Mudança para um estilo de vida ativo no envelhecimento: uma proposta de um estudo piloto em promoção da saúde

Resumo: Introdução: Atualmente, a mudança para um estilo de vida ativo pela prática de exercício físico em programas para promoção da saúde vem assumindo relevo. Entretanto, as taxas de adesão pelos idosos são diminutas. Objetivos: Conhecer os níveis de adesão dos idosos em instituições desportivas, bem como os motivos de adesão ou desistência a programas de exercício físico; Conhecer o papel do exercício físico na percepção dos idosos. Metodologia: Estudo transversal retrospectivo e descritivo de taxas de adesão e desistência dos idosos em instituição desportiva entre 2007-2012. No estudo descritivo dos idosos (>65 a.) de ambos os sexos, ativos (n=96), valorizou-se a caracterização sociodemográfica, as taxas de motivação de acordo com grau de satisfação com a saúde, o relacional, as modalidades de escolha e a frequência de prática semanal através de questionário geral. Resultados: Em seis anos as taxas de adesão dos idosos mostraram declínio gradual, 2007:37% - 2012:10%. Em comparação com Adultos maduro (46-59), 2007:19.5% - 2012: 18.5% e com Adultos jovens (30-45) 2007:13% - 2012:21% declinou após o terceiro ano. A desistência foi similar entre os idosos e adultos; Idosos 62%, Adultos maduro 64%, Adultos Jovens 68%. Predominantemente o motivo da adesão foi voluntário 52%, os objetivos que levaram a adesão estão relacionados com a saúde e desempenho físico 60%, a satisfação com a condição física geral foi de 86% e 58% afirmaram ter uma vida social melhor. Conclusões: O estudo revela a problemática da adesão a programas de exercício físico por parte dos idosos. Por outro lado mostra os benefícios percebidos pelos idosos ativos ao permanecerem nos programas. São necessários mais estudos envolvendo um maior número de instituições desportivas, assim como interessa conduzir os idosos a perceberem o grau de importância e influência que o exercício físico tem na saúde e na longevidade com qualidade de vida. Palavras-chave: exercício físico, idoso, prevenção, promoção da saúde

What Mathematical Models Are Accurate for Prescribing Aerobic Exercise in Women with Fibromyalgia?

Objectives: This article aims to verify the agreement between the standard method to determine the heart rate achieved in the ventilatory threshold 1 in the cardiopulmonary exercise testing (VT1) and the mathematical models with exercise intensities suggested by the literature in order to check the most precise for fibromyalgia (FM) patients. Methods: Seventeen women with FM were included in this study. The VT1 was used as the standard method to compare four mathematical models applied in the literature to calculate the exercise intensity in FM patients: the well-known “220 − age” at 76%, Tanaka predictive equation “208 − 0.7 × age” at 76%, the FM model HRMax “209 – 0.85 × age” at 76%, and Karvonen Formula at 60%. Bland–Altman analysis and correlation analyses were used to explore agreement and correlation between the standard method and the mathematical models. Results: Significant correlations between the heart rate at the VT1 and the four mathematical estimation models were observed. However, the Bland-Altman analysis only showed agreement between VT1 and “220 − age” (bias = −114.83 + 0.868 × x; 95% LOA = −114.83 + 0.868 × x + 1.96 × 7.46 to −114.83 + 0.868 × x − 1.96 × 7.46, where x is the average between the heart rate obtained in the CPET at VT1 and “220 − age”, in this case 129.15; p = 0.519) and “209 − 0.85 × age”(bias = −129.58 + 1.024 × x; 95% LOA = −129.58 + 1.024 × x + 1.96 × 6.619 to −129.58 + 1.024 × x − 1.96 × 6.619, where x is the average between the heart rate obtained in the CPET at VT1 and “209 − 0.85 × age”, in this case 127.30; p = 0.403). Conclusions: The well-known predictive equation “220 − age” and the FM model HRMax (“209 − 0.85 × age”) showed agreement with the standard method (VT1), revealing that it is a precise model to calculate the exercise intensity in sedentary FM patients. However, proportional bias has been detected in all the mathematical models, with a higher heart rate obtained in CPET than obtained in the mathematical model. The chronotropic incompetence observed in people with FM (inability to increase heart rate with increasing exercise intensities) could explain why methods that tend to underestimate the HRmax in the general population fit better in this population

Increased physical activity and fitness above the 50th percentile avoid the threat of older adults becoming institutionalized: A cross-sectional pilot study.

Objective: To analyze the impact of physical fitness and physical activity on the threat of older adults without cognitive impairment becoming institutionalized. Methods: This cross-sectional study involved 195 non-institutionalized (80.1±4.4yrs) and 186 institutionalized (83.8±5.2yrs) participants. Cognitive impairment was assessed using Mini-Mental State Examination, measures of physical fitness were determined by the Senior Fitness Test, and physical activity was assessed using the International Physical Activity Questionnaire. Results: Multivariate binary logistic analysis selected 4 main determinants of institutionalization in both genders: the likelihood of becoming institutionalized increased by +18.6% for each additional year of age, while it decreased by -24.8% by each fewer kg/m2 in BMI, by -0.9% for each additional meter performed in the aerobic endurance test and by -2.0% for each additional 100MET-min/wk of physical activity expenditure (p<0.05). Values ≤50th percentile (age ≥81yrs, BMI ≥26.7kg/m2, aerobic endurance 367.6m, and physical activity 693MET-min/wk) were computed using Receiver Operating Characteristics analysis as cut-offs discriminating institutionalized from non-institutionalized older adults. Conclusions: The performance of physical activity, allied to an improvement in physical fitness (mainly BMI and aerobic endurance), may avoid the threat of institutionalization of older adults without cognitive impairment only if they are above the 50th percentile; the following is highly recommend: expending ≥693MET-min/wk on physical activity, being ≤26.7kg/m2 on BMI, and being able to walk ≥367.6m in the aerobic endurance test, especially above the age of 80 years. The discovery of this trigger justifies the development of physical activity programs targeting the pointed cut-offs in old, and very old adults

Increased physical activity and fitness above the 50th percentile prevents the institutionalization of elderly people: a cross-sectional pilot study.

Introduction Institutionalization in a nursing home restricts autonomy, most notably free will, free choice, and free action. Decreased physical activity and fitness are predictive of disability and dependence (Rikli & Jones, 2013; Tak, Kuiper, Chorus, & Hopman-Rock, 2014); however little is known about the impact of these factors on institutionalization. Thus, this study aimed to analyze the impact of physical activity and fitness and on the risk of elderly people without cognitive impairment become institutionalized. Methods This cross-sectional study involved 195 non-institutionalized (80.14.4yrs) and 186 institutionalized (83.85.2yrs) participants. Cognitive impairment was assessed using Mini-Mental State Examination, physical activity was assessed using the International Physical Activity Questionnaire, and measures of physical fitness were determined by the Senior Fitness Test. Results: Multivariate binary logistic analysis selected 4 main predictors of institutionalization in both genders. The likelihood of becoming institutionalized increased by +18.6% for each additional year of age, while it decreased by -24.8% by each fewer kg/m2 in BMI, by -0.9% for each additional meter performed in the aerobic endurance test and by -2.0% for each additional 100MET-min/wk of physical activity expenditure (p<0.05). Values ≤50th percentile (age ≥81yrs, BMI≥26.7kg/m2, aerobic endurance ≤367.6m, and physical activity ≤693MET-min/wk) were computed using Receiver Operating Characteristics analysis as cut-offs discriminating institutionalized from non-institutionalized elderly people. Conclusion The performance of physical activity, allied to an improvement in physical fitness (mainly BMI and aerobic endurance) may prevent the institutionalization of elderly people without cognitive impairment only if they are above the 50th percentile; the following is highly recommend: expending ≥693MET-min/wk on physical activity, being ≤26.7kg/m2 on BMI, and being able to walk ≥367.6m in the aerobic endurance test, especially above the age of 80 years. The discovery of this trigger justifies the development of physical activity programs targeting the pointed cut-offs in old, and very old people. References Rikli, R., & Jones, C. (2013). Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist, 53, 255-267. Tak, E., Kuiper, R., Chorus, A., & Hopman-Rock, M. (2014). Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing Res Rev, 12, 329-338

A cross-sectional study on physical and sedentary activity and health-related quality of life in institutionalized vs. non-institutionalized elderly

Aims: to compare the physical activity, sedentary activity and health-related quality of life (HRQoL) in institutionalized vs. non-institutionalized elderly, and to establish a pattern of relationship and prediction of physical and sedentary activity with physical and mental components of HRQoL. Methods: the sample consisted of 383 elderly with ≥ 75 years old (n=187 institutionalized and n=196 non-institutionalized). Were administered the International Physical Activity Questionnaire (IPAQ) and Short Form 36 Health Survey (SF-36) for evaluated the physical and sedentary activity and HRQoL. Also was used the Mini Mental State Examination (MMSE) as exclusion criteria for cognitive problems in the elderly. Results: differences between institutionalized and non-institutionalized elderly were found in moderate-intensity activities and walking, a favour of non-institutionalized. The institutionalized elderly remain more minutes in sedentary activity. Also, were observed differences between both groups in physical component of HRQoL, a favour of non-institutionalized elderly. The mental component remained unchanged. The multivariate regression analyses showed that physical activity predicted the physical (8 to 12%) and mental (5 to 8%) components of HRQoL for institutionalized and non-institutionalized elderly. Conclusions: non-institutionalized elderly were more physically active, spent less time in sedentary activity and showed better perception physical component of HRQoL that institutionalized elderly. An important and encouraging result of this study was that physical activity is a predictor of improved physical and mental component of HRQoL for institutionalized and non-institutionalized elderly

Effects of respiratory muscle training on respiratory efficiency and health-related quality of life in sedentary women with fibromyalgia: a randomised controlled trial

Objectives: Fibromyalgia syndrome (FM) is a complex disease that is mainly characterised by chronic pain, fatigue, and sleep disturbances and may be precipitated or worsened by many stressors. The aim of this study was to examine the effects of respiratory muscle training (RMT) on respiratory efficiency and health-related quality of life (HRQoL) in women with FM. Methods: A total of 30 women with FM were included in the intention to treat analyses: 15 were assigned to the RMT group and 15 to the control group. The intervention consisted of 12 weeks of RMT. The primary outcome was the change in pulmonary function assessed by global body plethysmography at 12 weeks compared with baseline. Secondary outcomes included changes of scores in HRQoL assessed by the Short Form 36 Health Survey-Portuguese version. Results: The maximal inspiratory pressure (MIP) improved by 17.5% (p-value = .033), maximal expiratory pressure (MEP) improved 21.6% (p-value = 0.045) and maximum occlusion pressure (P0.1 max) increased 27.7% (p-value = 0.007). HRQoL improved in the dimensions of physical function, physical role, bodily pain and vitality (p-value <0.05). Conclusions: RMT results in a significant improvement of respiratory efficiency and HRQoL after 12 weeks. RMT could be an effective therapy to enhance respiratory function and quality of life in women with FM

Relação entre a dor generalizada e o limiar de tolerância à dor nos pontos sensíveis em mulheres portuguesas com fibromialgia: impacto sobre a vida diária.

Objectives: to establish a relationship between wide - spread pain subjectively perceived and threshold pain tolerance on tender points, and to determine whether there are differences in threshold pain tolerance on tender points between the upper and lower body, as well as between the dominant and non-dominant side, and whether these differences have an impact on the daily life of Portuguese women with fibromyalgia (FM). Material e Methods: thirty-one women with FM aged between 34 and 67 years volunteered for the study. Threshold pain tolerance was assessed at critical points using a digital algometer pressure; the widespread pain index (WPI) was constructed by the addition of 19 painful body regions; and the impact on the daily life assessed by the Portuguese version of the Fibromyalgia Impact Questionnaire (FIQ), with individual interviews. Results: significant differences between the percentage of threshold pain tolerance of the whole body and the scales of widespread pain subjectively perceived were observed, showing that the widespread pain subjectively perceived by patients was between +25.9% and +27.5%. Also, significant differences between threshold pain tolerance of tender points located on the upper and lower body (1.9 ± 0.5 kg/cm2 vs. 2.6 ± 0.7 Tomas-Carus P1, Branco JC2, Raimundo A3, Garcia J4, Sousa PM5, Biehl-Printes C5 kg/cm2; respectively) were observed. However, no significant differences were found between threshold pain tolerance of tender points located on dominant and non-dominant sides (2.1 ± 0.5 kg/cm2 e 2.1 ± 0.6 kg/cm2; respectively). Additionally, the analysis showed significant correlations between pain and patient`s daily life in: FIQ total score, physical function, feel good, job ability and fatigue. Conclusions: the women with FM show higher widespread pain subjectively perceived than threshold pain tolerance on tender points. Furthermore, the pain suffered by the patients with FM, especially that located on the upper body, either on the dominant or on the non-dominant side, has a negative influence on physical function, job ability, fatigue and feel good, affecting daily life

Prática de exercício físico ou esporte dos idosos jovens e longevos e o conhecimento dos mesmos em programas públicos: pesquisa nacional de saúde 2013 = Physical exercise or sport of the old-adult and oldest old and the knowledge of them government programs: national health survey 2013

Objetivo: descrever e relacionar a prática, participação, conhecimento e motivos de não-participação em relação às modalidades oferecidas pelos programas públicos de exercício físico ou esporte aos idosos jovens e longevos. Métodos: análise secundária de resultados da Pesquisa Nacional de Saúde 2013. Foram analisadas as frequências das respostas às questões P34 (prática de exercício físico ou esporte), P47 (conhecimento de algum programa público de exercício físico ou esporte), P48 (participação nesses programas), P49 (motivo de não participar desses programas) e P36 (exercício físico ou esporte que pratica com mais frequência) entre duas faixas etárias: idosos jovens (de 60 a 79 anos) e longevos (80 anos ou mais). O teste do qui-quadrado foi usado para verificar a distribuição das frequências considerando p<0,05. Resultados: O estudo teve 9,679 idosos jovens e 1,498 idosos longevos. 78,9% dos idosos brasileiros não praticam exercício físico com diferenças significativas entre idosos jovens (77,3%) e longevos (89,3%). Além disso 81,6% não conhecem a existência de programas e dos que conhecem a grande maioria não participa, 82,6%. O motivo mais frequente de não-participação foi a falta de interesse (39%) e a caminhada é a modalidade mais atrativa 58,4%. Conclusões: O estudo revela uma baixa adesão dos idosos à prática de exercício físico ou esporte. Os indicadores mostram uma necessidade de ampliar a divulgação e diversificar os programas públicos de estímulo à prática do exercício físico ou esporte. São encorajados novos estudos sobre os mecanismos de comunicação utilizados na rede pública para divulgação desses programa

Perspectivas da educação física para a população idosa = Perspectives of physical education for the elderly population = Perspectivas de la educación física para la población anciana

OBJETIVOS: Caracterizar: i) o papel da educação física na população idosa, ii) os programas e as propostas de exercício físico que são utilizados no Brasil nos últimos 10 anos e iii) as perspectivas da educação física na população idosa. DELINEAMENTO: Revisão de literatura e resumos de Anais (2007-2017) conduzidos nas bases PubMed, MEDLINE, SciELO e Scholar-Google por meio dos seguintes descritores: exercício físico, educação física, expectativa de vida, anos de vida saudável, entre outros. Livros com teor científico também foram consultados. Após, realizou-se uma análise crítica sobre os estudos encontrados na forma de texto descritivo. CONCLUSÃO: A educação física tem reconhecida pertinência no envelhecimento, sendo que novas perspectivas se estabelecem no empoderamento político e social em promoção da saúde no idoso. Os programas de atividade física carecem alargar oportunidades e evidenciar resultados de efetividade/eficáci

Physical activity and medication in the control of blood pressure: secondary analysis of the Brazilian national health research

AIM: To test the effectiveness of different physical activities (PA) in controlling blood pressure. The dependent variable was controlled and uncontrolled blood pressure (BP). METHODS: This is a secondary analysis of a cross-sectional, observational, descriptive and analytical study from the Brazilian National Health Research (PNS) database. The PNS was conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 2013, in partnership with the Ministry of Health. Total PA was calculated in minutes per week (MPS) with the sum of 3 activities, physical exercise, time spent walking to work, and heavy work activity. Sociodemographic variables and the use of hypertension medications were analyzed as possible associated factors. RESULTS: The chances of having controlled BP were calculated by logistic regression. Among the 10199 participants aged 40 years and older, who reported hypertension, 5398 (53%) had controlled BP, being higher among the women (56%), within the age range of 40-59 years-old (56%), and on medication for hypertension (54%). The controlled-BP group performed 64 ± 146.1 MPW of PA while the uncontrolled-BP spent 46 ± 150.7 MPW in PA (p &lt; 0.001). Work activity was also higher among the controlled-BP group (p = 0.019). Participants who performed total PA between 90-149 MPW had 21% higher odds of controlled-BP (p = 0.024) and those who performed 150 MPW or more, 22% (p = 0.001). Medication increased the chance of BP control by 18% (p = 0.003). The odds of having controlled-BP were higher in physical exercise: 42% on 90-149 MPW (p = 0.001) and 40% on 150 MPW or more (p &lt; 0.001). CONCLUSION: Physical exercise was significantly associated with better BP control than just total PA. Both exercise and total physical activity were significantly associated with better BP control than medication.</p