[Evaluation of the effectiveness of exercise classes for middle-aged and older people using the Kokuho database]

Objectives　This study evaluated the long-term effects of exercise classes for middle-aged and older people with reduced medical care expenditures. Participants who had previously been compared with regards to medical costs through a retrospective cohort study were further followed up for eight years using the Kokuho database, comparing medical care expenditures, long-term care (LTC) costs, survival rates, and independence rates.Methods　A total of 416 matched pairs (832 individuals) of exercise-class participants and non-participants were followed between April 1, 2015 and March 31, 2023. For the survival and independence analyses, 410 pairs (820 individuals) were included, excluding those certified as requiring Level 2 nursing care or higher by March 31, 2015. To compare medical and LTC costs, 345 pairs (690 individuals) insured under the National Health Insurance or Late-Stage Senior Citizen's Health Insurance until March 31, 2023, were analyzed. Descriptive statistics were calculated for medical and LTC costs and paired t-tests were performed to compare expenditures between the participating and the non-participating groups. McNemar's test was used to compare the recipients of medical treatment. Kaplan-Meier curves were generated to calculate the eight-year survival and independence rates for both groups. In addition, stratified log-rank tests were performed for survival time analysis. Statistical significance set at P＜0.05.Results　When comparing hospitalization expenditures, the participating group incurred significantly lower hospitalization costs (P＝0.009) and higher outpatient and pharmacy expenses than the non-participating group (P＝0.019). For LTC costs, the facility and total service scores were higher in the non-participating group; however, these differences were not significant. The non-participating group was significantly more likely to receive inpatient treatment (P＝0.032), whereas the participating group was significantly more likely to receive outpatient care (P＝0.004). Survival analysis revealed significantly lower survival and independence rates in the non-participating group (P＝0.031 and P＝0.003, respectively).Conclusion　The participating group had significantly lower mortality, loss of independence, hospital admissions, and hospitalization expenditures. These findings indicate that regular participation in exercise classes assists in maintaining quality of life and extending healthy life expectancy in middle-aged and older people.