J Rehabil Health Sci 2018; 15: 41-46© 2018 Osaka Prefecture University

Journal of Rehabilitation and Health Sciences
Online ISSN 2185-8004

Short Communication

Evaluation of Long-term Preventive Care Activities for the Elderly -10year
tracking survey of fitness testsNobuko OHSAKA1, 2, Miyoko MICHIKAWA2, Saki YAMAMOTO1 and Kazuo HIGAKI3
1

Research Institute of Rehabilitation Science, Osaka Prefecture University, Habikino3-7-3,Habikino,Osaka,538-8555,Japan

2

Daito City Department of Public Health and Medical Care, Senior Citizen’s Long-Term Care Office,Tanigawa1-1-1,Daito,Osaka,574-8555,Japan3Department of Community Health, Osaka Prefecture University,Habikino3-7-3,Habikino,Osaka,538-8555,Japan

Received 19 June 2017; accepted 25 January 2017
Key words: Community-Centered Preventive Care, Physical Strengths Improvement, Reduction of Medical Cost

1 Introduction

sense of value of elderly citizens who live in local communities.

The prevention of long-term geriatric nursing care is anDaito City, the municipality in which this study wasurgent task for Japan, a country which is about to become aconducted, had a population of 123,321 as of March 2016 withsuper-aged society.

a population aging rate of 25.4%. Of its 31,351 elderly citizens

The number of people certified as being in need of long-aged 65 years old or over, 5,706 (18.2%) had been certified

term care (or support) was 2.18 million in 2000 when theat that time as being in need of long-term care (or support)

government of Japan began enforcement of the Long-Termunder the nation’s Long-term Care Insurance System. With its

Care Insurance Act, and that number had nearly tripled by 2015,

western border being adjacent to Osaka City and its easternreaching 6.3 million1. Under these circumstances, preventive

end neighboring Ikoma City, which is part of Nara Prefecture,care services managed by local municipalities should bear theDaito City serves as a bedroom community for Osaka and Nara

responsibility for curbing the increasing trend in the number ofprefectures.

elderly citizens who are certified as being in need of long-termcare (or support)2-4.

In 2005, setting a precedent for the preventive caremovement throughout the country, Daito City in Osaka

These community-supportive preventive care services,

Prefecture initiated efforts to spread the use of its originallyintroduced after a revision was made to the Long-Term Caredeveloped health-promoting physical exercise program named

Insurance Act in fiscal 2006, changed forms to become general“Daito Genki-demasse Taiso” (literally meaning exercise

preventive care services in fiscal 2015 following a series of legal

designed to make you feel energized; hereinafter called “Daitoamendments requiring care preventive services to be provided

Energizing Exercise”), and as of December 2016, a total ofin a combined manner without separating out fragile elderly

approximately 1,700 elderly citizens from 97 regional groupspeople, who are subject to secondary prevention, from healthyacross the city had participated in the program almost once a5elderly people, who are subject to primary prevention .

week on a continuing basis. The exercise program, in which

Regarding general preventive care services, local

community residents are supposed to play a leading role, hasgovernments are required to set up places throughout eachbeen conducted under a supportive framework in which healthy

municipality where both healthy and fragile elderly citizens canelderly citizens are expected to help their fragile peers. Elderly

get together and continue to take part in preventive care activities

citizens having widely different physical conditions have been

managed by community initiative. In order to develop andjoining the exercise scheme, including those subject to primary

expand general preventive care services even further, however,or secondary prevention, senior citizens certified as being in

we need to introduce new viewpoints that have been mostly

need of support, and fragile elderly residents who are in need ofoverlooked to date, such as the specific behavioral patterns andintensive nursing care and classified as level 5, the highest levelof requirement for long-term care under the nation’s Long-term†Corresponding author, E-mail: ohsaka@city.daito.lg.jp

Care Insurance System.

42

These community-wide preventive care services have not

Table 1 Average ages of the participants at baseline depending

only helped participants to improve their physical strength but

on continuous years of exercise participation and ahave also led to the expansion of social interactions among thebreakdown for men and women

elderly, bringing about beneficial effects on the promotion ofboth mental and physical fitness and preventing situations in

6 years of participation

which elderly citizens isolate themselves from society.
The objectives of the present study were to follow the timecourse of the changes in the physical strength and medical costs

7 years of participationof the initial participants who joined the program when it was
first introduced in Daito City in fiscal 2005 and to clarify what
effects the long-term preventive care activities could have had

8 years of participationon the elderly citizens.
9 years of participation

MenWomen

Number1724

Overall40

Mean age

75.4

75.6

75.5
65-84

Renge

70-82

65-84

Number132532

Mean age

77.5

76.0

76.8

Renge

72-84

65-86

65-86

Number

71921

Mean age

77.6

79.1

78.4

Renge

73-85

67-88

67-87

Number49132 Methods

Mean age

79.3

78.9

79.1

2.1 Changes in physical strength caused by long-term preventive

Renge

74-85

74-89

74-89

care activities among elderly citizens

10 years of participation

Subjects: Of 132 elderly citizens who joined the Daito
Energizing Exercise Program in fiscal 2005, 41 people were

Number

4610Mean age

80.5

78.5

79.5

Renge

81-87

75-82

75-87

selected who had taken part in physical strength and fitness tests,
which were conducted by the municipal government for program
participants, on a continuous basis since fiscal 2005 (the shortest

some of whom were selected as the subjects of this study,

period of participation was 6 years; the longest was 10 years).

provided written consent every year to Daito City, accepting

Table 1 shows the average ages of the participants at the timeself-responsibility for participation in the exercise program andof initiation of the exercise program and a breakdown of theallowing the municipal government to use individual data that

numbers of men and women.

were expected to contribute to preventive care services. The

Evaluation contents: The following two tests were selected:
one-leg standing with eyes open and the Timed Up and Go (calledauthors used individual data in a careful manner so that theywould not identify any particular individual.

hereinafter the TUG).
Analytical methods: We performed the t-test and multiple
comparisons according to continuous years of exercise
participation.

4 Results
4.1 Changes in physical strength
In the TUG, the analytical results of the t-test revealed a

2.2 Effects of long-term preventive care activities among elderly

significant difference at around six years after the start of thecitizens on medical costs

program among those who continued to exercise for six years

Subjects: The subjects were 54 elderly citizens who started(6-year participants), at around seven years among 7-year

to exercise in fiscal 2005 (mean age:70.7 years; range:66-80participants, and at around six and seven years among 8-yearyears). At the time of this report, four of these citizens continue

participants. In the one-leg standing with eyes open test, noto join the program.

significant difference was found among those who continued

Evaluation contents: For each subject, we randomly

to join the program for six years or longer, whereas a tendency

selected 10 citizens of the same age and gender living in thefor improvement was observed among those who continued

same area as the subject and selected from them the one, whothe activities for 6-8 years. The 9-year participants and 10-acted as the control, with medical costs for fiscal 2004, the year

year participants were found to have been able to maintain their

before initiation of the exercise program, that were the closest

baseline levels. In addition, the analytical results of multiple

to those of the subject. We then made comparisons between thecomparisons demonstrated a significant difference only inchanges in annual medical costs of the subject and the control

the TUG tests at around five and seven years after the start offor five years starting from fiscal 2004.

the activities among 7-year and 8-year participants, while no

Analytical methods: We performed multiple comparisons of
the changes in the total annual medical costs of the 54 subjects
and 54 controls.

significant difference was found in the one-leg standing witheyes open tests (Fig. 1).
Regarding the changes in physical strength among dropouts
who quit participating in the exercise program in the middle of

3 Ethical considerations
The participants in the Daito Energizing Exercise Program,the study, no significant differences were confirmed in physicalstrength during the six-year period among those who continued

43

to exercise for six years and quit doing so in the seventhcontrols. The figures rose year after year both for the subjects

year. Similarly, no significant differences were observed inand the controls, with the total medical costs of the controls

physical strength throughout the exercise period among thosesurpassing those of the subjects in every fiscal year. Whereas

who dropped out in the eighth and tenth years, respectively.

the difference in total medical costs between the subjects andRegarding the changes in physical strength during the eight-

the controls was 299,911 yen in 2004, the gap widened in theyear period among those who dropped out in the ninth year, nosubsequent five years to reach 4,909,779 yen in 2009, showing

significant differences were found in the one-leg standing withthat the gap in total medical costs between these two groups

eyes open tests, but significant differences were demonstrated in

expanded over time, with the difference per person being 92,647

the TUG tests (Fig. 2).

yen on average.

4.2 Changes in medical costs
In 2004, annual medical costs totaled 13,186,114 yen forthe subjects and 13,486,025 yen for the controls. In 2009, they
were 18,748,431 yen for the subjects and 23,658,210 yen for theOn an individual basis, the widest gap in medical costs
between the lowest-spending subject and highest-spending
control was 4,336,960 yen in 2009.
In addition, the analytical results of multiple comparisonsdemonstrated no significant differences in the changes in total

Fig.2

Changes in physical strength of dropouts (seniorcitizens who quit exercising after 8 years ofparticipation)

annual medical costs among the subjects between any fiscalyears, while significant differences in total medical costs werefound in the controls among fiscal 2004, 2008, and 2009 (Fig. 3).
5 Discussion
A preceding study suggested that regular physicalactivities and exercise in advanced stages of life could leadto improvement in both mental and physical functions and anindependent lifestyle, a decrease in morbidity and mortality,and prevention of dementia and depression 6. The results ofour present study revealed that a community-wide approachto preventive nursing care in Daito City based on long-term
participation by senior citizens in regular exercise activities
resulted in improvement in their physical strength for anextended period of time. Shigematsu et al.7 reported that it waseasier for the elderly to continue exercising if they did so withpeers. Similarly, our results suggested that the Daito Energizing
Fig.1

Changes in physical strength among senior

Exercise Program devised by the Daito municipal government

citizens who continued to exercise for 6-8 years

played a role in encouraging continuous participation in that

44senior citizens joined the exercise program together with otherof elderly citizens into type 1, in which individuals isolate

residents at a familiar community center or public hall in athemselves from the social community because their levelnearby area and performed exercise regularly every week at theof mobility is low, and type 2, in which individuals isolate

same place together with other community members whom they

themselves from the social community despite the fact that

may have exchanged greetings with on the street previously

their level of mobility is relatively high. Meanwhile, Murayamabut were otherwise unknown. Participation in the program

et al. 11 reported that relative factors commonly observed inprovided them with time together to exchange and share various

both homeboundness types were regular exercise habits andkinds of information and to deepen ties and build up a sense ofparticipation in community activities.

fellowship.

Based on these reports and other findings, it is assumed

In order to prevent elderly citizens from isolatingthat the Daito Energizing Exercise Program has been playing

themselves from society, it is important to encourage them toa role in the prevention of isolation (homeboundness) because

become part of the community before they adopt an isolated

it ensures regular exercise habits and participation in regional

lifestyle so that they can maintain a role in society and engage inactivities among elderly participants before they adopt anintellectual activities. Shinkai8 reported that social engagement

isolated lifestyle.

is a generic term that indicates a wide variety of types and forms

According to our research survey on medical costs, it wasof participation in group activities, such as work, hobbies, takingfound that although medical costs rose in both the exercise andlessons, lifelong learning, and volunteer activities, which, along

non-exercise groups over the course of the fiscal years covered

with living behaviors, have the greatest impact on the energy

by the study, the difference between these groups widened. The

consumption of elderly people. When elderly people engage

gap in medical costs between the exercise and non-exercise

in any kind of “participation” or “activities,” their energy

groups reached an average of 90,000 yen or more on an annual

consumption would naturally increase. A populational approachbasis.

to preventive nursing care suggests that we should assist theThe present study revealed that the preventive care services

promotion of social participation and the activation of daily

introduced by Daito City have been exerting a beneficial effectliving behaviors of elderly people with the goal of attaining

on the physical strength and medical costs of the elderly citizens

active aging or productive aging.

who took part in the exercise program for an extended period ofThis belief is in accordance with the Internationaltime.

Classification of Functioning, Disability and Health (ICF)

Nakano et al.12 reported that since social participation andmodel proposed by the WHO in 20019. The ICF recognizes that

continuance of physical exercise are interrelated, it is necessary

three domains—body functions and structure, activities, andto set up places in regional communities where senior residents

participation—are interrelated with each other.

can get together and to extend support to encourage their social

Shinkai et al. 10 proposed classifying “homeboundness”

engagement with the aim of developing a community whereFig.3 Comparisons of annual medical costs between the exercise group and non-exercise group (n=108)

45community. Japanese Journal of Geriatrics, 44:238-246.

senior citizens can take part in social activities easily. In addition,
regarding the frequency of interactions among the elderly,

4

Misuzu Watanabe, Takemasa Watanabe, Takamaro

Nakamura et al.13 indicated that the more socially interactive

Matsuura et al. (2005) Incidence of disability indays an elderly person has per week, the more frequently he/housebound elderly people living in a rural community.

she goes out during the week, suggesting that it is important toJapanese Journal of Geriatrics, 42:99-105.

adopt an approach to help senior citizens maintain a certain level5

Ministry of Health, Labour and Welfare, Guidelinesof activeness according to their degree of independence andfor comprehensive care prevention and daily life

to provide opportunities for increased social interactions withsupport businesses. http://www.mhlw.go.jp/file/06-

others. They also mentioned that by creating an environment

Seisakujouhou-12300000-Roukenkyoku/0000088520.pdf

where senior citizens can interact with people and society in an(cited on August 4, 2015).

active manner before they separate themselves from the outside

6

Keiko Nakamura and Kiyomi Yamada (2009) Factors

world and providing sites and opportunities for interactions

which Determine How often Frail Elderly People Go(though they may be passive), we could increase interactive

Outdoors. Journal of Japan Society of Nursing Research,occasions and prevent the elderly from being in need of long-

32:29-38.

term care even if they adopt an isolated lifestyle.

7Ryosuke Shigematsu, Rei Nakanishi et al. (2011) Reasons

Based on these findings, an effective means of enhancing

for older adults independently continuing exercise after

preventive care would be to set up accessible places throughout

a supervised Square-Stepping Exercise intervention.

the community where fragile elderly citizens living in theJapanese Journal of Public Health, 58:22-29.

vicinity who are subject to secondary prevention can get together

8

Shoji Shinkai (2009) Sports, physical activities andeasily with a light heart and to create opportunities for them topublic health (18) “Significance of physical activities

interact with other residents in the neighborhood.

and exercise for older adults from the perspectives ofIn sum, maintenance and improvement of physical strength

gerontology.” Japanese Journal of Public Health, 56:682-of senior citizens, promotion of their social interactions withothers, and enhancement of a healthy lifestyle among them could

687.
9be significant factors for the elderly to continue to live a vibrantT h e Wo r l d H e a l t h O rg a n i z a t i o n . I n t e r n a t i o n a lClassification of Functioning, Disability and Health,life.

WHO.2001.
As a limitation of this study, the analytical power of the10

Shoji Shinkai, Koji Fujita, Yoshinori Fujiwara et al.

statistics was limited due to the small number of subjects, as(2005) Prognosis of Different Types of Homeboundness

we only included senior citizens who continued to exercise forAmong Community-Living Older Adults: Two-Yearsix consecutive years starting in fiscal 2006. In a future study,

Prospective Study. Japanese Journal of Public Health,

it would be possible to analyze the changes in physical strength

52:627-638.

of a larger number of elderly who participate in exercise on a

11Hiroshi Murakami, Yu Shibui et al. (2011) Homeboundcontinuous basis by including those who, as determined at thatstatus and life space among Japanese community-time, have continued to join the program for a longer duration in

dwelling elderly in an urban area．Japanese Journal ofyears than the present subjects.
We plan to conduct a further investigation to clarify factors

Public Health，58:851-866.
12Satoko Nakano, Junko Okuno et al. (2015) Factors

related to the continuance of physical exercise and how changes

Associated with Maintenance of Physical Activity amongin physical strength would have an impact on the daily lives andOlder Adults Who Participated in the Class in a Care

activities of elderly citizens.

Prevention Program. Physical Therapy Research, 42:511518.

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Keiko Nakamura, Kiyomi Yamada (2011) Factors

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