坂井宏旭ら： わが国における脊髄損傷の現状．J Spine Research 1：41－51，2010.
阪本桂造：運動器不安定症 運動療法．Clinician 568：489－494，2008.
Noriko Yoshimura, Shigeyuki Muraki, Hiroyuki Oka, Sakae Tanaka, Toru Ogata, Hiroshi Kawaguchi, Toru Akune, Kozo Nakamura
Erratum to: Association between new indices in the locomotive syndrome risk test and decline in mobility: third survey of the ROAD study.
J Orthop Sci. 2015 Sep;20(5):906. doi: 10.1007/s00776-015-0765-x.
Abstract/Text
坂田悍教：運動器不安定症を有する地域高齢者に関する開眼起立特性．整・災外 50：17－25，2007.
新開省二：地域在住高齢者の「要介護」予防をめざした目標体力水準の設定．東京都老人総合研究所研究報告：151－157，2000.
日本医師会総合政策研究機構：一般高齢者～軽度介護者の歩行機能／日常生活活動状況の実態とサービス提供／マネジメント／ハイリスク者抽出方法に関する調査研究．日本医師会総合政策研究機構報告書 第70号，2005.
鳥羽研二、菊池令子、岩田安希子：転倒ハイリスク者の早期発見における‘転倒スコア’の有用性．日本臨床65：597－601，2007.
東京都高齢者研究・福祉振興財団：介護予防（特定高齢者把握事業）におけるより効率的・効果的スクリーニング指標の開発と応用に関する調査・研究事業 報告書，2008.
坂田悍教：3mTUG・開眼片脚起立試験の意義と実践法．Clinician 559：592－597，2007.
鶯 春夫、岡 洋子、楠 裕英ら：高齢障害者が横断歩道を利用する際の問題点．理学療法学24：126，1997.
小野寺理江、佐野充：横断歩道における横断時間と安全性．国際交通安全学会誌30：102－109，2005.
黄川昭雄、山本利春、佐々木敦之ら：機能的筋力測定・評価法－体重支持指数（WBI）の有効性と評価の実際．日本整形外科スポーツ医学会誌 10：463－457，1991.
村永信吾：立ち上がり動作を用いた下肢筋力評価とその臨床応用．昭和医会誌61：362－367，2001.
星地亜都司、星野雄一、岩谷 力ら：高齢者運動器障害のリスクと早期発見ツールの開発．THE BONE24：43－49，2010.
K R Baker, M E Nelson, D T Felson, J E Layne, R Sarno, R Roubenoff
The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial.
J Rheumatol. 2001 Jul;28(7):1655-65.
Abstract/Text
OBJECTIVE: To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis (OA) of the knee.
METHODS: Forty-six community dwelling patients, aged 55 years or older with knee pain and radiographic evidence of knee OA, were randomized to a 4 month home based progressive strength training program or a nutrition education program (attention control). Thirty-eight patients completed the trial with an adherence of 84% to the intervention and 65% to the attention control. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index pain and physical function subscales. Secondary outcomes included clinical knee examination, muscle strength, physical performance measures, and questionnaires to measure quality of life variables.
RESULTS: Patients in the strength training group who completed the trial had a 71% improvement in knee extension strength in the leg reported as most painful versus a 3% improvement in the control group (p < 0.01). In a modified intent to treat analysis, self-reported pain improved by 36% and physical function by 38% in the strength training group versus 11 and 21%, respectively, in the control group (p = 0.01 for between group comparison). In addition, those patients in the strength training group who completed the trial had a 43% mean reduction in pain (p = 0.01 vs controls), a 44% mean improvement in self-reported physical function (p < 0.01 vs controls), and improvements in physical performance, quality of life, and self-efficacy when compared to the control group.
CONCLUSION: High intensity, home based strength training can produce substantial improvements in strength, pain, physical function and quality of life in patients with knee OA.
Robert Topp, Sandra Woolley, Joseph Hornyak, Sadik Khuder, Bashar Kahaleh
The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee.
Arch Phys Med Rehabil. 2002 Sep;83(9):1187-95.
Abstract/Text
OBJECTIVE: To compare 16 weeks of isometric versus dynamic resistance training versus a control on knee pain and functioning among patients with knee osteoarthritis (OA).
DESIGN: Randomized clinical trial.
SETTING: Outpatient setting.
PARTICIPANTS: A total of 102 volunteer subjects with OA of the knee randomized to isometric (n=32) and dynamic (n=35) resistance training groups or a control (n=35).
INTERVENTIONS: Strength exercises for the legs, 3 times weekly for 16 weeks. Dynamic group: exercises across a functional range of motion; isometric: exercises at discrete joint angles.
MAIN OUTCOME MEASURES: The time to descend and ascend a flight of 27 stairs and to get down and up off of the floor. Knee pain was assessed immediately after each functional task. The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess perceived pain, stiffness, and functional ability.
RESULTS: In the isometric group, time to perform all 4 functional tasks decreased (P<.05) by 16% to 23%. In the dynamic group, time to descend and ascend stairs decreased by 13% to 17%. Both groups decreased knee pain while performing the functional tasks by 28% to 58%. Other measures of pain and functioning were significantly and favorably affected in the training groups. The improvements in the 2 training groups as a result of their respective therapies were not significantly different. The control group did not change over the duration of the study.
CONCLUSION: Dynamic or isometric resistance training improves functional ability and reduces knee joint pain of patients with knee OA.
北潔、佐浦隆一、西林保朗ら：運動器虚弱高齢者に対する転倒介護予防．整形災害外科 48：697－704、2005.
M A Province, E C Hadley, M C Hornbrook, L A Lipsitz, J P Miller, C D Mulrow, M G Ory, R W Sattin, M E Tinetti, S L Wolf
The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques.
JAMA. 1995 May 3;273(17):1341-7.
Abstract/Text
OBJECTIVE: To determine if short-term exercise reduces falls and fall-related injuries in the elderly.
DESIGN: A preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT)--independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 weeks. Fall and injury follow-up was obtained for up to 2 to 4 years.
SETTING: Two nursing home and five community-dwelling (three health maintenance organizations) sites. Six were group and center based; one was conducted at home.
PARTICIPANTS: Numbers of participants ranged from 100 to 1323 per study. Subjects were mostly ambulatory and cognitively intact, with minimum ages of 60 to 75 years, although some studies required additional deficits, such as functionally dependent in two or more activities of daily living, balance deficits or lower extremity weakness, or high risk of falling.
INTERVENTIONS: Exercise components varied across studies in character, duration, frequency, and intensity. Training was performed in one area or more of endurance, flexibility, balance platform, Tai Chi (dynamic balance), and resistance. Several treatment arms included additional nonexercise components, such as behavioral components, medication changes, education, functional activity, or nutritional supplements.
MAIN OUTCOME MEASURES: Time to each fall (fall-related injury) by self-report and/or medical records.
RESULTS: Using the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treatment arms including general exercise was 0.90 (95% confidence limits [CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.70, 0.98). No exercise component was significant for injurious falls, but power was low to detect this outcome.
CONCLUSIONS: Treatments including exercise for elderly adults reduce the risk of falls.
T Rantanen, J M Guralnik, L Ferrucci, B W Penninx, S Leveille, S Sipilä, L P Fried
Coimpairments as predictors of severe walking disability in older women.
J Am Geriatr Soc. 2001 Jan;49(1):21-7.
Abstract/Text
OBJECTIVE: Severe disabilities are common among older people who have impairments in a range of physiologic systems. It is not known, however, whether the presence of multiple impairments, or coimpairments, is associated with increased risk of developing new disability. The aim of this study was to determine the combined effects of two impairments, decreased knee-extension strength and poor standing balance, on the risk of developing severe walking disability among older, moderately-to-severely disabled women who did not have severe walking disability at baseline.
DESIGN: The Women's Health and Aging Study is a 3-year prospective study with 6 semi-annual follow-up data-collection rounds following the baseline.
SETTING: At baseline, knee-extension strength and standing balance tests took place in the participants' homes.
PARTICIPANTS: 758 women who were not severely walking disabled at baseline.
MEASUREMENTS: Severe walking disability was defined as customary walking speed of < 0.4 meters/second and inability to walk one quarter of a mile, or being unable to walk.
RESULTS: Over the course of the study, 173 women became severely disabled in walking. The cumulative incidence of severe walking disability from the first to the sixth follow-up was: 7.8%, 12.0%, 15.1% 19.5% 21.2%, and 22.8%. In Cox proportional hazards models, both strength and balance were significant predictors of new walking disability. In the best balance category, the rates of developing severe walking disability expressed per 100 person years were 3.1, 6.1, and 5.3 in the highest- to lowest-strength tertiles. In the middle balance category, the rates were 9.6, 13.2, and 14.7, and in the poorest balance category 21.6, 12.7, and 37.1, correspondingly. The relative risk (RR) of onset of severe walking disability adjusted for age, height, weight, and race was more than five times greater in the group with poorest balance and strength (RR 5.12, 95% confidence limit [95% CI] 2.68-9.80) compared with the group with best balance and strength (the reference group). Among those who had poorest balance and best strength, the RR of severe walking disability was 3.08 (95% CI 1.33-7.14). Among those with best balance and poorest strength, the RR was 0.97 (95% CI 0.49-1.93), as compared with the reference group.
CONCLUSION: The presence of coimpairments is a powerful predictor of new, severe walking disability, an underlying cause of dependence in older people. Substantial reduction in the risk of walking disability could be achieved even if interventions were successful in correcting only one of the impairments because a deficit in only one physiologic system may be compensated for by good capacity in another system.
B J Vellas, S J Wayne, L Romero, R N Baumgartner, L Z Rubenstein, P J Garry
One-leg balance is an important predictor of injurious falls in older persons.
J Am Geriatr Soc. 1997 Jun;45(6):735-8.
Abstract/Text
OBJECTIVE: To test the hypothesis that one-leg balance is a significant predictor of falls and injurious falls.
DESIGN: Analysis of data from a longitudinal cohort study.
SUBJECTS: Healthy, community-living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years).
MAIN OUTCOME MEASURES: Falls and injurious falls detected via reports every other month.
INDEPENDENT VARIABLES: Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assessment, and one-leg balance (ability to stand unassisted for 5 seconds on one leg).
RESULTS: At baseline, 84.5% of subjects could perform one-leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3-year follow-up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one-leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34; P = .03).
CONCLUSION: One-leg balance appears to be a significant and easy-to-administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.
村永信吾：立ち上がり動作を用いた下肢筋力評価とその臨床応用．昭和医学会誌61：362－367，2001.
