Abstract: Introduction: The increase of the Elderly population as the main characteristic of the demographic transition brings with it multiple challenges for public health. As part of the public politics of the World Health Organization (WHO) on healthy aging, Physical Activity (PA) is relevant, being the subject of multiple studies about its benefits on the quality of life of older people. Method: This article is a systematic review of the PubMed, Google Scholar, Elsevier, Scielo and Redalyc index. Using the keywords “physical activity”, “exercise”, “elderly” and “quality of life”, 138 related articles were found, however, according to the inclusion and exclusion criteria, 120 articles were discarded, leaving 18 studies for review. Results: 72% of the studies showed benefits at a physical level: PA in old age improves strength, balance, flexibility and muscle tone. It is also related to a significant reduction in arterial stiffness. 11% of the investigations refer to improvements in the psychoemotional sphere: PA generates positive feelings such as happiness or good self-perception. And 17% of the articles focused on quality of life: PA favours the perception of better quality of life. Conclusion: Physical activity improves health in the physical, mental and social spheres of older adults, improving their quality of life and promoting healthy aging.
Keywords: Physical activity, exercise, elderly, quality of life.
Resumen: Introducción: El incremento de la población Adulta Mayor como principal característica de la transición demográfica, trae consigo múltiples retos para la salud pública. Como parte de la política pública de la Organización Mundial de la Salud (OMS) sobre envejecimeinto saludable, la Actividad Física (AF) toma relevancia, siendo objeto de mútiples estudios acerca de sus beneficios en la calidad de vida de las personas mayores. Método: El presente artículo es una revisión sistemática en los índices PubMed, Google Schoolar, Elsevier, Scielo y Redalyc. Utilizando las palabras clave “actividad física”, “ejercicio”, “adulto mayor” y “calidad de vida”, se encontraron 138 artículos relacionados, sin embargo, de acuerdo con los criterios de inclusión y exclusión, se descartaron 120 artículos, quedando para su revision 18 estudios. Resultados: El 72% de los estudios mostraron beneficios a nivel físico: La AF en la vejez mejora la fuerza, equilibrio, flexibilidad y tono muscular. También está relacionada con una importante reducción en la rigidez arterial. El 11% de las investigaciones refieren mejorías en la esfera psicoemocional: La AF genera sentimientos positivos como felicidad o buena autopersepción. Y el 17% de los artículos se centraron en la calidad de vida: La AF favorece la percepción de mayor calidad de vida. Conclusión: La actividad física mejora la salud en las esferas física, mental y social de los adultos mayores, mejorando su calidad de vida y favoreciendo el envejecimiento saludable.
Palabras clave: Actividad física, ejercicio, adulto mayor, calidad de vida.
INTRODUCTION
Globally, population dynamics is essentially centred on a phenomenon: population aging, for which the two most important variables are low fertility rate and increased life expectancy; where the aging population increases to the detriment of the other age groups.1,2 By 2019, one in 11 people in the world (9%) were older adults, and projections indicate that by 2050, one in six people in the world will be older (16%).3 These demographic changes also bring their own problems, which have been addressed since 1982, when the first world assembly on aging was held, where The Vienna International Action Plan of Action on Aging. In said assembly, member countries suggested carrying out specific actions on topics such as health, nutrition, housing and the environment, family, social welfare, income and employment security, education, and the compilation and analysis of research data.4
In accordance with the Sustainable Development Goals (SDG), the 2020-2030 decade is established as the decade of healthy aging. Healthy aging "is the process of development and maintenance of functional capacity that allows well-being in old age." 5 The World Health Organization (WHO) argues that current demographic changes must be considered and older adults should be given the importance they have in the development of populations, in order to achieve equitable, passive and safe communities.6
However, achieving healthy aging is not easy, since in the normal aging process, morphological and functional changes become imminent, often decreasing the ability to function.7 One of the most notable and important changes with the physical activity carried out by the elderly is the loss of muscle mass.8,9 Functional performance is having the physiological capacity to carry out normal daily activities safely and independently without excessive fatigue.10 But it does not only refer to the capacities characteristic of the person (intrinsic capacity), but also of the environment in which it develops (extrinsic capacity).11
According to the WHO, physical activity in old age consists of recreational activities, displacements, occupational activities, domestic tasks, sports or programmed exercises in order to improve cardiorespiratory functions, functionality and reduce the risk of NCDs, depression, risk cognitive and falls.10
The promotion of Physical Activity (PA) is a key element to achieve healthier old people. Various studies have been conducted with the aim of recognizing the benefits of PA in older adults. This review aims to update the information that is available.
MATERIAL AND METHODS
A systematic review was performed on the PubMed, Google Scholar, Elsevier, Scielo and Redalyc indexes; about the benefits of physical activity observed in older adults, using as keywords “physical activity”, “exercise”, “older adults” and “quality of life”. As selection criteria, original articles published in English or Spanish, of applied research with older adults (60+ year), regardless of sex and unlimited publication dates. And as exclusion criteria, those investigations applied to children, young people, young adults (<60), review articles, descriptive studies, or don´t provide significant information about the theme of study.
Once the articles were selected, they were classified into three groups according to the area of health in which the benefits of PA were evaluated in: physical / physiological effects, psycho-emotional effects and effects on quality of life.
RESULTS
According to the search criteria, 138 related articles were identified, however, following the criteria determined at the beginning of this review, 120 manuscripts were discarded for not meeting the selection criteria or being within the exclusion criteria. The remaining 18 articles were considered for review and were grouped according to the main variable evaluated. To analyse the results of the studies and compare them, two tables were made. Table 1 includes reference, design, sample, method and instruments (including the time during which the training program or exercise was applied) and main findings. Table 2 describes only 12 of the 18 studies since they are the ones that specifically applied training or exercise programs in older adults and measured their effects at the physical / physiological level. Through this table it is possible to compare the results and identify the types of training that obtained the best results. Table 2 includes reference, method and instruments, results of pre and post evaluations and the value of P. 11% of the investigations report improvements in the psycho-emotional sphere: PA generates positive feelings such as happiness or good self-perception.12,13 72% of studies showed benefits on a physical level: PA in old age improves strength, balance, flexibility and muscle tone.14-26 It is also related to a significant reduction in arterial stiffness. And 17% of the articles focused on quality of life: PA favours the perception of a higher quality of life.27-29 Finally, 66.7% of the studies were carried out applying an exercise or training program, which show important differences in their design and results. Varying in the application time from four weeks to 48 weeks. As shown in Table 2, which describes the results of pre and post evaluations.
DISCUSSION
Aging is very often related to a decline in different human functions, such as cognitive state, strength, balance, the musculoskeletal and cardiovascular systems, among others.30 This deterioration is closely linked to the decrease in PA.31 However, according to different investigations, it has been identified that the AF contributes significantly to the health of the elderly, since it promotes strength, flexibility, agility, speed and endurance on a physical level. As Miller KL et al. In a quasi-experimental study of an exercise program with a duration of four weeks applied in older adults, where it was shown that through this type of PA, there are significant improvements in balance confidence, balance performance and walking in weakened .19 It is important to highlight that not all forms of PA have the same functions or reach the expected results, such is the case of research applied by Wolf SL et al., in which after 48 weeks of Tai Chi training, there was no evidence of statistically significant reduction in the risk of falls in the elderly.21
The investigations made by Jorgensen MG et al. and Pluchino A. et al is interesting and innovative, who applied PA programs for older adults using the Nintendo Wii. Both programs were effective as there were substantial improvements in muscle function, muscle performance, and functional performance. 22,23 Video games can be a new window of opportunity to improve the physical condition of the elderly, as it can be applied at home, providing economic savings, time, transfers and risks.
On an emotional level, PA generates a feeling of happiness, a positive effect on mood and on different mental illnesses such as depression. As evidenced by Bohórquez MR et al. with a descriptive study applied to 104 elderly adults where PA is related to happiness. The results show that the practice of PA in the past, in the present or throughout life, influences in a significant way the mood and feeling of happiness of the elderly.13 If we consider that depression as well as the feelings of sadness are very frequent in older adults, PA turns out to be an economic tool and significant tool in mental health care in old age.32,33
Finally, it is useful to rescue that PA has been studied in its impact on the quality of life of the elderly, as demonstrated by Guallar-Castillón P et al. in a cross-sectional research carried out with 3066 older adults, where it concludes that the higher the PA practiced during free time, the higher the Health-Related Quality of Life (HRQL) reported by the elderly.27
Although strategies aimed at promoting a healthy lifestyle have been created worldwide and policies have been implemented, these have not been sufficient, since although they are aimed at preventing chronic non-communicable diseases (NCDs), this has not been achieved. NCDs lead the prevalence of diseases and are also the main causes of death in the world. The worst thing is that they are diseases that are mostly preventable with the adoption of good lifestyles, such as a healthy and balanced diet and PA. As a result, we have a young and adult population with sufficient risk factors to reach an old age with multiple diseases or premature death, and for those who are already old, it means functional deterioration, disability and premature death.
CONCLUSIONS
According to the revised references, PA improves health in the physical, mental and social spheres of older adults, improving their quality of life and promoting healthy aging. Including PA as part of the activities of daily life of the elderly promotes balance, prevents falls, improves physical strength and flexibility. In addition, it improves the cognitive condition, favours positive attitudes and encourages a feeling of happiness. PA has positive consequences at the vascular level, decreasing arterial stiffness. It also favours social relationships necessary for the well-being of the elderly.
REFERENCES
[1] Rutherford OM. Is there a role for exercise in the prevention of osteoporotic fractures?. Br. J. Sports Med. 1999;33(6):378–86.
[2] González KD. Demographic aging in Mexico: comparative analysis between the federal entities. CONAPO. Available at:http://www.omi.conapo.gob.mx/work/models/CONAPO/Resource/2701/1/images/06_envejecimiento.pdf [Accessed Feb 29, 2020].
[3] United Nations. Growing at a slower rate, the world population is expected to reach 9.7 billion in 2050 and a peak of almost 11 billion around 2100. Available at:https://population.un.org/wpp/Publications/Files/WPP2019_PressRelease_ES.pdf [Accessed Feb 22 2020].
[4] United Nations. Vienna International Plan of Action on Aging. Available at:https://undocs.org/es/A/RES/46/91 [Accessed 22 Feb 2020].
[5] World Health Organization. Decade of healthy aging 2020-2030. First progress report, March 2019. Available at: https://www.who.int/docs/defaultsource/documents/decade-of-health-ageing/decade-healthy-ageing-update1en.pdf?sfvrsn=d9c40733_0 [Consulted Feb 22, 2020].
[7] Salech MF, Jaral LR, Michea AL. Physiological changes associated with aging. Rev. Méd. Clin. Counts. 2012;23(1):19-29.
[8] Campbell MJ, McComas AJ, Petito F. Physiological changes in aging muscles. J. Neurol. Neurosurg. Psychiatry. 1973;36:174-182.
[9] Cruz-Jimenez M. Normal Changes in Gait and Mobility Problems in the Elderly. Phys. Med. Rehabil. Clin. 2017;28:713-725.
[10] World Health Organization. Physical activity in older adults. Global Strategy on Diet, Physical Activity and Health. Available at:https://www.who.int/dietphysicalactivity/factsheet_olderadults/en/ [Consulted Feb 22, 2020].
[11] Patiño Villada FA, Márquez Arabia JJ. Physical Activity and Physical Exercise in Health: Challenges in a globalized context. 1 ed. Medellín, Colombia: University of Antioquia; 2009.
[12] Medina Briones MR, López Hernández M, Zuñiga Vargas ML, Ibarra Mata L. Perceived pros and cons of physical activity carried out by older adults. Enf. Univ. 2009;6(3):8-13.
[13] Bohórquez MR, Lorenzo M, García AJ. Happiness and physical activity in older people. Psychology writings. 2013;6(2):6-12.
[14] Liu IT, Lee WJ, Lin SY, Chang ST, Kao CL, Cheng YY, The Therapeutic Effects of Exercise Training on Elderly Patients with Dementia: A Randomized Controlled Trial. Arch. Phys. Med. Rehabil. 2020; pii: S0003-9993(20)30092-7.
[15] Orr R, de Vos NJ, Singh NA, Ross DA, Stavrinos TM, Fiatarone-Singh MA. Power training improves balance in healthy older adults. J. Gerontol. A. Biol. Sci. Med. Sci. 2006;61(1):78-85.
[16] Kobayashi R, Kasahara Y, Ikeo T, Asaki K, Sato K, Matsui T, Iwanuma S, Ohashi N, Hashiguchi T. Effects of different intensities and durations of aerobic exercise training on arterial stiffness. J. Phys. Ther. Sci. 2020;32(2):104-109.
[17] Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomized controlled trial of a general practice program of home based exercise to prevent falls in elderly women. BMJ. 1997;315(7115):1065-9.
[18] Castillo de Lima, V., Castaño, LAA, Boas, VV, Uchida, MC A Training Program Using an Agility Ladder for Community-Dwelling Older Adults. J. Vis. Exp. 2020;(157),e60468.
[19] Miller KL, Magel JR, Hayes JG. The Effects of a Home-Based Exercise Program on Balance Confidence, Balance Performance, and Gait in Debilitated, Ambulatory Community-Dwelling Older Adults: A Pilot Study. J. Geriatr. Phys. Ther. 2010;33(2):85-91.
[20] Faber MJ, Bosscher RJ, Chin A Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Arch. Phys. Med. Rehabil. 2006;87(7):885-96.
[21] Wolf SL, Sattin RW, Kutner M, O'Grady M, Greenspan AI, Gregor RJ. Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. J. Am. Geriatr. Soc. 2003;51(12):1693-701.
[22] Jorgensen MG, Laessoe U, Hendriksen C, Nielsen OB, Aagaard P. Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial. J. Gerontol. A Biol. Sci. Med. Sci. 2013;68(7):845-52.
[23] Pluchino A, Lee SY, Asfour S, Roos BA, Signorile JF. Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs. Arch. Phys. Med. Rehabil. 2012;93(7):1138-46.
[24] Chimbo-Yunga JM, Chuchuca-Cajamarca AJ, Wong S, Encalada-Torres LE. Metabolic syndrome and physical activity in older adults in the Ecuadorian highlands. Rev. Public Health. 2017;19(6):754-59.
[25] Gómez-Cabello A, Vila-Maldonado S, Pedrero-Chamizo R, Villa-Vicente JG, Gusi N, Espino L, González-Gross M, Casajús JA, Ara I. Organized physical activity in the elderly, a tool to improve physical condition in old age. Rev. Esp. Public Health. 2018;92:1-10.
[26] Chalapud-Narváez LM, Escobar Almario A. Physical activity to improve strength and balance in the elderly. Rev. Univ. Health. 2017;19(1):94-101.
[27] Guallar-Castillón P, Santa-Olalla Peralta P, Banegas JR, López E, Rodríguez-Artalejo F. Physical activity and quality of life of the elderly population in Spain. Med Clin. 2004;123(16):606-10.
[28] Herrera Mor. Emilia Maria. Effects of a Comprehensive Physical Activity Program on the Quality of Life of the Elderly [Doctorate]. Catholic University of Valencia San Vicente Mártir; 2015.
[29] Gallegos Carrillo K, Honorato Cabañas Y, Macías N, García Peña C, N Flores Y, Salmerón J. Preventive health services and physical activity improve health-related quality of life in Mexican older adults. Public Health of Mexico. 2019;61(2):106-15.
[30] Taylor, D. Physical activity is medicine for older adults. Postgrad. Med. J. 2014; 90: 26-32. In: Gallè F, Sabella EA, Da Molin G, Parisi EA, Liguori G, Montagna MT, De Giglio O, Tondini L, Orsi GB, and Napoli C. Physical Activity in Older Adults: An Investigation in a Metropolitan Area of Southern Italy . Int. J. Environ. Res. Public Health. 2020;17(3).pii:E1034.
[31] Jaeger C. Physiology of Aging. EMC- Kinesiotherapy- Physical Medicine. 2011;23(3):1-8.
[32] Zavala-González MA, Posada-Arévalo SE, Cantú-Pérez RG. Functional dependency and depression in an elderly group from Villahermosa, México. Arch. Med. Fam. 2010;12(4):116-26.
[33] Sarró-Maluquer M, Ferrer-Feliub A, Rando-Matos Y, Formigac F, Rojas-Farreras S. Depression in the elderly: prevalence and associated factors. SEMERGEN. Med. Fam. Depression in the elderly: prevalence and associated factors. 2013;39(7):354-60.
[6] World Health Organization. Summary World report on aging and health. World Health Organization, 2015. Available at:https://apps.who.int/iris/bitstream/handle/10665/186466/9789240694873_spa.pdf?sequence=1 [Consulted Feb 25, 2020].
Appendix
