Biehl-Printes, C., et al (2014) A comparative study of the functional fitness and perception of quality of life among elderly participants and non-participants of Universities of third age, Journal of Aging & Inovation, 3 (3): 39-49
ARTIGO ORIGINAL / ORIGINAL ARTICLE
DEZEMBRO, 2014
UM ESTUDO COMPARATIVO DA APTIDÃO FÍSICA FUNCIONAL E PERCEPÇÃO DA QUALIDADE DE VIDA ENTRE IDOSOS FREQUENTADORES E NÃO-FREQUENTADORES DE UNIVERSIDADE SÉNIOR A COMPARATIVE STUDY OF THE FUNCTIONAL FITNESS AND PERCEPTION OF QUALITY OF LIFE AMONG ELDERLY PARTICIPANTS AND NON-PARTICIPANTS OF UNIVERSITIES OF THIRD AGE UN ESTUDIO COMPARATIVO DE LA CONDICIÓN FÍSICA FUNCIONAL Y DE LA PERCEPCIÓN DE CUALIDAD DE VIDA ENTRE LOS ANCIANOS FRECUENTADORES Y NO-FRECUENTADORES DE UNIVERSIDAD DE LA TERCERA EDAD Autores Biehl-Printes, Clarissa 1; Teixeira, Diogo 1; Costa, Armando 1; Pinheiro, Valter1; Sousa, Paulo 1; Cruz, Joana2; Tomas-Carus, Pablo 3 1
Departamento de Ciências do Desporto. Instituto Superior de Ciências Educativas – ISCE. Lisboa. Portugal, 2 Departamento
Social e Cultural. Instituto Superior de Ciências Educativas – ISCE. Lisboa. Portugal, 3 Departamento de Ciências do Desporto e
Saúde, Universidade de Évora. Évora. Portugal Corresponding Author: cbprintes.isce@gmail.com Author contributions Biehl-Printes C. conceived of the study, participated in its design and coordination, analysed the data, contributed to the results discussion and wrote the manuscript; Teixeira D., analysed the data and contributed to the results discussion; Costa A., Pinheiro V., and Sousa P., contributed to the results discussion; Cruz J., participated in coordination and data collection. Tomas-Carus P., participated in the study design and coordination, and contributed to the results discussion. All authors read and approved the final manuscript. Abstract - Objectives: To analyze the contributions of Universities of third age (U3A) through their proposed activities and effects in functional fitness and quality of life of elderly participants and non-participants. Methods: The sample was composed of two groups: elderly participants in U3A (EPG; n=25) and elderly non-participants (ENPG; n=25). Data collection was obtained through questionnaires: one about sociodemografic characteristics and U3A attendance (General questionnaire) and another about quality of life (WHOQOL-BREF Portuguese version). Also, were applied two test of the Fullerton Tests battery (30-second chair stand and 8-food up and go). Results: The results show statistically significant differences in attendance between women (76%) and men (24%). There is a predominance of married (68%) that attend the U3A. The educational level indicates that the EPG present more years of education (28%) and more people with higher education (24%). The main reason why the ENPG didn’t attend U3A was lack of time (44%). For lower body strength, the results showed differences between EPG and ENPG (p=0.022), in favor of EPG. No differences were observed between groups for agility/dynamic balance (p=0.977). In quality of life were observed differences between groups in the physical domain (p=0.026), with the EPG presenting higher scores that ENPG. For all the other domains, no differences were observed (all p>0.050). Conclusions: This study showed a prevalence of attendance of women to U3A and that the enrolled elderlies have more previous years of schooling. The elderly participants in U3A showed better physical domain than non-participants. However, in other domains were not found differences between participants and non-participants. For future studies, it is proposed that the sample should encompass groups with higher age range that may produce results with new interpretations. Keywords: active aging; university of third age, functional fitness, quality of life. Resumo - Objetivos: Analisar as contribuições da Universidade da Terceira Idade (UTI) através de suas atividades propostas e os efeitos na aptidão funcional e qualidade de vida dos idosos participantes e não-participantes. Métodos: A amostra foi composta por dois grupos: idosos participantes na UTI (GIP; n=25) e idosos não-participantes (GINP). A coleta de dados foi obtida por meio de questionários: um sobre as características sóciodemográficas e particpação na U3A (questionário geral) e outro sobre a qualidade de vida (WHOQOL-BREF versão Portuguesa). Além disso, foram aplicados dois testes da bateria Fullerton Tests (30-chair stand and 8-food up and go). Resultados: Os resultados mostraram diferenças estatísticas significativas na participação entre as mulheres (76%) e homens (24%). Há um predomínio de casados (68%) dos idosos que participam na U3A. O nível de escolaridade indica que os idosos do GIP apresentam mais anos de escolaridade (28%), e mais idosos com ensino superior (24%). A principal razão pela qual o GINP não adere a U3A está associada à falta de tempo (44%). Para aptidão física funcional, os resultados mostraram diferenças entre o GIP e GINP (p=0.022) para uma menor força do corpo. Não foram observadas diferenças entre os grupos para a agilidade/equilíbrio dinámico (p=0.977). Na qualidade de vida foram obeservadas diferenças entre os grupos no domínio físico (p=0.026), valores mais elevados no GIP. Para todos os outros domínios não foram encontradas diferenças (todos p>0,050). Conclusões: Este estudo mostrou uma prevalência de participação das mulheres na U3A, e que os idosos inscritos têm mais anos e nível de escolaridade. Os idosos participantes mostraram melhor domínio físico que os não-participantes. No entanto nos outros domínios não foram encontradas diferenças. Para estudos futuros, propõe-se uma amostra com uma faixa etária mais elevada, de modo a possibilitar outro tipo de resultados sujeitos a novas interpretações. Palavras chaves: envelhecimento ativo, universidade sénior, aptidão física funcional, qualidade de vida.
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Introduction
OMS, 1980; ONU, 1982). However, that socioeducative response, targeting the creation and
World population age has arisen in the
dynamization of regular social, cultural,
last decades. Despite this, several conquests
educational, physical and socializing activities
were made in modern societies as a mean to
reflect a perfect integration of the previously
adjust to this new social paradigm. It is possible
framework if the active aging concept previously
to observe that these populations are
proposed by OMS (1990), that envisions as a
experiencing the challenge of an active aging. It
major objective to create opportunities to
is commonly accepted that a person with 65 or
optimize conditions to health, participation and
more years old is considered an elderly
security, that may allow the quality of life as
individual (3rd age), but new definitions arise in
people become older (Jacob et al., 2012; WHO,
order to adjust to the prolonged life expectancy
2002).
and to better distinguish among the vast
Data from Portuguese senses tends to
amplitude previously existing. For this matter, a
show a crescent trend in the number of people
new stratification now seems to be consensual,
with more than 65 years (19.1% of the
4th
population), surpassing that of young (15%),
ranging between 80-85 or more years (i.e. age) ( Formosa, 2012; Stathi & Simey, 2007).
accentuating the verified trend in 2001 senses
In Europe changes in this age group has
(Carrilho & Patrício, 2010). Due to the evidence
been a matter of concern and interest for more
that elderly people are increasing, it becomes
than 40 years, in which France stood as one of
even more relevant to stimulate programs and
the countries to boost successful aging trough
politics of healthy aging, assuring the
higher education institutions (Cachioni, 2012;
continuities of a productive, healthy and quality
Lemieux, Boutin, Snachez & Riendeau, 2003). In
life. Therefore, the concept of quality of life in the
the 70’s Portugal, alongside France,
advanced age is considered as one of main
implemented the concept and practice of free
indicators to evaluate the condition of life of the
time associations denominated Universities of
elderly, involving different dimensions that
3rd
Age (U3A) or Senior Universities (SU), but
encompass the optimum level of physical,
adopted an English structured model based in
mental, social, performance functioning, and
non-profit associations or self-organized groups,
satisfaction with life and their well-being (Fleck
with non-formal education, differing from the
et al., 2000; Fonseca, 2005). Corroborating the
French model associated with formal
perspective of a comprehensive concept of
Universities (Jacob, Jesus & Sampaio, 2012;
quality of life that involve a wide array of
Lemieux et al., 2003; Pinto, 2003).
multidisciplinary perspectives (e.g. sociologic,
Gradually, the chronologic concept
biomedical, psychological, economical and
adopted by U3A and SU in the 60’ and 70’
environmental) (Walker, 2005), interested
decades that referred this association as a
investigate the contribution that the social
socio-educative response to individuals starting
support networks that allow organization of 3rd
50 years of age, has been weakened by the
age activities (i.e. U3A/SU) brings to functional
senescence age attributed in the 80’ decade by
health, independent life, social relations and to
OMS of 60 and 65 years (Jacob et al., 2012; JOURNAL OF AGING AND INOVATION (EM LINHA) ISSN: 2182-696X / (IMPRESSO) ISSN: 2182-6951
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psychological well-being of these people. As an
activities and effects in physical fitness and
example, previous studies show that adherence
quality of life elderly people.
to these organizations influence physical and psychological well being. In this sense, an
Material and Methods
association between the participation in U3A and
Sample selection
a lower intensity depression was found (Irigaray
For this exploratory cross-sectional study
& Schneider, 2007). The interest in physical
were used posters and verbal communication to
activities practices and the pursuance of well-
call for voluntary participants in Senior University
being was demonstrated as a determinant
of Odivelas (SUO), integrated in Superior
indicator of the U3A participants, as for a better
Institute of Educational Sciences (ISCE).
perception of the factors related to the
Selection criteria were: men and women >65
environmental and psychological domains and
years, elderly participants of SUO (EPG; n=25)
global perception of quality of life and health in
and elderly non- participants (ENPG; n=25 -
middle age and elderly people (Castro et al.,
elderly friends and family of the participants of
2007; Fenalti & Swartz, 2000).
SUO - we asked participants of U3A to bring to
To the extent of our knowledge, it seems
the evaluation day a friend or family member)
to exist a discrepancy between the high number
without cognitive and locomotors problems (we
of U3A/SU in Portugal (over 200 registered in
allowed the participation of elderlies that used a
2012) and scientific work published within this
canadian cane). Exclusion criteria: elderly that
approach (5). Several studies are unanimous to
already attending another U3A or other social
assume the influence of an active life style with
organization for 3rd age (i.e. sports club, social
some variability of physical and cognitive
solidarity association, inhabitant association) or
activities to the promotion of the quality of the
those that participate in entities or organizations
lived years (Colombe & Krower, 2003; Chou,
directed to this population (i.e. day centers,
Hwang & Wu, 2012). In these sense, the
recreational collectivities, municipal services).
multidisciplinary set offered by U3A in physical
The participants were informed of study
activities, such as physical education, walking,
procedures and given the informed consent to
dancing, yoga and senior bocce are normally
voluntary participate in the research. All were
available to elderly students.
approved by the Ethics Committee of Health and
Thus, assuming U3A as a prepared
Welfare of the University of Évora (Document Nº
organization with a wide array of
13020) and were in accordance with the 1975
multidisciplinary opportunities with continuous
Helsinki Declaration.
and regular formation, we ought to explore these contexts and develop scientific knowledge to
Procedures and instruments
ensure the promotion and valorization required to continue a healthy and active aging.
Sociodemographic characteristics, cognitive
Therefore, in this study we propose to analyze
problems and adherence to the U3A
the contributions of U3A through their proposed
All participants were asked about the age, civil status and education level.
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Immediately, the Watch Design Test
calculated by a syntax that considers answers in
(Freitas & Simões, 2010) was used as exclusion
each question composing the domain, resulting
criteria for cognitive problems in the elderly.
in final scores in a scale of 4 to 20, comparable
Each participant was asked to make a clock (no
to dose of WHOQOL-100, which can be
pre-defined time), making a circle and putting
transformed in a 0 to 100 scale.
the numbers in the correct position, without looking in to his watch. When finished, it is
Functional fitness
asked to put the indicators marking 10 minutes
For assess lower body strength and
to 2 o’clock. This test is used to evaluate: visual
agility/dynamic balance were applied two test of
perception, construction praxis, right hemisphere
Fullerton Functional Fitness Test Battery (Rikli &
dysfunction and left hemisphere negligence. For
Jones, 1999): 30-Second Chair Stand and 8-
example: small watch indicates lack of planning
Foot Up and Go. The 30-Second Chair Stand
and inadequate positioned numbers point to
Test assess lower body strength, needed for
executive deficit. Additionally, was analyzed the
numerous tasks such as climbing stairs, walking
characteristics of adherence to the U3A by the
and getting out of a chair, tub or car. The elderly
senior participants. Only the EPG were asked
people should perform the maximum number of
about years attends U3A, times per week,
full stands that can be completed in 30 seconds
motivational factors, intent of leaving and
with arms folded across chest. The 8-Foot Up
number of disciplines attended. The ENPG were
and Go Test assess agility/dynamic balance,
asked about the reasons why they didn’t attend
which is important in tasks that require quick
U3A.
manoeuvring, such as getting off a bus in time or getting up to attend to something in the kitchen,
Quality of Life
to go to the bathroom or to answer the phone.
The Portuguese version of World Health
The elderly people should to get up from a
Organization Quality of Life Group (WHOQOL-
seated position, walk 2.44 metres (8 foot) and
Bref) (Fleck et al., 2000) was applied to assess
return to seated position.
quality of life. This instrument has 26 questions divided in four domains of quality of life: physical
Statistical analysis
capacity, psychological well-being, social
Normality of data was initially tested
relations and the environment where the
using the Kolmogorov-Smirnov test. Differences
individual is inserted. Besides these four
between groups were tested using Kruskal-
domains, WHOQOL-Bref it is also composed by
Wallis test for continuous variables (age,
a domain that assesses global quality of life.
functional fitness and quality of life) and Chi-
Each domain is composed by questions where
square test for categorical variables (sex, civil
higher scores (between 1 and 5) represent
status, educational level). For all tests the
better quality of life. Some characteristics,
significance level was set at p<0.05. These
designed as facets are not formulated in a
analyses were performed in SPSS 22.0
positive sense. In these cases higher scores do not mean better quality of life. Scoring is JOURNAL OF AGING AND INOVATION (EM LINHA) ISSN: 2182-696X / (IMPRESSO) ISSN: 2182-6951
software.
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Results Sociodemographic characteristics
educational level. The results showed that the women’s attend more U3A than men. Also was showed that there is a predominance of married
Were observed significant differences between
elderly that attend the institution. The
EPG and ENPG in sex, civil status and
educational level indicates that the elderly in the EPG present more years of education and more people with higher education (Table 1).
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Additionally, we have analyzed the characteristics of adherence to the U3A by the EPG. We observed that our sample attends U3A for 3,88 ± 1,76 years with a frequency of 3,48 ± 1,12 times per week; the three more motivational factors were 1) own will – 18 (72%), 2) refer of a friend – 4 (16%) and 3) refer of family – 2 (8%); the intent of leaving U3A 1) Yes - 1 (4%) and No - 24 (96%); number of disciplines attended was 4,44 ± 1,63; the five more attended disciplines were 1) Music – 13 (52%), 2) English – 12 (48%), 3) Painting – 11 (44%), 4) Informatics – 10 (40%) and 5) Spanish – 8 (32%). We also asked the ENPG the reasons why they didn’t attend U3A, being that the three main reasons were 1) lack of time – 11 (44%), 2) does not consider an adequate ambient for themselves –
Functional fitness and Quality of life Were showed significant differences between EPG and ENPG in lower body strength. The EPG showed more strength in the lower body. No differences were observed between groups in agility/dynamic balance. In addition, were observed differences between groups in the physical domain (p=0.026), with the EPG presenting higher scores that the ENPG. For all the other domains, no differences were observed between groups. Nonetheless, the EPG presents marginally higher scores in three other of the five non-statistically significant variables (perception of overall quality of life, psychological domain and social relationships domain) (Table 2).
8 (32%),3) financial limitations – 3 (12%) and 4) locomotors difficulties – 1 (4%).
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Discussion
interactions with the elderly people. The range of
This comparative study showed that the
disciplines provided promotes an interaction that
more women go to U3A and that elderly enrolled
allows the training and development of physical,
have more previous years of schooling. The
social, cultural and psychological domains. The
frequency engage in activities was of 3 times/
combination of disciplines attended by the
week and there is no report of intention the leave
elderly will ultimately define the benefits
the U3A after enrolling. Non-enrolled elders
obtained (Pinto, 2003). As seen in ours results,
consider the lack of time the main cause
the participants in U3A tend to enrolled in the
preventing them to start in U3A. The participants
institution by self-initiative, of the thirty
in U3A showed better strength and quality of life
disciplines they attend in average 4, were the
in physical domain that non-participants in U3A.
most frequented are music, painting, informatics,
However, in all domains they present a “good”
English and Spanish, all promoters of sedentary
classification in quality of life.
or light physical activity during class time.
The data presented in the
However, these activities are promoters of a high
sociodemographic analysis supports previous
cognitive and motor-cognitive function, marked
findings. The age, sex and level of education
today as important to this population. Several
distribution in our EPG is in accordance with
studies have indicated that cognitive training
studies done in other countries that have
have advantages to retard the cognitive decline
functioning U3As and have demographic
in the process of healthy aging, were new
similarities with Portugal (Alfageme, 2007;
technologies like computers and video games
Formosa, 2012; Mindwinter, 1996). In our study,
present themselves as alternatives of
the mean age is clearly within the
3rd
age group
intervention to be expanded (Kueide, Parisi,
for elderly men and women, women are the
Gross, & Rebok, 2012). Additionally, it is
highest percentage of members in U3A and the
suggested that cognitive domain practices may
participants have higher levels of education. This
bring gains in the cognitive performance of
is an expected trend repeatedly presented in
healthy elderlies that may manifest 5 years after
previous studies. This generally represents the
training (Willis et al., 2006). Moreover, previous
retirement age of this population, the absence of
studies support the efficacy of the practice of
similar services in this age group, higher life
motor coordination activities, trough gross and
expectancies for women, and a set of secondary
fine motor abilities activation, that act positively
and post-secondary education experiences that
in executive functions that may seem to be
may have influenced the motivations and
independent of gains obtain by cardiovascular
pleasure associated with learning in the past,
and strength training (Voelcker-Rehage, Godde
contrasting with the heavy class baggage
& Staudinger, 2011; Yan & Zhou, 2009). Physical
associated with the name “university” for the
activities are presented in several disciplines
owners of lower education levels (Formosa,
and by different modalities, where students
2012).
presented their preference in boccia (20%), The U3A provides a space that has
dance (20%) and physical activities (12%),
multidimensional and multidisciplinary
which in general shows an adherence as
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significant as music, languages, painting and
health benefits for their members (Formosa,
informatics. However, bearing in mind the
2012; Ordonez, Lima-Silva & Cachioni, 2011;
several possible ways to promote a healthy and
Sonati, Modeneze, Vilarta, Maciel & Boccalett,
active aging, it is suggested and supported the
2011), and that there is a positive relationship
pertinence of each filed of intervention, either by
between psychological wellbeing and
cognitive abilities, motor-cognitive associated
participating in U3A with extension to other
with physical exercise, physical activities, social
areas of life (Maniecka-Bryłaemail, Gajewska,
relation, nutrition, etc., all contributing to retard
Burzyńska, & Bryla, 2013). Additionally, EPG
the cognitive decline associated to the loss of
shows a sustained connection to U3A with the
functional independence, autonomy and quality
duration of 4 years, assuming a frequency of 3
of life (Williams & Kemper, 2010).
times per week, reflecting the capability for
The participants in U3A showed better quality of life in physical domain that nonparticipants. This domain explores pain and discomfort, energy and fatigue and stress and rest facets (Fleck et al., 2000). From the data collected it is not possible to clearly identify the reasons behind this result. One factor that may be influencing the higher results presented in physical domain by the EPG is the lower body strength score. It is possible to observe that there were differences between groups in this parameter, in favor of EPG. However, all domains quality of life showed a classification of “good” (score ≈75 in scale 0-100), this could be due to the age (years) of the attendees 66,6 (EPG) and 67,2 (ENPG), functional and mental conditions adequate to an independent and active life that may have a low interference in quality of life. This, associated with the concept that aging is a dynamic and progressive process that involve physical, functional, biochemical, psychological and social changes that, when associated with an active healthy life style, results in a bigger longevity, described in
retaining for a long period elderlies in activities. Continuous adherence of elderly in health promoting activities is the question of interest in this research, considered as problematic for the shift in the healthy life style (Caetano & Raposo, 2005). For this matter, it seems interesting to point out that U3A is a promoter of this change. The present study also included limitations, which require further discussion. First, the age in the group studied may have influenced the results, regarding that they already enjoy good functional, mental and physical health, associated with quality of life. Besides, ENPG considers that they do not attended U3A mainly because of lack of time (44%), maintaining themselves active and involved in other activities, being, this way, equally active to EPG, condition that influence directly in the evaluation of quality of life. Another possible analysis to be considered on sociodemographic variables is labor situation (i.e. working; retired). The association with work and health is well documented, where labor activities are seen as having a positive role in
previous studies (Castro et al., 2007; Chodzko-
preservation some health variables, whereas
Zajko & Schwingel, 2009; Ferreira, Maciel,
unemployment is associated with higher rates of
Costa, Silva & Moreira, 2012). Several studies
mortality, psychiatric symptoms and worst health
pointed out the importance of U3A in promoting
conditions (Arber, 1987; Janlert, 1997). Few
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studies had addressed this theme with elderly.
2. Stathi, A & Simey, P. (2007). Quality of life in
Findings described on the relation of the
the Fourth Age: exercise experiences of
capacity of sustaining a healthy living associated
nursing home residents. Journal of Aging and
with non-formal work, sociodemographic
Physical Activity, 15 (3), 272-286.
characteristics, higher levels of schooling, health
3. Lemieux, A. Boutin, G. Sanchez, M. &
condition, autonomy and independence (Giatti, &
Riendeau, J. (2003). The faculties of
Barreto, 2003; Marmot & Shipley, 1986).
education in the traditional universities and
However, and in U3A context, we consider this
the third age universities: A model of
study as pioneer in elderly and quality of life
partnership. Versão policopiada. 9: 2.
characterization.
4. Cachioni, M. (2012). Universidade da Terceira Idade: história e pesquisa. Revista
Conclusion
Temática Kairós Gerontologia, 15 (7), 01-08.
This study showed a higher adherence of
5. Jacob, L. Jesus, A. & Sampaio, J. (2012).
women to U3A and that elderly enrolled have
Universidades Seniores: criar novos projetos
more previous years of schooling. Additionally,
de vida. Lisboa: Ed. Rutis.
the participants in U3A engage in activities with
6. Pinto, M. (2003). As Universidades da
a weekly frequency on average of 3 times and
Terceira Idade em Portugal: das origens aos
there is no report of intention the leave the U3A
novos desafios no futuro. Revista da
after enrolling. The ENPG considered the lack of
Faculdade de Letras – Línguas e Literaturas,
time the main cause preventing them to start in
20(2), 467-478.
U3A. Moreover, were observed higher levels in
7. Organización Mundial de la Salud (1980).
lower body strength and physical domain in
Informe de la conferencia preparatoria de la
participants of U3A. However, in all domains
OMS para a asamblea mundial de las
they present a good classification in quality of
naciones unidas sobre el envejecimiento.
life. We propose the development of studies with
México.
higher age groups, mainly because they may
8. Organização das Nações Unidas (1982).
possess different characteristics and present
Asamblea mundial sobre el envejecimiento.
results worthy of new interpretations.
Viena 9. World Health Organization (2002). Active
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demographic Changes in Portugal. Lisboa:
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