Quantitative assessment of locomotive syndrome in Japanese office workers

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1 J Phys Fitness Sorts Med, 7 (2): 43-4 (208) DOI: 0.700/jfsm.7.43 JPFSM: Regular Article Quantitative assessment of locomotive syndrome in Jaanese office workers Kurumi Tsuruta *, Saori Yoshinaga, Tomoko Shiomitsu 2, Hiroki Tamura 3, Yoshinori Fujii 4 and Etsuo Chosa Faculty of Medicine, University of Miyazaki, 5200 Kiyotake-cho, Kihara, Miyazaki City, Miyazaki 88-2, Jaan 2 Tohto College of Health Sciences, - Hibino, Mihama-ku, Chiba 2-002, Jaan 3 Faculty of Engineering, University of Miyazaki, - Gakuen kibanadai-nishi, Miyazaki 88-22, Jaan 4 Faculty of Education, University of Miyazaki, - Gakuen kibanadai-nishi, Miyazaki 88-22, Jaan Received: December 2, 207 / Acceted: February 3, 208 Abstract To reduce the risk of long-term care, it is imortant to revent the functional decline of the locomotorium of elderly individuals early in life. This study aimed to clarify locomotive syndrome (LS) in Jaanese office workers. The articiants included 23 workers that mainly erformed deskwork. Particiants erformed the LS risk test and comleted a self-administered questionnaire survey that focused on lifestyle-related diseases, anxiety about hysical strength, ain in the locomotorium, and health-related quality of life. Sixty articiants (22.8%) were at risk for LS, and 7.5% of these articiants were in their 20s. Of the articiants at risk for LS (LS grou), 30.0% had anxiety about hysical strength, which was a significantly high ratio comared to the 4.3% of articiants who exressed anxiety about hysical strength, but were not at risk for LS (non-ls grou) (χ 2 =., <.05). There were significant differences between risk for LS and ain in the back and hi joints (χ 2 = 5.83, <.05, χ 2 = 4.85, <.05). The LS grou had a significantly lower mean hysical summary score than the non-ls grou (t = 3.28, <.0). Thus, an intervention to revent LS is imortant during the early stages, and signs such as ain in the locomotorium and anxiety about hysical strength must not be overlooked. Keywords : locomotive syndrome, risk test, office workers Introduction The average life san of Jaanese eole is one of the longest in the world, and Jaanese men and women are ranked first globally for a healthy life exectancy,2). According to data from the Cabinet Office of Jaan 3), the differences between the average life san and healthy life exectancy are aroximately 3 years for women and aroximately years for men. The exense burden for long-term care and medical care increases as the difference between the average life san and healthy life exectancy increases. In Jaan, the ratio of the oulation 5 years of age and older is increasing raidly, and is estimated to reach 30.% by 2024 and 3.0% by 205 4). Therefore, extension of the healthy life exectancy is regarded as an imortant issue for reducing the exense burden and imroving the quality of life of the aging oulation. Locomotive syndrome (LS) was roosed by the Jaanese Orthoaedic Association as a condition that laces eole at high risk for needing long-term care. Some causes of LS are reduced muscle strength and balance associated with aging and disorders of the locomotive system, which consists of bones, joints, muscles, and *Corresondence: hamham@med.miyazaki-u.ac.j nerves 5). More than million eole in Jaan are estimated to have LS ). According to a recent comrehensive survey of living conditions by the Ministry of Health, Labour and Welfare in Jaan 7), aroximately 0% of individuals that require long-term care in Jaan have roblems associated with diseases of the locomotive organs. The Jaanese government roosed measures to romote the extension of healthy life exectancy in a growth strategy imlemented in 203 8), and one of the target areas was health romotion of the working generation. Moreover, a olicy on health romotion sought to raise eole s awareness about LS ). Thus, it is imortant to revent the functional decline of the locomotorium in elderly individuals early in life to reduce the risk for needing long-term care. While there have been many studies on LS in older subjects, there have been very few studies on LS that include the working generation, including subjects in their 20s. Thus, this study aimed to clarify LS in Jaanese office workers by means of an LS risk test and self-administered questionnaire survey. Methods Particiants. The articiants included 23 Jaanese workers that mainly erformed deskwork [37 men, age

2 44 JPFSM: Tsuruta K, et al. range: 25-7 years (mean ± standard deviation, 4. ± 0.2 years); 2 women, age range: 20-3 years (3. ± 0. years)]. The mean age of all articiants was 42. ± years. The mean body mass index of all articiants was 22.4 ± 3.3 kg/m 2. This study was aroved by the ethics review board of the Deartment of Medicine at Miyazaki University (Aroval No ). All articiants rovided written informed consent after receiving a thorough exlanation of the study. Data collection. Particiants were asked to erform the LS risk test and comlete a self-administered questionnaire survey that focused on lifestyle-related diseases, anxiety about hysical strength, ain in the locomotorium, and health-related quality of life. The LS risk test consists of the following three arts.. The stand-u test for assessing leg strength. Four seats at different heights are reared: 40, 30, 20, and 0 cm. Starting at 40 cm, articiants stand u from each seated osition, first with both legs, then with one leg. 2. The two-ste test for measuring stride length. This test can also be used as a general assessment of walking ability, including muscular strength, balance, and flexibility of the lower limbs. 3. The 25-question risk assessment. This assessment focuses on body ain and activities of daily life for the most recent month. Particiants were assessed as having no LS risk (non-ls grou), or an LS risk level of or 2 (LS grou), using the clinical levels devised by the Jaanese Orthoaedic Association in 205 0). Particiants at risk level met one of the following criteria: unable to stand u from a height of 40 cm using either leg, a two-ste score less than.3, or 7 oints or more on the 25-question risk assessment. Particiants at risk level 2 met one of the following criteria: unable to stand u from a height of 20 cm using both legs, a two-ste score less than., or oints or more on the 25-question risk assessment. We used the Jaanese version of the SF-8 as a healthrelated quality of life measure ). Each item of the SF-8 indicates a health rofile of eight dimensions: general health ercetions (GF), hysical function (PF), role limitations due to hysical health (RP), bodily ain (BP), vitality (VIT), social functioning (SF), mental health (MH), and role limitations due to emotional roblems (RE). Furthermore, the SF-8 roduces two higher-order summary scores: the hysical comonent summary (PCS) and the mental comonent summary (MCS) scores. Statistical Analysis. Differences in gender, age, BMI were comared using the Chi-square test, Student s t-test or Welch s t-test, as aroriate. The Mann-Whitney U test was used to examine the relevance of gender and age on LS and anxiety about hysical strength. The Mantel- Haenszel test was used to examine the relevance of anxiety about hysical strength, lifestyle-related diseases, and ain in the locomotorium to LS. Welch s t-test was used to examine the differences in SF-8 scores between the LS and non-ls grous. Seven articiants did not comlete the SF-8. All statistical analyses were conducted using IBM SPSS 22.0 (IBM Cor., Released 203. Armonk, NY, USA). The level of significance was set at 5%. Results Distribution of articiant characteristics according to resence of LS. Table shows distribution of articiant characteristics according to the resence of LS. The mean age of articiants in the LS grou was significantly higher than that of articiants in the non-ls grou ( =.02). There were no significant differences in gender or BMI between the LS and non-ls grous. Classification of LS and relationshis of LS with gender and age. Sixty articiants (22.8%) were found to have a level or level 2 risk for LS. Most of the articiants found to be at level or level 2 risk for LS were in their Table. Distribution of the articiant characteristics according to resence of LS LS + (n=0) LS (n=203) Gender 28 (4.7%) 0 (53.7%).48 Age (years) 45.7 ± ± * BMI (kg/m 2 ) 22. ± ± Note: Gender value indicates number of men (differences analysis using Chi-square test) Age and BMI, values were the mean ± standard deviation Age differences were analyzed using Student s t-test, * <.05 BMI differences were analyzed using Welch s t-test

3 JPFSM: Locomotive syndrome in Jaanese office workers 45 0s (50.0%), followed by those in their 50s (23.4%), 40s (22.8%), 30s (7.7%), and 20s (7.5%). When classified by gender, there was a significant difference between age and articiants at risk for LS ( =.035; Mann-Whitney U test). The number of articiants at risk for LS significantly increased in older age grous. Regarding gender differences, 25.4% of woman were at risk for LS, with a majority of those at risk in their 40s (3.8%), whereas 20.4% of men were at risk for LS, with a majority of those at risk in their 0s (57.%). For men, there was a significant difference between the ratio of articiants at risk for LS and age ( =.00). This difference was not observed for woman (Table 2). Relationshi between anxiety about hysical strength and LS. There was a significant difference between anxiety about hysical strength and age ( =.03). More articiants in the younger age grous exressed anxiety about hysical strength [20s (22.5%), 30s (24.2%), 40s (20.3%), 50s (.4%) and 0s (5.%)]. In contrast, there were no significant differences between anxiety about hysical strength and gender (Table 3). The ratio of articiants who were at risk for LS and the ratio of articiants who had anxiety about hysical strength were examined using the Mantel-Haenszel test, as there were influences from both gender and age. There was a significant difference between the ratio of articiants at risk for LS and anxiety about hysical strength (χ 2 =., =.0), and there was a significantly high ratio (30.0%) in comarison to the 4.3% of articiants who were not at risk for LS (Table 4). Table 2. Relationshi of LS with gender and age n (%) LS Age (years) 20 s 30 s 40 s 50 s 0 s Male (n=37) Female (n=2) (n=23) (.) 8 (88.) (.4) 25 (80.) 7 (7.5) 33 (82.5) 5 (.7) 25 (83.3) (8.8) 2 (8.3) (7.7) 5 (82.3) 4 (.8) 37 (0.2) 4 (3.8) 24 (3.2) 8 (22.8) (77.2) 0 (23.3) 33 (7.7) 5 (23.8) (7.2) 5 (23.4) 4 (7.) 8 (57.) (42.) (25.0) 3 (75.0) (50.0) (50.0) 28 (20.4) 0 (7.) 32 (25.4) 4 (74.) 0 (22.8) 203 (77.2).00 ** * Note: Mann Whitney U test, * <.05, ** <.0 Male (n=37) Female (n=2) (n=23) Table 3. Relationshi of anxiety about hysical strength with gender and age Anxiety Age (years) 20 s 30 s 40 s 50 s 0 s 0 (0.0) (00.0) (22.5) 3 (77.5) (22.5) 3 (77.5) Note: Mann Whitney U test, * <.05 3 (0.0) 27 (0.0) 5 (24.2) (75.8) 5 (24.2) (75.8) 3 (7.3) 38 (2.7) (20.3) 3 (7.7) (20.3) 3 (7.7) 2 (4.7) 4 (5.3) (.4) 58 (0.) (.4) 58 (0.) 0 (0.0) 4 (00.0) (5.) 7 (4.4) (5.) 7 (4.4) 8 (5.8) 2 (4.2) (7.) 2 (82.) (7.) 2 (82.) n (%) *

4 4 JPFSM: Tsuruta K, et al. Relationshi between lifestyle-related diseases and LS. The relationshi between lifestyle-related diseases and the risk for LS was examined using the Mantel-Haenszel test, as there were influences from both gender and age. There were no significant differences between high blood ressure, diabetes, anemia, cerebrovascular disease and the risk for LS. However, the ratio of those at risk for LS was high for articiants with diabetes and those with a cerebrovascular disease (Table 5). Relationshi between ain in the locomotorium and LS. The relationshi between ain in the locomotorium and the risk for LS was examined using the Mantel-Haenszel test, as there were influences from gender and age. There were significant differences between the risk for LS and ain in the hi joint (χ 2 = 4.85, =.027) and back (χ 2 = 5.83, =.0). In contrast, there were no significant differences between the risk for LS and ain in the shoulder and knee (Table ). Differences in SF-8 scores between the LS and non-ls grous. The SF-8 scores were analyzed for 25 articiants, as seven articiants did not comlete the survey. The LS grou had a significantly lower mean PCS (hysical comonent summary) score, 4. ±.2, than the non- LS grou, 5. ± 4. (t = 3.28, =.002). The mean MCS (mental comonent summary) score was 4. ± 8.2 for the LS grou and 50.7 ± 5.4 for the non-ls grou. The LS grou had a lower mean MCS score, but the difference was not significant (Table 7). Discussion Locomotive syndrome is a condition that laces eole at high risk for needing long-term care, and reduced muscle strength and balance associated with certain disorders and aging are factors related to LS. Studies of LS in elderly eole have been reorted 2,3), but there have been few investigations of eole younger than 0 years old. The resent study investigated LS in 23 workers ranging in Table 4. Relationshi between LS and anxiety about hysical strength n (%) Anxiety about hysical strength + χ 2 LS + (n=0) 8 (30.0) 42 (70.0) LS (n=203) 2 (4.3) 74 (85.7)..0 * Note: Both gender and age were adjusted using the Mantel Haenszel test, * <.05 Table 5. Relationshi between lifestyle-related diseases and LS LS Lifestyle-related disease + χ 2 n (%) Hyertension 7 (33.3) 4 (.7) 53 (2.) 8 (78.) Diabetes 2 (.7) (33.3) 58 (22.3) 202 (77.7) Anemia 5 (2.7) 8 (78.3) 55 (22.) 85 (77.) Vascular brain disease 2 (00) 0 58 (22.2) 203 (77.8) Note: Both gender and age were adjusted using the Mantel Haenszel test

5 JPFSM: Locomotive syndrome in Jaanese office workers age from 20 to 7 years old, and there were some workers at risk for LS in each age grou. Particiant level of risk for LS was assessed using the clinical levels devised by the Jaanese Orthoaedic Association in 205 0). An LS risk level of indicates that a decline in locomotive functions has already begun, whereas an LS risk level of 2 indicates that the decline of locomotive functions is already advanced and the risk of becoming unable to lead an indeendent lifestyle is high. Thus, the results of the resent study show that the signs of a decrease in movement ability were resent in aroximately 30% of the workers, some of whom were in their 20s. Therefore, some tye of intervention to revent LS in younger eole is necessary. A greater number of women in their 40s and a greater number of men in their 0s were at risk for LS comared to the other age grous. Women tended to have an increased risk for LS at a younger age comared to men. Yamada et al. 4) reorted that a decrease in mobility, as assessed using the LS risk test, was related to age. Osteoorosis is considered one of the causative diseases of LS. Because the decrease in sex hormone levels associated with menoause reduces bone mineral density, women are at risk for osteoorosis. Moreover, women tend to have less muscle mass than men, and overall muscle mass begins to decrease after years of age 5,). Therefore, the functional decline of the locomotive system may be more evident in women at a younger age, as shown in the resent study. In Jaan, 30% of the women requiring nursing care are assumed to have diseases of locomotive organs, and this ratio is higher than that for men 7). Thus, intervention to revent LS during its early stages is esecially imortant for women. Weakening of hysical strength with aging and a lack of exercise lead to a decrease in hysical function, which is a factor for LS. In the resent study, high ratios of young articiants and articiants in the LS grou had Table. Relationshi between ain of locomotorium and LS n (%) Pain in the locomotorium LS + χ 2 Shoulder + 8 (24.2) 25 (75.8) 52 (22.) 78 (77.4).04.7 Back + 3 (4.) 8 (58.) (20.3) 85 (7.7) * Knee + 7 (3.8) 5 (8.2) 53 (22.0) 88 (78.0) Hi joint + (0.0) 4 (40.0) 54 (2.3) (78.7) * Note: Both gender and age were adjusted using the Mantel Haenszel test, * <.05 Table 7. Differences in SF-8 scores between the LS and non-ls grous SF-8 LS + (n=58) LS (n=8) t PCS 4. ± ± ** MSC 4. ± ± PCS: hysical comonent summary, MSC: mental comonent summary Note: Seven articiants did not comlete the SF-8 Welch s t-test, ** <.0, values are mean ± standard deviation

6 48 JPFSM: Tsuruta K, et al. anxiety about hysical strength comared to articiants in the non-ls grou. Therefore, intervention to imrove hysical strength might be effective for reventing LS in younger eole. Numerous factors related to lifestyle-related diseases have been studied in Euroe, America and Asian countries 8-2). In Jaan, secific health checkus for the urose of reventing lifestyle-related diseases, as mandated by the law concerning healthcare for senior citizens, have been carried out for those 40 years old and older since 2008; and detailed analyses of the health data have been conducted. Moreover, secific health guidance deending on the risk level for lifestyle-related diseases is offered 22). The association between LS and lifestyle-related diseases has begun to attract attention, because disuse or functional decline of the locomotorium can lead to lifestylerelated diseases 23,24). Although the results of the resent study do not indicate an association between lifestylerelated diseases and LS, erforming health checks for LS in arallel with those for lifestyle-related diseases may be effective for not only monitoring visceral fat obesity, but also assessing the function of the locomotorium. In a cross-sectional study, Akahane et al. examined the association between LS and lifestyle-related factors, such as smoking and dental health 25). From the ersective of LS revention, additional studies on the association of various lifestyles with LS are needed. Regarding the differences in SF-8 scores between the LS and non-ls grous, the mean PCS score of the articiants in the LS grou was significantly lower than that of articiants in the non-ls grou. Therefore, lower subjective evaluations of hysical health corresonded with anxiety about hysical strength. Imagama et al. reorted that comlaints about and ain of the locomotorium worsened with a decline in mobility, as assessed by the LS risk test, and reduced quality of life, as measured by the 3-Item Short Form Health Survey (SF-3) 2). A strong association between LS and ain in both the back and hi joint was shown in the resent study, and ain in the back and hi joint might be a factor related to the lower hysical health evaluations of articiants with LS. In conclusion, this study demonstrated that aroximately 30% of 23 workers between 20 and 7 years old were at risk for LS, with some of those at risk in their 20s. High ratios of young articiants and articiants in the LS grou were also found to have anxiety about their hysical strength comared to articiants in the non-ls grou. Furthermore, a strong association between LS and ain in both the back and hi joint was shown, and the mean PCS score of the articiants in the LS grou was significantly lower than that of articiants in the non- LS grou. Thus, intervention to revent LS is imortant during its early stages, and signs such as ain in the locomotorium and anxiety about hysical strength must not be overlooked. Conflict of Interests The authors declare that they have no cometing interests. Acknowledgments This work was suorted by JSPS KAKENHI Grant Number JPK228. References ) GBD 203 DALYs and HALE Collaborators Global, regional, and national disability-adjusted life years (DALY) for 30 diseases and injuries and healthy life exectancy (HALE) for 88 countries, 0-203: quantifying the eidemiological transition. Lancet 38: doi: 0.0/ S040-73(5)340-x. Accessed 27 Aug ) Ministry of Health, Labour and Welfare, Jaan. Jaanese Life Tables. htt:// Accessed 3 Jan ) Cabinet Office, Government of Jaan. 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