Publication date: Sep 01, 2025

Locomotive syndrome (LS), characterized by reduced mobility due to musculoskeletal problems, and metabolic syndrome (MetS) are significant public health concerns with considerable societal impact. This study aimed to investigate the bidirectional association between LS and MetS in a cohort of Japanese manufacturing workers using a 6-year longitudinal dataset. This retrospective cohort study used annual health checkup data from actively employed adults (aged ≥40) from 2016 to 2022. LS was assessed using the LS Risk Test, including the Two-Step Test, modified Stand-Up Test, and Geriatric Locomotive Function Scale. Cox proportional hazards models estimated hazard ratios (HRs) and 95 % confidence intervals (CIs) for the incidence of MetS and LS according to baseline status. Covariates included age, sex, and lifestyle-related behaviors. Sensitivity analyses excluding the COVID-19 pandemic period and subgroup analyses were also conducted. Among the 4301 participants without MetS at baseline, 20. 4 % developed MetS during the follow-up period. LS was associated with an increased risk of MetS (adjusted HR: 1. 34, 95 % CI: 1. 16, 1. 55). In contrast, among the 3359 participants without LS at baseline, 38. 5 % developed LS; however, MetS was not associated with the incidence of LS (adjusted HR: 1. 07, 95 % CI: 0. 88, 1. 31). Additional analyses confirmed the robustness of the findings. LS was a significant risk factor for MetS, but MetS did not contribute to LS progression. These findings highlight the importance of mobility preservation in MetS prevention and suggest the need for workplace interventions that target musculoskeletal health among aging workers.

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