Efecto de la actividad física en la salud física y mental de la población mayor

Abstract

The health impact and economic costs attributable to physical inactivity are enormous and can be reversed with increasing levels of Physical Activity (PA). The advantages of PA are numerous and include reduction in morbidity, reduction in the risk of functional losses and the maintenance of independence. There is also a relationship between higher levels of physical activity and disease prevention. Evidence shows that there is a relationship between physical activity and the intertwined factors of mental and physical health as well as independence. Among several factors related to the health of the population, it is estimated that an increase in PA in the senior population has the greatest impact on public health. A population-based approach has an influence on the environment and the development of policies such as increased accessibility and free access, help individuals and make physical activity both easier and more accessible. This study is divided into three studies: 1 - To determine the profile of people at fall risk (FR) in the senior population of the Algarve region; 2 - Translation, cultural adaptation, and validation of the Physical Activity Scale for the Elderly – PASE instrument for the Portuguese population; 3 – The effect of physical activity on the physical and mental health of the senior population. Aim: Study 1 aims to determine predictor variables of fall risk and changes in mobility in the senior population, study 2 aims to translate, culturally adapt, and validate the PASE for the Portuguese population and study 3 aims to determine the effect of physical activity on the physical and mental health of the senior population. Methods: Study 1 was a population-based cross-sectional study, where 192 seniors were evaluated, concerning health, social, environmental and risk factors associated with Fall Risk (FR) and an exploratory analysis was performed utilizing the nonhierarchical divisive cluster method to determine the multivariate effect of the combined and independent variables, with the objective of identifying a specific profile (optimal group of variables). Study 2 was a methodological study of translation and cross-cultural adaptation for the Portuguese population of the PASE measurement instrument, according to the guidelines of the Report of ISPOR Translation and Cultural Adaptation and its metric validation was evaluated using the analysis of reliability (internal consistency, intertemporal stability) and validity (concurrent validity). Study 3 is an experimental, non-randomized clinical study. There were two PA intervention groups, one through walking (W) and another through virtual reality (VR) as well as a control group. Evaluations were carried out before and after the interventions to 116 seniors, with an average age of 74.8 years. The evaluations aimed to evaluate the effects that these two aspects have on physical health, including balance (Berg Balance Scale and center of pressure oscillation), FR (Tinetti test), functionality (LEFS and TUG) and isokinetic muscle strength, as well as mental health, utilizing cognitive status (MoCA) and quality of life (SF-36). Results: In study 1, the categories of health, social, environmental and risk factors on their own were not considered an ideal group as they do not predict the FR. The most significant predictor variables were an interaction of different categories, which resulted in a profile of pain, osteoarthritis and being a woman. In study 2, the results showed that the PASE-PT is a reliable and valid instrument to assess PA levels among the Portuguese population, with excellent test-retest reliability in the various domains and in total, with an ICC between 0.938 and 1.00, an acceptable internal consistency, with Cronbach's alpha of α = 0.695 and α = 0.675 and is significantly related to TUG (r=-0.303) and accelerometer AF levels (r=0.416). In study 3, the interventions had beneficial effects in terms of physical health. The W intervention group resulted in an increase in the level of PA, functional mobility, the work of the flexors of the dominant limb, the range of motion of the flexors of both limbs, the dynamic and static balance. A decrease in FR was also observed. The VR intervention group were found to have an increase in functional mobility, peak torque and power of the extensors and flexors of both limbs, the work of the flexors of both limbs and of the non-dominant limb extensors, dynamic and static balance. A decrease in FR, visceral fat and waist circumference was also observed. It is also possible to state that W was more effective than VR in increasing the level of PA, while VR had a greater effect on reducing visceral fat. In terms of mental health, it is possible to conclude that both interventions improved cognitive performance, but only W allowed gains in terms of quality of life, namely, in the self-perception of physical performance, which was distinguished from the intervention by VR. Conclusions: In study 1, the discovery of a profile that allows health professionals to quickly identify seniors at FR, will make it possible to reduce injuries and fractures resulting from falls and, consequently, the associated costs. Study 2 concludes that the Portuguese version of the Physical Activity Scale for the Elderly (PASE-PT) is an instrument that can be used in clinical practice and in research studies related to the elderly population, as it is a reliable and valid instrument. Study 3 concludes that PA through W and VR improves physical and mental health in the senior population, and thus reinforces the need for this population to adhere to PA programs.