Faculty Profiles - MAKIZAKO Hyuma

Papers - MAKIZAKO Hyuma

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牧迫飛雄馬, 木山良二, 中井雄貴, 富岡一俊, 谷口善昭, 竹中俊宏 . サルコペニアに対する運動療法の標準化と効果の検証　ランダム化比較対照試験 . 大和証券ヘルス財団研究業績集 ( 44 ) 113 - 117 2021.3

Language：Japanese Publisher：(公財)大和証券ヘルス財団

サルコペニアを有する高齢者を対象として、運動群と対照群にランダムに割り付け、サルコペニアに対する運動療法の効果を検証した。対象者を運動群(36名)と対照群(36名)にランダムに割り付け、3ヵ月間の介入前後での身体機能と大腿筋量(MRI画像)の変化を比較した。運動介入は、ゴムバンドによる筋力トレーニングを中心とした多面的運動プログラムを週1回(60分)の頻度で12回実施した。欠損値補正を行ったITT(intention-to-treat)解析で3ヵ月間の変化を比較した。その結果、5回立ち座りテストとTimed UP and Goで群と時間(介入前後)の有意な交互作用を認め、運動群での改善を認めた。大腿の筋面積・筋体積の変化では、運動群で減少を抑制する傾向であったが、有意な交互作用は認められなかった。また、サブグループ解析として、同運動教室に参加していた高齢者15名(平均年齢78.1±6.4歳、女性80%)を対象に、新型コロナウイルス感染症の感染拡大予防対策に伴う外出自粛時期前後での身体活動量の変化を調べた。緊急事態宣言前に比べて緊急事態宣言中では2割の者で町外への外出(生活空間レベル5)をしておらず、身体活動量と生活空間(LSA)スコアが低下傾向であったが、有意な変化ではなかった。身体活動量も有意な変化はなかった。運動教室に参加していた高齢者においては、緊急事態宣言中における生活範囲の顕著な変化および身体活動量の低下は認められなかった。

佐藤菜々, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 木山良二, 和田あゆみ, 窪園琢郎, 竹中俊宏, 大石充 . 地域在住高齢者における社会参加とサルコペニアの関連性 . 理学療法学47 ( Suppl.1 ) 25 - 25 2021.3

富岡一俊, 牧迫飛雄馬, 中井雄貴, 谷口善昭, 木山良二, 和田あゆみ, 佐藤奈々, 窪園琢朗, 竹中俊宏, 大石充 . 地域在住高齢者における身体活動量と身体・認知機能および身体組成との関連性 . 理学療法学47 ( Suppl.1 ) 12 - 12 2021.3

WADA, Ayumi, MAKIZAKO, Hyuma, NAKAI, Yuki, TOMIOKA, Kazutoshi, TANIGUCHI, Yoshiaki, SATO, Nana, KIYAMA, Ryoji, TABIRA, Takayuki, KUBOZONO, Takuro, TAKENAKA, Toshihiro, OHISHI, Mitsuru . The Association between Social Frailty and Depressive Symptoms in Community-dwelling Older Adults . Bulletin of the School of Health Sciences, Faculty of Medicine, Kagoshima University31 ( 1 ) 11 - 18 2021.3

Language：Japanese

PURPOSE: Social and psychological problems can have a negative impact on older adults’ healthy life expectancy. A better understanding of the aspects associated with social frailty and strategies for its prevention could, be useful for psychological health in older adults. The purpose of this study was to examine the association between social frailty and depressive symptoms in community-dwelling older adults. METHOD: Data from 812 community-dwelling older adults (aged ? 65 years, mean age 74.8 years, 62.6% female), who had participated in a community-based health check survey (Tarumizu Study 2018) were analyzed. Older adults who were requiring long-term care and having a history of dementia and depression were excluded. Social frailty was defined using responses to five questions (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone and not talking with someone every day). If two or more items out of the five were defined as social frailty. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS15), and a total score of 5 or more were considered as depressive symptoms. RESULTS: The prevalence of social frailty was 13.8%. Participants with social frailty showed a higher prevalence of depressive symptoms than those without (33.0% versus 12.9%, p < 0.01). Four items (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family and not talking with someone every day) were associated with a high percentage of depressive symptoms (p < 0.01). Based on the results of logistic regression analysis, social frailty was significantly associated with depressive symptoms (odds ratio 3.04, 95% confidence interval 1.88?4.92), after adjusting for sex, age, education, grip strength, walking speed and Mini-Cog total score. CONCLUSION: The results of this study suggested that social frailty was associated with depressive symptoms. Moreover, the social aspects of frailty could have a negative impact on psychological health. Further longitudinal studies will be needed to examine the causal relationship between social frailty and depression and the effect of interventions on social aspects.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03364&link_issn=&doc_id=20210415410002&doc_link_id=http%3A%2F%2Fhdl.handle.net%2F10232%2F00031668&url=http%3A%2F%2Fhdl.handle.net%2F10232%2F00031668&type=%8E%AD%8E%99%93%87%91%E5%8Aw%81F%8E%AD%8E%99%93%87%91%E5%8Aw%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80042_3.gif

牧迫飛雄馬 . 【フレイル予防・対策:基礎研究から臨床、そして地域へ】フレイルの全体像を学ぶ　フレイルとは　多面性とフレイルサイクル . Advances in Aging and Health Research2020 19 - 26 2021.3

Kaori Kaimoto, Mikako Yamashita, Taro Suzuki, Hyuma Makizako, Chihaya Koriyama, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi, Hiroaki Kanouchi, The Tarumizu Study Diet Group . Association of Protein and Magnesium Intake with Prevalence of Prefrailty and Frailty in Community-Dwelling Older Japanese Women . J Nutr Sci Vitaminol67 ( 1 ) 39 - 47 2021.2Reviewed

Kaimoto Kaori, Yamashita Mikako, Suzuki Taro, Makizako Hyuma, Koriyama Chihaya, Kubozono Takuro, Takenaka Toshihiro, Ohishi Mitsuru, Kanouchi Hiroaki, the Tarumizu Study Diet Group . Association of Protein and Magnesium Intake with Prevalence of Prefrailty and Frailty in Community-Dwelling Older Japanese Women(和訳中) . Journal of Nutritional Science and Vitaminology67 ( 1 ) 39 - 47 2021.2

Language：English Publisher：(公社)日本栄養・食糧学会

高齢者815名(女性515名、平均74.9歳)を対象に、栄養素摂取状況とプレフレイル(疲労感、動作緩慢、虚弱、活動量低下、または体重減少のいずれか一つ以上の存在)との関係について検討した。男性の52%および女性の54%がプレフレイルに該当した。男性では栄養素摂取状況とプレフレイルの間に有意な関連はみられなかった。女性の場合、健常群と比較して、プレフレイル群はビタミンKとB群(B1、B2、葉酸、パントテン酸)、リン、カリウム、カルシウム、マグネシウム、鉄、亜鉛、銅の摂取量が有意に少なかった。このうちプレフレイルに関連する有意な変数として抽出されたのはマグネシウムのみであった。マグネシウム摂取量の四分位別にみた女性のプレフレイルの調整オッズ比(95%信頼区間)は、第1分位を基準として、第2分位が0.52(0.29〜0.92,p=0.024)、第3分位が0.51(0.28〜0.95,p=0.033)、第4分位が0.38(0.19〜0.74,p=0.005)であった。以上から、高齢日本人女性において、マグネシウムはプレフレイル予防に重要な栄養素であると考えられた。

牧迫飛雄馬, 谷口善昭 . 脆弱性骨折による運動器障害とその予防-理学療法のエビデンスを踏まえて- 高齢期におけるオステオサルコペニアのリスクと対策 . 日本骨粗鬆症学会雑誌7 ( 1 ) 141 - 145 2021.2

牧迫飛雄馬 . リハビリテーション職種が知っておくべき臨床統計　基礎から最新の話題まで母集団とサンプル、パラメータの推定 . Journal of Clinical Rehabilitation30 ( 1 ) 71 - 75 2021.1

Yu Kume, Seongryu Bae, Sangyoon Lee, Hyuma Makizako, Yuriko Matsuzaki-Kihara, Ichiro Miyano, Hunkyung Kim, Hiroyuki Shimada, Hidetaka Ota . Association between Kihon check list score and geriatric depression among older adults from ORANGE registry . PLoS ONE16 ( 6 ) e0252723 2021Reviewed International journal

Language：English Publishing type：Research paper (scientific journal)

Objective Older adults in Japan are tackling health-related challenges brought by comprehensive geriatric symptoms, such as physical and cognitive problems and social-psychological issues. In this nationwide study, we mainly focused on the Kihon checklist (KCL) as certificated necessity of long-term care for Japanese older adults and investigated whether the KCL score was associated with geriatric depression. In addition, we aimed to identify critical factors that influence the relationship between the KCL score and geriatric depression. Methods This survey was a cross-sectional observational study design, performed from 2013 to 2019. A total of 8, 760 participants aged 65 years and over were recruited from five cohorts in Japan, consisting of 6, 755 persons in Chubu, 1, 328 in Kanto, 481 in Kyushu, 49 in Shikoku and 147 in Tohoku. After obtaining informed consent from each participant, assessments were conducted, and outcomes were evaluated according to the ORANGE protocol. We collected data on demographics, KCL, physical, cognitive and mental evaluations. To clarify the relationship between the KCL and geriatric depression or critical factors, a random intercept model of multi-level models was estimated using individual and provincial variables depending on five cohorts. Results The KCL score was correlated with depression status. Moreover, the results of a random intercept model showed that the KCL score and geriatric depression were associated, and its association was affected by provincial factors of slow walking speed, polypharmacy and sex difference. Conclusions These results suggest that provincial factors of low walking performance, polypharmacy and sex difference (female) might be clinically targeted to improve the KCL score in older adults.

DOI： 10.1371/journal.pone.0252723

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Michio Maruta, Hyuma Makizako, Yuriko Ikeda, Hironori Miyata, Atsushi Nakamura, Gwanghee Han, Suguru Shimokihara, Keiichiro Tokuda, Takuro Kubozono, Mitsuru Ohishi, Takayuki Tabira . Association between apathy and satisfaction with meaningful activities in older adults with mild cognitive impairment: A population‐based cross‐sectional study . International Journal of Geriatric Psychiatry36 ( 7 ) 1065 - 1074 2021Reviewed International journal

Language：English Publishing type：Research paper (scientific journal) Publisher：Wiley

OBJECTIVES: This cross-sectional study aimed to clarify the relationship between apathy, meaningful activities, and satisfaction with such activities of older adults with mild cognitive impairment (MCI). METHODS: We analyzed 235 older adults with MCI (≥65 years, mean age: 76.9 ± 6.4 years, women: 63.4%) who participated in a community-based health check survey (Tarumizu Study 2018). MCI was defined as at least 1.5 SD below the reference threshold (age- and education-adjusted score) on one or more of the computerized cognitive test including memory, attention, executive functions, and processing speed. Apathy symptoms were assessed using three of the 15 items of Geriatric Depression Scale. Participants selected meaningful activities from the 95 activities of the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. RESULTS: Apathy in MCI was prevalent by 23.8%. The categories of meaningful activities revealed no difference, with, or without apathy. Logistic regression analysis showed that activity satisfaction was significantly associated with apathy after adjusting for age, sex, education, instrumental activities of daily living, depressive symptoms, and MCI subtype (OR, 0.62; 95% CI, 0.44-0.88, p = 0.008). CONCLUSIONS: Satisfaction with the activities that are deemed meaningful is associated with apathy among community-dwelling older adults with MCI.

DOI： 10.1002/gps.5544

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PubMed

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/gps.5544

Makizako Hyuma, Akaida Shoma . Age Related Psychological Changes . Physical Therapy Japan48 ( 2 ) 242 - 247 2021

Kaori Kaimoto, Mikako Yamashita, Taro Suzuki, Hyuma Makizako, Chihaya Koriyama, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi, Hiroaki Kanouchi, The Tarumizu Study Diet Group . Association of Protein and Magnesium Intake with Prevalence of Prefrailty and Frailty in Community-Dwelling Older Japanese Women. . Journal of nutritional science and vitaminology67 ( 1 ) 39 - 47 2021

Language：English Publishing type：Research paper (scientific journal) Publisher：Center for Academic Publications Japan

We examined the association between nutrient intake and prefrailty. Data from 815 older people (63% women) who participated in a community-based health check survey (Tarumizu Study) were analyzed. Prefrailty were defined using five parameters (exhaustion, slowness, weakness, low physical activity, and weight loss). Participants with one or more components were considered to belong to the prefrailty group. Nutrition intake was estimated from a validated brief-type self-administered diet history questionnaire. Among the participants, 154 men (52%) and 278 women (54%) were found to be in a status of prefrailty. In men, there were no significant associations between nutrient intake and prefrailty. In women, carbohydrate intake was slightly higher in prefrailty group. Vitamins K, B1, B2, folic acid, pantothenic acid, phosphorus, potassium, calcium, magnesium, iron, zinc, and copper intake was significantly lower in the prefrailty group. Among the nutrients, magnesium was identified as a significant covariate of prefrailty using a stepwise regression method. In women adjusted ORs (95%CI, p value) for prefrailty in the first, second, third, and fourth quartiles of magnesium intake were 1.00 (reference), 0.52 (0.29-0.92, 0.024), 0.51 (0.28-0.95, 0.033), and 0.38 (0.19-0.74, 0.005), respectively, by multivariate logistic regression analysis (variates: age, body mass index, energy intake, supplement use, osteoporosis, magnesium, and protein intake). Protein intake did not related to prefrailty. Protein intake might be sufficient to prevent prefrailty in the present study. We propose magnesium to be an important micronutrient that prevents prefrailty in community-dwelling older Japanese women.

DOI： 10.3177/jnsv.67.39

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Yuto Kiuchi, Hyuma Makizako, Yuki Nakai, Kazutoshi Tomioka, Yoshiaki Taniguchi, Mika Kimura, Hiroaki Kanouchi, Toshihiro Takenaka, Takuro Kubozono, Mitsuru Ohishi . The Association between Dietary Variety and Physical Frailty in Community-Dwelling Older Adults. . Healthcare (Basel, Switzerland)9 ( 1 ) 2021International journal

Language：English Publishing type：Research paper (scientific journal)

The aim of this cross-sectional study was to examine the association between diet variety and physical frailty in community-dwelling older adults. Data of 577 older adults (mean age: 74.0 ± 6.3 years, women: 62.5%) were analyzed. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk & dairy products, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Physical frailty was assessed using Fried's component (slowness, weakness, exhaustion, low physical activity, and weight loss). The participants were classified into frail, pre-frail, and non-frail groups. The prevalence of physical frailty was 6.6%. This study found significant associations between physical frailty and low FFS after adjusting for covariates (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84-0.97, p < 0.01). The optimal cutoff point of the FFS for physical frailty was ≤16 points. FFS lower than the cutoff point were significantly associated with physical frailty after adjusting for covariates (OR 3.46, 95% CI 1.60-7.50, p < 0.01). Diet variety assessed using the FFS cutoff value of ≤16 points was related to the physical frailty status in community-dwelling older adults.

DOI： 10.3390/healthcare9010032

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PubMed

Hyuma Makizako, Hiroyuki Shimada, Kota Tsutsumimoto, Keitaro Makino, Sho Nakakubo, Hideaki Ishii, Takao Suzuki, Takehiko Doi . Physical Frailty and Future Costs of Long-Term Care in Older Adults: Results from the NCGG-SGS. . Gerontology67 ( 6 ) 1 - 10 2021International journal

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Frailty is associated with adverse outcomes, but few studies have determined associations between the frailty phenotype and measures of healthcare burden, including long-term care insurance (LTCI) costs, in older community-dwelling populations. OBJECTIVE: The aim of this study was to examine the association between frailty status and subsequent LTCI costs in Japanese community-dwelling older adults. METHODS: The prospective data were from a cohort study (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes [NCGG-SGS]). The participants were community-dwelling older adults (mean age 71.8 years, women 50.7%) participating in an NCGG-SGS baseline examination held between August 2011 and February 2012 in Obu, Japan (N = 4,539). At baseline, we assessed the physical frailty phenotype using the Japanese version of the CHS criteria and categorized it as robust, pre-frail, or frail. We also ascertained care-needs certification and total costs using long-term care services in Japan's public LTCI system during the 29 months. RESULTS: During the 29-month follow-up period, 239 participants (5.3%) required the LTCI system's care-needs certification and 163 participants (3.6%) used LTCI services. Participants classified as frail (odds ratio 5.85, 95% confidence interval 3.54-9.66) or pre-frail (2.40, 1.58-3.66) at the baseline assessment had an increased risk of requiring care-needs certification compared with robust participants. The mean total costs for LTCI services during the 29 months were \6,434 ($63.1) for robust, \19,324 ($189.5) for pre-frail, and \147,718 ($1,448.2) for frail participants (1 US dollar = 102 Japanese yen in July 2014). There were significantly higher costs associated with advancing frailty status. Individual frailty components (slowness, weakness, exhaustion, low activity, and weight loss) were also associated with higher total costs for using LTCI services. DISCUSSION/CONCLUSION: Frail community-dwelling older adults had a higher risk of requiring the LTCI system's care-needs certification and the subsequent total LTCI costs.

DOI： 10.1159/000514679

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Keitaro Makino, Sangyoon Lee, Seongryu Bae, Ippei Chiba, Kenji Harada, Osamu Katayama, Yohei Shinkai, Hyuma Makizako, Hiroyuki Shimada . Diabetes and Prediabetes Inhibit Reversion from Mild Cognitive Impairment to Normal Cognition. . Journal of the American Medical Directors Association22 ( 9 ) 1912 - 1918 2021International journal

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: Diabetes and prediabetes contribute to an increased risk of cognitive decline and dementia. Currently, it remains unclear whether elevated blood HbA1c levels, including prediabetes levels, affect reversion from mild cognitive impairment (MCI) to normal cognition. This study, therefore, aimed to examine the prospective associations of diabetes and prediabetes with reversion from MCI to normal cognition among community-dwelling older adults. DESIGN: Longitudinal cohort study with a 4-year follow-up. SETTING AND PARTICIPANTS: Community-dwelling older adults with MCI, aged ≥65 years at baseline (n = 787). METHODS: Participants' medical history of diabetes and blood HbA1c levels at baseline were assessed, and they were classified as control, prediabetes, and diabetes. Objective cognitive screening was performed using a multicomponent neurocognitive test at baseline and follow-up. Reversion from MCI to normal cognition over 4 years was determined. In the longitudinal analysis, we performed multiple imputations to adjust for a selection bias and loss of information. RESULTS: The reversion rates of MCI in the control, prediabetes, and diabetes groups were 63.4%, 55.6%, and 42.9%, respectively, in the completed follow-up dataset, and 54.6%, 47.2%, and 34.1%, respectively, in the imputed dataset. Multivariate logistic regression showed that diabetes decreases the probability of MCI reversion both before and after multiple imputations [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.18-0.74 for before imputation, OR 0.37; 95% CI 0.19-0.72 for after imputation]. Furthermore, prediabetes also showed significantly decreased probabilities of MCI reversion both before and after multiple imputations (OR 0.57; 95% CI 0.34-0.94 for before imputation, OR 0.60; 95% CI 0.37-0.97 for after imputation). CONCLUSIONS AND IMPLICATIONS: Diabetes and prediabetes could inhibit MCI reversion. Adequate glycemic control may be effective in enhancing the reversion from MCI to normal cognition in a community setting.

DOI： 10.1016/j.jamda.2021.02.033

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NAKAI Yuki, TOMIOKA Kazutoshi, TANIGUCHI Yoshiaki, TAKENAKA Toshihiro, MAKIZAKO Hyuma . Changes in Physical Activity Levels between before and during the COVID-19 Outbreak of Older Community-dwelling Adults: A Survey of Older Adults Who Participated in Exercise Programs . Rigakuryoho Kagaku36 ( 1 ) 35 - 40 2021

Language：Japanese Publisher：The Society of Physical Therapy Science

[Purpose] This study examined the changes in physical activity (PA) levels before and during the COVID-19 outbreak of older Japanese community-dwelling adults participating in exercise programs. [Participants and Methods] This observational study recruited 15 older adults. Participants were required to continuously wear an accelerometer on an elastic band on their hips for a week. Average daily duration of light, moderate, and total PA (min/day), as well as daily steps were calculated. Life-space assessment (LSA) scores were also assessed using a questionnaire. [Results] Although all participants reached 5 levels (from home to out of town) before the COVID-19 state of emergency declaration, 20% of them did not reach 5 levels during the state of emergency. Thus, there were no significant changes in any of the physical activity parameters and LSA before and during the declaration of emergency. [Conclusion] This study concludes that there was no significant decrease in physical activity levels among older community-dwelling adults participating in exercise programs before the COVID-19 outbreak in April 2020.

DOI： 10.1589/rika.36.35

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J-GLOBAL

H. Makizako, Y. Nishita, S. Jeong, R. Otsuka, H. Shimada, K. Iijima, S. Obuchi, H. Kim, A. Kitamura, Y. Ohara, S. Awata, N. Yoshimura, M. Yamada, K. Toba, T. Suzuki . TRENDS IN THE PREVALENCE OF FRAILTY IN JAPAN: A META-ANALYSIS FROM THE ILSA-J . The Journal of frailty & aging10 ( 3 ) 211 - 218 2021

Language：Japanese Publishing type：Research paper (scientific journal)

OBJECTIVE: To examine whether age-specific prevalence of frailty in Japan changed between 2012 and 2017. DESIGN: This study performed meta-analyses of data collected from 2012 to 2017 using the Integrated Longitudinal Studies on Aging in Japan (ILSA-J), a collection of representative Japanese cohort studies. SETTING: The ILSA-J studies were conducted on community-living older adults. PARTICIPANTS: ILSA-J studies were considered eligible for analysis if they assessed physical frailty status and presence of frailty in the sample. Seven studies were analyzed for 2012 (±1 year; n = 10312) and eight studies were analyzed for 2017 (±1 year; n = 7010). Five studies were analyzed for both 2012 and 2017. MEASUREMENTS: The study assessed the prevalence of frailty and frailty status according to 5 criteria: slowness, weakness, low activity, exhaustion, and weight loss. RESULTS: The overall prevalence of physical frailty was 7.0% in 2012 and 5.3% in 2017. The prevalence of frailty, especially in people 70 years and older, tended to decrease in 2017 compared to 2012. Slight decreases were found in the prevalence of frailty subitems including weight loss, slowness, exhaustion, and low activity between 2012 and 2017, but change in the prevalence of weakness was weaker than other components. CONCLUSIONS: The prevalence of physical frailty decreased from 2012 to 2017. There are age- and gender-related variations in the decrease of each component of frailty.

DOI： 10.14283/jfa.2020.68

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PubMed

牧迫飛雄馬 . 日常生活での運動を再考する:─運動量さえ増えればいいのか？─ . 理学療法学Supplement48 ( 0 ) C - 61-C-61 2021

Language：Japanese Publisher：公益社団法人日本理学療法士協会

日常生活において，運動によって身体活動を促進することは，全世代を通して心身に効果的であることはおそらく疑いの余地はないであろう。身体活動の減少は，喫煙，高血圧に次いで日本人の死亡に及ぼす危険因子とされており，さまざまな疾患の発症リスクを増大させる（Ikeda N, et al. 2011）。とくに，高齢期の日常生活における身体活動（physical activity）を促進することは，健康寿命の延伸を目指すうえでの重要な課題のひとつと考える。　習慣的な運動や積極的な身体活動は，認知症の発症リスクを低減させることにも寄与するとされている。週3回以上の運動習慣（15分以上の運動：ウォーキング，ハイキング，サイクリング，スイミング，水中運動，有酸素運動や柔軟体操，筋力トレーニングやストレッチングなど）を有する者では，週3回未満の者に比べて認知症を発症する危険が約38％低かったことが報告されている（Larson EB, et al. 2006）。さらに，運動習慣が認知症の発症に及ぼす影響は，軽度から中等度の運動機能の低下を認めた高齢者ほど顕著であった。つまり，やや運動機能の低下が生じ始めた時期に，より意識的に身体活動を維持・向上しておくことの重要性を示している。また，日常的な運動習慣は，加齢による脳萎縮の抑制に対しても効果的であることが期待されている（Cabral DF, et al. 2019）。　しかしながら，身体的活動を増加させるほどに望ましいかについては慎重になるべきである。高齢女性16,741名を対象に1日の歩数と死亡発生との関連を縦断的に調べた報告によると，約7,500歩に達するまでは1日歩数の増加は死亡リスク低減と関連したが，1日10,000歩に達することの付加的な利得は認められなかった（Lee IM, et al. 2019）。　一般的に健康的な心身機能を維持するためには週150分（1日30分，週5日間）程度の中強度程度（やや速歩き相当）の運動の実施が推奨されている（Nelson ME, 2007）。しかし，高齢者にとっては中強度以上の負荷を伴う運動はさまざまな障壁やリスクを抱えることも少なくない。低強度から中強度の運動による身体活動（週3回程度）であっても，将来の認知障害の発生が有意に低くなることが報告されており（Sofi F, et al. 2011），たとえ低強度から中強度程度の負荷の運動であっても習慣化することが高齢期の認知機能低下の予防に有効であるかもしれない。さらに，アルツハイマー病を発症する9～10年程度前から身体活動量が低下し始めるとされている（Sabia S, et al. 2017）。そのため，一時的に運動習慣を習得して身体活動量を高めるだけではなく，高めた身体活動量を維持する生活スタイルをいかにして確立するかがさらに重要である。　日常におけるさまざまな活動には，身体的活動（physical activity）の他，知的活動（cognitive activity），社会的活動（social activity）などがあり，これらが高齢期における健康関連指標へ影響を及ぼすことが示唆されている。日常でこれらの活動をいかに多面的に促進していくかが健康長寿の鍵になると考えられ，理学療法には対象者の活動の多様性と継続性を支援することも重要な対策のひとつと考えられる。

DOI： 10.14900/cjpt.48S1.C-61

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牧迫飛雄馬, 大石充, 中井雄貴, 桑波田聡, 富岡一俊, 谷口善昭, 佐藤菜々, 和田あゆみ, 竹中俊宏, 窪薗琢郎 . 地域在住高齢者の睡眠と主観的健康感 . 理学療法学Supplement48 ( 0 ) E - 71_1-E-71_1 2021

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