Open-access Effects of a remote multicomponent training intervention on quality of life of older people: a randomized controlled clinical trial

Efeitos de uma intervenção de treinamento remoto multicomponente na qualidade de vida de idosos: um ensaio clínico randomizado controlado

Efectos de una intervención de entrenamiento multicomponente a distancia sobre la calidad de vida de las personas mayores: un ensayo clínico controlado aleatorio

ABSTRACT

This study aimed to assess how remote multicomponent training group (MTG) influences the quality of life (QoL) among older individuals. Fifty-six participants (63 ± 2.93 years) were divided into two groups: the (MTG, n = 28) and the control group (CG, n = 28). The assessment of QoL used WHOQOL-BREF and WHOQOL-OLD. Data analysis employed Generalized Estimating Equations (ɑ= 0.05). The findings showed no significant differences in overall QoL or its domains when assessed using WHOQOL-BREF. However, WHOQOL-OLD revealed a noteworthy overall QoL enhancement (p = 0.049) in both groups. In conclusion, remote MTG was effective in enhancing QoL, particularly in domains associated with aging, such as Social Participation and Death and Dying.

Keywords:  Internet-based intervention; Healthy aging; Physical distancing; Circuit-based exercise

RESUMO

Este estudo teve como objetivo avaliar como o grupo de treinamento multicomponente remoto (GMT) influencia a qualidade de vida (QV) de idosos. Cinquenta e seis participantes (63 ± 2,93 anos) foram divididos em dois grupos: o (GMT, n = 28) e o grupo controle (GC, n = 28). A avaliação da QV utilizou o WHOQOL-BREF e o WHOQOL-OLD. A análise dos dados empregou Equações de Estimativa Generalizadas (ɑ= 0,05). Os achados não mostraram diferenças significativas na QV geral ou em seus domínios quando avaliada pelo WHOQOL-BREF. No entanto, o WHOQOL-OLD revelou uma notável melhoria geral da QV (p = 0,049) em ambos os grupos. Concluindo, o MTG remoto demonstrou eficiência na melhoria da QV, particularmente em domínios associados ao envelhecimento, como Participação Social e Morte e Morrer.

Palavras-chave:  Intervenção baseada em internet; Envelhecimento saudável; Distanciamento físico; Exercícios em circuitos

RESUMEN

Este estudio tuvo como objetivo evaluar cómo el grupo de entrenamiento multicomponente (MTG) remoto influye en la calidad de vida (CdV) entre las personas mayores. Cincuenta y seis participantes (63 ± 2,93 años) se dividieron en dos grupos: el (MTG, n = 28) y el grupo de control (CG, n = 28). La evaluación de la CV utilizó WHOQOL-BREF y WHOQOL-OLD. El análisis de datos empleó ecuaciones de estimación generalizadas (ɑ= 0,05). Los hallazgos no mostraron diferencias significativas en la calidad de vida general o sus dominios cuando se evaluaron mediante WHOQOL-BREF. Sin embargo, WHOQOL-OLD reveló una mejora notable en la calidad de vida general (p = 0,049) en ambos grupos. En conclusión, el MTG remoto demostró eficiencia para mejorar la calidad de vida, particularmente en dominios asociados con el envejecimiento, como la participación social y la muerte y los moribundos.

Palabras-clave:  Intervención basada en la internet; Envejecimiento saludable; Distanciamiento físico; Ejercicios en circuitos

INTRODUCTION

The coronavirus (Covid-19) pandemic was a global public health emergency that required governments to implement sanitary measures, such as social distancing and isolation (Brooks et al., 2020; Ornell et al., 2020).

Considering that the older people are more susceptible to fatal cases (Hashim et al., 2020), preventive measures, such as social isolation, were fundamental for the protection of this population at the most critical moment. On the other hand, social isolation has led to a series of limitations in accessing training centers and performing daily activities, which is expected to negatively affect the quality of life of the older adults (Newman-Norlund et al., 2022). Given that physical, psychological, and social factors modulate the quality of life, multicomponent training seems to be a more appropriate approach to treat different aspects of functional fitness and provide greater well-being in the older adult population (Jofré-Saldía et al., 2023; Chang et al., 2023).

Faced with this, an interesting alternative for maintaining an active lifestyle during the critical period of the Covid-19 pandemic was physical training performed at home, remotely conducted with a professional, which can be individualized or in a group. Previous evidence suggests that synchronous training has higher adherence rates than in-person training (Valenzuela et al., 2018). Specifically for older adults, the online exercise strategy allows for greater ease of access, lower financial and transportation costs, and reduced safety concerns related to leaving home (Fuentes Diaz et al., 2024). Regarding the delivery module, synchronous exercise sessions provide better adherence results among older participants compared to asynchronous sessions (Dagenais et al., 2023). Furthermore, Moratelli et al. (2022) observed that older people with neurological disorders reduced their physical exercise during the pandemic, considering that those who were physically active before isolation were less likely to become insufficiently active, unlike inactive individuals.

To date, evidence in the literature is focused on demonstrating the feasibility, adherence, and physical function of synchronous remote exercise training (Fuentes Diaz et al., 2024). To our knowledge, few studies have investigated outcomes associated with quality of life (Fuentes Diaz et al., 2024; Santinelli et al., 2021; Alpozgen et al., 2022), especially in moments after social isolation (Berní et al., 2023). In view of the above, maintaining an active lifestyle with physical exercise has become even more important during the pandemic period, in order to ensure a good QoL for the older population. Thus, the objective of the present study was to evaluate the effects of a remotely performed multicomponent training on QoL aspects of older people. We hypothesize that MTG will benefit positively in terms of quality of life outcomes while CG will maintain its baseline values.

MATERIALS AND METHODS

Study design

This is a randomized controlled clinical trial with a superiority design. The results presented in this paper are the secondary outcomes of the study. The trial was conducted according to CONSORT recommendations (Boutron et al., 2017) and registered in the Clinical Trials Brazilian Register (ReBEC - RBR-2t7pt25). The study was approved by the Research Ethics Committee of the Universidade Federal do Rio Grande do Sul (number 45736621.9.0000.5347) and followed the ethical standards of the Helsinki Declaration.

The intervention was performed with group multicomponent training (MTG) with 12 weeks of duration. The MTG remotely performed supervised exercises, while the control group (CG) received a booklet with physical exercises to be performed at home without supervision, in addition to weekly lectures held online with the theme of healthy aging.

Participants

Fifty-six healthy older people participated in the study. As inclusion criteria, the participants should: be aged between 60 and 70 years, not be practicing regular and systematic physical exercises for at least 12 months; be a resident of the State of Rio Grande do Sul; have internet access and device for video calling; not be a smoker; not have uncontrolled cardiovascular diseases or associated complications; not present musculoskeletal problems that prevent the practice of physical exercise; have available time to perform the exercise sessions.

Sample size calculation was performed using GPOWER software (version 3.1), adopting α=0.05 and a power of 95%. We used the test TUG effect size values ​​from the study by Brandão et al. (2021) because the primary outcome of the clinical trial was functional mobility. From the calculations, a sample size of at least fifteen volunteers in each group was required. Approximately twice as many participants were added to each group because a 47.4% dropout rate was observed after completing the first recruitment.

The sample was recruited through virtual posters disclosed in the main social media and in local media. The eligible candidates performed an assessment by video call in which they read and signed an informed consent form, as well as answered anamnesis and the International Physical Activity Questionnaire – short version (IPAQ-Bref) (Matsudo et al., 2012). The participants were randomized (RAND function - Excel 2016) into two groups according to the classification of physical activity levels: MTG, n = 28, and CG, n = 28.

Assessments

The assessments took place virtually through video calls and electronic Google forms. Initially, the evaluators sent a link via the messaging app for the participants to enter the virtual room. Then, the evaluator shared his/her screen to read the consent form and, after solving all doubts, the volunteer marked the specific field of the form to give his/her consent. After that, an anamnesis was carried out in the form of an interview, collecting data on age, body mass and height (self-reported), disease history, use of medication, time in social isolation and whether the participant had Covid-19.

After the virtual interview, the evaluator sent a message containing the link that gave access to the electronic form of the QoL questionnaires (WHOQOL-BREF and WHOQOL-OLD) for the participant to answer individually within 72 hours. The evaluators were properly familiarized and trained with the assessment instruments and were blinded regarding the group that each participant was randomized. QoL was measured using two questionnaires. The WHOQOL-BREF Questionnaire (Fleck et al., 2000) indicates general QoL through 26 questions, with scores ranging from 0-100 points. In the same sense, the WHOQOL-OLD (Fleck et al., 2003) is a questionnaire that assesses general QoL of the older people through 24 questions.

Intervention

The MTG carried out a remotely supervised group-based exercise intervention using the Google Meet platform. Training was held twice a week on non-consecutive days and the sessions were collectively performed. Before starting the training, two familiarization sessions with the exercise technique, the virtual environment and the Perceived Exertion Scale (6-20) (Borg, 1982) were carried out.

Training sessions lasted 45 min and were divided into three parts: warm-up (mobility exercises and dynamic stretching of the main joints used in training), main part (11 exercises divided into four blocks with one minute of rest between blocks) and cool down (passive stretching and breathing exercises involving the muscle groups worked in the exercise session). The exercises used in the main part were based on the MT method and were performed in circuits. Block one consisted of core strengthening exercises, blocks two and three were aimed at working upper and lower limbs movement patterns, and block four focused on aerobic conditioning exercises. Exercise intensity was controlled using the Perceived Exertion Scale (6-20) (Borg, 1982) and there was a progression of intensity, number of sets, stimulus/rest time and volume of the main part. To perform the strength exercises in blocks two and three, the participants used plastic bottles filled with water, varying the weight (0.5l to 5l) and the execution speed according to the RPE.

The CG was encouraged to participate in two activities characterized as a health education intervention. Firstly, a booklet (Supplementary Material) was delivered containing guidelines regarding the practice of physical exercises for balance, strength, and flexibility. Secondly, weekly virtual lectures were held on the theme of healthy aging (Supplementary Material). All participants were instructed not to join other regular physical activity programs.

Data analysis

Data are presented as mean and 95% Confidence Interval (95% CI). Normality was verified using the Shapiro-Wilk test, in which only the age variable had a non-parametric distribution. For descriptive analysis, Student's t-tests were used to compare the groups in the pre-intervention period. Comparisons between groups for QoL outcomes were performed using the Generalized Estimating Equations method, with group and time factors, and the complementary Bonferroni test. Outcomes were analyzed using per-protocol (PP) analysis, in which data from participants who performed at least one assessment were included. The significance level adopted was α= 0.05 and the statistical program used was SPSS (version 22.0).

RESULTS

Characterization

Three recruitments were carried out between May 2021 and April 2022 to reach the required sample. In total, 246 older people made contact to register, and only 56 met the inclusion criteria. Participants were then randomized into two groups (MTG, n = 28; CG, n = 28). Reasons for dropping out are reported in the flowchart (Figure 1).

Figure 1
Flowchart of the study participants.

Regarding sample characterization, MTG was significantly older compared to the CG (p = 0.029). On the other hand, there were no significant differences between groups for body mass; height; and body mass index. (Table 1).

Table 1
Characterization of both groups in the baseline moment.

Regarding QoL data assessed by the WHOQOL-BREF, in the analysis of overall QoL, there was no difference in group and time factors and a significant interaction between group and time (p = 0.894) (Table 2). In the analysis of the domains, no significant interactions were found for Physical; Psychological; Social Relationships; and Environment domains (Table 2).

Table 2
Results of quality of life (WHOQOL-BREF) after 12 weeks of intervention.

Regarding QoL data assessed by the WHOQOL-OLD, there was a significant improvement in time (p = 0.049) in both groups, with no difference between them and no significant interaction (Table 3). When further analyzing each domain, a significant interaction was observed for the Autonomy domain (p = 0.038), in which the MTG started the intervention with higher values compared to the CG and maintained the same values after 12 weeks. In turn, the CG achieved a significant improvement in this domain after 12 weeks (Table 3). Moreover, there were significant improvements over time in the Social Participation (p = 0.003) and Death and Dying (p = 0.021) domains for both groups, with no difference between them. Finally, no significant interactions were found for the Sensory Functioning; Past, Present and Future Activities and Intimacy domains (Table 3).

Table 3
Results of quality of life (WHOQOL-OLD) after 12 weeks of intervention.

DISCUSSION

The objective of the present study was to evaluate the effects of a remote multicomponent training intervention on the quality of life outcomes of older adults during the pandemic's social distancing. Interestingly, both the MTG and CG achieved significant improvements in overall QoL, as well as in the domains of Social Participation and Death and Dying. The results of the present study partially contradicted our initial hypotheses. While the positive result of the MTG was particularly expected, the improvement in the CG parameters was somewhat unexpected, given the superiority trial design.

There was already evidence in the literature concerning the positive impacts of physical exercise on the QoL of older people (Wei et al., 2022). However, most interventions were carried out before the pandemic period and in-person. In this sense, corroborating our findings, recent studies developed during the pandemic demonstrated that supervised remote exercises can also have a positive impact on people's QoL (Pérez de Sevilla et al., 2021; Alpozgen et al., 2022). Even with a short intervention period, Alpozgen et al. (2022) found significant improvements in the QoL of older people who performed remote supervised physical exercises, unlike the CG, which worsened their QoL after 6 weeks. In this study, the CG was only instructed to maintain their activities of daily living, unlike the CG of the present study, which received a booklet with exercises and weekly online lectures.

The findings are of great clinical importance, as quality of life is positively associated with functional mobility in older people (Davis et al., 2015). In this sense, greater mobility (resulting from multicomponent exercises) can be essential to improve tasks involving a motor-cognitive challenge (Ivaniski-Mello et al., 2023) and promote healthy aging.

Regarding the Social Participation domain of the WHOQOL-OLD, which involves opportunities to participate in community activities, satisfaction with the level of daily activity and the use of time (Fleck et al., 2006), we observed an improvement in this aspect in both groups. Such behavior can be explained by the fact that the exercise sessions were developed in real-time and collectively, in addition to having a small social interaction in the messaging app used to send messages to the MTG participants.

Although there were no moments when the CG interacted synchronously (on a video call) with the other participants, the fact that they received weekly content in the messaging app may have generated a feeling of collectivity and care, easing the feeling of loneliness. In fact, information and communication technologies foster new forms of socialization. They can be a valuable tool to maintain older people's mental health during periods of isolation (Llorente-Barroso et al., 2021).

Regarding the score of the Death and Dying domain of WHOQOL-OLD, our findings point to an improvement in this facet in both MTG and CG. Considering that physical exercise can improve the immune system (Scheffer and Latini. 2020), improve autonomy (Talar et al., 2021), fight anxiety and promote improvements in mental health (Callow et al., 2020), these may be possible factors that ease the feeling of death in this population.

Autonomy in older people plays a fundamental role in maintaining a good quality of life, since it is related to the individual ability to carry out daily activities, make their own decisions and do the things they want (Sánchez-García et al., 2017). Interestingly, only the CG in the present study achieved improvements in the autonomy domain. However, upon further analysis of the interaction, it was observed that the CG started the intervention with lower values than the MTG, but at the end of 12 weeks the values became similar between the two groups. In this sense, the maintenance of the autonomy values of the MTG can be explained by the fact that they already had values considered good even before starting the intervention (pre-training = 76.16 (95% CI: 71.06 - 81.25)). In this sense, it is worth mentioning that the CG received a booklet of physical exercises to be performed at home without supervision, which was not controlled or limited in terms of the weekly frequency in which the exercises were performed.

The CG obtained benefits similar to those of the group that performed remote physical exercises despite the superiority of the design. According to the meta-analysis by Zhao et al. (2021), interventions with health education groups benefit special populations' quality of life. When associated with other physical activities, health education interventions can lead to better results in functional capacity (Domingues et al., 2023) and COGNITIVE aspects (Wang et al., 2024) when compared to isolated health education interventions (Wang et al., 2024; Trombetti et al., 2018). Therefore, the present study's findings highlight the importance of physical exercise (whether supervised or not) and health education in facing emotional difficulties during social isolation. Future research could investigate whether there are differences between online synchronous exercise and home-based exercise regarding health parameters in older adults.

One of the limitations found in the present study concerns the recruitment of volunteers at different times of the pandemic, with varying guidelines regarding the need for isolation and social distancing, which can differently influence the quality of life of the participants. Furthermore, significant age differences were observed between the groups despite the randomization process, which may have influenced quality-of-life responses. Another limitation was the lack of control over cognitive decline. With the aging process and social isolation, older adults could have difficulty understanding how to report data characterizing, answer the quality of life questionnaire, and perform the exercises.

Thus, it is concluded that remote MTG was effective in enhancing QoL, particularly in domains associated with aging, such as Social Participation and Death and Dying. In addition, it should be noted that the recommendations in the exercise booklet and the health education videos had similar results to the intervention group and may also be a viable alternative.

Supplementary Material

Supplementary material accompanies this paper.

Physical activity booklet

This material is available as part of the online article from https://doi.org/10.1590/rbce.46.20240002

  • FUNDING
    The present work did not receive financial support of any nature for its realization.

REFERENCES

  • Alpozgen AZ, Kardes K, Acikbas E, Demirhan F, Sagir K, Avcil E. The effectiveness of synchronous tele-exercise to maintain the physical fitness, quality of life, and mood of older people: a randomized and controlled study. Eur Geriatr Med. 2022;13(5):1177-85. http://doi.org/10.1007/s41999-022-00672-y PMid:35881310.
    » http://doi.org/10.1007/s41999-022-00672-y
  • Berní FC, Kanitz AC, Miranda C, Oliveira DB, Bergamin M, Bullo V, et al. Effects of a remotely supervised physical training program combined with cognitive training for older individuals at increased risk of clinical-functional vulnerability: study protocol for a randomized clinical trial. Trials. 2023;24(1):547. http://doi.org/10.1186/s13063-023-07567-8 PMid:37599360.
    » http://doi.org/10.1186/s13063-023-07567-8
  • Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81. http://doi.org/10.1249/00005768-198205000-00012 PMid:7154893.
    » http://doi.org/10.1249/00005768-198205000-00012
  • Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med. 2017;167(1):40-7. http://doi.org/10.7326/M17-0046 PMid:28630973.
    » http://doi.org/10.7326/M17-0046
  • Brandão GS, Brandão GS, Sampaio AAC, Damas Andrade L, Fonseca AL, Campos FKR, et al. Home physical exercise improves functional mobility and quality of life in the elderly: a CONSORT-prospective, randomised controlled clinical trial. Int J Clin Pract. 2021;75(8):e14347. http://doi.org/10.1111/ijcp.14347 PMid:33977587.
    » http://doi.org/10.1111/ijcp.14347
  • Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-20. http://doi.org/10.1016/S0140-6736(20)30460-8 PMid:32112714.
    » http://doi.org/10.1016/S0140-6736(20)30460-8
  • Callow DD, Arnold-Nedimala NA, Jordan LS, Pena GS, Won J, Woodard JL, et al. The mental health benefits of physical activity in older adults survive the COVID-19 pandemic. Am J Geriatr Psychiatry. 2020;28(10):1046-57. http://doi.org/10.1016/j.jagp.2020.06.024 PMid:32713754.
    » http://doi.org/10.1016/j.jagp.2020.06.024
  • Chang SH, Chiang CC, Chien NH. Efficacy of a multicomponent exercise training program intervention in community-dwelling older adults during the COVID-19 pandemic: a cluster randomized controlled trial. Geriatr Nurs. 2023;49:148-56. http://doi.org/10.1016/j.gerinurse.2022.11.019 PMid:36528997.
    » http://doi.org/10.1016/j.gerinurse.2022.11.019
  • Dagenais M, Parker O, Galway S, Gammage K. Online exercise programming among older adults: a scoping review. J Aging Phys Act. 2023;31(2):289-302. http://doi.org/10.1123/japa.2021-0417 PMid:36087933.
    » http://doi.org/10.1123/japa.2021-0417
  • Davis JC, Bryan S, Best JR, Li LC, Hsu CL, Gomez C, et al. Mobility predicts change in older adults’ health-related quality of life: evidence from a Vancouver falls prevention prospective cohort study. Health Qual Life Outcomes. 2015;13(1):101. http://doi.org/10.1186/s12955-015-0299-0 PMid:26168922.
    » http://doi.org/10.1186/s12955-015-0299-0
  • Domingues LB, Payano CE, Peres MS, Sant’Anna VH, Cadore EL, Rodrigues-Krause JC, et al. Effects of dancing associated with resistance training on functional parameters and quality of life of aging women: a randomized controlled trial. J Aging Phys Act. 2023;31(6):995-1002. http://doi.org/10.1123/japa.2023-0010 PMid:37442550.
    » http://doi.org/10.1123/japa.2023-0010
  • Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida” WHOQOL-bref. Rev Saude Publica. 2000;34(2):178-83. http://doi.org/10.1590/S0034-89102000000200012 PMid:10881154.
    » http://doi.org/10.1590/S0034-89102000000200012
  • Fleck MP, Chachamovich E, Trentini CM. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saúde Pública. 2006;40(5):785-91. https://doi.org/10.1590/S0034-89102006000600007
    » https://doi.org/10.1590/S0034-89102006000600007
  • Fleck MP, Chachamovich E, Trentini CM. Projeto WHOQOL-OLD: método e resultados de grupos focais no Brasil. Rev Saude Publica. 2003;37(6):793-9. http://doi.org/10.1590/S0034-89102003000600016 PMid:14666311.
    » http://doi.org/10.1590/S0034-89102003000600016
  • Fuentes Diaz MFF, Leadbetter B, Pitre V, Nowell S, Sénéchal M, Bouchard DR. Synchronous group-based online exercise programs for older adults living in the community: a scoping review. J Aging Phys Act. 2024;1:1-15. http://doi.org/10.1123/japa.2023-0214
    » http://doi.org/10.1123/japa.2023-0214
  • Hashim M, Alsuwaidi AR, Khan G. Population risk factors for COVID-19 mortality in 93 countries. J Epidemiol Glob Health. 2020;10(3):204-8. http://doi.org/10.2991/jegh.k.200721.001 PMid:32954710.
    » http://doi.org/10.2991/jegh.k.200721.001
  • Ivaniski-Mello A, Müller VT, de Liz Alves L, Casal MZ, Haas AN, Correale L, et al. Determinants of dual-task gait speed in older adults with and without Parkinson’s disease. Int J Sports Med. 2023;44(10):744-50. http://doi.org/10.1055/a-2085-1429 PMid:37130568.
    » http://doi.org/10.1055/a-2085-1429
  • Jofré-Saldía E, Villalobos-Gorigoitía Á, Cofré-Bolados C, Ferrari G, Gea-García GM. Multicomponent training in progressive phases improves functional capacity, physical capacity, quality of life, and exercise motivation in community-dwelling older adults: a randomized clinical trial. Int J Environ Res Public Health. 2023;20(3):2755. http://doi.org/10.3390/ijerph20032755 PMid:36768119.
    » http://doi.org/10.3390/ijerph20032755
  • Llorente-Barroso C, Kolotouchkina O, Mañas-Viniegra L. The enabling role of ICT to mitigate the negative effects of emotional and social loneliness of the elderly during COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(8):3923. http://doi.org/10.3390/ijerph18083923 PMid:33917966.
    » http://doi.org/10.3390/ijerph18083923
  • Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, et al. Questionário Internacional de Atividade física (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fís Saúd. 2012;6(2):5-18.
  • Moratelli JA, Sonza A, Haas AN, Passos-Monteiro E, Corrêa CL, Peyré-Tartaruga LA, et al. Physical activity of individuals with Parkinson's in social isolation before and during the COVID-19 pandemic. Rev Bras Phys Phys Saúde. 2022;26:1-8. https://doi.org/10.12820/rbafs.26e0237
    » https://doi.org/10.12820/rbafs.26e0237
  • Newman-Norlund RD, Newman-Norlund SE, Sayers S, McLain AC, Riccardi N, Fridriksson J. Effects of social isolation on quality of life in elderly adults. PLoS One. 2022;17(11):e0276590. http://doi.org/10.1371/journal.pone.0276590 PMid:36327259.
    » http://doi.org/10.1371/journal.pone.0276590
  • Ornell F, Schuch JB, Sordi AO, Kessler FHP. “Pandemic fear” and COVID-19: mental health burden and strategies. Br J Psychiatry. 2020;42(3):232-5. http://doi.org/10.1590/1516-4446-2020-0008 PMid:32267343.
    » http://doi.org/10.1590/1516-4446-2020-0008
  • Pérez de Sevilla G, Barceló Guido O, De la Cruz MP, Fernández AB, Alejo LB, Ramírez Goercke MI, et al. Remotely supervised exercise during the COVID-19 pandemic versus in-Person-supervised exercise in achieving long-term adherence to a healthy lifestyle. Int J Environ Res Public Health. 2021;18(22):12198. http://doi.org/10.3390/ijerph182212198 PMid:34831954.
    » http://doi.org/10.3390/ijerph182212198
  • Sánchez-García S, Gallegos-Carrillo K, Espinel-Bermudez MC, Doubova SV, Sánchez-Arenas R, García-Peña C, et al. Comparison of quality of life among community-dwelling older adults with the frailty phenotype. Qual Life Res. 2017;26(10):2693-703. http://doi.org/10.1007/s11136-017-1630-5 PMid:28667436.
    » http://doi.org/10.1007/s11136-017-1630-5
  • Santinelli FB, Simieli L, Costa EC, Marteli LN, Fen CH, Tardelli E, et al. Synchronous and asynchronous remote exercise may improve motor and non-motor symptoms in people with Parkinson’s disease during the COVID-19 pandemic. Brazilian Journal of Motor Behavior. 2021;15(1):47-60. http://doi.org/10.20338/bjmb.v15i1.236
    » http://doi.org/10.20338/bjmb.v15i1.236
  • Scheffer DDL, Latini A. Exercise-induced immune system response: anti-inflammatory status on peripheral and central organs. Biochim Biophys Acta Mol Basis Dis. 2020;1866(10):165823. http://doi.org/10.1016/j.bbadis.2020.165823 PMid:32360589.
    » http://doi.org/10.1016/j.bbadis.2020.165823
  • Talar K, Hernández-Belmonte A, Vetrovsky T, Steffl M, Kałamacka E, Courel-Ibáñez J. Benefits of resistance training in early and late stages of frailty and sarcopenia: a systematic review and meta-analysis of randomized controlled studies. J Clin Med. 2021;10(8):1630. http://doi.org/10.3390/jcm10081630 PMid:33921356.
    » http://doi.org/10.3390/jcm10081630
  • Trombetti A, Hars M, Hsu FC, Reid KF, Church TS, Gill TM, et al. Effect of physical activity on frailty: secondary analysis of a randomized controlled trial. Ann Intern Med. 2018;168(5):309-16. http://doi.org/10.7326/M16-2011 PMid:29310138.
    » http://doi.org/10.7326/M16-2011
  • Valenzuela T, Okubo Y, Woodbury A, Lord SR, Delbaere K. Adherence to technology-based exercise programs in older adults: a systematic review. J Geriatr Phys Ther. 2018;41(1):49-61. http://doi.org/10.1519/JPT.0000000000000095
    » http://doi.org/10.1519/JPT.0000000000000095
  • Wang P, Yang T, Peng W, Wang M, Chen X, Yang Y, et al. Effects of a multicomponent intervention with cognitive training and lifestyle guidance for older adults at risk of dementia: a randomized controlled trial. J Clin Psychiatry. 2024;85(2):23m15112. http://doi.org/10.4088/JCP.23m15112
    » http://doi.org/10.4088/JCP.23m15112
  • Wei L, Hu Y, Tao Y, Hu R, Zhang L. The effects of physical exercise on the quality of life of healthy older adults in china: a systematic review. Front Psychol. 2022;13:895373. http://doi.org/10.3389/fpsyg.2022.895373 PMid:35800916.
    » http://doi.org/10.3389/fpsyg.2022.895373
  • Zhao G, Zhang Y, Liu C. The effect of health education on the quality of life of postoperative patients with gastric cancer: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(10):10633-42. http://doi.org/10.21037/apm-21-2420 PMid:34763511.
    » http://doi.org/10.21037/apm-21-2420

Publication Dates

  • Publication in this collection
    13 Dec 2024
  • Date of issue
    2024

History

  • Received
    24 Jan 2024
  • Accepted
    16 Oct 2024
location_on
Colégio Brasileiro de Ciências do Esporte (CBCE) Rua Benjamin Constant, 1286, Bairro Aparecida, CEP: 38400-678 - Uberlândia - MG - Brazil
E-mail: rbceonline@gmail.com
rss_feed Stay informed of issues for this journal through your RSS reader
Accessibility / Report Error