Longer, healthier lives

World Health • SOth Year, No. 4, July-August 1997 31 longer, healthier lives Toshihito Katsumura & Adrian D. Hinman With the highest life expectancy in the world, Japan has to face the challenge and meet the cost of caring for its burgeoning elderly population. Photo Keystone/!. Sirman© In the 21 st century, a physically active lifestyle will be a main contributor to maintaining a high quality of /if e in old age, and help us to see our later years as a time of we/I-being. I n 1950, the average life expectancy in Japan was just over 50 years of age. Now, less than a half a century later, this figure has increased to over 75 for men and over 80 for women, giving the coun- try the highest average life expectancy in the world. Japan is becoming the focus of much atten- tion, as researchers try to determine what has enabled its people to attain such longevity, and as other coun- tries search for solutions to the problems inextricably linked to an increasing life expectancy, such as caring for the elderly, and the costs associated with that care. As the number of people over 65 years of age in the Japanese popula- tion has steadily increased, so too have the costs of medical care. Elderly citizens who are bedridden or suffering from dementia comprise a large portion of those requiring medical care. So the search is on for ways to maintain and promote health, particularly for over-65-year- olds, in an effort to improve the quality of life for the elderly as well as to curb health care costs. Given this trend of longevity in Japan, one of the primary goals of the WHO Collaborating Centre for Health Promotion through Research and Training in Sports Medicine is to find cost-effective methods of increasing the quality of life for the elderly and reducing the number of those who are bedridden or suffering from debilitating di seases. A signif- icant portion of our research here has focused on the benefits of physical activity for the aged. Physical activ- ity and exercise promotion can be carried out with very few resources, and are therefore more cost-effective - as well as more enjoyable - than most other types of preventive medicine. Disease prevention It is often said that remaining physi- cally active contributes to the main- tenance of good health, but what role does exercise actually play in pre- venting di sease and slowing down the effects of ageing? Our research has focused on the effects of aerobic and other forms of exercise in pre- serving good health throughout life. The benefits of exercise include strengthening muscles and joints, increasing flexibility and improving balance and agility, all of which are known to deteriorate with age. As strength and flexibility improve, the likelihood of injury to joints, bones and muscles decreases. Further, as people remain longer in better physi- cal condition, they will also remain 32 more independent of crutches, walk- ers, wheelchairs and human help. Maintaining a physically active lifestyle from a young age also appears to help to prevent the onset of osteoporosis later in life. Our longitudinal studies on both physically active and sedentary people suggest that regular aerobic exercise confers the added advan- tage of reducing risk factors for heart disease, such as atherosclerosis. In Japan, the number of elderly people suffering from dementia as a result of cerebrovascular disease is greater than the number of those suffering from dementia caused by degenera- tive diseases of the nervous system, such as Alzheimer disease. Thus, by helping to prevent atherosclerosis, regular physical activity may also help to reduce the risk of cerebrovas- cular disease and, in many cases, the resultant onset of dementia. Besides strengthening the mus- cles, joints and bones and combating age-related diseases, physical activ- ity improves the quality of life of the older population, enabling people to remain independent and active for much longer. We are also studying the effect of regular exercise on mood and general mental health. Exercise is often done in groups, making interaction easier among people who might otherwise become isolated. For elderly people who have retired or have reduced the amount of time they spend working, a regular habit of exercise provides their everyday life with consistency and purpose, and can help to fill the vacuum which is often experienced after retirement. Government support In the last few years, the Japanese Government has promoted physical activity among its citizens as a means of preserving health. In July 1993, the Tokyo Metropolitan Government opened its Health Promotion Centre, and in March of this year, the Japanese Ministry of Health and Welfare published the report of the Committee for Health Promotion through Physical Activity World Health • SOth Year, No. 4, July-August 1997 Making tofu in the Kyoto oreo. Encouraging physical activity as a means to prevent diseases opens the way to an active and independent life for many elderly people. Photo Panos Pictures/}. Holmes © throughout Life. This report gives information on the frequency, dura- tion and specific types of exercise that are beneficial for elder individu- als, and also provides guidelines on exercise for younger people which will help them to maintain their health throughout their lives. It was written and published with help from our centre, and we will produce an English version later this year. In order to study the effects of physical activity on health in more depth, we investigate differences in the mental and physical health of people involved in different levels of exercise, ranging from those who lead a sedentary life to full-time athletes. While determining the benefits of exercise, we also focus on possible negative effects , such as over-training, so as to make a recom- mended exercise "prescription" that will enable people to live not only longer but better. We work closely with the Tokyo Metropolitan Health Promotion Centre in educating people on health maintenance through physical activity and proper nutrition. The Tokyo Metropolitan Health Promotion Centre holds 13-week practical instruction pro- grammes for Tokyo citizens during which participants and instructors work to develop an individualized exercise plan to suit the participant's lifestyle and current physical fitness level. Through periodic physical exam- inations and investigative research during the programme and in the following years, we monitor changes in physical health that have resulted from the participant's adopted exer- cise regimen. The goal is to generate enthusiasm for physical activity, as well as to develop a specific routine to be followed. The success of the Tokyo Metropolitan Health Promotion Centre has led to the growth of other centres throughout Japan, and may inspire similar government-sponsored health pro- motion centres in other countries. In the 21st century, as advances in medicine continue to be made, average life expectancy wi ll proba- bly continue to increase, as will the percentage of the population consist- ing of people aged over 65 . A physi- cally active lifestyle will be a main contributor to maintaining a high quality of life during those later years. Perhaps more importantly, the effects of keeping active will help us to see old age as a time of well- being. • Dr Toshihito Katsumura is Director of the WHO Collaborating Centre for Health Promotion through Research and Training in Sports Medicine, and Director and Professor of the Department of Preventive Medicine and Public Health, Tokyo Medical College, 1-1 Shin;uku 6-chome, Shinjuku-ku, Tokyo 160, Japan. Dr Adrian D. Hinman is Assistant to Dr Katsumura.