Locomotive syndrome testing in young and middle adulthood

Body weight is associated with the ability to perform deep squats in school-aged Japanese children and adolescents: A retrospective cohort study

BACKGROUND

The ability to perform deep squats in children and adolescents is an essential component of lower extremity function. Especially for school-aged children and adolescents, the ability to perform deep squats is related to their daily life and school activities. Few reports have investigated the factors associated with deep squats ability in this population. This study aimed to identify the factors associated with deep squat ability in healthy Japanese children and adolescents.

METHODS

A retrospective cohort study was conducted with children and adolescents aged 8-14 years in Japan from 2017 to 2019. Data on height, weight, ability to perform deep squats, general joint laxity, lower limb tightness, and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale score were collected at the beginning of each year. Participants who were able to squat during their musculoskeletal screening were divided into two groups: those who could deep squat the following year and those who could not. Logistic regression analysis with variable selection was performed to calculate the odds ratio for each predicted risk factor associated with the inability to perform a deep squat.

RESULTS

A total of 636 children and adolescents were included in the analysis, with 7.5 % of them being unable to perform deep squats the following year. The risk of being unable to deep squats significantly decreased with increasing age (odds ratio 0.66, 95 % confidence interval 0.50-0.87). In addition, higher weight (odds ratio 1.12, 95 % confidence interval 1.07-1.17) and higher Hospital for Special Surgery Pediatric Functional Activity Brief Scale score (odds ratio 1.05, 95 % confidence interval 1.01-1.10) were identified as risk factors associated with the inability to perform a deep squat. Other physical factors did not significantly contribute to the occurrence of deep squat abnormalities.

CONCLUSIONS

Age, body weight, and physical activity levels were found to be associated with the ability to perform deep squats in healthy Japanese children and adolescents.

Current status and risk determinants of locomotive syndrome in geriatric cancer survivors in China-a single-center cross-sectional survey

Objective

To assess the prevalence and risk determinants of locomotive syndrome (LS) in geriatric cancer survivors in China. To generate evidence-based insights for the clinical prevention and intervention strategies concerning LS in this vulnerable population, emphasizing the need for integrated public health initiatives focused on maintaining mobility among geriatric cancer survivors.

Methods

Six hundred geriatric cancer survivors were recruited at a hospital in China. A demographic questionnaire, the International Physical Activity Questionnaire-Short (IPAQ-S), and the Geriatric Locomotive Function Scale (GLFS-25) were administered. Survivors were stratified into three physical activity level (PAL) groups via IPAQ-S scores: low, medium, and high. LS was operationally defined via GLFS-25 scores, with cut-offs established for LS-1, LS-2, and LS-3. Elevated GLFS-25 scores signified deteriorated motor function (MF) and increased severity of LS. Data analysis was done to investigate the risk determinants to the occurrence and exacerbation of LS among geriatric cancer survivors.

Results

Of the 524 geriatric cancer survivors who completed the study, 292 (55.7%) were diagnosed with LS, including 152 (29%) categorized under LS-1, 52 (9.9%) under LS-2, and 88 (16.8%) under LS-3. Univariate analysis indicated that variations in exercise habits, prior occupational type, presence of tumor metastasis or recurrence, visual impairments, somatosensory abnormalities, and PAL were significantly associated with differing occurrences and severities of LS (p < 0.05). Ordinal logistic regression revealed that prior occupational type (OR = 0.466), tumor metastasis (OR = 0.404), tumor recurrence (OR = 0.341), and PAL (medium: OR = 7.178; high: OR = 1.984) were independent risk determinants modulating both the occurrence and severity of LS in cancer survivors (p < 0.05).

Conclusion

The occurrence of LS is notably elevated among geriatric cancer survivors in China, indicating a significant public health concern. Individuals who were previously engaged in non-physically demanding occupations and those with histories of tumor metastasis or recurrence, coupled with reduced PAL, demonstrate a heightened susceptibility and severities to LS. Early identification of these risk determinants is imperative for mitigating the onset and progression of LS. Comprehensive public health strategies, including regular screening programs, targeted physical rehabilitation initiatives, and community-based interventions, are essential to mitigate the onset and progression of LS in this vulnerable population, ultimately reducing its broader impact on aging-related health outcomes.

The relationship between locomotive syndrome and depression in young Chinese college students

OBJECTIVES

This study investigates the relationship between locomotive syndrome (LS) and mental disorder (depression) in young Chinese college students.

METHODS

Our study population (n = 165; mean age of 19.82 ±1.90 years) comprises college student residents at Tsinghua University in Beijing, China. Three screening methods were used to evaluate LS: 25-question Geriatric Locomotive Function Scale (GLFS-25), a two-step test, and a stand-up test. Depression was screened by the Chinese version of the Zung Self-Rating Depression Scale (ZSDS).

RESULTS

The prevalence of LS and depression was 20.1% and 30.9%, respectively. The LS group had lower grip strength and higher ZSDS scores than the non-LS group.

CONCLUSION

Young Chinese college students have a relatively high prevalence of LS, and LS and GLFS-25 scores were significantly related to depression. The present results suggest that management strategies for LS should consider depressive symptoms among young adults.

Identifying factors associated with locomotive syndrome using machine learning methods: The third survey of the research on osteoarthritis/osteoporosis against disability study

AIM

To identify factors associated with locomotive syndrome (LS) using medical questionnaire data and machine learning.

METHODS

A total of 1575 participants underwent the LS risk tests from the third survey of the research on osteoarthritis/osteoporosis against disability study (ROAD) study. LS was defined as stage 1 or higher based on clinical decision limits of the Japanese Orthopaedic Association. A total of 1335 items of medical questionnaire data came from this study. The number of medical questionnaire items was reduced from 1335 to 331 in data cleaning. From the 331 items, identify factors associated with LS use by light gradient boosting machine-based recursive feature elimination with cross-validation. The performance of each set was evaluated using an average of seven performance metrics, including 95% confidence intervals, using a bootstrapping method. The smallest set of items is determined with the highest average of receiver operating characteristic area under the curve (ROC-AUC) under 20 items as association factors of LS. Additionally, the performance of the selected items was compared with the LS risk tests and Loco-check.

RESULTS

The nine items have the best average ROC-AUC under 20 items. The nine items show an average ROC-AUC of 0.858 (95% confidence interval 0.816-0.898). Age and back pain during walking were strongly associated with the prevalence of LS. The ROC-AUC of nine items is higher than that of existing questionnaire-based LS assessments, including the 25-question Geriatric Locomotor Scale and Loco-check.

CONCLUSIONS

The identified nine items could aid early LS detection, enhancing understanding and prevention. Geriatr Gerontol Int 2024; 24: 806-813.

Reliability and validity tests of the Chinese version of the Geriatric Locomotive Function Scale (GLFS-25) in tumor survivors

Objective

To evaluate the reliability and validity of the Chinese-translated Geriatric Locomotive Function Scale (GLFS-25) for the assessment of locomotive syndrome (LS) in individuals surviving malignancies.

Methods

393 tumor survivors at a general hospital in China were recruited. The Chinese version of GLFS-25 was utilized to conduct a cross-sectional survey to ascertain the tool's efficacy in measuring LS in this cohort. The scale's validity was examined through content, structural and discriminant validity assessments, while its reliability was investigated by determining the internal consistency (via Cronbach's α coefficient) and test-retest reliability (via intragroup correlation coefficient, ICC).

Results

The Chinese-adapted GLFS-25 demonstrated a robust scale-level content validity index of 0.94, while item-level content validity indices ranged from 0.83 to 1.00 across individual items. The suitability of the scale for structural validity assessment was confirmed via exploratory factor analysis, yielding a Kaiser-Meyer-Olkin measure of 0.930 and a significant Bartlett's test of sphericity (χ2 = 3217.714, df = 300, P < 0.001). Subsequent confirmatory factor analysis (CFA) extracted four distinct factors: Social Activity Engagement, Daily Living Ability, Pain Experience and Physical Mobility. These factors accounted for 72.668 % of the variance, indicating substantial construct validity for measuring LS among this population. CFA supported the model's fit with the following indices: χ2/df = 1.559, RMSEA = 0.077, GFI = 0.924, CFI = 0.941, NFI = 0.919, and TLI = 0.933. The factor loadings for the four factors ranged from 0.771 to 0.931, indicating the items corresponding to the four factors effectively represented the constructs they were designed to measure. The correlation coefficients among the four factors were between 0.306 and 0.469, all lower than the square roots of the respective AVEs (0.838-0.867). This suggests a moderate correlation among the four factors and a distinct differentiation between them, indicating the Chinese version of the GLFS-25 exhibits strong discriminant validity in Chinese tumor survivors. Reliability testing revealed a high Cronbach's α coefficient for the overall scale at 0.961, with the subscales yielding coefficients of 0.751, 0.836, 0.930, and 0.952. The overall ICC was determined to be 0.935, with subscale ICCs ranging from 0.857 to 0.941, reinforcing the scale's reliability in this context.

Conclusions

The Chinese version of the GLFS-25 exhibits strong reliability and validity for the assessment of LS in tumor survivors. It may serve as a diagnostic tool for LS, contributing to the prevention and management of musculoskeletal disorders and enhancing the prognosis for this patient population.

Temporal validation of a clinical prediction rule for distinguishing locomotive syndromes in community-dwelling older adults: A cross-sectional study from the DETECt-L study

Objectives

Clinical prediction rules are used to discriminate patients with locomotive syndrome and may enable early detection. This study aimed to validate the clinical predictive rules for locomotive syndrome in community-dwelling older adults.

Methods

We assessed the clinical prediction rules for locomotive syndrome in a cross-sectional setting. The age, sex, and body mass index of participants were recorded. Five physical function tests-grip strength, single-leg standing time, timed up-and-go test, and preferred and maximum walking speeds-were measured as predictive factors. Three previously developed clinical prediction models for determining the severity of locomotive syndrome were assessed using a decision tree analysis. To assess validity, the sensitivity, specificity, likelihood ratio, and post-test probability of the clinical prediction rules were calculated using receiver operating characteristic curve analysis for each model.

Results

Overall, 280 older adults were included (240 women; mean age, 74.8 ± 5.2 years), and 232 (82.9%), 68 (24.3%), and 28 (10.0%) participants had locomotive syndrome stages ≥ 1, ≥ 2, and = 3, respectively. The areas under the receiver operating characteristics curves were 0.701, 0.709, and 0.603, in models 1, 2, and 3, respectively. The accuracies of models 1 and 2 were moderate.

Conclusions

These findings indicate that the models are reliable for community-dwelling older adults.

Relationship between oral frailty and locomotive syndrome in working-age individuals: a cross-sectional survey of workers in Japan

BACKGROUND

Although the relationship between oral and physical frailty in older adults has been investigated, few studies have focused on the working-age population. This study examined the relationships of the number of remaining teeth and masticatory ability, i.e., signs of oral frailty, with locomotive syndrome (LS) in the working-age population.

METHODS

The number of remaining teeth, masticatory ability, and presence of LS in 501 participants from four companies were examined. The relationships between the number of remaining teeth groups (≥ 20 teeth or ≤ 19 teeth) and LS and between the masticatory ability groups (high or low) and LS were examined. A binomial logistic regression analysis was conducted using LS from the stand-up test as the objective variable and the two subgroups based on the number of remaining teeth and potential crossover factors as covariates.

RESULTS

The analysis included 495 participants (354 males and 141 females; median age, 43 years). The median number of remaining teeth among the participants was 28, and 10 participants (2.0%) had ≤ 19 teeth. The mean masticatory ability values were 39.9 for males and 37.7 for females, and 31 participants (6.3%) had low masticatory ability. In the stand-up test, those with ≤ 19 teeth had a higher LS rate than those with ≥ 20 teeth. The odds ratio for LS in the group with ≤ 19 remaining teeth was 5.99, and the confidence interval was 1.44-24.95.

CONCLUSIONS

The results confirmed signs of oral frailty in the working-age population. Further, the number of remaining teeth possibly affects standing movement. Thus, oral frailty is associated with LS in the working-age population.

Phytochemicals and Vitamin D for a Healthy Life and Prevention of Diseases

A variety of phytocompounds contained in medical plants have been used as medication, including Kampo (traditional Japanese) medicine. Phytochemicals are one category of the chemical compounds mainly known as antioxidants, and recently, their anti-inflammatory effects in preventing chronic inflammation have received much attention. Here, we present a narrative review of the health-promotion and disease-prevention effects of phytochemicals, including polyphenols, the latter of which are abundant in onions, oranges, tea, soybeans, turmeric, cacao, and grapes, along with the synergetic effects of vitamin D. A phenomenon currently gaining popularity in Japan is finding non-disease conditions, so-called ME-BYO (mibyou) and treating them before they develop into illnesses. In addition to lifestyle-related diseases such as metabolic syndrome and obesity, dementia and frailty, commonly found in the elderly, are included as underlying conditions. These conditions are typically induced by chronic inflammation and might result in multiple organ failure or cancer if left untreated. Maintaining gut microbiota is important for suppressing (recently increasing) intestinal disorders and for upregulating immunity. During the COVID-19 pandemic, the interest in phytochemicals and vitamin D for disease prevention increased, as viral and bacterial infection to the lung causes fatal inflammation, and chronic inflammation induces pulmonary fibrosis. Furthermore, sepsis is a disorder inducing severe organ failure by the infection of microbes, with a high mortality ratio in non-coronary ICUs. However, antimicrobial peptides (AMPs) working using natural immunity suppress sepsis at the early stage. The intake of phytochemicals and vitamin D enhances anti-inflammatory effects, upregulates immunity, and reduces the risk of chronic disorders by means of keeping healthy gut microbiota. Evidence acquired during the COVID-19 pandemic revealed that daily improvement and prevention of underlying conditions, in terms of lifestyle-related diseases, is very important because they increase the risk of infectious diseases. This narrative review discusses the importance of the intake of phytochemicals and vitamin D for a healthy lifestyle and the prevention of ME-BYO, non-disease conditions.

Relationship between Locomotive Syndrome and Musculoskeletal Pain and Generalized Joint Laxity in Young Chinese Adults

This study aims to investigate the prevalence of locomotive syndrome (LS) and to examine the relationship of LS with musculoskeletal symptoms (pain, generalized joint laxity (GJL)) in young Chinese adults. Our study population (n = 157; mean age of 19.8 ± 1.2 years) comprises college student residents at Tsinghua University in Beijing, China. Three screening methods were used to evaluate LS: 25-question Geriatric Locomotive Function Scale (GLFS-25), a two-step test, and a stand-up test. Musculoskeletal pain was assessed by self-report and visual analog scale (VAS), and joint body laxity was evaluated using the GJL test. The prevalence of LS was 21.7% of all participants. Musculoskeletal pain affected 77.8% of the college students with LS and was strongly associated with LS. A total of 55.0% of college students with LS had four or more site joints that were positive for GJL, and higher scores of GJL were associated with a higher prevalence rate of LS. Young Chinese college students have a relatively high prevalence of LS, and musculoskeletal pain and GJL were significantly related to LS. The present results suggest that we need early screening of musculoskeletal symptoms and LS health education in young adults to prevent the mobility limitations of LS in the future.

Effects of arm and leg positions on lumbar multifidus muscle activity while on hands and knees or while standing

BACKGROUND

The lumbar multifidus (LMF) muscle, which is involved in the mechanical stability of the lumbar spine, reportedly undergoes atrophy in patients with low back pain. Preventing or mitigating low back pain requires strengthening the LMF muscle; however, methods for triggering selective and significant contraction of this muscle have not been fully studied. This study aims to clarify how, in the hands-and-knees or standing position, the position of the arm and leg on one side affects the activity of the lumbar erector spinae (LES) and LMF muscles.

METHODS

We recruited nine adult men with no prior history of low back pain. Measurements were taken in four different postures under varying conditions (that is, one arm and one leg were lifted in either the hands-and-knees or standing position,) as follows: (1) shoulder joint flexion and hip joint extension in the hands-and-knees position; (2) 90° shoulder joint abduction and hip joint abduction in the hands-and-knees position; (3) shoulder joint flexion and hip joint extension in the standing position; and (4) 90° shoulder joint abduction and hip joint abduction in the standing position. The 90° shoulder joint abduction involved simultaneous horizontal abduction, while the hip joint abduction involved simultaneous extension. Muscle activity of the LES and LMF in each posture was measured using a surface electromyograph.

RESULTS

Muscle activity of the LMF was significantly higher in 90° shoulder joint abduction and hip joint abduction than in shoulder joint flexion and hip joint extension in both the hands-and-knees and standing positions. The LES muscle showed no significant differences in activity between each posture.

CONCLUSIONS

The results suggest that unilateral 90° shoulder joint abduction and contralateral hip joint abduction in the hands-and-knees and standing positions may produce selective and significant contraction of the LMF muscle.

Locomotive Syndrome and Lumbar Spine Disease: A Systematic Review

Locomotive syndrome (LS) is defined based on the Loco-Check, 25-question Geriatric Locomotive Function Scale (GLFS-25), 5-question Geriatric Locomotive Function Scale (GLFS-5), Stand-Up Test, Two-Step Test, or a total assessment (i.e., positive for one or more of the GLFS-25, Stand-Up Test, and Two-Step Test). Lumbar spine disease has been reported to be one of the most common musculoskeletal disorders leading to LS. We therefore conducted a systematic review via PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 studies were considered to be eligible for inclusion in this systematic review. The GLFS-25 showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis but not vertebral fracture. The GLFS-5 showed an association with low back pain and lumbar spinal stenosis. The Loco-Check and Two-Step Test showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis. The Stand-Up Test showed no association with lumbar spinal stenosis. The total assessment showed an association with low back pain and lumbar spinal stenosis. Furthermore, the GLFS-25, Two-Step Test, and total assessment were improved by spinal surgery for lumbar spinal stenosis. The current evidence concerning the relationship between LS and lumbar spine disease still seems insufficient, so further investigations are required on this topic.

Is musculoskeletal pain related to locomotive syndrome even in young and middle-aged adults?

OBJECTIVES

Locomotive syndrome (LS) is the leading cause of persons needing long-term care in old age and is characterized by locomotive organ impairment including musculoskeletal pain. The aim was to examine the association between musculoskeletal pain and LS in young and middle-aged persons.

METHODS

A total of 836 participants (male 667, female 169; mean age 44.4 years) were examined in this cross-sectional study. The LS was evaluated by three screening tools: the two-step test, the stand-up test, and the 25-question Geriatric Locomotive Function Scale. Musculoskeletal pain, exercise habits, physical function (walkability and muscle strength), and physical activity were also assessed.

RESULTS

The LS was found in 22.8% of participants. The number with musculoskeletal pain was significantly higher in those with the LS. A significant correlation was found between the degree of musculoskeletal pain and exercise habits. Less regular exercise was significantly associated with higher LS prevalence. Physical activity and function were greater in participants with more regular exercise.

CONCLUSION

Musculoskeletal pain was significantly related to LS even in young and middle-aged persons. The present results suggest that control of musculoskeletal pain and improvement of exercise habits in young and middle-aged persons might help prevent the LS.

Identifying preventative measures against frailty, locomotive syndrome, and sarcopenia in young adults: a pilot study

[Purpose] The purpose of this study was to propose potential preventive measures against future mobility impairments and muscle loss in healthy young adults by comprehensively evaluating their status of frailty, locomotive syndrome, and sarcopenia. [Participants and Methods] A total of 83 Japanese young adults were enrolled in this study and evaluated using the diagnostic criteria for frailty (Japanese version of the Cardiovascular Health Study), locomotive syndrome (calculated as scores of the LOCOMO-25, the stand-up test, and two-step test), and sarcopenia (handgrip strength, usual gait test, skeletal muscle index). [Results] The prevalence of frailty-prefrailty (45.9%) was higher than that of presarcopenia (22.3%) and locomotive syndrome (14.1%). The prevalence of combinations of frailty-prefrailty and presarcopenia; frailty-prefrailty and locomotive syndrome; and frailty-prefrailty, locomotive syndrome, and pre-sarcopenia was 9.4%, 4.7%, and 3.5%, respectively. [Conclusion] Only 40% of the participants did not meet the three diagnostic criteria. On the other hand, there were not many participants with sarcopenia and/or locomotive syndrome diagnoses, suggesting that the improvement in intrinsic skeletal muscle mass rather than physical function is important for healthy Japanese young adults and could possibly be protective against future mobility or muscle-loss disorders.

Is locomotion training effective for middle-aged workers?

OBJECTIVES

Locomotion training (LT) consisting of single-leg standing and squatting was developed to help prevent locomotive syndrome (LS), and is typically used in older people. The objective of this study was to examine the effects of LT on young and middle-aged people.

METHODS

This study was performed at two companies. Workers in company A engaged in LT five times/week for 1 year, whereas workers in company B did not. Baseline and follow-up checkups consisted of questionnaires and physical performance tests, including three kinds of locomotion tests.

RESULTS

In total, 88 and 101 workers in companies A and B, respectively, met the inclusion criteria. LS stage, stand-up test results, and scores on a geriatric locomotive function scale significantly improved among workers in company A, but only stand-up test results significantly improved among workers in company B. Quadriceps power increased in company A, but did not change in company B. Especially, workers with LS in company A had more significant changes than those without LS and those in company B.

CONCLUSIONS

The results of this longitudinal study suggest that LT is useful even for young and middle-aged workers. LT was especially more effective for workers than those without LS.

Relationships between body mass index, lifestyle habits, and locomotive syndrome in young- and middle-aged adults: A cross-sectional survey of workers in Japan

OBJECTIVES

Although many studies have examined locomotive syndrome (LS) among elderly people, few studies have examined LS in young- and middle-aged adults. This study aimed to provide basic data on the epidemiological characteristics of LS, including in young- and middle-aged adults.

METHOD

We conducted a cross-sectional survey of a nonrandom sample of 852 adults aged 18-64 (678 males, 174 females) working in five companies in Japan, between December 2015 and February 2018. LS stage was determined using the criteria proposed by the Japanese Orthopaedic Association (JOA). LS stage 0 was defined as No-LS, and stages 1 and 2 were defined as LS. Multiple logistic regression analysis was used to investigate the independent relationship between LS and sociodemographic, smoking, alcohol drinking (AD), frequency of breakfast consumption (FBC), dietary variety score (DVS), and the University of California Los Angeles (UCLA) activity score after adjusting for age and sex.

RESULTS

We found that 23.1% of participants were evaluated as LS, including 21.5% of males and 29.3% of females (P < 0.05). Participants aged ≥45 years exhibited higher rates of LS (males: 23.1%, females: 43.6%) compared with those aged <45 years (P < 0.05). Logistic regression analysis revealed that age, body mass index (BMI), AD, UCLA activity score, and FBC were also related to LS.

CONCLUSION

Education initiatives about LS should be targeted not only to elderly populations but also to young- and middle-aged adults in the workplace.