黒瀨 聖司

Abstract Aim This prospective non‐randomized controlled study examined the Autonomy‐Supportive Circuit Training Program (ASCTP), a structured physical activity intervention. The primary objective was to assess and compare changes in internalizing (emotional symptoms) and externalizing (behavioral difficulties) traits between children with autism spectrum disorder (ASD) and those with subthreshold ASD following ASCTP participation. Methods A total of 28 boys (aged 4–10 years) were divided into an ASD (n = 14) and a non‐ASD group (n = 14). The ASCTP intervention was developed and implemented in an exercise‐focused daycare center for children with disabilities in Japan. The intervention consisted of a structured 45‐min exercise program conducted once a week for 6 months. It emphasized an autonomy‐supportive and standardized session structure, implemented by trained facilitators, and was specifically designed to support children's self‐regulation and individualized activity selection. Emotional and behavioral traits were assessed pre‐ and post‐intervention using the Strengths and Difficulties Questionnaire, completed by the parents. Additionally, the children's lifestyle habits (sleep, screen time, and breakfast consumption) were recorded pre‐ and post‐intervention through parental reports. Results The ASD group showed a significant reduction in behavioral difficulties, whereas the non‐ASD group exhibited an increase in behavioral difficulties (−1 [−2 to 0] vs. 1 [−1 to 1], adjusted p = 0.034, r = 0.45). Although no significant changes in emotional symptoms were present in either group, a decreasing trend was observed. Conclusion Participation in the ASCTP was associated with a reduction in behavioral difficulties in children with ASD, which may reflect the potential benefits of the structured framework of the program. Conversely, the increased behavioral difficulties observed in the non‐ASD group may indicate the need for more flexible intervention approaches.

ABSTRACT Background The long‐term prognosis of patients with heart failure (HF) remains poor. Most patients with HF are older, and multiple factors involved in geriatric syndromes are associated with worse long‐term prognosis. Sarcopenia is a major component of geriatric syndrome. Early diagnosis and therapeutic intervention for sarcopenia are clinically important in patients with HF; however, the prevalence and long‐term prognostic impact of sarcopenia in patients with stage B HF remain unclear. This study aimed to determine the prevalence of sarcopenia in older patients with stage B HF and its impact on the long‐term prognosis. Methods The PAPRIKA‐HF study was a multicenter, prospective study that enrolled outpatients ≥ 65 years who were diagnosed with stage B HF. Sarcopenia was assessed based on the Asian Working Group for Sarcopenia 2019 diagnostic criteria. The primary endpoint was a composite endpoint (all‐cause mortality, incident myocardial infarction, or hospitalization for heart failure) of > 2 years. Results Among 312 patients (mean age: 78.2 ± 6.5 years, 45% female), 17.7% (56 of 312 patients) had sarcopenia. The rate of the composite endpoint over 2 years was significantly higher in patients with sarcopenia than in those without (25.0% vs. 2.7%, log‐rank test, p < 0.0001). Multivariate analysis using the Cox proportional hazards model showed that sarcopenia was an independent predictor of long‐term prognosis (hazard ratio: 5.78, 95% confidence interval: 2.16–15.43, p < 0.001). Conclusions Sarcopenia was associated with a worse long‐term prognosis in older patients with stage B HF, highlighting the importance of early diagnosis of sarcopenia.

Background Regular and appropriate physical activity has health benefits; however, to ensure safety, a pre-exercise medical check based on health information is important. In this study, we aimed to clarify the relationship between risk classification by physicians at a health promotion facility in Japan and the occurrence of adverse events during facility use. Methods We evaluated 3,571 individuals, excluding those with an unknown sex, age, medical assessment of exercise limitations, and facility usage status. Based on the results of the medical checkups conducted by a physician, the participants were divided into an exercise-prohibited group and an exercise-permitted group (exercise-permitted group, subdivided into non-restricted, orthopedic-restricted, internal medical-restricted, and combined-restricted groups). The risk of adverse events was examined. Results The group in which exercise was prohibited comprised 72 participants, and that in which exercise was permitted comprised 1935, 612, 456, and 496 participants in the non-restricted, orthopedic-restricted, internal medical-restricted, and combined-restricted groups, respectively. Logistic regression analysis was performed on the four subgroups of the exercise-permitted group, and the odds ratios for adverse events adjusted for individual attributes were 1.04 [95% confidence interval (CI), 0.59–1.84; p = 0.89], 0.97 (95% CI, 0.53–1.78; p = 0.93), and 0.80 (95% CI, 0.42–1.54; p = 0.51) for the orthopedic-restricted, internal medical-restricted, and combined-restricted groups, respectively. A power analysis revealed that the study had a high level of power (0.99), based on a Cox–Snell R² of 0.05 and a sample size of 3,499, indicating sufficient sensitivity to detect differences between groups. Conclusion No significant difference in the odds of adverse events was found regardless of the presence or absence of exercise restrictions. Therefore, despite exercise-related risks, pre-exercise screening can help ensure that exercise is performed as safely as it is by individuals without such risks. However, further discussion is required regarding the necessity of screening for all exercise participants.