J Phys Fitness Sports Med, 10 (3): 139-144 (2021)

DOI: 10.7600/jpfsm.10.139
Special Issue

JPFSM: Review Article

High-intensity interval walking training using internet of things (IoT):

past and future
Hiroshi Nose1,2, Mayuko Morikawa2,3,4, Mayuka Furihata2,3 and Shizue Masuki2,3,4*
1
Department of e-Health Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano
390-8621, Japan
2
Jukunen Taiikudaigaku Research Center, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
3
Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto,
Nagano 390-8621, Japan
4
Institute for Biomedical Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan

Received: August 31, 2020 / Accepted: September 9, 2020

Abstract Facing the rapid growth in the elderly population worldwide, the need for exercise
prescriptions according to individual physical fitness has become increasingly apparent. De-
spite this, the training system broadly available has not been developed. Accordingly, we have
developed a system with internet of things (IoT) for middle-aged and older people called “e-
Health Promotion System”, based on interval walking training (IWT). IWT is a training regi-
・
men repeating 5 sets of fast walking at more than 70% peak aerobic capacity (VO2peak) and slow
・
walking at ~40% VO2peak for 3 min each per day. The system is composed of a device that is
equipped with a tri-axial accelerometer and a barometer, and connected to a central server. The
sever has a program for storing walking records transferred from the device through the inter-
net, as well as for instructing participants regarding IWT in a feedback manner based on the
server database. Using this system, we examined the effects of 5-month IWT in more than 8,700
・
middle-aged and older people, and found that the training increased VO2peak by 15%, improved
lifestyle-related disease symptoms by 20%, and reduced healthcare costs by ~20% on average.
We subsequently reported that the effects of IWT depended only on average fast walking time,
rather than average slow or total walking time per week. Recently, we also developed a mobile
application program to provide participants with this service on their smartphone so that we can
examine the effects of IWT in a much larger population of people at the same time and across
generations. The system has great potential to increase interdisciplinary studies between sports
sciences and other fields of science to establish and promote a society for health and longevity.
Keywords : sensors for exercise intensity measurements, interval walking training, peak aerobic
capacity, lifestyle-related diseases

costs will increase to 35 trillion JPY (330 billion USD)

Introduction
The rapid growth in the elderly population in many
countries has highlighted the importance of exercise
training for decreasing the likelihood of disability and
age-associated diseases. In Japan, approximately 29%
of the total population was over 65 years old in 2020,
and according to National Institute of Population and
Security Research projections from 2019, the figure will
likely increase to over 31% by 2030. One of the serious
problems resulting from the rapid increase in the number
of older people is the related cost of healthcare. Japanese
healthcare costs for people aged 65 and over were 25 tril-
lion JPY (236 billion USD) in 2015, and estimates from
the Ministry of Health and Welfare from 2019 are that
*Correspondence: masuki@shinshu-u.ac.jp
by 2025, an amount equivalent to 35% of the 2019 annual
national budget.
Facing this national fiscal crisis, the Japanese govern-
ment enacted a law in 2008 to reform the medical system
to provide preventive medical care services1) by which
people are obliged to receive health checkups for age-
and lifestyle-related diseases (LSDs) when they reach 40
years of age. If abnormal results are indicated, people are
encouraged to receive nutritional and/or exercise counsel-
ing at local healthcare institutions. While it is well known
that an exercise prescription should conform to individual
physical fitness in order to achieve specific effects2), no
relevant guidelines have been provided by the govern-
ment, possibly because exercise prescriptions for indi-
viduals would cost more than standard walking training,
and also because there has been little evidence to suggest
140 JPFSM : Nose H, et al.
that the cost of developing such exercise prescriptions for
individuals would be less than the cost of current clinical
expenditures.
Given these considerations, we have developed an exer-
cise prescription system using the internet of things (IoT)
for middle-aged and older individuals which can be run
at low cost, and which achieves health outcomes that are
at least equivalent to those of current standard exercise
prescriptions carried out in gyms. While the details have
been reported in our previous review articles3-5), in the
present review we focus on the history of the develop-
ment of the system, we provide an up-to-date overview of
the system and its current use, and we discuss the poten-
tial for future studies using the system.
Brief history of interval walking training development
One year prior to the 1998 Nagano Winter Olympic
Games, Matsumoto City started a health promotion
program of walking training for middle-aged and older
people. Known as Matsumoto “Jukunen Taiikudaigaku”,
this program was based on a proposal by the late Tadashi
Aruga, a former mayor of the city. Since its inception,
we have been engaged in the project, designing the initial
program and examining the effects on health promotion
of the participants. At the outset of the project in 1997,
we instructed participants to perform walking training
with a target of 10,000 steps per day, while having them
report to us the steps measured with a pedometer. More
than 30% of the roughly 100 participants walked more
than 10,000 steps/day, more than 4 days/week, for a year.
However, after our year-long program of intervention,
・
we found little increase in peak aerobic capacity (VO2peak)
6)
and minimal improvement in LSDs .
The following year, we examined the effects of an
exercise training program based on guidelines from the
American College of Sports Medicine (ACSM)2). Par-
ticipants in the program were recruited from those who
had finished the walking training the previous year. They
were instructed to perform running or cycling exercise
・
at 60% or more of individual VO2peak in a gym, 30 min/
day or more, 2-3 days/week, for 4 months or more. The
・
results showed that VO2peak had increased by 10-20%,
with marked improvements in the symptoms of LSDs, as
envisaged by the ACSM guidelines7). However, we found
that such training, implemented on a larger scale, would
require considerable financial expenditure for establish-
ing facilities and employing trainers, estimated at 300,000
JPY (2,830 USD) or more per participant per year, a po-
tentially prohibitive amount3).
To solve this problem, we developed the e-Health Pro-
motion System, composed of 1) interval walking training
(IWT), repeating fast and slow walking for 3 min each,
equivalent to greater than 70% and approximately 40%
・ ・
of individual VO2peak, respectively; 2) an original por-
table calorimeter equipped with a tri-axial accelerometer
and a barometer (JD Mate, Kissei Comtec, Matsumoto,
Japan) for precisely measuring energy expenditure even
during fast walking on inclines; and 3) a server com-
puter in Shinshu University for remotely instructing the
・
participants3,4,5,8). Individual VO2peak was determined by
the graded walking test, performed at subjectively slow,
moderate, and high speeds for 3 min each while energy
expenditure was measured with JD Mate, which was con-
firmed to agree with values separately determined by the
standard graded cycling test using respiratory gas analy-
sis5). Participants were instructed to perform IWT at their
convenient time and place, and to visit community offices
near their homes once a month to transfer their walking
records stored in the JD Mate to the server and to receive
further instruction for continuing the training from the
server. Using the system, we successfully accumulated
data on the effects of 5-month IWT in 8,700 middle-aged
・
and older people, which showed an increase in VO2peak
of 15%, an improvement in LSD symptoms of 20%, and
a reduction in healthcare costs of 20%, on average3-5,9,10).
These results suggested that exercise intensity is a key
factor in acquiring the benefits of exercise training.
Exercise intensity and volume of walking training
・
Recently, we examined the effects of IWT on VO2peak
and LSD symptoms while focusing on exercise intensity
and volume in middle-aged and older people11). We ana-
lyzed retrospectively how exercise intensity and volume
・
of IWT affected the increase in VO2peak and the improve-
ment of the LSD symptoms in 679 middle-aged and older
people aged approximately 65 years, 196 men and 483
women, who had been instructed to perform IWT more
than 30 min/day, more than 4 days/week, for 5 months. In
case they did not have enough time for IWT on weekdays,
we allowed them to perform the training in one session
per week, i.e., on the weekend, provided their total fast
walking time per week was 60 min or more.
During the 5-month IWT, some of the participants per-
formed the training as instructed, with half of the total
training time for fast walking and the remaining half for
slow walking. Some participants, however, performed
fast walking almost exclusively throughout the training
period, while others performed only slow walking. Impor-
tantly, however, more than 95% of the total participants
completed the program.
For the analyses, we divided the participants into small
groups according to individual average fast (A), slow (B),
and total (C) walking time per week and assessed the ef-
・
fects of respective walking time on changes in VO2peak
from the baselines after the 5-month training (Fig. 1). As
・
shown in panel A, we found that VO2peak increased lin-
early as average fast walking time per week increased up
to 50 min; but above this time, it reached a plateau level.
On the other hand, as shown in panels B and C, VO2peak
did not increase as average slow or total walking time per
 ・
JPFSM : Walking intensity to increase VO2peak 141

Fig. 1
6
* A
4

Number of subjects
200
-2 0 0
0 100 200 300 550
Fast walking time, min/week
'VO2peak, ml/kg/min

6
* *
B
4

Number of subjects
0
200
-2
0 0
.

0 100 200 300 400 500

Slow walking time, min/week

8 *
6
C
4 *
2
Number of subjects

0
200
-2
0 0
0 200 400 600 800 1000

Total walking time, min/week

・ ・
Fig. 1 The relationships between average fast (A), slow (B), and total (C) walking time per week vs the change in VO2peak (ΔVO2peak)
from the baseline, respectively, after 5-month IWT in middle-aged and older people. We calculated the average fast walking
・
time and the corresponding average ΔVO2peak value, according to individual walking time per week, for each of the small groups
into which all participants were divided. Calculations were performed for every 6-min increment of the walking time up to 60
min, every ~30-min increment up to 180 min, every ~60-min increment up to 240 min, and the values above this time. Similarly,
・
we calculated the average slow walking time and the corresponding ΔVO2peak value up to 180 min as done for the fast walking
time, and every ~60-min increment up to 400 min and the values above this time. In addition, we calculated the average total
・
walking time and the corresponding ΔVO2peak value every 10-min increment up to 200 min, every 50-min increment up to 500
min, every 100-min increment up to 600 min, and the values above this time. The closed circles and bars indicate the mean and
standard error for each group, respectively. The open circles indicate the number of participants in each group. The *’s indicate
the significant differences from the baseline before starting IWT. Redrawn from Masuki S et al., 201911).
142 JPFSM : Nose H, et al.
week increased. These results suggest that the increase in
・
VO2peak after the training depends on average fast walking
time, but not on either average slow or total walking time
per week. Furthermore, we found that at least 50 min/
week of fast walking above a given exercise intensity was
・
necessary to acquire the maximal increase in VO2peak.
・
Separately, as shown in panel A, we found that VO2peak
marked the values below the baselines when fast walking
time was less than 10 min, suggesting that less than this
amount of time was not enough to prevent any reduction
・
in VO2peak with aging. On the other hand, as shown in pan-
・
el B, we found that the VO2peak marked the values above
the baselines even around 0 min of slow walking time,
suggesting that the participants in the relevant groups
performed only fast walking with no slow walking during
the training period.
Fig. 2 shows the effects of average fast (A), slow (B),
and total (C) walking time per week on changes in the
LSD score from baseline after the 5-month training pe-
riod. The LSD score was calculated with reference to both
Japanese and US healthcare guidelines, as previously
described10,12). We added 1 point when a value met one of
the following four criteria: (1) body mass index 25 kg/
m2 or greater; (2) systolic blood pressure 130 mmHg or
greater or diastolic blood pressure 85 mmHg or greater;
(3) triglyceride level 150 mg/dl or greater, high-density
lipoprotein cholesterol level less than 40 mg/dl, or low-
density lipoprotein cholesterol level 130 g/dl or greater;
and (4) blood fasting glucose level 110 mg/dl or greater.
Therefore, the maximum total score was 4 points when
all criteria were met. As seen in panel A in the figure,
the LSD score decreased as average fast walking time
increased up to 50 min; but above this time, the score
reached a plateau. When we looked at the effects of aver-
age slow and total walking time per week on the LSD
score, we found that the score did not decrease as aver-
age slow or total walking time per week increased. These
results suggest that an improvement in LSD symptoms
depends on average fast walking time, but not on average
slow or total walking time per week. In other words, an
improvement in LSD symptoms was closely associated
・
with an increase in VO2peak, which was attained by exer-
cise training above a given intensity relative to individual
・
VO2peak, such as IWT fast walking.
Future directions
One of the problems with the present e-Health Promo-
tion System is that the participants need to visit commu-
nity offices near their homes once a month at a given time
and date in order to transfer their walking records using a
PC and the internet. While the system may be more read-
ily available to older people whose schedules are relative-
ly free after their retirement, it may not be as accessible to
younger people who are working. To solve this problem,
we have recently developed an application program spe-
cifically for mobile phones. The most recent model of
mobile phone is equipped with a tri-axial accelerometer
and a barometer. This development, made possible thanks
to a 2017-2018 grant from the Japan Agency for Medical
Research and Development (AMED), has allowed us to
develop functions equivalent to those in the JD Mate13).
Fig. 3 shows the quick response (QR) code which readers
can use for trying out IWT with a sample of the applica-
tion program.
To guarantee high adherence to training using the pres-
ent system with JD Mate and a PC, we have also included
3 specific features in the application program: 1) Recog-
nition of progress based on individual walking and health
records returned to each individual from the server com-
puter. Participants can recognize their achievements and
training effects, which motivates them to continue IWT
with confidence that their efforts have results; 2) Com-
parison with other participants – if participants recognize
training achievements in the up-to-date histograms made
from combined participant data, then this knowledge
stimulates a competitive spirit; 3) Community promotion
– if participants see an up-to-date ranking of the training
achievements in their community, then they may encour-
age colleagues in their own community to elevate the
ranking. We have conducted a validation study of par-
ticipants divided into four groups – university students,
company workers, retired older people, and hospital out-
patients – by having them perform IWT for 5 months. As
a result, we found that the adherence to and the effects
of IWT using the application program were equivalent to
those using the present system in each group of partici-
pants.
The development of an application program for mobile
phones will enable us to examine the effects of exercise
training for increasing physical fitness in a much larger
population of people over multiple generations at the
same time in the field by extending individualized train-
ing beyond gyms. Thereby, it will also enable us to ex-
plore new research areas of sports sciences in conjunction
with other disciplines while focusing on exercise intensity
in order to establish and promote a society for health and
longevity by exercise training.
Conclusions
We developed a field training system to perform IWT
・
according to individual VO2peak while continuously moni-
toring exercise intensity. Our findings suggest that high-
intensity walking time during IWT is a key determinant
・
for increasing VO2peak and improving LSD risk factors in
middle-aged and older people. The system should signifi-
cantly contribute to realizing a society that enjoys health
and longevity.
 ・
JPFSM : Walking intensity to increase VO2peak 143

Fig. 2
0.4
A

-0.4
*
* * *
* *
-0.8
0 100 200 300 550
Fast walking time, min/week

B
0.4
'LSD score

-0.4
* *
* *
-0.8 *
0 100 200 300 400 500
Slow walking time, min/week

C
0.4

-0.4
*
* *
-0.8
* *
0 200 400 600 800 1000
Total walking time, min/week

Fig. 2 The relationships between average fast (A), slow (B), and total (C) walking time per week vs the change in the lifestyle-related
disease (ΔLSD) score from the baseline, respectively, after 5-month IWT in middle-aged and older people. The procedure for

Fig. 3
dividing all participants into the small groups and the number of participants in each group are the same as in Fig. 1. The sym-
bols are also the same as in Fig. 1. Redrawn from Masuki S et al., 201911).

Fig. 3 A quick response (QR) code for the iPhone application

program developed under grants from AMED13).
144 JPFSM : Nose H, et al.
Grants
This research was supported by the Ministry of Health Labor
and Welfare of Japan (H17-Choju-Ippan-016), and the Japan
Society for the Promotion of Science (18H04083, 18H03147).
Preparation for this manuscript was partially supported by the
SEI Group CSR Foundation (2020-2022).
Conflict of Interests
No conflict of interests, financial or otherwise, is declared by
the authors.
Author Contributions
SM and MF prepared the figures. HN and SM drafted the
manuscript. HN, MM, MF, and SM edited and revised the man-
uscript. HN, MM, MF, and SM approved the final version of the
manuscript.
References
1) Health Insurance Bureau. 2007. Implement Manual for
Health Checkups and Healthcare Active with a Particular
Focus on the Metabolic Syndrome (in Japanese). Health
Insurance Bureau, Ministry of Health, Labor, and Welfare,
Japan.
2) American College of Sports Medicine. 2014. General prin-
ciples of exercise prescription. In: Pescatello LS, editor.
ACSM’s Guidelines for Exercise Testing and Prescription (9th
ed). Baltimore, MD: Lippincott Williams & Wilkins, p. 162-
193.
3) Nose H, Morikawa M, Yamazaki T, Nemoto K, Okazaki K,
Masuki S, Kamijo Y and Gen-no H. 2009. Beyond epide-
miology: field studies and the physiology laboratory as the
whole world. J Physiol 587: 5569-5575.
4) Masuki S, Morikawa M and Nose H. 2017. Interval walk-
ing training can increase physical fitness in middle-aged and
older people. Exerc Sport Sci Rev 45: 154-162.
5) Masuki S, Morikawa M and Nose H. 2020. Internet of things
(IoT) system and field sensors for exercise intensity mea-
surements. Compr Physiol 10: 1207-1240.
6) Sakai A, Terasawa K, Inaki M, Yanagidaira Y, Kobayashi I,
Oana S and Nose H. 2000. Physical effects of “Matsumoto
physical training program for senior citizens”. Shinshu Med
J 48: 89-96 (in Japanese).
7) Okazaki K, Kamijo Y, Takeno Y, Okumoto T, Masuki S and
Nose H. 2002. Effects of exercise training on thermoregu-
latory responses and blood volume in older men. J Appl
Physiol 93: 1630-1637.
8) Yamazaki T, Gen-no H, Kamijo Y, Okazaki K, Masuki S and
・
Nose H. 2009. A new device to estimate VO2 during incline
walking by accelerometry and barometry. Med Sci Sports
Exerc 41: 2213-2219.
9) Nemoto K, Gen-no H, Masuki S, Okazaki K and Nose H.
2007. Effects of high-intensity interval walking training on
physical fitness and blood pressure in middle-aged and older
people. Mayo Clin Proc 82: 803-811.
10) Morikawa M, Okazaki K, Masuki S, Kamijo Y, Yamazaki T,
Gen-no H and Nose H. 2011. Physical fitness and indices of
lifestyle-related diseases before and after interval walking
training in middle-aged and older people. Br J Sports Med
45: 216-224.
11) Masuki S, Morikawa M and Nose H. 2019. High-intensity
walking time is a key determinant to increase physical fitness
and improve health outcomes after interval walking training
in middle-aged and older people. Mayo Clin Proc 94: 2415-
2426.
12) Masuki S, Mori M, Tabara Y, Sakurai A, Hashimoto S, Mori-
kawa M, Miyagawa K, Sumiyoshi E, Miki T, Higuchi K,
Nose H and Shinshu University Genetic Research Consor-
tium. 2015. The factors affecting adherence to a long-term
interval walking training program in middle-aged and older
people. J Appl Physiol 118: 595-603.
13) Masuki S, Furihata M, Morikawa M and Nose H. 2019. De-
velopment of a mobile application for remotely supervised
exercise training system using IoT system to increase the
number of participants [abstract]. AMED Meeting: 16.