Shunsuke Kumagai
Rapport Kamiooka Sports and Cultural Center for People with Disabilities

1. Introduction

Society’s interest in sports for people with disabilities is increasing, prompted by the decision to hold the Tokyo 2020 Olympic and Paralympic Games. Incidentally, our country is a super-aging society, with 28.4% of the total population aged 65 and over, the highest rate of aging in the world[1]. The rate of aging among people with disabilities is even higher; in particular, 72.6% of people with physical disabilities are aged 65 and over[2].

Against this background, interest is growing not only in highly competitive sports, with the Olympics and Paralympics at the apex, but also in sporting activities for people to get and stay healthy. In the “Opinion Poll on the Actual State of Sports” carried out by the Japan Sports Agency[3], 75.2% of respondents gave “health” as the reason for taking part in sport or exercise in the past year, making this the most popular response.

On the other hand, it is reported that around 50,000 people die each year in our country due to insufficient exercise, putting this behind only smoking and high blood pressure[4], and so the elimination of insufficient exercise is an important issue when it comes to extending healthy life expectancy. Moreover, for people with disabilities, mental and physical functions decline due to the aftereffects of illnesses or accidents, and their physical activities are easily limited, making them liable to fall into a chronically inactive lifestyle. Since an inactive lifestyle is a cause of obesity or weight loss (loss of muscle strength), leading an active lifestyle is essential for people with disabilities to get and remain healthy in practice.

In this article, I will introduce Yokohama City’s initiatives and the actual content that has been implemented, and discuss future issues which have become visible.

2. Initiatives taken in Yokohama City up to the present

Yokohama City is promoting health and social participation for people with disabilities through sports, recreation, and cultural activities, with Yokohama Rapport Sports and Cultural Centre for People with Disabilities (hereinafter, “Yokohama Rapport”), opened in 1992, as the city centre hub. A distinctive feature is a team approach in partnership with the professionals in medical care, welfare, engineering, and so on at the adjoining Yokohama City General Rehabilitation Centre, which allows sports to be introduced from the earliest stage of rehabilitation. 

In addition, in order for people to be able to continue with sporting activities throughout their lives after moving back into community life, sports instructors are dispatched to local communities and, through instruction on the ground and technical assistance to the organisations involved, they put in place environments which allow people with disabilities to continue their sporting activities in the communities with which they are familiar.

A new hub for southern Yokohama was then opened in 2020: Rapport Kamiooka Sports and Cultural Center for People with Disabilities (hereinafter, “Rapport Kamiooka”). Rapport Kamiooka is a small-scale facility compared with Yokohama Rapport, but it connects directly with Kamiooka Station, which acts a subcentre of Yokohama City, so the ease of access is convenient for people with disabilities. Making use of the knowhow developed through the initiatives at Yokohama Rapport, we are developing our work, with a focus on enabling people with disabilities to get and stay healthy. 

3. The content of Rapport Kamiooka’s health promotion programme

(1) Programme outline

 At Rapport Kamiooka, we are carrying out a health promotion programme providing comprehensive support with exercise, nutrition, and lifestyle, in order to enable people with disabilities to take the initiative in getting and staying healthy and physically strong.

We first have a new user register with us and hold a consultation. After social workers or nurses have shared information with the organisations involved, we check the information necessary for the person to participate in the programme safely and with peace of mind. This includes the progress of rehabilitation, status of utilization of disability welfare services, health situation, use of medications, etc.

Next, we measure their height, weight, waist circumference, muscle mass, body fat mass, and so on. Taking into account the results of these measurements of body composition and physical strength, sports instructors draw up an individualized training menu according to the person’s disability, their level of physical strength, and the support aims. They use this menu to provide instruction. In addition, a registered dietitian carries out dietary consultation with the person and their family, giving support with dietary modification bearing in mind the person’s living situation. Through this kind of partnership between professionals, we provide comprehensive support with getting and staying healthy.

(2) Examples of programme implementation and its effects

I will introduce some actual effects obtained through participation in the programme. The subjects are 27 people who participated with the aim of losing weight. Their disabilities included physical disabilities due to cerebrovascular disease, heart disease, or bone and joint disease; intellectual disabilities; and mental illnesses due to schizophrenia or mood disorders. The subjects were given instruction during training sessions of around 90 minutes held twice a week for between three and six months, and a statistical examination was carried out of the changes in their body weights, BMIs, body fat percentages, and waist circumferences before and after participation. The results showed significant improvements to all items on the obesity index.   

4. Issues for the future

We have understood that the practice of adequate exercise and balanced eating are effective in enabling people with disabilities to get and stay healthy. However, there are some issues when it comes to making these practices a part of daily life. According to the Report on the FY 2019 Survey of the Sports Awareness of Yokohama City Residents[5] , although “maintaining or increasing health and physical strength” was the most popular reason for people with disabilities to practice sports, with 66.9%, the proportion of people practicing sports “one or more days a week” was 36.7%, failing to attain the goal of 40% laid down in the Yokohama City Sports Promotion Plan, and showing that the practice of sports was insufficient.

Moreover, the number of people with disabilities in Yokohama City in FY 2019[6] is 99,732 people with physical disabilities, 32,281 people with intellectual disabilities, and 39,232 people with mental illnesses: a total of around 170,000. However, it is impossible for Yokohama Rapport and Rapport Kamiooka to respond to all these people. Given this, the development and utilization of personnel who can support sporting activities by people with disabilities are key to future initiatives. In partnership and collaboration with Yokohama Sport Association and its member sports bodies, who have the core responsibility for sports promotion in the Yokohama area, the role of coordinator to match up these personnel, such as instructors and volunteers, and the people actually running the activities is a crucial one. 

5. Conclusion

 I have discussed initiatives taken in Yokohama City until now, the concrete content of programmes implemented, and issues for the future. When implementing programmes enabling people with disabilities to get and stay healthy, each local government faces different issues and situations. However, the importance not only of separate support by each facility but of comprehensive support, which takes into account the totality of the lives of people with disabilities through the appropriate division of responsibilities between the organisations involved, is something which they share in common.

The resources of each facility are limited, but quite a few issues can be resolved if multiple organisations work in partnership and collaboration. I believe that the first step towards health promotion is get as close to the targets as possible and get to know their situation in order to understand what they need in their lives.