OBJECTIVES:The World Health Organization's (WHO) Global Network of Age-Friendly Cities and Communities (AFCCs) promotes the development of urban environments, policies and services that support the health and participation of older adults. This systematic review examined contemporary evidence concerning associations between WHO AFCC conditions and directly measured health and physical activity outcomes among older residents. METHODS:The registered review adhered to the PRISMA protocol for systematic reviews and meta-analyses and applied the Downs and Black quality criteria for randomised and non-randomised research. RESULTS:Structured Boolean searches of five research repositories identified 17 peer-reviewed studies published between 2017 and 2025 based upon original research conducted in WHO AFCC signatory cities. Although most studies reported positive associations between age-friendly features and domains, such as accessible transport, walkable environments, outdoor infrastructure and self-rated health or physical activity, the strength of evidence was limited by methodological inconsistency, variable study quality and reliance on self-reports. Barriers to evaluation included limited use of longitudinal or quasi-experimental designs, heterogeneous outcome measures, subjective response data and the challenge of establishing appropriate comparison conditions in complex municipal settings. CONCLUSIONS:Strengthening evaluation frameworks for AFCC initiatives is essential for evidence-based urban health policy and governance in rapidly ageing societies. A research agenda is proposed to strengthen AFCC evaluation through standardised measurement, community-based and mixed-methods research, and a greater commitment to co-designed assessment frameworks.

Cities across Aotearoa New Zealand are undergoing rapid demographic transitions towards super-aged communities. Such changes necessitate innovations to support healthy ageing that incorporate social and environmental developments in addition to health service improvements. The World Health Organization (WHO) Age-Friendly Cities (AFC) framework and global network provide guidance and pathways to enhance livability and well-being for ageing societies. New Zealand's engagement with the WHO AFC network has been both recent and inconsistent, with only seven municipalities formally participating since 2018, and limited uptake among larger population centres. Drawing on published action plans and evaluation reports at city and district level, demographic trend data at national and sub-national scale, and government and WHO policy and procedural documents, this paper critically examines the progress and challenges associated with AFC initiatives in New Zealand since 2018. While there is evidence of gradual increases in AFC commitment at both national and local level in New Zealand, including growth of a local proxy network, significant gaps and limitations remain with engagement and implementation. Five key challenges are identified, including the lack of operationalisation and measurement of indicators of AFC development and success, overreliance on implementation partners, a lack of sustainable funding commitments, limited support for community advocates and volunteers, and challenges engaging cities and districts in the context of competing urban design frameworks. Actionable recommendations are proposed to strengthen AFC development, including improved integration of AFC principles in urban planning, formalised key performance indicators, and enhanced support for community champions.

This research note addresses the novel measurement and environmental outcomes of processes of urban change near two marquee Olympic host venues as a follow-up to pre-hosting baseline evaluations. This research is critical for improving understanding about how to assess and conceptualise urban remediation processes, driven by sports event hosting, that potentially alter residential behaviour settings and contribute to fulfilling mandated Olympic legacy objectives. Two venues were selected for the longitudinal analysis, the Olympic Stadium and Athlete Village, as marquee case examples of multi-use public access spaces close to residential areas. The mixed-methods approach included geospatial mapping, systematic walking audits, and collection of photographs and field notes during the pedestrian journey from the closest transit point to, and around, host venues. Results showed positive changes to features and amenities and reductions in incivilities over the hosting cycle. Changes to footpath conditions (widening, separation of users, and accommodation of visual impairment) and open space areas (landscaping, expanded uses, and supporting amenities) constituted prominent improvements. The remaining challenges included a lack of protection from adverse climatic conditions and prescriptive rules for the use of play and recreational areas. Mixed-methods techniques for public space auditing support elucidation of nuance in urban sport event legacies and reveal the street-level experience of moving through changing spaces. Some uncertainty remains about the long-term sustainability of these spaces regarding prescriptive public use and threats from climate change.

OBJECTIVE:Population ageing and urbanisation are global trends that highlight the importance of cities as a nexus for policy and planning to support healthy ageing. This study assessed whether membership in the World Health Organization's Age-Friendly Cities and Communities (AFCC) Network is associated with improved health behaviours and outcomes among older adults in urban Japan. METHODS:Three geographically diverse Japanese AFCCs (Akita, Takarazuka and Fujisawa) and one non-AFCC (Musashino) were selected. Quota samples of 175 middle-aged and older adults were obtained in each city (n = 700). Validated Japanese-language instruments measured physical activity (IPAQ-SF), environmental perceptions (IPAQ-ENV), health-related quality of life (WHOQOL-BREF) and expectations regarding ageing (ERA-12). RESULTS:Over 60% of AFCC residents met physical activity guidelines, with walking as the dominant mode. However, AFCCs performed no better than the non-AFCC in terms of physical activity, health status or future health expectations. Akita, Japan's longest-standing AFCC member, recorded significantly lower scores across all health and activity indicators. Environmental features, including walkability and access to services, were not significantly associated with sufficient weekly physical activity. Only physical health status was a significant predictor of adequate activity. CONCLUSIONS:Membership of an AFCC Network was not associated with better physical activity or health outcomes in urban Japan. Findings raise concerns about the implementation and impact of the AFCC framework, highlighting the need for more robust evaluation, greater national coordination and participatory planning. Policy reform may be necessary to ensure that symbolic commitments to age-friendly planning are translated into tangible health benefits for older urban populations.

INTRODUCTION:COVID-19 caused major disruptions across the super-aged nation of Japan, yet few studies explored temporal changes among middle-aged and older cohorts from baseline to the height of community transmission. Changes in physical activity and sedentary behavior during global pandemics may alter patterns of morbidity and mortality among susceptible aging populations. OBJECTIVES:This study investigated patterns of physical activity, sitting behavior, and health among representative samples of middle-aged and older adults in Tokyo before and during the pandemic. METHODS:Repeated online surveys were conducted with quota samples of 800 Tokyo residents in 2019 and 2021 using validated Japanese-language measures, including the short form-International Physical Activity Questionnaire and the Basic Ecological Health Scale-6. Statistical analyses included comparative evaluations of activity parameters by age cohort, gender, and selected covariates. Statistical tests included the Kruskal-Wallis test, Mann-Whitney U test, chi-square test for Independence and Hierarchical Regression. RESULTS:Over 34% of respondents were inactive at each data collection point, and 72% reported negative impacts of COVID-19 on their physical activities. Older adults showed no significant changes in their activity and sitting behavior and reported better health compared with those in middle age across the pandemic. Middle-aged males reported a significant decline in total activity of 33% across the pandemic period (U = 16,958, z = -2.64, p = .008, r = .13). Middle-aged females reported the lowest levels of physical activity, and health, and showed a 29% increase in sitting behavior across the pandemic (U = 16,925, z = -2.68, p = .007, r = .13). Subjective health status was consistently associated with higher overall activity and walking before and during the pandemic. CONCLUSION:Differential outcomes were identified between age and gender regarding health, physical activity, walking, and sitting across the pandemic with significantly worse impacts reported among middle-aged samples. IMPLICATIONS:These results have implications for healthy transitions to later life and the design of postpandemic interventions to address activity opportunities in Japan.

Tokyo is the most aged mega-city in the world, yet it has been subjected to few micro-scale evaluations of walkability in its super-aged neighborhoods. Systematic walking audits were conducted in two aging cities within western aspect of Tokyo to assess street-level walkability from older-adult housing to local destinations. A multi-method approach included administration of the Microscale Analysis of Pedestrian Streetscapes (MAPS-mini) tool augmented with GIS analyses and photography across 10 super-aged neighborhoods (40 walking routes and 102 street segments) in the cities of Musashino and Mitaka. Musashino city had measurably better conditions for walking than the adjacent municipality of Mitaka with evidence of significant intra- and inter-city environmental variations. Prevailing barriers across both cities included poor access to parks and public transit, limited seating and shelter, inconsistent pedestrian infrastructure, narrow roadways, and few traffic calming measures. Signs of neighborhood disorder were conspicuously absent suggesting that sociocultural influences may enhance walkability in the context of sparse infrastructural support. These findings have implications for age-friendly remediation of pedestrian conditions in aging mega cities.

The design of urban environments often influences neighborhood physical activity and is crucial to supporting the health and mobility of aging urban populations. However, changes to urban infrastructure take time to implement and are rarely evaluated over long periods. In this study, we examined the long-term outcomes of rapid urban change and rebuilding following a sequence of devastating earthquakes in Christchurch, New Zealand. The study drew on a novel mixed-methods approach, including on-site environmental audits, desktop spatial analyses, and subjective auditor observations, to track support for active aging over a decade of post-disaster rebuilding in 10 aging neighborhoods.

This study explored expectations regarding aging among a diverse cohort of undergraduates in Japan. A concurrent mixed methods design was employed with online administration of the Expectations Regarding Aging scale (ERA-12), and open-format and demographic questions among 133 culturally diverse undergraduates in Tokyo. Independent samples t-tests, one-way analysis of variance (ANOVA), descriptive sta­tistics, and thematic analysis were used to explore the data. ERA-12 scores and physical and cognitive function subscale results revealed negative perceptions about the aging process, while scores on the mental health subscale were significantly higher and positive. No significant differences emerged based on gender or cultural background. Qualitative data anal­ysis revealed student awareness of lifestyle influences on health in later life, concerns about current health and risk factors, and potential to tran­scend negative physical changes by finding meaning in other aspects of life. Understanding expectations regarding aging among younger cohorts may inform gerontological education and public health promotion to sup­port a life course approach to healthy aging.

Participation in compulsory physical education (PE) is a controversial aspect of the Japanese university system.English-language education programs in Japanese universities often incorporate aspects of the traditional curricula, including experiential PE.The purpose of the study was to explore the extent to which compulsory PE in a Tokyo-based global university program contributes to overall physical activity (PA) and to elucidate how experiential PE intersects with student beliefs and motivations.The study sample included 199 domestic and international students attending PE courses in a Top Global University in Tokyo, Japan.All students who undertook compulsory PE classes in English were invited to complete an online survey in 2018-19.Survey measures included scores on a valid and reliable iteration of the Global Physical Activity Questionnaire (GPAQ), self-reports of PA influences, and PA-related health beliefs.Overall PA was high among the cohort, yet there were significant differences based on gender and country of origin, with male and international students reporting higher activity.Most students perceived a positive relationship between PA participation and disease prevention, which reinforced common health motives for activity, particularly weight control and stress reduction.Compulsory and experiential PE within a Japanese global university program potentially contributes to higher PA levels among ethnically diverse undergraduates but should adapt to a more wellness focused curriculum to address behavioral and motivational variations.

This editorial sets the scene for our Special Issue on the growing problem of sedentary behavior and physical inactivity in the Asia-Pacific region. In many societies, more than 40% of the adult population and growing numbers of children are insufficiently physically active to safeguard their health. This is contributing to high rates of cardiovascular disease, obesity, and other deleterious health outcomes across the region. The Asia-Pacific is heterogeneous and complex, with diverse social, cultural, and environmental barriers that affect intentions and opportunities for regular physical activity. Recently, the problem has been compounded by the acceleration of population aging, the worsening effects of anthropogenic climate change, and the ongoing COVID-19 pandemic. Without strong leadership, enduring funding support, and innovative interventions that cut across policy and society, we may yet be facing a century of unmitigated expansion of morbidity across the Asia-Pacific.

Hosting the Olympic Games provides opportunities for municipalities to re-imagine urban spaces to promote active leisure. Our research systematically assessed the pre-Olympic conditions for leisure time physical activity (LTPA) in the vicinity of multi-use venues for the Tokyo Games. Researchers conducted walking audits in the surrounds of three venues within two years of the opening ceremony, including the Olympic Stadium, Athlete Village and Musashino Sports Plaza. Audits employed the validated Physical Activity Resource Assessment (PARA) instrument, photographic protocols and GPS mapping. Audit scores for urban features, amenities and incivilities were averaged across researchers, and summative scores provided. Photographs and field notes augmented the evaluation. Six environmental challenges for LTPA legacies were identified, including limited resource accessibility, lack of amenities, health nuisance, vegetation overgrowth, heat effects and disaster risk. These findings indicate that there are important ecological considerations that should be addressed to leverage Olympic hosting in support of LTPA objectives.

Background and objectives: Health-related expectations regarding aging is a gerontological construct that is potentially predictive of morbidity and mortality in later life. The Expectations Regarding Ageing scale (ERA-12) is a widely used measure of health-related expectations, although it has not previously been administered in Japanese. The present research aimed to elucidate the psychometric properties of the first Japanese translation of the ERA-12 and evaluate health-related expectations among middle-aged and older Japanese. Research design and methods: Repeated online surveys were conducted with representative quota samples of middle-aged and older adults in Tokyo during 2021 (N = 1600). Primary outcome measures included total and subscale scores on a Japanese translation of the ERA-12 (ERA-12-J) addressing perceptions of physical, mental, and cognitive health. Standard measures were also used to gather information regarding respondent demographic details, general health, and health-related behavior. Results: The ERA-12-J and associated subscales showed acceptable test-retest reliability (t(1598) = 0.60, p = 0.63), internal consistency (α > 0.80), inter-item correlation (r = 0.21–0.78) and item-total correlation (r = 0.53–0.73). Confirmatory Factor Analysis verified the hypothesized three-factor structure and construct validity on four common indices of fit (GFI = 0.968; CFI = 0.978; AGFI = 0.950; RMSEA = 0.059). ERA-12-J scores among Japanese respondents revealed prevailing negative sentiments concerning physical and cognitive health, with less negative sentiment regarding mental health. Significant and independent differences emerged concerning gender and age cohort, with middle-aged adults and females holding more negative expectations about their future health. Discussion and implications: The ERA-12-J provides a sound basis for the elucidation of health-related expectations about aging in Japan and a useful tool for international comparative studies. Education and workplace intervention may be required in Japan to address age and gender disparities in health-related expectations.

Amidst ongoing debate about the viability of physical activity (PA) legacies associated with hosting international sports mega events, this systematic review explores quantitative evidence from population studies that utilize repeated measures. This review is guided by the PRISMA protocol and includes article quality evaluation techniques from health intervention research. Structured Boolean searches were conducted across six databases and grey literature sources. In total, 12 studies were identified from the last two decades across four event typologies. Among these studies, 9 were evaluated as being of higher quality, but only 4 employed standard definitions or measures of PA. Among the higher quality studies, two-thirds found no evidence for statistically significantly PA legacies, although gaps and limitations precluded definitive assessment. Common concerns include limited evaluation of covariates, sweeping conclusions based on insufficient evidence, arbitrary conceptualization and operalization of PA, and lack of triangulation. Research recommendations for resolving the impasse are proposed.

Population aging may increase chronic disease prevalence in Japan without widespread health behavior change. Walking and sitting are common behaviors that are amenable to intervention. This study examined age-related variations in daily walking and sitting time among middle-aged and older Japanese who live in urban areas. An online survey including validated measures was administered with a representative sample of 4,000 middle-aged and older adults from five large cities. Walking time showed a significant association with age, and the oldest cohort walked 25% more per day compared to those in early middle age, F (3, 3996) = 8.04, p <.001. Sitting time showed a significant decline with age, F (3, 3996) = 3.83, p < .001, although gender differences were evident among the oldest cohorts. Early middle age (45-54 years) appears to be associated with less walking and more sitting time in Japan. This study has implications for healthy aging and successful transitions to retirement in Japan. Occupational and environmental interventions are recommended to facilitate increases in activity and reductions in sedentary behavior. Copyright (C) 2021, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

This review highlights two intersecting environmental phenomena that have significantly impacted the Tokyo Summer Olympic and Paralympic Games: infectious disease outbreaks and anthropogenic climate change. Following systematic searches of five databases and the gray literature, 15 studies were identified that addressed infectious disease and climate-related health risks associated with the Summer Games and similar sports mega-events. Over two decades, infectious disease surveillance at the Summer Games has identified low-level threats from vaccine-preventable illnesses and respiratory conditions. However, the COVID-19 pandemic and expansion of vector-borne diseases represent emerging and existential challenges for cities that host mass gathering sports competitions due to the absence of effective vaccines. Ongoing threats from heat injury among athletes and spectators have also been identified at international sports events from Asia to North America due to a confluence of rising Summer temperatures, urban heat island effects and venue crowding. Projections for the Tokyo Games and beyond suggest that heat injury risks are reaching a dangerous tipping point, which will necessitate relocation or mitigation with long-format and endurance events. Without systematic change to its format or staging location, the Summer Games have the potential to drive deleterious health outcomes for athletes, spectators and host communities.

Standing desks have the potential to improve educational and health outcomes in elementary schools, yet limited intervention studies have been undertaken using mixed methods approaches or in Asian countries. The aim of this research was to elucidate the subjective experiences and objective effects of standing desk use in a Japanese elementary school. Respondents in the intervention included a class of 22 year six students and their teacher at a public elementary school in Nagano, Japan. Standing desks were implemented in the classroom for nine months. Subjective focus group and interview data were generated on two occasions during the intervention period to facilitate data saturation. Objective accelerometry data were used to record active and sedentary behaviour before and during the intervention. Focus group and interview data highlighted positive physical and educational effects, including perceived improvements in endurance and posture, self-expression, peer interaction, and reduced state anxiety. These data also revealed concerns about age-appropriateness and practicality of implementation in a conservative education system. Accelerometry findings showed significant changes in moderate- to vigorous-intensity physical activity during both school and non-school hours. Standing desks provide a practical approach for modernizing Japanese elementary education, which may hold benefits across both health and education. Follow-up multi-site randomized controlled interventions and comparisons of teacher style and philosophy in standing desk classrooms are recommended to confirm and expand the present findings.

This research examines physical activity (PA) parameters among urban-living middle-aged and older Japanese during the Tokyo Olympic build-up period. Population sampling was employed, and an online survey was administered with 4,000 adults across Japan's five largest cities. The International Physical Activity Questionnaire-Short Form constituted the main outcome variable, with auxiliary measures of Olympic interest and engagement, readiness for PA behavior change, perceived environmental barriers, and demographic information. Despite interest in the Olympics (>60% moderate-high interest), planned engagement with the event was low (>70% planned passive engagement). Higher levels of interest and planned engagement were both significantly correlated with greater self-reported PA participation (p < .001). Across the sample, the PA levels were in the low-moderate range (990 metabolic equivalent of task-min/week), with significant variations observed by the age-cohort and geographic area (p < .001). Age-cohort and geographic variations were also identified with regard to readiness for PA behavior change and perceived environmental barriers to activity (p < .001). Older age (65 years and above) and host city (Tokyo) residence emerged as correlates of higher levels of PA, greater readiness for behavior change, and fewer reported barriers to participation. These findings have implications for Olympic legacy management and successful transitions from middle age to later life in Japan.

Health benefits of physical activity are well known, yet available physical activity data is limited from children living in African and Asian countries. The purpose of the cross-sectional study was to evaluate and compare physical activity and sedentary behavior patterns, particularly hourly variations, among children in Kenya and Japan. Participants included 298 primary school students (122 Kenyan, 176 Japanese) aged 9–12 years. Physical activity and sedentary behavior were measured with accelerometers. Domain-specific physical activity, screen time, and proportion of children using active transport to school were measured by questionnaire. A two-way ANOVA (countries × time) was used to examine the differences in the activity patterns between Kenyan and Japanese children. The results from the present study demonstrated that Kenyan children spent more time in moderate-to-vigorous physical activity compared to Japanese children (p < 0.05) with the greatest differences found for weekday evenings (for boys and girls) and weekend afternoons (for girls). This suggests that these were ‘critical periods’ to differentiate the physical activity levels between Kenyan and Japanese children. However, a higher proportion of the children from Japan used active transport to school and spent less time in television viewing and computer gaming. The results suggest that both countries have successes and challenges that can aid in developing effective and country-specific intervention strategies for promoting physical activity.