Ao-dake-humi (ADH) is a traditional Japanese bamboo foot stimulator consisting of a half-pipe-shaped step made of bamboo used to stimulate the foot by stepping on it, and is commonly used to promote general health among the elderly in Japan. 
On the other hand, refloxology is a traditional medicine to promote health via stimulation on foot and other body part. A brief foot chart in refloexology is shown in Figure A. The hot spot of ADH is on urinary bladder and rectum. Then, ADH can be applied for management of LUTS and constipation. In deed, the previous report indicated the effects of ADH on lower urinary tract symptoms (LUTS), constipation, and hypersensitivity to cold (HC) in the previous report. (Ref.#1) The previous study was conducted in a single-center single-arm prospective study as a pilot trial. Herein, we conducted the second step trial as a multi center cross-over trial to show the exact effects and mechanisms of ADH on health-care among elder people. Simple step (SS) exercise was used as control to exclude exercise effects of ADH.

This study was a multicenter, randomized, open-label, cross-over trial, and was conducted at 7 nursing homes in Japan. Elder people over 60 years with LUTS, constipation, insomnia, or HC as clinically diagnosed were randomized. Patients were excluded if they cannot walk by themselves. Eligible patients were then randomized in 1:1 ratio to the ADH preceding group and the SS preceding group using envelope method. ADH used in this study was made of bamboo, 40 cm in length, 8.5 cm in width, 4.5 cm in height, and almost 290 g in weight. (Figure B) The ADHi was brought to each participant’s nursing homes. ADH and SS was performed twice a day, in the morning (after waking up) and evening (after taking a bath/shower or before going to bed) for 28 days. Holding something such as the wall, desk, or pillar, participants placed the arches of both feet on the ADH, and then made repeated steps for 2 min in a set as shown in Figure C-F. In accordance with the usual use of ADH, steps were made 30– 60 times/min, and participants could control the rate by themselves. If participants felt pain, they could reduce use to once a day. Achievement rates of ADH and SS were counted for evaluation of harmfulness of ADH.
ADH and SS were done twice a day for 28 days. Before and 28 days after starting ADH or SS, international prostate symptom score (IPSS), quality-of-life (QoL) score, overactive bladder symptom score (OABSS), Athene Insmnia Scale (AIS), a visual analogue scale on constipation (VAS-constipation), HC (VAS-HC), and defecation frequency were used for evaluation. After 28 days of initial treatment, ADH and SS were crossed each other, then ADH and SS were done for 28 days. 
The obtained results were compared between the baseline and the results after ADH or SS using paired t-test statistically. And, the ADH and SS were also compared statistically using unpaired t-test.

A total of 37 elder people (6 male and 31 female) were enrolled in this study. Finally, 25 in total (4 male and 21 female, 80.8 y.o. average) were evaluated.
IPSS, especially storage-subscore, and OABSS decreased significantly after ADH. (Table) In accordance with the results of AIH and VAS, ADH improved insomnia and HC significantly. On the other hand, constipation did not change after ADH and SS. The achievement rates of ADH and SS were 92.7% and 91.7%, respectively.

ADH is a Japanese traditional foot stimulator to promote general health. However, we did not know what the effect is, and how to use it. This study showed that ADH has a better therapeutic effect than SS on LUTS, constipation, HC, and insomnia. These results indicated that ADH is not only an exercise equipment, but also a physical neuromodulator. The achievement rate was high, and indicate that ADH is not a harmful even in elder people. To the best of our knowledge, the present study is the first investigation showing the effect of ADH on LUTS and other aging problems using a randomized trial.

The results of this study indicated that ADH has therapeutic efficacy in cases of LUTS, insomnia, and HC more than SS. The possibility of ADH as physical neuromodulator was shown comparing SS exercise.

Minagawa T, Saitou T, Suzuki T, Domen T, Yokoyama H, Ishikawa M, Hirakata S, Nagai T, Nakazawa M, Ogawa T, Ishizuka O. Impact of ao-dake-humi, Japanese traditional bamboo foot stimulator, on lower urinary tract symptoms, constipation, and hypersensitivity to cold: a single-arm prospective pilot study. BMC Complement Altern Med 16: 513. 2016