79
Journal of Exercise Physiologyonline
October 2015
Volume 18 Number 5
Editor-in-Chief
Official Research Journal of
Tommy
the American
Boone, PhD,
Society
MBA
of
Review
Board
Exercise
Physiologists
Todd Astorino, PhD
Julien Baker,
ISSN 1097-9751
PhD
Steve Brock, PhD
Lance Dalleck, PhD
Eric Goulet, PhD
Robert Gotshall, PhD
Alexander Hutchison, PhD
M. Knight-Maloney, PhD
Len Kravitz, PhD
James Laskin, PhD
Yit Aun Lim, PhD
Lonnie Lowery, PhD
Derek Marks, PhD
Cristine Mermier, PhD
Robert Robergs, PhD
Chantal Vella, PhD
Dale Wagner, PhD
Frank Wyatt, PhD
Ben Zhou, PhD
Official Research Journal
of the American Society of
Exercise Physiologists
ISSN 1097-9751
JEPonline
Exercise Workload of the “Fujisawa +10 Exercise”
Program in Older Women
Yusuke Osawa1,2, Yoshinobu Saito2,3,4, Naomi Tsunekawa2,
Tomohiro Manabe2, Yuko Oguma2,4
1Center
for Supercentenarian Medical Research, Keio University
School of Medicine, Tokyo, Japan, 2Sports Medicine Research
Center, Keio University, Kanagawa, Japan, 3Fujisawa City Health
and Medical Foundation, Kanagawa, Japan, 4Graduate School of
Health Management, Keio University, Kanagawa, Japan
ABSTRACT
Osawa Y, Saito Y, Tsunekawa N, Manabe T, Oguma Y. Exercise
Workload of the “Fujisawa +10 Exercise” Program in Older Women.
JEPonline 2015;18(5):79-85. The purpose of this study was to
investigate the exercise intensity of the “Fujisawa +10 exercise”
program in the elderly. Seven women (aged 65 to 75 yrs old)
performed the newly developed exercise program in both standing
and sitting conditions. Expired gas and heart rate were measured
throughout the program, and participants quantified their effort using
the rating of perceived exertion (RPE). The cardiorespiratory
exercise responses while standing were 2.7 ± 0.3 METs (metabolic
equivalents) and 88.0 ± 15.4 beats·min-1. The responses to the
program while sitting were 2.0 ± 0.3 METs and 80.2 ± 13.6
beats·min-1. In addition, oxygen consumption (VO2 max) was 42.0 ±
9.1% mL·kg-1·min-1 in the standing position and 31.7 ± 8.7% in the
sitting position. The subjects’ RPE ranged from “very light” to “fairly
light” during the exercise program under both conditions. In
conclusion, the findings indicate that the exercises that comprise the
“Fujisawa +10 exercise” program are of low intensity. The program
should be easily applicable for introducing daily exercise habits in
the elderly.
Key Words: Elderly, Breath-by-breath Oxygen consumption, Heart
rate, Rating of perceived exertion
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INTRODUCTION
Accumulated evidence shows that physical activity and structured exercise improve health
and reduce the risk of several lifestyle-related diseases, including type 2 diabetes, lipid
metabolism abnormalities, and cancers of the colon and breast (12,16). In addition, moderate
to vigorous physical activity improves muscle function, musculoskeletal mobility, and
cognitive ability in the elderly (4,6,9). Based on these findings, it is recommended that elderly
individuals should perform physical activity of moderate-intensity for approximately 150
min·wk-1 (2).
Several types of structured exercise programs, particularly Tai-chi exercise, which is
extremely popular in the East Asian countries, achieve an exercise intensity of 4.0 METs (i.e.,
metabolic equivalents). This MET level corresponds to moderate-intensity physical activity
and, therefore, it is suitable for achieving the weekly recommended levels of activity (1).
However, the movements and positions required by these exercise programs are difficult to
perform in the untrained elderly and typically require intensive instruction.
Although physical activity is a major factor contributing to health and longevity, the number of
inactive people has rapidly increased worldwide (10). For this reason, governments of nearly
all countries have implemented policies aimed at promoting physical activity. In Japan, the
National Institute of Health and Nutrition of the Ministry of Health, Labour, and Welfare
published an “Active Guide” that includes physical activity recommendations such as
performing an additional 10 min of physical activity in one’s daily routine (13,19). For the
elderly, the Guide also recommends engaging in any intensity of physical activity for 40
min·d-1 (19). To meet these recommendations, local governments and healthcare providers in
Japan have developed strategies that include health promotion events and the introduction of
urban walking courses.
In Fujisawa City, which is located in the eastern part of Japan, the Fujisawa City Health and
Medical Center and Keio University collaboratively developed the “Fujisawa +10 exercise”
program. The program is designed for the easy implementation of an additional 10 min of
daily physical activity that is performed during daily routines or recreational activities without
needing equipment. However, because the workload of the exercise program has not been
well characterized in the elderly (i.e., physiologically speaking), the purpose of the study was
to evaluate the exercise intensity of the “Fujisawa +10 exercise” program in elderly subjects.
METHODS
Subjects
Seven women (65 to 79 yrs age) were recruited from the Fujisawa City Health and Medical
Center. The subjects were required to have a medical checkup at the Center within 1 yr of
entering the study. The checkup included a cardiorespiratory fitness test (Table 1). Exclusion
criteria included a history of severe orthopedic abnormality, cardiovascular disease, and the
use of drugs that could potentially alter outcome measurements. This study was approved by
the local ethics committee of Keio University. Written informed consent was obtained from all
subjects. All experimental procedures were performed in accordance with the ethical
standards outlined in the 1964 Declaration of Helsinki.
81
Table 1. Characteristics of the Study Participants.
Characteristics
Mean ± SD
(n = 7)
Age (yrs)
Body height (cm)
71.6 ± 3.4
153.6 ± 4.2
Body weight (kg)
50.7 ± 4.3
-1
-1
Estimated VO2 max (mL·kg ·min )
SBP (mmHg)
DBP (mmHg)
23.0 ± 3.4
127.3 ± 15.2
77.6 ± 7.9
“Fujisawa +10 Exercise” Program
The “Fujisawa +10 exercise” program is a 10-min body weight exercise program that consists
of dynamic and static stretching exercises, knee-ups, squatting or knee extensions, arm circle
exercises, and body balance exercises in the standing or sitting positions. The subjects
performed the exercise program under the supervision of a Health Fitness Programmer in the
Fujisawa City Health and Medical Center. Each subject was asked to practice the exercise
program at home. For evaluation of the exercise intensity of the program, the subjects visited
the laboratory on a separate day to perform the exercise program in the standing and sitting
positions while watching a video recording of each exercise being performed to music with
verbal instructions for the proper exercise positions.
Measurements
Expired gas was measured throughout the testing period using a Quark CPET pulmonary gas
exchange system (COSMED, Rome, Italy). Heart rate (HR) was recorded using a COSMED
wireless HR monitor connected to the gas exchange system used for the measurement of
oxygen consumption (VO2). Before each test, the Quark system turbine flowmeter was
calibrated with a 3-L syringe. The Quark gas analyzer was calibrated with ambient air
(oxygen, 20.93%; carbon dioxide, 0.03%). Prior to the testing, the subjects were fitted with a
mask for breath-by-breath VO2 measurements and, then rested quietly in a sitting position for
5 min. After completion of the exercise program, the subjects again rested in a sitting position
for 10 min. During the rest period, the subjects were asked to refrain from moving, talking, or
sleeping.
Oxygen consumption and HR were measured continuously in the pre-exercise, exercise, and
post-exercise periods using the gas exchange system. After the data were averaged for 1min intervals, then, the data were averaged for each period (pre-exercise, exercise, and postexercise). In addition to absolute VO2, the subjects’ MET level was calculated by dividing
relative VO2 (mL·kg-1·min-1) by 3.5 mL·kg-1·min-1 (8). We also calculated the relative exercise
intensity of the cardiorespiratory fitness test that was conducted during the medical check of
the subjects. Briefly, the test was performed using a cycle ergometer (STB-2400, COMBI,
82
Tokyo, Japan). The subjects began cycling at 15 Watts (W). Power output was increased by
15 W every minute until the subjects were unable to maintain a cadence of 50 rev·min-1 (18).
Based on the peak power output (W), age, and body weight (BW), VO2 max was calculated
using the following equation (17): VO2 max (mL·min-1) = 9.39 W x 7.7 BW – 5.88 yrs old +
136.7 mL·min-1
The subjects were asked to rate their subjective perceived exertion during the exercise
program using the Borg 6 to 20 scale (3). Rating of perceived exertion (RPE) was recorded at
the end of each exercise modality.
Data Analyses
All values are presented as the mean ± standard deviation. All analyses were performed
using IBM SPSS version 22.0 for Macintosh (SPSS, Inc., Tokyo, Japan).
RESULTS
Table 2 shows the results of objective and subjective assessments of the exercise intensity of
the “Fujisawa +10 exercise” program. The cardiorespiratory responses to the exercise
program in the: (a) standing position were 2.7 ± 0.3 METs and 88.0 ± 15.4 beats·min-1; and
(b) sitting position were 2.0 ± 0.3 METs and 80.2 ± 13.6 beats·min-1. The relative exercise
workloads in the standing and sitting positions were 42.0 ± 9.1 %VO2 max and 31.7 ± 8.7
%VO2 max, respectively. The subjects’ RPE ranged from “very light” to “fairly light” throughout
the exercise program in both positions (Table 2).
Table 2. Cardiorespiratory Responses to the “Fujisawa +10 Exercise” Program.
Parameters
Standing
(Mean ± SD)
Sitting
(Mean ± SD)
VO2 (mL·kg-1·min-1) [rest 5 min]
VO2 (mL·kg-1·min-1) [exercise]
VO2 (mL·kg-1·min-1) [post 10 min]
METs (3.5 mL·kg-1·min-1) [rest 5 min]
METs (3.5 mL·kg-1·min-1) [exercise]
METs (3.5 mL·kg-1·min-1) [post 10 min]
HR (beat·min-1) [rest 5 min]
4.6
9.4
5.1
1.3
2.7
1.5
73.8
±
±
±
±
±
±
±
0.6
1.2
0.6
0.2
0.3
0.2
13.5
4.4
7.1
4.6
1.2
2.0
1.3
72.8
±
±
±
±
±
±
±
0.8
1.2
0.8
0.2
0.3
0.2
13.5
HR (beat·min-1) [exercise]
HR (beat·min-1) [post 10 min]
RPE [after stretching exercises]
RPE [after knee-ups]
RPE [after squatting/knee extension]
RPE [after balance exercises]
88.0
75.9
10.0
10.4
10.6
10.7
±
±
±
±
±
±
15.4
13.2
1.7
1.5
1.9
1.4
80.2
74.9
9.9
10.0
10.4
10.1
±
±
±
±
±
±
13.6
15.3
1.7
1.4
1.7
1.6
83
DISCUSSION
Various bodyweight exercise programs have been developed and used worldwide. However,
the exercise intensities of only a few of such programs have been objectively and subjectively
evaluated (1). The present study investigated the exercise intensity of the “Fujisawa +10
exercise” program, which was designed to increase daily physical activity of elderly female
subjects by 10 min through simple exercises. Cardiorespiratory responses and the RPE
measurements of the “Fujisawa +10 exercise” program indicated that the exercises were of
low-intensity and would be highly suitable as part of an introductory exercise program for
elderly individuals (14).
The physical activity position statement of the American College of Sports Medicine for the
elderly recommends that if individuals cannot perform physical activity of moderate intensity,
they should, at a minimum, engage in regular physical activity and avoid inactivity (2).
However, due to physiological deterioration and time constraints, many elderly individuals
may be unable to accomplish the recommended physical activity levels (20). In addition,
changes in skeletal muscle systems, such as the loss of muscle mass and/or functions, often
lead to reduced physical activity (5,7).
Recent studies suggest that light-intensity physical activity may contribute to the maintenance
of physical function in the elderly (11,15). Based on these findings and the reported physical
activity levels among the elderly, decreasing the amount of physical inactivity may be a more
realistic approach for improving health and well-being than achieving the physical activity
recommendations (11). However, to our knowledge, few evidence-based low-intensity
structured exercise programs have been developed. In this regard, the “Fujisawa +10
exercise” program, which is demonstrated in the present study to be a low-intensity exercise
program, may be suitable for increasing physical activity in the elderly.
A few limitations of this study should be considered when interpreting and generalizing the
findings. First, because only exercise intensity was investigated, further research is needed to
examine the long-term effects of the exercise program on health-related outcomes. Second,
because the study subjects had regular exercise habits, further investigations are warranted
to examine the exercise intensity of the program in the frail elderly individuals.
CONCLUSIONS
The present study investigated the exercise intensity of the “Fujisawa +10 exercise” program
in healthy elderly women. The results suggest that the exercise intensity of the program was
equivalent to low-intensity, and that the program would be applicable for the introduction of
exercise habits in the elderly.
84
ACKNOWLEDGMENTS
This research was supported by Comprehensive Research on Aging and Health Science
Research Grants for Dementia R&D from the Japan Agency for Medical Research and
Development (AMED).
Address for correspondence: Yusuke Osawa, PhD, Address: 35 Shinanomachi, Shinjukuku, Tokyo 160-8582, Japan E-mail: yosawa@keio.jp
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