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

The Present Situation and Future of Doping Problem

When looking back into the history of doping, we realize that the illegal use of performance enhancing drugs has spread over the world rapidly over the last 10 years, and has become more complex, cunning and even organized. To fight the spread of such drugs, the doping control procedures are required to be more effective, by increasing the number of testing laboratories and improving the methods of testing. It shall also be effective to increase the number of out-of-competition tests and to conduct tests at each federation. However, not to mention names like Ben Johnson, Katrin Krabbe or the 7 Chinese swimmers at the \u2794 Asian Games, the cases of doping has spread widely around the globe. An effective method for doping control is essential. Doping control is necessary for recognizing and proving that the records were established in a fair manner. It must be recognized that the use of such drugs will destruct the competitor\u27s health and the fairness of the sport itself. It will also be a disgrace to the values and the faith in the world of sports. Finally, the authors believe it is very important that all of those who get involved in sports realize this, and we shall always keep sending this message to them

A Follow-Up Study of the Effects of ""Falls Prevention Program"" on Bone Mass and Mobility Parameters

PURPOSE : As demanded by the present situation, the ""Falls Prevention program"" has been carried out in Japan as a national policy. At present, it is considered to symbolize its idea and significance of the health promotion. The purpose of the present study was to examine how the program influenced the mobility parameters one year or more after the end of the program. RELEVANCE : Dargent-Molina [1999] reported that the walking ability (10m-rapid gait time and cadence) related to rate of falls and bone fracture. Therefore, in the program, training for improving mobility walking ability is a main part. DESCRIPTION : 169 female middle and aged subjected, subjects completed 12 weeks falls prevention program, were recruited. In the present study, the maximum walking speed for 10-meters, the maximum step length, 40-cm steps and single leg stance were assessed as mobility parameters. Quantitative ultrasound bone measurements (AOS100, Aloka Co. Ltd, Tokyo, Japan) were used to calculate the Osteo Sono-Assesment Index (OSI) of the calcaneus which is an indicator of the bone mass. The mobility parameters and the bone mass were measured at the end of the program and at one year or more after completion of the program. EVALUATION : Subjects were 169 women and 22 men who had completed twelve weeks program, for Falls Prevention. In the present study, the maximum walking speed for 10-meters, the maximum step length, 40-cm steps and single leg stance were assessed as mobility parameters. Quantitative ultrasound bone measurements (AOS100, Aloka Co. Ltd, Tokyo, Japan) were used to calculate the Osteo Sono-Assesment Index (OSI) of the calcaneus which is an indicator of the bone mass. The mobility parameters and the bone mass were measured at the end of the program and at one year or more after completion of the program. CONCLUSIONS : It was found that the calcaneal bone strength did not decrease in the subjects whose mobility parameters were better than normal at the end of program period. Since walking is practical and easy exercise to practice and its ability might be a reliable indicator for estimating the risk of falls, improving the walking ability is considered to be a good strategy to prevent falls and bone fracture. IMPLICATIONS : Since maintenance of high mobility parameters influences the calcaneal bone mass, compliance of a habit to exercise regularly seems to be important. Therefore, an educational system encouraging maintenance of the habit for life should be constructed for the community-dwelling peoples

How Can We Cope with Doping in Sports ?

This research has thoroughly studied the actual situation and the recent trends of doping in sports, looking closely into the responses taken by the parties concerned in recent doping cases and throwing light upon the backgrounds and the very essence of doping itself. The aim of this study is to indicate the task we are facing in the fight against doping. The banned substances and procedures of doping has both increased and diversified in the recent years, and so is the percentage of actual positive test results increasing. Doping in sports has spread across the globe. Japan is not an exception to this; there has been cases where a competitor has tested to be positive. Many of the anti-doping activities are taking place, including doping control, and these activities are being reinforced. However, when looking closely into the responses taken by the parties concerned in major doping cases in the past, such as the case of Canadian sprinter Ben Johnson, we have noticed that not in all cases were the responses taken fairly and impartially acording to the regulations and prescribed procedures. The commercialism, nationalism! and heroism of modern sports and the competitors\u27attitude to "rely on materials" cause temptations towards doping and are the backgrounds of doping. We have reached the conclusion, that it is necessary to fully recognize the immorality of doping in both regions of sports competition and medicine, and the fact that doping is an act of depriving the competitor of his/her liberty, humanity and human rights. And this recognition must be passed on to the competitors and instructors through appropriate education

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

Measurement of submaximal aerobic power in children

PWC150 in 935 school children whose ages were ranged from 6 to 17 yrs, was measured using a computarized bicycle ergometer. The absolute values of boys increased with age, while thase of girls increased in like mannar until 11 yrs, but maintained the almost same level over 11 yrs. Sex difference was observed in the relative value of PWC150 to body weight. It was concluded that PWC150 was available for easy assessment of submaximal aerobic power in children although further researches were required for obtaining the reliable norm

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

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

チイキザイジュウコウレイシャ ニ オケル テントウヨボウジココウリョクカン ト HDL コレステロール オヨビ シンタイノウリョク トノ カンレン コスゲムラオウダンケンキュウ

背景 : 本研究の目的は,転倒予防自己効力感とHDLコレステロール及び身体能力との関連性を調べることであった。方法 : 対象者は山梨県小菅村に在住する65歳以上の高齢者339名で,本調査には132名(38.9%)が参加した。移動能力として10m全力歩行,最大一歩幅,40cm踏台昇降を,バランス能力としてつぎ足歩行を測定した。血液性状の中で,主要なアウトカムとして,HDLコレステロールを用いた。転倒予防自己効力感は,10項目,4リッカートスケールからなる質問紙で評価した。研究デザインは,転倒恐怖の有無による2群間比較の横断研究である。結果 : 転倒予防自己効力感とHDLコレステロールの間に有意な関連はなかったが,転倒予防自己効力感が低い群では有意に移動能力が低かった。また,膝痛や腰痛を伴う男性では,転倒予防自己効力感が低かった。結論 : 自己効力感とHDLコレステロールとの関連は認められなかったが,本研究は地域在住で独立生活を営む高齢者に限定されているため,今後,良くデザインされた大規模な観察研究が必要だと考えられた。Background : The aim of the current study was to clarify relationships between self-efficacy and high-density lipoprotein cholesterol (HDL-C) and physical strength.Methods : Target participants were 339 elderly residents aged 65 years or older from Kosuge Village, Yamanashi Prefecture in Japan. One hundred and thirty two persons participated in the study (38.9%). Outcome measurements included the 10-m walking time, the maximal step length and 40-cm step test as moving ability, the tandem gait as balance ability, and HDL-C. Fall-prevention self-efficacy (FPSE) was evaluated using a questionnaire that examined 10 items (actions) and 4 Likert scale. A total of 40 points could be awarded. This research design was a cross-sectional study that divided the elderly into two groups by the existence of a fear of falling.Results : Although there was no significant relationship between fall-prevention self-efficacy and HDL-C, we demonstrated that a group with poor self-efficacy had significantly deteriorated moving ability and that only one male participant with knee pain and/or lumbago exhibited poor self-efficacy.Conclusions : We could not find significant relationships between self-efficacy and HDL-C. But this study is limited to the independent elderly people in a local area, and further studies should be conducted to detect the relationships