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Background <p>Mobility decline is a gradual process that begins earlier than recognized. Locomotive syndrome (LS) captures early mobility impairment using performance tests and a self-reported questionnaire. Although physical activity is important for maintaining mobility, whether simple self-reported exercise habits and daily activity relate to long-term age-specific risk of incident LS has not been fully investigated. This study examined age-specific associations of exercise habits and daily activity with the eight-year cumulative incidence of LS.</p> Methods <p>This cohort study included 21,339 Japanese adults aged 21–84 (median, 48) years without LS at baseline who participated in annual health checkups between 2016 and 2024. Baseline exercise habits and daily activity were assessed by self-report using dichotomous questionnaire items, and participants were classified into four groups according to the combination of these responses: inactive (Ex−/Da−), daily activity only (Ex−/Da+), exercise only (Ex+/Da−), and both exercise and daily activity (Ex+/Da+). Analyses were stratified by age (≤ 39, 40–64, ≥ 65 years). Incident LS was defined based on the two-step test, stand-up test, and 25-item Geriatric Locomotive Function Scale. Cumulative incidence was estimated using Kaplan–Meier methods, and associations were assessed with multivariable Cox proportional hazards models adjusted for lifestyle-related factors.</p> Results <p>Over eight years, 7183 participants developed incident LS. Among adults aged 40–64 years, cumulative LS incidence at 8 years showed a statistically significant decline from 0.45 in the Ex−/Da− group to 0.37 in the Ex+/Da+ group (log-rank <i>P</i> &lt; 0.001), which showed the lowest adjusted risk (hazard ratio, 0.79, 95% CI, 0.72–0.85). A similar statistically significant association was observed in adults aged ≥ 65 years (log-rank <i>P</i> &lt; 0.001), with the lowest adjusted risk in the Ex+/Da+ group (hazard ratio, 0.70, 95% CI, 0.56–0.86). The incidence was higher when LS was defined by the 25-item Geriatric Locomotive Function Scale, suggesting that subjective functional decline precedes performance-based impairment.</p> Conclusion <p>Mobility decline, warranting preventive attention, begins in midlife, not only in older age. Both daily physical activity and exercise were associated with lower long-term risk, and their combination provides the greatest benefit. Subjective functional assessment may represent a useful early intervention target.</p>

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Exercise, daily physical activity, and age-specific cumulative incidence of mobility decline: an 8-year cohort study of locomotive syndrome

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  • 发表日期：

    2026年6月29日

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  • Satoshi Yamaguchi,
  • Keiko Yamada,
  • Masaru Moriyama,
  • Tomoyuki Arai,
  • Yasuhiro Morita,
  • Hideaki Ishibashi,
  • Tadashi Ohe,
  • Seiji Ohtori,
  • Ryo Nakagawa

摘要

Background

Mobility decline is a gradual process that begins earlier than recognized. Locomotive syndrome (LS) captures early mobility impairment using performance tests and a self-reported questionnaire. Although physical activity is important for maintaining mobility, whether simple self-reported exercise habits and daily activity relate to long-term age-specific risk of incident LS has not been fully investigated. This study examined age-specific associations of exercise habits and daily activity with the eight-year cumulative incidence of LS.

Methods

This cohort study included 21,339 Japanese adults aged 21–84 (median, 48) years without LS at baseline who participated in annual health checkups between 2016 and 2024. Baseline exercise habits and daily activity were assessed by self-report using dichotomous questionnaire items, and participants were classified into four groups according to the combination of these responses: inactive (Ex−/Da−), daily activity only (Ex−/Da+), exercise only (Ex+/Da−), and both exercise and daily activity (Ex+/Da+). Analyses were stratified by age (≤ 39, 40–64, ≥ 65 years). Incident LS was defined based on the two-step test, stand-up test, and 25-item Geriatric Locomotive Function Scale. Cumulative incidence was estimated using Kaplan–Meier methods, and associations were assessed with multivariable Cox proportional hazards models adjusted for lifestyle-related factors.

Results

Over eight years, 7183 participants developed incident LS. Among adults aged 40–64 years, cumulative LS incidence at 8 years showed a statistically significant decline from 0.45 in the Ex−/Da− group to 0.37 in the Ex+/Da+ group (log-rank P < 0.001), which showed the lowest adjusted risk (hazard ratio, 0.79, 95% CI, 0.72–0.85). A similar statistically significant association was observed in adults aged ≥ 65 years (log-rank P < 0.001), with the lowest adjusted risk in the Ex+/Da+ group (hazard ratio, 0.70, 95% CI, 0.56–0.86). The incidence was higher when LS was defined by the 25-item Geriatric Locomotive Function Scale, suggesting that subjective functional decline precedes performance-based impairment.

Conclusion

Mobility decline, warranting preventive attention, begins in midlife, not only in older age. Both daily physical activity and exercise were associated with lower long-term risk, and their combination provides the greatest benefit. Subjective functional assessment may represent a useful early intervention target.