Two-Year Repeated Study on Health Effect of Net-Step Exercise Program in Community-Dwelling Older Persons

  

    
Sub-categories of Kihon    Checklist
    
Sex
    
Source
    
F value
    
P value
  
  

    
Difficulty in activities of daily living
    
Males
    
NSE
    
10.40
    
<0.001
  
  

    
Survey (Year)
    
35.83
    
<0.001
  
  

    
NSE × Survey
    
0.59
    
0.554
  
  

    
Females
    
NSE
    
27.30
    
<0.001
  
  

    
Survey (Year)
    
10.17
    
0.002
  
  

    
NSE × Survey
    
0.39
    
0.676
  
  

    
Houseboundness
    
Males
    
NSE
    
1.09
    
0.335
  
  

    
Survey (Year)
    
0.01
    
0.924
  
  

    
NSE × Survey
    
2.31
    
0.100
  
  

    
Females
    
NSE
    
26.44
    
<0.001
  
  

    
Survey (Year)
    
3.13
    
0.077
  
  

    
NSE × Survey
    
1.00
    
0.369
  
  

    
Impaired cognitive function
    
Males
    
NSE
    
2.93
    
0.054
  
  

    
Survey (Year)
    
0.19
    
0.660
  
  

    
NSE × Survey
    
2.80
    
0.062
  
  

    
Females
    
NSE
    
5.51
    
0.004
  
  

    
Survey (Year)
    
0.03
    
0.861
  
  

    
NSE × Survey
    
0.33
    
0.720
  
  

    
Depressive status
    
Males
    
NSE
    
0.93
    
0.396
  
  

    
Survey (Year)
    
1.28
    
0.257
  
  

    
NSE × Survey
    
2.08
    
0.126
  
  

    
Females
    
NSE
    
5.53
    
0.004
  
  

    
Survey (Year)
    
4.55
    
0.033
  
  

    
NSE × Survey
    
0.02
    
0.981
  
  

    
NSE: Net-step exercise. 
  

Table 5: Results of repeated-measures ANOVA for four sub-categories of Kihon
Checklist found to be significantly different in 2018 and/or 2019 Surveys for NSE
Participants compared with NSE Non-participants by sex.

Discussion

We demonstrated that, in either or both of the male or the female subjects, NSE Participants had significantly better status than NSE Non-participants in four sub-categories of KCL such as difficulty in activities of daily living, houseboundness, impaired cognitive function, and depressive status. Especially, significantly reduced risk was associated with NSE participation in difficulty in activities of daily living in both sexes and houseboundness in females, consistently between 2018 and 2019 Surveys.

In KCL, [8] activities of daily living consist of five questions such as (i) Do you go out by bus or train by yourself? (ii) Do you go shopping to buy daily necessities by yourself? (iii) Do you manage your own deposits and savings at the bank? (iv) Do you sometimes visit your friends? (v) Do you turn to your family or friends for advice? Houseboundness consists of two questions such as (i) Do you go out at least once a week? (ii) Do you go out less frequently compared to last year?

Being consistent with our results, there are several reports that physical exercise has improved Activities of Daily Living (ADL). Oida et al. [11] showed that five-year intervention of exercise and health education significantly reduced the risk of ADL impairment in both men and women. They measured ADL impairment with categories that required help, for example, eating, dressing, using the toilet, and other activities at home. According to a six-year cohort study by Nagamatsu et al., [12] functional fitness significantly reduced the risk of ADL such as hand working and self-care working in males, but not in females.

Women were consistently reported to be prone to houseboundness, compared with men [13-16]. However, proportions of houseboundness were larger in the male subjects than the female subjects in our results of both the 2018 and 2019 Surveys. Some reports suggested that exercise programs prevented houseboundness [17,18]. Ohtake et al. [17] elucidated from a randomized controlled trial that an eight-week exercise program resulted in an intervention group with a lower degree of houseboundness. They defined degree of houseboundness with 20 questions including social activities. Uemura et al. [18] revealed that sarcopenia measured with the specific instrument were associated with significantly increased risk of becoming housebound, and sarcopenia is reflected by low physical performance or low muscle strength. Because these studies did not show the results by sex [17,18], it is difficult to explain that our significant finding only in the female subjects is generally observed or not with regard to preventive effect of physical activity program for houseboundness.

Results of NSE participants were significantly better in terms of cognitive function. This was found in our study of the male subjects at 2018 Survey as well as of the female subjects with the repeatedmeasure ANOVA. Kitazawa et al. [1] reported that NSE participants showed significant improvement in cognitive function from the result of experimental pretest/posttest study for 60 healthy older adults. Larson et al. [19] also showed in a prospective cohort study that regular exercise was associated with reduced risk of dementia. Lautenschlager et al. [20] denoted with randomized controlled trial that a six-month program of physical activity provided significant improvement in cognition among adults with subjective memory impairment.

We found that NSE participants showed significant reduced risk of depressive status in the female subjects. Likewise, Showa et al. [2] revealed from a cross-sectional study of community-dwelling elderly that NSE had marginally significant inverse association with risk of depressive symptoms after adjusting for sex, although they did not show the results by sex. Similar to our results, Heesch et al. [21] reported, from a cohort study of community-dwelling women aged 70-78, the inverse dose-response association between leisuretime and score of depression and anxiety. Some other studies [22- 24] revealed that greater physical activity was protective against depression in community-dwelling older adults, although the results were not shown by sex.

Intensity of NSE is as low as slow walking. Ogawa et al. [4] reported that, with measuring circulation of 72 older adults before and after a 30min NSE program, the post-exercise Systolic Blood Pressure (SBP) and the post-exercise Pulse Rate (PR) was rather lower than the pre-exercise SBP and pre-exercise PR. They inferred from the results that NSE was so low-intensity and comfortable to stimulate parasympathetic nerve activity, but not sympathetic nerve activity. There are several reports showing that even low-intensity physical exercise was effective in health promotion in older adults [25,26]. Kolbe-Alexander et al. [25] showed from a result of 20-week intervention study that a community-based, low-intensity exercise program improved dynamic balance and lower body strength. Brown et al. [26] also exhibited from a result of a randomized controlled study that significant improvement was made by the three-month low-intensity exercise group on a physical performance test.

Our study concentrated on the age class between 75 years and 80 years. Studies for effectiveness of physical exercise restricted to very old people, namely, aged over 75 years, are relatively few in Japan. Outside Japan, Lihavainen et al. [27] reported from the three-year intervention study on people aged 75-98 years that the intervention group improved in balance and walking speed, as compared with the control group. Bonnefoy et al. [28] suggested that those participants over 78 years old who lived at home independently participated in a self-administrated exercise program with good compliance. Because Japanese life expectancy is getting longer, more epidemiological studies are needed with regard to association of daily activity with health in very old persons.

Tomata et al. [5] indicated from a cohort study that all of the criteria in KCL were useful for predicting the risk of incident longterm care insurance certification. Satake et al. [8] as well as Yamada et al. [9] suggested from a cross-sectional study that KCL is a useful tool for frailty screening, although Fukutomi et al. [6,7] denoted from a cohort study that only physical strength in KCL was a predictor of the incident long-term insurance certification. We think that KCL is useful for surveys of older persons, because it is easy for them to understand and is composed of seven necessary sub-categories for assessing their daily living.

There are several limitations in this study. Firstly, the response rate was 69.2% and 93.3% to 2018 Survey and 2019 Survey, respectively. However, it is thought that majority of the study candidates participated in the survey. Secondly, data on some potential confounding factors, such as socio-economic status, were not included in this study, although age, daily activity, and participation in any other program for prevention of long-term care were adjusted in the analysis. Thirdly, although the study design was the repeatedmeasuring type, in addition to the cross-sectional study at two points, causal relationship between participation in NSE program and better status in health could be not indicated.

Conclusion

In conclusion, participation in the NSE program had brought better status in difficulty in activities of daily living, houseboundness, impaired cognitive function, and depressive status in the male and/or female subjects among persons aged from 75 years to 80 years. Either performance of NSE itself or participation in the program, or both, may promote healthy status in older persons.

Declarations

Ethics approval and consent to participation

Written informed consent was obtained from each subject. The Committee of Institutional Review Board of Hokkaido Chitose College of Rehabilitation (No.18006) approved the study.

Availability of data

Data sharing is not applicable to this article as no data are publicity available due to personal privacy but are available from the corresponding author on reasonable request.

Funding

This study was supported for conducting the survey in part by JSPS KAKENHI Grant Number JP18K10072, and was funded for collecting the data in part by Hokkaido Chitose College of Rehabilitation.

Authors’ contribution

MM contributed to the research mainly for planning of the study, analyzing the data, and preparing the manuscript. KK, SS, and MT contributed to the research mainly for conducting the surveys. TS and ST contributed to the research mainly for preparing the surveys and making the data sets. All authors read and approved the final manuscript.

Acknowledgment

We are grateful very much for all of the participants in this study.

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