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SUMMARY: Frailty affects the functional autonomy (FA) of older adults and could manifest itself in muscle imbalances in the limbs, resulting in a disparity in size and strength between them. In Chile, information on the relationship between muscle strength (MS) levels and FA asymmetries in older women is limited. This study related the levels of MS, anthropometric parameters, and asymmetries of the lower and upper limbs, with the FA of a group of older Chilean women. The study included 39 women who participated, and their FA was evaluated using the GDLAM index (IG). Based on the score obtained in the IG, they were classified by percentiles as Group 1 with favorable FA (P ≤ 50) and Group 2 with low FA (P > 50). Anthropometric parameters were BMI, fat percentage, bone mass, circumferences (arm, thigh, calf), diameters (humerus, femur) and upper/lower limb strength was evaluated to determine asymmetries. The differences between the covariates of both groups were evaluated using the student's t test and the Mann-Whitney test for independent samples. G1 presented less asymmetry (p > 0.05) in the lower limbs and greater calf circumference than G2 (p < 0.05). G1 presented greater bilateral strength (dominant and non-dominant limb) compared to G2 (p < 0.05). The covariates of age, anthropometry, MS, and lower/upper limb asymmetries influence FA in older women.

La fragilidad afecta la autonomía funcional (AF) de las personas mayores y podría manifestarse en desequilibrios musculares en los miembros, dando lugar a una disparidad de tamaño y fuerza entre ellos. En Chile, la información que relaciona los niveles de fuerza muscular (FM) y las asimetrías con la AF en mujeres mayores es limitada. Este estudio relacionó los niveles de FM, parámetros antropométricos y asimetrías de los miembros inferiores y superiores, con la AF de un grupo de mujeres mayores chilenas. Participaron 39 mujeres, cuya AF se evaluó mediante el índice GDLAM (IG). En función de la puntuación obtenida en el IG, se clasificaron por percentiles en Grupo 1 con AF favorable (P ≤ 50) y Grupo 2 con AF baja (P > 50). Los parámetros antropométricos fueron IMC, porcentaje de grasa, masa ósea, circunferencias (brazo, muslo, pantorrilla), diámetros (húmero, fémur) y se evaluó la fuerza de los miembros superiores/ inferiores para determinar asimetrías. Las diferencias entre las covariables de ambos grupos se evaluaron mediante la prueba t de student y la prueba de Mann-Whitney para muestras independientes. G1 presentó menor asimetría (p > 0,05) en los miembros inferiores y mayor perímetro de pantorrilla que G2 (p < 0,05). G1 presentó mayor fuerza bilateral (miembro dominante y no dominante) en comparación con G2 (p < 0,05). Las covariables de antropometría, FM y asimetrías de extremidades inferiores/superiores influyen en la AF en mujeres mayores.

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The objectives of this study were: (a) to determine asymmetries, both lower limb (LL) and upper limb (UL), in Chilean older adults, and (b) to relate asymmetries to FA in both LL and UL. Forty-one older adults voluntarily participated in this study (mean ± standard deviation [SD]: age 72.0 ± 8.0 years, LL asymmetries 13.78 ± 14.87%, UL asymmetries 10.70 ± 8.85%, FA 40.35 ± 16.26 points). The variables were: (1) asymmetries of LL and UL, assessed through a force platform and handgrip, respectively; (2) FA, assessed through the Latin American Group for Maturity (GDLAM) and the GDLAM index of autonomy (GI) protocol. The relationship between the variables was performed through Spearman's correlation. The analysis showed that 39% of the participants presented asymmetries above 15% in the LL. Likewise, this 39% of older adults presented a lower FA than their peers with asymmetries below 15% in the LL (≤15%: 35.64 ± 12.26 points vs. >15%: 47.69 ± 19.23 points, p = 0.003). The analysis showed a small correlation between LL and GI asymmetries (r = 0.27, p = 0.07) and a small but negative correlation between UL and GI (r = -0.21). The mean values of asymmetries of both LL and UL are within 'normal' parameters. However, several older adults were identified as being at risk. In parallel, older adults who presented a higher level of asymmetries in LL showed a lower level of FA.

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Resumen La incapacidad funcional del adulto asociada al envejecimiento poblacional genera un problema de salud pública. El objetivo de este artículo es estudiar la asociación existente entre el nivel educativo y la autonomía funcional de los adultos del Distrito Metropolitano de Quito (DMQ) en Ecuador. Para ello se realizó un análisis secundario con la información de la base de datos del estudio "Montreal Cognitive Assessment (MoCA): datos normativos para la población ecuatoriana", que tiene un diseño transversal con adultos de 45 a 85 años. Se utilizó un modelo multivariado de regresión logística. El tamaño muestral fue de 328 participantes, de los cuales 301 fueron incluidos. Los resultados muestran diferencias significativas en cuanto al nivel educativo y la autonomía funcional: primero, permiten observar que un nivel educativo igual o mayor a los 12 años de instrucción es un factor de prevención de la pérdida de la autonomía funcional; segundo, muestran que hay una mayor posibilidad de pérdida de autonomía en función de la edad. Esta asociación existente entre el nivel educativo y la preservación de la autonomía funcional en el adulto en el DMQ muestra la importancia de promover el acceso a prácticas educativas permanentes en la población como parte de un programa de prevención de la pérdida de la autonomía mencionada.

Abstract The functional disability of the adult associated with population aging generates a public health problem due to the impact on the health and social care systems. The objective of this investigation was to study the association between educational level and functional autonomy of adults of the Metropolitan District of Quito (DMQ) in Ecuador. For this, a secondary analysis was done with the information from the database of the study "Montreal cognitive assesment (MOCA): normative data for the Ecuadorian population", the same one that has a cross-sectional study design with adults from 45 to 85 years old. A multivariate logistic regression model was used. The sample number was 328 participants of which 301 were included. The results show the significant differences in terms of educational level and functional autonomy, being a factor of prevention an educational level equal to or greater than 12 years of instruction. In addition, showing greater possibility of loss of autonomy based on age. This existing association between educational level and the preservation of functional autonomy in adults in the DMQ demonstrates the importance of promoting access to permanent educational practices in the population as part of a program to prevent the loss of functional autonomy.

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The aim of this study was to determine the effects of Pilates-based mat exercises on functional autonomy and life satisfaction among elderly women. A randomized controlled trial was conducted in Caxias do Sul, Brazil in 2015, in which 61 healthy older women were randomized into two groups (experimental group, EG = 31 participants with 64.25 mean years of age, SD = 0.14, and a control group, CG = 30 participants, 63.75 mean years of age; SD = 0.08). The EG participants performed the mat Pilates twice per week, 60-min per session. The same measurements were performed at baseline and after 16 weeks. No significant differences were found between groups at baseline (p > 0.05). In the EG, the following factors were increased after the 16-weeks training period: flexibility of lower limbs, flexibility of upper limbs, strength in lower and upper limbs, aerobic endurance and dynamic balance. This study revealed significant improvements on the life satisfaction scale's score for the EG when compared to the CG, after 16 weeks of intervention. No differences were found between baseline and after 16 weeks on the functional autonomy and life satisfaction scores for the CG. According to the results of this study, it was found that functional autonomy and life satisfaction for elderly women was improved after exposure to 16 weeks of the PM, suggesting this practice helps with healthy aging.

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The identification of the older people who are functionally dependant is essential for planning interventions with emphasis on secondary and tertiary prevention. Therefore, a simplified tool, able to identify these individuals for a more comprehensive evaluation, is required. However, the use of a measuring tool in a different socio-cultural context requires prior adaptation. This article aims to verify the psychometric properties of the PRISMA-7 in Brazilian context. This instrument was previously shown as able to identify older persons living in the community who have risk of functional loss in a Canadian study. In a sample of 1748 older persons, the internal consistency assessed by Cronbach's alpha showed a borderline value credited to the reduced number of questionnaire items. Factor analysis identified two well correlated factors, except for items 2 and 6. For criterion validity the SMAF scale (French acronym, Functional Autonomy Measurement System) was used as the gold standard. The analysis of the ROC curve indicated a sensitivity of 74.4% and specificity of 87.4% for the cut-off point of 4, while the Canadian version had a cut-off point of 3 for disability detection. Inter and intra-observer reliability, investigated by the Kappa Cohen were high and statistically significant. In conclusion, the results suggest that the validation process was adequate, and recommend the Brazilian version of PRISMA-7, to track older people with functional loss in the community.

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A perda da autonomia funcional no idoso relaciona-se não somente com a limitação no estado físico, mas também a função cognitiva e psíquica, tornando-o mais inativo no meio social em que convive. Dessa forma, é de suma importância à inserção do idoso em programas que estimulem a prática regular de exercício físico e o convívio social. O presente estudo centrou-se em avaliar os efeitos de um programa de treinamento concorrente sobre a autonomia funcional de idosas pós-menopáusicas. Foram selecionadas 51 idosas, residentes no município de Muriaé (MG), voluntárias, distribuídas em dois grupos, um grupo treinamento concorrente (GTC=25), com média de idade de 69,44±6,82 anos e um grupo controle (GC=26) com média de idade de 68,30±6,34 anos. Os parâmetros biofísicos foram estimados por meio da massa corporal, estatura e índice de massa corporal. A avaliação da autonomia funcional foi feita pela bateria de testes do Grupo de Desenvolvimento Latino-Americano para a Maturidade (GDLAM), composta de: caminhar 10m (C10m), levantar-se da posição sentada (LPS), levantar-se da posição decúbito ventral (LPDV), levantar-se da cadeira e locomover-se pela casa (LCLC) e o teste de vestir e tirar uma camiseta (VTC). Após a intervenção, o GTC apresentou um valor fraco nos testes C10m e LPDV; regular nos testes LCLC, VTC e no índice de GDLAM e bom no teste LPS. Os resultados mostraram que o GTF no pós-teste apresentou melhores resultados em todas as variáveis da autonomia funcional, exceto no teste de LPDV (p=0,057) em relação ao GC (p<0,0125). Na avaliação intragrupos no GTC, encontrouse diferenças estatisticamente significativas para os testes de autonomia funcional C10m (p=0,007), LPS (p=0,000) e IG (p=0,007). Esta pesquisa confirma que a prática regular de exercício físico é essencial para a restauração e controle da autonomia funcional na população de idosos.(AU)

The loss of functional independence in the elderly is related not only to the limitation in physical state, but also the cognitive and mental function, making it inactive in the social environment in which lives. Thus, it is of paramount importance to the insertion of the elderly in programs that encourage the regular practice of physical exercise and social interaction. This study focused on evaluating the effects of a concurrent training program on functional autonomy of postmenopausal elderly. 51 elderly were selected residents in the city of Muriaé (MG), volunteers, divided into two groups, a concurrent training group (CTG=25), with a mean age of 69.44±6.82years and a control group (CG=26) with mean age of 68.30±6.34 years. The biophysical parameters were estimated using the body mass, height and body mass index. The assessment of function0061l autonomy was made by the test battery of the Latin American Development Group for Maturity (LADGM), composed of: walk 10m (W10m), rising from a sitting position (RSP), rising from a recumbent position ventral (RRPV), rising from a chair and walk around the house (RCWH) and the test of wear and take a T-shirt (WTT). After the intervention, the CTG offered very little value in W10m and RRPV tests; regular in RCWH testing, WTT and index LADGM and good in RSP test. The results showed that the CTG in the post-test showed better results in all the variables of the functional autonomy, except in the test RRPV (p=0.057) compared to the CG (p <0.0125). In intragroup evaluation in CTG, we found statistically significant differences in the functional autonomy tests W10m (p=0.007), RSP (p=0.000) and index LADGM (p=0.007). This research confirms that regular physical activity is essential for the restoration and control of the functional autonomy of the elderly population.(AU)

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En este artículo se establece la relación entre autoestima y autonomía funcional en una muestra de ancianos institucionalizados en función del apoyo social externo. Los participantes fueron 30 ancianos entre 67 y 93 años de ambos géneros, que en promedio llevan cinco años viviendo en un asilo de ancianos. Para medir la autoestima, se utilizó la escala de Rosenberg (2007) y para medir la autonomía funcional, el índice de Barthel (1993). Los resultados confirman que existe una relación entre la autoestima y autonomía funcional, y que la capacidad de desplazamiento sin ayuda externa es un factor determinante de la autoestima. Por otra parte, no se encontraron diferencias significativas en la autoestima en lo que respecta al apoyo social representado en visitas externas. Se concluyó que el factor determinante de la autoestima en ancianos institucionalizados es la autonomía funcional relacionada con el desplazamiento sin ayuda antes que el apoyo social externo.

This paper aims to establish a relationship between self-esteem and functional autonomy. 30 elderly participants between 67 and 93 years old of both sexes who spent 5 years living in a nursing home were sampled. To measure their functional autonomy, the Rosenber Scale (2007) was used self-esteem, the Barthel index (1993). The results confirm that there is a relationship between self-esteem and functional autonomy, and the ability to move without external assistance is a determinant factor of self-esteem. Conversely, significant differences were not found in self-esteem related to the social support represented by outpatient visits. It was concluded that the determinant factor for elderly self-esteem is their functional autonomy related to movement without help, rather than external social support.

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OBJETIVO: Analisar os fatores associados à percepção negativa de saúde em idosos brasileiros. MÉTODOS: Estudo de base populacional com delineamento transversal realizado no ano de 2009, em três cidades do Brasil. A amostra estratificada de forma aleatória simples foi composta de 909 adultos de 60 a 91 anos. Na identificação dos fatores associados com a percepção negativa de saúde (PNS), foi realizada análise bruta e mutivariável por estimativas das Razões de Prevalência (RP), por meio da regressão de Poisson; p < 0.05. RESULTADOS: A prevalência para PNS foi de 49,6 por cento, e após análise multivariada foi observado associação para os homens com o aumento da idade RP = 1,03 (IC = 1,01 - 1,06), risco de desnutrição RP = 1,66 (IC = 1,13 - 2,43) e incapacidade funcional RP = 1,79 (IC = 1,21-1,77). Para as mulheres, o uso superior a dois medicamentos RP = 1,41 (IC = 1,13 - 2,52), hipertensão arterial RP = 1,52 (IC = 1,43 - 1,97) e a incapacidade funcional RP = 1,36 (IC = 1,13 - 1,86). CONCLUSÕES: Quase a metade dos idosos possuem uma PNS, de maneira que ações preventivas de diminuição ao uso de medicamentos e comportamentos que favoreçam melhores condições nutricionais devem estar atreladas às políticas públicas à promoção da autonomia funcional e do bem-estar dos idosos.

OBJECTIVE: To analyze the factors associated with negative health perception in older Brazilians. METHODS: Population study of a cross-sectional sample, conducted in 2009 in three cities of Brazil. The stratified simple random sample consisted of 909 adults between 60 and 91 years of age. A gross and multivariate analysis by estimated prevalence rate (PR) using Poisson regression with calculation of adjusted prevalence ratios, p < 0.05 was performed to identify factors associated with negative perception of health (NPH). RESULTS: The prevalence of NPH was 49.6 percent. After the multivariate association, a certain association for men with older age PR = 1.03 (Cl = 1.01 to 1.06), risk of malnutrition PR = 1.66 (CI = 1.13 to 2.43) and disability PR = 1.79 (CI = 1.21 to 1.77) was observed. For women, the association was with taking more than two medications PR = 1.41 (CI = 1.13 to 2.52), hypertension PR = 1.52 (CI = 1.43 to 1.97) and functional disability PR = 1.36 (CI = 1.13 to 1.86). CONCLUSIONS: Nearly half of the elderly have NHP, therefore preventive actions that decrease drug use and encourage behaviors toward better nutritional conditions should be tied to public policies in order to promote the functional independence and well-being of the elderly.

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Os níveis de fator de crescimento insulina símile tipo 1 (IGF-1), força muscular e autonomia funcional, tendem a declinar com a idade. O presente estudo teve como objetivo avaliar os efeitos da cinesioterapia sobre os níveis de IGF-1, força muscular e autonomia funcional em mulheres idosas com disfunções musculoesqueléticas. A amostra de 52 idosas foi dividida aleatoriamente em dois grupos iguais: Grupo Experimental (GE, idade: 68,52 ±4,68 anos; IMC: 28,05 ± 20,83), submetido a 12 semanas de cinesioterapia, e Grupo Controle (GC, idade: 67,52 ± 7,34 anos; IMC: 26,96 ± 4,01). Foram avaliados os níveis séricos de IGF-1 através do método de Quimioluminescência e de força muscular através do teste de umarepetição máxima (1RM) nos movimentos de flexão (FQ) e extensão de quadril (EQ), flexão (FO) e extensão de ombro (EO) e a autonomia funcional, através do protocolo GDLAM. A ANOVA de medidas repetidas mostrou que o GE aumentou os níveis de IGF-1 (?=19,74 ng/ml; p=0,028) do pré para o pós-teste. O GE aumentou os níveis de força muscular nos exercícios de flexão (?FO=1,26 kg; p=0,001) e extensão de ombros (?EO=1,90 kg; p=0,0001)e de extensão (?EQ=2,52 kg; p=0,0001) e flexão de quadril (?FQ=2,82 kg; p=0,0001) do pré para o pós-teste. O GE reduziu os escores do IG (?= -16,73; p=0,004) do pré para o pós-teste. Concluiu-se que, através do exercício resistido, podem-se obter resultados positivos sobre os níveis de IGF-1, força muscular e autonomia funcional em mulheres idosas comdisfunção musculo-esquelética.

The levels of insulin-like growth factor-1 (IGF-1), muscle strength and functional autonomy tend to decrease with age. The objective of this study was to evaluate the effects of kinesiotherapy on IGF-1 levels, muscle strength and functional autonomy in older women with musculoskeletal dysfunction. A sample of 52 women was randomly divided into two groups: an experimental group (age: 68.52 ± 4.68 years, BMI: 28.05 ± 20.83) submitted to 12 weeks of exercise, and a control group (age: 67.52 ± 7.34 years; BMI: 26.96 ± 4.01). Serum IGF-1 levels were measured by a chemiluminescence method. Muscle strength was evaluated by one-repetitionmaximum (1-RM) testing of hip flexion (HF) and extension (HE) and shoulder flexion (SF) and extension (SE). The GDLAM protocol was used for the evaluation of functional autonomy. Repeated measures ANOVA showed an increase in IGF-1 levels after kinesiotherapy in the experimental group (? = 19.74 ng/ml, p = 0.028). In the experimental group, muscle strengthfor shoulder flexion (?SF = 1.26 kg, p = 0.001) and extension exercise (?SE = 1.90 kg, p = 0.0001) and for hip extension (?HE = 2.52 kg, p = 0.0001) and flexion (?HF = 2.82 kg, p = 0.0001) exercise increased after therapy. IG scores were reduced in the experimental group after therapy (? = -16.73, p = 0.004). In conclusion, resistance exercise can improve IGF-1 levels,muscle strength and functional autonomy in older women with musculoskeletal dysfunction.