Factors associated with physical activity inleisure fail between elderly

Abstracts

INTRODUÇÃO: As modificações estruturais e funcionais observa-das no envelhecimento, associadas ao sedentaris-mo, aceleram o declínio da capacidade funcional. OBJETIVO: Analisar os fatores associados à atividade física insuficiente no lazer entre idosos. MÉTODOS: Estudo transversal com amostra constituída de 562 indivíduos residentes no município de Feira de Santana, BA, 69,6% do sexo feminino e 30,4% do sexo masculino com média de idade de 68,93 ± 7,05 anos. Foi utilizado um formulário contendo informações sociodemográficas, doenças referidas e participação em atividades físicas no lazer. A participação em atividade física no lazer foi avaliada segundo autopercepção do tipo e da intensidade da atividade (leve moderada ou pesada). Para análise estatística, foi utilizada a técnica de regressão logística, com o cálculo das razões de prevalência, intervalo de confiança (95%) e nível de significância p≤0,05. RESULTADOS: Entre os indivíduos estudados, apenas 18,3% foram classificados como ativos no lazer. A população investigada apresenta uma elevada frequência de indivíduos inativos no lazer, principalmente entre as pessoas de baixa renda e entre aqueles com idades mais avançadas. CONCLUSÃO: Estes achados fomentam a discussão sobre a necessidade de implementação de políticas públicas de saúde e a criação de espaços de prática do lazer ativo destinados a população idosa no âmbito do SUS.

atividade física; estudos transversais; envelhecimento; idoso

ORIGINAL ARTICLE

EXERCISE AND SPORTS MEDICINE CLINIC

Factors associated with physical activity inleisure fail between elderly

Saulo Vasconcelos Rocha^I; Maura Maria Guimarães de Almeida^II; Tânia Maria de Araújo^II; Loiamara Barreto Santos^I; Wisla Keile Medeiros Rodrigues^I

^IUniversidade Estadual do Sudoeste da Bahia (UESB), Brasil

^IIUniversidade Estadual de Feira de Santana (UEFS) – Feira de Santana, BA, Brasil

^{Mailing address}

ABSTRACT

INTRODUCTION: The structural and functional alterations seen in aging, associated with a sedentary lifestyle, accelarate the decline of functional ability.

OBJECTIVE: The purpose of this study was to analyze the factors associated with insufficient physical activity during leisure time among older adults.

METHOD: Cross sectional sample consisting of 562 individuals living in the city of Feira de Santana, 69.6% female and 30.4% male with a mean age of 68.93 ± 7.05 years. We used a questionnaire containing sociodemographic information, such diseases and participation in physical activity during leisure time. Participation in leisure physical activity was assessed by self-perception of the type and intensity of activity (mild moderate or heavy). For statistical analysis we used logistic regression, calculating the prevalence ratios, confidence intervals (95%) and significance level p ≤ 0.05.

RESULTS: Among the subjects studied, only 18.3% were classified as active during leisure time. The investigated population has a high frequency of individuals inactive during leisure time, especially among low-income people and those with older ages.

CONCLUSION: These findings encourage discussion of the need to implement public health policies and the creation of spaces for the practice of leisure activities for the elderly in the NHS.

Keywords: motor activity physical activity, cross-sectional studies, aging, elderly.

INTRODUCTION

Aging is a complex process which involves a series of factors which interact among each other and influence the way which we reach a certain age¹. In Brazil, the growth of the older population is a current and consolidated event which demands immediate facing and prevention strategies providing hence active, healthy and independent aging².

The structural and functional alterations observed in aging, aassociated with sedentarism, accelerate the decline of functional capacity, facilitating both development of chronic-degenerative diseases, physical incapacity, colon, lung and prostate cancer, as well as cardiovascular diseases³. Therefore, the need to understand which factors contribute to the process and in the adoption of healthier behavior is evident⁴. When studying these factors in the elderly population, it is necessary to determine the amplitude and mechanisms in which physical activity may improve health, functional capacity, quality of life and independence in this population.

Sedentarism or insufficient leisure physical activity is associated with blood hypertension and diabetes^5,6, with increase in the number of hospitalizations⁷. It is more prevalent in women⁸, elderly¹and individuals with low educational level⁵. Increase in the level of physical activity may cause positive effects among individuals at advanced ages, among which, improvement in muscular strength and resistance; increase of the aerobic capacity; greater articular flexibility; better balance and coordination; greater psychological wellness; weight loss and better administration of chronic diseases or defficiencies⁹. These potential benefits may result in better functional capacity, kept or increased, favoring hence the reversion of the fragility condition¹⁰, as well as decrease the risk of early mortality in those individuals with good physical fitness and with high energy expenditure. Despite all the mentioned benefits, studies about physical activity among the elderly residents in the northeastern part of Brazil are still scarce.The knowledge about the active leisure behavior and its determinants will possible ground the managing of activities which promote leisure physical activities practice among the elderly, producing hence useful information for the design of physical activity programs aimed at this population.Based on this scenario, the aim of this investigation was to analyze the frequency and the factors associated with insufficient leisure physical activity among the elderly residents in urban areas of a county in the northeast of Brazil.

METHODS

The data of this study were obtained from the home inquiry of Characterization of Mental Health of the Feira de Santanacounty,Bahia, conducted by the Epidemiology Center from the State University of Feira de Santana, in 2007. It is a transversal study involving a representative sample of the population with 15 or more years of residency in urban areas, according to definition from IBGE (urban area means the internal area to the urban perimeter of a city or village, defined by municipal law) of the Feira de Santana county. The sample was randomly selected. In this questionnaire, 3,597 individuals were interviewed.

Feira de Santana is situated 116 km from Salvador, the capital of Bahia state. It is the second biggest city in the state, being the 31^st Brazilian county, the 13^th non-capital county most populated in the country. In 2007, its total population was 571,997 inhabitants, being 41.466 60 years old or older than that.

Sample size was calculated using the prevalence of common mental disorders estimation of 24%¹¹, sample error of 3%, with 95% of confidence. After the separameters were considered, a sample of 800 individuals was established. Considering the effect of the study outlining (by conglomerate sampling) and the refusals and losses around 20%, the sample size was defined at 1,920 individuals.

This study used a population cohort analyzing only the data of the population aged 60 years or older (elderly). This study included 562 individuals of both sexes (15.6% of the participants of the applied questionnaire) age ≥ 60 years, age limit recommended by the WHO for countries in development for the definition of elderly. The data were collected through a form. The instrument had sociodemographic information (sex, age, marital status, education and income), information on self-referred diseases (diabetes, hypertension, high cholesterol, obesity, cancer, cardiopathy) and participation and time dedicated to leisure activities and leisure physical activity practice.

In order to evaluate sufficient leisure physical activity practice, the individuals were asked if they regularly participated in leisure physical activities, being these classified by the intensities according to the metabolic equivalents (MET): light (< 3 METs), moderate (3-6 METs) and heavy (>6 METs)¹².Those who practiced physical activity during leisurewith moderate or heavy intensity for more than 150 minutes/weekwere considered active during leisure and those who did not meet the classification were inactive. The procedure adopted was similar to the one in other studies found in the literature^13-15.

Initially, descriptive analysis was performed considering sociodemographic variables and presence of chronic diseases, with the aim to present the profile of the studied population.

The frequency of the sufficient leisure physical activity was estimated and stratified according to the sociodemographic variables (sex, age, income, educational status and marital status) and presence of chronic diseases (diabetes, hypertension, high cholesterol, obesity and cardiopathy).

Prevalence ratios and their respective confidence intervals at 95% were calculated.Statistical significance was measured through the Pearson chi-square test, adopting α=5%. Multivariate logistic regression analysis (MLRA), with exploratory aim was applied for simultaneous evaluation of the factors included in the study.

The MLRA was carried out according the procedures recommended by Hosmer & Lemeshow¹⁴ including the following steps: 1) verification of the assumptions; 2) pre-selection of basic variables; 3) pre-selection of interaction terms; 4) evaluation of confusion. The magnitude of the estimated variation coefficients and of the respective ORs of the main exposure variable (leisure physical activity) was verified for analysis of the potentially confusing variables.The variable was considered confusing when the coefficient of main exposure presented variation above 10%; 5) Analysis of logistic regression itself. The logistic regression adopted backward procedure for the selection of the best model. The variables which were associated with the response, that is to say, the ones which presented (p≤0.25), remained in the model.The effect alteration was assessed by similarity ratio test, adopting significance level of 20%. The complete model included the sociodemographic variables age and income.

Since the MLRA has been developed for use in case-control studies, producing OR measurements and not PR, the OR estimates use obtained in the MLRA has not been recommended for study of high-frequency effects, since in these cases the OR overestimates the considered effect. As the estimated leisure physical activity frequency was higher than 25%, it was necessary to calculate the PR estimates. Based on the parameters of the final model, the prevalence ratios and respective confidence intervals were estimated using the Delta Method, a program specifically developed for this purpose¹⁵.

Databank was designed with the software Epidata, version 3.1b. Analysis used the statistical packages SPSS (version 9.0) and R, version 2.7.2.

This research followed the ethical principles present in the Declaration of Helsinki and the Resolution196/96 from the National Health Board. The research protocols were evaluated and approved by the Human Research Ethics Committee of the State University of Feira de Santana (legal opinion # 042/06).

RESULTS

The characteristics of the sample are found in table 1. Higher percentage of women is observed (69.6%). There was prevalence of individuals in the age group between 60 and 79 years (91.3%) and the group of individuals who have a partner (50.2%). Concerning income and education, 81.7% made up to one minimum wage and 85.4% had finished elementary school.

Prevalence of chronic diseases was of 59.8% (table 2). Among the self-reported clinical conditions, the highest prevalence was observed for hypertension (59.8%) and high cholesterol(30.7%). The lowestprevalencewasfor obesity (9.3%).

The frequency of leisure physical activity participation was low: only 18.3% were classified as active during leisure. Therefore, 81.7% of the studied population was classified as insufficiently active during leisure activities.

The data of table 3 describe the association between leisure physical activities and sociodemographic characteristics.The frequency of leisure physical activity practice was higher among male individuals, from younger age groups, with income above one minimum wage, with higher educational levels, among those who do not have a partner, and who have reported chronic disease.

In the multivariate analysis for all factors assessed in the study, the following variables were retained in the final model obtained: age and income. Thus, these variables were associated with insufficient leisure physical activity practice at significant statistical levels (table 4).

DISCUSSION

Urban growth had decrease of spaces available for physical and leisure activities practice as a consequence.Such fact, joined with social problems such as urban violence, long work hours and technological easier access, favor the adoption of sedentary habits.

Taking into consideration this reality, the present study had the aim to analyze the frequency and factors associeted with insufficient leisure physical activity among elderly subjects resident in urban areas of one county in the northeast of Brazil.

It was observed in the studied population that the participation of elderly residents of urban areas in leisure physical activities was low: only 18.3%, that is, more than 80% of the elderly presented insufficient levels of leisure physical activity.

The findings in this research evidence data of high concern, since regular practice of physical activity is a protective behavior for the development of obesity, cardiovascular diseases, type II diabetes, colon cancer¹⁶and hypertension¹⁷, besides contributing to the improvement of wellness sensation¹⁸.

The practice of physical activities favors social interaction, improves self-assuredness (belief of the individual in his/her capacity to perform specific tasks) and provides higher sensation of control over the events and demands of the environment. Moreover, increase in the physical activity level is related to improvement in the depression and anxiety symptoms, better tolerance to stress and increase in self-esteem^19,20, reducing isolation and favoring socialization of new groups²¹.

In a study with elderly from Florianópolis²², SC, findings different from the ones found in the present study were observed, since most part of the elderly was considered non-sedentary (59.3%), being the domain leisure the one which contributed the most to the active condition of the male sex and the domain domestic activities to the female sex; another study carried out in the city of Pelotas²⁰ with male individuals from 40 years old corroborates the data of this research, with 82.9% of the individuals being classified as insufficiently active in leisure.

The regional characteristics concerning the access to physical activity practice and leisure activities may be important elements to explain the differences.

After the multivariate analysis, the age group and income variables kept statistically significant association with insufficient physical activity.

Evidence in the literature highlight that younger subjects, single, with lower number of children, with more years of education, higher income and white, presented higher physical activity level^23-25.

Insufficient spaces and available leisure activities in public spaces, joined with barriers such as: available time, need to compensate for low income of retirement, institutionalization and functional losses consequent of the aging process are aspects which may influence on the decrease of physical activity practice in the free time along the years.

In a study conducted in the city of Salvador, BA²⁶, prevalence of sedentarism in leisure of 72% was identified; being it more frequent in women aged between 40-59 years and men older than 60 years, in individuals with low educational level and among the married and separated, corroborating hence the findings of the present study. The life conditions and life style are crucial to determine existence conditions which characterize one population²⁷.

Possible contributions to the increase of the physical activity level of the population are the construction of leisure equipment (courts, walking tracks, soccer fields, swimming pools) and the designing of education and health programs aimed at changes in behavior and encouragement of adoption of public active life styles, such as inclusion of physical activities among the activities developed in the primary health care, through the Family Health Strategy.

Based on our findings here, prevention actions can be grounded on interventions which are able to lead to higher social integration with performance of active leisure activities and on public policies of better income distribution.

The results obtained represent useful information for health management, being rawmaterial for public policies of health intervention.

Among the limitations of the study, we can mention the outlining of the research itself. The fact of being a transversal study hampers the evaluation of direct cause relations among the studied variables. The sample plan was not designed for specific study of the elderly population (includes one population sample aged 15 years or older); therefore, some important aspects for this specific population group may have not been considered since it was not a sample selected to represent the elderly population of the county.

Moreover, life expectancy bias may have occurred, since it is a relevant aspect in studies with older individuals. Despite these limitations, the study assessed an expressive number of individuals (N= 562), including elderly residents of all the subdistricts of the studied county, which made is possible to estimate the frequency of leisure physical activities participation in this county and its relation with other variables.

CONCLUSION

Thus, the study was able to provide useful and valid information which may contribute to the policies on health attention and guarantee of quality of life in different phases of life and to guide intervention measures aimed at this population group which is experiencing continuous growth in the Brazilian population.

ACKNOWLEDGEMENTS

The Fapesb-CNPQ scholarship for the researcher in the Interinstitutional Doctorate Program –Federal University of Santa Catarina-State University of Santa Cruz.

All authors have declared there is not any potential conflict of interests concerning this article.

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Publication Dates

• Publication in this collection
  19 Aug 2013
• Date of issue
  June 2013