The TAKE10!® for Older Adults program at community centers appears to have improved dietary habits among community-dwelling older adults. In addition to the food intake frequency for 6 food groups, FFS and DVS were significantly increased in the intervention group, suggesting that the participants’ dietary habits changed and that dietary variety was greater than before. Increases in the frequency of intake of high-protein foods and high-fiber foods were especially positive results and may help older Japanese adults to maintain good nutritional status. There were no changes in BMI (p = 0.561) or appetite (p = 1.000) seen in the intervention group, which indicates that it was the quality not quantity of food intake in their diets that changed. The fact that 55% of participants with a baseline DVS of 1–3 improved to a post-intervention score of ≥4 indicates their risk of a decrease in higher-level functional capacity had been lowered. In addition, the interaction effects of FFS and DVS and similar results seen in the crossover intervention group indicate the efficacy of this intervention program on dietary habits.
Physical activity and good nutritional habits are important to helping community-dwelling older adults avoid or delay the need for long-term nursing care . Because of difficulties in evaluating nutritional programs for older adults, few studies on such programs have been conducted to date. However, some studies have shown associations between dietary variety and nutritional status [23, 24, 31], quality of life [30, 32], and physical and cognitive function [33, 34]. It is clear that promoting dietary variety is one of the best ways to maintain proper nutritional status among older adults. Moreover, in a super-aging society like Japan, there is an urgent need for social programs that are easy to implement and follow and that do not require individual advice and attention from professionals.
It was interesting that frequency of walking and doing stretching and muscle strengthening exercises did not change even in the intervention group. Some possible reasons are that, first, the end point of this intervention was during the coldest time of year in Japan, and many people undoubtedly preferred to stay indoors. Second, at baseline, 78% participants were already in the habit of walking or engaging in exercise 5 days per week, and in this community attending radio calisthenics (“rajio taisou”) broadcasts in nearby parks is very popular. Third, 8 (14%) subjects did not participate in the sessions beyond the first lecture and another 8 (14%) subjects participated in fewer than 3 sessions, so they might not have been interested in our program and thus not have mastered the exercises enough to perform them at home without assistance. However, in response to the question in the post-intervention questionnaire “Did you do TAKE10 exercises at home?” 83% participants answered “Yes”, and to “How many days did you do them a week?” 78% participants answered “every 2 days or more”. In the winter, it is possible that some participants replaced their attendance of the radio calisthenics broadcasts with TAKE10 exercise as it was more difficult to go outside. In addition, significant differences were observed in the frequency of exercise in the crossover intervention group, suggesting the possibility of intervention effects on physical activity.
Self-rated health improved in the intervention group compared to baseline, although a significant difference in improvement rate was not seen between groups. Self-rated health is a global measure of health, and many studies have shown correlations with relative risk of mortality [35–38], well-being, and functional capacity . For community-dwelling older adults, self-rated health is a possible indicator of quality of life. However, the observed effect may have been the result of not only attending this program, but also simply gathering together with other members of the community.
This study has several limitations. First, the study design was not an ideal randomized control trial. In order to eliminate transportation barriers to participation in this program, participants were assigned to groups according to their home address. In addition, to secure the same floor conditions at the 6 community centers, randomization was conducted before recruitment. Therefore, the two groups differed in the number of participants at baseline. However, as shown in Table 1, there were no significant differences between the two groups in the variables measured at baseline. Also, we compared the 3 baseline measures (sex, age, and TMIG Index of Competence) between the 6 clusters and no significant differences were seen. The sample size was less than the ideal 50 participants per group, and as the participants were recruited through the ward’s bulletin, participants who enrolled might have been more motivated and health conscious. This might also explain the large percentage of female participants . Other recruitment methods should be considered in future studies.
Although we did not examine behavioral stage and self-efficacy, we did find some behavior changes among the participants. In response to “Did your awareness of diet change after participating in this program?” 94% participants answered “Yes”, indicating that behavioural stage or self-efficacy might have changed, although we did not evaluate this scientifically. In addition, we used the TAKE10!® Check Sheet and the TAKE10!® Calendar only as tools to motivate participants and not to measure outcomes. The tools could be used to evaluate behavioral aspects in future studies. Also, seasonal changes in participant behavior were not considered and the intervention program did not reflect this. The program started in autumn which is a good season for outdoor exercise, walking, and eating, but ended in mid-winter.
Our main outcomes on diet do not indicate the quantity of food consumed from each food group, and we did not evaluate participants’ nutritional status using biochemical indicators. From our findings, we can estimate changes in dietary habits, but cannot indicate definite effects on health. In addition, it is necessary that good habits be maintained to observe the effects. However, we did not examine how long the behavioral changes continued following the intervention. We also did not measure how much physical fitness improved as a result of the exercise training undertaken by the intervention group. Further studies are therefore needed to confirm the effects of this program.
Ultimately, we consider this intervention program to be the first step toward introducing more healthy lifestyles to community-dwelling older adults, with its focus on improving their self-management abilities and aiming to increase the health status of the community as a whole. We believe the program can serve as an important form of social support that contributes to meeting present and future healthcare challenges. Personalized programs tailored to each individual’s abilities, behavioral stage, and environment would be a good next step.