Photo/Illutration The Imperial Household Agency released this Oct. 9 photo of Emperor Emeritus Akihito and Empress Emerita Michiko at the Sento Imperial Palace in Tokyo on Oct. 20, Michiko's 91st birthday. (Provided by the Imperial Household Agency)

Empress Emerita Michiko, who spent much of the past year recovering from a fractured right femur while supporting her husband, Emperor Emeritus Akihito, turned 91 on Oct. 20.

According to the Imperial Household Agency, Michiko has continued a light exercise routine and still reads aloud with Akihito after breakfast.

Although Michiko appears to tire more easily and her physical strength is gradually declining, she finds peace in spending her days calmly by the side of Akihito, who has a chronic heart condition, the agency said.

Much of her time has been devoted to managing both of their health.

To mark her birthday, the agency released an update on her condition.

The right femur fracture, suffered in October last year, has nearly completely healed.

However, Michiko continues to experience afternoon fevers, and her BNP levels, a diagnostic marker for heart failure, remain above normal, the agency said.

With assistance from court physicians, Michiko takes walks around the Sento Imperial Palace, the couple’s residence in Tokyo’s Moto-Akasaka area, and within the Akasaka Imperial Estate to maintain her leg strength.

When Akihito was hospitalized at the University of Tokyo Hospital in Bunkyo Ward in May and July, she visited him daily to offer support.

On Sept. 6, following the coming-of-age ceremony for their grandson, Prince Hisahito, son of Crown Prince Akishino and Princess Kiko, Michiko and Akihito received a visit from Hisahito at the Sento Imperial Palace.

They were reportedly pleased and proud of his growth.

Aside from medical visits and hospital stays, her outings have been limited.

But, together with Akihito, she visited the Kasumi Kaikan Memorial Gakushuin Museum in the capital’s Toshima Ward at the end of April to view a special exhibition.

In late August, for rest and recuperation, she went to Karuizawa in Nagano Prefecture and revisited the Ohinata Settlement, where people repatriated from former Manchuria (now northeastern China) settled after World War II.

She strolled through cabbage fields in the area.

Michiko has repeatedly visited the area since the Showa Era (1926-1989) out of compassion for the repatriates.

She appeared relieved to be able to return to this historically significant site in the 80th year since the war’s end.

In June, Michiko and Akihito received a briefing from officials of Kodomonokuni, a park facility built with congratulatory funds from the public upon their marriage.

Located across Yokohama’s Aoba Ward and the Tokyo suburb of Machida, the facility marked its 60th anniversary this year.

The couple expressed joy that the park remains beloved by so many people and conveyed renewed gratitude to those who have supported it over the years.

In addition to reading aloud with Akihito, Michiko also reads on her own.

One of the books she has recently read is “Nour’s Secret Library” by Wafa' Tarnowska, a picture book inspired by a real library that existed during the Syrian civil war.

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