Previously, we have reported that age-predicted heart rate at 50%VO₂max (HR@50%VO₂max) is an effective index of adjusting appropriate exercise intensity for health promotion exercise. Thus, the aim of this study is to elucidate the change in HR at double product break point (HR@DPBP) and the validity of HR@50%VO₂max due to improvement of cardiovascular fitness. Ninety two healthy adults (57 +/- 9 years old), who participated in the health exercise training course, were studied. Participants were instructed how to control the intensity of physical activity for DPBP during their daily life. DPBP was determined with the use of incremental exercise test, and METs at DPBP (METs@DPBP), HR@DPBP, ratings of perceived exertion at DPBP (RPE@DPBP) were measured before and after the course. HR@50%VO₂max was calculated with the following formula; 138 - age/2 (bpm). METs@DPBP significantly increased (p<0.001) after 10 weeks of the course, whereas HR@DPBP did not change. Interestingly, however, there was a significantly positive correlation (p<0.001) between amount of change in METs@DPBP and that in HR@DPBP (ΔHR@DPBP). Multiple linear regression analysis indicated this correlation was independent from sex, age and amount of change in HR at rest (p<0.001). Before and after the course, proportion of study subjects’ %ΔHRs ((HR@50%VO₂max - HR@DPBP) / HR@DPBP x 100) within -10% ~ +10% were both 48.9%, and proportion of study subjects’ RPEs@DPBP within 11~13 were 92% and 85%, respectively. In this study, it was identified that significantly positive relation between amount of change in cardiovascular fitness and that of ΔHR@DPBP. This finding was independent from potentially affecting factors. In conclusion, this longitudinal study could suggest that HR@50%VO₂max and RPE were valuable indexes of determining exercise intensity for health promotion exercise.

This study aimed to clarify whether a regional palliative care intervention program, the OPTIM project, increased home hospice utilization, and explore the potential association between the home hospice utilization and the hospital staff's perceptions on home care. A questionnaire survey was conducted involving 154 physicians and 469 nurses. The rate of patients who made the transition to home-based care increased 967% in A Hospital, 295% in B Hospital, and 221% in C Hospital in 2010 compared to 2007, which was assumed to be 100. Staff of a hospital where many patients made the transition to home-based care were more likely to agree with the following statements concerning home care perspectives: “I started to consider that even cancer patients can be treated at home until the last moment of their life”, “I usually ask patients whether they wish to receive home-based care”, “We decided on coping strategies for sudden changes in the course of disease and a place to contact in advance”, and “I started to simplify treatment procedures, such as prescriptions during hospitalization for patients and their families to prepare for home-based care“.