The effects of physical activity on anxiety , depression , and quality of life in elderly people living in the community

Introdução: Problemas de saúde podem afetar negativamente nos aspectos físicos e psicológicos, influenciando a qualidade de vida dos idosos. O objetivo deste estudo foi analisar os efeitos da atividade física sobre a qualidade de vida, ansiedade e depressão na população idosa. Métodos: Foi realizado estudo transversal com 200 idosos de ambos os sexos, divididos em dois grupos: um grupo com 100 idosos envolvidos em atividades físicas do centro social para idosos; outro composto por 100 sujeitos que viviam na comunidade, mas não estavam envolvidos em atividades físicas. Os instrumentos utilizados para avaliação das atividades físicas, qualidade de vida, ansiedade e depressão foram, respectivamente: o questionário de Baecke modificado; o Questionário de Qualidade de Vida (SF-36); e a Escala Hospitalar de Ansiedade e Depressão (HADS). Os dados foram analisados por testes t de Student, Pearson (r) e análise de variância (ANOVA), com odds ratio e nível de significância de 5% (p<0,05). Resultados: Observamos que o grupo ativo apresentou maiores escores de atividade física e qualidade de vida. Por outro lado, o grupo sedentário revelou maiores escores de ansiedade e depressão. A avaliação dos dados revelou uma forte correlação entre os domínios qualidade de vida, nível de vitalidade e saúde mental (r=0,77). A razão de prevalência mostrou que a atividade física é fator de proteção contra ansiedade e depressão em idosos. Conclusão: Os achados sugerem uma correlação entre baixos níveis de atividade física e sintomas de ansiedade e depressão em idosos que vivem na comunidade. Palavras-chave: Envelhecimento, transtornos mentais orgânicos, atividade física, escalas. Abstract


Introduction
With the aging process, quality of life (QOL) among the elderly population may gradually decrease. 1 QOL can be conceptualized as the harmonious set of satisfactions that individuals get in their daily lives, which considers the physical, psychological, and social aspects of life. 1,2 Good QOL for the elderly can be defined as feeling better, properly carrying out their basic activities of daily living (ADLs), and living independently. 3 Therefore, QOL becomes a target for programs aimed at assisting the elderly. 4 Currently, we observe an increased incidence of psychological disorders in the elderly. The World Health Organization (WHO) estimates that approximately one of every 10 older adults might suffer from depression. 5 Depression is the second most common cause of physical and psychosocial disability in the general population, 6,7 falling behind only cardiovascular diseases. 8 It is a mental disorder often associated with increased psychological distress in the elderly. Some depressive symptoms may appear in the elderly due to the use of multiple medications, or after other psychiatric disorders, such as obsessive-compulsive disorder or panic disorder. 5,9,10 Anxiety is characterized by widespread, excessive, and unrealistic worries about daily life events or activities. This psychiatric disorder is also common in health professionals. Anxiety symptoms may occur on most days for at least six months. The most common symptoms include tachycardia, sleep problems, sweating, dizziness, gastrointestinal disorders, and nausea. 11,12 Thus, depression produces a delay in therapeutic response and worsens prognosis in patients with anxiety disorders, 10 most likely leading to suicide attempts in geriatric patients. 13 All of these factors impair QOL, favoring social isolation and the appearance of severe cases of clinical diseases. 14,15 Physical activity is defined as any bodily movement produced by skeletal muscles that requires expenditure of energy 16  Rehabilitative interventions must be programmed in order to meet the needs of each individual. 21 For this reason, regular physical activity practice should be a common habit in order to break the vicious circle of sedentary lifestyle, diseases, and incapacity. 19,22 Moreover, physical exercise may contribute to greater social participation, resulting in biopsychophysical benefits, and hence improving the QOL of the elderly. 23 In this context, assessing QOL, anxiety, depression, and physical activity levels (PAL) seems especially important in the elderly, since these aspects can speed up or slow down the symptoms associated with the prevalence of chronic degenerative diseases. 24 However, few data have been published in the literature about PAL among elderly people in the city of Cuiabá, either to support national and international comparisons or to suggest indicators for possible public health interventions.
Therefore, the aim of this general study was to evaluate PAL and its relationship with QOL, anxiety, and depression in the elderly. Our specific aim was to compare QOL, anxiety, and depression levels of sedentary and physically active older adults to assess the correlation between PAL and the presence of anxiety and depression in the community-dwelling older adults.

Data collection
The interviews were carried out in the premises of the Padre Firmo Social Center for the Elderly and the data were collected by the research team. All participants signed a written informed consent form prior to having their data collected.

Statistical analysis
We used the Shapiro-Wilk test to check the distribution of data samples. After that, we used descriptive statistics to calculate mean and standard deviation (SD) for the analyzed variables. We used unpaired Student's t-test for independent samples to compare the results of the two groups (active and sedentary). We used Pearson's correlation (r) to establish the possible relationship between the variables. ANOVA was used to detect possible differences between HADS-A and HADS-D. Pearson's chi-square test and logistic regression analysis were used with stepwise criteria for selection of variables, with measures of effect expressed as prevalence ratio. We adopted a 5% significance level (p<0.05).

Results
The sample of this study consisted of 200 non-  Table 1).  differences). We also observed that elderly people with higher vitality scores presented a strong correlation with mental health scores ( Table 3).
The prevalence ratio obtained showed that physical activity is a protective factor against anxiety and depression in the elderly ( Table 4).
The logistic regression model was adjusted with stepwise selection, and the protection ratio occurred in the categories with no symptoms for the variables general state of health and mental health score (Table 5).

Discussion
This study found that physically active elderly individuals had significantly higher overall QOL scores than their sedentary counterparts, who had the lowest results and a statistically significant relationship with anxiety and depression. However, from a physiological point of view, the aging process does not necessarily occur simultaneously to the advance of chronological age.
Aging can be influenced by multiple combined factors,   which include biological aging, disease occurrence, and certain lifestyle patterns, such as low PAL. 30 In our study, the highest scores obtained by the physically active older adults indicated a better QOL. 1 Therefore, the high scores observed for the various domains in this group (physical and social aspects, vitality, and functional capacity) had a positive influence on functional independence among elderly adults. Also, the highest scores obtained for the functional capacity domain were statistically associated with better general health state, in agreement with another study. 3 It has been suggested that functional limitations influence the behavior of older people. 14 In the SF-36, a high score for the physical appearance domain suggested that physically active elderly people had little professional or ADL limitation. 10 Thus, physical activity, when performed collectively, promoted both physical and psychological improvements. 9 The SF-36 also revealed that individuals with higher levels of involvement in social relationships were more active.
Thus, we can say that the higher the level of personal relationship involvement, the greater the social support Thus, it is suggested that regular physical activity can contribute to improved QOL. 1,26 In the present study, when comparing the results of anxiety and depression symptom measurements, a statistically significant difference was found. 14 Elderly people who exhibited symptoms of anxiety and depression had poorer QOL and a sedentary lifestyle. 1 Therefore, physical self-perception in the elderly increases their sense of competence, 32 making them believe in their ability to perform ADLs. These findings suggest that  Finally, we suggest that family members should encourage older people to take part in physical activities and stimulate their participation in activities offered by social centers for the elderly. These simple measures could contribute to a better aging process. We plan to extend our research into this topic with further tests and examinations.
It was concluded that PAL may contribute to QOL and reduce the symptoms of anxiety and depression in the elderly. In this way, it can maintain physical and functional abilities, vitality and psychological state. Our study revealed that active seniors have better QOL and fewer symptoms of anxiety and depression than their sedentary peers do. Therefore, it is important that day centers for the elderly offer physical activities in public and private spaces. Among all strategies known to ensure the promotion of elderly health, the regular practice of physical activity in urban and regional health centers should be prioritized.