Longitudinal association of social participation with locomotive syndrome among Japanese older adults: A 5-year community-based study

Background : Locomotive syndrome (LS), characterized by reduced mobility due to musculoskeletal impairment, is a major contributor to disability and long-term care dependency in aging populations. While structured exercise interventions have demonstrated benefits, the longitudinal impact of real-world social participation on LS remains unclear. Methods : This community-based prospective cohort study utilized municipal health data from 6,898 adults age ≥65 years in Hamamatsu, Japan who were followed from 2019 to 2024. LS was assessed using the 5-item Geriatric Locomotive Function Scale (GLFS-5). Characteristics of social participation, including frequency, group size, and the type of activity, were recorded. Generalized linear mixed-effects models (GLMMs) with a logit link were used to examine associations between social participation and LS over time, adjusting for age and sex. Missing data were handled using multiple imputation. Results : At the baseline, 20.4% of participants had LS. Being older and female were significantly associated with higher odds of LS ( p < 0.001). More frequent participation in social activities (≥2 times/month) and participation in larger groups (≥60 members) were associated with lower odds of LS. However, participation in tea party activities and dementia prevention programs was associated with higher odds of LS. These findings may reflect reverse causality, whereby individuals with poorer baseline physical function preferentially engage in less physically demanding activities. Conclusions : Characteristics of social participation are longitudinally associated with LS among older adults. These findings highlight the importance of considering the type of activity and participation patterns when designing community-based interventions for healthy aging.