Original Article|Articles in Press

Risk factors for progression of the severity of locomotive syndrome: A two-year longitudinal observational study

Published:March 08, 2023DOI:



      The risk factors for progression of severity of locomotive syndrome (LS) remain unclear.


      We conducted a longitudinal observational study of 1148 community-dwelling residents (median age, 68.0 years old; 548 males, 600 females) from 2016 to 2018. LS was assessed by the 25-question Geriatric Locomotive Function Scale (GLFS-25), and total scores of ≤6 points, 7–15 points, 16–23 points, and ≥24 points were diagnosed as non-LS, LS-1, LS-2, and LS-3, respectively. If the LS severity in 2018 was higher than in 2016, the case was defined as progression of LS severity; otherwise, it was defined as non-progressive LS. We compared the age, gender, body mass index, smoking status, alcohol consumption, living situation, car use, chronic musculoskeletal pain, comorbidities, metabolic syndrome, physical activity, and LS severity in 2016 between the progression and non-progression groups. Furthermore, a multivariate logistic regression analysis was performed to elucidate the risk factors for progression of LS severity.


      Participants in the progression group had a significantly older age, a lower rate of car use, a higher rate of low back pain, a higher rate of hip pain, a higher rate of knee pain, a higher GLFS-25 total score, and a higher rate of LS-2 than those in the non-progression group. The multivariate logistic regression analysis revealed that older age, female gender, higher body mass index (≥25.0 kg/m2), presence of low back pain, and presence of hip pain were risk factors for the progression of LS within two years.


      To prevent the progression of LS severity, related prophylaxis strategies should be implemented, especially for individuals with the above-mentioned characteristics. Further longitudinal studies with a longer observation period are necessary.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nakamura K.
        A “super-aged” society and the “Locomotive Syndrome”.
        J Orthop Sci. 2008 Jan; 13: 1-2
        • Seichi A.
        • Hoshino Y.
        • Doi T.
        • Akai M.
        • Tobimatsu Y.
        • Iwaya T.
        Development of a screening tool for risk of locomotive syndrome in the elderly: the 25-question Geriatric Locomotive Function Scale.
        J Orthop Sci. 2012 Mar; 17: 163-172
      1. The Japanese orthopedic association official locomotive syndrome prevention awareness official website. Accessed on February 26, 2022.

        • Kobayashi T.
        • Morimoto T.
        • Otani K.
        • Mawatari M.
        Locomotive syndrome and lumbar spine disease: a systematic review.
        J Clin Med. 2022; 11: 1304
        • Akahane M.
        • Yoshihara S.
        • Maeyashiki A.
        • Tanaka Y.
        • Imamura T.
        Lifestyle factors are significantly associated with the locomotive syndrome: a cross-sectional study.
        BMC Geriatr. 2017 Oct; 17: 241
        • Yoshinaga S.
        • Shiomitsu T.
        • Kamohara M.
        • Fujii Y.
        • Chosa E.
        • Tsuruta K.
        Lifestyle-related signs of locomotive syndrome in the general Japanese population: a cross-sectional study.
        J Orthop Sci. 2019 Nov; 24: 1105-1109
        • Sasaki E.
        • Ishibashi Y.
        • Tsuda E.
        • Ono A.
        • Yamamoto Y.
        • Inoue R.
        • et al.
        Evaluation of locomotive disability using Loco-Check: a cross-sectional study in the Japanese general population.
        J Orthop Sci. 2013 Jan; 18: 121-129
        • Iizuka Y.
        • Iizuka H.
        • Mieda T.
        • Tajika T.
        • Yamamoto A.
        • Takagishi K.
        Population-based study of the association of osteoporosis and chronic musculoskeletal pain and locomotive syndrome: the Katashina study.
        J Orthop Sci. 2015 Nov; 20: 1085-1089
        • Taniguchi M.
        • Ikezoe T.
        • Tsuboyama T.
        • Tabara Y.
        • Matsuda F.
        • Ichihashi N.
        Prevalence and physical characteristics of locomotive syndrome stages as classified by the new criteria 2020 in older Japanese people: results from the Nagahama study.
        BMC Geriatr. 2021 Sep; 21: 489
        • Kobayashi T.
        • Morimoto T.
        • Shimanoe C.
        • Ono R.
        • Otani K.
        • Mawatari M.
        The association of comorbidities with the 25-question Geriatric Locomotive Function Scale and the diagnosis of locomotive syndrome.
        J Orthop Sci. 2022 Jan 3; (S0949-2658(21)00392-4)
        • Mitani G.
        • Nakamura Y.
        • Miura T.
        • Harada Y.
        • Sato M.
        • Watanabe M.
        Evaluation of the association between locomotive syndrome and metabolic syndrome.
        J Orthop Sci. 2018 Nov; 23: 1056-1062
        • Yamada T.
        • Yamato Y.
        • Hasegawa T.
        • Yoshida G.
        • Banno T.
        • Arima H.
        • et al.
        Prevalence of locomotive dysfunction exacerbating systolic blood pressure and abdominal circumference: a longitudinal cohort analysis.
        Metab Syndr Relat Disord. 2021 Dec; 19: 562-566
        • Yamaguchi S.
        • Kishida S.
        • Yamazaki N.
        • Sato Y.
        • Shirai T.
        • Akagi R.
        • et al.
        Association of locomotive syndrome with present and past physical activities, and self-reported gait speed: a cross sectional study.
        Chiba Med J. 2018; 94E: 9-17
        • Ohtsuki M.
        • Nishimura A.
        • Kato T.
        • Sokejima S.
        • Shibata T.
        • Okada H.
        • et al.
        Relationships between body mass index, lifestyle habits, and locomotive syndrome in young- and middle-aged adults: a cross-sectional survey of workers in Japan.
        J Occup Health. 2019 Jul; 61: 311-319
        • Ishihara Y.
        • Ozaki H.
        • Nakagata T.
        • Ishibashi M.
        • Machida S.
        • Naito H.
        Locomotive syndrome relation to daily physical activity, physical function, and body composition in elderly people: a pilot study.
        Juntendo Med J. 2016; 62: 225-230
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        The strengthening the reporting of observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008 Apr; 61: 344-349
        • Avila-Palencia I.
        • Int Panis L.
        • Dons E.
        • Gaupp-Berghausen M.
        • Raser E.
        • Götschi T.
        • et al.
        The effects of transport mode use on self-perceived health, mental health, and social contact measures: a cross-sectional and longitudinal study.
        Environ Int. 2018 Nov; 120: 199-206
      2. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms.
        in: Prepared by the international association for the study of pain, Subcommittee on Taxonomy. vol. 3. Pain Supplement, 1986: S1-S226
        • Committee on Diagnostic Criteria for Metabolic Syndrome
        Metabolic syndrome: its definition and diagnostic criteria.
        J Jpn Soc Intern. 2005 Jun; 94 ([in Japanese]): 794-809
        • Wakabayashi I.
        Cross-sectional relationship between alcohol consumption and prevalence of metabolic syndrome in Japanese men and women.
        J Atherosclerosis Thromb. 2010 Jul; 17: 695-704
      3. Guidelines for data processing and analysis of the international physical activity questionnaire (IPAQ). 2005 (Available at:)
        • Yoshimura N.
        • Muraki S.
        • Nakamura K.
        • Tanaka S.
        Epidemiology of the locomotive syndrome: the research on osteoarthritis/osteoporosis against disability study 2005-2015.
        Mod Rheumatol. 2017 Jan; 27: 1-7
        • Otani K.
        • Takegami M.
        • Fukumori N.
        • Sekiguchi M.
        • Onishi Y.
        • Yamazaki S.
        • et al.
        Locomotor dysfunction and risk of cardiovascular disease, quality of life, and medical costs: design of the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) and baseline characteristics of the study population.
        J Orthop Sci. 2012 May; 17: 261-271
        • Ohtori S.
        • Ito T.
        • Yamashita M.
        • Murata Y.
        • Morinaga T.
        • Hirayama J.
        • et al.
        Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study: differences in scores based on age, sex, and type of disease.
        J Orthop Sci. 2010 Jan; 15: 86-91
        • Vo M.T.H.
        • Thonglor R.
        • Moncatar T.J.R.
        • Han T.D.T.
        • Tejativaddhana P.
        • Nakamura K.
        Fear of falling and associated factors among older adults in Southeast Asia: a systematic review.
        Publ Health. 2022 Oct 10;
        • Wolf J.M.
        • Cannada L.
        • Van Heest A.E.
        • O'Connor M.I.
        • Ladd A.L.
        Male and female differences in musculoskeletal disease.
        J Am Acad Orthop Surg. 2015 Jun; 23: 339-347
        • Viester L.
        • Verhagen E.A.
        • Oude Hengel K.M.
        • Koppes L.L.
        • van der Beek A.J.
        • Bongers P.M.
        The relation between body mass index and musculoskeletal symptoms in the working population.
        BMC Muscoskel Disord. 2013 Aug; 14: 238
        • Kobayashi T.
        • Morimoto T.
        • Shimanoe C.
        • Ono R.
        • Otani K.
        • Mawatari M.
        Development of a tool for screening the severity of locomotive syndrome by the loco-check.
        J Orthop Sci. 2022 May; 27: 701-706
        • Kobayashi T.
        • Morimoto T.
        • Shimanoe C.
        • Ono R.
        • Otani K.
        • Mawatari M.
        Development of a simple screening tool based on the 5-question geriatric locomotive function scale for locomotive syndrome.
        J Orthop Sci. 2022 Jul; 27: 913-920
        • Kobayashi T.
        • Morimoto T.
        • Ono R.
        • Otani K.
        • Mawatari M.
        Is grip strength useful in screening to predict the severity of locomotive syndrome?.
        J Orthop Sci. 2022 Apr 24;