Locomotive Syndrome Pamphlet 2015
Packed with info on preventing locomotive syndrome!

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The Locomotive Challenge! website

locomotive syndrome?
Visit the Locomotive Challenge website!
■ Locomotive Syndrome Advisors
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.

■ Locomotive syndrome Q&A
Anything you want to know about locomotive
syndrome? A Locomotive Syndrome Advisor willanswer all your questions.

Visit www.locomo-joa.jp!

Locomotive Challenge

Locomotive
Syndrome

SearchAbout the Locomotive Challenge!
Beating locomotive syndrome is one of the challenges facing Japan today.
The Japanese Orthopaedic Association believes that locomotive syndrome is a challenge thatneeds to be tackled by the whole of society, with healthcare providers, the private sector, andgovernment all joining forces. So we ve launched the Locomotive Challenge! Council toeducate the public about locomotive syndrome and build a society resilient to it.

The inspiration behind the Locomotive Challenge!
Japan has the oldest population in the world, and we consider educating the public about
locomotive syndrome prevention to be one of the big challenges facing Japanese society
today. So we ve made our slogan the Locomotive Challenge! .

The Locomotive Challenge!

Name of organization: The Locomotive Challenge! Council
Founded:August 2010

Address:

Japanese Orthopaedic Association

Some of the Councilʼsactivities

2-40-8 Hongo, Bunkyo-ku, Tokyo 113-8418, Japan
Phone:

03-6441-4610 (public relations)E-mail:contact@locomo-joa.jp

Chair:

Takashi Oe (Senior Chief Doctor, Orthopedic Surgery, NTT Medical Center Tokyo)

Vice Chair:

Kimihito Sato (Chairman of the Board, Sato Seikei-Geka Clinic)
Takeshi Fuji (Deputy Director, Japan Community Health Care Organization Osaka Hospital)

Advisors:

Ryoichi Izumida (Director, Keiyu Joint Reconstruction Center, Edogawa Hospital)
Yukihide Iwamoto (Professor, Department of Orthopaedic Surgery, Graduate School of Medical
Sciences, Kyushu University)
Shinichi Ota (Executive Director, Japanese Orthopaedic Association)
Kozo Nakamura (President, National Rehabilitation Center persons with Disabilities Professor Emeritus,

Publiclectures

University of Tokyo)
Keishi Marumo (Director, The Jikei University Hospital)
Committee Members: Muneaki Ishijima (Associate Professor of Orthopaedic Surgery, Faculty of Medicine, Juntendo

Walk on your own two feet for life.

University)
Hideaki Ishibashi (Director of Orthopaedic Surgery, Ina Hospital)
Arihiko Kanaji (Lecturer in Orthopaedic Surgery, Keio University School of Medicine)
Shunji Kishida (Head, Joint Center, Seirei Sakura Citizen Hospital)
Etsuo Chosa (Professor, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki)
Satoshi Yamaguchi (Associate Professor, College of Liberal Arts and Sciences, Chiba University)

Fun exercise
demos

Keiko Yamada (Medical Doctor, Department of Orthopaedic Surgery and Spinal Surgery, The
University of Tokyo Hospital)■ The musculoskeletal system and locomotive syndrome‥‥P01

External advisor:

Hakuhodo Inc.

Full Members:

Alcare Co., Ltd.; Asahi Kasei Pharma Corporation; Asahi Shimbun; Ajinomoto Co., Inc.; Astellas Pharma■ How does locomotive syndrome develop?‥‥‥‥‥‥‥‥‥‥P03

Inc.; Chugai Pharmaceutical Co., Ltd.; Curves Japan Co., Ltd.; Daiichi Sankyo Company, Limited; Ebara
Foods Industry, Inc.; Eli Lilly Japan K.K.; Hisamitsu Pharmaceutical Co., Inc.; ITOCHU Corporation;■ Assess yo u r loco motive fu n ctio ns!‥‥‥‥‥‥‥‥‥‥‥‥P05

Kaken Pharmaceutical Co., Ltd.; Kagome Co., Ltd.; Meiji Co., Ltd.; Morinaga Milk Industry Co., Ltd.; MSD
K.K.; Nippon Sigmax Co., Ltd.; Ohta s Isan Co., Ltd.; Ono Pharmaceutical Co., Ltd.; Otsuka
Pharmaceutical Co., Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Yomiuri Shimbun■ Asessing your locomotive syndrome risk level‥‥‥‥‥‥P 11

Friendly
consultations(in alphabetical order; as of April 1, 2016)
Associate Members: Eisai Co., Ltd.; Japan External Preparations Council; Kao Corporation; Megmilk Snow Brand Co., Ltd. ;■ Making exercise part of your routine‥‥‥‥‥‥‥‥‥‥‥‥‥P13

Mikasa Seiyaku Co., Ltd.; Teijin Pharma Ltd.; Zimmer Biomet G.K.
(in alphabetical order; as of April 1, 2016)

Inquiries

E-mail: contact@locomo-joa.jp Website: www.locomo-joa.jp■ Got a sore back or knees?‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥P14
Locomotive Challenge

F Y 2015 Locomotive Syndrome Pamphlet. Released October 1, 2015. Designed and produced by the Locomotive Challenge! Council, Japanese Orthopaedic Association.
• This pamphlet is copyright © the Locomotive Challenge! Council, Japanese Orthopaedic Association.
• No part of this pamphlet may be reproduced or republished without permission.
• For permission to reproduce or republish any part of this pamphlet, please contact the Locomotive Challenge! Council.

SearchThe Locomotive Challenge!

■ Preventing locomotive syndrome by eating right‥‥‥‥‥P15

Japanese Orthopaedic Association

The musculoskeletal system and locomotive syndrome
To prevent

Ever heard of the musculoskeletal system̶ the system that gives your body the ability to move?

locomotive syndrome,
it s important to knowa bit about themusculoskeletal
system, which moves
your body.

■The musculoskeletal system is like the engine and tires of a car.
Your body can t move properly if any part of the system is broken.

The musculoskeletal system■Parts of themusculoskeletal system
Muscles

The human body has diﬀerent systems specializing in diﬀerent functions. You re probably familiar with theDigestion

respiratory system (consisting of the trachea and lungs), which takes in oxygen and expels carbon dioxide;

Circulation

JointsIntervertebral
discRespiration

the circulatory system (consisting of the heart and blood vessels), through which blood ﬂows carrying

Brain

Cartilage

Spinal cord

oxygen, nutrition, and waste; and the digestive system (consisting of the stomach and intestines), which
digests and absorbs food. Well, what gives your body the ability to move is the musculoskeletal system,

Musculoskeletal system

consisting of your bones, joints, muscles, and nerves. The bones, joints, and muscles all work together inBonessync, and when any one of them is out of order, it diminishes your body s ability to move.

Peripheral
nervesMaximize your healthy life expectancy,
and walk on your own two feet for life.

Don t think you re too young to worry.
Get into the exercise habit while you re still youthful!

healthy life

The greatest threat to healthy life expectancy is

Did you realize that your bone and muscle mass

Cartilage and the discs of your spine, like muscles

expectancy ? Healthy life expectancy means thelosing your independence or becoming bedridden, so

peak in your twenties and thirties? Conditioning yourand bones, also need proper exercise. But placing

nu m b er of yea rs you ca n exp e ct to live in goo dthat you require special assistance or nursing care.

bones and muscles through moderate exercise,

excessive strain on them by overdoing sports orhealth. In Japan, the diﬀerence between average life

Do you know what the number one reason for thatalong with getting proper nutrition, is the way tobeing overweight actually damages them.

expectancy and healthy life expectancy is about

is? Disorders of the musculoskeletal system. If you

keep them strong and healthy. If you let them growConversely, being too thin weakens the muscles andnine years for men and twelve years for women.

end up requiring assistance or becoming conﬁned toweak, by your forties and ﬁfties you ll start feelingbones. So it s not good to be either overweight or

Everyone wants to lead a healthy, active life until thebed, you re not the only one aﬀected; so too areyour physical powers decline, and after hitting yourunderweight. Does either description apply to you?

end. So maximize your healthy life expectancy!

your family and others close to you. So you owe it

sixties you may ﬁnd your body no longer moves thenot just to yourself but also to friends and loved

way you want it to.

Are you familiar with the term

ones to keep your musculoskeletal system in good■Diﬀerence between average life expectancy
and healthy life expectancy in Japan
0

40

50

60

70

80

90

Average life expectancy 80.21

Males

Healthy life expectancy 71.19

Females■Change in bone mass with age

working order.
■Reasons forrequiring special
assistance or
nursing care

Average life expectancy 86.61

27%

Debilitation

Healthy life expectancy 74.21

SOURCES: For average life expectancy (2013), Japanese Ministry of Health,Labour and Welfare, Complete Life Tables 2013; for healthy life expectancy(2013), Study on Future Projections of Healthy Life Expectancy and the
Cost-Eﬀectiveness of Measures against Lifestyle Diseases(Health Labour Sciences Research Grant-funded project).

Other

13%

SOURCE: Japanese Ministryof Health, Labour andWelfare, Comprehensive
Survey of Living
Conditions 2013.

Males

Musculoskeletal
disorders

25%

Bone
mass

Dementia

19%

16%

LOCOMOTIVE SYNDROME .

Locomotive syndrome means being restricted in one s ability to walk or lead a normal life owing to a dysfunction in
one or more of the parts of the musculoskeletal system ̶ muscles, bones, joints, cartilage, or the intervertebral

0

the Japanese Orthopaedic Association proposed the concept of locomotive syndrome in 2007. Today all of us needto take steps to prevent locomotive syndrome and extend our healthy life expectancy, so we can all walk on our own

10

20

30

40

50

60

70

80

90 （age）■Locomotive syndrome: A conceptual diagram
Bones

Cartilagae/discs

Osteoporosis
Fractures

Osteoarthritis
Spondylosis
Spinal canal stenosis

discs. Japan faces a future as the most elderly society humankind has ever known, and with that prospect in mind

01

Females

Cerebrovasculardisorders

Requiring nursing care, or being at risk of doing so,
due to a decline in mobility resulting from a disorder of the musculoskeletal system is termed

two feet for life.

■Being either
underweight or
overweightcreates problems.

Muscles/nerves

Nerve damage

Pain
Limited rangeof motion
Loss of muscle
strength
Poor balance

Decline inmobility（gait disorder）

Restricteddaily activities
Limited social
participation
Need fornursing care

Turn the page formore information on
locomotive syndrome
and how to prevent it!

Sarcopenia**Loss of muscle mass and strength as part of the aging process.

02How does locomotive syndrome develop?

Mobilit y deﬁned:

Here are the causes and symptoms of locomotive syndrome.
Do any apply to you?
People lose their mobility imperceptibly by stages,
from being in good health to becoming dependent on nursing care.
Maybe your mobility is gradually declining
but you re pretending not to notice the signs.
Lack of regular exercise

Being under- or overweightIf you fail to get regular exercise, yourIf you re under weight, the bones andm u s c u l o s ke l e t a l s y s t e m w i l l s l o w l y

m u s c l e s t h a t s u p p o r t yo u r b o d y will

atrophy.

steadily lose strength. Being overweight

Do any apply to you?

Th e a bilit y to st a n d, walk, ru n, sit , clim b th e stairs, a n d
perform other physical functions essential to daily life.

1

Seven warning
signs oflocomotive
syndrome

2

3□ You can t put□ You often trip up
or slip aroundyour sock on
the house.
standing on one leg.

□ You need to holdon to the handrail whenclimbing the stairs.

4

5

6

7

□ You have diﬃculty
doing moderately
heavy housework.

□ You have diﬃculty
carrying home 2 kgof shopping.

□ You can t walkfor a quarter ofan hour nonstop.

□ You can t make it
across the road before
the light turns red.

puts tremendous stress on the hip andknee joints. Once the cartilage of thejoints becomes worn down, the tissue
can t easily be restored.

Unheeded pain andlistlessness
If you have a sore back or your knees●Healthy*Equivalent to 2 1-liter cartons of milk.

hurt, maybe you just ignore it because
you think it s part of the aging process.
Well, your musculoskeletal system could
be deteriorating without your knowing it.

Thin

Fat

Such aches may even be indicative of aserious illness lurking.

Onset of musculoskeletal disease■Osteoporosis●Musculoskeletal
damage■Osteoarthritis■Spondylosis

People with osteoporosis have brittle bones andO ste o a r th ritis c a u s e s p ain a n dThis disease occurs when pressure on

are susceptible to fractures. They can break alimits range of motion (the ability to

the spine wears down theb o n e wit h eve n a m i n o r fa ll a n d m ay s u ﬀ e r

ﬂex and extend the joints) due tointervertebral discs and deforms thecomp ression fractures of the spine withoutabrasion of the articular cartilage.

bone, causing serious pain.

even realizing it.

It s p a r tic ula rly c o m m o n in t h e

If the ner ves become pinched, aIf your back is hunched or you ve lost height,

joints of the knees and hips.

condition called spinal canal stenosis

osteoporosis may be suspected.

That s why it s important to moveresults, causing pain and tingling in thelegs.

Reduced physicalactivity

Overdoing sports andinjuring yourself

Consta ntly ta king the elevator a nd

The joints are extremely delicate, so if

your joints and tone the muscles

driving everywhere are among the habits

when playing sports you re too hard on

surrounding them.

that reduce physical activity, so beware!

them or fail to follow the proper form,

Walk on your own two feet.

you could suddenly injure yourself anddo some serious damage.

●Back andknee pain

Can t be bothered
to go out?

●Musculoskeletal
disease worsens as
signs go unheeded

W h e n p e o ple h ave diﬃc ultie s get tin garound, it can be bothersome or even
impossible to go out. Do you avoid
meeting friends or going out with family
and spend the whole day at home?

People s mobility varies greatly depending on their daily
lifestyle and whether or not they take appropriate action.
Regardless of age, if any of the above signs and symptoms
apply to you, it s important to take the right steps, whether
modifying your lifestyle, getting into the habit of regularexercise, or seeing a medical professional for a checkup.

●Heightened riskof becomingcare-dependent

Full-blown
locomotive syndrome●Dependent on
nursing care

Could you already have locomotive syndrome?
Turn the page for a detailed self-assessment.
03

04

Assess your locomotive functions!

Try the locomotive syndrome risk test

About the locomotive syndrome risk test
The locomotive syndrome risk test consists of three parts.

1 The stand-up test

2 The two-step test

for assessing leg strength1

3 A 25-question risk assessment

for measuring length of stride

on your physical condition and lifestyle

The stand - up test
This test assesses leg strength by having you stand up on one or both legs from a speciﬁed
height.

The two -step test

2

How to conduct the stand-up test

This test measures length of stride. It also lets you perform a general assessment of walking

Prepare four seats of diﬀerent heights ̶ 40 cm, 30 cm, 20 cm, and 10 cm.
Starting at 40 cm, stand up from each, ﬁrst with both legs, then with one leg.

ability, including muscular strength, balance, and ﬂexibility of the lower limbs.

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 gof 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.

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

posture for three seconds.

1
2

Hold posturefor 3 seconds

Take two long strides ̶ the longest you can ̶ then align both feet.
Me asure the length of the two strides(from the starting line to the position of the tips of your toes where you stopped).

On one leg
Stand up without
leaning back

Decide your starting line and stand with the toes of both feet behind it.
（If you lose your balance, the attempt is a failure.）3

On both legs

※NOTE: If you feelpain when standing
up on both legs,
consult with a
medical professional.

How to conduct the two -step test

4

Do the test twice and record the better result.

5

Calculate your two-step score using the following formula.
■Formula for calculating your two-step score

Stand up without
leaning back70˚

Length of both strides in cm ÷ your height in cm = your two-step score
Take the longest strides you can

10cm 20cm 30cm 40cm

You may bend your knee slightly

3 If in Step 2 you re able to stand up on one leg…

If in Step 2 you re unable to stand up on one leg…

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

If you can t stand up on both your right leg
and your left leg, you ve failed . Now try

from lower heights at 10 cm decrements.

standing up on both legs from lower heights at

Second
step

First
step

10 cm decrements.

HeightDetermining your result＜Able to stand up from 40 cm on one leg?⇒Try on one leg from a lower height＞
Try on one leg and then the other at 10 cm decrements.
The lowest height from which you can stand both on your right leg andon your left leg is your test result.

＜Unable to stand up from 40 cm on one leg?⇒Try it with both legs＞
Try the stand-up test with both legs at 10 cm decrements.
The lowest height from which you can stand on both legs is your test result.

Long stride

Long stride［Relative diﬃculty of standing from each height］
40cm, both legs<30cm, both legs<20cm, both legs<10cm, both legs<40cm,
one leg<30cm, one leg <20cm, one leg <10cm, one leg

Start●Be careful not to strain or injure yourself.

Caveats●If your knees start to hurt, stop the test.
●Don t lean back to gain momentum: you could topple backwards.
SOURCE: Shingo Muranaga, Journal of the Showa Medical Association (2001) 61(3):362-367.

05

Maximum length of double stride (distance covered in two steps)●Do the test on a non-slippery surface.

Caveats●Wear shoes if possible.
●Do warm-up exercises ﬁrst.

Finish●Only go as far as you can without
losing your balance.
●No jumping.

SOURCE: Shingo Muranaga et al., Journal of the Showa Medical Association (2003) 63(3):301-308.

06

Assess your locomotive functions!

Try the locomotive syndrome risk test3

25 - question risk assessment
Over the past month, have you experienced any pain or had diﬃculties with activities of daily living?
Please answer the following 25 questions to help determine your risk of locomotive syndrome

Not
diﬃcult

Mildlydiﬃcult

Moderately
diﬃcult

Considerably
diﬃcult

Extremely
diﬃcult

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＝

3 point＝

Q21

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

Q22■Following are questions about your body pain for the last one month:
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

Q1■Following are questions about your usual daily life for the last one month:07sses elf!
s
A
rs
yo u

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

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,
don t try to diagnose the problem on your own; consult with yourlocal 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 rome08

Assessing your locomotive syndrome risk level

Use your test results to determine
if you re at a risk level of 1 or 2!
How to determine your risk level
Determine your locomotive syndrome risk level from the present state ofyour locomotive functions as revealed by your results on the stand-up test,
the two-step test, and the 25-question risk assessment.

Regardless of your age, your risk level is deemed to be
1 or 2 if you meet even one of the relevant criteria.

Determining your level
Risk level 1

Risk level 2■Following are questions about your body pain for the last one month:Take the longest strides you can〈On one leg〉

First
step

Stand up without
leaning back

Hold posturefor 3 seconds

Height

You may bend your knee slightly

1

Can t stand up froma height of 40 cm
on one leg or the other

（

Start

Long stride

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

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

Q1

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

Q2

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

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

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

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

Q4

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

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〈On both legs〉■Following are questions about your usual daily life for the last one month:

Secondstep

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

Q1

FinishQ5

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?

Q10

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

Notdiﬃcult

Mildlydiﬃcult

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?

Q14

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

Notdiﬃcult

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

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)?

Q18

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

Notdiﬃcult

Not
diﬃcult

Not
diﬃcult
Not
diﬃcult

Mildlydiﬃcult

Mildlydiﬃcult
Mildlydiﬃcult

Moderately
diﬃcult
Moderately
diﬃcult

Moderately
diﬃcult
Moderately
diﬃcult

Considerably
diﬃcult
Considerably
diﬃcult

Considerably
diﬃcult
Considerably
diﬃcult

Extremely
diﬃcult

Mildlydiﬃcult
Mildlydiﬃcult

Moderately
diﬃcult
Moderately
diﬃcult
Moderately
diﬃcult※NOTE: If you feelpain when standing
up on both legs,
consult with a
medical professional.

Considerably
diﬃcult
Considerably
diﬃcult

Extremely
diﬃcult
Extremely
diﬃcult

Extremely
diﬃcult

Secondstep

70˚

Extremely
diﬃcult

Severepain

Extremely
diﬃcult

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?

Q10

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

Notdiﬃcult

Mildlydiﬃcult

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?

Q14

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

Notdiﬃcult

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

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)?

Q18

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

Notdiﬃcult

Not
diﬃcult

Not
diﬃcult
Not
diﬃcult

Mildlydiﬃcult

Mildlydiﬃcult
Mildlydiﬃcult

Moderately
diﬃcult
Moderately
diﬃcult

Moderately
diﬃcult
Moderately
diﬃcult

Considerably
diﬃcult
Considerably
diﬃcult

Considerably
diﬃcult
Considerably
diﬃcult

Extremely
diﬃcult
Extremely
diﬃcult

Extremely
diﬃcult
Extremely
diﬃcult

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

Moderately
diﬃcult
Moderately
diﬃcult
Moderately
diﬃcult

Considerably
diﬃcult
Considerably
diﬃcult

Extremely
diﬃcult
Extremely
diﬃcult

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

Notdiﬃcult

Mildlydiﬃcult

Extremely
diﬃcult

Q19

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

Notdiﬃcult

Mildlydiﬃcult

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

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

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

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?

Restricted
about half
the time

Considerably
restricted

Gave up all
activities

Q22

Have you been restricted from meeting your friends?

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

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

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

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＝

3 point＝

0 points＝

1 point＝

2 point＝

3 point＝

Enter the number of answers
Add up the number of points

Total

4 point＝

10cm 20cm 30cm 40cm

points23Your two-stepscore is lessthan 1.3

You got 7 points
or more on the
25 questions

If you meet even one of these criteria, your risk level is 1!

1

）

Start

Long stride

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

Finish2

Add up the number of points

Slightly
restricted

Total

Extremely
diﬃcult

4 point＝

points3

Can t stand up from Your two-stepa height of 20 cmscore is lesson both legs
than 1.1（

Enter the number of answers

Notrestricted

Considerably
diﬃcult

Extremely
diﬃcult

Q19

Long stride

Moderately
diﬃcult

Considerably
diﬃcult

Q21

Slightly
restricted

Considerably
diﬃcult

First
step

Severepain■Following are questions about your usual daily life for the last one month:
Q5

Q20

Not
restricted

Moderately
diﬃcult

Considerably
diﬃcult

Stand up without
leaning back

Extremely
diﬃcult

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

Take the longest strides you canSeverepain

You got 16 points
or more on the
25 questions）

If you meet even one of these criteria, your risk level is 2!

A locomotive syndrome risk level of 1 indicates that the decline of your locomotive

A locomotive syndrome risk level of 2 indicates that the decline of your locomotive functions

functions has already begun. Your muscular strength and balance are deteriorating, so you

is already advanced. You re at high risk of becoming unable to lead an independent lifestyle.

need to get into the habit of performing regular exercise such as locomotion training. Also

You may have a locomotive organ disorder, so it s recommended you see an orthopaedist.

take care to eat a balanced diet with plenty of protein and calcium.

Turn the page for actual ways toprevent locomotive syndrome!

Monitor the state of your locomotive functions by doing the locomotive syndrome risk test regularly.

09

10

Locomotion training for preventing locomotive syndrome

Keep your back and legs ﬁt for life
with locomotion training.
The important thing is to make it a habit.

Exercise at yourown pace.
Don t overdo it anddon t compare
yourself to others.

Locomotion training consists of just two exercises. Do them every day!

One-leg stands for improving your balance

Squats for strengthening your leg muscles.
If you can do theexercise without
touching, hold yourhands just above
the table.

NOTE: Do three times●Keep your back straighta day, one minuteduring the exercise.

for each leg.

●If you require something
to lean on, carefully place
your hands or ﬁngers

Always do theexercise where
there s something
to grab on to, so
you don t fall over.

30˚

on a table. You can use
either one or both hands.

Keep yourknees backAngle your feetoutward 30˚11Stand with your legs slightly
fu r th e r a p a r t th a n th e width of2

Lower your body while pushing your buttocks back.
Ensure your knees don t extend beyond the tips ofyour shoulders. Angle your feetyour toes, and keep them pointed in the direction ofoutward 30 degrees.

your second toe.

If unable to do squats, sit on a chair with yourhands on the table and repeatedly stand up andsit down.

NOTE: Repeat 5-6 times in sync with deep breathing. Do three times a day.
If you can performthe exercise withjust your ﬁngers
on the table, thendo it that way.

Raise your leg
so it s just oﬀ
the ﬂoor.

●Don t hold your breath while doing the squat.

TIPS●In order not to put excessive strain on your knees, avoid bending them more than 90 degrees.
●Perform the exercise slowly, conscious of your front and rear thigh muscles tensing.
●If you require something to lean on, carefully place your hands or ﬁngers on a table.

Exercises to add to your locomotion training program. Try them to the extent you re able!
Heel raises〈for toning the muscles of the calves〉
If you re unsteadyo n yo u r f e et , h o l dthe back of a chair
as you do theexercise.
Raise yourheels while
standing on
both legs.

TIP

Then slowly
lower them.

Front lunges〈for improving ﬂexibility, balance, and muscular strength of the lower limbs〉

If yo u thin k yo u
can do it on one
leg , place you r
hands against thewall and try it.

If you feel like you re going to lose your balance, place your hands on the wall or table.
And beware of raising your heels too high: you could easily fall over.

Daily quota: 10-20 times (as many as you can) × 2-3 sets

11Stand with both
feet on the
ground andarms akimbo.

Slowly take a large
lunge forwardwith one leg.

Lower yourhips until yourthigh is horizontal.

Straighten up
while returning
your leg to its
original position.

Posture before
lowering the hips

TIP

Keep the upper body straight with your chest thrust out .
Be careful not to lunge forward so far you lose your balance.

Daily quota: 5-10 times (as many as you can) × 2-3 sets

12

Making exercise part of your routine

Got a sore back or knees?

Take steps to improve ﬂexibility andmove your body more!

These exercises can help bring relief!
If you have pain o r oth er sym pto ms, co nsult with a medicalp rofessio nal b efo re tr ying th ese exercises .

Calisth enics a n d stretching . Also suita ble fo r wa rming u p a n d
wa rming d own b efo re a n d af ter exercise.

Light exercises

Exercises for back pain
1

For relaxing muscles and joints with large, leisurely movements.

Half sit-ups

2

Lie facing upward. Keeping yourSit upslowlychin in, slowly raise your upper
body to a 45-degree angle andhold for 5 seconds. (You don tbelly below the navel. Keeping your chinin, slowly raise your upper body about 10

Chin incm oﬀ the ﬂoor and hold for 5 seconds.

need to sit up that far if you lack

(You don t need to raise your body that

abdominal strength.) Raise yourfar if unable to do so.) Raise your upper

upper body by tensing yourStretching

Chin inputting your glutes to work as well.

7 Wrist and ankle rotations

1

4 Sideback bends

6 Back stretches

Pillowtense your buttocks at the same time,

stretches

3 Forward and5 Upper body rotations

exercise is even more eﬀective if you

2 Gentle leg

bends

Raise upper body 10 cm

body by tensing your back muscles. This45˚abdominal muscles.

1 KneeBack stretches

Lie face down with a pillow under yourstretches

8 Small jumps

9 Deep breathing

For relaxing muscles and joints with 20 seconds of light stretching.

3

2

Do at least t wo sets of ten of each exercise per day.

Hip, back, and ab stretches4

Lie fa cin g u pwa rd. G ra s p o n e

Lie facing upward. Bend the hipknee with both hands and slowly

joint of one leg 90 degrees andhold the back of your thigh withdraw it toward your chest while

Draw toward
you and holdtaking a deep breath. Hold for 10

Legs

Hamstring stretches

seconds. Repeat with the otherboth hands. Bend and stretch the90˚knee, then slowly extend it as far
as you can and hold it there forknee.

10 seconds.

3

4

Do at least t wo sets of ten of each exercise per day.
SOURCE: Japan Low Back Pain Evaluation Questionnaire（JLEQ）

1 Calves

2 Back of thighs

3 Front of thighs

Trunk

4 Inside of thighs

Exercises for knee pain

Shouldersand arms

Toning the quadriceps (the muscles at the front of the thigh)■Performed lying face upward
Lie facing upward with one knee

Raise 10 cm
oﬀ ﬂoorbent at least 90 degrees. Slowly

1 Buttocks and hips

2 Upper back3 Neck

1 Shoulders

2 Upper arms

raise the foot of the other leg 10

3 Wrists●Don t hold your breath.
●Stretch slowly for 20-30 seconds.

TIPS●Do these exercises in moderation; they shouldn t hurt.
●Be conscious of your muscles stretching as you do each exercise.
●Don t swing to gain momentum or push down on the part being exercised.

SOURCE: Ministry of Health, Labour and Welfare, Exercise Guide 2006.

Add an extra 10 minutes to your daily routine!

J ust

10

min utes!

An extra 10 minutes of physical activity can help prevent locomotive syndrome. Here are some of the things you can try.
● B i cyc l e o r wa l k to wo r k .
●Ta ke t h e s t a i r s i n s te a d of t h e e l eva to r o r e s c a l a to r.

●Wa l k to a s u p e r m a r ket f u r t h e r away t h a nu s u a l fo r yo u r s h o p p i n g .

● Cl e a n a n d l a u n d e r wit h ze s t .
S t r etc h w h e n yo u h ave a m o m e nt .

● U s e yo u r l o c a l p a r k o r s p o r t s c e nte r.
●Ta ke p a r t i n c o m m u n it y s p o r t s eve nt s .

● D o l o c o m oti o n t r a i n i n g o r s t r etc h i n g w h il e
wa tc h i n g T V.

● G o o u t to h ave f u n wit h fa m ily o r
f ri e n d s o n d ays o ﬀ.

●Ta ke a wa l k d u ri n g b r e a ks a t t h e o ﬃ c e .

●Wa l k b ris kly wit h l o n g s t ri d e s .

In fact any form of exercise can help prevent locomotive syndrome ̶radio gymnastics, community exercise programs, you name it.
SOURCE: Ministry of Health, Labour and Welfare, Activity Guide 2013.

13■Performed sitting on a chair
Sit o n th e e d ge of a tall c hair while
holding on to the sides. Keep one foot on
the ﬂoor and position the other leg withc m oﬀ th e ﬂo o r with th e k n e e

the ankle at a 90-degree angle and thes t r a ig ht . H o l d fo r 5 s e c o n d s ,knee straight. Maintaining that position,then slowly lower it. Once it sraise the heel 10 cm oﬀ the ﬂoor andback on the ﬂoor, rest for 2- 3

hold for 5 seconds. Then slowly lower it.

seconds. Repeat with the otherOnce it s back on the ﬂoor, rest for 2-3

leg.

seconds. Repeat with the other leg.

Raise 10 cm

Do at least t wo sets of t went y of either exercise per day.
SOURCE: Japanese Knee Osteoarthritis Measure（JKOM）

2.Knee ﬂexions and extensions■Knee extensions■Knee ﬂexions

Sit on the edge of a chair. Place your hand on

Backstraight

your thigh just above the kneecap and extend
your knee by slowly pushing down as much as

Push
down

you can without causing pain. To stretch yourcalf more, bend the ankle upward at the same

G rasp your ankle with both
hands and slowly draw it toward
your buttock, bending the knee
as much as you can withoutcausing pain.

time. To stretch the back of your thigh more,
keep your back straight and bend at the hip
joint. This exercise is most eﬀective performed

Bend ankle
upwardwhen your body is warm, as after a bath.

Per form each exercise for 15 - 30 seconds, repeating 1- 3 times.

14

Preventing locomotive syndrome by eating rightOnce you ve exercised, you need to getproper nutrition too. What kind of diet is bestfor preventing locomotive syndrome?

One in two men and one in ﬁve women of middle age or older in Japan have metabolic syndrome or are at highAs long as your diet is balanced over the week,that s ﬁne. Not being too strict is the secret
to sticking to a proper diet.

risk of developing it. Metabolic syndrome can result in hardening of the arteries, placing you at risk of

If your mornings are so hectic you don t have time for a proper breakfast, you can still improve your nutritional

Being overweight and underweight are both causes for concern!
Keep your musculoskeletal system healthy by eating properly.
life-threatening conditions such as heart disease, but that s not the only thing that s scary about it. If you rebalance by having a glass of milk or fruit with your toast, or consuming a bowl of miso soup with your rice ball.

overweight, the excess pounds put extra strain on your back and knees, which can lead in turn to locomotive

You may ﬁnd it diﬃcult to have a starch dish, a main item, and a side item with every meal. In that case balance

syndrome.

things out over the course of the whole day or, if even that s diﬃcult, over the course of the week. The

On the other hand, insuﬃcient nutrition due to dieting or lack of appetite reduces bone and muscle mass. Of

important thing is to get all the nutrition you need from the food you eat.

particular concern are the excessive desire of young women to be thin and the failure of many seniors to getadequate nutrition. If you don t want to fall victim to locomotive syndrome, it s important to be careful about
what you eat so you don t become either overweight or underweight.

Make mealtimes more fun by adding
variety to the menu or dining with company!

The key: obtaining a balanced combination of all ﬁve major
nutrients by eating three proper meals a day.

No matter what your age, an irregular diet can eventually disrupt your natural biological rhythm, heightening
your risk of developing health problems. So if you have poor eating habits, the ﬁrst thing you need to do is

So what s the best diet for preventing locomotive syndrome?

consider ways to improve your lifestyle. Malnutrition among seniors in Japan has become a serious concern

To lead a healthy life there are certain nutrients we all need: carbohydrates, fat, protein, vitamins, andm i n e r a ls . T h e s e a r e te r m e d t h e

ﬁve m a j o r n u t rie nt s ,over the past several years. You tend to lose your appetite as you get old, so it s a good idea to get the missing

a n d t h ey r e i n d is p e n s a b l e to ke e p i n g t h enutrients by having a snack in the morning and afternoon in addition to your three regular meals.

musculoskeletal system in good working order. It s important to replenish each of them by eating three proper

You may need to ﬁnd ways to stimulate your appetite so you obtain all the nutrition you require. You can add

meals a day.

variety to your menu by switching between Japanese, Chinese, and Western cuisine, or jazz up your meals by

A proper meal should consist of three elements: a starch dish with plenty of carbohydrates, such as rice,adding brightly colored vegetables. Also eﬀective is dining with family or friends, going to a restaurant, or

bread, or noodles; a main item with plenty of protein, such as meat, ﬁsh, egg, or soybean products; and a side

eating lunch outdoors, such as in the park. Or serve meals on nice crockery and turn them into a feast for theitem with plenty of vitamins and minerals, such as a garnish of vegetables or seaweed. Eating three meals aeye. There are so many ways to make mealtimes enjoyable.

day, each consisting of a starch dish, a main item, and a side item, and supplementing them with milk, dairy
products, and fruit, is the best way to obtain a balanced combination of all ﬁve major nutrients.

h
H e a lt
tips
Key①

The three keys to preventing locomotive
syndrome through diet

Figure 1■Dietary diversity
score
Shoji Shinkai

Nutrition Working Group, Locomotive Challenge! Council(Team Leader, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology)

Bewa re of u n d ern ou ris h ment!

Among the elderly, people who are thin or have a low level of nutrients (such as albumin) in the blood tend torequire nursing care sooner. Such a state is termed undernourishment. Undernourishment can easily lead toosteoporosis and sarcopenia (loss of muscle tissue), so preventing it is critical. A useful indicator here is yourdietary diversity score (Figure 1). You should if possible eat items from all ten food groups every day. Assign ascore of 1 for food categories you eat almost every day and 0 for those you eat less often. It s an establishedfact that people with a higher total score are less susceptible to undernourishment, maintain stronger muscles
and bones, and walk faster and have stronger grip (Figure 2).

Key②

15

Figure 2

A main item & side item each meal, plus milk or dairy & fruit daily

1.Meatpts.

2.Fish and shellﬁsh

pts.

Eat almost every day : 1 point
Eat less often: 0 points
6.Green andyellow vegetables

pts.

7.Seaweedpts.

■Dietary diversity score and physical functions
30
29

Grip (kg)Regular walking speed (m/s)

1.4

Test for trend = 0.001

Test for trend = <0.001

1.35

28
3.Eggspts.

8.Potatoes

pts.

pts.

9.Fruitpts.

5.Milk and dairy
products

pts.

10.Dishes made with oil

pts.

Yo u r s c o r e

pt s .

(Prepared by Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology)

The higher your score,
the less your risk of undernourishment!

Key③

1.3

27

4.Soybeans andsoybean products

1.25

26
25

Q1

Q2

Q3

Q4

Diversity score quartiles

1.2

Q1

Q2

Q3

Q4

Diversity score quartiles

Sample: 1,063 ordinary seniors living at home
4 diversity score quartiles: Q1=0-2 pts., Q2=2-4 pts., Q3=4-6 pts., Q4=6 pts. or above
Data: Average (adjusted for sex, age, region, and BMI) ± standard margin of error（SOURCE: Yokoyama et al., J Nutr Health Aging 2015 (in press), slightly modiﬁed）

A diet for stronger muscles and bones

Ever y meal, be sure to have a main item (like meat, ﬁsh, eggs, or soybean products) and a side item (likeOn the next two pages you ll ﬁnd detailed information on nutrients particularly

vegetables, mushrooms, or potatoes) in addition to a starch dish (like rice or noodles). Also, consume milk orvital to preventing osteoporosis and sarcopenia (loss of muscle tissue), bothdairy products as well as fruit every day.

causes of locomotive syndrome.

Next page: a diet forstronger muscles and bones!

16

Preventing locomotive syndrome by eating right

The raw materials from which bone andmuscle are formed come from your daily meals.
So keep locomotive syndrome at bay by following a proper diet.
Build stronger bones by eating rightVitamin D is produced by the body throughexposure to sunlight. So in addition to getting
proper nutrition, on a sunny day go out for awalk or some exercise.

Build stronger muscles by eating rightYour bones are constantly being regenerated, so theyrequire a steady supply of the right raw materials.

If you don t get enough energ y, you ll become
emaciated and lose muscle mass.

As bones get old they re broken down and replaced with new bone, so they re constantly being

No matter how much you exercise, if you don t eat properly, you ll become emaciated and lose

regenerated. If not enough of the raw material from which they re made is available, the bones

muscle mass. As with your bones, an adequate supply of the right raw materials is necessary to

become porous (the condition called osteoporosis) and susceptible to fractures. The most important

increasing muscle mass and strength. The most essential nutrient in this regard is protein, but it sof the nutrients from which bones are built is calcium, which Japanese tend not to get enough of. To

also important to obtain plenty of carbohydrates and fat, which supply energy. That s because if

prevent osteoporosis, it s recommended that you get 700-800 mg of calcium a day. So be sure toyour body doesn t get enough energy, it will try to generate it using the protein from which yourinclude things that contain lots of calcium in all three meals a day ̶ like milk and dairy products,

muscles are formed.

small ﬁsh, brightly colored vegetables, seaweed, and soybean products.

Besides calcium, also get plenty of protein,vitamin D, and vitamin K.

Obtain protein from a combination of sources.

But you need more than just calcium to build strong bones; you also need protein, vitamin D, andis a nutrient made up of twenty-odd amino acids, of which nine cannot be synthesized by the body

vitamin K. Protein is one of the building blocks of bones, so be sure to get enough of it. Meat, ﬁsh,milk, and soybeans are all sources of high-quality protein with a good amino acid balance. Vitamin D,
which increases absorption of calcium in the gut, occurs in large amounts in ﬁsh like salmon as wellas mushrooms. It can also be synthesized in your skin during exposure to sunshine, but it s important
to obtain plenty in your diet so you don t go short. Vitamin K, which plays a role in forming bones andmaintaining bone quality, occurs in large amounts in natto (fermented soybeans) and greens. Other

Meat, ﬁsh, eggs, dairy products, and soybean products are typical good sources of protein. Protein
and must therefore be obtained from food (these are called essential amino acids). Animal protein isdigested more eﬃciently than plant protein, but it s important to eat a combination of sources,
because diﬀerent foods contain diﬀerent amounts of essential amino acids. Older people areespecially encouraged to get plenty of protein, since they tend not to consume enough meat andeggs.

nutrients critical to formation of bones include magnesium, vitamin B6, vitamin B12, and folic acid, allof which you should get as an integral part of your daily diet. Magnesium occurs in large amounts insoybean products, seaweed, and seafood. Vitamin B occurs in large amounts in liver, chicken, andskipjack and tuna; Vitamin B12 in liver, saury, and asari (Japanese littleneck clams); and folic acid invegetables like spinach and garland chrysanthemum as well as strawberries.

Protein and vitamin B6 are best obtained together.
Vitamin B6 is the nutrient that promotes breakdown and synthesis of protein. It s a good idea toconsume protein in combination with rich sources of vitamin B6 like lean tuna, skipjack, red bell

Avoid overconsumption of sodium, phosphate,and caﬀeine, which impede calcium absorption!

pepper, kiwi, or banana. It s important to obtain protein in all three meals a day.
Muscle mass declines at a rate of 0.5-1% from your forties, but you can take preventive action by

The food additives used in processed and vacuum-packed foods contain lots of phosphate, which
when consumed in excess can impede absorption of calcium. Too much sodium and caﬀeine candoing regular moderate exercise and obtaining proper nutrition. So start doing whatever you cantoday to ensure you ll walk on your own two feet for life.

cause calcium to be ﬂushed out of the body in urine. So for the sake of healthy bones, avoid
overconsumption of instant foods and coﬀee, and try to cut down on salt.

Pra ctic altips

A dis h go o d fo rb uilding b o n e

BroccoliRich in vitamin K
and vitamin C!

Salmo n ch eese ba ke with b roccoli
Fillet of salmon, a rich source of vitamin D and protein,topped with calcium-packed cheese. Serve with a sideof quickly boiled broccoli, a source of vitamin K. A
simple, tasty way to obtain the nutrients essential tohealthy bones.

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SalmonRich in vitamin D
and protein!

CheeseRich in calcium!

Pra ctic altips

A dis h go o d fo rb uilding m u scle

Pork
Rich in protein!

Sweet- a n d - sou r p o rk
Sweet- and - sour pork is a great dish for eﬃciently
building muscle, since it combines pork, a source ofp rotein, with re d a n d yellow p e p p e rs, a so u rc e ofvitamin B6 and other vitamins. Plus the sweet-and-sour
ﬂavor stimulates the appetite.

Red pepper
Rich in Vitamin B6!

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