Intervention for the Prevention of Lifestyle-Related Diseases in Healthy Japanese Residents

*Masayo Nagai*

## **Abstract**

Lifestyle-related diseases can reduce their risk by improving their lives. Therefore, various efforts are being made, such as health education, to prevent lifestyle-related diseases. However, lifestyles are complicated and their prevention is not easy. Local residents who are active in health promotion are often working to improve their lifestyles. It is possible for residents to have excessive expectations for disease prevention simply by changing their lifestyles, paying attention only to the limited aspects of their lifestyles. However, if you pay attention to only one point and lack consideration for the whole, you cannot always expect the effect of lifestyle-related improvement. Therefore, it is necessary to understand how the subject perceives his/her lifestyle. This is also important for continued intervention. In addition, it is necessary to examine how health consciousness is related to the parameters of lifestyle-related diseases in such a health-conscious group. In this chapter, we would like to discuss the previously reported reports on the awareness of local residents regarding the prevention of lifestyle-related diseases, the need for health counseling, and issues in future efforts.

**Keywords:** lifestyle, lifestyle-related diseases, prevention, awareness of prevention, local residents

#### **1. Introduction**

The risk of lifestyle-related diseases can be reduced if a favorable lifestyle is followed, and various activities, such as education to promote health, have been performed to prevent such diseases [1–4]. Regional needs for health consultation have elevated with increases in the incidences of lifestyle-related diseases [5]. In community infirmaries located at places different from medical institutions, counseling involving prevention or information on medical practice, nursing, and health are provided, considering the region and family [6]. Regional health consultation may play many roles, such as health maintenance/promotion, disease prevention, and the early detection of abnormalities.

However, lifestyle is associated with a variety of individuals' daily lives, and it is not easy to prevent lifestyle-related diseases. A study investigated the association of lifestyle, including diet, with the degree of arteriosclerosis, visceral fat level, and bone mineral density (BMD) as an attempt to prevent lifestyle-related diseases in regional residents, and indicated that, in addition to the frequency of consuming various foods, the meal style was more strongly associated with lifestyle-related diseases [1], suggesting the necessity of guidance regarding personal lifestyle-matched diet. A survey regarding the relationship between exercise and parameters of lifestyle-related diseases [7] involved residents with positive attitudes toward health promotion, but exercise was not always positively correlated with parameters of lifestyle-related diseases. These studies suggest that complex factors are involved in lifestyle-related diseases, and that exercise alone does not absolutely reduce such diseases.

Many regional residents with positive attitudes toward health promotion make efforts to review their lifestyle [5]. Residents who are aware of lifestyle-related disease prevention may excessively expect disease prevention by lifestyle modification from a limited aspect alone. However, if consideration for the whole is absent, the effects of lifestyle improvement may not always be obtained. The risk of lifestyle-related diseases successively increases, and we cannot conclude that values above the reference range reflect the risk, whereas values below it reflect the safety. Therefore, it is important for residents after measurement to review their health or lifestyle regardless of the results of the measurement [2]. It is advantageous to understand how they recognize their own lifestyle for continuous intervention. Furthermore, few studies have examined how health consciousness is associated with parameters of lifestylerelated diseases in such a population with high-level health consciousness.

In this chapter, we introduce a previous report on regional residents' recognition regarding the prevention of lifestyle-related diseases [2] and analysis of previous results, and examine the needs for health consultation and issues for future attempts.

#### **2. Lifestyle consciousness**

According to a survey regarding Japanese people's awareness of health, 73.7% of the subjects selected "very healthy" or "slightly healthy" with respect to their health status [8]. Furthermore, persons undergoing a health checkup in the general areas of Japan are health-conscious, and many persons are positively doing health behaviors [9]. A study indicated that the levels of health consciousness and attitudes in persons who have not undergone a health checkup were lower than in those undergoing it and that the rate of persons who do not perform health habits was higher [10]. However, knowledge about a healthy lifestyle alone does not lead to an improvement in lifestyle [11]. If recognition regarding lifestyle is confirmed on measurement of parameters of lifestyle-related diseases, this may lead to an improvement in awareness of lifestyle, including diet and physical activities [1]. A previous study [2] examined how regional residents understand their health or lifestyle and whether these factors are associated with the speed of sound (SOS), arterial stiffness (acceleration plethysmography: APG), and visceral fat area (VFA) as parameters of lifestyle-related diseases.

With respect to the results of SOS, APG, and VFA measurement, multiple regression analysis with a questionnaire regarding lifestyle showed that there was no factor associated with these parameters. However, this previous study indicated that some recognitions regarding health or lifestyle were associated with age. In particular, in persons of more advanced age, the rate of those who are satisfied with their health management was higher (**Table 1**). It is known that there are differences in health behaviors among ages. According to a report from the Ministry of Health, Labour and Welfare [8], in persons aged ≥65 years, the number of matters for which they work


*P-value less than 0.05 were considered statistically significant and shown in the symbol followed (\* ). The statistical significance of the questionnaire responses was evaluated by multiple regression analysis. Dependent variable was age. Independent variables were index regarding the subjects' awareness of health and lifestyle. Reproduced from reference Nagai [2].*

#### **Table 1.**

*Independent factors contributing to age.*

actively or to which they pay attention for health promotion and lifestyle-related factors which they are aware of was larger than in other younger age groups. Furthermore, another survey involving Japanese with respect to age showed that the rate of persons practicing all items of lifestyle, and being aware of a healthy lifestyle, in those aged ≥45 years was higher than in those aged <45 years [12]. Another study indicated that the rate of awareness of the importance of physical activities and diet was high in ≥65-year-old persons participating in an exercise class, whereas that for physicalactivity- and diet-based health promotion was low in such persons aged 45 to 64 years [13]. The rate of persons who are mindful of their health increases with age [5].

Each person's or his/her family's/friend's experience with illness related to aging increases anxiety about health. This may contribute to interests in health emerging with age. Furthermore, many participants in our previous study [2] had retired from work. Having time to spare may also be a factor for interests in health [14].

In our population in which the level of health consciousness may be high, consisting of those independently participating in a regional health checkup, it was also confirmed that there was a close association between age and degree of satisfaction with health management [2]. Furthermore, the subjects of this previous study [2]


*\* BMD (Bone Mineral Density) estimated by SOS.*

*\*\*VFA (visceral fat area) measured by BIA (bioelectrical impedance).*

*BMI: body mass index, APG: arterial stiffness measured using acceleration plethysmography, SOS: sound of speed, VFA: visceral fat area.*

*Reproduced from reference Nagai [2].*

#### **Table 2.**

*Mean and range of each parameter in healthy subjects.*

were 180 healthy adults (28 males and 152 females); the rate of females was higher (**Table 2**). When analyzing the females alone, the degree of satisfaction with health management also significantly increased with age. Previous studies indicated that the level of health consciousness in females was higher than in males [15, 16]. In particular, Japanese females more frequently play roles, such as domestic affairs, childcare, and nursing, at home compared with males. Therefore, there may be more opportunities to think about lifestyle or health.

On the other hand, it was shown that it was more difficult to obtain social support at a more advanced age [2]. The results suggest that the number of surrounding people who can hear about anxiety has decreased despite aging-related increases in health consciousness and interest in diseases; the role of a health checkup as a social resource may be important. Many males answered that they consulted the attending physician about diseases, whereas ≥40% of females did not have any attending physician. This may be because, in females, the rate of those belonging to companies is lower than in males. A previous study [9] also indicated that ≥50% of females who have not undergone a health checkup were unemployed. Furthermore, it was reported that the quality of life (QOL) was better for those receiving more human support [17], and a strong relationship among residents improved the health checkup rate [9]. Social capitals are associated with lifestyle or health behaviors.

Concerning the understanding of lifestyle-related diseases, most persons recognized arteriosclerosis and osteoporosis as diseases, whereas the rate of those recognizing obesity as a disease decreased with age (**Table 1**). It was shown that the rate of persons who do not recognize obesity as a disease despite awareness of health or diseases was high in elderly persons [2]. Healthy participants may not feel disease morbidity, seriousness, or threat at the present stage [5]. People can imagine the association of arteriosclerosis with cerebrovascular or heart diseases and that of osteoporosis with serious circumstances, such as a bedridden state related to fractureprone features. However, obesity is more strongly associated with males, and this may have influenced the above finding.

The previous study [2] indicated that age was associated with some health consciousness items and health behaviors. In a health-conscious population, it was necessary to provide necessary information or motivation for continuation, suggesting the necessity of future continuous intervention. In addition, how these recognitions

*Intervention for the Prevention of Lifestyle-Related Diseases in Healthy Japanese Residents DOI: http://dx.doi.org/10.5772/intechopen.106405*

change through the provision of information or individual health consultation on participation in a health checkup and which type of information provision or health consultation is necessary must be examined.

### **3. Parameters of lifestyle-related diseases in the persons who continuously participate in a health check**

For the prevention of lifestyle-related diseases, it is important to continue a healthy lifestyle. However, it was reported that lifestyle-related diseases gradually progressed in a long lifestyle history with no symptoms, not leading to behavioral changes [18, 19]. The effects of changing lifestyles, such as exercise and diet, may be obtained if it is continued for a long period. However, discontinuation results in ineffectiveness, and long-term continuation is difficult [20–22]. In addition, control is difficult, [23], raising issues. Furthermore, few studies have reported continuous support [24]. On the other hand, continuous intervention reduces the risk of lifestylerelated diseases. It was reported that long-term intervention influenced cardiovascular health parameters [25].

A previous cross-sectional study clarified that the mode of diet was more strongly associated with parameters of lifestyle-related diseases in regional residents positively participating in a health checkup [1]. In this chapter, we investigated the effects of continuous participation on changes in parameters of lifestyle-related diseases in healthy regional residents, continuously participating in a health checkup, who did not report the results again among the subjects of the previous study [1].

Two hundred and eighty-nine residents participated in health consultation in our previous study [1]. Of these, 30 (10.4%, 4 males, and 26 females) were continuous participants. During the 1.5-year study period, the mean frequency of participation in health consultation was 3.6 times, and the mean interval of participation was 3.5 months. The contents of participation consisted of measurement of the arterial stiffness, BMD, and VFA, as parameters of lifestyle-related diseases, and a questionnaire survey regarding lifestyle. The study subjects explained the results of measurement, and health consultation regarding lifestyle was possible [1].

In this chapter, we reviewed changes in the participants' lifestyles or parameters of lifestyle-related diseases. We analyzed the changes between the first and second sessions of participation and between the second and third sessions of participation. As a result, there was a significant decrease in the body mass index (BMI) between the first and second sessions of participation in health consultation (p = 0.068). There were no changes in the other parameters (BMD, VFA, and arterial stiffness). Based on the responses to a questionnaire, there was no change in lifestyle.

Participation in health consultation was optional, and the subjects of this study may be health-conscious, and living a healthy life. In the study subjects, a decrease in BMI after participation in health consultation was confirmed; health consultation may be an opportunity for further motivation. BMI decreases with weight loss, and this may have contributed to the confirmation of its decrease during a period of 1.5 years. However, arteriosclerosis progresses with age even in healthy adults [26]; therefore, it may have been difficult to examine changes during the previous study period.

In future, a long-term continuous survey may clarify changes in parameters of lifestyle-related diseases, which may not change in a short period, and daily lifestyle. Furthermore, it was reported that the health checkup and screening rates were low in persons who participated in health consultation for the first time and those who

participated to measure health indices [27]. It is necessary to comprehensively support personal health or life in addition to measurement.

#### **4. Needs for measurement of parameters of lifestyle-related diseases**

Previously, we reported that health-conscious persons positively participated in health checkups [1, 2]. Furthermore, strongly motivated persons may achieve an improvement in lifestyle more readily [28]. It is important to recognize the results of measurement by participating in a health checkup, and this may lead to interest in health management, motivating individuals to improve their lifestyle. In the participants in health checkups in the previous studies [1, 2], a questionnaire survey regarding needs for measurement was conducted, but the results are not presented. In this chapter, we report the data through further validation.

Most subjects who participated in the previous studies positively accepted the measurement of parameters of lifestyle-related diseases (**Figure 1**). In addition, there was a description that measurement or its results might be utilized for future health management or lifestyle improvement. Of the subjects, ≥90% wished to measure these parameters in the future. As the most frequent reason, they wished for health management (**Table 3**). A study regarding health-checkup-undergoing behaviors [9] also indicated that the primary purpose of undergoing a health checkup was "health management."

Furthermore, our data showed that there was no significant association between the motivation for measurement and parameters of lifestyle-related diseases. It was also confirmed that the rate of persons wishing measurement differed among relevant diseases. Concerning measurement of the degree of arteriosclerosis, many persons wished to measure it; they may imagine the risk of cerebrovascular/cardiovascular diseases. Furthermore, the number of those wishing for BMD measurement was large. This was possible because many female participants considered the risk of fracture.

The visualization of lifestyle parameters through these measurements allows participating residents to maintain the goal of preventive attempts or motivation. Furthermore, several residents answered that they wished for measurement due to anxiety; measurement may play a role in relieving anxiety about health. A previous study [29] also reported that the rate of persons who are anxious about the results of measurement was higher in those recognizing a lower BMD and that the rate of those making efforts to increase the BMD was higher. It was indicated that recognition of the results of BMD measurement led to the opportunity of being interested in health management or efforts to improve lifestyle, resulting in the prevention of osteoporosis. Lifestyle, including diet and physical activities, may be improved through BMD measurement [30]. Furthermore, it was reported that habitual tooth brushing contributed to attention to health or consciousness, inhibiting an increase in the BMI or abdominal circumference [31]. Participation in a health checkup and measurement of physical data may be useful for providing motivation for primary prevention under interests in health or improving the QOL.

In addition, a study indicated that, after subjects received health guidance regarding the prevention of lifestyle-related diseases, approximately 30% of their family members felt favorable changes regarding health [32]. Furthermore, there was a significant difference in the age in the group with family changes, and elderly persons may have had time to spare. Among the subjects who participated in our survey, the rate of elderly subjects was high, and similar effects may be obtained.

*Intervention for the Prevention of Lifestyle-Related Diseases in Healthy Japanese Residents DOI: http://dx.doi.org/10.5772/intechopen.106405*

#### **Figure 1.**

*A. Reason for measuring calcaneal ultrasonic propagation velocity. The reason for participating in the calcaneal ultrasonic propagation velocity measurement was shown (N = 206). B. Reaction by receiving bone density measurement. Impressions after participating in bone density measurement were shown (N = 205). C. Needs for bone density measurement. Results of asking for participation in regular bone mineral density measurements are shown (N = 205).*


#### **Table 3.**

*Reasons for requesting to measure.*

In this chapter, we again confirmed regional residents' needs for the measurement of lifestyle-related disease-associated parameters in health consultation. An opportunity to review lifestyle, including diet and physical activities, may be provided through these measurements, leading to lifestyle improvement. Such measurements are useful as a motivation for health promotion. Regular measurements may contribute to the maintenance of subjects' and their families' motivations to make efforts for health promotion.

#### **5. Needs of behavioral changes to prevent lifestyle-related diseases**

To promote behavioral changes, a clear motivation, high feasibility, and the absence of resistance are necessary. Stress in daily living hinders behavioral practice [24]. Thus, mental factors may be closely related to the improvement of lifestylerelated behaviors. Among these factors, it is useful to improve confidence in selfmanagement behaviors and self-efficacy as a recognition of self-potential [33]. When lifestyle correction is difficult in high-risk patients for atherosclerotic cardiovascular diseases (ASCVDs), such as dyslipidemia and hypertension, the difficulty is related to a reduction in self-efficacy or its disappearance in many cases [34]. To improve self-efficacy, support by health care professionals and subjective life management are important [24, 33]. However, there is no fact that the values of lifestyle parameters are better in persons who are more strongly aware of a healthy lifestyle [2]. When improvement effects are not obtained, there may be a reduction in self-efficacy for the following reasons: the lifestyle improvement-related amelioration of test results leads to a sense of accomplishment, improving self-efficacy [35]; and test result-based confirmation alone is possible during the symptom-free period [19].

On the other hand, many regional residents who positively attempt to promote health have positively reviewed exercise and diet [15]. It is speculated that

#### *Intervention for the Prevention of Lifestyle-Related Diseases in Healthy Japanese Residents DOI: http://dx.doi.org/10.5772/intechopen.106405*

participants in health checkups or classes may essentially maintain a healthy lifestyle [1, 5, 10, 36]. According to a study, there was no change in the parameter of arteriosclerosis despite a change in lifestyle in some patients in whom the parameter was within the normal range before intervention [37]. Furthermore, a study [38] examined the influence of health education regarding the prevention of arteriosclerosis on health behaviors and indicated that there might have been no behavioral change due to the essentially high health behavior level of the subjects. In subjects who positively attempt to promote health, there may be no lifestyle-change-related improvement in the test results. Concerning the BMD and degree of vascular aging, even the maintenance of the status quo is sometimes evaluated as effective, considering aging [1].

Furthermore, the number of male participants was small during these health checkups. Another previous study also indicated that the number of male participants was small. Support for subjects who do not participate in the field of health promotion is emphasized as an issue [5]. In males, the presence of a spouse is a factor that promotes participation in a health checkup. In those without a spouse living together, encouragement by their families, close friends, or neighbors, who replace a spouse, is effective [9]. Among the participants in health checkups, there were many males participating at their spouses' invitation. Approaches to share health promotion with family members are also necessary.

According to the Comprehensive Survey of Living Conditions [39], the most frequent reasons why a health checkup or screening was skipped were "no time" and "expenditure." In the participant questionnaire we conducted, "free" was one of the reasons for wanting to receive the measurement. Participants answered that they did not want to measure in the future because they did not have time (**Table 3** and **Figure 2**). Furthermore, the absence of symptoms leads to a low lifestyle-related disease-associated health checkup rate in some cases [9, 40]. On regional health checkups, the free measurement may be available in a short time; this may be useful for maintaining health management behaviors. Concerning the absence of symptoms, visualization with parameters of lifestylerelated diseases may contribute to health management.

Persons utilizing regional health consultation answered that "counter consultation by medical specialists" was necessary to resolve anxiety or doubts about health [5]. A survey involving subjects who have not utilized regional health consultation [41] showed that even non-users highly recognized the necessity of health consultation. The contents of the needs included feeling free to consult a nurse as a specialist in the home city, free consultation, and attempts for individuality-emphasized continuous support. For lifestyle management, it is important to recognize individual problems and hear about various living conditions as the role of nursing [42].

The subjects who cooperated in our study had independently participated in health consultation; they may have comprised a health-conscious population. The participants may also require support from medical specialists. It is necessary to continue support for subjective attempts under specialists' assistance. Furthermore, the effects of group guidance may not appear if there is no merit in changing lifestyle. It is difficult to change lifestyle [43]. The presence of a place for individual consultation based on active participation may be important to change behaviors or maintain health behaviors.

However, lifestyle is an extremely private matter, and interference by other persons leads to uncomfortableness [44]. Excessive intervention may result in stress loading for healthy adults, inducing an unhealthy state through obesity, or an increase in the alcohol volume [45]. We can imagine that compulsive lifestyle intervention by other persons markedly reduces the mental QOL. For exercise support to improve the

#### **Figure 2.**

*A. Reason for measuringarteriosclerosis. The reason for participating in the arteriosclerosis measurement was shown (N = 150). B. Reaction by arteriosclerosis measurement. Impressions after participating in arteriosclerosis measurement were shown (N = 145). C. Needs for arteriosclerosis measurement. Results of asking for participation in regular arteriosclerosis measurements are shown (N = 144).*

*Intervention for the Prevention of Lifestyle-Related Diseases in Healthy Japanese Residents DOI: http://dx.doi.org/10.5772/intechopen.106405*

QOL, the intensity of exercise and subjectivity should be valued [37]. The purpose of health checkups is to improve participants' QOL through the prevention of lifestylerelated diseases. For support to improve lifestyle, it may also be important to value individuals' subjectivity based on scientific evidence.

### **6. Conclusions**

Even subjects with a healthy life have needs for attempts to prevent lifestylerelated diseases under specialists' support. In particular, aging increases health consciousness or interest in diseases, but there are few familiar persons to consult in some cases. Also, obesity should be recognized as a disease. Regional health consultation and measurement of parameters of lifestyle-related diseases by nurses are important for living toward prevention and continuous support. Lifestyle-related parameter measurements also have the purpose of maintaining an ongoing motivation for health care. For participants, this is an opportunity to review their lifestyle, being useful for individuals' health promotion. In addition, an approach to enhance self-efficacy is important for improving lifestyle to prevent lifestyle-related diseases.

#### **Acknowledgements**

The study was supported by volunteer participants and nurses. Also, the study was supported by Grant-in-Aid for Scientific Research from JSPS KAKENHI Grant Number JP20K23147 and JP22K17448.

#### **Conflict of interest**

The authors have declared that no competing interests exist.

#### **Author details**

Masayo Nagai Department of Nursing, Faculty of Health Science, Aino University, Japan

\*Address all correspondence to: m-nagai@ns-u.aino.ac.jp

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