Introduction

Population aging is a major challenge for the health system in Brazil, thus, one of the strategies is ensuring active and healthy aging through integrated actions at all levels of care, including strategies that shall promote health ^{1), (2}.

Regular physical activity contributes to reduce the complications of non-communicable chronic diseases that mainly affect the elderly, in addition to reducing costs, increasing social benefits and positively interfering in their quality of life ³. Furthermore, physical activity practice has been increasingly recommended due to its recognized physical, psychological and social benefits, especially among the elderly, since it promotes independence, health and quality of life; moreover, it shall reduce the use of the health service and medicines, the risk of developing chronic illnesses or diseases, death and institutionalization ⁴.

Surveillance and monitoring studies in physical activity have pointed to high prevalence of physical inactivity among the elderly in different regions of the world, such as Australia (50.8%), New Zealand (51.4%), Colombia (62.4%), Switzerland (67.5%) and Sweden representing the highest rate 72.2%. This prevalence in Brazil corresponds to 59.3% [5]; in the same way, it has been characterized by presenting worrying data regarding the prevalence of physical inactivity in the elderly population ⁶.

With the purpose of incorporating actions that might promote the quality of life in both the routine of the health services and the daily life of individuals, considering the reduction of morbimortality, complications of chronic noncommunicable diseases, and the number of hypertensive and diabetic older people. In addition to the health benefits through physical activity, the Fitness zone (FZ) was implanted by the City Hall of Maringá city, state of Paraná (PR) through a partnership with the Secretary of State for Health and Social Care, the Secretary of State for Sport, and private companies that support the equipment purchase.

Maringá is a municipality located in the north of Paraná. In the last Demographic Census of 2010, the city of Maringá had 357,077 inhabitants and of these, 12.2% are elderly. The municipality has a population density of 733.14 inhabitants per km². Considering households with monthly incomes of up to half a minimum wage per person, it had 26.1% of the population in these conditions, which placed it in position 377 of 399 among the state cities and in position 5,233 of 5,570 among the cities of Brazil. In addition, it presents 83% of households with adequate sanitary sewage, 97.3% of urban dwellings in public roads with afforestation and 90.6% of urban dwellings in public roads with adequate urbanization (presence of manhole, sidewalk, paving and curb) ⁷.

These FZs are made up of metallic equipment that can be used for performing stretching and muscular endurance exercises, and working aerobic capacity as well. In 2006, the first FZ was installed in Maringá, and in 2012 there were 50 FZs strategically located near the Basic Health Units (BHU) in order to facilitate the involvement of the professionals of the Family Health Strategy (FHS) and Expanded Family Health Center (EFHC) ⁸.

From a practical standpoint, this study is relevant insofar as it provides information on the elements that interfere in the level of physical activity of the elderly that attend the FZ, providing parameters for the development of actions to increase the practice of physical activity among the elderly.

In view of the above, this study aimed at identifying the level of physical activity and its associated factors related to the elderly who usually go to third age fitness centers in Maringá/PR.

Methods

Results

Out of the 970 subjects assessed, 728 (75.1%) were classified as active/very active, whereas 242 (24.9%) were classified as irregularly active. When analyzing the association between the physical activity level and the sociodemographic variables, a significant association was found only related to the marital status (P = 0.047) and education (P = 0.001), which indicates that being married and having completed higher education is significantly associated with higher physical activity level. (Table 1).

Different from the sociodemographic variables, the majority of health-related variables were significantly associated (P < 0.05) with the physical activity level (Table 2). There was a significant association between the physical activity level and health perception (P = 0.037), the amount of medicines used (P = 0.008), and history of near-falls in the last semester (P = 0.038). It is worth mentioning that the excellent health perception, the non-use of medicines and no history of near-falls were associated with the physical activity practice.

The analysis according to the diseases reported by the subjects (Table 3), only diabetes (P = 0.003) and osteoporosis (P = 0.001) were significantly associated with the physical activity level. It is worth mentioning that the absence of diabetes and osteoporosis was associated with physical activity practice.

Table 4 shows the sociodemographic and health factors associated with the active/very active physical activity levels of those who practice exercises. Considering the crude analysis, there was a significant association (P < 0.05) of the active/very active physical activity level with marital status, health self-perception, amount of medications, near-falls history, diabetes and osteoporosis.

When the analysis was adjusted by all the model variables (Table 4), only the marital status, near-fall history and osteoporosis were associated with the active/very active physical activity level. It is worth mentioning that the subjects who had no history of near-falls in the last six months and who did not have osteoporosis were 1.671 (95% CI = 1.009-2.613) and 1.891 (95% CI = 1.008-2.915) times more likely to be active/very active when compared to the elderly who had near-falls in the last semester and who had osteoporosis. The marital status (married) was seen as a protection factor, that is, the married women are 50% more likely to be physically active than the single ones, and 43% more likely than the divorced individuals.

Discussion

In this study, it was found that the elderly who resort to FZ are mostly physically active, indicating that these physical activity leisure spaces are important so that the elderly can be on the move. The literature shows that the benefits of physical activity and longevity are consensual among the health professionals who emphasize the importance of stimulating physical activity practice in public health actions. However, few studies have been carried out with individuals who go to FZ, which makes it difficult to compare the results of this research.

Most of the elderly herein assessed were classified by the IPAQ as active/very active subjects, and 24.9% as sedentary/irregularly active subjects. There was a lower rate of physical inactivity than that observed in a population of older people in the cities of Rio Grande do Sul and Santa Catarina (47.3%), and in some cities of the Northeast region of the country (67.5%) ¹³. Considering the worldwide prevalence of physical inactivity (21.4%), estimated by Dumith et al. ¹⁴ the frequency of such behavior in the population of the present study must be considered as adequate. National initiatives, such as the third age fitness centers for the elderly are useful for reducing the sedentary lifestyle in the population.

There was a statistically significant association with marital status and education. There is no consensus in the literature between the physical activity level and marital status. Some studies have found greater inactivity for divorced individuals and widowers ¹⁵, and others in individuals living with their partners ¹⁶. Education is directly related to financial conditions. Cassou ¹⁷ and Pitanga and Lessa ¹⁵ reported that people from low-income and education segments would have less access to the equipment, adequate safe public locations for physical activity practice, or even to private high-paid gyms. Moreover, these subjects do not have information either on physical activity or health, nor guidance from health professionals, in addition to their life conditions that prevent the incorporation of healthy practices. According to Pan et al. ¹⁸, individuals with a higher education level, as well as a higher income, have more opportunities, besides living in a social environment in which the practice is recognized by their counterparts as being favorable to health, which may facilitate accession. According to the authors, these groups tend to show better health conditions, better social support, and assimilate more easily the recommendations and benefits of regular physical activity ¹⁹.

The factors related to good health status (good health perception, absence of diabetes and osteoporosis, non-use or less medication use, no history of falls) are associated with greater physical activity practice, as shown in the present study. According to Lima-Costa, Firmo and Uchôa ²⁰ and Pagotto, Bachion and Silveira ²¹ health self-perception is considered an important indicator of the elderly health status, since it incorporates physical, cognitive and emotional aspects, as well as the aspects related to well-being and satisfaction with life itself. In addition, such self-protection has been widely used in population studies with older people because it is consistently associated with morbimortality and functional decline in this age group ^22)-(24.

The greater use of medicines by the elderly is related to a high frequency of chronic diseases and pain. Inactive long-lived older women have reported that pain in the lower and upper limbs, lumbar and/or cervical spine, and the body in general, makes it difficult for them to practice regular physical activity ²⁵, and accomplish habitual tasks. Moreover, considering daily life, the low physical activity level of people must lead to functional mobility loss, strength and muscular endurance, which may cause falls. Diseases and disability reduce the physical activity level which, in turn, predisposes the elderly to a greater risk of diseases and disability ²⁶. On the other hand, the regular physical activity practice shall positively interfere in the improvement of pain and use of medicines. There is strong epidemiological evidence that an active lifestyle is a fundamental factor in the prevention, treatment and control of chronic diseases ²⁷.

Other studies were also carried out with the elderly in the gyms of the Third Age in the state of Paraná ^28)-(29. One of them in Maringá - PR, analyzed the behavior of blood pressure and heart rate, showing that these sites are important for maintaining cardiovascular health ²⁸. In addition, another study in Matelândia - PR identified the factors associated with the physical activity of the elderly and verified a large number of active / very active elderly, and this was associated with lower age, less use of medication, use of medication and indication of physical activity ²⁹.

The cross-sectional model is a limitation of this study because it restricts the assessment of the cause and the variables effect, and, thus, the interpretation of the results must be made with caution. The use of information referred to physical activity by means of a questionnaire is also a limitation, since it confers a greater margin of error when compared to the direct measures of the physical activity level that use measuring equipment. However, the advantages of using self-referenced questionnaires refer to the low cost and speed to obtain the data ³⁰.

Conclusion

It was concluded that sociodemographic variables and health conditions are associated to the physical activity level. Specifically, being married, having completed higher education, perceiving with excellent health, the non-use of medicines, no history of near-falls, the absence of diabetes and osteoporosis were associated with the higher physical activity level. Further, elderly who reported the absence of a history of near falls and osteoporosis have more chance to be physically active. From a practical point of view, creating leisure spaces where the elderly can practice physical activities, such as the FZ, is important for their physical maintenance, in addition to preventing falls and diseases, such as osteoporosis, since a good health condition favor the permanence of the elderly in physical activities.