Original Article

http://dx.doi.org/10.12965/jer.1632566.283 Journal of Exercise Rehabilitation 2016;12(3):194-201

The level of physical activity affects the health of older

adults despite being active
Lorena Fernandez-Alonso1, Daniel Muñoz-García1,2,*, Roy La Touche1,2,3,4
1
Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
2
Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid,
Spain
3
Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
4
Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain

Health care in the ageing population is becoming a crucial issue, due to tween groups for the BBS (t= 2.21; P= 0.03, d= 0.27). The Pearson cor-
the quality of life. Physical activity, is of primary importance for older relation analysis shows in LA group a moderate correlation between
adults. This report compared the physical activity in two active older the BBS and age (r = -0.539; P < 0.01) and EQ-5D (r = 0.480; P < 0.01).
adults population with functionality, quality of life, and depression symp- Moreover, both groups had a moderate negative correlation between
toms. A cross-sectional study was developed with 64 older adults. GDS and the the EQ-5D time trade-off (r= -0.543; P= 0.02). Active older
Physical activity was assessed through the Yale Physical Activity Sur- adults with different amounts of physical activity differ in the BBS. This
vey for classification into a less activity (LA) group and a more activity functional score was higher in the MA group. When observing to quali-
(MA) group. Afterwards, the other health variables were measured ty of life, only the LA group was negatively associated with age while in
through specific questionnaires: the quality of life with the EuroQol (Eu- both groups were associated with depression index.
roQol five dimensions questionnaire, EQ-5D), functionality with the Berg
balance scale (BBS) and depression symptoms with the geriatric de- Keywords: Age, Physical activity, Motor activity, Postural balance,
pression scale (GDS). There is a statistical significant difference be- Quality of life, Depression in the elderly

INTRODUCTION tion is increasing faster than the older population in other Euro-
pean countries. Life expectancy has increased markedly in older
Ageing represents a fundamental problem for society due to the adults between 65 to 85 yr during this century, thus contributing
demographics changes in the older population, which is increas- to the global ageing community.
ing with the ages, and also to an increase in the dependency taxes. The physical, economic and social environments are changing
These facts suggest new perceptions around the older population, the daily living patterns of humans and this includes the demands
like the socioeconomic and sanitary environment (Abades Porcel of physical activity (PA) (Owen et al., 2010). Among older popu-
and Rayón Valpuesta, 2012). Societies have to improve the ro- lations the concept of healthy ageing has developed. This concept
bustness of health, long-term care, and welfare systems in Europe, includes issues like the person’s social life and economic security.
and to help people to be healthy and active in their older ages Home surroundings plays a role in developing and supporting
(Rechel et al., 2013). The predictions for 2050 are that there will personal strategies for healthy ageing (Sixsmith et al., 2014).
be 16 millions of older adults around the world, which correspond In recent studies, PA is associated with better physical health
to 30% of the total population. Currently, older adults represent and is a priority of public health with a successful ageing popula-
about 19% of the total population in Spain, though this popula- tion (Giglio et al., 2015; Moreno et al., 2014). Physical function

*Corresponding author: Daniel Muñoz-García http://orcid.org/0000-0001-7367-2551 This is an Open Access article distributed under the terms of the Creative Commons At-
Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. tribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)
Universidad Autónoma de Madrid, CSEULS-UAM, C/ La Salle, 10, 28023, Madrid, which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Spain
Tel: +34-91-740-1980 (ext 505), Fax: +34-91-357-1730, E-mail: danimgsan@gmail.com
Received: February 9, 2016 / Accepted: May 30, 2016
Copyright © 2016 Korean Society of Exercise Rehabilitation 194 http://www.e-jer.org pISSN 2288-176X
eISSN 2288-1778
Fernandez-Alonso L, et al. • The role of physical activity in elderly population

and PA are described as a consequence of well-being, which seems MATERIALS AND METHODS
especially important for older people. The importance of PA in-
fluences the physical health and functional status, as well as the Study design
life satisfaction, the life appraisal and the ‘‘age well’’ perceptions of This study is a cross-sectional study where we collected data
older adults. The positive psychological effects of PA in disabled about the relationships among PA and health variables in an ac-
subjects is emphasized (Garatachea et al., 2009). tive older population attending a dwelling-based community pro-
Studies have demonstrated that PA should be especially recom- gramme in Madrid (Spain), for a fixed time period of three
mended for the promotion and maintenance of better health and months. This specific community attend 2 times per week to de-
functional ability in older adults, this being a major public health velop PA sessions and the rest of the week had very different
concern. This is due to the increasing life expectancy and that the amounts of PA. Anonymity was not necessary during the moni-
prevalence of disease rises with age (Giné-Garriga et al., 2014; toring of the study and only the investigator who did the statisti-
Rechel et al., 2013; Stephan et al., 2011; Vallance et al., 2012; cal analysis was ‘blind’. All of the procedures used in this study
Withall et al., 2014). were planned under the ethical norms of the Helsinki Declaration
Evidence demonstrates that PA programs in the older commu- and were approved by the local ethics committee of the Centre for
nity can minimize the effect of diminishing strength and give an Advanced Studies University La Salle, (CSEULS-PI-046/2015).
improvement in functional ability (Giné-Garriga et al., 2014; This study follows the “Strengthening the Reporting of Observa-
Quehenberger et al., 2014). Mobility is also a major problem for tional Studies in Epidemiology” (STROBE statement) (von Elm
older adults because limited mobility can seriously decrease their et al., 2008).
quality of life (QoL). Quehenberger et al. (2014) and Salguero et
al. (2011) suggested that PA can show a benefit in the mental Recruitment of participants
perception as measured with the QoL and also shows a positive Participants had the following inclusion criteria: men and
impact on depression. These authors have shown that an increase women ranging in age from 65 to 80 yr, attending to different
in the amount of PA taken is positively related to a significant older adult community, with capacity for walking for at least
improvement in the depressive status. Along the same lines, the three minutes without help, with maintained cognitive functions,
recent literature (Hamer et al., 2014; Hupin et al., 2015; Jeoung, being able to read, write and understand the Spanish question-
2015; Ofei-Dodoo et al., 2016) shows that older adults have ex- naires. On the other hand, the exclusion criteria were: subjects
ponential health benefits and longevity as PA increases, whether with some incapacity, those hospitalized or with a dependency.
or not they were considered active, until their activity level Subjects with any cognitive pathology such as dementia, terminal
reached about ten times the international recommendation (Arem illness and relevant clinical records which may stop PA were also
et al., 2015). excluded. Participants were collected in three dwelling communi-
Nevertheless, while many studies have focused on the sedentary ties in Madrid where they go every day to participate in different
older adult population, there is a lack of information in the litera- physical activities. The participants completed the questionnaires
ture regarding specific findings about the association between in a private room in these same locations, under the supervision of
amounts of PA during daily life activity and important health the investigator.
variables in those older adults considered to be “active” (Nelson et
al., 2007), as balance in functional activities and depression symp- Procedure
toms. This protocol was performed by an evaluator who had not par-
To our knowledge, this study is the first to compare varying ticipated in the selection and data collection procedures, to ensure
amounts of PA with health indicators in two active elderly com- the ‘blinding’ status of the investigation. After consenting to the
munity. Our hypothesis is that higher amounts of PA in the older study, the recruited patients were given a set of questionnaires to
adult population will correlate with improvements in functional- complete on the day of the evaluation. All the measures were ac-
ity and balance scores. The secondary objective is to determine the quired on the same day, during an hour with each participant. All
association between depressive symptoms and perceived QoL be- questionnaires were coded with an identification number rather
tween groups. than a name to blind this data to the other investigators. These
included various self-reports for the identification of the PA level,

http://dx.doi.org/10.12965/jer.1632566.283 http://www.e-jer.org 195

Fernandez-Alonso L, et al. • The role of physical activity in elderly population

QoL and depression symptoms. Finally, a test to determine the capacity during the functionality activities. This scale includes 14
functionality of the participant was conducted. items each with a score ranging from 0 to 4, which are combined
All participants in this study were active enough to be consid- to get a final score ranging between 0 (balance is seriously affect-
ered ‘active,’ previously characterized in the literature as partici- ed) and 56 (excellent balance). These scores will be low if the par-
pating in moderate- to vigorous-intensity PA for at least 150 min ticipant cannot complete the task or has to complete the task with
per week (Nelson et al., 2007) for older adults without chronic help. The participants must be able to complete the 14 tasks
conditions. At present, no cutoff value is defined for active older while the examiner evaluates the capacity of each participant in
adults; however, comparing groups with differing amounts of PA each task. The results were classified into three simpler groups:
could yield important data about how activity affects various high risk (0–20), moderate risk (21–40), and low risk (41–56).
health conditions. Therefore, according to the Spanish version of The investigator demonstrated each task before assessing the par-
the Yale Physical Activity Survey (YPAS) summary index distri- ticipant who replicated it.
bution, the sample was divided into a more activity (MA) and a The depression level was measured in the subjects by the geri-
less activity (LA) group along the median, as described elsewhere atric depression scale (GDS), which is validated to Spanish (Ramos
(Salpakoski et al., 2011). Brieva et al., 1991) and is an easy questionnaire to fill out. In the
study, we used the short form of the GDS with 15 questions. Ten
Outcomes measures of the 15 questions indicate the level of depression when the par-
To evaluate the QoL parameter we used the questionnaire Euro- ticipant answers affirmative while the rest of the questions indi-
Qol (EuroQol five dimensions questionnaire, EQ-5D). This ques- cated depression when the participants answer negatively. Scores
tionnaire, which has been validated to Spanish (Herdman et al., of 0–4 are considered normal; 5–8 indicate mild depression; 9–11
2001), consists of two phases and a visual analogue scale (VAS), indicate moderate depression; and 12–15 indicate severe depres-
which measure the QoL in both healthy and sick people. The pa- sion.
tient state of health is evaluated in five dimensions: mobility, self- Finally, to measure the level of the subjects’ PA and classify
care, usual activities, pain/discomfort and anxiety/depression. Each them in two groups we used the Spanish version of the YPAS
dimension has three levels: no problems, some problems, and se- (Katz et al., 2014). The YPAS determines the type and amount of
vere problems, where the patient has to mark in the box the most PA and is based on a questionnaire designed for older adults and
appropriate item in each dimension. Each level has a quantitative provides an index for a typical week during the last month. This
number 1 to 3 but the patient does not know the meaning (Pradas also provides information on whether activities are light, moder-
Velasco et al., 2009). A unique health state is produced as a result ate or high intensity. The activity dimensions summary index (to-
of combining one level from each of the five dimensions and then tal units) was computed by estimating the number of hours spent
calculating a final EQ-5D index. A total of 243 possible health in five PA dimensions (vigorous activity, leisurely walking, mov-
states are defined in this way. Each state is referred to in terms of a ing, standing, and sitting), multiplying it by frequency, and mul-
5-digit code. For example, state 11111 indicates no problems in tiplying it again by a weighing factor.
any of the five dimensions. After that the patient again evaluates
his/her health in the VAS, a numeric scale extending to 20 cm, Sample size
where the endpoints are labelled ‘Best imaginable health state’ The sample size was estimated with G*Power 3.1.7 for Win-
and ‘Worst imaginable health state’ and its high score is 100 dows (G*Power from University of Dusseldorf, Dusseldorf, Ger-
points and fall (minimum) score is 0 points. This information can many) (Faul et al., 2007). It was considered a power calculation to
be used as a quantitative measure of health outcome as judged by detect between-group differences in the BBS. An independent
the individual respondents. The advantages of this questionnaire samples Student t-test analysis was used to detect mean difference
are that it is short, easy to complete and simple to understand. between groups (the MA and LA groups) because it was the main
Furthermore, its administration is rapid, the patient can fill out factor of interest. This used an effect-size of 0.65 (medium) based
the questionnaire in 2–3 min (Herdman et al., 2001). on a pilot study with a sample of 17 subjects (eight from the MA
The balance and functional capacity were measured by the Berg group and nine from the LA group). A medium effect size of 0.79
balance scale (BBS) which is validated to Spanish (Berg et al., was used to obtain 90% statistical power (1-β error probability)
1992). The BBS is an evaluation tool used to identify the balance with an α error level probability of 0.05 suggested a sample size

196 http://www.e-jer.org http://dx.doi.org/10.12965/jer.1632566.283

Fernandez-Alonso L, et al. • The role of physical activity in elderly population

of 58 participants (29 per group). BBS between groups (t=2.21, P=0.03, d=0.27). There were no
statistically significant differences between all the other variables.
Statistical analysis The Pearson correlation analysis shows in LA group a moderate
All data analyses were performed on IBM SPSS Statistics ver. correlation within the BBS and other variables as age (r=-0.539,
21.0 (IBM Co., Armonk, NY, USA). The statistical analyses were P<0.01), EQ-5D VAS (r=0.480, P<0.01), EQ-5D time trade-
conducted at a 95% confidence level and a P-value less than 0.05 off (TTO) (r=0.385, P=0.03), and Vigorous Exercise (r=0.383,
was considered statistically significant. Descriptive statistics in- P=0.03).
clude means and standard deviations. Moreover, both groups had a moderate negative correlation be-
A normal distribution of the data was confirmed with the tween GDS and the the EQ-5D TTO (r=-0.543, P=0.02). A
Kolmogorov-Smirnoff test. For comparison of the outcomes be- higher depression index is in line with lower QoL. All the results
tween the two groups a Student t-test for independent samples are presented in Table 2.
was used. Effect-sizes (Cohen d) were calculated for the outcome
variables. According to Cohen method, the magnitude of the ef-
Table 2. Pearson correlations coefficient between the different variables ana-
fect was classified as small (0.20 to 0.49), medium (0.50 to 0.79),
lyzed in the study
or large (≥0.8) (Cohen, 1988).
Variable Age QoL VAS EQ-5D TTO EQ-5D VAS Group
The relationship between PA, functionality, depressive symp-
QoL VAS -0.131 - - - LA
toms and state of health was examined using Pearson correlation -0.094 - - - MA
coefficients. A Pearson correlation coefficient greater than 0.60 in- EQ5D TTO -0.224 -0.049 - - LA
dicated a strong correlation, a coefficient between 0.30 and 0.60 -0.063 0.048 - - MA
indicated a moderate correlation, and a coefficient below 0.30 in- EQ5D VAS -0.235 0.040 0.956** - LA
-0.115 0.135 0.929** - MA
dicated a low or very low correlation (Hinkle et al., 1988).
GDS 0.278 -0.369* -0.401* -0.442* LA
-0.021 -0.330 -0.543** -0.506** MA
RESULTS BBS -0.539** -0.067 0.385* 0.480** LA
-0.258 0.282 0.314 0.386* MA
We measured a total of 64 subjects without missing values. YPAS -0.373* 0.072 0.117 0.116 LA
-0.280 0.332 -0.265 -0.288 MA
When the sample was divided in two groups with half of the sub-
QoL VAS, quality of life perceived in visual analogic scale; EQ-5D, EuroQol five di-
jects in each group, the LA group had 62% of females and the mensions questionnaire; EQ-5D TTO, quality of life score, EQ-5D time trade-off; EQ-
MA group 50% respectively. All the other characteristics of sub- 5D VAS, quality of life VAS score; MA, more activity; LA, less activity; GDS, geriatric
jects are shown in the Table 1. depression scale; BBS, Berg balance scale; YPAS, Yale Physical Activity Survey, fi-
nal index of physical activity per week.
Results of the Student t-test for equality of media in the inde- *The mean difference is significant at the 0.05 level. **The mean difference is sig-
pendent samples test demonstrated a significant PA factor for the nificant at the 0.01 level.

Table 1. Summary of demographic variables and comparison between groups with Student t-test
MA group (n= 32) LA group (n= 32)
Characteristic t Mean difference (95% CI) Effect size
Mean± SD Range Mean± SD Range
Age (yr) 69± 3.46 65–78 72± 6.38 65–88 2.29 2.94 (0.37 to 5.50)* 0.27
Qol VAS 82.03± 12.04 60–100 76.47± 14.15 40–100 -1.69 -5.56 (-12.13 to 1.00) -0.21
EQ-5D TTO 0.86± 0.15 0.424–1.000 0.78± 0.22 0.256–1.000 -1.82 -0.85 (-0.18 to 0.01) 0.21
EQ-5D VAS 0.81± 0.15 0.519–1.000 0.75± 0.19 0.378–1.000 -1.58 0.07 (-0.15 to 0.18) 0.17
GDS 1.84± 1.97 0–8 2.56± 2.38 0–7 1.32 0.72 (-0.37 to 1.81) -0.03
BBS 52.28± 3.77 44–56 48.88± 7.83 24–56 -2.22 -3.41 (-6.48 to -0.34)* 0.27
YPAS 195.37± 100.94 108–602 70.50± 26.59 13–105 -6.77 -124.87 (-161.76 to -87.99)** 0.65
MA, more activity; LA, less activity; SD, standard deviation; CI, confidence interval; QoL VAS, quality of life perceived in visual analogic scale; EQ-5D, EuroQol five dimensions
questionnaire; EQ-5D TTO, quality of life score, EQ-5D time trade-off; EQ-5D VAS, quality of life VAS score; GDS, geriatric depression scale; BBS, Berg balance scale; YPAS,
Yale Physical Activity Survey, final index of physical activity per week.
*The mean difference is significant at the 0.05 level. **The mean difference is significant at the 0.01 level.

http://dx.doi.org/10.12965/jer.1632566.283 http://www.e-jer.org 197

Fernandez-Alonso L, et al. • The role of physical activity in elderly population

al., 2011) and a reduced cell loss in sensitive areas like the hippo-
DISCUSSION campus, which may play a decisive role in successful everyday
functioning (Colcombe et al., 2003).
The purpose of this study is to investigate two groups of active Also we have found lower QoL when the BBS variable shows a
older adults who engage in different amounts of PA. The relation- lower score. Despite the lack of knowledge about the relationship
ship between PA and functional capacity, QoL, and depression with the type of physical activities on the QoL, some studies in
will be discussed. the literature regarding the ageing population often shows similar
Similar studies in the adult older population used sedentary and results with poor functional capacity in their ability to perform
active segmentation of the sample analyzed to describe the grade daily tasks when this variable is decreased (Motl and McAuley,
of PA. However, we used LA and MA groups because, in our 2010; Neto et al., 2015). This was also noted in previous studies
study, all the participants took part in a sufficient quantity of PA where declining functionality is associated with changes in hor-
(Nelson et al., 2007). mone levels, with an increase in cortisol blood levels (Mura et al.,
Statistically significant differences in the balance and functional 2014a).
capacity of the two groups of active older adults were found. Old- In our analysis of this group with LA, the type of PA was also
er adults allocated to the MA group had better BBS scores. Recent statistically associated with this variable, where those with less
literature has shown a medium risk of falling with similar mean vigorous activity reported poorer functionality. This issue was also
values for the BBS in this population (Allison et al., 2013) while found by Mura et al. (2014b) in an elderly community where they
other authors suggested that cutoff points below 49 and 50 (Rid- observed that the intervention group with vigorous activity main-
dle and Stratford, 1999; Shumway-Cook et al., 1997; Yümin et tained significantly-higher scores of QoL compared with other
al., 2011) indicate the patient is 3 times more likely to suffer a groups that achieved lower intensity rates. This QoL is frequently
fall. However, this scale has been found to be more sensitive in in- studied in this population (Neto et al., 2015) and in our study is
active older adults (Santos et al., 2011). This data matched with associated with lower depression index. In the same manner as our
our results of both groups of active elderly, where the LA group findings, Rodrigues et al. (2015) provided evidence in their study
mean score is less than 49 and the MA group is greater than 52 that depression is very prevalent in this population and has a
points. Moreover, in a recent intervention study involving an el- greater impact on QoL than other important comorbidities. Re-
derly population with BBS scores similar to our LA group, partic- cent studies also found important concerns about the QoL in the
ipating in a 6-week program achieved an improvement that was older adults population, which is mainly impaired by depression
comparable to our MA group (Cakar et al., 2010). (Unützer, 2009) and is also related to the PA function and general
When the sample is analysed within groups, the LA group health perceptions (Saarijärvi et al., 2002).
showed several relationships among the BBS and different mea- In recent years, several multitude clinical trials (Du et al., 2015;
sured variables, linked to the level of physical functionality in dai- Jeoung, 2014; Lincoln et al., 2011; Pereira et al., 2013; Yoshida
ly life activity and participants’ static and dynamic balance abili- et al., 2015) and a systematic review (Cho, 2014) where depres-
ties. In our study there was a significant observation when the sion index is being approach have been carried out with very good
participants get older in this group, there was an association with results associated with special PA programs for the elderly com-
this functional scale, which may predict a higher risk of falls, as munity. This is an important issue to both establish better treat-
seen in previous studies in the literature where the PA declines ments and a reduction of costs in the public health system (Luber
with increasing age (Fone and Lundgren-Lindquist, 2003). This et al., 2001). Therefore, prevention strategies with this type of in-
data indicates a lower functionality in daily life activity that was tervention should be a priority (Rovio et al., 2005).
very well studied previously, where neuromuscular function seems In conclusion, active older adults with different amounts of PA
to be a critical factor for maintaining muscle strength and physi- differ in their BBS score. This functional score was higher in the
cal independence (Tanimoto et al., 2012). These results were also MA group. With regards to QoL, only the LA group was nega-
in line with findings showing links between brain atrophy and tively associated with age while in both groups showed a negative
multidimensional physical functioning in older adults where association with the depression index.
muscle strength, balance and exercise capacity were related to Our study has some limitations; first the number of women was
brain volume changes in the medial temporal lobe (Makizako et relatively higher than men. Second, our sample was enrolled in an

198 http://www.e-jer.org http://dx.doi.org/10.12965/jer.1632566.283

Fernandez-Alonso L, et al. • The role of physical activity in elderly population

activity programme and the results may not be comparable with Du WJ, Tan JP, Yi F, Zou YM, Gao Y, Zhao YM, Wang LN. Physical activi-
other ageing populations with more sedentary lifestyles. Finally, ty as a protective factor against depressive symptoms in older Chinese
we consider that an important limitation in this study is that no veterans in the community: result from a national cross-sectional
anthropometric variables were measured, as these could influence study. Neuropsychiatr Dis Treat 2015;11:803-813.
the levels of PA. Future studies should investigate the relationship Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical
between functionality, QoL, PA levels with anthropometric vari- power analysis program for the social, behavioral, and biomedical sci-
ables. ences. Behav Res Methods 2007;39:175-191.
Fone S, Lundgren-Lindquist B. Health status and functional capacity in a
CONFLICT OF INTEREST group of successfully ageing 65-85-year-olds. Disabil Rehabil 2003;25:
1044-1051.
No potential conflict of interest relevant to this article was re- Garatachea N, Molinero O, Martínez-García R, Jiménez-Jiménez R,
ported. González-Gallego J, Márquez S. Feelings of well being in elderly peo-
ple: relationship to physical activity and physical function. Arch
ACKNOWLEDGMENTS Gerontol Geriatr 2009;48:306-312.
Giglio RE, Rodriguez-Blazquez C, de Pedro-Cuesta J, Forjaz MJ. Sense of
The authors thanks “Centro de día y mayores Fuenlabrada” for coherence and health of community-dwelling older adults in Spain.
helping with process of participants enrolment. Int Psychogeriatr 2015;27:621-628.
Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A.
REFERENCES Physical exercise interventions for improving performance-based
measures of physical function in community-dwelling, frail older
Abades Porcel M, Rayón Valpuesta E. Ageing in Spain: it’s a challenge or adults: a systematic review and meta-analysis. Arch Phys Med Rehabil
social problem? Gerokomos. Ediciones 2012;23:151-155. 2014;95:753-769.e3.
Allison LK, Painter JA, Emory A, Whitehurst P, Raby A. Participation re- Hamer M, Lavoie KL, Bacon SL. Taking up physical activity in later life
striction, not fear of falling, predicts actual balance and mobility abili- and healthy ageing: the English longitudinal study of ageing. Br J
ties in rural community-dwelling older adults. J Geriatr Phys Ther Sports Med 2014;48:239-243.
2013;36:13-23. Herdman M, Badia X, Berra S. EuroQol-5D: a simple alternative for mea-
Arem H, Moore SC, Patel A, Hartge P, Berrington de Gonzalez A, Visva- suring health-related quality of life in primary care. Aten Primaria
nathan K, Campbell PT, Freedman M, Weiderpass E, Adami HO, 2001;28:425-430.
Linet MS, Lee IM, Matthews CE. Leisure time physical activity and Hinkle DE, Wiersma W, Jurs SG. Applied statistics for the behavioral sci-
mortality: a detailed pooled analysis of the dose-response relation- ences. 2nd ed. Boston: Houghton Mifflin; 1988.
ship. JAMA Intern Med 2015;175:959-967. Hupin D, Roche F, Gremeaux V, Chatard JC, Oriol M, Gaspoz JM, Bar-
Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance thélémy JC, Edouard P. Even a low-dose of moderate-to-vigorous
in the elderly: validation of an instrument. Can J Public Health 1992;83 physical activity reduces mortality by 22% in adults aged ≥60 years: a
Suppl 2:S7-11. systematic review and meta-analysis. Br J Sports Med 2015;49:1262-
Cakar E, Dincer U, Kiralp MZ, Cakar DB, Durmus O, Kilac H, Soydan 1267.
FC, Sevinc S, Alper C. Jumping combined exercise programs reduce Jeoung BJ. Relationships of exercise with frailty, depression, and cogni-
fall risk and improve balance and life quality of elderly people who tive function in older women. J Exerc Rehabil 2014;10:291-294.
live in a long-term care facility. Eur J Phys Rehabil Med 2010;46:59-67. Jeoung BJ. Correlation between physical fitness and fall efficacy in elderly
Cho MH. Are Korean Adults meeting the recommendation for physical women in Korea. J Exerc Rehabil 2015;11:151-154.
activity during leisure time? J Phys Ther Sci 2014;26:841-844. Katz JN, Perez MT, Niu NN, Dong Y, Brownlee SA, Elman SA, Stenquist
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. DS, Santiago A, Sanchez ES, Collins JE. Development and validation
Hillsdale (NJ): Lawrence Erlbaum Associates Inc.; 1988. of a Spanish translation of the Yale activity questionnaire. BMC Mus-
Colcombe SJ, Erickson KI, Raz N, Webb AG, Cohen NJ, McAuley E, culoskelet Disord 2014;15:120.
Kramer AF. Aerobic fitness reduces brain tissue loss in aging humans. Lincoln AK, Shepherd A, Johnson PL, Castaneda-Sceppa C. The impact
J Gerontol A Biol Sci Med Sci 2003;58:176-180. of resistance exercise training on the mental health of older Puerto Ri-

http://dx.doi.org/10.12965/jer.1632566.283 http://www.e-jer.org 199

Fernandez-Alonso L, et al. • The role of physical activity in elderly population

can adults with type 2 diabetes. J Gerontol B Psychol Sci Soc Sci toms in elderly women--a randomized clinical trial. Arch Phys Med
2011;66:567-570. Rehabil 2013;94:1443-1450.
Luber MP, Meyers BS, Williams-Russo PG, Hollenberg JP, DiDomenico Pradas Velasco R, Antonanzas Villar F, Martínez-Zárate MP. Use of euro-
TN, Charlson ME, Alexopoulos GS. Depression and service utilization pean quality of life-5 dimensions (EQ-5D) questionnary to value the
in elderly primary care patients. Am J Geriatr Psychiatry 2001;9:169- health related quality of life variation because of influenza. Gac Sanit
176. 2009;23:104-108.
Makizako H, Shimada H, Doi T, Yoshida D, Ito K, Kato T, Shimokata H, Quehenberger V, Cichocki M, Krajic K. Sustainable effects of a low-
Washimi Y, Endo H, Suzuki T. The association between decline in threshold physical activity intervention on health-related quality of
physical functioning and atrophy of medial temporal areas in com- life in residential aged care. Clin Interv Aging 2014;9:1853-1864.
munity-dwelling older adults with amnestic and nonamnestic mild Ramos Brieva JA, Montejo Iglesias ML, Lafuente López R, Ponce de León
cognitive impairment. Arch Phys Med Rehabil 2011;92:1992-1999. Hernández C, Moreno Sarmiento A. Validation of the geriatric depres-
Moreno G, Mangione CM, Wang PC, Trejo L, Butch A, Tseng CH, Sarki- sion screening Scale. Actas Luso Esp Neurol Psiquiatr Cienc Afines
sian CA. Physical activity, physical performance, and biological mark- 1991;19:174-177.
ers of health among sedentary older latinos. Curr Gerontol Geriatr Rechel B, Grundy E, Robine JM, Cylus J, Mackenbach JP, Knai C, McKee
Res 2014;2014:535071. M. Ageing in the European Union. Lancet 2013;381:1312-1322.
Motl RW, McAuley E. Physical activity, disability, and quality of life in Riddle DL, Stratford PW. Interpreting validity indexes for diagnostic
older adults. Phys Med Rehabil Clin N Am 2010;21:299-308. tests: an illustration using the Berg balance test. Phys Ther 1999;
Mura G, Cossu G, Migliaccio GM, Atzori C, Nardi AE, Machado S, Carta 79:939-948.
MG. Quality of life, cortisol blood levels and exercise in older adults: Rodrigues GH, Gebara OC, Gerbi CC, Pierri H, Wajngarten M. Depres-
results of a randomized controlled trial. Clin Pract Epidemiol Ment sion as a clinical determinant of dependence and low quality of life in
Health 2014a;10:67-72. elderly patients with cardiovascular disease. Arq Bras Cardiol 2015;
Mura G, Sancassiani F, Migliaccio GM, Collu G, Carta MG. The associa- 104:443-449.
tion between different kinds of exercise and quality of life in the long Rovio S, Kåreholt I, Helkala EL, Viitanen M, Winblad B, Tuomilehto J, So-
term. Results of a randomized controlled trial on the elderly. Clin ininen H, Nissinen A, Kivipelto M. Leisure-time physical activity at
Pract Epidemiol Ment Health 2014b;10:36-41. midlife and the risk of dementia and Alzheimer’s disease. Lancet
Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Mac- Neurol 2005;4:705-711.
era CA, Castaneda-Sceppa C; American College of Sports Medicine; Saarijärvi S, Salminen JK, Toikka T, Raitasalo R. Health-related quality of
American Heart Association. Physical activity and public health in life among patients with major depression. Nord J Psychiatry 2002;56:
older adults: recommendation from the American College of Sports 261-264.
Medicine and the American Heart Association. Circulation 2007; Salguero A, Martínez-García R, Molinero O, Márquez S. Physical activity,
116:1094-1105. quality of life and symptoms of depression in community-dwelling
Neto GA, Pereira-Junior PP, Mura G, Carta MG, Machado S. Effects of and institutionalized older adults. Arch Gerontol Geriatr 2011;53:152-
different types of physical exercise on the perceived quality of life in 157.
active elderly. CNS Neurol Disord Drug Targets 2015;14:1152-1156. Salpakoski A, Portegijs E, Kallinen M, Sihvonen S, Kiviranta I, Alen M,
Ofei-Dodoo S, Rogers NL, Morgan AL, Amini SB, Takeshima N, Rogers Rantanen T, Sipilä S. Physical inactivity and pain in older men and
ME. The impact of an active lifestyle on the functional fitness level of women with hip fracture history. Gerontology 2011;57:19-27.
older women. J Appl Gerontol 2016 Apr 1 [Epub]. http://dx.doi.org/ Santos GM, Souza AC, Virtuoso JF, Tavares GM, Mazo GZ. Predictive
10.1177/0733464816641390. values at risk of falling in physically active and no active elderly with
Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: the Berg Balance Scale. Rev Bras Fisioter 2011;15:95-101.
population health science of sedentary behavior. Exerc Sport Sci Rev Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the
2010;38:105-113. probability for falls in community-dwelling older adults. Phys Ther
Pereira DS, de Queiroz BZ, Miranda AS, Rocha NP, Felício DC, Mateo 1997;77:812-819.
EC, Favero M, Coelho FM, Jesus-Moraleida F, Gomes Pereira DA, Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S,
Teixeira AL, Máximo Pereira LS. Effects of physical exercise on plas- Haak M, Dahlin-Ivanoff S, Woolrych R. Healthy ageing and home:
ma levels of brain-derived neurotrophic factor and depressive symp- the perspectives of very old people in five European countries. Soc Sci

200 http://www.e-jer.org http://dx.doi.org/10.12965/jer.1632566.283

Fernandez-Alonso L, et al. • The role of physical activity in elderly population

Med 2014;106:1-9. broucke JP; STROBE Initiative. The Strengthening the Reporting of
Stephan Y, Boiche J, Trouilloud D, Deroche T, Sarrazin P. The relation be- Observational Studies in Epidemiology (STROBE) statement: guide-
tween risk perceptions and physical activity among older adults: a lines for reporting observational studies. J Clin Epidemiol 2008;61:344-
prospective study. Psychol Health 2011;26:887-897. 349.
Tanimoto Y, Watanabe M, Sun W, Sugiura Y, Tsuda Y, Kimura M, Ha- Withall J, Stathi A, Davis M, Coulson J, Thompson JL, Fox KR. Objective
yashida I, Kusabiraki T, Kono K. Association between sarcopenia and indicators of physical activity and sedentary time and associations
higher-level functional capacity in daily living in community-dwell- with subjective well-being in adults aged 70 and over. Int J Environ
ing elderly subjects in Japan. Arch Gerontol Geriatr 2012;55:e9-13. Res Public Health 2014;11:643-656.
Unützer J. Top cited papers in International Psychogeriatrics: 2. Quality Yoshida Y, Iwasa H, Kumagai S, Suzuki T, Awata S, Yoshida H. Longitu-
adjusted life years in older adults with depressive symptoms and dinal association between habitual physical activity and depressive
chronic medical disorders. Int Psychogeriatr 2009;21:265-266. symptoms in older people. Psychiatry Clin Neurosci 2015;69:686-692.
Vallance JK, Eurich DT, Lavallee CM, Johnson ST. Physical activity and Yümin ET, Şimşek TT, Sertel M, Öztürk A, Yümin M. The effect of func-
health-related quality of life among older men: an examination of cur- tional mobility and balance on health-related quality of life (HRQoL)
rent physical activity recommendations. Prev Med 2012;54:234-236. among elderly people living at home and those living in nursing
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vanden- home. Arch Gerontol Geriatr 2011;52:e180-184.

http://dx.doi.org/10.12965/jer.1632566.283 http://www.e-jer.org 201