHODS: The exercise class consisted of weekly 60-min sessions over 24 weeks. The program to increase physical activity required the participants to record their daily step counts using pedometers. The primary outcome was the development of musculoskeletal pain, and secondary outcomes were physical function, psychological status, cognitive function, and physical activity levels. RESULTS: Twenty-four weeks after the intervention, the intervention group had a significantly lower prevalence of musculoskeletal pain (12.8%) than the control group (32.4%; P = .040). A time-by-group interaction emerged for cognitive function (P = .01) and physical activity levels (P < .001), both of which favored the intervention group. The intervention group also showed greater improvement in psychological status 24 weeks after the intervention than the control group (P = .018). CONCLUSIONS: The intervention program with increased physical activity prevented the development of musculoskeletal pain and improved cognitive function, physical activity levels, and psychological status more effectively than the program without increased physical activity. Our intervention program may be an effective pain prevention approach for older adults. TRIAL REGISTRATION: UMIN000032768; registered on June 1, 2018.

The mental health status of children who have been evacuated or migrated from rural areas in Fukushima prefecture after the Fukushima daiichi nuclear power station accident:results from the Fukushima health management survey.

INTRODUCTION: We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children's experience of the nuclear disaster. METHODS: We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS);FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the "Strengths and Difficulties Questionnaire (SDQ)" scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster - "nuclear disaster (+)" and "nuclear disaster (-)" - were also compared. RESULTS: Our effective response was 93 (59.6%);the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between "elementary school" and "junior high school" or "nuclear disaster" (+) and (-). There was no significant difference between these items. CONCLUSIONS: We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster.

Chronic pain is independently associated with social frailty in community-dwelling older adults.

AIM: The present study aimed to determine whether measures of chronic pain are associated with social frailty in community-dwelling older adults. METHODS: Participants comprised 248 older adults who enrolled for community-based exercise classes. Chronic pain was defined as the presence of significant pain-related symptoms within the past month that had continued for at least 6 months. Social frailty was defined as positive responses to two of the following five questions (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone and not talking with someone every day). Physical function was assessed using the Chair Stand and Timed Up and Go tests. RESULTS: A total of 55 participants (22.2%) met the criteria for social frailty. A total of 28 socially frail participants (50.9%) and 56 of the socially integrated participants (29.0%) reported chronic pain. The presence of chronic pain was significantly associated with social frailty after adjusting for age, sex and physical function measures (odds ratio 2.13, 95% confidence interval 1.01-4.48). Chronic pain was also significantly associated with three social frailty items: going out less frequently, rarely visiting friends and feeling unhelpful to friends or family. CONCLUSIONS: Chronic pain was independently associated with social frailty in community-dwelling older adults. Simple assessments of chronic pain and subsequent pain management interventions might be beneficial for older people with social frailty. Geriatr Gerontol Int 2019; 19: 1153-1156.

Effects of Exercise Training Combined with Increased Physical Activity to Prevent Chronic Pain in Community-Dwelling Older Adults: A Preliminary Randomized Controlled Trial.

Objective: With the aim of developing a chronic pain prevention program, this randomized controlled trial examined whether exercise training combined with increased physical activity more effectively improves pain and physical activity than exercise training alone in community-dwelling older adults without chronic pain. Methods: We randomized 76 older adults without chronic pain into an intervention group (n=38) involving exercise training combined with increased physical activity and a control group (n=38) involving exercise training alone. The exercise training comprised weekly 60-min sessions for 12 weeks. The program to increase physical activity required participants to record their daily step counts using pedometers. Pain intensity, total number of pain sites, and physical activity were assessed before and 12 weeks after the intervention. Results: A time-by-group interaction was found for physical activity, with the intervention group showing significant improvement (p < 0.05). The intervention group also showed greater improvement in pain intensity and total number of pain sites at 12 weeks after intervention than the control group (p < 0.05). Conclusions: In older adults without chronic pain, exercise training combind with increased physical activity improves key outcome indicators more effectively than exercise training alone. "This trial is registered with UMIN000018503."

Impact of frailty on chronic pain, activities of daily living and physical activity in community-dwelling older adults: A cross-sectional study.

AIM: The present cross-sectional study investigated the relationship between frailty and chronic pain, activities of daily living (ADL), and physical activity in community-dwelling older adults. METHODS: Participants were 379 older adults who attended community-based exercise classes. Outcome measures were frailty as determined by the Kihon Checklist, full pain assessment (including the sensory, emotional and cognitive aspects of pain), ADL and physical activity. These outcomes were evaluated using validated tests and instruments. Assessments were carried out before beginning the exercise classes. Outcome measures were compared for participants with and without frailty. Frailty was defined as a total Kihon Checklist score ≥7, and chronic pain as the presence of related symptoms within the past month that had continued for at least 6 months and corresponded with a numerical rating scale score of at ≥5 at the site of maximum pain. RESULTS: In total, 134 (35.4%) participants met the frailty criteria; 60.4% of this group had chronic pain. The frail group had significantly worse scores for the sensory, emotional and cognitive aspects of pain, ADL and physical activity than the non-frail group (P < 0.05). Logistic regression analysis adjusted for age and sex showed the sensory and emotional aspects of pain were associated with frailty. CONCLUSIONS: For community-dwelling older adults with frailty, chronic pain can negatively influence sensory, emotional and cognitive aspects of pain, leading to a decline in ADL and lower physical activity. Full pain assessment focused on sensory and emotional aspects of pain is important to identify frailty among older adults. Geriatr Gerontol Int 2018; 18: 1079-1084.

Factors associated with chronic musculoskeletal pain in Japanese community-dwelling older adults: A cross-sectional study.

Identifying older adults with chronic musculoskeletal pain (CMP) earlier is urgent because CMP is reportedly associated with deterioration in physical function, poor psychological status, and low physical activity level. The objective of this study was to identify factors that were most strongly associated with CMP in Japanese community-dwelling older adults.Using a cross-sectional design, we assessed 263 older adults (mean age = 79.1 ±â€Š5.9 years, 85.9% women) who participated in community exercise classes. Participants' physical function, psychological status, and activity levels were evaluated as outcome measures using a variety of tests and instruments. These assessments were conducted prior to beginning the exercise intervention program and compared participants with and without CMP. Additionally, relevant participant characteristics were collected and analyzed. In this study, CMP was defined as the presence of related symptoms within the past month that continued for at least 6 months and corresponded to a numerical rating scale of at least 5 or more at the site of maximum pain.A total of 143 (54.4%) participants met the criteria for CMP, and a high number of them had chronic lower back pain (64.3%). Outcome measures for the CMP group were significantly worse than for the non-CMP group (P < .05). Logistic regression analysis revealed that the Pain Catastrophizing Scale helplessness domain scores (odds ratio: 1.20, 95% confidence interval: 1.09-1.32) with an estimated value of 10 points was the factor most significantly associated with the presence of CMP.These findings suggest that assessment of the helplessness associated with pain-related catastrophizing is important for identification and the creation of interventions for older adults with CMP.

Effects of a resistance training program performed with an interocclusal splint for community-dwelling older adults: a randomized controlled trial.

[Purpose] To examine whether resistance training for elderly community-dwellers performed with an interocclusal splint resulted in greater lower extremity muscle strength and better balance than resistance training performed without an interocclusal splint. [Subjects and Methods] Eighty-eight elderly persons using Japanese community day centers were randomly divided into two groups: an intervention group (n=45), which performed resistance training with an interocclusal splint; and a control group (n=43), which performed resistance training without an interocclusal splint. The resistance training program comprised a 40-min session performed twice a week for 12 weeks. Outcome measures were the chair stand test (CST), timed up and go test (TUG), and one-leg standing test (OLST). Assessments were conducted before the intervention and every 2 weeks after the start of the intervention. [Results] There was a significant group × time interaction for the OLST, with the intervention group showing significant improvement from 8 to 12 weeks compared to the control group. For the CST and TUG, no significant differences were found between the two groups throughout the 12 weeks. [Conclusion] Resistance training with an interocclusal splint improved the balance ability of elderly community-dwellers more effectively than resistance training without an interocclusal splint.

Effectiveness of a balance-training program provided by qualified care workers for community-based older adults: A preliminary study.

The purpose of this study was to determine the effectiveness of a balance-training program provided by qualified care workers (QCWs) to community-based older adults attending day centers. Weekly balance training was conducted by QCWs working at day centers over a 6-month period. Fall risk factors, fear of falling, and physical function were compared between balance-training (n = 22) and control (n = 23) groups at baseline and after 6 months of intervention. Physical function assessments included the following: one-leg standing test, chair-standing test (CST), timed up-and-go test (TUGT), and a lower-extremity muscle strength test (LEST). Participants who underwent balance training significantly improved in the CST and LEST, and had reduced fear and risk of falling compared with the control group (p < 0.05). In the balance-training group, the TUGT was significantly better at 6 months than at baseline (p < 0.05). A balance-training program for community-dwelling older adults can be effectively implemented by QCWs.

Effects of a balance training program using a foam rubber pad in community-based older adults: a randomized controlled trial.

BACKGROUND AND PURPOSE: Exercise programs aimed at improving balance are effective in fall prevention for older adults. Guidelines indicate that unstable elements should be integrated in balance training with this population. Balance training on an unstable surface facilitates proprioception mediated by skin receptors in the soles of the feet and by mechanoreceptors in the joints and muscles. This randomized controlled trial examined whether balance training performed using a foam rubber pad was more beneficial than balance training performed on a stable flat surface in older adults. METHODS: Older adults using Japanese community day centers once or twice per week were enrolled in this trial. In total, 93 participants were randomized to 1 of 3 groups: foam rubber exercise group (n = 32), stable surface exercise group (n = 31), and control group (n = 30). Participants in the foam rubber and stable surface exercise groups attended a 60-minute exercise class once a week for 4 months and followed a home-based exercise routine. Outcome measures were the following performance tests: the one-leg standing test (OLST), the chair standing test, the timed up-and-go test (TUGT), and the tandem-stance test (TST). These assessments were conducted before the intervention, and at 1, 2, 3, and 4 months after starting the intervention. RESULTS: There were group × time interactions (P < 0.001) for all performance tests. The foam rubber exercise group showed significant improvements in the OLST, TST, and TUGT at 1 to 4 months compared with the control group (P < 0.02). The foam rubber exercise group also showed significant improvements in the OLST and TST at 2 and 3 months compared with the stable surface exercise group (P < 0.02). Within the foam rubber exercise group, the OLST, TUGT, and TST, at 1 to 4 months, were significantly improved compared with before the intervention (P < 0.01). Within the stable surface exercise group, the TUGT and TST, at 3 and 4 months, were significantly improved compared with before the intervention (P < 0.01). CONCLUSIONS: This study confirms that balance training in older adults performed using a foam rubber pad is effective for improving balance ability, and that this improvement occurs 2 months earlier compared with balance training performed on a stable surface. These findings suggest that balance training performed using a foam rubber pad is beneficial to clients and service providers because the programs improve physical functioning with a reduced number of exercise sessions.

A modified fall risk assessment tool that is specific to physical function predicts falls in community-dwelling elderly people.

BACKGROUND AND PURPOSE: Developing a practical fall risk assessment tool to predict the occurrence of falls in the primary care setting is important because investigators have reported deterioration of physical function associated with falls. Researchers have used many performance tests to predict the occurrence of falls. These performance tests predict falls and also assess physical function and determine exercise interventions. However, the need for such specialists as physical therapists to accurately conduct these tests limits their use in the primary care setting. Questionnaires for fall prediction offer an easy way to identify high-risk fallers without requiring specialists. Using an existing fall assessment questionnaire, this study aimed to identify items specific to physical function and determine whether those items were able to predict falls and estimate physical function of high-risk fallers. METHODS: The analysis consisted of both retrospective and prospective studies and used 2 different samples (retrospective, n = 1871; prospective, n = 292). The retrospective study and 3-month prospective study comprised community-dwelling individuals aged 65 years or older and older adults using community day centers. The number of falls, risk factors for falls (15 risk factors on the questionnaire), and physical function determined by chair standing test (CST) and Timed Up and Go Test (TUGT) were assessed. The retrospective study selected fall risk factors related to physical function. The prospective study investigated whether the number of selected risk factors could predict falls. The predictive power was determined using the area under the receiver operating characteristic curve. RESULTS: Seven of the 15 risk factors were related to physical function. The area under the receiver operating characteristic curve for the sum of the selected risk factors of previous falls plus the other risk factors was 0.82 (P = .00). The best cutoff point was 4 risk factors, with sensitivity and specificity of 84% and 68%, respectively. The mean values for the CST and TUGT at the best cutoff point were 12.9 and 12.5 seconds, respectively. In the retrospective study, the values for the CST and TUGT corresponding to the best cutoff point from the prospective study were 13.2 and 11.4 seconds, respectively. DISCUSSION: This study confirms that a screening tool comprising 7 fall risk factors can be used to predict falls. The values for the CST and TUGT corresponding to the best cutoff point for the selected 7 risk factors determined in our prospective study were similar to the cutoff points for the CST and TUGT in previous studies for fall prediction. We propose that the sum of the selected risk factors of previous falls plus the other risk factors may be identified as the estimated value for physical function. CONCLUSIONS: These findings may contribute to earlier identification of high-risk fallers and intervention for fall prevention.

Bone marrow adipocytes support dexamethasone-induced osteoclast differentiation.

The purpose of this study was to examine the ability of bone marrow adipocytes to support osteoclast differentiation in vitro. The primary bone marrow adipocytes were obtained from bone marrow fluid during prosthesis insertion. NFkappa-B ligand (RANKL), Osteoprotegerin (OPG), and macrophage colony stimulating factor (M-CSF) expressions in bone marrow adipocytes with or without dexamethasone were examined. In a co-culture system with bone marrow adipocytes and osteoclast precursor cells, osteoclast differentiation was assessed by the expression of titrate-resistant acid phosphatase (TRAP) staining. RANKL, OPG, and M-CSF mRNA expressions were confirmed in all individuals. Dexamethasone significantly induced RANKL and OPG expression. The RANKL/OPG ratio was increased by dexamethasone and was significant at 10(-7) M dexamethasone. With 10(-7) M dexamethasone, osteoclast precursor cells differentiated into multinucleated TRAP-positive cells when co-cultured with bone marrow adipocytes. The present study demonstrates for the first time that bone marrow adipocytes can support osteoclast differentiation in vitro.

Feasibility and effectiveness of a nurse-led community exercise programme for prevention of falls among frail elderly people: a multi-centre controlled trial.

OBJECTIVE: To determine whether an exercise programme provided by public health nurses is effective in improving physical function and psychological status in elderly people, in reducing falls and risk factors for falls in elderly people, and whether the intervention is a feasible programme within the community. DESIGN: Controlled intervention trial. SUBJECTS: Participants included 144 persons in the intervention group and 124 persons in the control group, who were living at home, aged over 65 years, and with 5 or more risk factors for falls identified using the questionnaire for fall assessment (Suzuki). METHODS: For participants in the intervention group, an exercise programme was provided by public health nurses. This comprised a weekly exercise class of 2 hours for 17 weeks, supplemented by daily home exercises. Number of risk factors, physical function and psychological status were compared between the intervention and control groups before and after intervention. The number of further falls during the intervention was also compared between the 2 groups. RESULTS: The programme significantly improved physical function and emotional status, and reduced the number of falls and risk factors for falls. The excellent adherence rate represented broad acceptance of the intervention. CONCLUSION: The intervention programme was effective and feasible to operate in the community.