Quality of life and functional capability of elderly Brazilian women

Abstract

BACKGROUND:

Quality of life is important at all ages, but maintaining a high quality of life is especially crucial to improve the functional capabilities of elder populations.

AIM:

To investigate the relationship between quality of life and the functional capabilities of elderly Brazilian women participating in the Open University for senior citizens (UATI) in the state of Bahia, Brazil.

METHODS:

A cross-sectional study involving 51 elderly women was performed along with the completion of sociodemographic, WHO Quality of life – BREF (WHOQOL-BREF) and WHO Quality of life – OLD (WHOQOL-OLD) questionnaires, and standardized functional capacity tests.

RESULTS:

The one-way ANOVA with a post hoc Tukey test showed interactions between functional capacity tests and the intimacy, autonomy, and death or dying domains of the WHOQOL-OLD.

CONCLUSION:

This study highlights the relationship between regular physical activity, improved functional capability, and quality of life, as demonstrated by better performances in the functional capacity tests resulting in a wider perception of quality of life for most of the senior women involved.

Keywords

Aging well-being physical fitness

1 Introduction

Aging is a continuous process characterized by physiological changes that generally lead to the progressive loss of functional capabilities and, as a result, loss of the ability to independently and safely perform daily activities [1, 2]. These biological and physiological advancements caused by aging prompt serious life changes, such as functional decay from chronic diseases and disabilities [3], for senior citizens, affecting their performances of daily and work activities [4 –6] and making them more vulnerable to health problems, with a consequent negative impact on overall quality of life [7].

By contrast, the adoption of a healthy lifestyle with regular and appropriate physical activity, particularly in community-based health promotion projects, can help senior citizens retain more active roles in society [8]. Regular physical activity has proved to be efficient in helping the elderly population maintain and promote health, fitness, and functional independence, especially in terms of endurance, muscular strength, flexibility, and balance, improving autonomy and increasing their senses of self-respect [9].

Quality of life, in turn, is related to health and centered around the capability to live healthily and overcome morbid conditions, and it depends on the personal satisfaction of each individual [10]. Quality of life also considers an individual’s physical health, psychological state, level of independence, social relationships, and relevant environmental characteristics [11]. Environments should offer favorable conditions for senior citizens to adapt their lifestyles, while considerations of limitations due to aging and evaluation of quality of life, values, and expectations on a personal and social level depends on the senior citizens themselves [12].

Miranda and Banhato [12] assert that the inclusion of senior citizens in social support groups promotes paradigmatic changes on the negative effects of aging such as limitations and incapacities because of the fact that such groups are often composed of active and autonomous senior citizens who are satisfied with their general conditions and involved in relationships with people of the same age or other age groups. Furthermore, studies have shown that practicing physical exercise in old age is crucial to bettering quality of life and functional capability, which directly improves functionality in daily life as a result [13, 14].

As a response to the above findings, programs have been implemented to include senior citizens in society. Namely, Open University for senior citizens (UATI) offers several physical and artistic activities. The UATI is a university extension program with the aim of using psychosocial reinsertion to exercise citizenship and develop permanent education actions; it focuses on stimulating reflection in senior citizens on several concepts about aging in their current situations. It is an informal educational program reaching people aged 60 or older of any gender and any socioeducational level [15, 16].

Despite the UATI being an important initiative for the elderly, there are still few studies evaluating the quality of life and functional capability of the population. Our present study aims to investigate the relationship between quality of life and functional capability of elderly women participating in the UATI in the state of Bahia, Brazil.

2 Methods

2.1 Study design

Our research consisted of a quantitative, descriptive cross-sectional study, which was approved by the State University of Bahia Ethics Committee on Human Research, with CAAE no. 335201014.2.0000.0057 and authorization no. 810.150. All participating senior citizen women signed a consent form to authorize data collection.

2.2 Place of study

The study occurred on the premises of the State University of Bahia Physical Education Laboratory on Campus IV in the Bahia city of Jacobina in northeast Brazil where the subjects participated in the Open University for senior citizens (UATI). Data collection occurred in the same place.

2.3 Participants

Target participants for this study consisted of elderly women aged 60 or older who were involved in and often took part in physical activities offered by the UATI. The UATI has 163 senior citizens enrolled, and 148 of them are women aged 60 or over. However, the following 97 were excluded after inclusion criteria were applied: 49 did not participate regularly in the activities, and 48 did not agree to take part in the research. The remaining 51 subjects were recruited using convenience sampling and composed the final sample.

2.4 Variables and research instruments

The World Health Organization Quality of Life — Brief questionnaire (WHOQOL-BREF) and the World Health Organization Quality of Life — OLD questionnaire (WHOQOL-OLD) were used to evaluate quality of life. The sociodemographic questionnaire was applied to characterize social and demographic factors, and standardized tests suggested by Study Center and Laboratory of Physical Fitness (CELAFISCS) were used to evaluate functional capability.

The WHOQOL-BREF is a questionnaire developed by the World Health Organization and used to evaluate quality of life. The WHOQOL-BREF is the Brazilian Portuguese version of the WHOQOL-100 based on methodology recommended for a version of this instrument designed by the WHOQOL Center in Brazil [17]. The questionnaire consists of 26 questions, including two general questions related to quality of life and 24 evaluating physical, psychological, social relationship, and environmental domains [17]. The score is obtained by summing the answers of each question with scores ranging from 4 to 20 per question. The total score is then calculated and translated into numbers ranging from 0 to 100 [18].

The WHOQOL-OLD is a questionnaire consisting of 24 items related to 6 different domains: sensorial operation (SO), autonomy (AUT), death and dying (DD) past, present and future activities (PPFA), social participation (SPA), and intimacy (INT). Each domain includes 4 items, with each individual score ranging from 1 to 5 and the range of possible marks varying from 5 to 20 for all domains. The scores of the 24 WHOQOL-OLD module items are combined to produce a general score, known as the “total score”, indicating the senior citizens’ quality of life reports, ranging from 24 to 120 [19].

It is worth noting that gross scores in this study were transformed in accordance with the WHOQOL Manual created by the WHOQOL Group to determine results on a scale of 0 to 100. This scale allows the results to show the score of each domain in percentages of the lowest possible (0) and highest possible (100) scores. The total score is directly proportional to elderly quality of life [19].

A standardized tests developed by CELAFISCS was adopted to evaluate functional fitness components; it proposes a wide range of motor tests to determine the index of general physical fitness of groups of people living in developing countries with better working conditions [20]. According to Matsudo [21], most tests can be applied to physically independent senior citizens over the age of 60. The tests chosen to determine physical fitness variables were as follows: muscular strength of upper and lower limbs; flexibility, agility, and balance; and aerobic endurance, including walking speed and ability.

After statistical analysis, only three of the eight functional capability tests showed relevant divergences from the scores related to the quality of life characteristics of the senior women recruited. Therefore, only results from walking speed (measuring walking speed and ability), 30-second chair stand (measuring muscular strength of lower limbs), and 2-minute step-in-place (measuring aerobic endurance) tests are shown.

Data on the sociodemographic profiles of the elderly women’s families were also collected using a questionnaire developed for the study to determine characteristics such as age, marital status, education, income, and number of children among other variables widely used in epidemiological studies [22, 23]. It is worth noting that we used the Brazilian (in Portuguese) versions of all instruments.

2.5 Procedures

Permission from the UATI was requested to obtain access to their facilities for data collection and for volunteers to participate. Data collection was scheduled in advance according to volunteers’ availabilities. All the tools used in the research were presented to the UATI coordinator, and after obtaining permission to continue research procedures, participants were clearly informed about the purpose and procedures of the study. All participants signed the Free and Clarified Consent Term form to authorize data collection. The questionnaires distributed after their consent to perform the study included sociodemographic, WHOQOL-BREF, WHOQOL-OLD, and the CELAFISC-approved tests, ordered from least to most physically demanding.

2.6 Statistical analysis

Data was descriptively analyzed to arrive at a mean to demonstrate sociodemographic variables through the distribution of relative and absolute frequencies and as a description for mean and standard deviations of quantitative variables. The one-way ANOVA was used to verify the relationship between the quality of life scores and scores obtained in the functional capability tests. The post hoc Tukey test was applied to verify possible relationships between variables, using quality of life as the dependent variable and functional capability as the independent variable in this study.

This study only describes the results from three tests of several functional capability tests since these were the only ones that indicated relevant associations between some categorized functional capability values and the quality of life scores.

Fig.1

Characteristics of functional capacity tests. Source: Adapted from Matsudo [21].

The subjects were divided into groups according to performance based on the frequencies found in their numeric performance scores for each test. After the walking speed test, volunteers were separated into 4 groups according to performance times as follows: group 1 (volunteers who performed the test between 2 and 2.66 seconds), group 2 (3 seconds), group 3 (between 3.33 and 3.66 seconds), and group 4 (between 4 and 7.66 seconds). Following the chair stand test, volunteers were categorized into 3 groups according to the number of repetitions they had performed: group 1 (6 to 9 repetitions), group 2 (10 to 12 repetitions), and group 3 (13 to 16 repetitions). After the 2-minute step-in-place test, volunteers were separated into 4 groups according to the number of steps achieved: group 1 (52 to 62 steps), group 2 (64 to 77), group 3 (79 to 88), and group 4 (91 to 120 steps). The level of significance adopted was 5% for analysis of all data. The Statistical Package for the Social Sciences (SPSS^®) version 20.0 was used.

3 Results

The final sample was composed of 51 volunteers from the UATI with an average age of 66.66 years (±7.49SD). Table 1 shows social and demographic data on the subjects.

Table 2 shows the distribution of quality of life scores using the WHOQOL-BREF and WHOQOL-OLD questionnaire domains in relation to performances in the walking speed capability test.

Table 1
Sociodemographic characteristics of UATI elderly women sample

VARIABLES N %

Age

52 to 63 years old 19 37.3

64 to 70 years old 18 35.3

72 to 84 years old 14 27.5

Education

Incomplete Elementary School 14 27.5

Complete Elementary School 05 09.8

Incomplete High School 02 03.9

Complete High School 20 39.2

Incomplete Graduation 3 05.9

Complete Superior Graduation 07 13.7

Have Husband/Partner

Yes 18 35.3

No 33 64.7

Labor Status

Work 05 09.8

Do not work 46 90.2

Number of Children

≤3 children 16 31.4

>3 children 35 68.6

Live with children

Yes 16 31.4

No 35 68.6

Live side by side with children

Yes 45 88.2

No 06 11.8

VARIABLES	N	%
Age
52 to 63 years old	19	37.3
64 to 70 years old	18	35.3
72 to 84 years old	14	27.5
Education
Incomplete Elementary School	14	27.5
Complete Elementary School	05	09.8
Incomplete High School	02	03.9
Complete High School	20	39.2
Incomplete Graduation	3	05.9
Complete Superior Graduation	07	13.7
Have Husband/Partner
Yes	18	35.3
No	33	64.7
Labor Status
Work	05	09.8
Do not work	46	90.2
Number of Children
≤3 children	16	31.4
>3 children	35	68.6
Live with children
Yes	16	31.4
No	35	68.6
Live side by side with children
Yes	45	88.2
No	06	11.8

Table 2

Distribution of Quality of Life, WHOQOL-BREF and WHOQOL-OLD scores, according to Walking Speed test

Scores on Quality of Life	Scores of Walking Speed test Average and Standard Deviation
	Group 1	Group 2	Group 3	Group 4	F	p^*
WHOQOL-BREF	2 to 2.66 s	3 s	3.33 to 3.66 s	4 to 7.66 s
Physical	64.27 (05.45)	58.47 (09.34)	61.20 (07.26)	57.13 (06.07)	1.33	0.27
Psychological	64.88 (09.28)	65.42 (09.45)	70.24 (10.59)	59.59 (13.75)	1.47	0.23
Social Interrelationships	71.42 (09.43)	70.37 (17.80)	82.14 (18.89)	60.84 (21.18)	1.97	0.13
Environment	63.84 (12.86)	62.40 (15.30)	73.21 (17.39)	63.13 (12.39)	1.01	0.39
Total	66.10 (07.63)	64.16 (10.91)	71.70 (10.20)	60.19 (10.25)	1.77	0.16
WHOQOL-OLD
Sensorial Process	73.21 (14.30)	76.80 (12.77)	78.57 (25.73)	66.22 (14.79)	1.31	0.28
Autonomy	66.85 (08.69)	68.23 (14.09)	75.82 (13.78)	66.15 (15.39)	0.79	0.50
Activity	76.78 (11.81)	72.19 (13.48)	79.46 (12.86)	70.62 (13.19)	0.87	0.46
Social Interaction	78.57 (09.44)	70.57 (14.70)	74.96 (12.01)	70.60 (11.44)	0.82	0.48
Death or Dying	44.64 (18.19)	66.86 (23.76)	79.42 (11.30)	56.82 (26.57)	3.30	0.02^*
Intimacy	69.60 (15.08)	71.03 (16.74)	82.10 (12.78)	58.12 (15.60)	3.26	0.02^*
Total	68.27 (04.74)	70.95 (10.25)	78.39 (12.90)	64.75 (09.93)	2.65	0.05

^*Level of significance p < 0.05 with the use of one-way ANOVA.

Meaningful differences could be detected among groups in the WHOQOL-OLD death and dying and intimacy domains through the ANOVA.

Discrepancies between the 2.66 s (X = 44.64± 18.19SD) and the 3.33–3.66 s groups (X = 79.42± 11.30SD) in the walking speed test could be determined using the post hoc Tukey test in relation to the death and dying WHOQOL-OLD domain (p = 0.02), showing that, among elderly women, performance in the latter test was better in direct proportion to lower scores in the death and dying domain for quality of life. Concerning the intimacy domain, a significant difference was found using the post hoc Tukey test between the 2–2.66 s (x = 69.60±15.08SD) and the 3.33–3.66 s groups (X = 82.10±12.78SD) (p = 0.01), indicating that higher speeds reached in the test did not necessarily correspond to a wider perception of quality of life in regards to the intimacy domain.

Table 3 shows the distribution of quality of life scores based on the WHOQOL-BREF and WHOQOL-OLD domains in relation to performances in the chair stand test. Significant differences among groups were observed using the ANOVA for the WHOQOL-OLD autonomy domain. Applying the post hoc Tukey test, a significant difference was found between the 6–9 repetition (X = 57.29±12.71SD) and 10–12 repetition groups (X = 72.02±12.49SD) (p = 0.005) and between the 6–9 repetition (X = 57.29±12.71SD) and 13–16 repetition groups (X = 71.29±12.39SD) (p = 0.02) in relation to the WHOQOL-OLD autonomy domain findings. These results indicate that the groups with better results in the chair stand test showed higher quality of life scores in the autonomy domain.

Table 3

Distribution of Quality of Life, WHOQOL-BREF and WHOQOL-OLD scores, according to the Chair Stand test (N = 51)

Scores on Quality of Life	Scores of the Chair Stand test Average and Standard Deviation
	Group 1	Group 2	Group 3	F	p ^*
WHOQOL-BREF	6–9 rep	10–12 rep	13–16 rep
Physical	55.83 (07.86)	59.68 (08.62)	61.90 (06.87)	1.65	0.20
Psychological	65.52 (08.96)	65.47 (12.25)	62.85 (08.41)	0.27	0.76
Social Interrelations	62.87 (20.54)	72.62 (18.95)	71.53 (13.96)	1.15	0.32
Environment	60.50 (16.20)	65.42 (14.55)	64.85 (14.78)	0.44	0.64
Total	61.19 (10.76)	65.80 (11.00)	65.28 (09.94)	0.76	0.46
WHOQOL-OLD
Operation of the sensorial system	70.97 (12.30)	77.22 (17.86)	71.29 (12.67)	0.94	0.39
Autonomy	57.29 (12.71)	72.02 (12.49)	71.29 (12.39)	5.81	<0.0001*
Activities	67.59 (14.48)	75.00 (11.02)	75.47 (15.68)	1.46	0.24
Social Interaction	66.40 (15.14)	74.32 (10.54)	72.89 (16.07)	1.47	0.23
Death or Dying	64.15 (20.93)	64.91 (25.13)	59.87 (25.48)	0.18	0.83
Intimacy	64.75 (16.83)	70.28 (17.41)	73.41 (16.03)	0.77	0.46
Total	65.19 (09.27)	72.29 (10.78)	70.70 (10.28)	1.85	0.16

^*Level of significance p < 0.05 with the use of one-way ANOVA.

Table 4 shows the distribution of quality of life scores across WHOQOL-BREF and WHOQOL-OLD domains according to the 2-minute step-in-place test performances. Relevant differences among groups could also be observed using the ANOVA for the WHOQOL-OLD autonomy domain.

The post hoc Tukey test indicated a significant difference between the 52–62 repetition (X = 58.75±12.59SD) and 79–88 repetition groups (X = 74.48±14.57SD) (p = 0.01) and between the 52–62 repetition (X = 58.75±12.59SD) and 91–120 repetition groups (X = 73.60±12.59SD) (p = 0.02) under the WHOQOL-OLD autonomy domain. These results show that groups with better 2-minute step-in-place test performances achieved higher quality of life scores in the autonomy domain.

Table 4

Distribution of scores on Quality of Life, WHOQOL-BREF and WHOQOL-OLD, according to the 2 Minute Step in Place test (N = 51)

Scores on Quality of Life	Scores of the 2 Min Step in place test Average and Standard Deviation
	Group 1	Group 2	Group 3	Group 4	F	p ^*
WHOQOL-BREF	52 to 62 steps	64 to 77 steps	79 to 88 steps	91 to 120 steps
Physical	58.92 (07.38)	56.55 (08.58)	61.25 (07.96)	60.45 (08.90)	0.78	0.50
Psychological	65.28 (09.47)	64.58 (14.91)	62.50 (09.77)	66.96 (08.70)	0.38	0.76
Social Interrelations	64.58 (19.83)	69.45 (19.57)	71.80 (21.39)	74.40 (12.84)	0.64	0.59
Environment	59.63 (14.63)	64.34 (15.33)	64.43 (16.84)	67.87 (12.88)	0.65	0.58
Total	62.10 (09.74)	63.73 (13.17)	64.99 (11.42)	67.42 (08.16)	0.57	0.63
WHOQOL-OLD
Sensorial operation	67.12 (11.05)	77.08 (15.84)	74.96 (16.76)	78.10 (17.48)	1.25	0.30
Autonomy	58.75 (12.59)	66.56 (09.41)	74.48 (14.57)	73.60 (12.59)	4.30	< 0.001*
Activities	71.87 (11.14)	67.16 (12.25)	74.48 (13.88)	79.46 (13.07)	2.12	0.11
Social Interaction	73.39 (11.39)	67.16 (13.36)	70.17 (14.92)	77.66 (11.70)	1.58	0.20
Death or Dying	69.77 (21.30)	60.35 (27.47)	59.09 (23.74)	65.16 (24.60)	0.49	0.68
Intimacy	66.62 (15.85)	66.66 (20.52)	74.03 (13.70)	71.37 (17.82)	0.57	0.63
Total	67.92 (09.01)	67.50 (10.21)	71.20 (12.47)	74.22 (09.85)	1.17	0.32

^*Level of significance p < 0.05 with the use of one-way ANOVA.

4 Discussion

The results indicate that there were significant differences among performance groups in the following functional capacity tests: walking speed, chair stand, and 2-minute step-in-place. Such differences correlated with quality of life scores in the WHOQOL-BREF and WHOQOL-OLD domains of death and dying, intimacy, and autonomy.

The WHOQOL-OLD questionnaire for the death and dying domain indicated significant negative correlations with the walking speed test performances, in which subjects with better performances also displayed lower quality of life scores.

These findings have been corroborated by other researchers as well. A study developed by Tavares and Dias [24] described the sociodemographic profile, functional capacity, and morbidity of elderly individuals in a sample of 2,142 elderly subjects in Uberaba-MG, Brazil and found that even those suffering from deeper incapacity showed higher quality of life scores in this aspect. Likewise, a study developed by Khoury and Neves [25] investigated control perception and quality of life in a sample of 66 elderly subjects in Belem-PA, Brazil using the death and dying domain, and no significant differences were found due to the elderly subjects’ perception of facing natural death as an inevitable event.

Different results were found in other studies [26, 27] in which the death and dying domain was associated with lower quality of life scores assessed by the WHOQOL-BREF. This could indicate that elderly individuals do not have the courage to talk about death or do not worry about it. Other studies [28, 29] show that the loss of independence is often considered worse than death by most of the elderly population.

The results of a study by Souza and Farias [30] corroborated our findings concerning the walking speed test, verifying through functional capacity test assessments that the rates of general aerobic endurance and walking ability (RAG) of elderly women were classified as good. The results also indicated that elderly subjects with higher walking speeds displayed better quality of life scores under the death and dying domain.

Consistent with the evidence that has been described, the practice of constant physical training correlates with functional capacity improvement, especially in the context of factors mentioned: speed, coordination, and agility. Practicing physical activity perceptibly improves lower limb strength gain due to more efficiently recruiting the activation and synchronization of motor units and contributes to a higher speed of nerve impulse and medullar reflex conduction [30].

Our study observed relevant differences between results for walking speed test groups 1 and 3 in relation to the WHOQOL-OLD intimacy domain. These results show that a higher speed attained in the test does not necessarily correspond with a better perception of quality of life within the intimacy domain. In other words, elderly subjects with better performances in the walking speed test showed lower scores in the intimacy domain, whereas those with higher scores in the same domain demonstrated worse performances in the walking speed test. This shows that performance in a functional capacity test does not always predict a better quality of life perception about intimacy even though most of the quality of life domains have been associated with higher functional capacity scores.

In a study by Bajotto and Goldim [26], the most significant averages were observed in the intimacy domain, showing that elderly subjects in their study were satisfied with their partners and with the people they lived with and expected to be able to establish close personal relationships.

Other studies found opposing results [23, 31] with the WHOQOL-OLD intimacy domain showing higher scores. Considering the fact that the study involved elderly subjects who were single, widowed, or divorced, this result can be validated. These intimacy domain scores indicate that close personal relationships are necessary to achieve a better perception of quality of life.

The results of our study indicate that elderly women with better walking speed test scores did not have better quality of life scores for the intimacy domain. These scores could have been a result of living alone due to being widowed, single, or divorced, leading them to seek leisure activities and physical training to avoid feeling isolated. They demonstrated functional capacity and speed benefits because they were more active, but their quality of life perception scores were lower in the intimacy domain due to the lack of a partner or the distance of their relatives. On the contrary, observing senior women with higher scores in the intimacy domain and lower results in the walking speed test, it is clear that a good performance in this test does not always indicate a good quality of life perception in the intimacy domain.

We observed significant differences in our study concerning WHOQOL-OLD autonomy domain results alongside chair stand test results, discovering that better autonomy domain scores correlated with better chair stand performances. The chair stand test is used to assess lower limb strength, and the WHOQOL-OLD autonomy domain refers to the extent of subjects’ capacity to make their own decisions and live an autonomous lifestyle [19, 21].

Regarding these results, it is also worth noting that elderly subjects with a better quality of life perception in the autonomy domain also showed better functional capacity in the assessment of lower limb strength performances. The maintenance of lower limb strength is extremely important for senior citizens to maintain autonomy, as demonstrated by those with higher lower limb strength scores being able to make their own decisions autonomously and expressing independence, which are two crucial quality of life elements. It is important to highlight that muscular strength is crucial for the maintenance of autonomy and quality of life for elderly individuals. Furthermore, this variable yields greater losses due to the aging process, with lower levels of physical fitness in muscular strength performance resulting in higher dependence on others to accomplish daily tasks [32].

Similarly, significant differences were noted among results from the 2-minute step-in-place test used to assess aerobic endurance. Elderly subjects with better performance in this test also had higher quality of life perception scores in the autonomy domain. Aerobic endurance also determines elderly subjects’ ability to perform daily activities to maintain a sense of autonomy and independence, which would contribute to achieving a better perception of quality of life. Aerobic endurance influences this sense of autonomy because high amounts of energy are necessary to maintain gait while impaired energy leads to early fatigue. Thus, the capacity to move efficiently and safely is important to maintain independence [33].

A corroborating study by Silva, Costa, and Guerra [34] also found that physically active elderly subjects had better levels of muscular strength and aerobic endurance, indicating higher levels of functional capacity in active subjects than that of sedentary subjects.

Similar results for WHOQOL-OLD were found in a study developed by Lima and Bittar [35] in which physically trained elderly individuals scored high in the autonomy domain. This shows that elderly individuals participating in group training have better quality of life perceptions in the autonomy domain compared with those who do not regularly take part in group physical activity.

A study by Tavares and Dias [24], however, reported different results: elderly subjects scored lower in the autonomy domain of quality of life. They cited a connection between higher functional incapacity and morbidity levels and lower quality of life scores in the autonomy domain. This is because the elderly individuals experiencing more difficulty performing daily activities feel more dependent on other people, which leads them to avoid making their own life decisions.

These results show that the decrease in autonomy is caused by an increase of morbidities, yet this does not manifest as an obstacle that prevents decision-making about issues in senior citizens’ lives as long as their cognitive capabilities are preserved, allowing them to make decisions despite physical dependency [24].

A Brazilian study [36] verified the functional fitness of 40 physically active women aged 80 or over and found good results in the muscular strength and general aerobic endurance tests from the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD). Despite the satisfactory results, the elderly women exhibited lower functional fitness, mainly regarding aerobic endurance, compared with younger elderly women. This is a characteristic of aging that comes from the natural decrease of VO₂max during this process.

The results of another study [37] indicated that older women who participated in less physical fitness exhibited higher levels of effort during exercise and consequently showed lower levels of quality of life. Their results also showed that younger elderly women tended to underestimate their fitness and the intensity of physical training they were able to perform. A separate previous study [28] indicates that elderly subjects with greater functional limitations believed they were unable to perform strength training even though strength training is necessary to improve functional capacity. Functional limitations can be halted or even reversed by restoring muscular strength.

These studies show that regular training can reduce the negative effects of aging and contribute to healthier lifestyles by improving functional capacity, prolonging performances of daily life activities, and therefore prolonging the period of activity and independence for senior citizens [36, 38].

Based on the findings that have been shown, it is important to mention that the loss of muscular functional capacity in senior citizens is related to the reduction of physical activity. This compromises corporal balance and leads to early muscle fatigue, decreasing muscular mass, strength, and power and increasing the risk of falls, which are consequences that limit physical independence and quality of life in old age [39].

To better understand quality of life perception in senior citizens, it is also worth examining levels of social interaction [40]. Evidence shows that quality of life is associated with opportunities for social interaction in addition to physical, mental, intellectual, and leisure activities [41]. Therefore, practicing regular physical activity or taking part in physical training programs are important strategies to not only improve life expectancy but also to extend the period of independent living, improve quality of life, decrease the risk of chronic diseases, and reduce morbidity and mortality [42].

Despite our study not using control groups, other works [43, 44] have compared groups of elderly subjects practicing and not practicing physical activity in programs. These studies indicated higher values in the scores for functional capacity and quality of life domains among elders of the first group. Therefore, it can be deduced that aging persons do not completely lose their functional capacity abilities, such as agility, motor coordination, flexibility, strength and aerobic endurance, because positive effects of physical performance can surpass the effects of decline caused by aging and/or related factors [30].

Because quality of life is a health indicator, the assessment of it using WHOQOL-OLD makes it possible to think of interventions to improve quality of life for the senior population. A stronger commitment to senior citizen quality of life will allow us to develop strategies to promote healthier lifestyles while considering implementing, for example, social interaction groups and other care programs as worthy paths to be explored [23].

We identified limitations in this study such as the excessive time to administer data collection instruments and the absence of a control group to compare results of women who participate in the UATI with those who do not. The results found, however, were fundamental to achieve the purpose of our research.

5 Conclusion

The quality of life and functional capacity of the elderly women participating in the UATI were considered to be good. Differences were found, however, among functional capacity test results for different groups of elderly participants; more specifically, some exhibited better results in the quality of life perception for the intimacy domain with low scores for the walking speed test, while others showed the opposite.

An association was found between quality of life and functional capacity in the elderly subjects because quality of life also depends on subjects’ autonomy and independence, factors that are only viable with a good functional capacity, which the elderly subjects involved in this research demonstrated. Sustained functional capacity will therefore improve quality of life and increase life expectancy, indicating that community programs, such as the UATI, are essential in improving the aging process.

Conflict of interest

None to report.

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