ABSTRACT
The aim of this study was to verify the effects of an online training program on aerobic capacity, quality of life, depressive symptoms and quality of sleep in elderly people with cardiovascular risk factors. A multicomponent training program was applied for 12 weeks and outcomes were assessed before and after the intervention. Twelve elderly people participated (69.08 ± 4.54 years; 41.67% women), with adherence of 49.17%. Worsening in sleep quality was observed (p = 0.016), and no change in other outcomes. In conclusion, the training program possibly helped maintain aerobic capacity, quality of life and depressive symptoms in elderly people with cardiovascular risk factors during the COVID-19 pandemic.
Keywords: COVID-19; Telerehabilitation; Exercise; Elderly health
RESUMO
O objetivo deste estudo foi verificar os efeitos de um programa de treinamento online na capacidade aeróbia, qualidade de vida, sintomas depressivos e qualidade do sono de idosos com fatores de risco cardiovascular. Um programa de treinamento multicomponente foi aplicado por 12 semanas e os desfechos foram avaliados antes e após a intervenção. Participaram 12 idosos (69.08 ± 4.54 anos; 41.67% mulheres), com aderência de 49.17%. Foi observada piora da qualidade do sono (p = 0.016), e nenhuma mudança para os demais desfechos. Em conclusão, o programa de treinamento possivelmente auxiliou na manutenção da capacidade aeróbia, na qualidade de vida e nos sintomas depressivos em idosos com fatores de risco cardiovascular durante a pandemia de COVID-19.
Palavras-chave: COVID-19; Tele reabilitação; Exercício físico; Saúde do idoso
RESUMEN
El objetivo del estudio fue verificar los efectos de un programa de entrenamiento online sobre la capacidad aeróbica, la calidad de vida, los síntomas depresivos y la calidad del sueño en personas mayores con factores de riesgo cardiovascular. Se aplicó un programa de entrenamiento multicomponente por 12 semanas y se evaluaron los resultados antes y después. Participaron 12 adultos mayores (69.08±4.54 años; 41.67% mujeres), con adherencia del 49.17%. Se observó una reducción de la calidad del sueño (p = 0.016) y ningún cambio en los otros resultados. En conclusión, el programa de entrenamiento posiblemente ayudó a mantener la capacidad aeróbica, la calidad de vida y los síntomas depresivos en personas mayores con factores de riesgo cardiovascular durante la pandemia de COVID-19.
Palabras-clave: COVID-19; Telerehabilitación; Ejercicio físico; Salud del anciano
INTRODUCTION
In December 2019, a new coronavirus called SARS-CoV-2 emerged and caused a worldwide pandemic (Wu et al., 2020). Older adults, people with obesity, hypertension, diabetes, and cardiovascular diseases were classified as a population at higher risk of mortality and severity of infection with the new coronavirus (Hu and Wang 2021; Dessie and Zewotir 2021). An alternative to contain the spread of the disease was the implementation of social isolation.
Although necessary, social isolation made several activities more difficult, such as the practice of physical activity (Pitanga et al., 2020). This strategy negatively affected the health of older adults and cardiovascular risk indicators, especially in those over 50 years of age, while physical activity levels decreased (Jiménez-Pavón et al., 2020; Ramírez Manent et al., 2022). Additionally, other factors such as poor sleep quality, and increased levels of depression, stress, and anxiety were observed in the elderly population due to social isolation (Sepúlveda-Loyola et al., 2020).
The World Health Organization suggested that people without any respiratory symptoms remain active during isolation, for example by following online classes with activities that promote relaxation (WHO,2022). In the same line, institutions such as the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) have guided the practice of exercises at home with the help of online classes/videos to maintain physical and mental health in the elderly (Sepúlveda-Loyola et al., 2020). However, throughout the pandemic, there was a decrease in the practice of exercise and a decline in the physical fitness of older adults (Oliveira et al., 2022), but an involvement in exercise programs provided positive effects in improving the physical and mental well-being of this population (Oliveira et al., 2021; De Maio et al., 2022).
Online classes were considered low-cost strategies that contributed to maintaining an active lifestyle with home training programs (De Maio et al., 2022). Through this strategy, an improvement in the physical function and life quality of patients with chronic diseases was observed (Brown et al., 2022), and in older adults with or without comorbidities (De Maio et al., 2022). The online training programs reported in these reviews primarily used strength and/or aerobic (Brown et al., 2022), or balance and/or strength training (De Maio et al., 2022), and many were not delivered in the context of social isolation. A training program that is equally effective in terms of life quality and functional capacity outcomes in older adults is multicomponent training, which combines strength, aerobic, balance, and flexibility exercises (Bouaziz et al., 2016). The investigation of this training method is important in the pandemic context, because of its many benefits to physical and mental health, in addition to knowing its impacts on the health of elderly people with cardiovascular risk factors.
In this sense, the objective of the present study was to verify the effects of an online multicomponent training program on the functional capacity, quality of life, depressive symptoms, and sleep quality of older adults with cardiovascular risk factors, in the context of the COVID-19 pandemic.
METHODS
This is a quasi-experimental pragmatic study. The dissemination of the study was carried out among participants of the Cardiorespiratory Prevention and Rehabilitation Program (PROCOR), which is a program of the Federal University of Santa Catarina (UFSC) aimed at the community. PROCOR activities were carried out in person at UFSC, however, due to the pandemic, activities were suspended for one year and six months. Thus, a program was proposed through supervised online classes with the aim of returning to PROCOR activities. The following eligibility criteria were used: accepting the practice of online training and having at least one cardiovascular risk factor (diabetes, hypertension, hypercholesterolemia).
All participants were informed of the research procedures and consented to their participation by signing an informed consent form. This study was approved by the local ethics committee (4.800.271 [[Q2: Q2]]).
Experimental protocol
A meeting in a virtual environment with all participants was held to find out the expectations regarding the new training proposal. In this meeting, the importance of performing the assessments, as well as self-control and self-monitoring of blood pressure, was explained.
Subsequently, the participants were contacted by the researchers to the assessments, and a link to the Google Meet® platform was made available to the participant and in this virtual environment, the script for the assessments was explained. The researcher provided a link to the Google Forms® tool for the participant to answer the questionnaires about quality of life, depressive symptoms and sleep quality. Then, the researcher and the participant met again in the virtual environment for the application of the 2-minute step test. This evaluation procedure was performed before and after the 12 weeks of intervention.
Assessment protocols
Anamnesis was applied to characterize the participants regarding sociodemographic characteristics and health conditions, especially cardiovascular health and its risk factors, aspects related to contamination by COVID-19 and practice of physical activity.
The 2-minute step test, used to assess functional capacity, followed the protocol established by Rikli and Jones (Rikli and Jones, 1999). For the test to be carried out, the camera was requested to be positioned in such a way as to allow adequate viewing of the participant.
Quality of life was assessed using the World Health Organization Quality of Life (WHOQOL-8) questionnaire (Pires et al., 2018). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) (Santos et al., 2013). Sleep quality was determined by the Pittsburgh Sleep Quality Index (Bertolazi et al., 2011).
Intervention
Twelve weeks of multicomponent training were carried out, with supervised guidance through the Google Meet® platform. Three weekly sessions lasting 40 minutes each were held. Aerobic and strength exercises were combined in two training sessions (Mondays and Fridays), and one session (Wednesday) consisted of flexibility/mobility/balance and relaxation exercises. All sessions were taught by physical education professionals or by a specific student in the training program.
The applied training model was the undulatory periodization. For the sessions that combined aerobic and strength exercises, there was an alternation of intensity, in which one week was performed at low intensity and the following week at moderate intensity. For the Wednesday sessions, the first six weeks were performed at low intensity, and in the following six weeks, the exercises were performed at moderate intensity.
The sessions with aerobic and strength exercises were performed with two minutes of warm-up, followed by the main part, and ending with 5 minutes of stretching. In the low intensity sessions, 2 sets of 30 seconds were performed in each strength exercise, performed with the highest possible number of repetitions, with a 1-minute rest period between sets. In moderate-intensity sessions, 3 sets of 20 seconds were performed, with a 45-second interval between them. Six exercises were performed alternately per segment (squat, push-ups, standing plantar flexion, rowing with bar, hip extension, push press).
Among the strength exercises, movements that had an aerobic character, such as jumping jacks and stationary running, were carried out and exercise intensity was controlled using the Rated Perceived Exertion (RPE) scale (Borg, 6 to 20). In low intensity sessions, one minute in RPE 11 was performed and in moderate intensity sessions, the time was reduced to 45 seconds (RPE 11 – 13).
Wednesday's sessions consisted of exercises for joint mobility, balance work with unipodal exercises, and stretching for large muscle groups, while relaxation was performed with breathing techniques for 5 minutes. For periodization two strategies were used: increasing the complexity of the exercises or increasing the volume.
Statistical analysis
To characterize the sample, continuous variables were expressed as mean and standard deviation, and categorical variables as relative frequency. The Shapiro-Wilk test was applied to verify the normality of the data and the Student’s t-test for pre- and post-intervention comparisons. Additionally, the effect size was calculated using Cohen's d test (Cohen, 1998), with the following classification: small (0.20 ≤ d < 0.50); medium (0.50 ≤ d <0.80), and large (d ≥ 0.80). The significance level adopted was 0.05. All analyzes were performed using SPSS, version 21.0.
RESULTS
Twenty-four patients were considered eligible to participate in the proposed activity, but 12 participants (69.08 ± 4.54 years) attended the sessions. Four participants achieved adherence to the program equal to or greater than 70% and eight participants performed at least one session, with an average adherence of 32%. Attendance at the training program by the 12 participants was 49.17 ± 28.98%. Table 1 presents the sociodemographic and health characteristics of the 12 participants who carried out the training sessions.
After 12 weeks of multicomponent training, maintenance of aerobic capacity, quality of life, and depressive symptoms was observed, with a slight deterioration in the participants' sleep quality (Table 2).
Effects of the intervention on aerobic capacity, quality of life, depressive symptoms and sleep quality (n=12).
DISCUSSION
The present study aimed to evaluate the effects of the online multicomponent training program on functional capacity, quality of life, depressive symptoms, and sleep quality in older adults with cardiovascular risk factors. As the main results, it was observed that there was the maintenance of functional capacity, quality of life and depressive symptoms, and worsening of sleep quality.
The 2-minute step test is an instrument with good sensitivity and specificity to assess functional capacity, with a cutoff point for hypertensive elderly people of 69 steps to identify normal capacity (Guedes et al., 2015). Rikli and Jones (1999) verified that the average value of the population aged 60 to 69 years is 104 steps, exactly the one found in our sample before the intervention. This means that participants were in good physical condition for this outcome prior to the training program, which may have contributed to the lack of results. Despite this condition, the functional capacity of the participants was maintained, even with low adherence to training.
Quality of life is defined as “an individual's perception of their position in life, in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns” (WHO, 1994). Therefore, the concept has a multifactorial dimension and demonstrates that quality of life should not be interpreted only from the perspective of an individual's levels of physical activity. In the context of a pandemic, there was a more pronounced reduction in quality of life in young individuals than in elderly (Bidzan-Bluma et al., 2020; Eicher et al., 2021). In this scenario, possibly, the quality of life of the older adult participants in our study may not have worsened with the pandemic, and this contributed to the lack of results with the proposed training.
In line with the behavior observed for quality of life, Nam et al. (2021) found that elderly are also less affected by symptoms of depression than younger people, in the context of social isolation. In addition, maintaining light physical activity levels during social isolation has been shown to help alleviate the negative impacts on mental health/depression (Callow et al., 2020), which could also justify the behavior in this outcome. Therefore, despite low adherence to the training program, we could speculate that it was sufficient to maintain depressive symptoms.
In our study, we observed a reduction in the participants' sleep quality after the training period. According to Neculicioiu et al. (2022), problems related to sleep quality affected older adults before the pandemic, but during this period these problems could be even more aggravated. In a multicenter study, a worsening of sleep quality and in physical activity levels was observed when comparing moments before and during social isolation, but weak correlations were observed between these two factors (Ammar et al., 2021). Because it is a multifactorial measure (Neculicioiu et al., 2022), other factors not evaluated in our study may have influenced this result. In addition, low adherence to the training program may have contributed to the lack of improvement in the participants' sleep quality.
The loneliness caused by the pandemic affected the elderly population, therefore, online social support should be used as a strategy to reduce this negative effect (Sayin Kasar and Karaman, 2021). Although our initiative was a valid strategy, we cannot rule out the fact that there was less social contact between participants compared to the face-to-face training program. This, associated with the low frequency of participants, maybe some of the factors responsible for the lack of positive results in the outcomes of quality of life, depressive symptoms, and sleep quality. However, the training program may have contributed in some way to the non-worsening of the physical conditions of the participants, which can be highlighted as a positive point of the intervention.
It is important to report some limitations present in our study. The study was designed to assist participants in a project aimed at the community and this made it impossible to form a control group. The pre-training assessments were carried out while the pandemic, so we do not know how much this context could have already affected the outcomes analyzed. In addition, familiarization sessions with the stationary gait test were not performed. However, as strengths, our study brings an online multicomponent training program that is safe, as no adverse events were reported by participants, with low cost and easy applicability, which can also be applied beyond the pandemic scenario.
CONCLUSION
We can conclude that this online multicomponent exercise program, during the pandemic, despite low adherence, possibly helped maintain the functional capacity, quality of life, and mental health of the elderly people with cardiovascular risk factors.
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FUNDING
The present work did not receive financial support of any nature for its realization.
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Publication Dates
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Publication in this collection
13 Dec 2024 -
Date of issue
2024
History
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Received
16 Feb 2024 -
Accepted
16 Oct 2024