Member
Rationale (1996-2001)
1.
Concept of Quality of Life
The measure of QoL in the older adult population can be affected by
a number of factors which are not stable across the lifespan.
Included tentatively in our definition of QoL which is supported by
many others are those factors such as health status, physical function,
energy level (vitality), sexual function, cognition, emotional stability,
feelings of well-being, life satisfaction, social integration, recreational
activity, nutritional status, body composition, economic factors, and
some others. While some of these factors are modifiable by good
lifestyle choices, it is increasingly apparent that many of the factors
that influence optimal QoL in older adults are highly dependent upon
one another. Thus, if we are to understand how these factors influence
optimal QoL in the older adult population, it will be necessary for
research scientists to develop multidimensional component measures.
As recommended in WHO Guidelines For Promoting Physical Activity
Among Older Persons, it is especially important that an overall instrument
of optimal QoL be developed, with the aid of a wide range of interested
parties, including policy makers and planners, health-care providers,
social workers, and perhaps most importantly, older adults themselves.
Since functional status is often the first dimension to be reduced
with the onset of age and contributes to one's ability to live independently,
it adds in a very significant way to understanding optimal QoL or successful
aging for seniors. It is also anticipated that substantial reductions
in morbidity would be accomplished by the widespread implementation
of physical activity programs in the older adult population. Consequently,
QoL is defined as a multi-dimensional facet for successful aging in
this project.
2. State of Exercise
Involvement as an Element of Overall QoL
Regular and systematic exercise throughout life may be assumed to provide
many health benefits, other than just staying alive. Higher levels
of cardiorespiratory capacity (stamina), muscular strength, and flexibility
enable individuals of all ages to be more active and expand the range
of physical and social activities in which he or she can participate.
In fact, the U.S. Surgeon General reports that regular participation
in physical activity may improve health-related QoL by: 1) improving
physical functioning in persons compromised by poor health, and 2) enhancing
psychological well-being. The loss of muscular strength and/or
stamina attributed to advancing age seems to be in part caused by reduced
involvement in physical activity. This means that people of all
ages may be able to improve their QoL through a lifelong practice of
moderate or vigorous physical activity. Although the close relationship
between the impact of physical activity and successful aging or optimal
QoL has not been thoroughly investigated by exercise scientists, medical
doctors, and policy planners, it seems logical to assume this relationship.
Importance of exercise habits or physical fitness level has been described
in several articles (Tanaka et al., 1994; Tanaka, 1997). The Journal
of Aging and Physical Activity will include a series of gerontological
investigations conducted very recently in Japan in a forthcoming issue.
In the issue Tanaka et al. (1999) will emphasize the importance
of assessing functional fitness based on the evidence this index is,
to a larger extent, an independent determinant of successful aging.
In their study, a relatively weak relationship of functional
fitness was observed with the original instrument called "Vital
Score" and the adopted instrument called "Vital Age".
The Vital Age instrument consists of a synthesized profile of
coronary risk factors and physical fitness measures among older adults.
The instrument has been validated among a variety of middle-aged
and older adults with multiple chronic conditions, both sedentary and
physically active individuals. In a recent study of successful
aging and social activity by Ohno et al. (1999), they discussed how
the effects of a better lifestyle, beginning in middle age, is the most
important determinant for successful aging. The Tokyo Metropolitan
Institute of Gerontology (TMIG) (Shibata, 1999) recognizes the need
for a major interdisciplinary longitudinal study on aging, and has initiated
a number of research projects during the last two decades. An
overview of the TMIG research projects has been described elsewhere
(Shibata et al., 1997).
Another study (Fujiwara et al., 1999) functioning as one of the TMIG
research projects will demonstrate how active lifestyles incorporated
with appropriate medical care may help delay the clinical onset of the
functional consequences of chronic diseases. The effects of physical
functioning on psychological well-being will be presented by Osada et
al. (1999), using survey data obtained in both rural and urban areas
of Japan. Significant relationships between habitual exercise and subjective
life satisfaction will be shown in the study of Ishikawa et al. (1999),
which has been funded by the Japanese Ministry of Health and Welfare.
Consequently, it seems logical to include an adjunct measure of functional
fitness or status of exercise involvement in a battery of QoL instruments.
3. A Japanese
Initiative for Promoting Successful Aging
The post World War II period was noted by a substantial increase in
the birth rate, not only in the U.S. but also in many other industrialized
nations, and particularly Japan. At present, the total population in
Japan is approximately 125 million, about one-half of the total population
of the U.S. The population born somewhere between 1945 and 1954 known
as "Baby Boomers" have grown up in a world with increased
food supplies, improved sanitation, and advanced medical technology.
These combined factors have led to substantial increases in life expectancy,
with a resultant change in the composition of the population pyramid
(Shephard, 1997). As a result, many industrialized societies now find
their populations to be comprised of relatively fewer younger people
and more middle-aged and older persons.
In Japan, the percentage of adults 65 years of age and older in the
total population comprized only 5% of the population in 1955; and in
1990, it had reached 12%. It has been estimated that by the year 1999,
approximately 15% of the Japanese population will be 65 years of age
and older. The Statistics Bureau and Statistics Center in the Management
and Coordination Agency of Japan estimates that, by the year 2025, when
most of the baby boom generation reaches retirement age, the segment
of society over 65 years old will peak at approximately 23-26% (30 million)
and those over 80 years old will constitute approximately 30% of the
65+ population. This represents a fivefold increase over the 1955 percentage
in the 65+ population. In contrast, the birth cohort that is between
ages 0-15 (born 1999-1984) in Japan is 14.9% in 1999, which is smaller
than 18.7% for Sweden in 1997, 19.3% for England in 1997, 21.8% for
the U.S. in 1996, 22.0% for Korea in 1998, 32.2% for Brazil in 1995,
and 35.2% for India in 1993. This 0-15 birth cohort will remain at a
low level, somewhere between 13 and 14%, until about 2025.
Of great concern is whether this increased longevity will result in
an accompanying increase in the number of people who suffer from various
kinds of chronic and disabling conditions. Or alternatively, whether
the increasing number of older people will consist primarily of those
who are aging qualitatively. In this report the author operationally
defines successful aging as a combination of factors and circumstances
which enable an individual to lead an active, healthy, productive and
independent life, and thereby to contribute significantly to society
in many different ways.
The aims set forth in the recently published WHO Guidelines For Promoting
Physical Activity Among Older Persons are consistent with the goals
of the Japanese Ministry of Health and Welfare (Ohta, 1997), the Tokyo
Metropolitan Institute of Gerontology (TMIG) (Shibata et al., 1993),
and the Center for Tsukuba Advanced Research Alliance (TARA) (Tanaka,
1997; Tanaka et al., 1997), and the Japanese Ministry of Education,
Science, Sports and Culture called 'Monbusho'. Each of these initiatives
are aimed at increasing the proportion of older persons within society
who are able to independently live an active, healthy and productive
life long into senescence.
4. A Japanese
Perspective for Maintenance of High QoL
Most Japanese today are spared the burden of excessive physical labor,
because few occupations require manual labor or vigorous physical activity.
Moreover, leisure time is increasingly filled with relatively sedentary
behaviors. As the older adult population in Japan continues to increase,
it is anticipated that while most individuals may live longer, not all
of them will enjoy active, happy, and independent lives. Many researchers
and public health officials fear that an increase in life expectancy,
without a corresponding decrease in the incidence and prevalence of
chronic disease will inevitably lead to an increasing number of disabled,
dependent older people in the population (Chodzko-Zajko, 1996).
In response to these concerns, the emphasis in gerontological research
has shifted from lengthening life to increasing the number of years
spent in good health, or in other words, reduced time spent with multiple
chronic conditions. The compression of morbid conditions (Fries, 1988)
to a shorter time period later in life contributes significantly to
raising the QoL for most persons, particularly for those most at risk
for functional impairment and physical frailty. Thus, one of the major
goals of interdisciplinary gerontology and applied exercise science
is to help compress the period of time during which older adults live
in a state of morbidity, and to help extend the portion of the lifespan
during which they live with high vitality and in good health. For this
purpose, in Japan, increasing physical activity and physical fitness
has recently been identified as a major health promotion objective for
the nation (Ohta, 1997). The time has come for both policy makers and
scientists to join forces in an attempt to develop research agendas
to help stimulate "successful aging" or "optimal quality
of life".