J Phys Fitness Sports Med, 1(1): 65-71 (2012)

JPFSM: Review Article

Exercise training based on individual physical fitness and interval walking

training to prevent lifestyle-related diseases in middle-aged and older people
Hiroshi Nose1,2*, Mayuko Morikawa1,2, Shizue Masuki1, Ken Miyagawa1,2,
Yoshi-ichiro Kamijo1 and Hirokazu Gen-no2
1
Department of Sports Medical Sciences, Division of Bioregulational Medicine, Institute of Pathogenesis and Disease
Prevention, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
2
Jukunen Taiikudaigaku Research Center, 3-1-1 Asahi, Matsumoto 390-8621, Japan

Received: March 13, 2012 / Accepted: April 21, 2012

Abstract Physical inactivity contributes to type II diabetes, cardiovascular disease, depres-

sion, dementia, and cancer, defined as the “diseasome of physical inactivity”; however, there
is no exercise training regimen broadly available in the field to prevent such diseasome. The
reasons are that there is no database on the effects of exercise training according to inter-
individual variations in physical fitness, disease, and genetic background. The authors have de-
veloped interval walking training, a portable calorimeter, and the e-Health Promotion System,
which enables one to develop a database to provide the most appropriate exercise prescription
for individuals to prevent diseasome. Also, it will enable exercise prescriptions to evolve to the
level of the current nutritional prescription system which is broadly used in hospitals and health
centers by dieticians and nurses and supported by national health insurance.
Keywords : lifestyle-related disease, diseasome, exercise prescription, interval walking training,
IT network, genomes

decreased to less than 25% of the peak level, we are not

Introduction
Physical fitness decreases gradually and unconsciously
with aging, similar to a person on a raft floating down-
stream. This decrease in physical fitness has been sug-
gested as a fundamental and common cause of many
age-associated diseases: hypertension, hyperglycemia,
obesity, and dyslipidemia; and exercise training has been
recommended for their prevention. To attain these effects,
exercise training should be performed with a subjective
feeling of “somewhat hard” intensity for more than 30
min per day, if possible, every day, similar to trying to
paddle the raft back upstream; however, it may be dif-
ficult for many people to accomplish this. Against this
difficulty, we have developed an interval walking training
system broadly available to middle-aged and older people
according to the American College of Sports Medicine
(ACSM) guidelines1). Here, we review the ACSM ex-
ercise prescription2), and report the effects of interval
walking training on physical fitness and lifestyle-related
diseases.
Physical fitness with aging
Physical fitness peaks in our twenties and, thereafter,
it gradually decreases by 5-10% per decade. When it has
*Correspondence: nosehir@shinshu-u.ac.jp
able to live independently. We call this as the functional
disability threshold3). Indeed, it has been suggested that
the cross-sectional area of the thigh muscle in our eighties
decreases to ~50% of what it was in our twenties. In addi-
・
tion, maximal aerobic capacity (VO2max) in our twenties is
~45ml/kg/min (0.23kcal) but decreases to ~30ml/kg/min
(0.15kcal) in our sixties, and further decreases to ~10ml/
kg/min (0.05kcal) in our eighties. These decreases in
physical fitness have been suggested to be caused by se-
nile muscle atrophy, called sarcopenia, which is thought
to be caused by similar genetic mechanisms of aging that
cause increased gray hair and wrinkles.
Physical fitness and age-associated diseases
It is interesting that health care costs increase with the
decrease in physical fitness with aging. Pedersen4) has
suggested that a reduction in muscle metabolism with ag-
ing and/or low physical activity causes lifestyle-related
diseases. She demonstrated that such a reduction induces
an increase in visceral fat, invasion of macrophages to
fat, chronic inflammation throughout the whole body,
resistance to insulin, atherosclerosis, deterioration of the
nervous system, and proliferation of cancer cells, which
results in various diseases: diabetes, cardiovascular dis-
ease, depression, dementia, and colonic and breast can-
cers. However, it must be stressed again that the funda-
66 JPFSM : Nose H, et al.
mental cause of these diseases is low muscle metabolism
and, therefore, these diseases are known as “diseasomes
of physical inactivity”. Moreover, since the syndrome is
spread throughout communities where people share simi-
lar lifestyles, it may be regarded as a type of infectious
disease. Accordingly, a community-based exercise pre-
scription system to prevent this is recommended.
Exercise training based on individual physical fitness
Exercise training is the most effective strategy to pre-
vent the deterioration of physical fitness with aging but
it should be prescribed according to trainees’ individual
fitness levels2). For example, before starting training to
increase muscle strength (resistance training), trainees
have to have the muscle strength of their target joints de-
termined by trainers in a gym by measuring the maximal
dumbbell weight that they can lift once, called one repeti-
tion maximum (1RM). Then, they are recommended to
lift a dumbbell weight of 50-80% 1RM, at >1 set of 3-15
times/day, 2-3 days/week. In addition, they are recom-
mended 1) to have a no-training day between the training
days, 2) not to perform the training more than 3 days/
week, and 3) to increase the dumbbell weight gradually
to the target level over 1-2 months to prevent any muscle
injuries due to over training.
On the other hand, if trainees have no access to ma-
chines and trainers’ services in a gym, they can perform
push-ups and squats using their body weight and resis-
tance exercise using a rubber band to increase muscle
strength. They are recommended to perform training at
a frequency that they feel to be “hard” for a set, 1-2 sets/
day, 3-7 days/week. The frequency of “hard” is 2-3 times
below the maximal frequency or the rate of perceived
exertion (RPE) of 15-16. The RPE, also called the Borg
Scale, is defined as 6 points for “very very light” and 20
points for “very very hard”. Whether one uses machines
or not, the thigh muscle strength of the target joint is ex-
pected to increase by 10-110% after following the above
resistance training regimen for 3-6 months.
Similar to resistance training, before starting training to
increase aerobic capacity (aerobic training), trainees have
to have their capacity checked by professional trainers in
a gym by measuring the oxygen consumption rate dur-
ing graded exercise on a cycle ergometer or treadmill2).
In cycle ergometer exercise, the intensity is increased by
60 watts every 3 min from 0 watts to the maximal level
at which the trainee is exhausted, during which period
the oxygen consumption rate, carbon dioxide produc-
tion rate, and heart rate are measured. It was determined
that the exercise intensity had reached the maximal level
when 3 of the 4 criteria were fulfilled: 1) the trainee can-
not continue to pedal at a given rhythm of 60 cycles/min),
2) the heart rate reaches the age-predicted maximal heart
rate (220 – age, measured in beats/min), 3) the respiratory
quotient has increased to more than 1.1, and 4) the oxy-
gen consumption rate does not increase despite increased
exercise intensity.
On the other hand, if trainees have no access to ma-
chines and trainers’ services in a gym, they are able to
roughly estimate their maximal aerobic capacity by using
the “12-min running test” 5), “20-m shuttle run test” 6,7)
or “walking or running at a given RPE” 2). For example,
using RPE, trainees walk or run on flat ground for 3 min
with the subjective feeling of “somewhat hard,” equiva-
lent to 13 points of RPE, the distance is measured, the
speed (m/min) is calculated, the oxygen consumption rate
is determined from Table 1, and then maximal aerobic
capacity is estimated by multiplying the value by 1.54
(20/13)8).
・
After determining VO2max, whether with machines or
not, trainees may exercise at the intensity of 60-70%
・
VO2max, 30-60 min/day, 4-7 days/week. They may start
・
exercise at 50% VO2max for the first month, and then grad-
ually increase the intensity to 60% for the 2nd month, and
・
end at 70% VO2max for the 3rd month; but they should not
・
exceed 85% VO2max. When they perform exercise train-
ing using machines for this purpose, for example, using
a cycle ergometer, it is easy to determine the intensity;
however, when they perform other styles of exercise, such
as swimming, tennis, and cycling in the field, it is diffi-
cult to know the intensity. In that case, they can determine
the target intensity by monitoring the heart rate during ex-
ercise. The target heart rate during exercise can be calcu-
lated from the equation [target heart rate = (age-predicted
peak heart rate – heart rate at rest) x (0.6-0.7) + heart rate
at rest], equivalent to the 80-90% age-predicted heart rate.
If they perform the exercise at this intensity, equivalent to
13 points of RPE, 30-60 min/day, 4-7 days/week, for 3-6
・
months, their VO2max is expected to increase by 10-20%2)).
When the energy expenditure per day is converted to cal-
ories, it is the equivalent of 300-600 kcal for trainees in
their twenties, 200-400 kcal for those in their sixties, and
50-100 kcal for those in their eighties; and the energy ex-
penditure per week is 1200 kcal, 800 kcal, and 200 kcal,
respectively.
Interval walking training
The exercise regimens stated above have been thought
to prevent age-associated diseases: hypertension, hyper-
glycemia, obesity, and dyslipidemia; however, it might
be difficult for middle-aged and older people to perform
such exercise training regimens at a given intensity regu-
larly. We recently found in middle-aged and older people
that 1) not only maximal aerobic capacity but also thigh
muscle strength increased after aerobic exercise train-
ing for 5 months using a cycle ergometer9) and 2) that we
were able to estimate maximal aerobic capacity by graded
walking in the field without using machines such as a
treadmill and cycle ergometer10). Accordingly, we have
applied these findings to exercise prescription with “in-
 JPFSM : Exercise prescription for the elderly 67

・
Table 1.　Estimation of VO2max and maximal workload from the measurements in the field.
VO2max, 12-min 20-m Cycling Running Walking Maximal Maximal
ml/ kg/min running shuttle run, intensity, speed, speed, work load, work load,
distance, frequency watts/kg m/min m/min kcal/kg/min METs
m
10 0.45 63 0.05 2.9
12 0.59 83 0.06 3.4
14 0.73 99 0.07 4.0
16 0.87 104 0.08 4.6
18 1.01 109 0.09 5.1
20 1.15 114 0.10 5.7
22 1.29 119 0.11 6.3
24 1.43 124 0.12 6.9
26 1.57 129 0.13 7.4
28 1.678 9 1.71 134 0.14 8.0
30 1.773 17 1.85 133 0.15 8.6
32 1.868 26 1.99 143 0.16 9.1
34 1.963 35 2.13 153 0.17 9.7
36 2.059 44 2.27 163 0.18 10.3
38 2.154 53 2.41 173 0.19 10.9
40 2.249 62 2.55 183 0.20 11.4
42 2.344 71 2.69 193 0.21 12.0
44 2.440 80 2.83 204 0.22 12.6
46 2.535 89 2.97 214 0.23 13.1
48 2.630 98 3.11 224 0.24 13.7
50 2.725 106 3.24 234 0.25 14.3
・
VO2max (ml/kg/min)
= 12-min running distance (m) x 0.021 – 7.233
= 20-m shuttle run (frequency) x 0.225 + 26.07
= Running speed (m/min) x 0.119 +3.5
= Walking speed (m/min) x 0.103 +3.5 (<99m/min)
= [Walking speed (m/min) x 0.392-28.2] +3.5 (>100m/min)
・
Maximal work lord (kcal/kg/min) = VO2max (ml/kg/min) x 0.005
・
Maximal work load (METs) = VO2max (ml/kg/min)/ 3.5

terval walking training (IWT)” for middle-aged and older
people in the field, named the Jukunen Taiikudaigaku
Project, starting in 1997 and since then, we have accumu-
lated a database regarding the effects of IWT on physical
fitness and the indices of lifestyle-related diseases. This
project has been organized by the Non-Profit Organiza-
tion of Jukunen Taiikudaigaku Research Center (JTRC)
since 2005, and detailed information on the project is
given by their web site10) As in Fig. 1, the project has four
features as follows:
1) Interval walking training (IWT)
・
Before starting training, peak aerobic capacity (VO2peak)
for walking was determined in individual participants.
Accordingly, they walked at subjectively slow, interme-
diate, and fast speeds for 3 min each, during which time
energy expenditure and heart rate were measured every 5
sec by triaxial accelerometry and by the near infrared ear
pick-up method (JD Mate: Kissei Comtec, Matsumoto),
respectively, and the values for the last 30 sec of fast
・
walking were averaged and adopted as VO2peak and HRpeak.
After this, participants were instructed to repeat IWT at
their preferred time and place at low and high intensity
walking alternately at the target levels of ~40% and ≥70%
・
VO2peak, respectively, for 3 min each, ≥4 days/week-1, for
12 weeks. During IWT, energy expenditure was moni-
tored with a tri-axial accelerometer (JD Mate) carried on
the mid-clavicular line of the right or left waist. A beeping
signal from the device alerted participants when a change
of intensity was scheduled and another sound let them
know when the intensity of fast walking had reached the
target level. Participants visited a local community office
every 2 weeks, and data from the tracking devices were
transferred to a central server computer. Then results were
sent back to participants and they received instructions
from trainers.
・
As a result, we found that VO2peak increased by ~10%
and knee extension and flexion forces increased by 17%
and 13%, respectively, while systolic and diastolic pres-
sure decreased by ~10mmHg and ~5 mmHg, respectively,
68 JPFSM : Nose H, et al.

Fig. 1 㪟㪼㪸㫃㫋㪿㩷㪺㪸㫉㪼㩷㫀㫅㫊㫋㫀㫋㫌㫋㫀㫆㫅㫊
㪫㫉㪸㫀㫅㪼㫉㫊
㪥㫌㫉㫊㪼㫊㪃㩷
㪛㫀㪼㫋㫀㫋㫀㪸㫅㫊㪃
㪧㪿㪸㫉㫄㪸㪺㫀㫊㫋㫊 㪼㪄㪢㪼㫐

㪘㪺

㪚㫃㫀㫅㫀㪺㪸㫃㩷㫉㪼㪺㫆㫉㪻㫊
㪫㫉㪸㫀㫅㫀㫅㪾㩷㫉㪼㪺㫆㫉㪻㫊
㪺㪼
㪉㪅㩷㪡㪛㩷㪤㪸㫋㪼
㫊㫊
㩷㫋 㫆
㪧㫉

㩷㪛
㪼㫊

㪙㩷
㪺㫉
㫀㫇㫋

㪊㪅㩷㪼㪄㪟㪼㪸㫃㫋㪿㩷 㪧㪸㫉㫋㫀㪺㫀㫇㪸㫅㫋㫊
㫀㫆㫅

㪧㫉㫆㫄㫆㫋㫀㫆㫅㩷㪪㫐㫊㫋㪼㫄
㪈㪅㩷㪠㫅㫋㪼㫉㫍㪸㫃㩷㫎㪸㫃㫂㫀㫅㪾㩷㫋㫉㪸㫀㫅㫀㫅㪾㩷

㪠㫅㫋㪼㫉㫅㪼㫋
㪘㪺㪺㪼㫊㫊㩷㫋㫆㩷㫆㫅㫃㫐㩷㫋㪿㪼㫀㫉㩷㫆㫎㫅㩷
㫉㪼㪺㫆㫉㪻㫊㩷㫎㫀㫋㪿㩷㫇㫉㪼㫊㪺㫉㫀㫇㫋㫀㫆㫅

㪛㪥㪘
㪘㪺㪺㪼㫊㫊㩷㫋㫆㩷
㪩㪼

㪺㫃㫀㫅㫀㪺㪸㫃㩷㪛㪙 㪘㫅㫆㫅㫐㫄㫀㫑㪼㪻 㪘㫅㫆㫅㫐㫄㫀㫑㪼㪻

㫍㫀㫊

㪝㫌㫅㪺㫋㫀㫆㫅㫊
㪼

㪄 㪘㪻㫄㫀㫅㫀㫊㫋㫉㪸㫋㫀㫆㫅㩷㫆㪽㩷㫌㫊㪼㫉㩷
㪸㪺㪺㪼㫊㫊㩷㩽㩷㪛㪙 㪋㪅㩷㪠㫅㪻㫀㫍㫀㪻㫌㪸㫃㩷㪾㪼㫅㫆㫄㫀㪺㩷㫍㪸㫉㫀㪸㫅㪺㪼
㪄 㪜㫏㪼㫉㪺㫀㫊㪼㪆㩷㪥㫌㫋㫉㫀㫋㫀㫆㫅㪸㫃㩷
㫇㫉㪼㫊㪺㫉㫀㫇㫋㫀㫆㫅㫊

㪚㫃㫀㫅㫀㪺㪸㫃㩷㪛㪙 㪦㫌㫋㪺㫆㫄㪼
㪄 㪧㪿㫐㫊㫀㪺㪸㫃㩷㪺㪿㪸㫉㪸㪺㫋㪼㫉㫀㫊㫋㫀㪺㫊㩷㩽
㫋㫉㪸㫀㫅㫀㫅㪾㩷㩽㩷㪺㫃㫀㫅㫀㪺㪸㫃㩷㫉㪼㪺㫆㫉㪻㫊 㪘㫅㫆㫅㫐㫄㫆㫌㫊㩷
㪼㪄㪢㪼㫐 㪾㪼㫅㫆㫄㫀㪺㩷㪛㪙

Fig. 1 Interval walking training and e-Health Promotion System. Participants in the training visit a health care institution, a drug store,
or a local community office every 2 weeks to transfer their walking records from the tracking device, JD Mate, to a central serv-
er computer over the Internet. The server computer gives them a trend graph of the records with advice automatically generated
by the server. Based on this, the staff, nurses, dietitians, or trainers, give them advice. If participants have a computer at home,
they can receive a similar service from the staff over the Internet. By anonymizing and combining the DNA data stored in a sep-
arate offline computer and the clinical data stored in the central server computer, we have started to search for genomic varia-
tions explaining inter-individual variations in response to the training. The outcome from the research may be used to revise the
e-Health Promotion System to develop an algorithm to predict the effects of interval walking training on physical fitness and the
indices of lifestyle-related diseases in individuals with different physical and genetic characteristics. e-Key is used to limit a per-
son’s access to the database (DB). The squares around the Internet circle indicate the firewall. The filled arrows indicate online
communications between users and the server over the Internet and the dotted arrows indicate offline communications. From [1]

after 5 months of training. On the other hand, standard
walking training of moderate intensity continuous walk-
・
ing at 40% VO2peak for 60 min/day, 4 days/week, for 5
months, produced only minimal results similar to those
of persons remaining sedentary during the same period11).
・
Moreover, we found in the study that VO2peak was signifi-
cantly correlated with isometric knee extension force (R2
= 0.49, P<0.0001), suggesting that thigh muscle strength
・
is a key determinant for VO2peak in subjects of this age.
・
Furthermore, these results indicate that increased VO2peak
induces a marked reduction in blood pressure.
Recently, using these techniques, we examined the ef-
fects of IWT on physical fitness and the indices of life-
style-related diseases (LSD) in 198 men and 468 women
aged ~65 years old12). They performed IWT, ~60min/day,
~4 days/week, for 4 months on average. We assessed the
scores of LSD before and after IWT according to the cri-
teria in the healthcare guideline for Japanese by the gov-
ernment (Health Insurance Bureau, Ministry of Health,
Labor, and Welfare, Japan 2007); 1) systolic blood pres-
sure ≥130 mmHg or diastolic blood pressure ≥85 mmHg,
2) triglyceride ≥150 mg/dl or blood high density lipopro-
tein cholesterol ≤40 mg/dl, 3) blood glucose ≥100 mg/dl,
4) BMI ≥25 kg/m2; therefore, the full score was 4 points
when all criteria were met.
To analyze the results, we divided the subjects into 3
・
groups according to VO2peak in women (Fig. 2-A) and men
・
(Fig. 2-B). The LSD scores decreased as VO2peak increased
・
and, moreover, when VO2peak increased after training, the
LSD score decreased in both genders. Furthermore, when
 JPFSM : Exercise prescription for the elderly 69

looking at the LSD score for each criterion in women
(Fig. 3-A) and men (Fig. 3-B), the hypertension score was
0.7-0.8, suggesting that 70-80% of subjects met the cri-
terion in both genders. Similarly, 40-60% and 20-50% of
subjects had hyperglycemia and high BMI, respectively,
in both genders. After training, subjects meeting each
criterion showed a decrease of 5-30% in hypertension,
10-40% in hyperglycemia, and 10-30% in high BMI, but
with no significant reduction in blood lipids. These results
・
suggest that increased VO2peak decreased blood pressure,
blood glucose, and BMI in that order while the effects on
blood lipids were modest.
2) Three-dimensional accelerometry
The authors have developed a new portable calorimeter
with which energy expenditure can be precisely measured
・
even when walking on inclines13). First, VO2 was mea-
sured by respiratory gas analysis and vector magnitude
(VM, G) from triaxial acceleration in middle-aged and
older men and women aged ~63 years during graded
walking on a treadmill while the incline was varied from
-15% to +15%. Participants walked at subjectively slow,
moderate and fast speeds on level and uphill inclines and,
in addition, at their fastest speed at 0% incline. Similarly,
they then walked on downhill inclines for 3 min each.
・
The regression equation to estimate VO2 from VM and
the theoretical vertical upward speed (Hu, m/min) and
downward speed (Hd, m/min) for the last 1 min of each
・
trial as was determined as VO2 = 0.0044VM + 1.365Hu +
0.553Hd.

Fig. 2 A 㪉㪅㪌 Women Fig. 2 B 㪉㪅㪌 #† Men

㪉㪅㪇 #† 㪉㪅㪇
before *# †
㪈㪅㪌 *# † after * *
Total LSD * * Total LSD
㪈㪅㪌

score 㪈㪅㪇
score 㪈㪅㪇

㪇㪅㪌 㪇㪅㪌

㪇㪅㪇 㪇㪅㪇
㪊㪇 㪊㪇
*
*† *
㪉㪌 㪉㪌 *†
䊶 *† 䊶 *†
VO2peak, 㪉㪇 VO2peak, 㪉㪇 †

ml/kg/min ml/kg/min #†
㪈㪌 㪈㪌

㪇 㪇
Low Middle High Low Middle High
(n = 156) (n = 156) (n = 156) (n = 66) (n = 66) (n = 66)
・
Fig. 2 Total lifestyle-related disease (LSD) score and peak aerobic capacity for walking (VO2peak) before and after interval walking
・
training in women (A) and men (B). When the subjects were divided equally into 3 groups according to VO2peak, the score
・ ・
was lower in higher VO2peak groups. After interval walking training for 4 months, the score decreased as VO2peak increased
in every group. From [12].

before after
SBP > 130 mmHg or DBP > 85 mmHg
Women Men
BG > 100 mg/dl
BMI > 25 kg/m2 㪈㪅㪇

TG > 150 mg/dl or HDL-C < 40 mg/dl

㪈㪅㪇 㪇㪅㪏

* *
*
LSD score

㪇㪅㪏 㪇㪅㪍 *
*
LSD score

*
㪇㪅㪍 * 㪇㪅㪋 *
* *
* *
*
㪇㪅㪉
㪇㪅㪋 *
*
*
㪇㪅㪉 㪇㪅㪇
*
Low Middle High
㪇㪅㪇 Fig. 3 B (n = 66) (n = 66) (n = 66)

Low Middle High

Fig. 3 A (n = 156) (n = 156) (n = 156)

Fig. 3 Lifestyle-related disease (LSD) score for each criterion; hypertension, hyperglycemia, high BMI, and dyslipidemia, in
・
women (A) and men (B). When the subjects were divided equally into 3 groups according to VO2peak before training, the
score was higher in the order of hypertension, hyperglycemia, high BMI, and dyslipidemia in every group. After training,
all scores except for dyslipidemia decreased by 10-40%. From [12]
70 JPFSM : Nose H, et al.
Second, to validate the precision of the equation, VM
and altitude changes were measured - with a portable de-
vice (JD Mate) equipped with a triaxial accelerometer and
a barometer - in middle-aged and older subjects walking
・
on an outdoor hill, and the estimated VO2 by the equation
stated above was compared with the value simultaneously
measured by respiratory gas analysis. It was found that
・
the estimated VO2 (y) from the equation was identical
・
to the VO2 measured by respiratory gas analysis during
walking on an outdoor hill. Thus, the authors were able
・
to develop a device for estimating VO2 precisely during
walking regardless of the geography. Moreover, subjects
・
can perform high-intensity exercise training ≥70%VO2peak
not only by fast walking on a flat surface but also by slow
or moderate walking on inclines or stairs.
3) e-Health Promotion System
Another reason hindering the extension of a nationwide
exercise prescription for individuals is the cost for train-
ers. To solve this problem, the authors have been devel-
oping the e-Health Promotion System, as shown in Fig.
1 1). The participants in the program visit local health care
institutes near their homes - a local community office and
a drug store, every 2 weeks, to transfer their walking re-
cords from the JD Mate to a central server computer, and
receive a trend graph of their achievements. Based on re-
cords from the DB regarding the effects of IWT on physi-
cal fitness over a 5-month period, the indices of LSD in
4,000 subjects, and other data, the staff (nurses, dietitians,
pharmacists or trainers) give the participants exercise and
nutritional prescriptions. If participants have a computer
in their own home, they are able to receive the same ser-
vice over the Internet without going out.
4) Individual genomic variance ercise is determined according to individual physical fit-
Recently, the authors started to analyze individual ge-
nomic variance in relation to inter-individual variation
in response to IWT14,15). Masuki et al.15) assessed whether
single nucleotide polymorphism rs1042615 of the vaso-
pressin V1a receptor altered the indices of LSD in sub-
jects; and, if so, whether it also altered the effects of IWT.
CC, CT, and TT carriers of rs1042615 (42, 118, and 64
men; 113, 263, and 154 women, respectively) performed
IWT, ≥4 days/wk, for 5 months. Before IWT, BMI and
diastolic blood pressure for men were both higher in
TT than in CC; however the differences disappeared af-
ter IWT despite similar training achievement between
groups. Moreover, after IWT, BMI and DBP decreased
more in TT than in CC with a greater decrease in low-
density lipoprotein (LDL) cholesterol in TT than CC. The
decreases in DBP and LDL cholesterol were still greater
in TT even after adjustment for their pre-training values.
On the other hand, for women, these parameters before
IWT and changes after IWT were similar between CC,
CT, and TT. Thus, polymorphism rs1042615 of the V1a
receptor altered BMI and DBP in middle-aged and older
men, and the training-induced responses of DBP and LDL
cholesterol; whereas women did not show any of these
responses. These results suggest that single nucleotide
polymorphism rs1042615 of the vasopressin V1a receptor
was involved in inter-individual variance in responses to
IWT in middle-aged and older men.
According to the outcome of these studies, a computer
program is being developed to predict the effects of
IWT on physical fitness and the indices of LSD accord-
ing to not only physical, but also genetic characteristics
of participants before training. If the program becomes
available to staff in the field, they will be able to give
participants more individual exercise prescriptions even
though they are not specialized in this subject. This would
increase the number of participants in IWT.
Future direction of exercise prescription in the field
In Japan, nutritional prescriptions to prevent lifestyle-
related diseases have been widely given in hospitals
and health centers by dietitians and nurses sponsored by
health insurance; however, the use of exercise prescrip-
tions has not reached this level. The success of nutritional
prescriptions may be partially because dietitians have
successfully determined the minimal requirement of
individual nutrients for our daily life and presented the
standards in physical/chemical units based on the recom-
mended daily allowance (RDA). On the other hand, since
there are so many styles of exercise, and since less atten-
tion has been paid to measuring energy expenditure in a
large population of people in the field, it has been difficult
to prescribe exercise training based on the cost vs effect
relationship; however, as stated above, if the target of ex-
ercise expenditure (exercise intensity) for all types of ex-
ness level, and exercise intensity and energy expenditure
during training are monitored in the field, it may enable
the promotion of exercise prescriptions to the same level
as nutritional prescriptions supported by national health
insurance.
In summary, interval walking training and the related
system explained above, which has been developed based
on ACSM guidelines, have enabled exercise prescriptions
for individual physical fitness to become broadly avail-
able in middle-aged and older people. If a sufficiently
large database can be built on the cost and effect relation-
ship of such training, it will make it possible for exercise
prescriptions to be supported by health insurance, as are
nutritional prescriptions in Japan.
 JPFSM : Exercise prescription for the elderly
Acknowledgments
This study was supported in part by grants from the Ministry
of Health, Labor, and Welfare (Comprehensive Research on
Aging and Health), the Japan Society of Promotion of Science,
and the Ministry of Economy, Trade, and industry of Japan. This
research was also supported in part by the Shinshu University
Partnership Project of Shinshu University, Jukunen Taiiku-
daigaku Research Center, the Ministry of Education, Culture,
Sports, Science and Technology of Japan, and Matsumoto City.
References
  1) Nose H, Morikawa M, Yamazaki T, Nemoto K, Okazaki K,
Masuki S, Kamijo Y, and Gen-no H. 2009. Beyond epide-
miology: field studies and the physiology laboratory as the
whole world. J. Physiol. (London) 587: 5569-5575.
  2) American College of Sports Medicine. 2010. ACSM’s
Guidelines for Exercise Testing and Prescription, 8th edition,
pp. 60-102, 152-180
  3) Haskell WL and Phillips WR. 1998. Effects of exercise
training oh health and physical functioning in older persons.
In: The 1997 Nagano Symposium on Sports Sciences (ed.
Nose H, Morimoto T, add Nadel E), pp. 399-417.
  4) Pedersen BK. 2009. The diseasome of physical inactivity -
and the role of myokines in muscle-fat cross talk. J. Physiol.
(London) 587: 5559-5568.
  5) Cooper KH. 1968. A means of assessing maximal oxygen
intake. JAMA. 203: 135-138.
  6) Ministry of Education, Culture, Sports, Science and Tech-
nology. 2000. Introduction of the New Guidelines for Exer-
cise Testing. Gyosei, Tokyo (in Japanese).
  7) Yamaji K. 2001. Science for Maximal Oxygen Intake. Kyo-
rin Shoten, Tokyo (in Japanese).
71
  8) Okazaki K, Gen-no H, Morikawa M, and Nose H. 2006. Ex-
ercise program for individuals based on the Exercise Guide
2006. Journal of Health, Physical Education and Recreation.
(Taiiku no Kagaku) 56: 627-634 (in Japanese).
  9) Okazaki K, Kmaijo Y, Takeno Y, Okumoto T, Masuki S, and
Nose H. 2002. Effects of exercise training on thermoregu-
latory responses and blood volume in older men. J. Appl.
Physiol. 93:1630-1637.
10) Jukunen Taiikudaigaku Research Center. 2012. http://www.
jtrc.or.jp (in Japanese).
11) Nemoto K, Gen-no H, Masuki S, Okazaki K, & Nose H.
2007. Effects of high-intensity interval walking training
on physical fitness and blood pressure in middle-aged and
older people. Mayo Clin. Proc. 82: 803-811.
12) Morikawa M, Okazaki K, Masuki S, Kamijo Y, Yamazaki
T, Gen-no H & Nose H. 2011. Physical fitness and indices
of lifestyle related diseases before and after interval walk-
ing training in middle-aged males and females. British J. of
Sports Medicine, 45: 216-224.
13) Yamazaki T, Gen-no H, Kamijo Y, Okazaki K, Masuki S &
・
Nose H. 2009. A new device to estimate VO2 during incline
walking by accelerometry and barometry. Medicine and
Science in Sports and Exercise, 41: 2213-2219.
14) Mori M, Higuchi K, Sakurai A, Tabara Y, Miki T, Nose H,
Shinshu University Genetic Research Consortium. 2009.
Genetic basis of inter-individual variance in the effects of
exercise on preventing life-style related diseases. J Physiol
London). 587: 5577–5584.
15) Masuki S, Mori M, Tabara Y, Miki T, Morikawa M, Miya-
gawa K, Higuchi K, and Nose H for the Shinshu University
Genetic Research Consortium. 2010. Vasopressin V1a Re-
ceptor polymorphism and high-intensity interval walking
training effects in middle-aged and older people. Hyperten-
sion, 55: 747-754.