Sample characterization: A total of 56 elderly people with multimorbidity were evaluated, consisting of most females (50 women and 6 men) aged between 62 and 77 years of age (70.81 ± 5.54; 67.26 ± 4.69). Both G1 and G2 presented body mass index (BMI) > 30, characterizing grade 1 obesity.
Table 1
Characterization of the sample
| G1 | G2 | P (value) |
Age | 70,81 ± 5,54 | 67,26 ± 4,69 | 0.082 |
Body mass | 76,92 ± 13,59 | 80,35 ± 12,65 | 0.091 |
Stature | 1,57 ± 0,08 | 1,58 ± 0,08 | 0.094 |
BMI (kg2) | 30,95 ± 4,54 | 31,94 ± 3,49 | 0.082 |
Sex (M/F) | 3/18 | 3/32 | |
Morbidities | | | |
Three pathologies | 15 | 21 | |
Two pathologies | 6 | 14 | |
Medical treatment | | | |
Losartan | 13 | 22 | |
Escitalopram | 4 | 13 | |
Bupropion | 1 | 5 | |
Fluoxetine | 5 | 2 | |
Amitriptyline | 4 | 3 | |
Clonazepam | 7 | 5 | |
Simvastatin | 2 | 15 | |
Enalapril | 0 | 8 | |
Glibenclamida | 9 | 29 | |
Glifage | 16 | 14 | |
Caption: G1 – Group that performed aqua gym 1x a week; G2 – Group that performed aqua gym 2x a week. The significance level was p < 0.05.
The intensity of the interval exercise protocol, measured in BPM (beats per minute), can be observed in Fig. 2. The heart rate behavior during exercises significantly varied, characterizing the interval method (p < 0.05). On G1 group, values increased significantly in exercise 1 (107 ± 8.8 before; 129 ± 6.2 at the end); exercise 2 (107 ± 9.2 before; 127 ± 7.2 at the end); exercise 3 (103 ± 8.8 before; 128 ± 7.9 at the end); exercise 4 (107 ± 4.8 before; 1297.2 at the end); exercise 5 (104 ± 5.5 before; 129 ± 6.6 at the end); exercise 6 (102 ± 8.3 before; 119 ± 5.6 at the end); exercise 7 (107 ± 8.5 before; 125 ± 7.3 at the end); and exercise 8 (106 ± 7.9 before; 129 ± 7.3 at the end). On G2 group, values also increased significantly in exercise 1 (108 ± 8.3 before; 121 ± 7.7 at the end); exercise 2 (105 ± 10.1 before; 123 ± 5.9 at the end); exercise 3 (105 ± 7.5 before; 130 ± 6.9 at the end); exercise 4 (105 ± 5.1 before; 132 ± 5.9 at the end); exercise 5 (106 ± 7.5 before; 133 ± 4.6 at the end); exercise 6 (105 ± 7.9 before; 129 ± 6.9 at the end); exercise 7 (106 ± 9.2 before; 129 ± 8.2 at the end); and exercise 8 (105 ± 4.6 before; 133 ± 6.1 at the end). These average heart rate ranges at the end of each exercise represents, for the elderly, an effort between 80 to 90% HRmax.
The intensity of the interval exercise protocol in RPE is shown on Fig. 3 The Borg Rating of Perceived Exertion (RPE) during the exercises behaved alternately, characterizing the interval method (p < 0.05). On G1 group, values increased significantly in exercise 1 (1 ± 0.8 before; 8.9 ± 0.3 at the end); exercise 2 (2.4 ± 0.2 before; 8.7 ± 0.5 at the end); exercise 3 (1.6 ± 0.7 before; 9.2 ± 0.7 at the end); exercise 4 (1.8 ± 0.5 before; 8.8 ± 0.7 at the end); exercise 5 (2.5 ± 0.8 before; 9.5 ± 0.6 at the end); exercise 6 (2.8 ± 0.3 before; 9.4 ± 0.6 at the end); exercise 7 (2.3 ± 0.5 before; 8.8 ± 0.4 at the end); and exercise 8 (2.8 ± 0.2 before; 9.4 ± 0.5 at the end). On G2 group, values also increased significantly in exercise 1 (1 ± 0.7 before; 8.4 ± 0.4 at the end); exercise 2 (1.2 ± 0.3 before; 9.2 ± 0.4 at the end); exercise 3 (1.6 ± 0.6 before; 9.2 ± 0.8 at the end); exercise 4 (1.7 ± 0.6 before; 9.2 ± 0.5 at the end); exercise 5 (2.7 ± 0.8 before; 8.3 ± 0.4 at the end); exercise 6 (2.8 ± 0.6 before; 9.2 ± 0.4 at the end); exercise 7 (2.5 ± 0.5 before; 9.1 ± 0.2 at the end); and exercise 8 (2.6 ± 0.6 before; 9.2 ± 0.4 at the end). This range of RPE at the end of each exercise represents a very intense effort for the elderly.
Mental health status is observed on the quality of sleep on group G2, which reduced significantly (5.3 ± 1.7) when compared to pre-training (10.5 ± 1.1) scores. Regarding the size of the effect of physical exercise, the same group (G2) showed a 49% increase in sleep quality. However, G1 did not present significant changes in post-training sleep quality (8.3 ± 1.2) compared to pre-training (10.8 ± 1.8) scores (p > 0.05).
Sleepiness levels are demonstrated on Table 2. Group G2 significantly reduced (4.1 ± 1.8), when compared to the pre-training (8 .3 ± 1.9) scores. Regarding the size of the effect of physical exercise in this group (G2), we observed a 50% reduction in drowsiness symptoms. However, G1 did not change post-training sleepiness symptoms significantly (6.2 ± 1.5 scores) in comparison to pre-training (7.9 ± 1.1 scores) (p > 0.05).
Anxiety levels, as observed on Table 2, show that group G2 significantly reduced (8.0 ± 1.6), when compared to pre-training (14.6 ± 1.3) scores. Regarding the size of the effect of physical exercise in this group (G2), we observed a 45% reduction in anxiety symptoms. However, G1 did not show significant score changes (11.6 ± 1.0) in post-training anxiety symptoms compared to pre-training (13.1 ± 1.6) (p > 0.05).
Table 2 also shows depression markers, where group G2 scores reduced significantly (6.6 ± 1.5), when compared to the pre-training (17.5 ± 1.9). Regarding the size of the effect of physical exercise in the same group (G2), we observed a 62% reduction in depression symptoms. However, G1 did not significantly change post-training depression symptoms (13.4 ± 4.2 scores) compared to pre-training (15.1 ± 5.1) (p > 0.05).
Table 2
Parameters | G1 | P (value) | G2 | P (value) | % |
PSQI (scores) Pre Post | 10,8 ± 1,8 8,3 ± 1,2 | 0.079 | 10,5 ± 1,1 5,3 ± 1,7* | 0.032 | +49 |
ESS-BR (scores) Pre Post | 7,9 ± 1,1 6,2 ± 1,5 | 0.231 | 8,3 ± 1,9 4,1 ± 1,8* | 0.041 | -50 |
Anxiety (BAI) (scores) Pre Post | 13,1 ± 1,6 11,6 ± 1,0 | 0.436 | 14,6 ± 1,3 8,0 ± 1,6* | 0.047 | -45 |
Depression BDI (scores) Pre Post | 15,1 ± 5,1 13,4 ± 4,2 | 0.652 | 17,5 ± 1,9 6,6 ± 1,5* | 0.017 | -62 |
Caption: G1 – Group that performed aqua gym 1x week; G2 – Group that performed aqua gym 2x week. PSQI - Pittsburg Sleep Quality Index; ESS-BR - Epworth Sleepiness Scale for the Brazilian population; Anxiety (BAI) – Beck Anxiety Scale; Depression (BDI) – Beck Depression Inventory. (*) indicates intragroup statistical difference. The significance level was p < 0.05.
Functional autonomy is observed through the autonomy of standing up and sitting down (Table 3). The aqua gym program performed by the G2 group significantly improved these parameters (18.5 ± 0.7 reps), when compared to pre-training (13.5 ± 1.0 reps). The same group increased the size of the effect of physical by 37% in the standing up and sitting down task. However, G1 did not significantly change the autonomy of standing up and sitting down after training (14.9 ± 1.1 reps) compared to pre-training (13.7 ± 1.1 reps) (p > 0.05).
The aqua gym program performed in group G2 significantly improved arm autonomy (19.6 ± 1.7 reps) when compared to pre-training (13.5 ± 1.7 reps), as demonstrated on Table 3. Regarding the size of the effect of physical exercise in this group (G2), we observed an increase of 45%. However, G1 did not change significantly (17.4 ± 1.9 reps) post-training arm autonomy compared to pre-training (14.4 ± 1.8 reps) (p > 0.05).
The autonomy of getting up and walking, demonstrated on Table 3, shows that the aqua gym program performed by the G2 group significantly improved these parameters (5.5 ± 0.3 sec), when compared to pre-training (8.9 ± 0.8 sec). Regarding the size of the effect of physical exercise in this group (G2), we observed an increase of 38%. However, G1 did not significantly change the autonomy to stand up and walk after training (7.9 ± 0.5 sec) compared to pre-training (7.8 ± 0.2 sec) (p > 0.05).
Gait autonomy significantly improved after the implementation of the aqua gym program performed in group G2 (121 ± 2.4 reps), when compared to pre-training (103 ± 3.6 reps) (Table 3). The size of the effect of physical exercise in the same group showed increase of 17% in walking autonomy. However, G1 did not show any significant change (p. >0.05).
Table 3
– Functional autonomy parameters
Parameters | G1 | P (value) | G2 | P (value) | % |
Getting up and sitting down (reps) Pre Post | 13,7 ± 1,1 14,9 ± 1,1 | 0.088 | 13,5 ± 1,0 18,5 ± 0,7* | 0.042 | + 37 |
Arm flexion (reps) Pre Post | 14,4 ± 1,8 17,4 ± 1,9 | 0,092 | 13,5 ± 1,7 19,6 ± 1,7* | 0,033 | + 45 |
Getting up e walking (seg) Pre Post | 7,8 ± 0,2 7,9 ± 0,5 | 0.287 | 8,9 ± 0,8 5,5 ± 0,3* | 0.039 | + 38 |
Stationary March (reps) Pre Post | 93,8 ± 5,6 88,5 ± 6,6 | 0.085 | 103,0 ± 3,6 121,0 ± 2,4* | 0.021 | + 17 |
Caption: G1 – Group that performed aqua gym 1x week; G2 – Group that performed aqua gym 2x week. All tests applied are from the Physical Ability Testing for the Elderly (TAFI) - Standing up and sitting down – Autonomy in standing up and sitting down; Arm flexion – Arm autonomy; Get up and walk – Autonomy to get up and walk; Stationary gait – Gait autonomy. (*) indicates an intragroup statistical difference. The significance level was p < 0.05.
Parameters of muscle efficiency, observed through the efficiency of leg muscle resistance, are described on Table 4 The stand-up and sit-down test on group G2 showed significant improvement (67, 6 ± 4.2 rms), reducing activity when compared to pre-training (82.6 ± 7.1 rms). Regarding the size effect of physical exercise in this group (G2), we observed significant improvement of 18%. However, G1 did not significantly change post-training leg muscle efficiency (78.6 ± 7.7 rms), when compared to pre-training (85.0 ± 8.2 rms) (p > 0.05).
Efficiency of arm muscle resistance (Table 4) s observed by the arm flexion test, where the aqua gym program performed by group G2 was significantly improved (148.6 ± 5.4 rms) reducing activity when compared to pre-training (180.8 ± 10.7 rms). Regarding the size of the effect of physical exercise in this group (G2), we observed a significant improvement of 18%. However, G1 did not significantly change post-training muscle efficiency of the arms (169.8 ± 2.8 rms) compared to pre-training (183.8 ± 7.2 rms) (p > 0.05).
Lastly, the efficiency of leg muscle strength (Table 4), observed through the test of standing up and sitting down with 20% of body weight attached to the trunk, the aqua gym program performed by group G2 significantly improved (48.9 ± 6.6 rms) reducing the activity, when compared to pre-training (60.3 ± 5.8 rms). The size of the effect of physical exercise in this group (G2) showed significant improvement of 19% in leg muscle strength. However, G1 did not significantly change post-training leg muscle efficiency (59.8 ± 3.8 rms) compared to pre-training (62.7 ± 4.2 rms) (p > 0.05).
Table 4
Muscle efficiency parameters
Parameters | G1 | P (value) | G2 | P (value) | % |
Getting up and sitting down (rms) Pre Post | 85,0 ± 8,2 78,6 ± 7,7 | 0.821 | 82,6 ± 7,1 67,6 ± 4,2* | 0,045 | + 18 |
Biceps (rms) Pre Post | 183,8 ± 7,2 169,8 ± 2,8 | 0,063 | 180,8 ± 10,7 148,6 ± 5,4* | 0,028 | + 18 |
Getting up from the chair with 20% of body weight (rms) Pre Post | 62,7 ± 4,2 59,8 ± 3,8 | 0.387 | 60,3 ± 5,8 48,9 ± 6,6* | 0.048 | + 19 |
Caption: G1 – Group that performed aqua gym 1x week; G2 – Group that performed aqua gym 2x week. Standing up and sitting down – Muscular endurance of legs; Biceps – Muscular resistance of arms; Lifting from a chair 10kg – Leg Muscle Strength. (*) indicates an intragroup statistical difference. The significance level was p < 0.05.