Original research••

Descriptive epidemiology of muscle-strengthening activities in Japanese middle-aged and older adults: the Hisayama Study

•,,,,,,,.

...

Abstract

Introduction Data on the prevalence of muscle-strengthening activities in Asia have been limited. Using data from a community-based cross-sectional survey of a general adult population in Japan, whose age and occupational distribution were very similar to the national averages, we aimed to estimate the prevalence of muscle-strengthening activities.

Methods A community survey of local residents over 40 years of age was conducted in 2017–2018 as part of the Hisayama Study. Information on muscle-strengthening activities was obtained by means of a face-to-face interview by nurses. The prevalence of muscle-strengthening activities according to sex and age groups was estimated using a modified Poisson regression model. The prevalence ratios by subgroups based on anthropometry, physical conditions and lifestyle and behavioural factors were also estimated.

Results Data on muscle-strengthening activities were available on 1509 men and 1946 women. Overall, 162 individuals (4.7%) engaged in muscle-strengthening activities at least 1 day/week, and 133 (3.8%) did so for 2 days or more per week. Women were less likely to engage in muscle-strengthening activities than men. The prevalence was generally comparable across subgroups of covariates, while an even lower prevalence was observed for some specific subpopulations, including individuals with diabetes and current smokers.

Conclusions The prevalence of muscle-strengthening activities was estimated to be low in a general Japanese adult population. Population-wide approaches for the entire country and tailored educational interventions for specific subpopulations may be necessary in order to effectively enhance the participation in muscle-strengthening activities at a population level.

What is already known on this topic

National and international public health recommendations have underlined the importance of participating in regular muscle-strengthening activities in addition to aerobic activities, but limited data are available on the prevalence of muscle-strengthening activities in Asia.

What this study adds

Using data from a well-characterised community-based epidemiological survey of a Japanese general middle-aged and older adult population, we showed that the estimated prevalence of muscle-strengthening activities was quite low, with only 4.7% performing such activities even 1 day/week and only 3.8% meeting the global guideline recommendation of at least 2 days/week. We did not find notable differences in the prevalence among subgroups of lifestyle and behavioural factors.

How this study might affect research, practice or policy

Population-wide approaches, complemented by tailored educational interventions for specific subpopulations, may be necessary in order to effectively enhance participation in muscle-strengthening activities at a population level.

Introduction

Promoting physical activity is a key strategy for the prevention and management of non-communicable diseases. The WHO 2020 guideline gave recommendations on integrating regular moderate-to-vigorous-intensity aerobic physical activities for adults.1 Several national and international public health recommendations also have underlined the importance of participating in regular muscle-strengthening activities such as resistance training in addition to aerobic activities.1–3 Meta-analyses of epidemiological studies have shown that engagement in muscle-strengthening activities may provide additional health benefits for reducing risks of total mortality, and incidence and mortality from cardiovascular disease, diabetes and cancer.4–6

Large epidemiological studies in nationally representative samples of European countries, Australia and the USA have reported that the prevalence of muscle-strengthening activities that meet the guideline recommendation (ie, ≥2 times/week) ranges from 17.3% to 30.2% in adult populations.7–10 On the other hand, data on the prevalence of muscle-strengthening activities in Asia have been limited. For example, the reported prevalence of muscle-strengthening activities in Japanese populations varies widely across studies, ranging from 3.9% to approximately 40%,11–13 which makes it difficult to draw definitive conclusions on the prevalence in Japan. The current physical activity guideline in Japan was published in 2013 and does not make any recommendations in regard to muscle-strengthening activities.14 The forthcoming revision of the Japanese guideline will include a recommendation for muscle-strengthening activities, thus epidemiological studies on muscle-strengthening activities are warranted.

In this study, we aimed to describe the prevalence of muscle-strengthening activities using data from a cross-sectional survey in a well-characterised cohort of a Japanese adult population in a community, the Hisayama Study. For more than half a century, the Hisayama Study has been collecting comprehensive information on physical health and lifestyle behaviours through annual health check-ups, which would provide an important perspective on the prevalence of muscle-strengthening activities in various subgroups as well as the entire population.

Materials and methods

Population

This study is a community-based cross-sectional study using data from the Hisayama Study. The design of the Hisayama Study has been detailed elsewhere.15 In brief, the Hisayama Study is a prospective cohort study of community-dwelling Japanese residents that has been conducted on an ongoing basis in the town of Hisayama, Fukuoka, Japan since 1961. Since the study first began, the distribution, population growth and occupational structure of the population of Hisayama have been very similar to those in the national census of Japan.15 Health examinations have been repeated annually for all residents aged 40 years and older since the start of the study, and large screening surveys have been conducted approximately every 5 years. For the current study, we used data from a screening survey performed in 2017 and 2018. Written informed consent was obtained from all study participants.

Muscle-strengthening activities

During the heath examinations, a face-to-face interview based on a questionnaire on lifestyle activities including exercise habits during leisure time was conducted by trained nurses. Participants were asked to indicate whether they participated in leisure-time exercise in the past month and, if so, the frequency and types of exercise. More than 10 exercise activities were presented as options, including training and other, and participants were permitted to select up to five of them. Respondents who selected training or other were further asked to specify the type of exercise. In the current study, muscle-strengthening activities refer specifically to the type of activities that increase muscle mass and strength, also sometimes called resistance training or strength training. We included both equipment-based activities (eg, dumbbells, elastic bands) and free weight trainings (eg, push-ups, sit-ups, knee bends), and both activities performed in the home and those performed in fitness/health facilities. Activities other than leisure-time exercise (ie, activities during work, farming and gardening, or rehabilitation in adult day care settings or specialised rehabilitation facilities) were excluded in order to exclude potentially non-voluntary activities. In the case that a participant reported a multicomponent exercise (eg, doing exercise at a gym, whole-body exercise), they were interviewed about their detailed exercise activities to determine whether the exercise included muscle-strengthening activities. If details were not available, we did not consider the exercise as muscle-strengthening activity. When a participant reported two or more muscle-strengthening activities, the activity engaged in most frequently was used to define the frequency of muscle-strengthening activity, because we did not collect information on whether participants performed these activities on the same day.

Measurement of other factors

Body height and weight were measured in light clothing without shoes, and body mass index (BMI, kg/m²) was calculated. Participants were categorised as lean (BMI<18.5 kg/m²), normal weight (18.5 kg/m²≤BMI<25.0 kg/m²) or obese (BMI≥25.0 kg/m²). Blood pressure was measured three times after ≥5 min of rest in the sitting position, and the mean of the three measurements was calculated. Plasma glucose levels were measured by the hexokinase method. Haemoglobin A1c levels were measured by high-performance liquid chromatography. Diabetes was defined as a fasting plasma glucose level of ≥7.0 mmol/L, casual or 2-hour postload plasma glucose (by a 75 g oral glucose tolerance test) ≥11.1 mmol/L, haemoglobin A1c of ≥6.5% or use of glucose-lowering agents.16 Serum total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides were measured by the enzymatic method, and non-HDL cholesterol levels were calculated by subtracting HDL cholesterol from total cholesterol values. Dyslipidaemia was defined as serum LDL cholesterol ≥3.62 mmol/L, serum HDL cholesterol <1.03 mmol/L, fasting serum triglycerides ≥1.69 mmol/L, non-HDL cholesterol ≥4.40 mmol/L or use of lipid-modifying agents.

Each participant completed a self-administered questionnaire that included items on lifestyle behaviour, medical history and current medication use. All participants underwent face-to-face interviews with a nurse based on their answers to the self-report questions. Alcohol drinking and smoking habits were classified as current, former or never use. Physical effort during work or household activities was classified using the following four categories: low (mostly sitting or lying down all day); light (mixed sitting, standing and walking); moderate (walking); and heavy (heavy labour). Due to the small number of respondents in the low and the heavy groups, we combined the top and bottom two categories into low-to-light and moderate-to-heavy work groups, respectively. Exercise habits, defined as engaging in sports or other forms of exercise during leisure time, were classified as regular (at least three times per week), occasional (one to two times per week) or no exercise. Since the number of exercise sessions per week was recorded regardless of the type of exercise, exercise habits included muscle-strengthening activities.

Statistical analysis

Individuals for whom information on muscle-strengthening activities was available were included in the analysis, and the number of missing values for other factors was reported. Descriptive statistics were calculated for the overall population and according to sex. The prevalences and their 95% CIs for muscle-strengthening activities by sex and by age group were estimated using a modified Poisson model with a log-link function having robust SE variance.17 18 Modified Poisson regression with robust variance estimates has been often used in recent years as a better alternative to logistic regression in cross-sectional studies, as it allows direct comparison of prevalence.18 As there was no significant interaction between the sex and age groups, estimates were respectively compared by sex and by each age group. Paired comparisons for the age groups were made using the age group of 60–69 years as a reference. To identify subpopulations that were potentially suitable or not suitable as targets for behavioural change interventions, prevalence ratios for each of the subgroups according to anthropometry, physical conditions and lifestyle and behavioural factors were estimated using the same method with adjustment for sex and age as covariates. Missing values on covariates were omitted from each analysis. The analyses were repeated separately for each sex, with sex omitted from the covariates. The interaction of each covariate with sex was tested by adding a multiplicative term. All analyses were performed using SAS V.9.4 (SAS Institute). All tests were two sided and p values <0.05 were considered to be statistically significant.

Patient and public involvement

The Hisayama Study has been conducted with a strong commitment to patient and public involvement in research. Since 1961, cooperation with the Hisayama Town Office and general practitioners has enabled the investigators to receive valuable feedback from the residents, and to identify the residents’ health issues and priorities that need to be addressed. In addition, health promotion activities were led by residents themselves in conjunction with research. The Hisayama Study also involves some town residents in the council meetings for the health examination each year. In addition, the investigators conduct briefing sessions regularly, which provide opportunities for direct discussion with residents. Further information on the cooperation between the study investigators and the town’s public health nurses, general practitioners and residents can be found in the introduction article archived at the following internet address: https://www.igaku-shoin.co.jp/paper/archive/y2011/PA02910_04 (in Japanese).

Results

In total, 3484 residents aged 40 years and older received the health examinations (69.7% of the town residents of the corresponding age), and 3472 agreed to participate in the study. Of these, 17 for whom data on exercise habits were not available were excluded, and the remaining 3455 were included in the present analysis. Table 1 shows the characteristics of the analysed participants, and online supplemental table 1 shows the same characteristics categorised by sex. For the overall study population of 3455 individuals, the mean (SD) age was 64.6 (13.9) years, and 43.7% of individuals were male participants.

Table 1

Characteristics of study participants

Overall, 4.7% (95% CI 4.0% to 5.4%) of participants engaged in muscle-strengthening activities at least 1 day/week (n=162), and 3.8% (95% CI 3.3% to 4.5%) did so for two or more days per week (n=133). Figure 1 shows the model-estimated prevalence of engagement in muscle-strengthening activity for at least 1 day/week by sex and by age groups. The prevalence of engaging in muscle-strengthening activities at least 1 day/week was significantly lower in women than in men (men 5.7%, 95% CI 4.6% to 7.0%; women 3.9%, 95% CI 3.1% to 4.9%; p value for sex difference=0.02). Compared with those aged 60–69, the prevalence was significantly lower in those aged 40–49 years (p=0.03) and in those aged 80 and over (p=0.002). The prevalence of the engagement in muscle-strengthening activity at least 2 days/week showed similar trends (online supplemental figure 1).

Request permission

Figure 1

Prevalence of individuals performing muscle-strengthening activities at least 1 day/week by sex and by age groups. Estimates of the prevalences and 95% CIs were derived by a modified Poisson model using a log-link function with robust SE variance. Vertical error bars represent the 95% CI. The comparison for the age groups was made using the age group of 60–69 years as a reference. *P<0.05; n.s., not significant.

Table 2 shows the proportion and age-adjusted and sex-adjusted prevalence ratios of muscle-strengthening activities according to subgroups of anthropometry, physical conditions and lifestyle and behavioural factors. We found a significantly lower prevalence ratio in those with diabetes, current smokers, occasional exercisers and those who engaged in a moderate-to-heavy physical effort during work or household activities compared with their respective counterparts in other subgroups. No significant differences in the prevalence were found across the subgroups according to the remaining factors. Online supplemental table 2 shows the results of the analyses separately for each sex. The prevalence ratios were generally similar to those determined for the overall population. None of the interaction terms for all subgrouping factors and sex were significant.

Table 2

Proportion and age-adjusted and sex-adjusted prevalence ratios for engaging in muscle-strengthening activities at least 1 day/week by subgroups

Discussion

Using cross-sectional survey data from a well-characterised population-based cohort, we estimated the prevalence of individuals performing muscle-strengthening activities at least 1 day/week at less than 5% in Japanese adults. With a few exceptions, the prevalence was similarly low across subgroups of lifestyle and behavioural factors, even in those who exercised regularly, in the present study. The findings of the current study highlight the generally low prevalence of muscle-strengthening activities among the Japanese adult population and the importance of implementing population-based approaches to promote muscle-strengthening activities.

We demonstrated that only 1 out of 20 people had engaged in muscle-strengthening activities at least 1 day/week, and only 3.8% achieved the guideline recommendation of 2 days/week, in a Japanese community-dwelling adult population. This estimate was substantially lower than those reported in previous studies from Europe, Australia and the USA, where the prevalence of subjects meeting the guideline recommendation of muscle-strengthening activities two or more times per week ranged from 16.0% to 26.6% in those aged 45–55 years, and from 7.6% to 21% even in those aged ≥75 years.7–9 No unified measures of muscle-strengthening activity have been developed, and there is variation in measurement methods in terms of terminology and inclusion of non-leisure activities across countries.19 In the present study, information on the implementation of muscle-strengthening activities was collected from questions regarding exercise during leisure time, and it is possible that this measurement method affected the low prevalence of muscle-strengthening activities. However, the prevalence in the present study was still notably lower than that reported in Australia,7 where activity was explicitly restricted to leisure time.

The prevalence of muscle-strengthening activities observed herein was similar to that reported in some previous studies of Japanese adult populations.11 12 One study using mail surveillance data from the 2006 SSF National Sport-Life Survey reported that 3.9% of the Japanese adult population aged 20 years and older met the guideline recommendation of 2 days/week.11 Another study in working adults aged 30–64 years without diabetes showed a prevalence of 4.1% for any muscle-strengthening activities.12 On the other hand, other studies have reported a higher prevalence of muscle-strengthening activities compared with the prevalence observed in the present study. A postal survey in community-dwelling older adults aged 65–74 showed that the prevalences of equipment-based and body weight-based muscle-strengthening activities were 9.2% and 26.2%, respectively.20 Also, in a baseline survey of a cluster randomised controlled trial of Japanese community-dwelling older adults, the prevalence of individuals performing muscle-strengthening activities for more than 2 days/week was in the range of approximately 35–40% across the trial arms.13 This discrepancy in the prevalence among studies may be primarily attributable to the difference in sampling strategies, since the studies of older adults excluded individuals with functional limitations based on research objectives, or to the differences in question items. Nonetheless, our present use of health check-up surveys involving face-to-face interviews to measure the prevalence of muscle-strengthening activities in a general Japanese population clearly demonstrated the need to promote greater engagement in muscle strengthening in the community.

It is intriguing that the prevalence of muscle-strengthening activities showed an upward trend between the ages of 40 and 69 years, and then declined afterwards. This trend differed from the monotonic decline with age observed in previous studies in other countries.7–9 The data from the 2019 National Health and Nutrition Survey of Japan showed an upward trend in the proportion of people who participated in regular exercise from middle age to older adulthood in both men and women.21 That report also showed that lack of time due to busy work schedules (including domestic work, childcare, etc) is the major obstacle to participation in regular exercise.21 Our observation of an upward trend across middle age might be attributable to a lack of available time for performing muscle-strengthening activities, especially in the working age population. These findings suggested that the prevalence of muscle-strengthening activities can be influenced by the social and environmental context, and that population-wide ecological approaches such as a public awareness campaign13 are needed to effectively promote the participation in muscle-strengthening activities.

We did not find obvious differences in the prevalence among the subgroups. This indicates that the prevalence of muscle-strengthening activities in Japan is generally low. The exception was an even lower prevalence in individuals with prevalent diabetes, those with a current smoking habit and those with a moderate-to-heavy workload. The exact reason for the lower prevalence in these subgroups was not clear. Previous studies reported that individuals with diabetes had low adherence to physical activity and low endurance capacity.22–24 A low prevalence of muscle-strengthening activities among current smokers was consistently reported in previous studies,7 9 10 and this finding has been considered attributable to a low exercise capacity and a low motivation for physical activity among current smokers.25–27 However, a low exercise capacity may not necessarily be a strong determinant of a lack of participation in muscle-strengthening activities, as we found no significant difference in the prevalence of muscle-strengthening activities by a history of chronic diseases, including pulmonary diseases. In the present study, muscle-strengthening activities were defined as leisure-time activities and were distinguished from the physical load of work and household chores. Not surprisingly, those who engaged in physically demanding work thus had a low prevalence of muscle-strengthening activities, possibly because they had less time for leisure-time exercise or less motivation due to exhaustion.28 29 Similar to the present study, a large study in 28 European countries showed a lower prevalence of muscle-strengthening activities in individuals who engaged in physically demanding work compared with that in individuals who mostly sat or stood at work.8 Our findings on the low prevalence of muscle-strengthening activities among specific subgroups suggest that, in addition to a population-wide approach, implementation of tailored counselling and educational approaches for these subpopulations may further increase the participation in muscle-strengthening activities.

Strengths of this study included the use of data from a well-characterised cohort with detailed information on lifestyles, which enabled us to accurately estimate the prevalence of muscle-strengthening activities and to examine the prevalence ratios in diverse subgroups. Limitations should also be noted. First, the use of self-report questions on muscle-strengthening activities may raise the possibility of information bias. However, any such bias might be mitigated by the fact that all participants underwent face-to-face interviews with a nurse based on their answers to the self-report questions. In addition, there is no objective device available to measure muscle-strengthening activities at the present. Second, we did not include muscle-strengthening activities performed in rehabilitation facilities. Therefore, the prevalence of muscle-strengthening activities among older participants in the current study may not be directly comparable with those in other studies. Third, we did not obtain information on the weekly duration of aerobic physical activities. Therefore, we were unable to examine the prevalence of individuals who met both aerobic activity and muscle-strengthening activity recommendations, as indicated by several previous studies. Fourth, the face-to-face interviews may have induced a social desirability bias. In this case, the prevalence of muscle-strengthening activities would be expected to be overestimated by the bias, meaning that the observed low prevalence of muscle-strengthening activities and its consequences were also understated. Finally, the survey of the present study was performed in 2017–2018, and prevalence rates may have changed since that time. Previous studies from the USA and Australia have shown an increasing trend of muscle-strengthening activity over time.30–32 In addition, the COVID-19 pandemic may have had a substantial impact on individuals’ behaviours, including muscle-strengthening activities.33 34 Further research is therefore warranted on the prevalence of muscle-strengthening activities after a pandemic.

In conclusion, the prevalence of muscle-strengthening activities in the present population was low, with 4.7% of participants performing such activities at least 1 day/week and only 3.8% meeting the guideline recommendation of at least 2 days/week. This finding suggested that very few Japanese adults engaged in muscle-strengthening activities. Population-wide approaches, complemented by tailored educational interventions for specific subpopulations, may be necessary in order to effectively enhance participation in muscle-strengthening activities at a population level.

Presented at: The results of the present study were partly presented in the symposium at the 76th Conference of the Japanese Society of Physical Fitness and Sports Medicine.
Contributors: TH contributed to the study concept and design, data collection, data analysis and interpretation, and drafted and edited the manuscript. JH, MS, SS, YF and EO contributed to the data collection, interpretation and critical review of the manuscript. TK contributed to the data interpretation and critical review of the manuscript. TN contributed to the study design and interpretation, study supervision and critical review of the manuscript. All authors read and provided final approval of the manuscript. TH is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: This study was supported in part by the Ministry of Education, Culture, Sports, Science and Technology of Japan (JSPS KAKENHI grant numbers: JP21H03200, JP21K07522, JP21K11725, JP21K10448, JP22K07421, JP22K17396, JP23K09692, JP23K09717, JP23K16330, JP23K06787 and JP23K09060); the Health and Labour Sciences Research Grants of the Ministry of Health, Labour and Welfare of Japan (JPMH23FA1006 and JPMH23FA1022); the Japan Agency for Medical Research and Development (JP23dk0207053 and JP23km0405209); and a JST Grant (JPMJPF2210).
Disclaimer: The study sponsors/funders were not involved in the design of the study; the collection, analysis and interpretation of data; or the writing of the report. In addition, the study sponsors/funders did not impose any restrictions regarding the publication of the report.
Competing interests: None declared.
Patient and public involvement: Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review: Not commissioned; externally peer reviewed.
Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Data are available upon reasonable request. Data are available on reasonable request and require the permission of Professor Toshiharu Ninomiya, the principal investigator of the Hisayama Study. The datasets used in the present study are not publicly available because they include confidential clinical data on the study subjects.

Ethics statements

Patient consent for publication:

Ethics approval:

This study involves human participants and was approved by Kyushu University Institutional Review Board for Clinical Research (2021-457). Participants gave informed consent to participate in the study before taking part.

Acknowledgements

The authors thank the residents of the town of Hisayama for their participation in the survey and the staff of the Division of Health of Hisayama for their cooperation with this study. We thank Dr Haruki Momma (Tohoku University), Dr Ryoko Kawakami (Meiji Yasuda Life Foundation of Health and Welfare), Dr Michiya Tanimoto (Juntendo University) and Professor Susumu S Sawada (Waseda University) for their insightful comments and discussions. The statistical analyses were carried out using the computer resources offered under the category of General Projects by the Research Institute for Information Technology, Kyushu University. We thank KN International for English proofreading.

Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54:1451–62.
doi:10.1136/bjsports-2020-102955•Google Scholar
National Health Service. Physical activity guidelines for adults aged 19 to 64. 2019;
Available: here [Accessed 08 Jan 2023]
Google Scholar
Department of Health and Aged Care. Physical activity and exercise guidelines for all Australians. 2021;
Available: here [Accessed 08 Jan 2023]
Google Scholar
Momma H, Kawakami R, Honda T, et al. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med 2022; 56:755–63.
doi:10.1136/bjsports-2021-105061•Google Scholar
Saeidifard F, Medina-Inojosa JR, West CP, et al. The association of resistance training with mortality: a systematic review and meta-analysis. Eur J Prev Cardiolog 2019; 26:1647–65.
doi:10.1177/2047487319850718•Google Scholar
Nascimento W, Ferrari G, Martins CB, et al. Muscle-strengthening activities and cancer incidence and mortality: a systematic review and meta-analysis of observational studies. Int J Behav Nutr Phys Act 2021; 18.
doi:10.1186/s12966-021-01142-7•Google Scholar
Bennie JA, Pedisic Z, van Uffelen JGZ, et al. The descriptive epidemiology of total physical activity, muscle-strengthening exercises and sedentary behaviour among Australian adults - results from the National nutrition and physical activity survey. BMC Public Health 2016; 16.
doi:10.1186/s12889-016-2736-3•Google Scholar
Bennie JA, De Cocker K, Smith JJ, et al. The epidemiology of muscle-strengthening exercise in Europe: a 28-country comparison including 280,605 adults. PLoS One 2020; 15.
doi:10.1371/journal.pone.0242220•Google Scholar
Bennie JA, Lee D-C, Khan A, et al. Muscle-strengthening exercise among 397,423 U.S. adults: prevalence, correlates, and associations with health conditions. Am J Prev Med 2018; 55:864–74.
doi:10.1016/j.amepre.2018.07.022•Google Scholar
Bennie JA, De Cocker K, Tittlbach S, et al. The epidemiology of muscle-strengthening and aerobic physical activity guideline adherence among 24,016 German adults. Scand J Med Sci Sports 2021; 31:1096–104.
doi:10.1111/sms.13922•Google Scholar
Harada K, Oka K, Ota A, et al. Prevalence and correlates of strength training among Japanese adults: analysis of the SSF national sports-life survey 2006. Int J Sport Health Sci 2008; 6:66–71.
doi:10.5432/ijshs.6.66•Google Scholar
Kuwahara K, Honda T, Nakagawa T, et al. Strength training and risk of type 2 diabetes in a Japanese working population: a cohort study. J Diabetes Investig 2015; 6:655–61.
doi:10.1111/jdi.12347•Google Scholar
Kamada M, Kitayuguchi J, Inoue S, et al. A community-wide campaign to promote physical activity in middle-aged and elderly people: a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2013; 10.
doi:10.1186/1479-5868-10-44•Google Scholar
Ministry of Health, Labour and Welfare of Japan. Physical activity reference for health promotion 2013.
Available: here [Accessed 17 Nov 2023]
Google Scholar
Ninomiya T. Japanese legacy cohort studies: the Hisayama study. J Epidemiol 2018; 28:444–51.
doi:10.2188/jea.JE20180150•Google Scholar
American Diabetes Association Professional Practice Committee. Classification and diagnosis of diabetes: standards of medical care in diabetes — 2022. Diabetes Care 2022; 45:17–38.
Google Scholar
Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159:702–6.
doi:10.1093/aje/kwh090•Google Scholar
Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003; 3.
doi:10.1186/1471-2288-3-21•Google Scholar
Shakespear-Druery J, De Cocker K, Biddle SJH, et al. Assessment of muscle-strengthening exercise in public health surveillance for adults: a systematic review. Prev Med 2021; 148:106566.
doi:10.1016/j.ypmed.2021.106566•Google Scholar
Harada K, Shibata A, Oka K, et al. Association of muscle-strengthening activity with knee and low back pain, falls, and health-related quality of life among Japanese older adults: a cross-sectional survey. J Aging Phys Act 2015; 23:1–8.
doi:10.1123/japa.2013-0038•Google Scholar
Ministry of Health Labour and Welfare of Japan. 2019 Japan national health and nutrition survey. 2019;
Available: here [Accessed 08 Jan 2023]
Google Scholar
Kennerly AM, Kirk A. Physical activity and sedentary behaviour of adults with type 2 diabetes: a systematic review. Practical Diabetes 2018; 35:86.
doi:10.1002/pdi.2169•Google Scholar
Regensteiner JG. Effects of NIDDM on oxygen consumption during treadmill exercise. Med Sci Sports Exerc 1995; 27:661–7.
doi:10.1249/00005768-199505000-00007•Google Scholar
Jarvie JL, Pandey A, Ayers CR, et al. Aerobic fitness and adherence to guideline-recommended minimum physical activity among ambulatory patients with type 2 diabetes mellitus. Diabetes Care 2019; 42:1333–9.
doi:10.2337/dc18-2634•Google Scholar
Sandvik L, Erikssen G, Thaulow E, et al. Long term effects of smoking on physical fitness and lung function: a longitudinal study of 1393 middle aged Norwegian men for seven years. BMJ 1995; 311:715–8.
doi:10.1136/bmj.311.7007.715•Google Scholar
Kobayashi Y, Takeuchi T, Hosoi T, et al. Effects of habitual smoking on cardiorespiratory responses to sub-maximal exercise. J Physiol Anthropol Appl Human Sci 2004; 23:163–9.
doi:10.2114/jpa.23.163•Google Scholar
Furlanetto KC, Mantoani LC, Bisca G, et al. Reduction of physical activity in daily life and its determinants in smokers without airflow obstruction. Respirology 2014; 19:369–75.
doi:10.1111/resp.12236•Google Scholar
Kirk MA, Rhodes RE. Occupation correlates of adults’ participation in leisure-time physical activity: a systematic review. Am J Prev Med 2011; 40:476–85.
doi:10.1016/j.amepre.2010.12.015•Google Scholar
Bláfoss R, Micheletti JK, Sundstrup E, et al. Is fatigue after work a barrier for leisure-time physical activity? Cross-sectional study among 10,000 adults from the general working population. Scand J Public Health 2019; 47:383–91.
doi:10.1177/1403494818765894•Google Scholar
Bennie JA, Pedisic Z, van Uffelen JGZ, et al. Pumping iron in Australia: prevalence, trends and sociodemographic correlates of muscle strengthening activity participation from a national sample of 195,926 adults. PLoS ONE 2016; 11.
doi:10.1371/journal.pone.0153225•Google Scholar
Calatayud J, López-Bueno R, Núñez-Cortés R, et al. Trends in adherence to the muscle-strengthening activity guidelines in the US over a 20-year span. Gen Hosp Psychiatry 2023; 84:89–95.
doi:10.1016/j.genhosppsych.2023.06.016•Google Scholar
Hyde ET, Whitfield GP, Omura JD, et al. Trends in meeting the physical activity guidelines: muscle-strengthening alone and combined with aerobic activity, United States, 1998-2018. J Phys Act Health 2021; 18:S37–44.
doi:10.1123/jpah.2021-0077•Google Scholar
Steele J, Androulakis-Korakakis P, Carlson L, et al. The impact of Coronavirus (COVID-19) related public-health measures on training behaviours of individuals previously participating in resistance training: a cross-sectional survey study. Sports Med 2021; 51:1561–80.
doi:10.1007/s40279-021-01438-5•Google Scholar
Herbec A, Schneider V, Fisher A, et al. Correlates of and changes in aerobic physical activity and strength training before and after the onset of COVID-19 pandemic in the UK: findings from the HEBECO study. BMJ Open 2022; 12.
doi:10.1136/bmjopen-2021-054029•Google Scholar

Overview

Abstract
Introduction
Materials and methods
Results
Discussion
References
Supplementary files
Footnotes
Publication history
Rapid Responses

Article metrics

Altmetric data not available for this article.

Dimensions