A systematic review of nonrandomized controlled trials on the curative effects of aquatic exercise

Hiroharu Kamioka1, Kiichiro Tsutani2, Yoshiteru Mutoh3, Hiroyasu Okuizum4, Miho Ohta5, Shuichi Handa4, Shinpei Okada6, Jun Kitayuguchi7, Masamitsu Kamada7, Nobuyoshi Shiozawa8, Sang-Jun Park4, Takuya Honda4, Shoko Moriyama41Faculty of Regional Environment Science, Tokyo University of Agriculture, Tokyo, Japan; 2Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, 3Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan; 4Mimaki Onsen (Spa) Clinic, Tomi City, Japan; 5Laboratory of Aqua, Health, and Sports Medicine, 6Physical Education and Medicine Research Foundation, Nagano, Japan; 7Physical Education and Medicine Research Center Unnan, Unnan City, Japan; 8Department of Longevity and Social Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanBackground: The objectives of this review were to integrate the evidence of curative effects through aquatic exercise and assess the quality of studies based on a review of nonrandomized controlled trials (nRCTs).Methods: Study design was a systematic review of nonrandomized controlled trials. Trials were eligible if they were nonrandomized clinical trials. Studies included one treatment group in which aquatic exercise was applied. We searched the following databases from 2000 up to July 20, 2009: MEDLINE via PubMed, CINAHL, and Ichushi-Web.Results: Twenty-one trials met all inclusion criteria. Languages included were English (N = 9), Japanese (N = 11), and Korean (N = 1). Target diseases were knee and/or hip osteoarthritis, poliomyelitis, chronic kidney disease, discomforts of pregnancy, cardiovascular diseases, and rotator cuff tears. Many studies on nonspecific disease (healthy participants) were included. All studies reported significant effectiveness in at least one or more outcomes. However results of evaluations with the TREND and CLEAR-NPT checklists generally showed a remarkable lack of description in the studies. Furthermore, there was the problem of heterogeneity, and we were therefore not able to perform a meta-analysis.Conclusion: Because there was insufficient evidence on aquatic exercise due to poor methodological and reporting quality and heterogeneity of nRCTs, we were unable to offer any conclusions about the effects of this intervention. However, we were able to identify problems with current nRCTs of aquatic exercise, and propose a strategy of strengthening study quality, stressing the importance of study feasibility as a future research agenda objective.Keywords: aquatic exercise, systematic review, nonrandomized controlled trials&nbsp

ダイガクセイ ノ セイシンテキ ケンコウド ト ライフ スタイル トノ カンケイ

The life style of the university students has been varing with the rapid transition of social economy and the trasient variation of culture lately． And it was quite possible that such abrupt variations exerted an ill infuluence on the mental and phyical health and the social life of the students． It was so serious a problem that it was important to clear the actual state of the usual life style and the subjective state of health， and then to evidence the relationship between them． On the one side， it was well known that the factors affecting the mental health， besides the life style， were the demographic fact（sex distinction， age， social and economical state），biological charactaristic（physical condition， clinical history， physique， physical fitness and so forth）， creed，estimation of value and so on． However， little work was designed in the subject of university students to elucidate the factors corelated with the health status（GHQ：The General Health Questionnaire）． Therefore， the purpose of the present paper is to reveal the health status and the life style of the students in the Gakushuin university and to the throw some light on the remarkable factors related to the mental health status． The questionnaire was put into operation to the subject of the students taking alesson in physical practise（The health and sports science I，named in this university）late in november，1996． The subjects were the first－year students belonging to the department of literature or science． The recovered data were presupPosed to be the representative of the first－year students this university， because they were required to study the lesson in physical practise． The 28－item General Health Questionnaire was utilized in order to detect the status of mental health． In addition， several articles were supplemented on the life style， fundamental attribution， creed， estimation of value and so forth with reference to the preceding Papers．As the index of the physical charactaristic（physique）， height and weight and BMI（Body Mass Index：weight（kg）／Height（m）2）were measured under the regular physical checkup in April，1996． The outcome of the physical strength and exercise examination fixed in September yearly was applied to the charactaristic of physical fitness． The score of Harvard－Step－Test was applied to the index of the aerobic work capacity（ general physical endurance）． Medicine－ball－throw and Standing－broad－jump were measured to the index of the anaerobic work capacity（power）． Side－step was to the index of the agility． As a result of statistical analysis by means of the quantification theory type I， the followings were obtained． There were some sexual differences in the items of the life style corelated with the mental health status remarkably． In male， the great factors related to the GHQ score were “Harvard－Step－Test” that indicated the general physical endurance， irregularity of eating habbit”， evaluation of student life”，and ‘‘the frequency of intentional neglect of class” in order of intensity． That is to say， general phyisical endurance and living a regular life and a substantial student life were exeedingly concerned in the mental health status． In female，“evaluation of student life”in itself like“the school record”，was most important． And also greatly participated “anxiety about health” like sickly，“increase and decrease in body weight” and “gamble”“Irregularity of eating habbit”“hours of spare time”and “average hours of sleep”also contributed to the GHQ score

ダイガク ジョシ トランポリン キョウギ センシュ ノ ボディー イメージ

This study attempted to grasp actual state of the body image（B1）in college female athletes of trampohne，and to clalify its differences between the levels ofcompetition of trampoline． Aquestionnaire study was conducted with 40 college female athletes of trampoline and 55 f¢male specialschool students who did not belong to school athletic teams．The questionnaire contained the Japanese translation of BSQ which cooper PJ．et aL had invented，and the space to write subjecビs height，weight， and ideal weight． Analyses of the comparisons between athletes and non－athletes，between BMI and ideal BMI，between the levels of competition were conducted． Results suggested that college female athletes of trampoline had Iess distortion of their body images than young female non－athletes，but they were not content with things as they were and wished to reduce weight．Also it was fbund that l 5％of them experienced vomiting or taking laxative， However，The difference of the levels of competition in this study was significant

コウレイシャ ノ テントウ ヨボウ ノタメノ ウンドウ バランス クンレン トシテノ ウンドウ アソビ

In Japan， a fams a third biggest cause which elderly persons become bedridden． Prevention of a fams veryimportant for elderly population to keep good health and QOL（quali吐y of li fe）・1nternal and external risk factors offalhng down in elderly population have been reported． Furthermore， the epidemiological study have demonstratedthat many interna置and externai factors cause elderly population falhng down． Many of these factors are difficultfor elderly population to prevent from falling down by themselves， f6r example， patients with certain disease suchas Parkinson syndrome have a tendency toward falhng down easily． On the other hand， elderly population are able｛o avoid some of risk factors with their efforts． One of吐hemis to have more active li fe style or to preserve and increase the capability of movement having Proper amount of亀exercise． This capability dearly decreases as peoP且e grow old， however， it will go down dramatically withoutexerclse． Recently， hospital staffs and researchers have developed classes to teach Iocal elderly populations how toprevent from falling down in many countries・ln Japan・the lirst class lbr prevention of fal］has been operated atTokyo Koseinenkin Hospita且since DecemberJ 997 and good resu且ts have been obtained． The proper exercise is acornerstone to prevent from famng down」t should be sa t’e and efficlenしhowever， it is dit’ficult to keep properexercise量felderly peoPle could not enjoy iし In this study， we introduce a new concept of recreation and a concrete method to improve the sense ofbalance abihty on the basis ofevidences and prac吐ical ins｛ructions of exercise・論説(Article

Exercise of a Mountain Farming Village Inhabitant : Centered on Kita-mimaki Mura Village. Nagano Prefecture

This research was carried out to investigate the characteristics of people using a swimming pool at the complex facilities of medical care, welfare and public health and to examine the significance of such facility in the future society. The questionnaire (98 items) was distributed to 598 village inhabitants. 407 respondents (68.1%) were analyzed. The following results were found : 1. There were 10 factors which showed significant differences between people who used the swimming pool and those who didn\u27t. 2. Demographic factors, exercise factors and physical factors were significantly influential in using the swimming pool, by factor analysis and discriminant analysis. 3. People using the swimming pool with bad physical shape comprised 16.8% of the total number of people. while 24.7% couldn\u27t swim well. 4. The swimming pool contributed to giving several village inhabitants the occasion of regular exercise for their health improvement. It is strongly suggested that such complex facilities had a considerable significance in the future aged society

リンショウケンキュウ ト エキガクケンキュウ ニ オケル ロンブン ノ シツ ヲ タカメルタメ ノ コクサイドウコウ ヒト ヲ タイショウ ト シタ ケンキュウデザイン ノ エビデンス・グレーディング

本研究は,人を対象とした治療や健康増進の効果を明らかにする研究のエビデンスを示す方法をレビューすることを目的とした。疫学や臨床研究においては,研究デザインによって,エビデンスのグレーディング(grading : 格付け)が行われている。各種の研究デザインにおける論文を評価したり,論文の質を高めるためにチェックリストや声明が開発されている。また,人を対象とした介入研究を実施する場合には,パブリケーション・バイアスの減少,研究の倫理,臨床試験参加の推進につながるため,事前の臨床試験登録(clinical trial registry : CTR)が必要である。世界的な11の医学雑誌からなる「国際医学雑誌編集者委員会(International Committee of Medical Journal Editors : ICMJE)」は,臨床試験の登録(clinical trial registry : CTR)を論文投稿の条件としている。疫学研究や臨床研究を実施する場合には,こうした動向を理解する必要がある。This narrative reviews the means of effectively evaluating evidence in the outcome of clinical trial and quality of health care. The grading of evidence in clinical and epidemiologic studies has been provided to improve the study design and to raise the quality of publications. Check lists and guidelines are developed to reduce publication bias, and clinical trial registry has the potential to facilitate ethics and to increase participation of clinical trials. The International Committee of Medical Journal Editors has proposed that only clinical trials are published that are registered at inception. These trends are to be appreciated when epidemiologic or clinical study is conducted

ソクヨク ニ オケル ジンコウ ボウショウセン ガ ジリツシンケイカツドウ ニ アタエル エイキョウ

本研究は人工芒硝泉による足浴が自律神経活動に及ぼす影響について検討することを目的とした。健康な若年男女計6名(男性3名 : 20.7±0.6歳,女性3名 : 21.3±0.6歳)を対象に,人工芒硝泉浴,淡水浴,湯なし条件(対照座位)の足浴条件を1日1条件,ランダムな順序で施行した。対象者には20分間座位安静をとってもらい,引き続き足浴前値の測定を行った。足浴は座位にて41℃(33L)の温湯に両足膝下約10cmまで15分間浸漬して行った。足浴終了後は対象者自身が水分を拭き取り,両足を毛布で覆い,60分間座位安静を保った。その間,心拍数,心拍変動周波数に基づく自律神経活動,鼓膜温を測定するとともに,体感温度,眠気,疲労感などの主観的評価をVisual Analogue Scale(VAS)を用いて記録した。その結果,人工芒硝泉浴及び淡水浴により体感温度は有意に上昇したが,鼓膜温及び心拍数に有意な変動は見られなかった。また淡水浴後は交感神経活動の有意な亢進が認められたが,人工芒硝泉浴後はそれが見られなかった。本結果から人工芒硝泉による足浴は足浴後の交感神経活動の亢進を抑え,疲労感の低減に寄与する可能性が示唆された。This study was conducted to estimate the effect of a footbath with sodium sulfate (Na2SO4) on autonomic nervous system (ANS) activity. Each of three young healthy males (age, 20.7±0.6 years) and females (age, 21.3±0.6 years) participated in 3 conditions in random order, footbaths with or without Na2SO4, and a sitting position without water as a control. Each subject sat on a chair and kept quiet for 20min with heart rate (HR) stabilized, and subsequently basal measurements were conducted. In a sitting position, they dipped their calves 10cm under their knee joints into hot water (41℃, 33L) for 15min. Immediately after the bathing, they removed moisture, covered their knees with a blanket and sat for 60min thereafter. Counts of HR, ANS activity based on frequency of HR variability, and a core temperature using an eardrum thermometer were measured. The degree of thermal comfort such as relatively hot or relatively cool, sleepiness and fatigue were also estimated using visual analogue scales (VAS). As a result, both footbaths with and without Na2SO4 significantly increased the subjective thermal comfort, while the core temperature and HR counts were unaffected. Sympathetic nervous system (SNS) activity was significantly increased by the footbath without Na2SO4, but not with Na2SO4. These observations suggested that in the footbath, Na2SO4 might have an inhibitory effect on increased SNS activity, and induce some depressive effects on feeling of fatigue

カソ コウレイカ ノ ススム ノウソンチョウソン ニ オケル チイキシンダン ト イリョウヒカンレンシヒョウ ノ ケントウ

本研究は,総務省が平成17年(2005)年に分類した小規模自治体を対象として,次のことを明らかにすることを目的とした。1)保健医療福祉の関連指標について,類似する自治体間で比較を行うこと,つまり地域診断を実施すること,2)介護及び医療費に関連する因子を明らかにすることである。対象となる類似自治体は,総務省類型分類(人口及び産業構造から分類)で,平成17(2005)年度に山梨県小菅村が該当した「町村I-1(人口5,000人未満で,第二,三次産業従事者が80%以上,第三次産業従事者55%未満),54自治体」であった。本研究開始時の平成20(2008)年8月時点において,54町村すべての合併状況を確認した結果,独立して存続している町村は11であった。用いた指標は,老人医療費,入院費,介護費,人口,高齢化率,核家族世帯数,第一次・二次・三次の各産業従事者割合,要介護認定率,平均寿命などあった。11町村の中で,特徴的だった例を4つ列挙する。1)長野県天竜村は平均寿命が長く,医療費と介護費も低い傾向にあった(医療費・介護費併用型)。2)小菅村と山梨県鳴沢村は,医療費や介護費,介護認定率が低かった(医療費・介護費安価型)。3)東京都御蔵島村と群馬県上野村は,医療費は低いが介護費が高かった(介護費依存型)。4)沖縄県北大東村は,寿命は長いが,介護費が高かった(その他型)。重回帰分析の結果,医療費と有意な相関があったのは,入院費であった。介護費と有意な相関があったのは,65歳以上の親族のいる核家族世帯数であった。小規模自治体において,介護保険依存と医療費依存の方向性を有する自治体があり,保健医療福祉の評価には,両者を合わせて検討する必要性が示唆された。サンプルサイズが小さいということや,検討に用いることができたデータの内容について限界はあるが,核家族と入院が介護費用と医療費に影響を及ぼしている可能性があることが示された。The objectives of this study were to compare medical expenses of similar local governments, and to clarify the factors related to expenses for care and medicine. The subjects of our investigation were local governments with a national classification in fiscal 2005 that was similar to Kosuge village in Yamanashi based on population and industrial structure : the population was smaller than 5000, the total percentage of secondary and tertiary industry was more than 80%, and the percentage of tertiary industry was less than 55%. These criteria were met by 54 local governments. When we started this investigation in August 2008, 11 governments remained unconsolidated. The indices consisted of medical expenses for the aged, hospital expenses, nursing-care expenses, population size, aging population, the number of nuclear families, the industrial structure, the percentage of advanced nursing care, and life expectancy. The outstanding points were as follows : 1) Tenryu village in Nagano showed long life expectancy and low medical and nursing-care expenses (combination type by medical and nursing-care expenses) ; 2) Kosuge and Narusawa village in Yamanashi showed low medical and nursing-care expenses and a low percentage of advanced nursing-care (low-cost type of medical and nursing-care expenses) ; 3) Mikurajima village in Tokyo and Ueno village in Gunma showed low medical expenses and high nursing-care expenses (dependent type by nursing-care expense) ; and 4) Kitadaito village in Okinawa showed long life expectancy and high nursing-care expenses (other type). In multiple regression analysis, only hospital expense was found to explain medical expenses, and the number of nuclear families consisting of the elderly was found to explain nursing-care expenses. These results imply that there are two types of local governments that must be considered in health care analyses : one depends on nursing-care, and the other depends on medicine. In spite of the small sample size as statistical data discussion for interpretation, results from this study suggest that nuclear families and hospitalization affect nursing-care and medical expenses

カソ コウレイカ ノ ススム ノウソンチョウソン ニ オケル チイキシンダン ト イリョウヒカンレンシヒョウ ノ ケントウ

本研究は,総務省が平成17年(2005)年に分類した小規模自治体を対象として,次のことを明らかにすることを目的とした。1)保健医療福祉の関連指標について,類似する自治体間で比較を行うこと,つまり地域診断を実施すること,2)介護及び医療費に関連する因子を明らかにすることである。対象となる類似自治体は,総務省類型分類(人口及び産業構造から分類)で,平成17(2005)年度に山梨県小菅村が該当した「町村I-1(人口5,000人未満で,第二,三次産業従事者が80%以上,第三次産業従事者55%未満),54自治体」であった。本研究開始時の平成20(2008)年8月時点において,54町村すべての合併状況を確認した結果,独立して存続している町村は11であった。用いた指標は,老人医療費,入院費,介護費,人口,高齢化率,核家族世帯数,第一次・二次・三次の各産業従事者割合,要介護認定率,平均寿命などあった。11町村の中で,特徴的だった例を4つ列挙する。1)長野県天竜村は平均寿命が長く,医療費と介護費も低い傾向にあった(医療費・介護費併用型)。2)小菅村と山梨県鳴沢村は,医療費や介護費,介護認定率が低かった(医療費・介護費安価型)。3)東京都御蔵島村と群馬県上野村は,医療費は低いが介護費が高かった(介護費依存型)。4)沖縄県北大東村は,寿命は長いが,介護費が高かった(その他型)。重回帰分析の結果,医療費と有意な相関があったのは,入院費であった。介護費と有意な相関があったのは,65歳以上の親族のいる核家族世帯数であった。小規模自治体において,介護保険依存と医療費依存の方向性を有する自治体があり,保健医療福祉の評価には,両者を合わせて検討する必要性が示唆された。サンプルサイズが小さいということや,検討に用いることができたデータの内容について限界はあるが,核家族と入院が介護費用と医療費に影響を及ぼしている可能性があることが示された。The objectives of this study were to compare medical expenses of similar local governments, and to clarify the factors related to expenses for care and medicine. The subjects of our investigation were local governments with a national classification in fiscal 2005 that was similar to Kosuge village in Yamanashi based on population and industrial structure : the population was smaller than 5000, the total percentage of secondary and tertiary industry was more than 80%, and the percentage of tertiary industry was less than 55%. These criteria were met by 54 local governments. When we started this investigation in August 2008, 11 governments remained unconsolidated. The indices consisted of medical expenses for the aged, hospital expenses, nursing-care expenses, population size, aging population, the number of nuclear families, the industrial structure, the percentage of advanced nursing care, and life expectancy. The outstanding points were as follows : 1) Tenryu village in Nagano showed long life expectancy and low medical and nursing-care expenses (combination type by medical and nursing-care expenses) ; 2) Kosuge and Narusawa village in Yamanashi showed low medical and nursing-care expenses and a low percentage of advanced nursing-care (low-cost type of medical and nursing-care expenses) ; 3) Mikurajima village in Tokyo and Ueno village in Gunma showed low medical expenses and high nursing-care expenses (dependent type by nursing-care expense) ; and 4) Kitadaito village in Okinawa showed long life expectancy and high nursing-care expenses (other type). In multiple regression analysis, only hospital expense was found to explain medical expenses, and the number of nuclear families consisting of the elderly was found to explain nursing-care expenses. These results imply that there are two types of local governments that must be considered in health care analyses : one depends on nursing-care, and the other depends on medicine. In spite of the small sample size as statistical data discussion for interpretation, results from this study suggest that nuclear families and hospitalization affect nursing-care and medical expenses