title: Community-wide promotion of physical activity in middle-aged and older Japanese: a 3-year evaluation of a cluster randomized trial.
abstract: BACKGROUND
  Promotion of physical activity (PA) is a key strategy to prevent non-communicable diseases. However, evidence on the effectiveness of community-wide interventions (CWIs) for promoting PA is limited.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a 3-year CWI for promoting PA in middle-aged and older adults compared with usual public health services. This study is an extension to an original 1-year investigation study.
  
  
  METHODS
  Cluster randomized controlled trial with community as unit of randomization and individual as unit of analysis.
  
  
  METHODS
  12 communities in Unnan, Japan were randomly allocated to the intervention (9) or the control (3). Additionally intervention communities were randomly allocated to aerobic activity promotion (Group A), flexibility and muscle-strengthening activities promotion (Group FM), or aerobic, flexibility, and muscle-strengthening activities promotion (Group AFM), each consisting of three communities. Randomly-sampled 4414 residents aged 40 to 79 years responded to the baseline survey (74%), and were analyzed in 2013-2014.
  
  
  METHODS
  A 3-year CWI based on social marketing, to promote PA from 2009 to 2012.
  
  
  METHODS
  The primary outcome was a change in regular aerobic, flexibility, and/or muscle-strengthening activities, defined by (1) engaging in 150 mins/week or more of walking, (2) engaging in daily flexibility activity, or (3) engaging 2 or more days/week in muscle-strengthening activities, evaluated at the individual level. Secondary outcomes were changes in specific types of PA and musculoskeletal pain. Outcomes were measured at baseline and at 1 and 3 years (2009, 2010, and 2012).
  
  
  RESULTS
  The CWI did not significantly increase the proportion of adults who reached recommended levels of aerobic, flexibility, and/or muscle-strengthening activities (adjusted change difference = 1.6% [95% CI: -3.5, 6.6]). In the subgroup analysis, compared to the controls, adults doing flexibility activity daily significantly increased in Group FM (6.3% [95% CI: 1.9, 10.7]). In Group A and AFM for PA outcomes and in all groups for pain outcomes, there was no significant change compared to controls.
  
  
  CONCLUSIONS
  The CWI did not achieve significant increase in the proportion of adults who reached recommended PA levels. However, it might be effective in promoting flexibility activity in middle-aged and older Japanese.
  
  
  BACKGROUND
  UMIN-CTR UMIN000002683 .
authors.affiliation: Department of Health Promotion and Exercise, National Institute of Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan. kamada@gakushikai.jp.|Division of Preventive Medicine, Brigham & Women's Hospital, Harvard Medical School, 900 Commonwealth Ave East, Boston, MA, 02215, USA. kamada@gakushikai.jp.|Physical Education and Medicine Research Center UNNAN, 1212-3 Mitoya, Mitoya-cho, Unnan, Shimane, 690-2404, Japan. kamada@gakushikai.jp.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Kamada
authors.affiliation: Physical Education and Medicine Research Center UNNAN, 1212-3 Mitoya, Mitoya-cho, Unnan, Shimane, 690-2404, Japan. junk_907@yahoo.co.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Kitayuguchi
authors.affiliation: Physical Education and Medicine Research Center UNNAN, 1212-3 Mitoya, Mitoya-cho, Unnan, Shimane, 690-2404, Japan. fussball527@yahoo.co.jp.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. taguri@yokohama-cu.ac.jp.
authors.forename: Masataka
authors.initials: M
authors.lastname: Taguri
authors.affiliation: Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan. inoue@tokyo-med.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. ishikun51@hotmail.com.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Functioning Activation, National Centre for Geriatrics and Gerontology, 7-430 Morioka-machi, Obu, Aichi, 474-8511, Japan. haradak@ncgg.go.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Harada
authors.affiliation: Division of Preventive Medicine, Brigham & Women's Hospital, Harvard Medical School, 900 Commonwealth Ave East, Boston, MA, 02215, USA. ilee@rics.bwh.harvard.edu.|Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. ilee@rics.bwh.harvard.edu.
authors.forename: I-Min
authors.initials: IM
authors.lastname: Lee
authors.affiliation: School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. adrian.bauman@sydney.edu.au.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bauman
authors.affiliation: Department of Health Promotion and Exercise, National Institute of Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan. miyachi@nih.go.jp.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Miyachi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016000:Cluster Analysis; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D053580:Muscle Strength / Q000502:physiology; D059352:Musculoskeletal Pain / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000379:methods; D018583:Pliability; D012111:Residence Characteristics / Q000706:statistics & numerical data; D055070:Resistance Training / Q000379:methods; D013997:Time Factors