Locomotive syndrome in Japan

Abstract

The present aging rate in Japan of some 28% will continue to increase along with the advancing age of elderly persons. Therefore, the demand for care will also increase. Approximately 25% of the need for nursing-care defined by the Japanese long-term care insurance system is associated with disorders or deterioration of locomotive organs. Therefore, the prevention and treatment of diseases in the locomotor system and maintenance of motor function are important for extended healthy life span and to decrease the demand for long-term care. Based on this background, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, which is defined as reduced mobility due to impaired locomotive organs. Changes in locomotion must be noticed early to ensure the timely implementation of appropriate checks and measures of locomotion can uncover risk of acquiring LS. The acquisition of an exercise habit, appropriate nutrition, being active and evaluating and treating locomotion-related diseases are important to delay or avoid LS. The JOA recommends locomotion training consisting of four exercises to prevent and improve LS. Countermeasures against LS should become a meaningful precedent not only for Japan, but for other countries with rapidly aging populations.

Keywords: Loco-check; Locomotion training; Locomotive syndrome.

Fig. 1

Population aged >65 years (column) and aging rates (line) in Japan between 1950 and 2040. Data up to 2017 and after 2020 are from statistics prepared by Japanese Ministry of Health, Labor and Welfare, Japan and estimates prepared by National Institute of Population and Social Security Research, respectively. The graph is quoted from Japan Ministry of Internal Affairs and Communication sources.

Fig. 2

Concepts and progression of locomotive syndrome. Locomotive syndrome is defined as declining mobility resulting from locomotive system disorders including decreased motor functions and musculoskeletal diseases that cause mobility deficits and demand for care. Besides aging and diseases of other organs or tissues, various factors such as lack of habitual exercise, sedentary lifestyle and inadequate nutrition accelerate progression of locomotive syndrome.

Fig. 3

Two-Step test. This test measures stride length to assess walking ability, muscular strength, balance, and lower limb flexibility. The Two-Step value, double strides divided body height and correlates with gait speed.

Fig. 4

Stand-Up test. This test assesses leg strength by standing up on one or both legs from seats of varying height.

Fig. 5

Prevalence of locomotive syndrome (LS) stages 1 and 2. A large cohort study that consisted of 3000 community-dwelling people aged 40s–80s investigated the age-specific rate of each stage LS stage in a large regional residential cohort in Japan.

Fig. 6

Standing on one leg with eyes open. This exercise mainly improves balance. Three repetitions per day of 1 min per leg are recommended.

Fig. 7

Squats. This simple, safe exercise strengthens lower extremity muscles. Posture with knees bent behind toes is important for correct squat technique. One squat should take 5 seconds to lower into position and 5 seconds to return to standing upright. One-to-three sets of 5–15 repetitions per day are recommended.

Fig. 8

Heel raises. This exercise strengthens gastrocnemius and soleus muscles (triceps) of lower extremities. Two-to-three sets of 10–20 raises per day are recommended.

Fig. 9

Front lunges. This exercise improves flexibility, balance, and muscular strength of lower limbs. Two-to-three sets of 5–10 lunges per day are recommended.