The effect of Ground Golf
on health
The Japan Ground Golf Association conducted health surveys in order to clarify physical characteristics and mobility functions of Ground Golf players; as well as, the general elderly in FY2015. In this paper, we report the summary of the study results.

1 PurposeIn this survey, we aimed to clarify the significance and the roles which Ground Golf
plays in society, especially from the aspect of health, by conducting academic research on the effect and the influence of Ground Golf on the health of players. In thismanner, we aimed to contribute toward further promotion of Ground Golf in the future.

Health survey

promotion of GG・health promotion

2 Participants（Subjects）
Ground Golf players who
participated in the grade
1 and 2 leaders training
session in FY2015 participated in this study. As acontrol group that does
not play Ground Golf,
the elderly people of thesame age as Ground Golf
players also participatedin the survey. The tableon the right shows descriptive characteristicsof the participants.

Ground Golf（GG）players 266（male : 175 ; female : 91）
Control group 259（male : 122 ; female : 137）
Sum 525（male : 297 ; female : 228）
GG players

Control

Age（yrs）
Height（cm）
Weight（kg）
Male
BMI（kg/m 2）
Diastolic pressure（mmHg）
Systolic blood pressure（mmHg）

73.5 ± 0.4
163.2 ± 0.5
63.6 ± 0.6
23.7 ± 0.2
147.7 ± 1.7
82.7 ± 1.1

72.5 ± 0.5
163.8 ± 0.6
64.1 ± 0.8
23.7 ± 0.2
147.9 ± 1.9
82.8 ± 1.2

Age（yrs）
Hight（cm）
Weight（kg）
FemaleBMI（kg/m 2）
Diastolic pressure（mmHg）
Systolic blood pressure（mmHg）

72.9 ± 0.5
150.7 ± 0.5
52.5 ± 0.8
23.0 ± 0.3
144.2 ± 2.2
79.1 ± 1.2

73.2 ± 0.5
151.5 ± 0.5
52.4 ± 0.6
22.7 ± 0.2
139.5 ± 1.8
78.7 ± 1.0
Average ± SD

http://www.groundgolf.or.jp

3 Survey contents
1）Physicalcharacteristics

Height, Weight, Blood pressure,Body fat, Muscle mass, Bone density, Vital capacity, and Grip strength

The state of the measurement by sports doctors
and researchers.

2）The locomotive The test included: ‘the stand-up test’, ‘the two-step test’, andsyndrome risk test ‘25-question risk assessment’. We especially evaluated mobility

functions, such as: standing up and walking. (Please see the figures below)3）Lifestyle

Smoking/frequency (number of cigarettes/cigars/tobacco), Alcohol
consumption, Physical activity, Types of physical activity, Ground
Golf history, Anxiety on psychological & physical conditions

The locomotive syndrome risk test

1 How to conduct the stand-up test
1 Prepare four seats of diﬀerent heights ̶ 40

2 If you can stand up from a height of 40 cm

40 cm seat, arms folded. Spread your legs to

Resume the posture of Step 1 , and raise

the width of your shoulders, with your shins ateither your right or left leg, bending thean angle of 70 degrees to the ﬂoor. (in the casek n e e slig htly. S t a n d u p with o u t le a nin g

cm, 30 cm, 20 cm, and 10 cm. First sit on theon both legs, nex t tr y it on one leg.

of t h e 4 0 c m s e a t ).T h e n s t a n d u p, wit h o u tback to gain momentum, and maintainleaning back to gain momentum, and maintainposture for three seconds.

2

The two-step test
■ Formula for calculating your two-step score

Length of both strides in cm ÷ your height in cm = your two-step score
Take the longest strides you canposture for three seconds.

On both legs

On one leg

70˚

2

You may bend your knee slightly

able to stand up on one leg…

unable to stand up on one leg…

2

If you can stand up on both your right and left
passed . Next try the same thing

failed . Now try

from lower heights at 10 cm decrements.

standing up on both legs from lower heights at
10 cm decrements.

Please answer the following 25 questions to help determine your risk of locomotive syndrome

Did you have any pain (including numbness)in your neck or upper limbs(shoulders, arms, or hand)?

No
pain

Mild
pain

Moderate
pain

Considerable
pain

Severepain

Q2

Did you have any pain in your back, lower back or buttocks?

No
pain

Mild
pain

Moderate
pain

Considerable
pain

Severepain

Q3

Did you have any pain (including numbness)in your lower limbs (hip, thigh, knee, calf, shin, ankle, or foot)?

No
pain

Mild
pain

Moderate
pain

Considerable
pain

Severepain

Q4

To what extent has it been painful to move your body in daily life?

No
pain

Mild
pain

Moderate
pain

Considerable
pain

Severepain

Q21

To what extent has it been diﬃcult to perform sports activity(jogging, swimming, gate ball, dancing, etc.)?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q22

Have you been restricted from meeting your friends?

Not
restricted

Slightly
restricted

Restricted
about half
the time

Considerably
restricted

Gave up all
activities

Q23

Have you been restricted from joining social activities(meeting friends, playing sport, engaging in activities and hobbies, etc.)?

Not
restricted

Slightly
restricted

Restricted
about half
the time

Considerably
restricted

Gave up all
activities

Q24

Have you ever felt anxious about falls in your house?

Have notfelt anxious

Haveoccasionallyfelt anxious

Havesometimes
felt anxious

Have often Have constantly
felt anxious felt anxious

Q25

Have you ever felt anxious about being unable to walk in the future?

Have notfelt anxious

Haveoccasionallyfelt anxious

Havesometimes
felt anxious

Have often Have constantly
felt anxious felt anxious

0 points＝

1 point＝

2 point＝■Following are questions about your usual daily life for the last one month:

3 point＝

Enter the number of answers
Add up the number of points

Q5

To what extent has it been diﬃcult to get up from a bed or lie down?

Not
diﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q6

To what extent has it been diﬃcult to stand up from a chair?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q7

To what extent has it been diﬃcult to walk inside the house?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q8

To what extent has it been diﬃcult to put on and take oﬀ shirts?

Not
diﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q9

To what extent has it been diﬃcult to put on and takeoﬀ trousers and pants?

Not
diﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q10

To what extent has it been diﬃcult to use the toilet?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q11

To what extent has it been diﬃcult to wash your body in the bath?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q12

To what extent has it been diﬃcult to go up and down stairs?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q13

To what extent has it been diﬃcult to walk briskly?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q14

To what extent has it been diﬃcult to keep yourself neat?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q15

How far can you keep walking without rest?
(please select the closest answer)

Mor than2-3 km

Q16

To what extent has it been diﬃcult to go out to visit neighbors?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q17

To what extent has it been diﬃcult to carry objects weighing approximately
2 kilograms (2 standard milk bottles or 2 PET bottles each containing 1 liter)?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q18

To what extent has it been diﬃcult to go out using public transportation?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q19

To what extent have simple tasks and housework(preparing meals, cleaning up, etc.) been diﬃcult?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

Q20

To what extent have load-bearing tasks and housework(cleaning the yard, carrying heavy bedding, etc.) been diﬃcult?

Notdiﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

approximately approximately approximately approximately
1 km
300 m
100 m
10 m

Long stride

What is locomotive syndrome?

s!
ses
A s r s e lf
yo u

25 - question risk assessment
Over the past month, have you experienced any pain or had diﬃculties with activities of daily living?

■Following are questions about your body pain for the last one month:
Q1

Long stride

FinishStart
Maximum length of double stride (distance covered in two steps)

Assess your locomotive functions!

Try the locomotive syndrome risk test

3

Secondstep

HeightStand up without
leaning back

10cm 20cm 30cm 40cm

3

First
step

Hold posturefor 3 seconds

Stand up without
leaning back
※NOTE: If you feelpain when standing
up on both legs,
consult with a
medical professional.

Total

4 point＝

points25-question risk assessment ©2009 Department of Orthopedic Surgery, Jichi Medical University. All rights reserved.
May be duplicated but not altered. For academic and public use only; unauthorized use for other purposes is prohibited.

If you already have pain or discomfort,
consult with your local orthopedist.
For professional advice on locomotive syndrome, ask your nearest

Locomotive Syndrome Advisor.
If you already suﬀer from pain or discomfort in your back or legs,
local orthopedist. Locomotive syndrome advisors are orthopedic
specialists able to oﬀer professional advice on
the condition. Find your nearest locomotive
syndrome advisor on the Locomotive
Challenge! website.

Visit www.locomo-joa.jp!

Locomotive Challenge

SearchDetermine you r risk of
locomotive synd rome

Reference: Japan Locomo Challenge Promotion Conference
https://locomo-joa.jp/en/index.pdf

Locomotive syndrome means being restricted in
one’s ability to walk or lead a normal life owing toa dysfunction in one or more parts of the musculoskeletal system (muscle, bones, joints, cartilage,or the intervertebral discs). The risk of requiring
nursing will increase as the conditions progress.
In the locomotive syndrome risk test, we evaluatedmobility functions through ‘the stand-up test’, ‘thetwo-step test’, and ‘25-question risk assessment’.

4 Results● Ground Golf players had a 40%, or more, lower risk as determined risk level 1
and 2 compared to the general elderly.

Locomotive syndrome risk level 1
Risk Level as determined by the
locomotive syndromeresults1

Locomotive functions (muscles, bones,

1

joints, nerves, etc.) to support and

0.8
0.6
0.4
0.2
0

move the body are beginning to decline.
1

Locomotive syndrome risk level 2

1
0.46

0.36

Risk level 1

0.37

0.56

Risk level 2

Decline of locomotive functions (muscle,bone, joint, nerve, etc.) to support andmove the body is already advanced.

Reference: All of locomotive syndrome ，Kozo Nakamura
・Sakae Tanaka ，Japan Medical Association● Ground Golf players had larger stride compared to the general elderly.
The two-step test value

1.5

1.4

1.46

1.3

1.43

1.31
1.2

■ General elderly
GG players■Play time (less than 2 hours/play)■Play time (more than 2 hours/play)

Decrease in stride leads tospeed,

lower walking

slower mobility function, andin-creased risk of falling. Maintaining stride inolder age is important for prevention of falls!

● Ground Golf players feel less anxiety in regards to psychological & physicalconditions compared to the general elderly.

Not at all : 0 point
Sometime : 1point
Often: 2 points
Always: 3 points
We calculated total scores below.

5.0
4.0
Total Score

Participants answered 13 questions
about psychological & physical conditions. The higher the total score is, themore you feel uneasy about your psychological and physical condition.

3.0
2.0

4.5

3.5

1.0
0.0

general elderly

GG players

5 Summary
From this health survey, it clarified that the Ground Golf players havethe following characteristics compared with the general elderly.

Lower risk of being determined as locomotive syndrome risk
level 1 & 2 which indicate a decrease in mobility function.
We found that the proportion of people determined as locomotive syndrome risk level 1 or 2, representing the state in which the mobility function is beginning to decline or is already advanced, issmall. Therefore, it is considered that the mobility function is maintained by playing Ground Golf.

"Stride" necessary for fall prevention is maintained.
Stride is related to muscle strength of lower limbs and falling history. In order to take a big step, the muscular strength that supports the body with one foot and one’s balance function are necessary. Playing
Ground Golf seems to increase the number of steps per day and the amount of physical activity and maintain the strength of the lower limbs. As a result, it preserves the mobility function to stand up and walk.

Less anxiety on psychological and physical conditions.
Enjoying Ground Golf as a group has positive effects on psychological and physical conditions
by increasing opportunities to contact with people and securing time for physical activity.

This survey revealed that enjoying Ground Golf throughout one’s lifetime has apossibility to prevent locomotive syndrome and falls. Based on these results, playing Ground Golf on a daily basis may be able to train locomotive functions andmaintain mental health, leading to one’s "extension of healthy lifespan."In the future, it is expected that Ground Golf, with 3.6 million players in Japan, will further spread all over the country, supporting healthy longevity society through sports.

Investigators and analyzers of this study
Dr. Masumi Mimura
Vice President & Sport Doctor of Japan Ground Golf Association		Director of Higashi Kawashima Clinic
Dr. Hiroyuki Sato
Sport Doctor of Japan Ground Golf Association 					Professor of Mejiro University Faculty of Health Sciences
Dr. Masashi Miyashita Associate Professor of Waseda University Faculty of Sport Sciences
Kyoko Kashiwabara
Graduate student of Waseda University Faculty of Sport Sciences