Journal of Sports Science and Medicine
Journal of Sports Science and Medicine
ISSN: 1303 - 2968   
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©Journal of Sports Science and Medicine (2021) 20, 635 - 641   DOI: https://doi.org/10.52082/jssm.2021.635

Research article
Site-Specific Muscle Loss in the Abdomen and Anterior Thigh in Elderly Males with Locomotive Syndrome
Toshiharu Natsume1,3, Hayao Ozaki2,4, Takashi Nakagata2,5, Toshinori Yoshihara1,2, Tomoharu Kitada2,6, Yoshihiko Ishihara2,7, Pengyu Deng2, Takuya Osawa1,8, Shuji Sawada1, Hiroyuki Kobayashi9, Shuich Machida1,2,10, , Hisashi Naito1,2,10
Author Information
1 COI project center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
10 Institute of Health and Sports Science & Medicine, Juntendo University, 1-1Hirakagakuendai, Inzai, Chiba, Japan
2 Graduate School of Health and Sports Science, Juntendo University, 1-1 Hirakagakuendai, Inzai, Chiba, Japan
3 Department of Human Structure & Function, School of Medicine, Tokai University, Shimokasuya, Kanagawa, Japan
4 School of Sport and Health Science, Tokai Gakuen University, Miyoshi, Aichi, Japan
5 Department of Physical Activity Research, National Institute of Health and Nutrition, NIBIOHN, Tokyo, Japan
6 Faculty of Business Administration, Seijoh University, 2-172 Fukinodai, Tokai, Aichi, Japan
7 Department of humanities and Social Sciences, School of Science and Technology forFuture Life, Tokyo Denki University, Adachi-ku, Tokyo, Japan
8 Department of Sports and Health Science, Faculty of Physical Education, Japan Women’s College of Physical Education, Setagaya-ku, Tokyo, Japan
9 Mito Medical Center, Tsukuba University Hospital, 3-2-7 Miyamachi, Mito, Tsukuba, Ibaraki, Japan

Shuich Machida
✉ Ph.D. Graduate School of Health and Sports Science, Juntendo University, 1-1 Hirakagakuendai, Inzai, Chiba 270-1695, Japan.
Email: machidas@juntendo.ac.jp
Publish Date
Received: 15-02-2021
Accepted: 05-07-2021
Published (online): 23-08-2021
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ABSTRACT

Although locomotive syndrome (LS) is a condition of reduced mobility, little information is available regarding the loss of site-specific skeletal muscle mass. The aim of the present study is to examine site-specific muscle loss in elderly males with LS. A total of 100 men ranging in age from 65 to 74 years were divided into two groups (LS and non-LS) using LS risk tests including the stand-up test, two-step test, and the 25-question geriatric locomotive function scale Muscle thickness (MTH) at eight sites—anterior and posterior thigh (AT and PT, respectively), anterior and posterior lower leg (AL and PL, respectively), rectus abdominis (RA), anterior and posterior upper arm (AU and PU, respectively), and anterior forearm (AF)—was evaluated using B-mode ultrasound. Furthermore, the 30-s chair stand test (CS-30), 10-m walking time, zig-zag walking time, and sit-up test were assessed as physical functions. There were no significant differences in age and body mass index between the LS and non-LS groups. The percentage of skeletal muscle was lower in the LS group than in the non-LS group. Although there were no differences in the MTH of AU, PU, AF, PT, Al and PL, site-specific muscle loss was observed at RA and AT in the LS group. CS-30, 10-m walking time, zig-zag walking time, and sit-up test in the LS group were all worse than those in the non-LS group. The MTHs of RA and AT were both correlated to those physical functions. In conclusion, the LS group had site-specific muscle loss and worse physical functions. This study suggests that site-specific changes may be associated with age-related physical functions. These results may suggest what the essential characteristics of LS are.

Key words: Mobility, elderly, geriatric locomotive function, muscle thickness, physical function


           Key Points
  • Locomotive syndrome related muscle loss was observed in the anterior thigh and rectus abdominis muscle in elderly males.
  • The elderly males with locomotive syndrome had lower physical functions (30-s chair stand test, 10-m walking time, zig-zag walking time, and sit-up test).
  • Site-specific muscle loss in elderly males with locomotive syndrome suggest age-related decline in physical functions.

INTRODUCTION

Japan has one of the longest life expectancies in the world, and the Japanese population is aging rapidly. By 2055, it is projected that the elderly people over 65 years old will account for 40.5% of Japan’s total population (Nakamura 2011). The concept of locomotive syndrome (LS) was proposed by the Japanese Orthopedic Association (JOA) in 2007, which described that problems with the locomotive organs such as skeletal muscles, joints, and bones (Nakamura and Ogata, 2016) predispose middle-aged and elderly individuals to a high risk of either requiring nursing care or becoming bedridden.

Methods of evaluating and assessing the risk of LS have been established by the JOA, and include three functional tests: the stand-up test, the two-step test, and the 25-question geriatric locomotive function scale (GLFS-25). Yoshimura et al. examined the association between these LS risk tests and a decline in mobility and demonstrated that these three LS risk tests predict immobility and an increased risk of LS (Yoshimura et al., 2015) and therefore reflect physical functions relevant to locomotion. Moreover, recent evidence has demonstrated that elderly people with LS have less muscle power in their lower limbs, and a shorter walking stride under maximum effort (Uesugi et al, 2020). These findings reflect difficulties in the ability to stand, walk, and perform other movements essential to daily life.

Excessive loss relevant to aging of skeletal muscle mass and muscle strength and physical functions, termed sarcopenia, is widely considered to be a cause of physical disability (Baumgartner et al., 1998; Chen et al., 2020). A low muscle mass index value has been used as a diagnostic criterion for sarcopenia. By contrast, LS has been mainly assessed by focusing on lower muscle functions with LS risk tests. Hence skeletal muscle mass is not considered in the assessment of LS. However, a study has demonstrated that site-specific muscle loss has an adverse effect on physical function (Abe et al, 2012), and it is therefore important to elucidate whether site-specific muscle loss also occurs in elderly people with LS. Unfortunately, there is currently limited information available for evaluating site-specific muscle loss in elderly individuals with LS. Moreover, in persons with LS, the relationship between site-specific muscle mass and the ability to perform physical functions is not fully understood.

The aim of the present study was to examine the site-specific loss of skeletal muscle in elderly males with LS. With regard to the prevention and improvement of LS, it is important to determine the differences in muscle mass between the elderly with LS and those without LS.

METHODS

Participants

A total of 100 community-dwelling elderly males ranging in age from 65 to 74 years were included in this study. All participants were recruited through printed media, such as recruitment flyers or posters that were distributed or displayed in community or public facilities. Elderly people ranging in age from 65 to 74 years are defined as early elderly in Japan. The prevalence rate of LS in males gradually increases from the 60s (Tokida et al., 2020). For these reasons, elderly males ranging in age from 65 to 74 years were enrolled in this study. None of the participants had taken part in any regular high-intensity resistance exercise for at least 1 year. All the participants had no overt chronic diseases, which was verified by careful medical history assessments. All participants were informed about the methods, procedures, and risks associated with the study and provided informed consent before enrolment. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee for Human Experiments of Juntendo University (Approval Number: 27-10).

Assessment of locomotive syndrome

LS was evaluated using the LS risk tests, namely the two-step test, the stand-up test, and GLFS-25. The participants were classified as having LS if they fulfilled one or more of the following criteria: (1) difficulty in standing from a seat at a height of 40 cm using one leg in the stand-up test (either leg), (2) a two-step test score < 1.3, and (3) a GLFS-25 score ≥ 7 (Nakamura and Ogata, 2016). These criteria were used to divide the participants into LS and non-LS groups (Table 1). The medical histories of the participants are shown in Table 2.

Stand-up test

The stand-up test assesses the leg strength by instructing the participants to stand up either on one or both legs from four sets of different heights (40, 30, 20, and 10 cm). Participants were instructed to stand up without leaning back to gain momentum and to maintain their posture for 3 s. If the participant was unable to stand on one leg (right or left) from a height of 40 cm, then they were challenged stand on both legs. A score of 0–8 was allocated to the performance as described by Ogata et al (Ogata et al., 2015).

Two-step test

The participants stood with the toes of both feet behind a starting line. They then took two long steps (as long as possible) and aligned both feet. The length of the two steps from the starting line to the tips of the toes was measured. The two-step test score was calculated using the following formula: length of the two steps (cm)/height (cm). The measurements were repeated twice for both legs of each participant, and the higher score was used.

25-Question geriatric locomotive function scale (GLFS-25)

This questionnaire evaluated whether participants experienced any pain or had difficulties of daily living over the past month and included questions regarding pain (4 questions), activities of daily living (16 questions), social functions (3 questions), and mental health status (2 questions). Each item was graded on a five-point scale, from no impairment (0 points) to severe impairment (4 points) (Seichi et al., 2012). The sum of all the scores was considered as the degree of LS. Participants with a GLFS-25 score greater than 7 points were diagnosed with LS.

Body composition

Body weight, skeletal muscle mass, fat mass, and percentage body fat (% fat) were measured by bioelectrical impedance analysis (BIA) using a body composition analyzer (Inbody 730, InBody, Korea). This system also uses an electrical current at multiple frequencies to determine the amount of extracellular and intracellular water. The participants stood on four metallic electrodes whilst holding metallic grip electrodes. Test–retest (inter-session) reliabilities were calculated using the intraclass correlation coefficient (ICC), standard errors of measurement (SEM), and minimal difference. The ICC, SEM, and minimal difference for skeletal muscle mass and body fat mass were determined in 10 older men and women: skeletal muscle mass: 0.996, 1.18 kg, 3.28 kg body fat mass: 0.988, 2.37 kg, 6.57 kg, respectively.

Measurement of muscle thickness

Muscle thickness (MTH) was measured with B-mode ultrasound using a 5-18 MHz scanning head (Noblus; Hitachi, Tokyo, Japan) at eight locations as follows: the anterior and posterior aspects of the right thigh (AT and PT, respectively) at 50% of the thigh’s length between the lateral condyle of the femur and the greater trochanter, the anterior and posterior aspects of the right lower leg (AL and PL, respectively) at 30% of the lower leg’s length between the lateral malleolus of the fibula and the lateral condyle of the tibia, the rectus abdominis (RA) at the level of the navel, the anterior and posterior aspects of the right upper arm (AU and PU, respectively) at 60% of the upper arm length between the acromion and the cracks of the lateral epicondyle of the humerus and radial head, and anterior aspects of the right forearm (AF) at 30% of the forearm length, between the cracks of the lateral epicondyle of the humerus and the radial head and the styloid process of the radius (Ozaki et al., 2020). All measurements were performed with the participant in the supine or prone position. The scanning head was coated with a water-soluble transmission gel and placed on each measurement site without depressing the dermal surface. The subcutaneous adipose tissue-muscle interface and muscle-bone interfaces were identified on ultrasound images, and the distance between the two interfaces was recorded as the MTH. The ICC, SEM, and minimal difference for MT were determined at eight locations as follows: AU: 0.986, 0.39 mm, 1.08 mm; PU: 0.998, 0.15 mm, 0.42 mm; AF: 0.987, 0.28 mm, 0.78 mm; RA: 0.998, 0.09 mm, 0.25 mm; AT: 0.992, 0.37 mm, 1.03 mm; PT: 0.994, 0.37 mm, 1.03 mm; AL: 0.993, 0.21 mm, 0.58 mm; PL: 0.998, 0.22 mm, 0.61 mm.

Evaluation of physical functions

30-s chair stand test (CS-30)

The participants were asked to sit on a 40 cm stool with both arms crossed against the chest. The participant was instructed to stand up when the participant’s bottom touched the stool. The test was started from a sitting position and the participant repeatedly stood up and sat down. The number of times the activity was completed in 30 s was counted using a digital counter (T.K.K.5805, Takei Co, Niigata, Japan). The test-retest (intersession) reliabilities of the CS-30 using the ICC, SEM, and minimal difference were 0.779, 1.14 repetitions, and 3.17 repetitions, respectively.

Sit-up test

The participants lay on a flat surface with the knee bent at ~90° (0° = knee full extension) and with both arms crossed against the chest throughout the test. The participants were asked to raise the upper body until the crossed arms touched the front of the thighs and return to the floor. The number of times the activity was completed in 30 s was recorded. The test-retest (intersession) reliabilities of the sit-up test using the ICC, SEM, and minimal difference were 0.986, 2.63 repetitions, and 7.29 repetitions, respectively.

10-m walking time

The participants walked a 10-m straight course twice on a hard-surface floor as fast as possible without running. To exclude acceleration and deceleration phase during the 10-m walking test, at least 2 meters of space was provided at the start and finish line. The walking times were measured using a digital counter (T.K.K.5801, Takei Co, Niigata, Japan), and the best time was used in the data analysis. The test-retest (intersession) reliabilities of the 10-m walking time using the ICC, SEM, and minimal difference were 0.833, 0.20 s, and 0.57 s, respectively.

Zig-zag walking time

Zig-zag walking time was measured using a 10-m walkway. Four cones were placed on the floor (2 m apart) between the start and finish positions. A line was drawn from the start to the finish point and the cones were set to alternate from side to side at a specific distance (0.5 m) from the line. Participants were asked to walk as quickly as possible around the outside of each cone and through to the finish point. The time taken for the participant to pass the start and finish point was recorded using a digital counter (T.K.K.5801, Takei Co, Niigata, Japan). The best time of two trials was used as the zig-zag walking time. The test-retest (intersession) reliabilities of the zig-zag walking time using the ICC, SEM, and minimal difference were 0.865, 0.29 s, and 0.81 s, respectively.

Statistical analysis

All data are expressed as mean values ± standard deviations. All variables were checked for normality and analyzed using the unpaired student t-test. All analyses were performed using SPSS version 22.0. Relationships between site-specific MTH and physical functions were evaluated with Pearson’s correlation coefficients. The statistical significance level was set as at p < 0.05.

RESULTS

Demographics of participants

The demographics of the participants are shown in Table 3. There was no significant difference in age and BMI between the LS and non-LS groups. The percentage of skeletal muscle mass in the LS group was lower than that in the non-LS group. However, there were no significant differences observed between the LS and non-LS groups with respect to body fat mass and percentage of body fat.

Muscle thickness

The differences in MTH are shown in Table 4. The MTHs of RA and AT were lower in the LS group than those in the non-LS group. However, the MTHs of other parts (AU, PU, AF, PT, AL, and PL) did not differ between the groups.

Physical functions

The differences in physical function are shown in Table 5. All physical functions were lower in the LS group than those in the non-LS group.

Correlation between MTH and physical function tests

Pearson’s correlation coefficients between MTH and physical functions are shown in Table 6. MTHs of RA and AT were positively correlated with the CS-30 (RA, r = 0.291, p < 0.01; AT, r = 0.312, p < 0.01), sit-up test (RA, r = 0.597, p < 0.001; AT, r = 0.407, p < 0.001). MTHs of RA and AT were inversely correlated with both the 10-m walking time (RA, r = -0.221, p < 0.05; AT, r = -0.372, p < 0.01) and the zig-zag walking time (RA, r = -0.226, p < 0.05; AT, r = -0.292, p < 0.05).

DISCUSSION

This study investigated whether site-specific muscle loss was observed in elderly males with LS. The results showed site-specific muscle loss in the RA and AT in elderly males with LS. Moreover, the reduction in site-specific muscle mass significantly correlated to LS-related physical functions. These results may suggest what the essential characteristics of LS are. It is known that site-specific muscle mass loss caused by aging precedes whole-body muscle mass loss.

The MTH of the AT was significantly lower in elderly persons with LS. Ohsawa et al. reported a trend toward reduced muscle mass in the lower leg (measured by BIA) in the elderly with LS compared to those without LS, although it was not significant (p = 0.056) (Ohsawa et al., 2016). However, no studies have focused on the site-specific changes in muscle mass in LS. Therefore, this is the first study in which the occurrence of site-specific muscle loss of the AT in elderly males with LS was observed. The MTH of the AT in this study only included the rectus femoris and vastus intermedius muscles. However, the MTH of the AT is a valid index of the quadriceps muscle cross-sectional area (CSA), because it correlates highly with the quadriceps CSA (r=0.91) (Abe et al.,1997). Coordinated contraction of the quadriceps muscle causes hip flexion and/or knee extension. Knee extension moments are required in order to stand up from a sitting position (Yoshioka et al., 2014). In addition, knee extension and hip flexion moments contribute to an increase in walking speed and stride length (McGarth et al., 2019; Ardestani et al., 2016). Given that the MTH correlates with muscle strength (Nishihara et al., 2018), the decline on the knee and hip joint moments induced by the site-specific muscle loss in the AT may adversely affect physical functions (CS-30 and walking speed) and LS risk tests (stand-up tests and 2-step test) in elderly individuals. However, causal relationships were not clearly established because we performed a cross-sectional study. Moreover, as reported in a study by Santos et al., improvement of the lower limb muscular strength following 8 weeks of resistance training was associated with physical function (walking speed) in elderly people, but not lower skeletal muscle mass in older females (Santos et al., 2017). Therefore, a future longitudinal study is required to elucidate causal relationships among these factors in older males with LS.

In addition to the site-related difference in limb muscle, this study also provided evidence that like the TA, the muscle located in the trunk region, especially in the abdomen, influences physical functions. Previous studies have shown the site-specific reduction in abdominal muscle with age (Miyatani et al., 2003; Fukumoto et al., 2015). However, whether the size of the abdominal muscle decreases in the elderly with LS was unknown. Site-specific muscle loss in the abdomen may influence the decrease in the locomotive function in the elderly. Indeed, the superficial trunk muscles recruit in concert with the deep muscle and are thought to contribute to the efficient transfer to the body’s center of mass (Crenna et al., 1987; Frank and Earl, 1990), maintenance of lumbo-pelvic equilibrium (Hodges et al., 1999), and the absorption of reaction forces associated with ground contact events (Iida et al., 2011; Jonsson, 1970). Moreover, our study showing that the site-specific muscle loss in the RA, which is the superficial trunk muscle, not only correlated with the sit-up test, but also with the 10-m walking time and is therefore relevant to locomotion. Our results agree with the previous studies that demonstrated a relationship between the CSA of the RA and the 6 min walk test in elderly persons (Saunders et al., 2004; Shahtahmassebi et al., 2017). Given that it has been observed that the abdominal muscles are gradually recruited during increasing locomotion speed (Saunders et al., 2004; 2005), the muscle would therefore contribute to high-speed locomotion. These results imply that the preservation of the trunk muscle size may also be an important factor to prevent LS. From the practical aspects, exercises using the AT and abdominal muscles may help in prevention and improvement of LS.

The decline in hormone levels such as testosterone in the aging male are expected to have adverse effects for locomotive organs including the skeletal muscle (Fink et al., 2020). Previous studies have reported that a greater amount of physical activity is associated with a higher level of testosterone concentration (Shiels et al., 2009; Muller et al., 2003). Our pilot study investigated the difference in daily physical activity between elderly people with and without LS using an accelerometer and found that elderly people with LS have lower daily physical activity compared to elderly people without LS (Ishihara et al., 2016). Therefore, the interrelationship between physical activity in daily life and etiologic factors may contribute to a decrease in muscle mass. However, it is difficult to discern the mechanism behind the site-specific muscle loss in male elderly people.

This study had several limitations. First, participants were limited to men aged 65–74 years. It is unclear whether a similar trend would be observed in males over 75 years, and in elderly females. Second, the prevalence of LS in this study (42%) was lower than that in a previous study, which reported that the prevalence in the 60–70 years age group is approximately 67–85% (Yoshimura et al, 2015). Third, as described above, we could not refer to the causal relationships between the site-specific muscle loss of AT and RA and physical functions because of the cross-sectional study design. Fourth, the number of people recruited in this study was limited. Therefore, a future follow-up study is required to clarify the causal relationships among these factors.

CONCLUSION

In conclusion, we found site-specific muscle loss in the AT and RA, and poor physical function in elderly males with LS. This study suggests that the decline of site-specific muscle may be associated with age-related physical functions. These results may suggest what the essential characteristics of LS are.

ACKNOWLEDGEMENTS

This study was supported by the center of innovation program from Japan Science and Technology Agency (JST) and the MEXT-Supported Program for Strategic Research Foundation at Private Universities. TN (Natsume), HO, TN2 (Nakagata), TY, TK, YI, PD, TO, SS, SM and HN were involved in the original conception and design of the study. Data acquisition was conducted by TN1, HO, TN2, TY, TK, YI, PD, TO, SS and SM conducted statistical analysis and interpretation of data. TN1 and SM drafted the manuscript. All authors conducted critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript. This text was proofread by editage. The experiments comply with the current laws of the country in which they were performed. The authors have no conflict of interest to declare. The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author who was an organizer of the study.

AUTHOR BIOGRAPHY

Journal of Sports Science and Medicine Toshiharu Natsume
Employment: COI project center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: natsumetoshiharu@gmail.com
 

Journal of Sports Science and Medicine Hayao Ozaki
Employment: School of Sport and Health Science, Tokai Gakuen University, Miyoshi, Aichi, Japan
Degree: Ph.D.
Research interests: Exercise physiology, Training science
E-mail: ozaki.hayao@gmail.com
 

Journal of Sports Science and Medicine Takashi Nakagata
Employment: Department of Physical Activity Research, National Institute of Health and Nutrition, NIBIOHN, Tokyo, 162-8636, Japan.
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: takashi.nakagata@gmail.com
 

Journal of Sports Science and Medicine Toshinori Yoshihara
Employment: Graduate School of Health and Sports Science, Juntendo University, 1-1 Hirakagakuendai, Inzai, Chiba 270-1695, Japan
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: t-yoshih@juntendo.ac.jp
 

Journal of Sports Science and Medicine Tomoharu Kitada
Employment: Faculty of Business Administration, Seijoh University, 2-172 Fukinodai, Tokai, Aichi 476-8588, Japan
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: t.kitada85@gmail.com
 

Journal of Sports Science and Medicine Yoshihiko Ishihara
Employment: Department of humanities and Social Sciences, School of Science and Technology for Future Life, Tokyo Denki University, Adachi-ku, Tokyo, Japan.
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: yoshi61616@gmail.com
 

Journal of Sports Science and Medicine Pengyu Deng
Employment: School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: houu.tou@gmail.com
 

Journal of Sports Science and Medicine Takuya Osawa
Employment: Department of Sports and Health Science, Faculty of Physical Education, Japan Women’s College of Physical Education, Setagaya-ku, Tokyo, Japan
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: osawa.takuya@jwcpe.ac.jp
 

Journal of Sports Science and Medicine Shuji Sawada
Employment: COI project center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: sh-sawada@juntendo.ac.jp
 

Journal of Sports Science and Medicine Hiroyuki Kobayashi
Employment: Department of General Medicine, Mito Medical Center, Tsukuba University Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, Japan
Degree: M.D., Ph.D.
Research interests: Sports Medicine
E-mail: hrkoba1@gmail.com
 

Journal of Sports Science and Medicine Shuich Machida
Employment: Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: machidas@juntendo.ac.jp
 

Journal of Sports Science and Medicine Hisashi Naito
Employment: Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
Degree: Ph.D.
Research interests: Exercise physiology
E-mail: hnaitou@juntendo.ac.jp
 
 
REFERENCES
Journal of Sports Science and Medicine Abe T., Kawakami Y., Suzuki Y., Gunji A., Fukunaga T. (1997) Effects of 20 days bed rest on muscle morphology. Journal of Gravitational Physiology 4, 10-14.
Journal of Sports Science and Medicine Abe T., Ogawa M., Loenneke J.P., Thiebaud R.S., Loftin M., Mitsukawa N. (2012) Relationship between site-specific loss of thigh muscle and gait performance in women: the HIREGASAKI study. Archives of Gerontology and Geriatrics 55, 21-25.  Crossref
Journal of Sports Science and Medicine Ardestani M.M., Ferrigno C., Moazen M., Wimmer M.A. (2016) From normal to fast walking: impact of cadence and stride length on lower extremity joint moments. Gait & Posture 46, 118-125.  Crossref
Journal of Sports Science and Medicine Baumgartner R.N., Koehler K.M., Gallagher D., Romero L., Heymsfield S.B., Ross R.R. (1998) Epidemiology of sarcopenia among the elderly in New Mexico. American Journal of Epidemiology 147, 755-763.  Crossref
Journal of Sports Science and Medicine Chen L.K., Woo J., Assantachai P., Auyeung T.W., Chou M.Y., Iijima K., Jang H.C., Kang L., Kim M., Kim S., Kojima T., Kazuya M., Lee J.S.W., Lee S.Y., Lee W.J., Lee Y., Liang C.K., Lim J.Y., Lim W.S., Peng L.N., Sugimoto K., Tanaka T., Won C.W., Yamada M., Zhang T., Akishita M., Arai H. (2020) Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. Journal of the American Medical Directors Association 21, 300-307.  Crossref
Journal of Sports Science and Medicine Crenna P., Frigo C., Massion J., Pedotti A. (1987) Forward and backward axial synergies in man. Exprimental Brain Research 65, 538-544.  Crossref
Journal of Sports Science and Medicine Fink J.E., Hackney A.C., Matsumoto M., Maekawa T., Horie S. (2020) Mobility and biomechanical functions in the aging male: testosterone and the locomotive syndrome. Aging Male 23, 403-410.  Crossref
Journal of Sports Science and Medicine Frank J.S., Earl M. (1990) Coordination of posture and movement. Physical Therapy 70, 855-863.  Crossref
Journal of Sports Science and Medicine Fukumoto Y., Ikezoe T., Yamada Y., Tsukagoshi R., Nakamura M., Takagi Y. (2015) Age-related ultrasound changes in muscle quantity and quality in women. Ultrasound in Medicine & Biology 41, 3013-3017.  Crossref
Journal of Sports Science and Medicine Hodges P.W. (1999) Is there a role for transversus abdominis in lumbo-pelvic stability?. Manual Therapy 4, 74-86.  Crossref
Journal of Sports Science and Medicine Iida Y., Kanehisa H., Inaba Y., Nakazawa K. (2011) Activity modulations of trunk and lower limb muscles during impact-absorbing landing. Journal of Electromyography and Kinesiology 21, 602-609.  Crossref
Journal of Sports Science and Medicine Ishihara Y., Ozaki H., Nakagata T., Ishibashi M., Machida S., Naito H. (2016) Locomotive syndrome relation to daily physical activity, physical function, and body composition in elderly people: a pilot study. Juntendo Medical Journal 62, 225-230.  Crossref
Journal of Sports Science and Medicine Jonsson B. (1970) The functions of individual muscles in the lumbar part of the spinae muscle. Electromyography 10, 5-21.
Journal of Sports Science and Medicine McGrath R.L., Ziegler M.L., Pires-Fernandes M., Knarr B.A., Higginson J.S., Sergi F. (2019) The effect of stride length on lower extremity joint kinetics at various gait speeds. Plos One 14, e0200862.  Crossref
Journal of Sports Science and Medicine Miyatani M., Kanehisa H., Azuma K., Kuno S., Fukunaga T. (2003) Site-related differences in muscle loss with aging. International Journal of Sport and Health Science 1, 34-40.  Crossref
Journal of Sports Science and Medicine Muller M., Tonkelaar I.D., Thijssen J.H.H., Grobbee D.E., Schouw Y.T. (2003) Endogenous sex hormones in men aged 40-80 years. European Journal of Endocrinology 149, 583-589.  Crossref
Journal of Sports Science and Medicine Nakamura K. (2011) The concept and treatment of locomotive syndrome: its acceptance and spread in Japan. Journal of Orthopaedic Science 16, 489-491.  Crossref
Journal of Sports Science and Medicine Nakamura K., Ogata T. (2016) Locomotive syndrome: definition and management. Clinical Reviews in Bone and Mineral Metabolism 14, 56-67.  Crossref
Journal of Sports Science and Medicine Nishihara K., Kawai H., Kera T., Hirano H., Watanabe Y., Fujiwara Y. (2018) Correlation of physical function with the thickness of multiple muscles of the quadriceps femoris in community-dwelling elderly individuals. Clinical Interventions in Aging 13, 1945-1951.  Crossref
Journal of Sports Science and Medicine Ogata T., Muranaga S., Ishibashi H., Ohe T., Izumida R., Yoshimura N. (2015) Development of a screening program to assess motor function in the adult population: a cross-sectional observational study. Journal of Orthopaedic Science 20, 888-895.  Crossref
Journal of Sports Science and Medicine Ohsawa T., Yanagisawa S., Shiozawa H., Omodaka T., Saito K., Kitagawa T. (2016) Relationship between knee osteoarthritis and the locomotive syndrome risk tests: a cross-sectional study. Journal of Orthopaedic Science 21, 512-516.  Crossref
Journal of Sports Science and Medicine Ozaki H., Sawada S., Osawa T., Natsume T., Yoshihara T., Deng P., Machida S., Naito H. (2020) Muscle size and strength of the lower body in supervised and in combined supervised and unsupervised low-load resistance training. Journal of Sports Science and Medicine 19, 721-726.  Pubmed
Journal of Sports Science and Medicine Santos L., Ribeiro A.S., Schoenfeld B.J., Nascimento M.A., Tomeleri C.M., Souza M.F., Pina Fabio L.C., Cyrino E.S. (2017) The improvement in walking speed induced by resistance training associated with increased muscular strength but not skeletal muscle mass in older women. European Journal of Sports Science 17, 488-494.  Crossref
Journal of Sports Science and Medicine Saunders S.W., Rath D., Hodges P.W. (2004) Postural and respiratory activation of the trunk muscles changes with mode and speed of locomotion. Gait & Posture 20, 280-290.  Crossref
Journal of Sports Science and Medicine Saunders S.W., Schache A., Rath D., Hodges P.W. (2005) Changes in three dimensional lumbo-pelvic kinematics and trunk muscle activity with speed and mode of locomotion. Clinical Biomechanics 20, 784-793.  Crossref
Journal of Sports Science and Medicine Seichi A., Hoshino Y., Doi T., Akai M., Tobimatsu Y., Iwaya T. (2012) Development of a screening tool for risk of locomotive syndrome in the elderly: the 25-question Geriatric Locomotive Function Scale. Journal of Orthopaedic Science 17, 163-172.  Crossref
Journal of Sports Science and Medicine Shahtahmassebi B., Hebert J.J., Hecimovich M.D., Fairchild T.J. (2017) Associations between trunk muscle morphology, strength and function in older adults. Scientific Reports 7, 1-10.  Crossref
Journal of Sports Science and Medicine Shiels M.S., Rohrmann S., Menke A., Selvin E., Crespo C.J., Rifai N., Dobs A., Feinleib M., Guallar E., Platz E.A. (2009) Association of cigarette smoking, alcohol consumption, and physical activity with sex steroid hormone levels in US men. Cancer Causes & Control 20, 877-886.  Crossref
Journal of Sports Science and Medicine Tokida R., Ikegami S., Takahashi J., Ido Y., Sato A., Sakai N., Horiuchi H., Kato H. (2020) Association between musculoskeletal function deterioration and locomotive syndrome in the general elderly population: a Japanese cohort survey randomly sampled from a basic resident registry. BioMed Central Musculoskeletal Disorders 21, 431.  Crossref
Journal of Sports Science and Medicine Uesugi Y., Kanaya S., Nakanishi H., Naito Y. (2020) The relationship between locomotive syndrome risk, gait pattern, and standing posture in young Japanese women: a cross-sectional study. Healthcare 15, 565.  Crossref
Journal of Sports Science and Medicine Yoshimura N., Muraki S., Oka H., Tanaka S., Ogata T., Kawaguchi H. (2015) Association between new indices in the locomotive syndrome risk test and decline in mobility: third survey of the ROAD study. Journal of Orthopaedic Science 20, 896-905.  Crossref
Journal of Sports Science and Medicine Yoshioka S., Nagano A., Hay D.C., Fukashiro S. (2014) Peak hip and knee joint moments during a sit-to-stand movement are invariant to the change of seat height within the range of low to normal seat height. BioMedical Engineering OnLine 13, 27.  Crossref
 
 
 
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