Community-wide promotion of physical activity in middle-aged and older Japanese: A 3-year evaluation of a cluster randomized trial

Masamitsu Kamada*, Jun Kitayuguchi, Takafumi Abe, Masataka Taguri, Shigeru Inoue, Yoshiki Ishikawa, Kazuhiro Harada, I. Min Lee, Adrian Bauman, Motohiko Miyachi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Background: Promotion of physical activity (PA) is a key strategy to prevent non-communicable diseases. However, evidence on the effectiveness of community-wide interventions (CWIs) for promoting PA is limited. Purpose: To evaluate the effectiveness of a 3-year CWI for promoting PA in middle-aged and older adults compared with usual public health services. This study is an extension to an original 1-year investigation study. Design: Cluster randomized controlled trial with community as unit of randomization and individual as unit of analysis. Setting/participants: 12 communities in Unnan, Japan were randomly allocated to the intervention (9) or the control (3). Additionally intervention communities were randomly allocated to aerobic activity promotion (Group A), flexibility and muscle-strengthening activities promotion (Group FM), or aerobic, flexibility, and muscle-strengthening activities promotion (Group AFM), each consisting of three communities. Randomly-sampled 4414 residents aged 40 to 79 years responded to the baseline survey (74 %), and were analyzed in 2013-2014. Intervention: A 3-year CWI based on social marketing, to promote PA from 2009 to 2012. Main outcome measures: The primary outcome was a change in regular aerobic, flexibility, and/or muscle-strengthening activities, defined by (1) engaging in 150 mins/week or more of walking, (2) engaging in daily flexibility activity, or (3) engaging 2 or more days/week in muscle-strengthening activities, evaluated at the individual level. Secondary outcomes were changes in specific types of PA and musculoskeletal pain. Outcomes were measured at baseline and at 1 and 3 years (2009, 2010, and 2012). Results: The CWI did not significantly increase the proportion of adults who reached recommended levels of aerobic, flexibility, and/or muscle-strengthening activities (adjusted change difference = 1.6 % [95 % CI: -3.5, 6.6]). In the subgroup analysis, compared to the controls, adults doing flexibility activity daily significantly increased in Group FM (6.3 % [95 % CI: 1.9, 10.7]). In Group A and AFM for PA outcomes and in all groups for pain outcomes, there was no significant change compared to controls. Conclusions: The CWI did not achieve significant increase in the proportion of adults who reached recommended PA levels. However, it might be effective in promoting flexibility activity in middle-aged and older Japanese. Trial registration: UMIN-CTR UMIN000002683.

Original languageEnglish
Article number82
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Issue number1
Publication statusPublished - 2015 Jun 23
Externally publishedYes


  • Health communication
  • Muscle stretching exercises
  • Musculoskeletal diseases
  • Resistance training
  • Walking

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Nutrition and Dietetics


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