Takashi Arao

Effect of a worksite-based intervention program on metabolic parameters in middle-aged male white-collar workers: A randomized controlled trial

OBJECTIVE An effective program for preventing metabolic diseases through lifestyle modification is urgently needed. We investigated the effects of the Life Style Modification Program for Physical Activity and Nutrition program (LiSM10!) on metabolic parameters in middle-aged male Japanese white-collar workers. METHODS One hundred and one male office workers, 30 to 59 years of age, with metabolic syndrome risk factors, were randomly allocated into no-treatment control (n=49) and LiSM intervention (n=52) groups. The LiSM group attended individualized assessment and collaborative goal setting sessions based on food group intake and physical activity, followed by two individual counseling sessions with a registered dietitian and physical trainer, and received monthly website advice during the 4-month period from December 2006 to May 2007, in Tokyo, Japan. They were encouraged to enter current targeted food intakes and pedometer data on self-monitoring websites during the entire study period. RESULTS Habitual food group intakes changed significantly in the LiSM group, showing improvements in 14 anthropometric and biochemical parameters contributing to inter-group differences in body weight, body mass index, fasting plasma glucose, insulin and homeostasis model assessment of insulin resistance changes (p<0.01). CONCLUSION The LiSM10! program effectively improved insulin resistance-related metabolic parameters in middle-aged male white-collar workers.

Prevalence Rates of Self-Care Behaviors and Related Factors in a Rural Hypertension Population: A Questionnaire Survey

The objective of this study was to investigate the self-care behaviors among hypertensive patients in primary care. A cross-sectional survey, with 318 hypertensive patients, was conducted in a rural area in Beijing, China, in 2012. Participants were mainly recruited from a community health clinic and completed questionnaires assessing their self-care behaviors, including data on adherence to a prescribed medication regimen, low-salt diet intake, smoking habits, alcohol consumption, blood pressure monitoring, and physical exercise. The logistic regression model was used for the analysis of any association between self-care behaviors and age, gender, duration of hypertension, self-rated health, marital status, education level, diabetes status, or body mass index. Subjects that adhered to their medication schedule were more likely to have hypertension for a long duration (OR, 3.44; 95% CI 1.99–5.97). Older participants (OR, 1.80; 95% CI 1.08–2.99) were more likely to monitor their blood pressure. Subjects who did not partake in physical exercise were more likely to be men, although the difference between genders was not significant (OR, 0.60; 95% CI 0.36–1.01). Patients with shorter history of hypertension, younger and being males have lower self-care behaviors. Primary care providers and public health practitioner should pay more attention to patients recently diagnosed with hypertension as well as younger male patients.

Study on Current Levels of Physical Activity and Sedentary Behavior among Middle School Students in Beijing, China

Introduction This study aimed to determine current levels of physical activity and sedentary behavior in middle school students on the basis of grade, sex, student attitudes toward physical education, and residence location. Methods In 2013, a cross-sectional study of 1793 students aged 12 to 15 years was conducted across eight middle schools in Beijing, China. Four schools were selected from an urban district and another four schools were from a suburban district. Physical activity and sedentary behavior data were collected using the commonly used school-based Chinese version of the China Health and Nutrition Survey. Results The mean age of sampled students was 13.3±1.0 years; 51.5% were boys. Approximately 76.6% of students reported having three 45-minute physical education classes every week. A total of 35.6% students spent ≥1 h/day performing moderate to vigorous physical activity (MVPA) during school, and 34.9% spent ≥1 h/day in MVPA outside school time. Approximately half (49.7%) of the students engaged in reading, writing, or drawing for ≥2 h/day, and 42.9% reported screen time for ≥2 h/day. Although boys spent more time engaged in physical activity than girls did, they also spent more time exhibiting sedentary behavior. Each 10-unit increase in attitudes toward physical education was associated with an increased odds of 1.15 (95%CI: 1.09–1.20) for spending more than 1 h/day on MVPA. Students in suburban schools reported engaging in physical activity less when compared with those in urban schools. Conclusion The majority of our students did not meet the current physical activity recommendations, and about half of the students spent excessive time engaging in sedentary behaviors. Findings from this study highlight a positive association between student attitudes toward physical education and physical activity. Studies are needed to further explore the role of student attitudes toward physical education in promoting physical activity among Chinese students.

Validation of a Chinese Version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale in Patients with Hypertension in Primary Care

The aim of this study was to validate a Chinese version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C). In 2012, a cross-sectional study was conducted in a community clinic, in Beijing, China. A total of 262 hypertension patients participated in this study. Concurrent validity was validated by Pearson’s correlations between the SES6C and Hospital Anxiety and Depression Scale (HADS). Intraclass correlation coefficients (ICC) were performed to evaluate test-retest reliability of the scale. Related factors of self-efficacy were explored in linear regression models. The results of our study display acceptable psychometric properties: the scale was two-dimensional, reproducible (ICC = 0.78; 95% CI, 0.70–0.84), and the reliability was good (Cronbach’s alpha = 0.88). Significant (; ) correlation was found between the level of self-efficacy and the level of psychological distress. In multivariable analysis, the factors significantly associated with self-efficacy were regular exercise (, ), HADS total score (, ) and health status (, ). The study provides evidence that the SES6C is acceptable, valid and repeatable for hypertension patients.

Prevalence, Purposes, and Perceived Effectiveness of Complementary and Alternative Medicine Use in a Hypertension Population: A Questionnaire Survey

Complementary and alternative medicine (CAM) is widely used among patients with hypertension. This study aimed to determine the use of CAM in community-dwelling individuals with hypertension. A cross-sectional questionnaire survey was administered to 318 hypertension patients to examine prevalence and patterns of CAM use; the use of CAM, specifically for treatment of hypertension or other conditions, and perceived effectiveness of CAM were examined. CAM use in the last 12 months was reported by 236 (74.2%) participants. Only 13.1% of these CAM users reported using CAM to treat hypertension. CAM users did not differ statistically from non-CAM users by age, marital status, health status, duration of hypertension, income, or education. Females showed a significantly higher prevalence of CAM use than that of males (OR 1.82, 95% CI 1.09, 3.11). Family/relatives, doctors, and patients themselves were the three main sources of information about CAM. More than 70% of responses were able to perceive the effectiveness of alternative medical systems, mind-body medicine, and manipulative/body-based therapies. There was a high prevalence of CAM use among hypertension patients, although the majority of CAM use was not specifically for hypertension. Further research is needed to assess the safety and efficacy of diverse CAM.

Development of the Chinese Family Support Scale in a Sample of Chinese Patients with Hypertension

Background Despite strong recommendations to involve family social support in hypertension control, few questionnaires have been designed to measure family support in Chinese patients. The Chinese Family Support Scale is a self-rated questionnaire that assesses family support over a 6-month period. Methods A total of 282 patients with hypertension participated in this study and 136 of them completed the questionnaire twice within an interval of two to three weeks. Exploratory factor analysis was conducted to assess the structural validity of the scale. Concurrent validity was determined by measuring the correlation between the Chinese Family Support Scale, and Hospital Anxiety and Depression Scale using the Sperman’s Correlation Coefficient. Cronbach’s alpha and intraclass correlation coefficients were employed to evaluate the internal and test-retest reliability of the scale. Results Exploratory factor analysis revealed a three-factor solution accounting for 62% of the total variance. The three underlying sub-scale dimensions were kinship, nuclear family, and social resources. Significant correlation (r=-0.266; p<0.01) was found between the depression subscales of the Hospital Anxiety and Depression Scale and the extent of support perceived by the patients as measured by the Chinese Family Support Scale. The Chinese Family Support Scale had an acceptable internal consistency (Cronbach’s alpha = 0.84) and test-retest reliability (intraclass correlation coefficient = 0.82). Conclusion The study provides preliminary evidence that the12-item Chinese Family Support Scale is acceptable, valid and reliable for measuring the perceived family support in hypertension patients. It is a promising tool which can be easily incorporated into epidemiological surveys.

A cross-sectional study on the factors related to cognitive decline in community-dwelling elderly

AIM The aim of this study was to examine the relationship between cognitive decline and physical activity, sitting time, and social participation among elderly people living independently in a local community. METHODS In January 2015, 1,133 independently-living elderly individuals from a local Japanese community completed self-administrated questionnaires. A total of 929 participants completed the questionnaire (valid response rate: 82.0%). A multiple logistic regression analysis was conducted to examine the relationship between cognitive decline, physical activity, sitting time, and social participation. The factors related to cognitive decline were examined using three statistical models: (1) Model 1 was not adjusted for any factors; (2) Model 2 was adjusted for age, education level, smoking status, and drinking status; and (3) Model 3 was adjusted for the covariates in Model 2, plus depression. RESULTS Cognitive decline was observed in 33% of men and 26% of women. The results indicated that decreased social participation was significantly related to cognitive decline in Models 1 and 2. For men, local community activity and political/economic activity were significantly associated with cognitive decline in Models 1 and 2. Among women, physical activity was significantly related to cognitive decline in Model 1. There was also a significant association between social participation and cognitive decline in Models 1 and 2; decreased volunteer activity was significantly related to cognitive decline in all three models. CONCLUSION The results of the present study indicated that attending volunteer activities was significantly related to cognitive decline in women.

The association of single and combined factors of sedentary behavior and physical activity with subjective cognitive complaints among community-dwelling older adults: Cross-sectional study

Subjective cognitive complaints (SCC) might be a meaningful indicator of dementia onset or mild cognitive impairment, and identifying the related factors of SCC could contribute to preventing these diseases. However, the relationship between SCC and lifestyle factors remains largely unproven. The purpose of this study was to examine the association of type of sedentary behavior, physical activity, or their combination with SCC among community-dwelling older adults. In 2016, 6677 community-living elderly were recruited to participate in a survey investigating cognition, physical activity, and sedentary behavior. In total, 5328 participants responded to the questionnaire (79.8% valid response rate). SCC was assessed using the National Functional Survey Questionnaire (Kihon checklist). The relationships between SCC and physical activity, sedentary behavior (reading books or newspapers, and television viewing), or combined physical activity and sedentary behavior were examined via multiple logistic regression analysis. The analysis revealed that moderate-to-vigorous physical activity (≥150 min/week) was significantly related with a lower risk of SCC (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.74–0.97), and that reading behavior showed a dose-response relationship with SCC (OR for 10–20 min/day = 0.63; 95% CI = 0.53–0.75; OR for 20–30 min/day = 0.59; 95% CI = 0.49–0.71; OR for ≥30 min/day = 0.47; 95% CI = 0.39–0.57). In addition, among those reporting high physical activity and ≥30 min/day for reading time, the OR for SCC was 0.40 (95% CI = 0.32–0.50) compared with the combined group reporting lower physical activity and non-readers. The present study shows that increased physical activity and reading time may be related to a reduced risk for SCC among community-dwelling older adults.

Reduction in Vegetable Intake Disparities With a Web-Based Nutrition Education Intervention Among Lower-Income Adults in Japan: Randomized Controlled Trial

Background No existing Web-based nutrition education interventions have been evaluated in light of socioeconomic status just in Japan. Objective The aim was to investigate the effect of a Web-based intervention program on reducing vegetable intake disparities between low- and middle-income Japanese adults. Methods In this randomized controlled trial, participants were assessed at three time points—baseline, postintervention (5 weeks later), and a follow-up after 3 months—from October 2015 to March 2016. We collected data via a Japanese online research service company from 8564 adults aged 30 to 59 years. Participants were stratified according to national population statistics for gender and age, and randomly selected. They were then randomly allocated into intervention (n=900) and control (n=600) groups such that both groups contained an equal number of individuals with low and middle income. The intervention program encouraged behavior change using behavioral theories and techniques tailored to their assumed stage of change. The outcome was vegetable intake servings per day (1 serving being approximately 70 g). Results Out of 900 participants who started, 450 were from the middle income group (of which 386 or 85.7% completed the intervention), and 450 were from the low income group (of which 371 or 82.4% completed). In the intervention group, vegetable intake increased in the low-income participants from baseline to postintervention (0.42 servings, 95% CI 0.11-0.72). A two-way analysis of variance showed that low-income participants had significant main effects of group (η2=0.04, P=.01) and time (η2=0.01, P<.001), and a significant interaction (η2=0.01, P=.009). Middle-income participants also had a significant main effect of time (η2=0.01, P=.006) and a significant interaction (η2=0.01, P=.046). Conclusions This Web-based nutritional education intervention could fill the vegetable intake gap between low- and middle-income adults in Japan, and is expected to prevent noncommunicable and lifestyle-related diseases. Further intervention program improvements are necessary to maintain and increase vegetable intake for other groups. Trial Registration Current Controlled Trials (UMIN-ICDR): UMIN000019376; https://upload.umin.ac.jp/cgi-open-bin/ icdr_e/ctr_view.cgi?recptno=R000022404 (Archived by WebCite at http://www.webcitation.org/6u9wihBZU)

Population Strategy for Physical Activity Promotion in the Community

The importance of population-wide interventions for disease prevention and health promotion has been increasingly recognized among both researchers and health professionals. To stimulate and accelerate research on community-wide intervention for physical activity promotion, the strategies used for and scientific evidence of community-wide intervention program effectiveness were reviewed and the profile of our research, which is intended to promote physical activity in the whole population, of the community was described.