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0Journal of Clinical Gerontology & Geriatrics xxx (2016) 1—6
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Original article
Effects of Japanese drum exercise on depression and physical function in community-dwelling older women
Masayo Tanaka MS a, Fumiko Komura PhD a, Akiko Hanai MS a, Tadao Tsuboyama MD, PhD a, Hidenori Arai MD, PhD a'b' *
a Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan b National Center for Geriatrics and Gerontology, Obu, Japan
ARTICLE INFO
Article history: Received 29 January 2016 Accepted 31 January 2016 Available online xxx
Keywords: depression geriatric medicine intervention Japanese drum Kihon checklist quality of life
ABSTRACT
Background/Purpose: We examined whether a 3-month Japanese drum exercise program can ameliorate depressive mood and improve physical fitness in community-dwelling older women. Methods: The participants were 40 community-dwelling older women aged 65 years and older who satisfied one or more of the mood items on the Kihon checklist. They were divided into two groups: a 3-month Japanese drum exercise group and a control group. The study included 21 women who participated in Japanese drum exercises (mean age, 76.8 ± 5.2 years) and 19 control participants (79.8 ± 5.4 years). To evaluate the participants' psychological status, we used the depression item (D) on the short form of the profile of mood states. The body composition of participants was determined using bioelectrical impedance analysis. In addition, gait speed, grip strength, and scores on the morale scale, the geriatric depression scale, the trail making test, and the mini-mental state examination were measured before and after the intervention.
Results: After the 3-month intervention, we found no significant main effect-induced differences (p = 0.135) in Profile of Mood States between the groups. No significant difference was found between groups for any of the psychophysiological or physical fitness measures after the intervention. Conclusion: Our results did not support the hypothesis that the Japanese drum exercise can improve depressive mood in older women. However, depressive mood showed a slight improvement in the intervention group, suggesting that a longer or more frequent session of intervention might have had an effect.
Copyright © 2016, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).
1. Introduction
With the current aging population, it is very important to prolong healthy lifespan and prevent frailty and disability to ensure that older people have active and independent lives. If the difference between the average overall life expectancy and healthy life expectancy can be decreased through the prevention of disease, promotion of public health, and reduction of nursing care, the following will be more likely: (1) individuals will be more satisfied with their lives and have something to live for; (2) a decrease in individuals' quality of life will be prevented; and (3) less financial
* Corresponding author. National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan. E-mail address: harai@ncgg.go.jp (H. Arai).
assistance from the government will be required. Thus, in addition to preventing and treating diseases, the approaches to meeting the needs of an aging society have increasingly focused on overcoming frailty and comorbidities and on maintaining/improving daily functions. Therefore, it is necessary to clarify the causes of age-related changes in daily functions as well as their processes and to adopt measures to prevent such changes.
Among age-related clinical problems, depression is one of the most debilitating geriatric syndromes and an important aspect of geriatrics worldwide. As a result of the high rate of suicide rate among older people, many Japanese researchers have attempted to address the problem of depression in this population. Previous studies attempted to ameliorate depressive symptoms through a variety of relaxation and physical/cognitive interventions.1 According to recent meta-analyses, both supervised and unsupervised physical activity interventions are effective in reducing depressive
http://dx.doi.org/10.1016/jocgg.2016.01.001
2210-8335/Copyright © 2016, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
M. Tanaka et al. / Journal of Clinical Gerontology & Geriatrics xxx (2016) 1—6
symptoms among adults without clinical depression.2 Using the definition of exercise employed by the American College of Sports Medicine, Cooney et al3 reported on the effectiveness of exercise interventions in Cochrane Reviews and concluded that moderate exercise is effective in relieving depression. However, the optimal type, intensity, duration, and frequency of exercise for the prevention of depression have yet to be determined.
In addition to exercise interventions, music therapy showed sustained beneficial effects on study participants' self-esteem, mood, depression, and psychological distress.4,5 Among the musical interventions, playing Japanese drums is attractive because it requires the movement of individuals' entire body, particularly their arms, while both sitting and standing. Thus, like dancing, playing a Japanese drum is a full-body exercise. It involves dynamic motions, vocalization (e.g., increasing tone and pitch), sounds with various intensities, and rhythms with different tempos. By watching instructors' movements and listening to the sounds that they produce, Japanese drum players can understand the proper rhythms and tempos and play original music using drumsticks in their own way, which could ameliorate depressive mood and improve physical fitness even in frail older adults. Indeed, a study investigating the effects of playing Japanese drums on stress reduction in six Japanese men and women with the average age of 60.6 years showed that the rhythmic sounds of the drums, used for a therapeutic purpose, relieved tension.6
Therefore, it is expected that if older people with depressive mood regularly play a Japanese drum, they might improve their psychophysiological and physical functions. However, it is unknown whether playing a Japanese drum effectively reduces depressive symptoms in addition to improving players' physical fitness. Thus, the aim of this study was to investigate the effects of Japanese drum exercise on depressive mood and physical fitness in community-dwelling older women.
2. Methods
2.1. Participants
Prior to recruitment, sample size was calculated using the
depression item of short form of the profile of mood states as the
primary outcome and considering the value from previous litera-
ture on depression improvement by music therapy as reference
with an approximate effect size of 0.31.7 To reach a power of 0.8,
with a set at 0.05 and b at 0.2, the required sample size calculated
was 76. We included four more participants as dropout precaution,
totalizing an original plan intended for 80 people.
A total of 189 community-dwelling older people (27 men and 162 women) who regularly visited a community disability-prevention center in Kyoto, Japan were recruited for the study. The inclusion criterion for this study was at least one positive response indicating a depressive mood among answers to the five mood questions on the Kihon checklist, which has questions similar to those of the geriatric depression scale (GDS).8 Individuals
who were taking medications for depression and those with visual impairment or physical disability were excluded from the study.
Among the 189 recruited, 114 did not meet the inclusion criterion or were excluded because of meeting the exclusion criteria stated above. Among the remaining 75 people 43 (3 men and 40
women) agreed to participate in this study. Because most of the participants were women, we asked only women to participate in
this study. Thus, the planned sample size could not be reached,
unfortunately. Written informed contest was obtained from each participant in accordance with the guidelines of Kyoto University Graduate School of Medicine, Kyoto, Japan. The study protocol was
approved by the Kyoto University Graduate School of Medicine Ethics Committee (No. E 1910-2).
In this study we nonrandomly divided 40 participants of community-dwelling older women (> 65 years) living in Kyoto City into an intervention group of 3 months of Japanese drum exercise (21 participants) and a control group (19 participants), who performed exercise independently for the same period of time (Figure 1). The allocation to the intervention or control group was performed by one healthcare professional in a community disability-prevention center in Kyoto, according to the participants' willingness to participate in the drum exercise and the convenience to commute to the drum exercise venue. The exercise intervention consisted of one 40-minute session consisting of warming up for 5 minutes, group drum exercise of moderate to vigorous intensity for 30 minutes, and cooling down and stretching for 5 minutes and the intervention group participated in this program once a week for 12 weeks. The control group was instructed to increase the amount of exercises such as stretching, and walking, and to maintain the usual level of activity during the study period according to their own discretion. The intervention group was also instructed in the same way.
2.2. Measurements
We recorded age, years of education, medication use, sleeping hours, and medical history (e.g., stroke, heart disease, diabetes, low back pain, knee osteoarthritis, cancer). Data on self-rated health status, appetite, sleep disturbance, self-efficacy, behavioral intention to go out, mood, and lifestyle changes were also collected. Changes in participants' physical condition were assessed by a questionnaire, and body mass index (BMI) was calculated as weight (kg) divided by height (m) squared. The Kihon checklist for frailty and the Tokyo Metropolitan Institute of Gerontology index of competence9 for instrumental activities of daily living (ADLs) were administered. The Tokyo Metropolitan Institute of Gerontology index of competence, developed according to the hierarchical model of competence proposed by Lawton,10 is a multidimensional, 13-item index used to assess advanced life function, which cannot be evaluated with a scale that assesses ADLs. This index is used to measure three types of competence: instrumental self-maintenance, intellectual activity, and social role.
2.3. Psychophysiological Junction
We used the short form of the profile of mood states (POMS-SF) to assess psychophysiological function.11,12 This is a 30-item (6 subscales) self-completed questionnaire used to evaluate an individual's mood and the following six types of emotions: tension—anxiety; depression—dejection; anger—hostility; vigor; fatigue; and confusion. Each item was scored on a scale from 0 to 4 points (0, not at all; 4, very often). For each subscale, we calculated the total scores, which were adjusted for age to obtain a participant's T score. For all these subscales, higher scores indicate higher levels of the corresponding emotion. Yokoyama13 developed the short Japanese form of the POMS, verified its reliability and validity, and confirmed the appropriateness of the translated terms. Aka-bayashi et al,14 who employed the POMS in clinical settings, reported that the scale facilitates self-evaluation of emotion and mood in patients with depressive symptoms or anxiety-related neurosis and that the scale's scores accurately represent patients' emotional state.
The Philadelphia Geriatric Center morale scale9 was used to assess older people's morale, the GDS15 to assess mood, the trail making test (TMT)16 and the mini-mental state examination (MMSE)17 to assess cognitive function. The International
M. Tanaka et al. / Journal of Clinical Gerontology & Geriatrics xxx (2016) 1—6 3
Community-dwelling elderly (n = 189)
Excluded (n =146 ) . 114 did not meet the inclusion criteria . 32 refused to participate
Agreed (n = 43)
Excluded (n =3 ) 3 men
Figure 1. Flow chart showing the distribution of participants throughout the trial.
Consultation on Incontinence questionnaire—short form18 was used to assess urinary incontinence. We also asked all participants "How do you assess your own health condition?" before and after the intervention.
2.4. Assessment of physical function
We measured fat-free body mass, muscle mass, body fat, and body weight for all participants. A bioelectrical impedance data-acquisition system (Inbody 430; Biospace, Seoul, Korea) was used to determine fat-free body mass, muscle mass, and body fat.19 Using segmental body composition and muscle mass, a value for appen-dicular skeletal muscle mass was determined and used for further analysis. Muscle mass was converted into the skeletal muscle mass index by dividing weight by height squared (kg/m2). This index has been used in several epidemiological studies.20,21
We also conducted the timed up and go test22 and recorded the time taken to walk 10 m at both normal and maximum walking speeds. To determine the participants' general endurance, we performed the shuttle stamina test—walking (SSTw),23 in which the participants were instructed to walk as fast as possible for 3 minutes to measure their maximum walking distance. Maximal voluntary isometric strength of handgrip was measured using a JAMAR hand dynamometer (North Coast Medical Inc., Gilroy, CA, USA). The measurement was taken for the dominant hand while the participant was in a sitting position. The muscle strength test was carried out three times. The handgrip strength score was defined as the best performance of three trials.
2.5. Statistical analysis
Analyses were performed on those who completed both the baseline and final evaluations. The Japanese drum exercise group's and the control group's pre- and postintervention scores for item D (depression—dejection), the primary endpoint of this study, were compared using a two-way analysis of variance with a repeated measurement method (split-plot analysis of variance). To conduct
between-group comparisons before and after the intervention, we used the unpaired t test (for age, BMI, timed up and go test, normal walking speed, maximum walking speed, SSTw, grip strength and skeletal muscle mass index) and Mann—Whitney Utest [foryears of education, instrumental activities of daily living, Kihon checklist (depression item), POMS(D), Philadelphia Geriatric Center morale scale, GDS, TMT-A, TMT-B, MMSE, and International Consultation on Incontinence questionnaire—short form]. A difference-indifference analysis was carried out to compare the differences in the change (the values after the intervention minus the values before the intervention) in each of the variables between the two groups using the unpaired t test or Mann—Whitney U test as above. The data were managed and analyzed using SPSS (Windows version 22; SPSS Inc., Chicago, IL, USA). A p value < 0.05 was considered to indicate statistical significance for all analyses.
3. Results
We analyzed 21 participants in the Japanese drum exercise group [mean age ± standard deviation (SD) 76.8 ± 5.2 years] and 19 in the control group (79.8 ± 5.4 years). There were no adverse
Table 1
Baseline characteristics of the two groups.3
Japanese drum exercise Control group group
n Mean ± SD n Mean ± SD p
Age (y) 21 76.8 ± 5.2 19 79.8 ± 5.4 0.079
Weight (kg) 21 48.4 ± 5.6 19 48.3 ± 8.6 0.75
Body mass index (kg/m2) 21 22.0 ± 2.5 19 21.9 ± 3.0 0.823
Education years 21 11.5 ± 1.8 19 12.0 ± 10.6 0.08
Instrumental ADL 21 12.3± 0.8 19 12.0 ± 12.2 0.823
Kihon checklist (depression) 21 1.4 ± 1.2 19 1.0 ± 1.7 0.562
SD = standard deviation.
a Control group vs. Japanese drum exercise group by t test (age, weight, body mass index); control group vs. Japanese drum exercise group by Mann—Whitney U test [education years, instrumental activities of daily living (ADL), Kihon checklist (depression)].
4 M. Tanaka et al. / Journal of Clinical Gerontology & Geriatrics xxx (2016) 1—6
Table 2
Physical performance in two groups at baseline and after 3 months.a
Baseline Post
n Japanese drum exercise group n Control group p n Japanese drum exercise group n Control group p Mean ± SD Mean ± SD Mean ± SD Mean ± SD
Physical performance
Timed up & go test (s) 21 8.6 ± 1.6 18 9.0 ± 2.2 0.508 21 9.3 ± 2.4 18 9.7 ± 2.8 0.185
Normal walking speed (m/s) 21 1.1 ± 0.2 18 1.2 ± 0.3 0.781 21 1.3 ± 0.2 17 1.3 ± 0.2 0.811
Maximum walking speed (m/s) 21 1.5 ± 0.3 18 1.4 ± 0.3 0.165 21 1.6 ± 0.4 17 1.5 ± 0.3 0.263
Shuttle stamina test by walking (m) 21 1.84 ± 0.42 17 1.81 ± 0.49 0.779 21 2.03 ± 0.41 18 1.75 ± 0.47 0.051
Hand grip strength (kg) 21 19.8 ± 4.0 18 22.4 ± 4.9 0.075 21 19.2 ± 4.1 18 17.3 ± 5.0 0.191
SMI (kg/m2) 21 5.7 ± 0.5 19 5.6 ± 0.8 0.656 21 5.6 ± 0.6 18 5.6 ± 0.9 0.871
SD = standard deviation; SMI = skeletal muscle mass index. a Control group vs. Japanese drum exercise group by t test.
Table 3
Cognitive function in two groups at baseline and after 3 months.a
Baseline Post
Japanese drum exercise group Control group p Japanese drum exercise group Control group p
n Median IQR n Median IQR n Median IQR n Median IQR
Functional states
POMS (D) 21 49.0 45.0—53.0 19 45.0 45.0—51.0 0.411 21 47.0 42.0—50.0 19 47.0 42.0—53.0 0.848
PGC 21 12.0 9.5—14.0 19 11.0 9.0—13.0 0.429 21 13.0 10.0—13.5 19 11.0 8.0—14.0 0.347
GDS 21 4.0 2.5—7.0 19 4.0 2.0—7.0 0.913 21 2.0 0.5—6.0 19 3.0 2.0—9.0 0.199
TMT-A(s) 21 56.0 46.0—60.0 19 56.0 48.0—87.0 0.233 21 45.0 35.5—56.5 17 50.0 43.0—67.0 0.419
TMT-B(s) 21 108.0 96.0—137.0 18 152.5 98.0—207.5 0.151 21 104.0 95.5—144.0 17 122.0 83.5—164.0 0.803
MMSE 21 27.0 26.5—30.0 19 27.0 26.0—29.0 0.366 20 28.5 26.3—30.0 17 28.0 27.0—29.0 0.332
ICIQ—SF 21 1.0 0.0—4.0 19 1.0 0.0—5.0 0.842 18 0.0 0.0—4.3 17 0.0 0.0—4.0 0.914
GDS = geriatric depression scale; ICIQ-SF = International Consultation on incontinence questionnaire-short form; MMSE = mini-mental state examination; PGC = Philadelphia Geriatric Center morale scale; TMT = trail making test. a Control group vs. Japanese drum exercise group by Mann—Whitney U test.
events in either group. Table 1 shows the baseline characteristics of the participants. The average rate of Japanese drum exercise class attendance was 90%. There was no significant difference in the baseline characteristics, psychophysiological function, physical function, or lifestyle factors (i.e., physical activity and dietary habits) between the two groups (Tables 1—3). Using a repeated measurement method, analysis of variance was performed on the participants' T scores for item D; the test did not show a significant difference between the drum and control groups (main effect: F = 2.334, p = 0.135; interaction: F = 1.587, p = 0.215; Figure 2). In healthy individuals, the score for item D generally ranged from 40 points to 60 points.12 The item D score showed a larger decrease in the intervention group than in the control, although the difference did not reach statistical significance. Concerning the other psy-chophysiological measures, no significant difference was found between groups before or after the intervention. As seen in the item D score, the GDS scores had a larger decrease in the intervention group than in the control, although the difference did not reach statistical significance (Table 3). The difference-in-difference analysis showed that SSTw performance and grip strength were significantly improved by the intervention (Table 4).
4. Discussion
In this study, we examined the effect of playing the Japanese drum on depressive mood and on psychophysiological and motor functions after the intervention in Japanese older women (see Supplemental Table). However, we did not observe a significant effect of the Japanese drum exercise intervention after 3 months. No significant difference was noted in the psychophysiological or physical indices between the intervention and control groups. However, when we performed a difference-in-differences analysis
Figure 2. Comparison of profile of mood states (POMS) T score D before and after the intervention. Changes in the POMS-short form T score D in the Japanese drum and the control groups. A repeated-measures analysis of variance was performed to compare the Japanese drum and the control groups (F = 1.587, p = 0.215). Because the median line and the bottom of the box in the control group overlap, this line cannot be seen clearly.
M. Tanaka et al. / Journal of Clinical Gerontology & Geriatrics xxx (2016) 1—6
Table 4
Comparison of the difference between the change across the intervention period.3
n Japanese drum n Control p exercise group group
Mean ± SD Mean ± SD
Physical performance
Timed up & go test (s) 21 0.4: 1.2 17 0.4 1.2 0.847
Normal walking speed (m/s) 21 6.8 z 1.5 18 17.3 - t 29.8 0.154
Maximum walking speed (m/s) 21 0.1 0.2 16 0.1 0.2 0.928
Shuttle stamina test by walking (m) 21 18.6 24.8 16 -3.6 15.9 0.002
Hand grip strength (kg) 21 -0.5 z 4.5 17 -5.0 3.0 0.001
SMI (kg/m2) 21 0.0 0.2 18 0.0 0.2 0.398
SD = standard deviation; SMI = skeletal muscle mass index. a Control group vs. Japanese drum exercise group by t test.
(Table 4), we found a significant effect of the Japanese drum exercise intervention on SSTw and handgrip strength.
Although our primary results did not support the hypothesis that depressive mood can be ameliorated by participating in a Japanese drum exercise class once per week, the T score for item D of the POMS-SF showed a larger improvement in the intervention group than in the control group; however, this difference did not reach statistical significance. This result is consistent with a previous study in which the participants with a normal baseline score for depression showed little change in their mood after a music intervention.24
Although we recruited participants with depressive mood based on the Kihon checklist, the POMS-D scores were in the normal range and the mean GDS scores were relatively low in both groups, potentially affecting the outcome of this study. Although exercise has been reported to be effective in improving cognitive function,25 individuals with cognitive dysfunction can face difficulties in understanding how to perform tasks with specific exercise patterns, which might preclude the effects of exercise on several out-comes.26-29 However, because the mean MMSE scores in this cohort were relatively high before the intervention (i.e., 27.3 ± 2.2) it is likely that the participants were able to understand the exercise program. Because the participants in the Japanese drum exercise group were eager to continue the program and did not complain about severe bodily pain caused by the exercise, we might have obtained a positive result with a program of higher frequency and longer duration.
The study had several limitations. First, the intended sample size could not be reached. Thus, the achieved number of participants has insufficient statistical power to delineate meaningful effect size. Second, the nonrandom allocation could cause some confounding. Third, we evaluated mental health status only in a subjective manner using a questionnaire. Therefore, it would be necessary to evaluate mental health in a more objective manner, such as by using physiological techniques, such as cortisol concentration. Fourth, there was only one exercise session per week due to the limited space and time availability in the community center, while two or three sessions per week are usually recommended. Fifth, given that the participants were regular visitors to a community disability-prevention center, many of them must have been interested in exercise. Thus, the study participants may have had a high level of health literacy prior to the study, potentially making it difficult to obtain a positive result. Targeting a more vulnerable population might be a more appropriate approach. Personalized programs tailored to each individual's abilities, behavioral stage, and environment should be addressed in future studies.
In conclusion, we addressed the effect of Japanese drum exercise on mood, physical fitness, cognitive function, quality of life, and urinary incontinence in Japanese older women and did not obtain positive results. However, the exercise was well tolerated and
received a favorable response. Therefore, we propose that more frequent and longer interventions would be effective in ameliorating depressive mood and hopefully increasing physical fitness in older adults with mild depressive mood.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgments
This study was supported by Grants-in-Aid for Comprehensive Research on Aging and the Kyoto Academia Public Cooperation Mechanism of Japan. We would like to thank Munenori Higashi, Hideo Hirosue, Misao Aihara, and all the staff members at Taiko Center Co., Ltd. and members at Shimogyo Region Disability Prevention Promoting Center, Kyoto, Japan for the Japanese drum training and recruiting the participants of this study.
Appendix. Supplementary material
Supplementary material associated with this article is available at http://dx.doi.org/10.1016/j.anbehav.2016.03.004.
References
1. Carek PJ, Laibstain SE, Carek SM. Exercise for the treatment of depression and anxiety. Int J Psychiatry Med 2011;41:15-28.
2. Conn VS. Depressive symptom outcomes of physical activity interventions: meta-analysis findings. Ann Behav Med 2010;39:128-38.
3. Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR. Exercise for depression. Cochrane Database Syst Rev 2013;9:CD004366.
4. Hanser SB, Mandel SE, Bertman L Feist J. Manage your stress & pain through music. Boston: Berklee Press; 2010.
5. Hanser SB. Music therapy-based mechanisms for coping with stress and pain. J Urb Cult Res 2013;6:98-107.
6. Kobayashi R, Shirahama K, Moriyama H, Kanemura N. The effects of a functional training program using Japanese drum in public health center on the stress and sleep quality. Jpn JOccupMed Traumatol 2006;54:25-8 [In Japanese].
7. Hanser SB, Thompson LW. Effects of a music therapy strategy on depressed older adults. J Gerontol 1994;49:P265-9.
8. Arai H, Satake S. English translation of the Kihon checklist. Geriatr Gerontol Int 2015;15:518-9.
9. Koyano W, Shibata H, Nakazato K, Haga H, Suyama Y. Measurement of competence: reliability and validity of the TMIG index of competence. Arch Gerontol Geriatr 1991;13:103-16.
10. Lawton MP. The Philadelphia Geriatric Center Morale Scale: a revision. J Gerontol 1975;30:85-9.
11. Curran SL, Andrykowski MA, Studts JL. Short form of the profile of mood states (POMS-SF): psychometric information. Psychol Assess 1995;7:80-3.
12. Bourgeois A, LeUnes A, Meyers M. Full-scale and short-form of the profile of mood states: a factor analytic comparison. J Sport Behav 2010;33:355-76.
13. Yokoyama K. Profile of mood states—brief form Japanese version. Tokyo: Kane-koshobo; 2005.
14. Akabayashi A, Yokoyama K, Araki S, Shimada K. Clinical application of the Japanese edition of the profile of mood states (POMS). Jpn J Psychosom Med 1991;31:577-82.
15. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982;17:37-49.
16. Hashimoto R, Meguro K, Lee E, Kasai M, Ishii H, Yamaguchi S. Effect of age and education on the trail making test and determination of normative data for Japanese elderly people: the Tajiri Project. Psychiatry Clin Neurosci 2006;60: 422-8.
17. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
18. Gotoh M. Quality of life assessment for patients with urinary incontinence. Nagoya J Med Sci 2007;69:123-31.
19. Gibson AL, Holmes JC, Desautels RL, Edmonds LB, Nuudi L. Ability of new octapolar bioimpedance spectroscopy analyzers to predict 4-component-model percentage body fat in Hispanic, black, and white adults. Am J Clin Nutr 2008;87:332-8.
20. Janssen I. Influence of sarcopenia on the development of physical disability: the cardiovascular health study. J Am Geriatr Soc 2006;54:56-62.
M. Tanaka et al. / Journal of Clinical Gerontology & Geriatrics xxx (2016) 1—6
21. Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol 2004;159:413—21.
22. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142—8.
23. Kimura M, Okayama Y, Tanaka Y. Reliability and validity of a simple endurance test for the elderly; Shuttle stamina walk test (SSTw). J Phys Fit Sport Med 1998;47:401—10.
24. Takahashi S, Takahashi S, Yamamoto K, Yamamoto K, Matsuura S, Matsuura S, et al. An effect of appreciating music on emotion: follow up of the Profile Of Mood States score before and after appreciating music. Jpn J Psychosom Med 1999;39:167—75.
25. Plassman BL, Williams Jr JW, Burke JR, Holsinger T, Benjamin S. Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Ann Intern Med 2010;153:182—93.
26. Kramer AF, Erickson KI. Capitalizing on cortical plasticity: influence of physical activity on cognition and brain function. Trends Cogn Sci 2007;8:342—8.
27. de Andrade LP, Gobbi LTB, Coelho FMG, Christofoletti G, Riani JLR, Stella F. Benefits of multimodal exercise intervention for postural control and frontal cognitive functions in individuals with Alzheimer's disease: a controlled trial. J Am Geriatr Soc 2013;61:1919—26.
28. Uemura K, Shimada H, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, et al. Cognitive function affects trainability for physical performance in exercise intervention among older adults with mild cognitive impairment. Clin Interv Aging 2013;8:97—102.
29. Lautenschlager NT, Cox KL, Flicker L, Foster JK, van Bockxmeer FM, Xiao J, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 2008;300:1027—37.
