Fatores associados à adesão de idosas em diferentes programas de exercícios terapêuticos

Abstract

Parallel to the demographic transition in Brazil, has been anepidemiological transition, related to changes in morbidity and mortality, with infectious diseases being replaced by chronic degenerative diseases. This reality points to an increasing complexity in alternative care needs of this new age group and their impact on health and levels of independence and autonomy of its aging population. A method for promoting quality of life is to keep seniors independent and it may be possible by performing regular exercise, which leads to functional improvement and performance of Activities of Daily Life. Evidencesuggests that 50% of the population that starts an exercise program stop within six months. It advocated an adherence of at least 80 to 85% for the intervention results are satisfactory. The concept of adherence is controversial in the literature, varying according to the author. However, what is more widely accepted and used is that adherence to an exercise program is defined as the number of sessions held by the elderly, divided by number of sessions tendered and, according with the literature this relationship often is very low . This study was divided into two stages and the main objective was to identify factors associated with older people adherence in three different therapeutic exercise programs: the first study compared a program of muscle strengthening with aerobic program, and the second study developed a home program, postambulatory training. This is an exploratory observational study with a sample of 151(mean age 70.7 +/- 4.9) in strengthening group, 231(mean age 70.5 +/- 4.6)elderly in the aerobic group, and 96 (mean age 70.8 +/- 5.1) in home group, that was a follow-up of the strengthen group. To evaluate the clinical and functional measures was drawn up a structured questionnaire with standardized tests, motivators and barriers to exercise. These variables were chosen from a theoretical framework about their impact on elderly adherence to exercise. The results of the first study found that the compliance rate was 49.70% in the aerobic group and 56.20% in strengthening. The multiple logistic regressionmodel with motivators to exercise was significant (p = 0.003) for the group of muscle strengthening, with R2 = 0.310 and the aerobic (p = 0.008) with R2 = 0.154. The regression model with the barriers to exercise, was significant only for strengthening group (p = 0.003), with R2 = 0.236. The clinical and functional model was not statistically significant for either group. In the second study, the program retention rate was 86.4% and the rate of compliance was 36.03%. We developed three logistic regression models to explain the adherence, but were not significant for the clinical and functional (p = 0.09), not for motivators to exercise (p = 0.053) and not for barriers (p = 0.053). The present study showed no direct relationship with the worst health conditions with poor adherence, as lower performance on functional tests or worse scores on standardized tests -GDS, MMSE, self-perceived stress and self-perceived health. Although the models did not show predictors of adherence, we observed in the descriptive analyzes, the high incidence of negative factors that hinder the practice of therapeutic exercises, which can guide health professionals how to manage them. Factors related to adherence to the exercise of the elderly are multifactorial and studies to elucidate the factors that might control, should be encouraged.