Associação da atividade física e do comportamento sedentário com a síndrome de fragilidade em idosos residentes na comunidade

Abstract

The increasing number of older adults in Brazil represents a challenge in many scopes, since this public is more susceptible to negative health events. Among the specific geriatric conditions there is the frailty syndrome, which is characterized by exacerbated deficits in multiple body systems and in physiological and functional reserves. Considering behavioral aspects and biopsychosocial factors may contribute to a better understanding of this syndrome. Thus, a cross-sectional population-based study was carried out which aimed at estimating direct and indirect associations of physical activity and sedentary behavior with frailty syndrome in the elderly; and examining the hypothetical effects of replacing time spent on sleep, sedentary behavior and moderate and vigorous physical activity on frailty syndrome in the elderly. The study was performed with 456 elderly, aged ≥ 60 years old, residents of Alcobaça, in the state of Bahia, and enrolled in the Family Health Strategy. Older adults answered an interview based structured questionnaire, and were submitted to anthropometric and physical performance tests. Frailty syndrome was assessed by frailty phenotype, to answer the first aim, and by the Study of Osteoporotic Fractures to answer the second one. Physical activity and sedentary behavior were measured by means of the International Physical Activity Questionnaire and sleep was assessed by the Pittsburgh Sleep Quality Index. Path Analysis and Isotemporal Substitution model were applied to analyze the data through Poisson regression. The Path Analysis model indicated that physical activity and sedentary behavior presented only indirect associations with the frailty syndrome. Physical activity was associated with the syndrome mediated by depressive symptoms, basic and instrumental activities of daily living and number of medications. In pathways related with sedentary behavior, the associations with frailty syndrome were mediated by basic and instrumental activities of daily living, number of hospitalizations and number of medications. With regard to the hypothetical isotemporal substitution model, it was observed that replacing the time spent sitting or sleeping with the same amount of moderate physical activity time may reduce frailty syndrome, and the longer the substitution time, the greater the benefits. According to these results, it is highlighted the importance of considering the mediator factors found as well as the relevance of monitoring the older adults’ behaviors adopted along the day so as to establish interventions and recommendations related to the physical activity increase and the sedentary behavior decrease, in order to obtain broader and more expressive results to improve the health of frail or at-risk elderly people.