Prof. Yoshikazu Yonei, M.D., Ph.D.Anti-Aging Medical Research Center, Graduate School of Life and Medical Sciences, Doshisha University

1-3 Tatara-Miyakodani, Kyotanabe-city, Kyoto 610-0321 JapanTel: +81-774-65-6394 / Fax: +81-774-65-6394 / E-mail: yyonei@mail.doshisha.ac.jp

Anti-Aging Medicine 7 (7) : 73-84, 2010(c) Japanese Society of Anti-Aging Medicine

Original ArticleEfficacy of a Health Promotion Program with Anti-Aging Medical Checkup and Instructions for Walking under Pedometer Management in Factory Workers

73

Objective: We developed an easily maintained health promotion program for factory workers in a company which introduced an anti-aging medical checkup with pedometer-based walking management. Here, we describe it’s effect on body and mind. Methods: Subjects were 17 male employees (mean age, 50.6±4.3 years old; mean body weight 82.8±9.2kg; mean BMI, 27.2±1.9kg/m2: mean abdominal circumference; 95.6±5.7cm) of a machine factory (Murata Machinery, Inuyama-city, Aichi) who were judged to require lifestyle guidance. They were provided with pedometers and encouraged to walk. Data records for the number of steps taken were collected every four weeks. An anti-aging medical checkup was conducted three times before, 12 weeks and 24 weeks after the study.Results: Collection ratio for information on the number of steps walked was 82.8%. The average daily number of steps walked increased from a baseline of 10277 steps by 1096 steps (10.7%) at 24 weeks. Anthropometry showed significant improvements in weight (– 3.9%, p=0.013) BMI (–3.6%, p=0.014) and abdominal circumference (– 4.8%, p=0.003). Clinical laboratory tests showed significant improvements in HDL cholesterol (pre-value 51.0±10.0mg/dl, 12.7%, p=0.043), HbA1c (pre-value 5.5±0.6%,

– 8.4%, p<0.001) and adiponectin (pre-value 5.17±1.03μg/ml, 39.9%, p=0.001). Anti-aging medical checkup showed the highest functional age, 35.3% in nerves, 35.3% in bone, and 29.4% in blood vessels, as well as significant changes in vascular age by acceleration plethysmography SDP-100 (pre-value 52.1±12.0 years old, – 12.7%, p=0.024), calcaneus bone stiffness by ultrasonography A-1000 (9.5%, p=0.007), and response time by the Wisconsin card sorting test (p=0.024). No significant change was noted in muscle age as evaluated by bioelectrical impedance analysis (Physion MD). The questionnaire showed that the major reason for continuation with the program was “the presence of an anti-aging medical checkup”, health promotion was assisted by “results of anti-aging medical checkup”, and the modified behavior was “increased amount of exercise”.Conclusion: This health promotion program, consisting of an anti-aging medical checkup and pedometer-guided walking program, appears effective in improving the lifestyle and condition of factory workers.

Abstract

Keitaro Nomoto, Ryo Miyazaki, Tsutomu Hasegawa, Umenoi Hamada, Hiroshi Ichikawa, Yoshikazu Yonei

Anti-Aging Medical Research Center, Graduate School of Life and Medical Sciences, Doshisha University

KEY WORDS: physical exercise, walking, pedometer, adiponectin, industrial health

Received: Mar. 29, 2010Accepted: May. 24, 2010Published online: Jun 21, 2010

Introduction The incidence of lifestyle-related diseases has increased steadily in recent years, and has become a major social issue. The results of a national health and nutrition survey in 2008 indicated that one of two males and one of five females from the age of 40 to 74 years was at risk of developing metabolic syndrome 1). These diseases occur frequently in middle-aged and elderly persons. Though it’s time of full activity for the labors, diseases present at this age are difficult to resolve. It is therefore important to motivate middle aged laborers to improve their lifestyle. We consider that the promotion of hearth produces a synergistic effect, for example by decreasing the incidence of workplace accidents and increasing productivity. Prevention of lifestyle-related diseases in middle-aged men is therefore an important focus in Anti-Aging Medicine.

Consistent with this, a number of company labor unions in Japan have policies promoting a healthy employment environment for workers. We received a request from a company, Murata Machinery Co. Ltd. (Fushimi-ku, Kyoto) to introduce an anti-aging medical checkup which is consistent with the theory and practice of Anti-Aging Medicine 2). We therefore developed a health promotion program for employees to easily practice and maintain in the workplace. We then implemented this checkup in some workers. Anti-aging medical checkup presents the physiological function of subjects in terms of functional age, facilitating patient understanding of their health condition as compared to usual health checkups. For this reason, we also consider that this approach promotes the motivation of employees to use the system. An additional consideration in encouraging the adoption of health-promoting practices among older workers is their compliance

in making and maintaining life-style change, such as increasing the amount of exercise they undertake. In this program, therefore, we implemented an intervention to increase the number of steps each subject makes per day 3-5). Walking is an aerobic exercise which is easily adopted and maintained in the workplace. An increase in the number of daily steps is easily monitored using pedometers. Epidemiological studies suggest that it is ideal for people to walk “10,000 steps per day” 1,3). Against this background, the present study was undertaken to evaluate the effects of a long-term intervention based on a health promotion program which sought to increase the number of daily steps and frequent nutritional guidance on various anti-aging indicators in a group of employees.

Methods

Subjects The subjects were 17 male employees (mean, 50.6±4.3 years old, weight: 82.8±9.2kg, BMI: 27.2±1.9kg/m2, abdominal circumference: 95.6±5.7cm) of a machinery factory, located at Inuyama, Aichi, who were judged to require daily life guidance. Of the 17 men, 3 dropped out (drop out ratio: 17.6%), 2 due to scheduling conflicts and 1 to an unrelated accident. Of the remaining 14 men, 2 were under medication for type 2 diabetes mellitus (HbA1c≥6.1%), 4 had borderline type 2 diabetes mellitus (HbA1c≥5.5% and ≤6.1%), 3 had high insulin resistance (HOMA-R≥ 2.5), and 2 had hypertension (blood pressure≥140/90 mmHg).

Health Promotion Program The intervention period was 24 weeks, during which the subjects were asked to maintain their normal daily routine except with regard to the nutritional and exercise instructions given to them. They were also instructed to avoid a lack of sleep. The intervention commenced on July 9, 2009 and was completed on December 21, 2009. Instructions were individually provided to the subjects based on the results of their anti-aging medical checkup in Weeks 0 and 12. Checkups were conducted every 4 weeks (Weeks 0, 4, 8, 12, 16 and 20) and took about 30 minutes each. This system is recently called ‘Anti-Aging Dock’ in Japan, Korea and Taiwan. Each subject was provided with a pedometer (HJ-710IT, Omron Health Care Co. Ltd., Ukyo-ku, Kyoto) which automatically recorded the number of steps taken 3). Although it retains a maximum of 42 days’ data, data were collected regularly each month. The pedometer is equipped with a screen which enables the user to check the data recorded for any 7-day period prior to a given day, broken down into parameters such as “number of steps”, “energy consumed”, and “distance walked.” The pedometer also measures the amount of physical exercise undertaken, and has been reported to be effective in increasing physical exercise. Information regarding the number of steps taken was transferred by USB cable to a personal computer and entered into the management system (Pochittolife, Chealcomm Co. Ltd., Chiyoda-ku, Tokyo). In the walking instructions, we checked the date on how much each subject walked and encouraged him to walk “10,000 steps per day” 3).

Exercise instruction was provided by a physical therapist qualified as a health fitness instructor (Yoko Amenomori, Excellcia, Shinjuku-ku, Tokyo). Exercises that the subjects could perform at home or office were demonstrated by the therapist, and were also provided on a DVD the subject could review later 6). Compliance with exercise was checked using a self-completed life diary. Nutritional instruction was provided by medical laboratory technicians, who planned the diets for each subject based on his hematological data, and provided simple instructions such as the order in which to eat various foods at mealtime. Further, the subjects also underwent an anti-aging medical check up to provide them with a source of motivation. In this checkup, using the Age Management Check system (Ginga Kobo, Naka-ku, Nagoya-city, Aichi), relative functional age for muscles, blood vessels, nerves, hormones, and bones was calculated based on population information taken for each of these parameters, and each subject was notified of his resultant functional age 3). This process was intended to help subjects recognize their individual weak points related to aging and to encourage them to attempt to rejuvenate their bodies, and hence facilitate a change in behavior. To evaluate the effectiveness of this program, we sent out a questionnaire to the subjects. The items were “The reason why you can continue this program”, “The contents which was of benefit to your health”, and “The contents of changing life-style”.

Evaluation of Subjective Symptoms Subjective symptoms were evaluated by dividing them into two categories, “physical symptoms” and “mental symptoms.” As previously reported, the Anti-Aging QOL Common Questionnaire (AAQol) was used to rate individual symptoms according to a 5-grade scale ranging from 1 to 5 points 3,7). The score means “1: Not at all”, “2: Almost none”, “3: A little”, “Moderate degree”, “High degree”. We defined that the higher a score was, the worth their condition was. With regard to life-style, subjects were questioned about dietary habits, fitness habits, sleep, cigarette smoking, alcohol drinking, and water consumption. The questionnaire was performed seven times during the intervention, once every four weeks.

Anthropometry Examination Anthropometry was performed a total of three times, on Weeks 0, 12 and 24. Body composition testing was performed using a bioelectrical impedance analyzer for muscle mass (Physion MD, Physion, Shimogyo-ku, Kyoto) 3,8) which provides precision measurement of total body composition (body fat amount, percentage body fat, and lean body) mass, water content, muscle mass, and bone mass.

Blood Biochemistry Examination Blood biochemistry examination was performed a total of three times, on Weeks 0, 12 and 24. Inspection items in addition to specific health examination items were leukocyte count, platelet count, neutrophils, lymphocytes, monocytes, eosinophils, basophils, total protein, albumin, albumin/globulin (A/G) ratio, lactic dehydrogenase (LDH), total bilirubin, alkaline phosphatase (ALP), creatine phosphokinase (CPK), urea nitrogen, creatinine, uric acid, sodium, chlorine, potassium, calcium, serum iron, total cholesterol, insulin, cortisol, dehydroepiandrosterone-sulfate (DHEA-s), adiponectin and insulin-like growth factor-I (IGF-I). Blood biochemistry examination was performed at Mitsubishi

74

Effect of Walking under Pedometer Management in Factory Workers

Education, Culture, Sports, Science and Technology. The study protocol was approved by the ethics committee of Doshisha University Ethical Review Board. Approval from the person in charge of the labor union involved and the industrial physician of the enterprise was obtained. Each subject decided to participate in the study of his own accord by providing written informed consent. Further, subjects were informed that they could withdraw consent for any reason without fear of being disadvantaged in any way.

Statistical Analysis Repetition decentralization analysis was used to compare the measurements from Weeks 0, 12 and 24. All data was expressed as mean ± standard deviation (SD). Correlation analysis was performed by Spearman’s method. Significance level was set at p<0.05. All statistical analysis was done using SPSS for Windows Ver.15.0 (SPSS Japan, Shibuya-ku, Tokyo).

Chemical BCL Co. (Itabashi-ku, Tokyo). Based on the results, arterial sclerosis index ((total cholesterol – HDL cholesterol) ÷ HDL cholesterol), LDL cholesterol/HDL cholesterol ratio. HOMA-R ((blood glucose × insulin) ÷ 405) (It is an index of the insulin resistance), and DHEA-s/ Cortisol ratio (an index of the stress) were calculated.

Anti-Aging Medical Checkup Physical function related to aging was evaluated by measuring muscle mass, bone density, by hormonal tests, by degree of atherosclerosis, and by executive brain function tests as follows. To evaluate muscle age, muscle mass was determined with a bioelectrical impedance analyzer for muscle mass (Physion MD) 9). Measurements obtained with this analyzer correlate well with MRI data, with correlation coefficients of 0.940 for the upper extremity, 0.917 for the leg, 0.968 for the upper arm, and 0.901 for the thigh 10). We previously reported a large-scale analysis of body composition and segmental muscle mass using data obtained with this analyzer in 10,335 healthy Japanese individuals 8). Lower limb muscles, especially the quadriceps muscle, play an important role in loaded movements such as walking, stepping exercises, and standing up, which are required in activities of dairy living (ADL). Therefore, maintaining the strength of the quadriceps muscle is recommended for the maintenance of QOL in the elderly. To assess the ability of ADL, the weight-bearing index (WBI) 11,12) was calculated. That is, the quadriceps femur muscle volume and maximum strength were calculated from segmental muscle mass values and body balances (right and left, upper and lower limbs, trunk and extremities balances), and then WBI was calculated from the formula: WBI = quadriceps muscle maximum strength ÷ body weight. Bone age was evaluated from the value of stiffness of the calcaneus bone as determined by ultrasonography (A-1000, GE Yokogawa Medical Systems, Ltd., Hino-city, Tokyo) 13,14). There is a high correlation between stiffness and bone mineral density by dual-energy X-ray absorptiometry (DEXA), with the correlation coefficient in this bone of r=0.6~0.8 14). Results were expressed as stiffness values and % young adult mean (%YAM). Hormonal age was evaluated from the serum concentration of DHEA-s and IGF-I, which are known to decrease with aging, by referring to the reference data of Age Management Check 3). The degree of atherosclerosis was evaluated by acceleration plethysmography (SDP-100, Fukuda Denshi Co. Ltd., Bunkyo-ku, Tokyo) 15,16), and the results were expressed as vascular age 17). Executive brain function was evaluated by Wisconsin card sorting test (WCST) 19,20). Results were expressed as categories achieved (CA), numbers of response cards used until the first category achieved (NUCA), total errors (TE), preservative errors of Nelson (PEN), preservative errors of Milner (PEM), unique errors (UE), BR (bizarre response (BR) and response time.

Ethical Considerations The study was conducted in accordance with the principles of the Declaration of Helsinki, including the amendments made in the Tokyo general meeting in 2004, and the Act for Protection of Computer Processed Personal Data held by Administrative Organs, as well as with the “Ministerial ordinance (GCP) concerning the standard of the execution of the clinical trial of the medicine” (Public Welfare Ministerial Ordinance No. 28, March 27, 1997). Further, it was conducted at a health care center in the enterprise referring to “Ethics indicator concerning the epidemiologic study” of the Ministry of Health, Labour and Welfare and the Ministry of

Results

Health Promotion Program Subject compliance with the methods of each intervention is shown in Table 1. Compliance with the walking guidance was assumed to be a ratio assessable from the number of steps taken in the intervention period; and in the exercise guidance, from a DVD audience rating for the exercise at home; and in the nutritional guidance, from the participation rate of the subject on the guidance day. Compliance was 82.8% with the walking guidance, 17.4% from the exercise guidance, and 92.0% with the nutritional guidance. Results of the number of daily steps of the subjects during the program are shown in Fig. 1. Although no significant increase in the average number of daily steps was seen at four-week intervals when walking guidance was assumed, the average number of daily steps (11,373) of the subjects during the intervention period markedly exceeded the average number of daily steps of Japanese men.

Subjective Symptoms Evaluated by the AAQol Five of 34 physical symptoms, namely “tendency to gain weight”(p=0.012), “lethargy” (p=0.007), “hair loss” (p=0.039), “lumbago” (p=0.008), and “sweat easily” (p=0.016) (Table 2), and 3 of 21 mental symptoms, namely “inability to concentrate” (p=0.017), “inability to solve problems” (p=0.024) , and “feeling tense” (p=0.039), (Table 3) improved significantly by Week 24. With regard to lifestyle-related behaviors, no significant change was seen.

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Table 1 Compliance of the health promotion program

Contents Compliance

82.8

17.4

92.0

3.8

7.0

8.1

±

±

±

%

%

%

Walking

Exercise with DVD

Attendance rate to nutritional guidance

Mean ± SD. n=14.

76

Effect of Walking under Pedometer Management in Factory Workers

Table 2 Physical symptoms

mean SD

3.3 2.9 1.6 3.4 2.6 1.8 1.9 3.9 1.2 2.6 2.2 2.2 2.1 1.8 1.9 2.0 2.0 2.1 2.4 1.9 2.7 3.2 2.1 2.1 1.9 3.2 2.7 2.3 3.4 2.9 1.9 1.4

±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±

1.1 1.1 0.6 1.3 1.2 0.8 0.9 1.2 0.4 0.5 0.6 1.2 1.1 0.6 0.7 0.7 0.8 0.8 0.8 1.0 1.1 1.5 0.8 0.7 0.7 1.3 1.2 1.0 1.0 1.3 0.5 0.5

mean SD

2.8 2.6 1.6 3.1 2.9 1.7 1.7 3.6 2.0 2.2 2.1 1.9 1.9 1.6 1.9 1.8 1.9 2.1 2.3 1.9 2.3 3.3 2.0 1.9 1.9 2.9 2.4 2.2 3.1 2.6 1.6 1.4

±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±

1.3 1.2 0.9 1.4 1.1 0.7 0.7 0.9 0.7 1.0 0.9 1.0 0.7 0.6 0.8 0.9 0.8 0.8 0.9 0.9 1.1 1.2 1.0 0.8 1.0 1.4 1.3 0.8 1.3 1.2 0.8 0.5

mean SD

2.8 2.6 1.7 2.8 2.5 1.7 1.8 3.0 1.9 1.9 2.1 2.1 1.8 1.6 1.8 1.9 1.9 1.9 1.9 2.0 2.2 3.0 2.1 1.8 1.7 2.5 2.4 2.0 2.5 2.4 1.8 1.6

±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±

1.0 0.9 0.7 1.3 1.2 0.5 0.6 1.0 0.9 0.6 0.5 0.7 0.8 0.5 0.6 0.5 0.5 0.7 0.8 0.7 0.9 1.2 0.6 0.6 0.9 1.1 1.3 0.7 1.3 1.1 0.7 0.6

（vs. week 0)

0.860 0.225 1.000 0.067 1.000 1.000 1.000 0.012 0.065 0.007 1.000 1.000 1.000 1.000 1.000 1.000 1.000 0.817 0.268 1.000 0.039 0.817 1.000 0.288 1.000 0.008 0.494 1.000 0.016 0.331 1.000 0.817

*

**

*

**

*

Tired eyesBlurred visionPainful eyesStiff shouldersMuscular pain/stiffnessPalpitationsShortness of breathTendency to gain weightWeight loss/thinLethargyNo sense of wellnessThirstSkin problemsAnorexiaEarly satietyEpigastralgiaLiable to catch coldsCoughing and sputumDiarrheaConstipationHair lossGray hairHeadacheDizzinessTinnitusLumbago ArthralgiaEdematousSweat easilyFrequent urinationHot flashesCold skin

p-valueWeek 0 Week 12 Week 24

n=14. * p<0.05, ** p<0.01.

0

4000

8000

12000

16000

20000

Time course (week)

Ave

rage

of d

aily

step

s

1~4 21~2417~2013~169~12 5~8

Fig. 1. Transition of average number of daily walking steps during the observation period (n=12)

Table 3 Mental symptoms and lifestyle-related behaviors

mean SD

2.1 2.4 2.1 2.0 2.0 2.0 1.8 1.9 1.8 1.9 2.3 1.9 2.0 3.0 2.5 2.2 1.9 1.9 2.6 1.9 1.6

±±±±±±±±±±±±±±±±±±±±±

0.5 0.8 0.4 0.8 0.7 0.7 0.4 0.5 0.4 0.5 0.9 1.0 0.9 1.2 0.8 0.6 0.5 0.5 0.6 0.5 0.5

6.4 407.1

3.6 1.3 6.1 1.5 5.5

±±±±±±±

8.6 301.8 2.6 1.4 0.6 0.8 1.9

mean SD

2.2 2.0 2.0 2.0 1.9 1.9 1.8 1.8 1.9 1.9 2.4 2.0 1.9 2.7 2.3 1.8 1.7 1.9 2.1 1.7 1.8

±±±±±±±±±±±±±±±±±±±±±

0.7 0.6 0.8 0.7 0.6 0.7 0.6 0.7 0.4 0.6 0.7 0.5 1.3 1.2 1.0 0.4 0.5 0.5 0.6 0.5 0.6

6.1 425.0

3.3 3.3 6.1 1.9 6.2

±±±±±±±

8.5 257.8 2.3 2.5 0.7 1.0 2.3

mean SD

2.1 2.4 2.1 2.0 2.0 2.0 1.8 1.9 1.8 1.9 2.3 1.9 2.0 3.0 2.5 2.2 1.9 1.9 2.6 1.9 1.6

±±±±±±±±±±±±±±±±±±±±±

0.5 0.8 0.4 0.8 0.7 0.7 0.4 0.5 0.4 0.5 0.9 1.0 0.9 1.2 0.8 0.6 0.5 0.5 0.6 0.5 0.5

6.3 508.6

3.6 2.9 6.2 1.7 5.9

±±±±±±±

8.5 489.5 2.4 2.3 0.6 0.7 2.6

（vs. week 0)

1.000 0.141 0.568 1.000 1.000 0.568 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 0.017 0.024 1.000 1.000 0.039 1.000 0.817

1.000 0.744 1.000 0.067 1.000 1.000 1.000

**

*

Mental symptomsIrritabilityEasily angeredLoss of motivationUnhappyNothing to look forward to in lifeDaily life is not enjoyableNo confidenceReluctance to talk with othersDepressedFeeling uselessShallow sleepDifficulty falling asleepPessimismMemory lapse Inability to concentrateInability to solve problemsInability to readily make judgmentsInability to sleep due to worriesFeeling tenseFeeling anxious for no particular reasonVague feeling of fear

Lifestyle-related behaviors

SmokingAlcohol consumptionFrequency of alcohol drinking ExerciseSleeping hoursWater consumptionVDT working hours

Cigarettes/day mL/daytimes/weekdays/weekhours/dayL/dayhours/day

p-valueWeek 0 Week 12 Week 24

n=14. * p<0.05, ** p<0.01.

Table 4 Anthropometry

mean SD

173.6 82.8 27.4 95.6

131.0 81.4 76.9

±±±±±±

5.9 9.2 1.9 5.7 11.2 8.8 11.7

21.3 25.6 61.5 74.4 30.1 36.2 13.1 15.7 45.0 54.5

1711.0

±±±±±±±

3.8 2.8 6.6 2.8 4.6 3.0 2.1 1.4 4.8 2.1 168.6

mean SD

80.1 26.6 92.4

130.3 80.0 75.3

±±±±±±

8.2 1.8 6.2 8.6 10.2 8.6

20.0 24.8 60.2 75.3 29.1 36.3 12.6 15.8 44.1 55.1

1673.1

±±±±±±±

4.2 3.8 5.8 3.7 4.2 3.5 1.9 1.6 4.2 2.7 146.2

mean SD

79.626.4

91.0 134.3

84.873.2

±±±±±±

8.91.96.38.68.68.6

19.824.759.975.328.836.212.815.843.855.1

1663.6

±±±±±±±

4.54.0 6.34.0 4.23.41.91.54.62.9160.0

（vs. week 0)

0.013 0.014 0.003 0.805 0.441 0.476

0.147 0.530 0.008 0.530 0.011 1.000 0.023 1.000 0.008 0.512 0.005

****

**

*

*

**

**

HeightWeightBMIAbdominal CircumferenceSystolic blood pressureDiastolic blood pressureHeart Rate

cmkg

cmmmHgmmHgbpm

Body composition testing

Amount of fatPercentage body fatLean body massPercentage Lean body massMuscle massPercentage muscleBone massPercentage boneWater contentPercentage waterBasal metabolic rate

kg%kg%kg%kg%kg%kcal

p-valueWeek 0 Week 12 Week 24

n=14. * p<0.05, ** p<0.01.

77

Anthropometry Comparison of pre- and post-intervention data revealed a significant reduction in body weight (– 3.9%, p=0.013), BMI (– 3.6%, p=0.014), and abdominal circumference (– 4.8%, p=0.003) (Table 4). Pre- and post-intervention body composition data by bioelectrical impedance analysis revealed a significant reduction in lean body mass (– 2.6%, p=0.008), muscle mass (– 4.3%, p=0.011), bone mass (– 2.3%, p=0.023), water content (– 2.7%, p=0.008), and basal metabolic rate (– 2.8%, p=0.005).

Blood Biochemistry Blood biochemistry revealed a significant change by Week 24 in sodium (1.1%, p=0.004), within the range of physiologic change (Table 5). Concerning lipid metabolism, total cholesterol, LDL-cholesterol, and triglyceride showed no significant changes, while HDL-cholesterol (12.7%, p=0.043) significantly improved. Adiponectin (39.9%, p=0.001), which is related with lipid metabolism, also significantly improved. Concerning blood sugar metabolism, blood glucose and insulin showed no significant changes, while HbA1c (– 8.4%, p<0.001) significantly decreased. Stress-related hormones DHEA-s, cortisol, DHEA-s/cortisol ratio, and IGF-I (an index of the hormonal age) showed no significant changes.

Effect of Walking under Pedometer Management in Factory Workers

78

Table 5 Blood biochemistry

mean SD

6257 498

15.9 48.3 24.5 52.4 38.8

5.3 3.0 0.5 7.7 4.7 1.6

24.9 33.6

183.4 1.2

227.6 57.5

158.4 11.8 0.86

6.1 141.5 103.5

4.2 9.8

114.7 200.4 123.9

51.1 2.6

129.4 3.1

93.3 5.5 7.7 1.8 9.4

179.1 20.4 5.17

192.3

±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±

2199 33 1.0 3.1 4.8 8.6 8.1 1.4 1.7 0.4 0.3 0.1 0.2 9.9 20.5 19.5 1.1 66.6 58.3 136.6 1.7 0.13 1.1 1.4 2.4 0.2 0.3 55.1 27.0 21.9 9.7 0.9 78.3 1.1 10.9 0.6 3.2 0.9 2.9 53.9 7.7 1.03 34.8

mean SD

6100 486

15.6 48.0 22.7 54.0 37.8

4.3 3.2 0.7 7.5 4.6 1.6

23.5 27.0

182.6 1.1

210.7 51.1

150.9 13.4 0.87

6.3 142.9 104.1

4.4 9.9

108.6 202.4 124.4

54.0 2.4

103.8 2.9

91.4 5.1 5.8 1.3

11.4 196.1

18.9 6.04

191.0

±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±

1817 33 1.1 3.5 4.3 5.4 5.6 1.5 1.8 0.4 0.5 0.2 0.2 6.1 11.4 17.7 0.7 52.3 52.6 88.7 3.2 0.11 1.1 1.8 2.6 0.3 0.3 26.9 20.9 18.2 9.4 0.7 65.8 0.9 8.5 0.4 2.4 0.6 3.0 67.9 9.7 3.61 36.7

mean SD

6207 508

15.9 49.4 23.7 56.3 34.9

5.2 3.0 0.7 7.9 4.8 1.6

22.4 25.9

186.1 1.0

220.2 53.3

150.4 12.9 0.82

6.2 143.1 103.7

4.3 9.9

124.8 207.6 125.6

57.6 2.3

112.4 2.7

97.1 5.0 7.4 1.8

10.7 194.1

18.8 7.24

205.7

±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±±

1810 31 1.0 3.6 4.9 7.2 6.0 1.5 1.6 0.5 0.3 0.2 0.2 6.0 11.9 23.5 0.5 58.7 55.5 50.0 3.0 0.10 1.2 1.2 1.7 0.3 0.3 44.7 25.0 26.8 9.3 0.8 67.6 1.0 8.3 0.4 2.9 0.7 2.6 75.6 7.3 3.55 43.2

（vs. week 0)

1.000 0.185 1.000 0.081 0.227 0.428 0.354 1.000 1.000 0.376 0.064 0.066 1.000 1.000 0.551 1.000 0.817 1.000 0.891 1.000 0.559 0.070 1.000 0.004 1.000 0.547 1.000 1.000 0.449 1.000 0.043 0.075 1.000 0.056 0.533 < 0.0011.000 1.000 0.505 0.589 0.610 0.001 0.171

**

*

**

**

Leukocyte countErythrocyte countHemoglobinHematocritPlatelet countNeutrophilsLymphocytesMonocytesEosinophilsBasophilsTotal proteinAlbuminA/G ratioASTALTLDHTotal bilirubinALPγGTPCPKUrea nitrogenCreatinineUric acidSodiumChlorinePotassiumCalciumSerum ironTotal cholesterolLDL cholesterolHDL cholesterolL/H ratioTriglycerideArterial sclerosis indexBlood glucoseHbA1cInsulinHOMA-RCortisolDHEA-sDHEA-s/Cortisol ratioAdiponectinIGF-I

/μL

×104/μL

g/dL

%

×104/μL

%

%

%

%

%

g/dL

g/dL

IU/L

IU/L

IU/L

mg/dL

IU/L

IU/L

IU/L

mg/dL

mg/dL

mg/dL

mEq/L

mEq/L

mEq/L

mg/dL

μg/dL

mg/dL

mg/dL

mg/dL

mg/dL

mg/dL

%

μU/mL

μg/dL

μg/dL

μg/mL

ng/mL

p-valueWeek 0 Week 12 Week 24

n=14. * p<0.05, ** p<0.01.

79

Table 6 Anti-aging medical checkup

mean SD

0.90 0.66 1.56 4.64 2.00 6.64 6.98

0.83 0.67 1.50 4.76 2.03 6.79 6.58

92.7 101.5

96.4 102.4 101.5 102.2

94.6

0.840 0.861

±±±±±±±

±±±±±±±

±±±±±±±

±±

0.18 0.10 0.27 0.62 0.27 0.88 1.24

0.17 0.11 0.27 0.76 0.31 0.99 1.08

5.6 5.7 4.3 4.5 6.6 3.5 5.0

0.049 0.064

52.1 ± 12.0

mean SD

0.89 0.65 1.47 4.50 1.97 6.47 6.73

0.83 0.63 1.46 4.52 2.00 6.52 6.36

94.0 97.3 95.4

100.5 101.2 100.7

95.0

0.839 0.842

±±±±±±

0.17 0.10 0.39 0.63 0.31 0.90 1.14

0.14 0.09 0.22 0.69 0.35 0.98 0.86

5.0 4.5 4.3 3.3 4.8 2.3 4.7

0.074 0.071

52.2 ± 12.0

mean SD

0.90 0.64 1.55 4.42 1.95 6.37 6.74

0.83 0.62 1.45 4.48 1.93 6.41 6.32

92.7 97.2 94.6

101.3 98.8

100.5 94.5

0.832 0.843

±±±±±±

0.23 0.12 0.34 0.52 0.30 0.78 1.23

0.16 0.10 0.25 0.58 0.35 0.87 0.85

6.2 7.0 5.7 5.1 6.8 4.3 5.6

0.059 0.071

45.5 ± 10.4

（vs. week 0)

1.000 0.548 1.000 0.001 1.000 0.040 0.101

1.000 0.006 0.169 0.028 0.545 0.107 0.107

1.000 0.091 0.440 1.000 0.546 0.500 1.000

1.000 0.711

0.024

**

*

**

*

*

Muscle mass

(Right side)Upper armForearmUpper limb Thigh Leg Lower limb Trunk (Left side)Upper arm Forearm Upper limb Thigh Leg Lower limb Trunk (Right-left balance)Upper arm Forearm Upper limb Thigh Leg Lower limb Trunk (WBI)RightLeft

kg

kg

kg

kg

kg

kg

kg

kg

kg

kg

kg

kg

kg

kg

%

%

%

%

%

%

%

Acceleration plethysmography

Vascular age years

88.1 84.5

±±

16.2 15.6

89.5 85.8

±±

18.2 17.3

96.5 92.6

±±

22.2 21.4

0.007 0.007

****

Bone mineral density tests

Stiffness valueComparison with the younger age group

%

5.2 3.0

13.7 0.8 1.5 0.2 0.0

74.7

±±±±±±±±

0.7 3.3 3.5 1.6 1.8 0.4 0.0 12.6

5.4 1.7

12.0 0.6 0.9 0.2 0.0

70.4

±±±±±±±±

0.8 2.4 4.2 1.1 1.4 0.8 0.0 15.0

5.7 1.1

10.2 0.2 0.4 0.0 0.0

59.3

±±±±±±±±

0.5 1.4 2.2 0.4 0.9 0.3 0.0 7.9

0.268 0.251 0.054 0.689 0.302 1.000 ND< 0.001 **

Brain executive function test: WCST

CANUCATEPENPEMUEBRResponse time ssecond

p-valueWeek 0 Week 12 Week 24

n=14. * p<0.05, ** p<0.01. ND: not determined.CA: categories achieved.NUCA: numbers of response cards used until the first category achieved.TE: total errors.PEM: perseverative errors of Milner.PEN: perseverative errors of Nelson.UE: unique errorsBR: bizarre response.

Anti-Aging Medical Checkup Results of muscle mass measurement in each segment are shown in Table 6. Muscle mass significantly decreased in thigh (right: p=0.001, left: p=0.028), left forehand (p=0.006), and right limb (thigh + leg) (p=0.040). There was no significant difference when adjusted by weight. WBI did not change significantly.The executive brain function test by WCST showed a significantly shortening of reaction time , indicating improvement of function. With regard to atherosclerosis, vascular age by acceleration plethysmography was significantly reduced by – 12.7% (p=0.024). Bone density tests showed a significant improvement in stiffness value in the calcaneus bone (9.5%, p=0.007) and in %YAM (9.6%, p=0.007). Results of functional age calculated by Age Management Check, an evaluation system for aging, are shown in Table 7. The highest value in the five categories of functional age was 35.3% (6 of 17) in nervous system age, 35.3% (6 of 17) in bone age, and 29.4% (5 of 17) in vascular age at Week 0. No one had the highest values in muscle age and hormonal age. Vascular age was significantly reduced by -15.6% (p=0.013). The results of the overall questionnaire were as follows. The most frequent answer to “the reason why you can continue this program” was “the presence of anti-aging medical checkup”. The most frequent answer for “the contents which was of benefit to your health” was “results of anti-aging medical checkup”, and that for “the contents of changing life-style” was “increased amount of exercise”.

Walking Steps and Correlation Analysis In order to evaluate the effect of walking, correlation analysis was performed with regard to the average number of steps and change in the number of steps. The average number of steps was calculated as the average of the daily number of steps for 24 weeks in all participants. The change in the number of steps was the difference in values between the first 4 weeks and the overall 24 weeks. Items which showed a significant correlation with the average number of steps were as follows: weight (r=– 0.644, p=0.024), body fat mass (r=– 0.581, p=0.048), BMI (r=– 0.639, p=0.025), basal metabolic rate (r=– 0.588, p=0.044), creatinine (r=– 0.605, p=0.037), HDL cholesterol (r=0.718, p=0.009) (Fig.2), HbA1c (r=– 0.712, p=0.009) (Fig.3), arterial sclerosis index (r=– 0.715, p=0.009), adiponectin (r=0.704, p=0.011) (Fig.4), and L/H ratio (r=– 0.705, p=0.010). Items which showed a significant correlation with change in the average number of steps were as follows: bone stiffness value (r=0.726, p=0.008), %YAM (r=0.723, p=0.008), fasting blood sugar (r=– 0.661, p=0.019), HbA1c (r=– 0.776, p=0.003).

Effect of Walking under Pedometer Management in Factory Workers

Table 7 Functional ages and risk factor score for aging using the Age Management Check system

mean SD

41.254.454.943.852.8

±±±±±

2.812.0 13.64.919.2

mean SD

41.751.147.143.854.4

±±±±±

3.210.711.85.920.3

mean SD

41.545.943.443.051.6

±±±±±

3.37.48.95.418.6

（vs. week 0)

0.950 0.013 0.095 0.944 1.000

*Muscle ageVascular ageNervous ageHormonal ageBone age

yearsyearsyearsyearsyears

p-valueWeek 0

Degree of aging

Week 12 Week 24

n=14. * p<0.05, ** p<0.01.

80

Fig. 2. Correlation between average number of daily walking steps and percentage change of HDL cholesterol (n=12) Percentage change of HDL cholesterol: y = 0.028 x – 17.54, r=0.718, p=0.009

020406080

100120140

0 5000 10000 15000 20000 25000

Average of daily steps

% C

hang

e of

Adi

pone

ctin

81

Fig. 3. Correlation between average number of daily walking steps and percentage change of HbA1c (n=12) Percentage change of HbA1c: y = 0.006 x – 1.37, r=0.712, p=0.009

-20

-15

-10

-5

0

0 5000 10000 15000 20000 25000

Average of daily steps

% C

hang

e of

HbA

1c

Fig. 4. Correlation between average number of daily walking steps and percentage change Percentage change of adiponectin (n=12) Percentage change of adiponectin: y = 0.046 x – 3.77, r=0.704, p=0.011

-20-10

0102030405060

0 5000 10000 15000 20000 25000

Average of daily step

% C

hang

e of

HD

L-C

hole

ster

ol (%

)

Effect of Walking under Pedometer Management in Factory Workers

Discussion

Evaluation of the Health Promotion Program In the present health promotion program, compliance with walking was high (82.6%). Walking is an aerobic activity that can be easily done and continued, and thus workers can easily adopt it into their daily life. On the other hand, exercise was limited to home, and it took time for the DVD to start, either of which may explain why compliance was low. The effect of the program in the present study is thought to been chiefly due to walking. With regard to the nutrition instructions, the participation rate of subjects on the guidance day was markedly high, at nearly 80%. A large-scale cohort study aimed at preventing metabolic syndrome in workers showed that the risk of new-onset hypertension decreased by 21% in men who walked 21 minutes or more one way when commuting 21). Moreover, the incident risk of type 2 diabetes mellitus decreased by 44% when patients positively exercised on holidays, even though it was difficult to do so on weekdays 22). A habit of regular exercise decreases the risk of lifestyle-related diseases. However, this is not easy for workers, who too are busy to include exercise into daily life. Here, therefore, we investigated “instructions for walking under pedometer management”. Although walking is an easy activity, temporary use of a pedometer cannot determine whether a subject actually walks. We considered that regularly presenting pooled data for the number of daily steps to their manager would be a suitable means of applying the psychological pressure required to make them comply with behavior modification. In “the instructions for walking under pedometer management”, the number of daily steps is one of the key indicators. Results showed no significant increase in the average number of daily steps before and after intervention. It is meaningful that the average number of daily steps greatly exceeded of the average of Japanese men during the intervention period.

Anthropometry and clinical laboratory tests Concerning anthropometry, weight (– 3.9%), BMI (– 3.6%), and abdominal circumference (– 4.8%) improved during the study period, indicating that the program exerted a favorable effect on the body. In the body composition analysis by the bioelectrical impedance method, a significant decrease in muscle mass and the bone mass was seen. However, when the data were adjusted for weight, no significant change was noted in the percentage muscle mass and percentage bone mass. We therefore considered that this was effect was not unfavorable. Generally, muscle mass decreases with aging 8), and so it was necessary to instruct the participants to undertake more intensively muscle training. Moreover, bone mass, water content, and basal metabolic rate are secondary calculated values, and there were insufficient data for correlation with the data obtained by the direct methods. These data should be interpreted with these characteristics in mind. With regard to body fat, the bio-electrical impedance method measures both subcutaneous and visceral fat. Visceral fat is a risk factor for cardiovascular events and correlates with weight, BMI and abdominal circumference 23). In the present study, while total body fat did not significantly change, abdominal circumference did significantly decrease, indicating a decrease in visceral fat. Although sodium levels showed a significant change, the value was within the standard range and accordingly judged within the physiological range. With regard to lipid profile, no significant change was seen in total cholesterol, LDL cholesterol and triglyceride. In contrast, a

significant increase was seen in HDL cholesterol and adiponectin, which are factors which prevent atherosclerosis. These findings are consistent with our previous report 3), supporting the efficacy of “instructions for walking under pedometer management”. In the test of blood sugar metabolism, blood glucose and insulin at week 24 increased than that at week 12, whereas HbA1c showed an improvement at week 24. Week 24 occurred around the end of December, a period characterized by many opportunities for social eating and drinking. This may explain the temporary deterioration in blood sugar and insulin levels. In contrast, we consider that that the success in managing HbA1c levels, which reflect blood sugar metabolism for a longer period, was more meaningful. Adiponectin shows a negative correlation with visceral fat, and reduces insulin resistance 24). We also consider that the decrease in the amount of fat with weight loss and increase in adiponectin was effective in improving sugar metabolism. Cortisol is a commonly used marker for evaluating stress conditions. Recently, attention has focused on DHEA-s/cortisol ratio 25). During the observation period, no significant change was seen in either cortisol or DHEA-s/cortisol ratio, indicating that the intervention did not induce excessive physical stress on the participants, who did not originally have an exercise habit.

Anti-Aging Medical Checkup and Evaluation for Functional Age In the present study, we have induced to the company an anti-aging medical checkup system called the “Age Management Check” which provides recipients with their functional age. This system determines muscle age, vascular age, nervous age, hormonal age and bone age, calculated based on reference data collected, and allows them to understand their individual risk factors. Results have shown a number of favorable effects on the physical condition of the participants. First, vascular age turned out to be significantly younger than the pre-value. Vascular age measured by acceleration plethysmography reflects both histological change and vascular tone. In this study, vascular tone was thought to have improved during the 6-month observation period. The causes include the improvement of blood sugar metabolism and lipid profile, in turn leading to a favorable balance of oxidative stress, which affects the arterial tone 26). Secondary, stiffness values for the calcaneus bone were markedly improved at week 24. Stiffness values are the second parameters which reflect both the amount of bone and the architecture of bone. The mechanical pressure of walking may have had a favorable stimulatory effect on this bone, leading to a strengthening of the trabecula to a level detectable by ultrasonography. Measurement of bone mineral density was not conducted by DEXA (dual energy X-ray absorptiometry).more precise and higher in reproducibility than ultrasonography due to the following reasons; ultrasonography does not cause radiation exposure, and is cheap in cost, easy to carry and suitable for the screening tests intended for the large number of subjects. Also, the calcaneus bones, rich in cancellous bones, are a suitable part for monitoring the effect of walking. Many studies have reported the favorable influence of walking on neural activity. A study of aged women (70 to 81 years old) who walked for long periods on a regular basis showed that their cognitive function was significantly superior than the age-matched women who did not walk a lot and its decline was relatively minor 27). A study of aged men (71 to 93 years old) suggested that walking may reduce the risk of cognitive dysfunction and that

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Ministry of Health, Labour and Welfare of Japan: The national health and nutrition survey in Japan, 2007. Web site: http://www.mhlw.go.jp/houdou/2008/12/dl/h1225-5d.pdf. (in Japanese) Yonei Y, Mizuno Y: The human dock of tomorrow: annual health check-up for anti-aging. Ningen Dock 19; 5-8: 2005Miyazaki R, Hasegawa T, Fujioka N, et al: Effects on anti-aging indicators in middle-aged men of an intervention to prevent lifestyle-related diseases: pilot study utilizing a company-wide anti-aging medical checkup and pedometers. Anti-Aging Medicine 6; 83-94: 2009Ishii K, Miyazaki R, Azuma Y, et al: A practical exercise prescription for health counseling. Journal of Japan Society for the Study of Obesity 15; 126-132: 2009 (in Japanese)

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Miyazaki R, Hasegawa T, Fujioka N, et al: Effects on anti-aging indicators in middle-aged men of an intervention to prevent lifestyle-related diseases: pilot study utilizing a company-wide anti-aging medical checkup and pedometers. Anti-Aging Medicine 6; 83-94: 2006Mochizuki T, Amenomori Y, Miyazaki R, et al: Evaluation of exercise programs at a fitness club in female exercise beginners using anti-aging medical indicators. Anti-Aging Medicine 6; 66-78: 2009Yonei Y, Takahashi Y, Hibino S, et al: The effects of walking on quality of life and various symptoms and issues relating to aging. Anti-Aging Medicine 5; 22-29: 2008Yonei Y, Miwa Y, Hibino S, et al: Japanese anthropometric reference data: special emphasis on bioelectrical impedance analysis of muscle mass. Anti-Aging Medicine 5; 63-72: 2008

References

promotion of an active lifestyle contributes to the retention of cognitive function for older men who can exercise 28). These findings are consistent with our present finding of a significant shortening of response time, a parameter of WCST. Generally, muscle mass decreases by approximately 1% a year if muscle load training is not performed 8). In this study, muscle mass significantly decreased in the thigh (both sides), right limb (thigh + leg), and left forehand. In this health promotion program, we didn’t add the muscle loading training. On the other hand, it is thought that the reason for the reduction in muscle mass is that fat in the muscle decreases. It is suggested a high quality muscle with the speed and endurance. This may be due to the lack of muscle load training in the health promotion program. The prevention of muscle aging is a future task. In our previous study with female exercise beginners (40.1±2.3 years old), a 2-month program of exercise accelerated the secretion of IGF-I and DHEA-s 6). In contrast, there was no significant change in male participants (50.6±4.3 years old). The difference may be due to differences in age, sex, or experience of exercise, and others. Further investigation of this difference is warranted. When we evaluate functional age, it is important to figure out which is the oldest in the five elements (muscle, blood vessels, nerve, hormone or bone). Before beginning the intervention, the oldest part in the anti-aging medical checkup was nerve 35.3%, bone 35.3%, and blood vessels 29.4%. The participants had a common background, including middle-aged men who were mid-level managers in their company, and it is of interest to have biased the weak point before it intervenes it to the nerve, the bone, and the blood vessel. This may be due to similarities in office, region, and social position. The target of a conventional medical checkup (human medical dock) is the prevention and earlier detection of cancer and lifestyle-related disease. In contrast, the target of an anti-aging medical checkup, in addition to the above items, is the prevention and earlier detection of pathological aging and the deterioration of QOL 2). This is a future type of medical checkup which we have introduced into the industrial health promotion system. In the present study, the combination of “anti-aging medical checkup”

Conclusion

To improve the lifestyle of corporate workers, we conducted a health promotion program that consisted of an anti-aging medical checkup and pedometer-based walking program. The walking was the relatively effective of the program contents because it was easy for factory workers to execute and continue. Anthropometry and clinical laboratory tests showed that several determinants of lifestyle-related disease significantly improved and vascular age became younger. As a result of the questionnaire, the anti-aging medical checkup was effective in motivation and behavior modification, and the increased amount of exercise was the most frequent answer in the contents of the health promotion program. We therefore consider that the “anti-aging medical checkup” and “instructions for walking under pedometer management” were effective in improving the lifestyle of factory workers.

Ackowledgment

This paper was presented at the 10th meeting of Japanese Society of Anti-Aging Medicne in 2010. This research was supported by the Japan Science and Technology Agency (JST) Comprehensive Support Programs for Creation of Regional Innovation “Research for Promoting Technological Seeds” in 2009.

and “instructions for walking under pedometer management” greatly contributed to the motivation and behavior modification of the participants by presenting them with the aging of their bodily functions as "functional age," and by putting pressure on them to walk.

83

Effect of Walking under Pedometer Management in Factory Workers

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