Ryuichi Sawa

Reliability and validity of the Japanese version of the simplified nutritional appetite questionnaire in community-dwelling older adults

To translate the Simplified Nutritional Appetite Questionnaire (SNAQ) into Japanese, and assess its reliability and validity in Japanese community‐dwelling older adults.

Does arm swing emphasized deliberately increase the trunk stability during walking in the elderly adults

The purpose of this study was to determine whether trunk stability while walking changes when arm swing is deliberately altered in elderly individuals. Participants included 21 community-dwelling elderly individuals (7 men and 14 women; age, 81.8 ± 5.0 years). We measured trunk acceleration by using a wireless miniature sensor unit containing a tri-axial linear accelerometer under 3 walking conditions: normal walking (normal condition), deliberately walking without any arm swing (no swing condition), and walking with a deliberately emphasized arm swing (over swing condition). To evaluate trunk stability during walking, we calculated harmonic ratios (HRs) based on trunk tri-axial acceleration signals (anteroposterior: AP, vertical: VT, and mediolateral: ML). HR-AP and HR-VT were not significantly different across the 3 conditions, but HR-ML in the over swing condition was significantly higher than that in the other 2 conditions by generalized estimating equations (GEE) adjusted for walking speed (p<0.05). These findings indicate that trunk stability in the ML direction increased when the elderly individuals walked with a deliberately emphasized arm swing.

The association between fear of falling and gait variability in both leg and trunk movements

The aim of this study was to explore whether FoF was associated with variability in both leg and trunk movements during gait in community-dwelling elderly. Ninety-three elderly people participated in this study. Each participant was categorized into either Fear or No-Fear group on the basis of having FoF. The participants walked 15m at their preferred speed. The wireless motion recording sensor units were attached to L3 spinous process and right posterior surface of heel during gait. Gait velocity, stride time and stride length were calculated. Variability in lower limb movements was represented by coefficient of variation (CV) of stride time. Trunk variability was represented by autocorrelation coefficients (AC) in three directions (vertical: VT, mediolateral: ML and anteroposterior: AP), respectively. Gait parameters were compared between groups, and further analyses were performed using generalized linear regression models after adjustment of age, sex, fall experience, height, weight, and gait velocity. Although gait velocity, mean stride time and stride length did not differ significantly between groups, stride time CV and all ACs were significantly worse in the Fear group after adjustment for variables, even including gait velocity (stride time CV: p=0.003, β=-0.793; AC-VT: p=0.011, β=0.053; AC-ML: p=0.044, β=0.075; AC-AP: p=0.002, β=0.078). Our results suggest that fear of falling is associated with variability in both leg and trunk movements during gait in community-dwelling elderly. Further studies are needed to prove a causal relationship.

Effects of multicomponent exercise on spatial–temporal gait parameters among the elderly with amnestic mild cognitive impairment (aMCI): Preliminary results from a randomized controlled trial (RCT)

Exercise training has been shown to increase physical function in the elderly. However, the effects of exercise on elderly individuals with amnestic aMCI are unclear. The aim of this RCT was to investigate the effect of multicomponent exercise on gait in the elderly. Fifty elderly individuals with aMCI (age: 65-92 years) participated in the study and were randomly allocated to a multicomponent exercise or control group. Multicomponent exercise training was performed for 90 min, twice a week over six months. Gait was analyzed at baseline and after the six month intervention. Gait analysis was performed on an eleven meter walkway at each subjects comfortable walking speed. A miniature tri-axial accelerometer was attached to the L3 spinous process and was used to analyze gait speed, stride length, stride time, and the harmonic ratio (HR) (representing the smoothness of trunk movement). There were no differences in the participant characteristics or gait parameters between the groups at baseline. After adjustment for covariates the multicomponent exercise program had a significant (p<0.05) effect on gait speed, stride length, and the vertical HR. Through improving gait, multicomponent exercise training improves the physical health of the elderly with aMCI.

Guidelines for Assessment of Gait and Reference Values for Spatiotemporal Gait Parameters in Older Adults: The Biomathics and Canadian Gait Consortiums Initiative

Background: Gait disorders, a highly prevalent condition in older adults, are associated with several adverse health consequences. Gait analysis allows qualitative and quantitative assessments of gait that improves the understanding of mechanisms of gait disorders and the choice of interventions. This manuscript aims (1) to give consensus guidance for clinical and spatiotemporal gait analysis based on the recorded footfalls in older adults aged 65 years and over, and (2) to provide reference values for spatiotemporal gait parameters based on the recorded footfalls in healthy older adults free of cognitive impairment and multi-morbidities. Methods: International experts working in a network of two different consortiums (i.e., Biomathics and Canadian Gait Consortium) participated in this initiative. First, they identified items of standardized information following the usual procedure of formulation of consensus findings. Second, they merged databases including spatiotemporal gait assessments with GAITRite® system and clinical information from the “Gait, cOgnitiOn & Decline” (GOOD) initiative and the Generation 100 (Gen 100) study. Only healthy—free of cognitive impairment and multi-morbidities (i.e., ≤ 3 therapeutics taken daily)—participants aged 65 and older were selected. Age, sex, body mass index, mean values, and coefficients of variation (CoV) of gait parameters were used for the analyses. Results: Standardized systematic assessment of three categories of items, which were demographics and clinical information, and gait characteristics (clinical and spatiotemporal gait analysis based on the recorded footfalls), were selected for the proposed guidelines. Two complementary sets of items were distinguished: a minimal data set and a full data set. In addition, a total of 954 participants (mean age 72.8 ± 4.8 years, 45.8% women) were recruited to establish the reference values. Performance of spatiotemporal gait parameters based on the recorded footfalls declined with increasing age (mean values and CoV) and demonstrated sex differences (mean values). Conclusions: Based on an international multicenter collaboration, we propose consensus guidelines for gait assessment and spatiotemporal gait analysis based on the recorded footfalls, and reference values for healthy older adults.

Differences in trunk control between early and late pregnancy during gait

The aim of this study was to compare gait characteristics, including the functional ability of the trunk, between women before and during the third trimester of pregnancy. Gait measurements were performed on 27 pregnant women, who were divided into two groups using the threshold of 28 gestational weeks. The subjects were instructed to walk at their preferred speed. In addition to stride-time coefficient of variation, root mean square (RMS) and autocorrelation coefficient, coefficient of attenuation (CoA) of acceleration was computed as an index to assess the functional ability of the trunk. Differences of gait characteristics between the groups were determined by the Mann-Whitney U test. Gait characteristics that showed a significant difference between the groups were further analyzed with adjustment by age, height, weight and gait velocity by using multiple regression analysis. Women during the third trimester of pregnancy showed significantly smaller RMS in the anteroposterior direction at the lower trunk than those before the third trimester of pregnancy, even after adjusting for age, height, weight and gait velocity [β=0.47; 95% confidence interval (CI) 0.07-0.25]. CoA in the anteroposterior direction was also significantly lower in women during the third trimester of pregnancy than in those before the third trimester of pregnancy after adjustment by age, height, weight and gait velocity (β=0.44; 95% CI 0.39-18.52). The present cross-sectional study suggests the possibility that the functional ability of the trunk during gait declines in late pregnancy.

Association between gait abnormality and malnutrition in a community-dwelling elderly population

Malnutrition is common in older adults, and contributes to the risk of falls and functional impairment. Gait performance also contributes to falls and functional impairment; however, the association between malnutrition and gait performance remains unclear. The purpose of the present study was to investigate the association between malnutrition risk and gait performance.

Association between the Cardio-Ankle Vascular Index and Executive Function in Community-Dwelling Elderly People.

AIM The aim of this study was to investigate the cross-sectional association between arterial stiffness (AS) measured with the cardio-ankle vascular index (CAVI) and executive function in community-dwelling elderly people. METHODS Subjects were 140 community-dwelling elderly people who participated in the study at Kobe, Japan during the period of August-September 2014, of which 126 (mean age±SD: 73.2±6.1, female: 67.5%) met the inclusion criteria and completed the study. Age, sex, body mass index, global cognition, existence of chronic disease, medication, smoking history, and years of education were assessed. The degree of AS was assessed using CAVI. Executive function was assessed using the Category Word Fluency Test (CWFT), Letter Word Fluency Test (LWFT), and Digit Symbol Substitution Test (DSST). We used a correlation analysis and multiple linear regression analysis to investigate whether higher CAVI was independently associated with lower executive function. RESULTS In the univariate analysis, higher mean CAVI correlated with lower CWFT (rho=－0.21, p=0.020), LWFT (rho=－0.32, p＜0.001), and DSST (rho=－0.31, p＜0.001). In the multivariate analysis, higher mean CAVI was associated with lower LWFT (β=－0.21, p=0.046) after adjusting for confounding factors, although there was no association with CWFT (β=－0.05, p=0.61) and DSST (β=－0.06, p=0.51). CONCLUSIONS We found that high CAVI was associated with lower LWFT. These results suggest that arterial stiffness is associated with lower performance in phonemic fluency.

Decreased skin temperature of the foot increases gait variability in healthy young adults

We investigated the effects of reduction in plantar skin temperature on gait. Thirty-four healthy subjects (20 men and 14 women; mean age 22.2±2.5 years; mean height 166.8±8.3cm) walked 16m under two different conditions - normal conditions (NC) with the skin at a basal temperature, and cold conditions (CC) after cooling of the plantar skin to about 15°C. Wireless motion-recording sensor units were placed on the back at the level of L3 and on both heels to measure acceleration and angular velocity. Gait velocity and mean stride, stance and swing times were calculated. The variability of lower limb movement was represented by the coefficients of variation (CVs) of stride, stance and swing times, and that of trunk movement was represented by autocorrelation coefficients (ACs) in three directions (vertical: VT; mediolateral: ML; and anteroposterior: AP). Gait velocity was significantly lower under CC conditions than under NC (p<0.0001). None of the temporal parameters were changed by plantar cooling. However, all parameters of gait variability were significantly worse under CC, and AC-VT, AC-ML, and AC-AP were significantly lower under CC than under NC, even after adjusting for gait velocity (p=0.0005, 0.0071, and 0.0126, respectively). Our results suggest that reducing plantar skin temperature induces gait variability among healthy young adults. Further studies are now needed to explore the relationship between plantar skin temperature and gait in the elderly.

Influence of Habitual Physical Activity During Late Pregnancy on the Duration of Labor

BACKGROUND Physical activity during pregnancy has numerous benefits, but the influence on the duration of labor is unclear. We investigated the influence of habitual physical activity during late pregnancy on the duration of labor, with consideration of previous delivery experience and the stage of labor. METHODS This prospective study included 103 women (48 nulliparous, 55 multiparous) in late pregnancy. Habitual physical activity was evaluated using the Baecke physical activity questionnaire (BQ). Women were divided into a high activity group (HA) and a low activity group (LA) based on their median total BQ score. Data pertaining to the duration of labor were obtained from the birth records after delivery. RESULTS In multiparous women, the duration of the second stage of labor was significantly shorter in the HA group than in the LA group [median (range): HA, 11 min (1-102 min); LA, 20 min (4-175 min); P < .05]. The significant difference persisted after adjusting for confounding variables (standardized β = -0.34; P = .01). In nulliparous women, there were no significant differences in duration of labor between groups. CONCLUSIONS Higher physical activity in multiparous women during late pregnancy might positively influence the duration of the second stage of labor.