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Frailty and Musculoskeletal Health Research


Theme Leader :
Hiroyuki Sasai, Ph.D.
Researcher :
Narumi Kojima, M.S., Yosuke Osuka, Ph.D.
Adjunct Researcher :
Kazushi Maruo, Ph.D., Shigeho Tanaka, Ph.D., Hiroyuki Shimada, Ph.D.


Sarcopenic obesity, Sarcopenia, Frailty, Urinary incontinence, Falls, Knee pain, Geriatric syndrome, Comprehensive intervention, Follow-up, Community-dwelling elderly, RCT, ADL disability, Lower extremity muscle strength

Major Research Titles

  1. 1.RCT intervention for sarcopenic obesity
  2. 2.Comprehensive intervention for frailty
  3. 3.Comprehensive intervention for sarcopenia
  4. 4.RCT intervention for urinary incontinence
  5. 5.RCT intervention for fall prevention
  6. 6.Association between knee extension strength and IADL


The focus of this research theme is on the development of intervention programs for geriatric syndromes, which have been considered an important factor for admission into long-term care, and has been associated with loss of independence, reduced quality of life, restricted social activities, and increased anxiety. We conducted randomized and controlled trials to evaluate the effects of the exercise and nutritional interventions as well as other treatments aimed to reduce the symptoms of sarcopenic obesity, frailty, walking disability, sarcopenia, urinary incontinence, and falling in the community-dwelling elderly population.
    Sarcopenic obesity – A total of 1,213 community-dwelling elderly people (575 in 2012, and 638 in 2013) were screened for sarcopenic obesity, defined as body fat percentage greater than 32.0% measured by DXA, skeletal muscle index below 5.46kg/m2, grip strength below 17.0kg, and/or usual walking speed below 1.0m/s. Among them, 307 people were defined as sarcopenic obese. Based on the inclusion and exclusion criteria, 139 people were included in the RCT: the exercise+nutrition (n=36), the exercise (n=35), nutrition (n=34) and control groups (n=34). The exercise intervention consisted of 60 minute aerobic and resistance training sessions twice a week, and the nutrition included tea fortified with 540mg of tea catechins as well as 3g of essential amino acid supplementation for three months. Pre-post intervention comparisons showed that significant group×time interactions were observed in fat mass, trunk fat mass, stride, step width, and vitamin D.
    Frailty – We investigated the effects of exercise and nutrition supplementation on 131 frail, community-dwelling women over 72 years of age. Exercise and nutrition supplementation had separate effects in improving walking ability and blood components including BDNF, myostatin and IGF1/IGFBP3, but the combination of both also increased muscle mass as well as improved physical function and reversed frailty.
    Sarcopenia – The efficacy of exercise and/or amino-acid supplementation was examined in 155 sarcopenic women over 75 years old. Exercise and amino-acid supplementation each had positive effects in enhancing function, but the combination may be effective in enhancing muscle strength, skeletal muscle mass, and physical function. A 4 year follow-up study on this population showed that participation in a 3 month intervention could prevent declines in lower extremity leg muscle mass, strength and mobility in the long-term. Furthermore, participation in an intervention may suppress long-term increases in fall rate. We have also investigated predictors of sarcopenia onset in community-dwelling older women. Among women who were not sarcopenic in 2008, 39.6% were defined as sarcopenic after 4 years, in 2012. Age, BMI, calf circumference and TUG were predictors of presarcopenia, sarcopenia, and severe sarcopenia based on the European Working Group on Sarcopenia on Older People definition. The results also showed that kidney function measured by cystatin C, may be associated with higher odds incident severe sarcopenia.
    Urinary incontinence – We examined the effects of exercise and thermal therapy on 147 women aged over 70 years with all different types of urinary incontinence. The exercise group attended a one-hour class aimed at strengthening the pelvic floor muscle and reducing abdominal fat, twice a week for three months, the heat therapy group was asked to place a heat and steam generating sheet on the lower back, and a combination of both interventions were provided for those in the combined group. While exercise and heat both had incontinence-alleviating effects, the combination of both is more effecting for treating urine loss independent of UI type.
    Falls – The effects of an exercise intervention was assessed in 105 women over the age of 70 with a history of falls. The exercise group attended a one-hour exercise class to improve strength, balance, and walking ability, twice a week for three months. The incidences of falls and fractures significantly decreased compared to the control group, suggesting that exercise is effective in reducing falls in the elderly faller.
    Knee extension strength and IADL – The association between knee extension strength and IADL was investigated in 927 community-dwelling elderly women. The results showed an increasing trend in IADL disability with decreasing knee extension strength. In order to maintain ADL well, the maintenance or improvement of lower extremity strength is of vital importance.


  1. 1.Kim H, Kim M, Kojima N, Fujino K, Hosoi E, Kobayashi H, Somekawa S, Niki Y, Yamashiro Y, Yoshida H. Exercise and nutritional supplementation on community-dwelling elderly Japanese women with sarcopenic obesity: a randomized controlled trial. J Am Med Dir Assoc. 17(11):1011-1019, 2016
  2. 2.Kim H, Hirano H, Edahiro A, Ohara Y, Watanabe Y, Kojima N, Kim M, Hosoi E, Yoshida Y, Yoshida H, Shinkai S. Sarcopenia: Prevalence and associated factors based on different suggested definitions in community-dwelling older adults. Geriatr Gerontol Int. 16(Supple 1):110-122, 2016.
  3. 3.Kim H, Suzuki T, Saito K, Kojima N, Hosoi E, Yoshida H. Long-term effects of exercise and amino acid supplementation on muscle mass, physical function and falls in community-dwelling elderly Japanese sarcopenic women: A 4-year follow-up study. Geriatr Gerontol Int. 16(2):175-181, 2016.
  4. 4.Jung S, Yabushita N, Kim M, Seino S, Nemoto M, Osuka Y, Okubo Y, Figueroa R, Tanaka K. Obesity and muscle weakness as risk factors for mobility limitation in community-dwelling older Japanese women: A two-year follow-up investigation. J Nutr Health Aging. 20(1):28-34, 2016
  5. 5.Okubo Y, Osuka Y, Jung S, Rafael F, Tsujimoto T, Aiba T, Kim T, Tanaka K. Walking can be more effective than balance training in fall prevention among community-dwelling older adults. Geriatr Gerontol Int. 16(1):118-125, 2016
  6. 6.Ihara K, Yoshida H, Jones PB, Hashizume M, Suzuki Y, Ishijima H, Kim H, Suzuki T, Hachimisu M. Serum BDNF levels before and after the development of mood disorders: a case-control study in a population cohort. Transl Psychiatry. 6:e782, 2016.
  7. 7.Kim H, Suzuki T, Kim M, Kojima N, Ota N, Shimotoyodome A, Hase T, Hosoi E, Yoshida H. Effects of exercise and milk fat globule membrane (MFGM) supplementation on body composition, physical function, and hematological parameters in community-dwelling frail Japanese women: A randomized double blind, placebo-controlled, follow-up trial. PLoS One, 10(2):e0116256, 2015.
  8. 8.Kim H, Suzuki T, Kim M, Kojima N, Yoshida Y, Hirano H, Saito K, Iwasa H, Shimada H, Hosoi E, Yoshida H. Incidence and predictors of sarcopenia onset in community-dwelling elderly Japanese women: 4-year follow-up study. J Am Med Dir Assoc. 16(1):85.e1-85.e8, 2015.
  9. 9.Kwon J, Yoshida Y, Yoshida H, Kim H, Suzuki T, Lee Y. Effects of a combined physical training and nutrition intervention on physical performance and health-related quality of life in prefrail older women living in the community: a randomized controlled trial. J Am Med Dir Assoc. 16(3):263.e1-8, 2015.
  10. 10.Suzuki H, Kawai H, Hirano H, Yoshida H, Ihara K, Kim H, Chaves PH, Minami Y, Yasunaga M, Obuchi S, Fujiwara Y. One-year change in the Japanese version of the Montreal Cognitive Assessment performance and related predictors in community-dwelling older adults. J Am Geriatr Soc. 63(9):1874-1879, 2015.
  11. 11.Kim H, Yoshida H, Hu X, Saito K, Yoshida Y, Kim M, Hirano H, Kojima N, Hosoi E, Suzuki T. Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: A cross-sectional study. Neurourol Urodyn. 34(4):322-326, 2015.
  12. 12.Kojima N, Kim M, Saito K, Yoshida H, Yoshida Y, Hirano H, Obuchi S, Shimada H, Suzuki T, Kim H. Lifestyle-related factors contributing to decline in knee extension strength among elderly women: A cross-sectional and longitudinal cohort study. PLoS One. 10(7):e0132523, 2015.
  13. 13.Kim M, Yoshida H, Sasai H, Kojima N, Kim H: Association between objectively measured sleep quality and physical function among community-dwelling oldest old Japanese: A cross-sectional study. Geriatr Gerontol Int. 15(8):1040-1048, 2015 .
  14. 14.Kim M, Shinkai S, Murayama H, Mori S. Comparison of segmental multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for the assessment of body composition in a community-dwelling older population. Geriatr Gerontol Int. 15(8):1013-1022, 2015.
  15. 15.Kim M, Sasai H, Kojima N, Kim H. Objectively measured night-to-night sleep variations are associated with body composition in very elderly women. J Sleep Res. 24(6):639-647, 2015.
  16. 16.Kim M. Isotemporal substitution analysis of accelerometer-derived sedentary behavior, physical activity time, and physical function in older women: A preliminary study. Exercise Science. 24(4):373-381, 2015.
  17. 17.Kim H, Yoshida H, Suzuki T: Falls and fractures in participants and excluded non-participants of a fall prevention exercise program for elderly women with a history of falls: 1-year follow-up study. Geriatr Gerontol Int. 14(2):285-292, 2014.
  18. 18.Kojima N, Kim H, Saito K, Yoshida H, Yoshida Y, Hirano H, Obuchi S, Shimada H, Suzuki T: Association of knee-extension strength with instrumental activities of daily living in community-dwelling older adults. Geriatr Gerontol Int. 14(3):674-80, 2014.
  19. 19.Kim H, Suzuki T, Saito K, Yoshida H, Kojima N, Kim M, Sudo M, Yamashiro Y, Tokimitsu I. Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: A randomized controlled trial. Geriatr Gerontol Int 13(2):458-465, 2013.
  20. 20.Kim M, Kim H. Accuracy of segmental multi-frequency bioelectrical impedance analysis for whole-body and appendicular fat mass and lean soft tissue mass in frail women aged 75 years and older. Eur J Clin Nutr 67(4):395-400, 2013.
  21. 21.Kim H, Suzuki T, Saito K, Yoshida H, Kobayashi H, Kato H, Katayama M. Effects of exercise and amino-acid supplementation on body composition and physical function in community-dwelling Japanese sarcopenic women: A randomized controlled trial. J Am Geriatr Soc. 60(1):16-23, 2012.
  22. 22.Kim H, Suzuki T, Yoshida H: The effects of multidimensional exercise on functional decline, urinary incontinence, and fear of falling in community-dwelling elderly women with multiple symptoms of geriatric syndrome: A randomized controlled and 6-month follow-up trial. Arch Gerontol Geriatr. 52(1): 99-105, 2011.
  23. 23.Kim H, Yoshida H, Suzuki T. The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: A randomized controlled trial. Int J Nurs Stud. 48(10): 1165-1172, 2011.
  24. 24.Kim H, Yoshida H, Suzuki T. The effects of exercise treatment with or without heat and steam generating sheet on urine loss in community-dwelling Japanese elderly women with urinary incontinence. Geriatr Gerontol Int. 11(4):452-459, 2011.