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    • The crude odds ratio OR of

    2018-10-26

    The crude odds ratio (OR) of participation in the NSE class once a month at baseline against poor SRH two years later was 0.53 (95% CI: 0.34–0.85). The OR after adjusting for age and sex was 0.49 (95% CI: 0.30–0.78). Even after NSE class participation once a month at baseline against poor SRH two years later was adjusted for age, sex, years of education, regular exercise, living alone, and baseline SRH, the OR of NSE class participation was 0.46 (95% CI: 0.27–0.77). Furthermore, even after the data were adjusted for other physical activities (park golf, walking, and jogging), the OR was maintained (OR=0.50, 95% CI: 0.29–0.85; Table 2).
    4. Discussion The results obtained from our study supported previous study results; there was an association between physical activity and SRH (Malmberg et al., 2005; Cimarras-Otal et al., 2014; Han, Kim, Park, Kang, & Ryu, 2009; Wang et al., 2005). According to Malmberg et al. (2005), in a 10-year follow-up of a cohort aged 19–63 years, the risk of average or poor perceived health was significantly lower in a group who had at least some monthly sport activity compared to those with no sport activity. The results of the longitudinal association with NSE and poor SRH in our study were similar to this ion channel report. The results of our study also suggested a new method for exercise that was inversely associated with poor SRH in older people. As physical activity was associated with poor SRH (Han et al., 2009) in a cross-sectional study among older local residents aged 65 years or older, the group in which vigorous or moderate physical activity was performed three days to five days or more a week, showed fewer cases of poor SRH. In contrast, in our study, poor SRH was significantly less with NSE class participation at least once a month or more. The differences between these studies seemed to be associated with NSE characteristics. The NSE features characteristics of a dual task exercise with additional cognitive tasks (e.g., learning the steps, paying attention to the net while stepping over it) and walking at a slow pace, unlike aerobic exercise. In the previous study, low-frequency intervention of NSE (once a week) improved cognitive and gait functions in people 73 years or older (Kitazawa et al., 2015). Moreover, NSE requires mutually interactive group participation. The previous cross-sectional study showed the association between NSE participation and low rates of depressive symptoms (Showa, Kitazawa, Takeuchi, & Mori, 2015). Thus, NSE participation might result in favorable mental health effects. In addition, our study supported the reports of previous studies of significant associations between SRH and social participation by volunteers (Fujiwara et al., 2009; Hong & Morrow-Howell, 2010; Kanamori et al., 2014; Nieminen et al., 2010). We focused on the influence of health promotion activities initiated voluntarily by residents in a depopulated area without support or intervention from such authorities. Thus, it is thought that the present study’s result showed a concrete method of health promotion which residents could start and continue, which might be useful for older people’s health. To our knowledge, there are few reports identifying longitudinal effects of health promotion activities provided continuously by volunteer residents within a depopulated town. There are several limitations in this study. First, the one-time assessment of NSE class participation excluded the opportunity to account for later changes in NSE class participation. Second, data on some potential important confounders (income, social network, and social support) were unavailable in this study. According to previous studies, individuals who tend to participate in organizations or group activities have been previously good at social networking and social support and these skills are associated with SRH (Zunzunegui et al., 2004) and mental health (Koizumi et al., 2005). In addition, socio-economic status was potentially antecedent to the relationship between involvement and self-rated health (Veenstra et al., 2005). Therefore, these issues must be considered in future research. Third, because of the short follow-up period of two years, the possibility of causal reversal has not been completely eliminated, although baseline SRH was adjusted as confounding. Finally, since the population parameter was defined as the participants of the 2011 preliminary survey, there were people who did not reply, died, or changed residence before the baseline survey was conducted in 2012; thus, the cohort was limited to 56% of the population. Therefore, its level of representation was reduced and the results might be subject to selection bias. In addition, there might be limitations to how far these results can be generalized, as the entire sample of this study consisted of local residents in a single rural area.