DIFFERENCES BETWEEN TWO JAPANESE HEALTH PROMOTION PROGRAMS ON MEASURES OF HEALTH AND WELLNESS

Toshiaki Watanabe*1, Koji Terasawa1, Keisuke Nakade2, Yuki Murata1, Saiki Terasawa3, Kenich Nemoto4, Toshie Kobayashi5, Koki Nakajima4, Yong Zhang6, SuchindaJarupat Maruo7, Fumihito Sasamori3, Naoko Hirota4, Masao Okuhara8 *1Shinshu University, Faculty of Education, 6-Ro Nishinagano, Naganoshi, Nagano 380-8544, 2Minowa town Government Office, 10298 Nakaminowa, Minowamati, Kmiinagun, Nagano 399-4695, Japan 3Shinshu University Faculty of Electrical and Electronic Engineering, 4-17-1 Wakasato, Naganoshi, Nagano 380-0928, Japan


Steps and exercise steps
Significant differences were present in the average number of walking and exercise steps between the CA and CT groups. The CT group had a significantly higher averages compared with the CA group (p < 0.001; TableII).  Figure 1).   Figure 2).  Table III summarizes the results of the anthropometric and blood pressure measurements. Before and after the health education programs, male and female in the CT group showed significant decreases in weight(overall t = 4.0,malet = 3.0, femalet = 2.8) and waist circumference (overall t = 8.7,male t = 2.7,female t = 9.6).The CT groupalso showed significant decreases in weight (overall t = 2.9,female t = 4.5), BMI (overall t = 3.0,female t = 4.3), waist circumference (overall t = 4.5,male t = 2.2,female t = 4.3), systolic blood pressure (overall t = 4.5,male t = 3.4, femalet = 3.0), and diastolic blood pressure (overall t = 4.3,male t = 4.0, femalet = 2.1) from before to after the health education program.    Data are presented as mean ± SE. NS: not significant; CA group: monthly classroom activity only, the Matsumoto city cohort; CT group: the classroom/training (CT) group, monthly classroom activity plus weekly 90-min strength and weight training, the Minowa town cohort

Blood chemistry
Table V summarizes the results for the blood chemistry tests. The CA group showed no significant improvement in HDL, LDL, ortriglyceridelevels from before to after the health education program. However, fasting glucose (overall t = −3.6,male t = −2.6,female t = −2.6) and glycosylated hemoglobin (HbA1c;overall t = −7.9, malet = −2.9,female t = −8.7) levels were significantly increased after the health education program.The CT groupalso showed no significant improvement in HDL, LDL, or triglyceride levelsfrom before to after the health education program. However, fasting glucose levels (overall t = 2.5, p < 0.05,female t = 2.5) and HbA1c levels (overall t = 4.6,male t = 2.8, female t = 3.8) were significantly increased after the health education program. and females of the CA groupshowed no significant differences in response times for the differentiation task, the reverse differentiation task, total response times, number of forgets for the differentiation task, number of mistakes for the differentiation task, number of forgets for the reverse differentiation task, number of mistakes for the reverse differentiation task, or total number of forgets and mistakes before and after the health education program.However, they showedsignificant differences in response times for the formation task (overall t = −2.5, femalet = −2.3) from before to after the health education program. In contrast, the CT groupshowed no significant differences in response times for the formation task, response times for the reverse differentiation task, number of forgets for the differentiation task, number of forgets for the reverse differentiation task, number of mistakes for the reverse differentiation task, or total number of forgets and mistakes from before to after the health education program. However, they showedsignificant differences in response times for the differentiation task (overall t = 2.1, malet = 2.8), total response times (overall t = 2.4, male t = 3.2), and number of mistakes for the differentiation task (overall t = 4.2,male t = 3.8, femalet = 2.2) from before to after the health education program.  Data are presented as mean ± SE. NS: not significant.
The repeated two-way ANOVA results of the health education program for theCA and CT groups' before and after itemsshowed no significant differences.

Walking steps of the pedometer
The daily average walking steps in the CT groupwas 8687 compared with 7242 in the CA group, i.e., approximately 1,400 steps more. In the CA group, although the average amount of walking and exercise steps gradually increased from May to September, the number of walking steps decreased from September to February. A similar pattern was seen in the average amount of walking and exercise steps from May to October in the CT group, but both walking and exercise steps decreased from October to February. Minowatown (CT group) is approximately 50 km from the city of Matsumoto(CA group), and both areas have the same climate, with thetemperaturefalling from October toan average winter temperature of approximately−6.6°C. The numbers of walking steps began to decrease from October in the CA groupand from December in the CT group under comparable climates, suggesting that the CT group may have more health awareness. In addition,malesin both groups may have stronger health awareness than femalesin both groups because males performed more daily steps compared withfemales.
Paffenbargheret al. reported that expending more than 2000 kcal/week reduced the risk of heart attacks [17]. In addition, walking 10,000 steps/day improves glucose tolerance and reduces blood pressure, both of which are risk factors for type 2 diabetes [18,19]. However, participants of previous health education programs complained of knee and low back pain because of excessive walking [13]; hence, we measured the WBI and set individualized walking targets.

Anthropometry and blood pressure
The CA group showed significant decreases in weight and waist circumference from before to after the health education program. Although maleslost more weight than females did, males had smaller decreases in waist circumference. In the CA group, there were also no significant differences in either BMI or blood pressure from before to after the health education program. In contrast, the CT group showed significant decreases in weight, BMI, waist circumference, systolic blood pressure, and diastolic blood pressure from before to after the health education program. However, malesshowed no significant difference in weight or BMI from before to after the CT health education program. When comparing the CT andCA groups, the former showed the most significant improvement from before to after the program.Aerobic exercise and health education to walk more can help decrease weight, BMI, and blood pressure [20,21]. In our study, the CT groupshowed a significant improvement in the BMI and blood pressure compared with the CA group.
This may have been because the CT groupwalked an average of 1,400 steps more than the CA group and performed 90-minweight training once a week.

Physical fitness test
From before to after the health education programs, the CA group showed significant improvements in sit-ups, sit-and-reach flexibility, eyes-open single-leg stance, 10-m obstacle walk, and 6-min walk, whereas the CT group showed significant improvements in handgrip strength, sit-ups, sit-and-reach flexibility, 10-m obstacle walk, and 6-min walk.Although the CA group showed significant overall improvements in sit-ups and sit-and-reach flexibility after the health education program, femalesshowed no significant improvement in the sit-up domain (muscular endurance) and males showed no significant improvement in the sit-and-reach flexibility domain. This result may suggest that it is easier to improve muscular endurance in males, while flexibility is easier to improve in female.
The CT and CA groups showed no significant improvements in eyes-open single-leg stance and handgrip strength, respectively. However, the eyes-open single-leg stance in the CT group was almost 120 s of the maximum and was higher than in the CA group. Muscular strength isnot known to improve when exercising by only walking [22]. Therefore, handgrip strength may have decreased in the CA group after receiving health education only. The CT group showed a more significant improvement from before to after the health education program.

Blood chemistry
From before to after the health education program, the CA group showed significant increases in fasting glucose and HbA1c levels, whereas the CT group showed significant decreases in fasting glucose and HbA1c levels. This is consistent with evidence that HbA1c and fasting glucose significantly decreased in patients with diabetes who participated in aerobic and resistance exercise programs [23,24]. The afore mentioned differences in HbA1c and fasting glucose levels may have been due to the greater amount of walking and theweekly 90-min weight training in the CT group.

Go/no-go tasks of the brain function test
Although the go/no-go task was initially developed to investigate brain function in children [25], it has been reported to be suitable for brain function screening indementia [26]. A previous go/no-go task study suggested that a health program could improve brain function, including working memory [27].
In that study, participants performed an average of 6,500 steps/day in the first year of continuous exercise, at the end of which their go/no-go task reaction times increased significantly andthe number of error responses decreased significantly. In the secondyear, the walking exercise was continued at an average of 7,000 steps/day anda 2-h weight-training session was introduced. This led to further reductions in the reaction times and the number of error responses. In our study, the males andfemales in the CA groupshowed significant delays in response times for the formation task. In contrast, the CT group showed significantly faster response times for the differentiation task and the total response time. Furthermore, the CT group showed significant decreases in the number of mistakes during the differentiation and reverse differentiation tasks.

CONCLUSION
We implemented two 10-month health education programs that compared classroom activity alone (i.e., the CA program) with classroom activity plus weekly 90-min strength and weight training (i.e., the CT program). Overall, the CT program appeared to be more effective than the CA program on the measures tested. The CT group: walked more (energy expenditure); had greater improvements in BMI and blood pressure (anthropometric measures); showedsignificant improvements in handgrip strength, sit-ups, sit-and-reach flexibility, 10-m obstacle walk, and 6-min walk (physical fitness); showed decreasedHbA1c and fasting glucose (blood measures); and, in the go/no-go tasks, faster overall and differentiation response times, and significantly fewer mistakes in the differentiation and reverse differentiation elements (brain function). However, the CA group did show significant improvement in sit-ups, sit-and-reach flexibility, eyes-open single-leg stance, 10-m obstacle walk, and 6-min walk (physical fitness). Notably, the CA group also showed significant increases in both HbA1c and fasting glucose, as well as significant delays in the response times for the formation task (go/no-go task). Thus, the CT programwas superior to the CA program on the measures used.In conclusion, the CT program had added benefits over the CA program because of the higher average amount of walking (approximately 1,400 steps) and the inclusion of a weekly weight-training activity.

ACKNOWLEDGMENTS
This study was supported by a grant of the Preventive Medical Center of Shinshu University Hospital from Ministry of Education, Culture, Science and Technology. In addition, Koji Terasawa was supported by a Grant-in-Aid for the Scientist (Houga: 23650426, KibanA: 25257101) provided by the Ministry of Education, Culture, Sports, Science and Technology of Japan.