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AS BARREIRAS E OS FACILITADORES À PRÁTICA DE EXERCÍCIO FÍSICO NA PESSOA IDOSA INSTITUCIONALIZADA COM DIABETES, NA REGIÃO DE LEIRIA
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Abstract(s)
Introdução: As pessoas idosas institucionalizadas estão entre as mais frágeis da população (1), praticando níveis reduzidos de exercício. O exercício físico é uma ferramenta eficaz na melhoria da saúde e na prevenção de condições crónicas relevantes nesta população, como a diabetes mellitus, contribuindo para retardar a dependência funcional e a perda da capacidade física e cognitiva (2). A prática de exercício físico pode ser influenciada pela perceção das barreiras e dos facilitadores associados (3). Deste modo, identificar e compreender estes determinantes é importante para promover a mudança do comportamento sedentário na população idosa, sobretudo se institucionalizada e com reduzida funcionalidade. A literacia em saúde desempenha um papel significativo na adoção de comportamentos saudáveis e na autogestão de condições de saúde, como a diabetes (4). Contudo, existem poucos estudos que investiguem os determinantes (barreiras/facilitadores) que influenciam a prática de exercício nesta população (5) e, se existe alguma relação com a literacia em saúde e o desempenho funcional.
Objetivos: Este estudo teve como objetivo identificar e caracterizar os desafios, as barreiras e os facilitadores à prática de exercício físico percecionados pelas pessoas idosas institucionalizadas com diabetes, na região de Leiria, além de determinar possíveis relações com a literacia em saúde e o desempenho funcional.
Metodologia: Foram incluídos 27 participantes, com diagnóstico de diabetes e institucionalizados. Utilizou-se uma metodologia mista, conduzida ao longo de 3 fases, em 5 instituições na região de Leiria, no período de fevereiro a abril de 2024. Numa primeira visita, foram aplicados o questionário de dados sociodemográficos e clínicos e o questionário de literacia em saúde versão reduzida de 16 questões do European Health Literacy Survey (valores de 0 a 8 – nível inadequado; valores de 9 a 12 – nível problemático e valores de 13 a 16 – nível suficiente) que permitiu distribuir os participantes em 3 grupos de acordo com os níveis de literacia em saúde. Na segunda fase, foram conduzidas entrevistas semiestruturadas online, entre as instituições, utilizando os 3 grupos focais previamente determinados. Na terceira fase, recorreu-se à Escala de Benefícios e Barreiras do Exercício, para caracterizar quantitativamente a perceção das barreiras e dos benefícios associados à prática de exercício e, ao Short Physical Performance Battery para a avaliação do desempenho funcional (valores de 0 a 3 – incapacidade ou desempenho muito mau; valores de 4 a 6 – desempenho baixo; valores de 7 a 9 – desempenho moderado e valores de 10 a 12 – desempenho bom). Resultados: Participaram 9 pessoas do sexo feminino e 18 do sexo masculino, com idades compreendidas entre os 72 e os 97 anos. Os resultados revelaram que 40.7% dos participantes apresentaram um nível inadequado de literacia em saúde e 33.3% um nível problemático. As principais barreiras identificadas pelos grupos focais com níveis de literacia em saúde problemático e suficiente foram a dor e a fadiga, já as limitações físicas foram mais mencionadas pelo grupo focal com nível de literacia inadequado. O cansaço, a perceção do exercício como uma perda de tempo, a dificuldade em realizar exercício e a conveniência dos locais foram identificadas através da análise quantitativa. Por outro lado, os facilitadores mais reconhecidos pelo grupo focal com nível de literacia em saúde suficiente foram os sentimentos positivos e o apoio social, e a melhoria da mobilidade pelo grupo focal com nível de literacia inadequado. Adicionalmente, pela análise quantitativa das perceções foram identificados o gosto pela prática de exercício e a melhoria da saúde física e mental. Os resultados sugeriram uma correlação positiva moderada (ρ= 0.481) e estatisticamente significativa (α <0.05) entre o nível de literacia em saúde e a perceção dos benefícios e das barreiras à prática de exercício. Também foi encontrada uma correlação positiva forte (ρ=0.780; α <0.001) entre o desempenho funcional e a literacia em saúde. Alguns desafios para a gestão do cuidado nesta população foram identificados através da análise qualitativa, nomeadamente a perceção negativa da condição de saúde e a falta de reconhecimento do exercício como estratégia para a gestão e tratamento da diabetes.
Conclusão: Conclui-se que para o desenho e implementação de programas de exercício nas pessoas idosas institucionalizadas com diabetes, deverá considerar-se barreiras, como a dor, a fadiga e a capacidade funcional, e incorporar facilitadores, como o envolvimento de familiares e amigos, para aumentar a motivação e garantir a adesão contínua a esses programas. Salienta-se ainda o papel determinante da literacia em saúde e do desempenho funcional na perceção das barreiras e facilitadores à prática de exercício, com uma tendência para idosos com níveis de literacia suficiente e bom desempenho funcional a demonstrarem perceções mais positivas à prática de exercício. Apesar dos resultados promissores, o estudo reconhece limitações metodológicas, como o tamanho reduzido da amostra.
Introduction: Institutionalized elderly people are amongst the most vulnerable groups of the population (1), often engaging in low levels of exercise. Exercise is an effective tool for improving health and to prevent chronic conditions prevalent in this population, such as diabetes mellitus, helping to delay functional dependence and the loss of physical and cognitive capacity (2). The practice of exercise can be influenced by the perception of its barriers and facilitators (3). Therefore, identifying and understanding these determinants is crucial to promote a change in sedentary behavior amongst older adults, mainly if they are institutionalized and with reduced functionality. Health literacy plays a significant role in the adoption of healthy behaviors and the self-management of health conditions, such as diabetes (4). However, few studies have investigated the factors (barriers/facilitators) that influence exercise practice in this population (5) and whether there is any relationship with health literacy and functional performance. Aims: This study aimed to identify and characterize the challenges, barriers and facilitators to exercise perceived by institutionalized elderly people with diabetes in the Leiria region, as well as to determine possible relationships with health literacy and functional performance. Methods: The study included 27 participants diagnosed with diabetes and institutionalized. A mixed-methods approach was used, conducted in 3 phases across 5 institutions in the Leiria region, from February to April 2024. During the first visit, participants completed a sociodemographic and clinical data questionnaire, as well as the short version of the European Health Literacy Survey with 16 questions (scores 0–8: inadequate level; scores 9–12: problematic level; scores 13–16: sufficient level), which allowed grouping participants into three health literacy levels. In the second phase, online semi-structured interviews were conducted between institutions, using the previously determined 3 focus groups. In the third phase, the Exercise Benefits and Barriers Scale was used to quantitatively characterize the perception of barriers and benefits associated with exercise, and the Short Physical Performance Battery was used to assess functional performance (scores 0–3: disability or very poor performance; scores 4–6: low performance; scores 7–9: moderate performance; scores 10–12: good performance). Results: The study included 9 female and 18 male participants, aged between 72 and 97 years. The results showed that 40.7% of participants had an inadequate level of health literacy, and 33.3% had a problematic level. The main identified barriers by the focus groups with problematic and sufficient levels of health literacy were pain and fatigue, meanwhile, functional limitations were mentioned more by the focus group with inadequate level of health literacy. Fatigue, the perception of exercise as a waste of time, difficulty performing exercise, and the convenience of locations were identified by the quantitative analysis. On the other hand, the most recognized facilitators by the focus group with sufficient level of health literacy were positive feelings associated with exercise and social support, and improved mobility by the focus group with inadequate level of health literacy. Additionally, by the quantitative analysis of the perceptions, there were identified the enjoyment of exercise practice and physical and mental health improvement. The results suggested a moderate positive (ρ= 0.481) and statistically significant correlation (α <0.05) between the level of health literacy and the perception of benefits and barriers to exercise practice. A strong positive correlation (ρ= 0.780; α <0.001) was also found between functional performance and health literacy. There were some challenges identified through qualitative analysis for the management of care in this population, such as the negative perception of the health condition and the lack of recognition of exercise as a strategy for the management and treatment of diabetes. Conclusions: It is concluded that the design and implementation of exercise programs for institutionalized older people with diabetes should consider barriers such as pain, fatigue, and functional capacity, and incorporate facilitators, such as the involvement of family and friends, to increase motivation and ensure continuous adherence to these programs. The study also highlights the significant role of health literacy and functional performance in the perception of barriers and facilitators to exercise, with a tendency for older people with sufficient health literacy levels and good functional performance to demonstrate more positive perceptions to the exercise practice. Despite the promising results, the study acknowledges methodological limitations, such as the small sample size.
Introduction: Institutionalized elderly people are amongst the most vulnerable groups of the population (1), often engaging in low levels of exercise. Exercise is an effective tool for improving health and to prevent chronic conditions prevalent in this population, such as diabetes mellitus, helping to delay functional dependence and the loss of physical and cognitive capacity (2). The practice of exercise can be influenced by the perception of its barriers and facilitators (3). Therefore, identifying and understanding these determinants is crucial to promote a change in sedentary behavior amongst older adults, mainly if they are institutionalized and with reduced functionality. Health literacy plays a significant role in the adoption of healthy behaviors and the self-management of health conditions, such as diabetes (4). However, few studies have investigated the factors (barriers/facilitators) that influence exercise practice in this population (5) and whether there is any relationship with health literacy and functional performance. Aims: This study aimed to identify and characterize the challenges, barriers and facilitators to exercise perceived by institutionalized elderly people with diabetes in the Leiria region, as well as to determine possible relationships with health literacy and functional performance. Methods: The study included 27 participants diagnosed with diabetes and institutionalized. A mixed-methods approach was used, conducted in 3 phases across 5 institutions in the Leiria region, from February to April 2024. During the first visit, participants completed a sociodemographic and clinical data questionnaire, as well as the short version of the European Health Literacy Survey with 16 questions (scores 0–8: inadequate level; scores 9–12: problematic level; scores 13–16: sufficient level), which allowed grouping participants into three health literacy levels. In the second phase, online semi-structured interviews were conducted between institutions, using the previously determined 3 focus groups. In the third phase, the Exercise Benefits and Barriers Scale was used to quantitatively characterize the perception of barriers and benefits associated with exercise, and the Short Physical Performance Battery was used to assess functional performance (scores 0–3: disability or very poor performance; scores 4–6: low performance; scores 7–9: moderate performance; scores 10–12: good performance). Results: The study included 9 female and 18 male participants, aged between 72 and 97 years. The results showed that 40.7% of participants had an inadequate level of health literacy, and 33.3% had a problematic level. The main identified barriers by the focus groups with problematic and sufficient levels of health literacy were pain and fatigue, meanwhile, functional limitations were mentioned more by the focus group with inadequate level of health literacy. Fatigue, the perception of exercise as a waste of time, difficulty performing exercise, and the convenience of locations were identified by the quantitative analysis. On the other hand, the most recognized facilitators by the focus group with sufficient level of health literacy were positive feelings associated with exercise and social support, and improved mobility by the focus group with inadequate level of health literacy. Additionally, by the quantitative analysis of the perceptions, there were identified the enjoyment of exercise practice and physical and mental health improvement. The results suggested a moderate positive (ρ= 0.481) and statistically significant correlation (α <0.05) between the level of health literacy and the perception of benefits and barriers to exercise practice. A strong positive correlation (ρ= 0.780; α <0.001) was also found between functional performance and health literacy. There were some challenges identified through qualitative analysis for the management of care in this population, such as the negative perception of the health condition and the lack of recognition of exercise as a strategy for the management and treatment of diabetes. Conclusions: It is concluded that the design and implementation of exercise programs for institutionalized older people with diabetes should consider barriers such as pain, fatigue, and functional capacity, and incorporate facilitators, such as the involvement of family and friends, to increase motivation and ensure continuous adherence to these programs. The study also highlights the significant role of health literacy and functional performance in the perception of barriers and facilitators to exercise, with a tendency for older people with sufficient health literacy levels and good functional performance to demonstrate more positive perceptions to the exercise practice. Despite the promising results, the study acknowledges methodological limitations, such as the small sample size.
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Keywords
Pessoas idosas Institucionalização Barreiras ao exercício Facilitadores ao exercício Diabetes mellitus Literacia Em saúde Desempenho funcional