La influencia del ejercicio terapéutico en la calidad de vida de las personas mayores

Zusammenfassung

BACKGROUND: One of the most relevant aspects of the society worldwide is the increasing ageing of the population and Spain is one of the countries with the highest rate of older adults. The ageing process is associated with the deterioration of various physiological capacities that can lead to many disorders including functional limitation, loss of personal autonomy and the increasing prevalence of chronic disease. Several studies prove that regular moderate physical exercise has a positive effect in preventing chronic diseases and other common diseases in older adults. Therefore, various government agencies encourage the development of preventive, progressive and continued programs for stimulate the physical exercise practice. However, most of these physical exercise programs are generic and do not respect the individual characteristics of the participants, and this may cause musculoskeletal injuries in long term. Therefore, programs which include therapeutic exercise can be a good alternative for diminishing injuries and improve elderly people´s quality of life, because it is the exercise prescription to correct any deterioration or to improve musculoskeletal pain and function. The most common complaints of the healthy elderly in Primary Care in Spain are neck and low back pain. Pain has an impact on the quality of life of people who suffer it, affecting his mood, personality and social relationships, creating fatigue and decreased physical function and limiting overall performance of daily living activities. Therefore, this Doctoral Thesis aims to ensure that the implementation of Geriatric Physical Therapy Program which includes massage therapy, joint and soft tissue mobilizations, Stretching and directed and individualized Therapeutic Exercise, combined with educational and preventive measures to improve the health status, has a positive effect on older peoples´ quality of life and neck and low back pain. METHODS: Clinical trial non-randomized, 12-week duration study, with two different Geriatric Physical Therapy programs, on 70 healthy individuals in the Geriatric Physical Therapy Group and 140 for the Standardized Therapeutic Exercise Group, aged between 60 and 75 years old. For the Geriatric Physical Therapy Group, the Physical Therapy program consisted on five two-hour sessions, one per week for 5 consecutive weeks and a follow-up interview at week 12 after the intervention started. In the sessions, the participants received one hour of Manual Physical Therapy, with Massage therapy, Joint and soft tissue mobilizations and Stretching, thirty minutes of directed and individualized Therapeutic Exercise, and thirty minutes of educational and preventive measures to improve the health status. In the Therapeutic Exercise Group, there were 3 sessions, one per week for 3 consecutive weeks and a follow-up interview at week 12. The Physical Therapy Program consisted in Standardized Therapeutic Exercise combined with educational and preventive measures to improve the health status. The sociodemographic and anthropometric variables were collected at baseline assessment. Primary outcomes Health-Related Quality of Life (SF-36v2) and Neck and Low Back Pain (Visual Analogue Scale) were collected in three different moments, at baseline, after finishing the interventions and 12 weeks after the study began. Data analysis was performed for the description and comparison of sociodemographic and anthropometric characteristics of participants in both programs; percentage estimation of success achieved by each of the programs after each intervention and at week 12; evaluation of the effect achieved by each program after the intervention and at week 12 of Health-Related Quality of Life (SF-36v2) and Neck and Low Back Pain (Visual Analogue Scale); comparison between both programs at week 12. RESULTS: Of the 70 people included in the Geriatric Physical Therapy Group, 66 (94%) completed the program and 120 (86%) of 140 individuals in the Standardized Therapeutic Exercise Group. In the initial description of the sample there is not a statistically significant difference (p> 0.05) between groups in the variables sex, age, marital status, height, weight, BMI, neck pain and low back pain and in Physical Function, Bodily Pain, General Health, Social Function, Role Emotional, Mental Health and Mental Health Summary of SF-36v2 dimensions. On the other hand there is difference in the variables employment status (p=0.007), Physical Role (p=0.001) and Vitality (p=0.028) and in the Physical Health Summary (p=0.016). Of the participants in the Geriatric Physical Therapy Group, 62.9% were women, 75.7% married, 62.9% retired and 52.8% overweight or obese. In the Therapeutic Exercise Group 66.4% were women, 79.3% married; 46.4% retired and 46.4 overweight or obese. In relation to the Health-Related Quality of Life in the Geriatric Physical Therapy Group there was only a statistically significant difference in the Bodily Pain (p=0.019) in the comparison among the 3 assessments; in the short-term effect there was clinically relevant differences in Bodily Pain, Social Function and Mental Health and in the final assessment only Bodily Pain remained the same. In Therapeutic Exercise Group, excepting Emotional Role, all other dimensions have a significant difference (p> 0.05); in short-term effect clinically relevant differences were found in Physical Role, Bodily Pain and Vitality, which remained in the medium-term effects, except for Physical Role. The success rate of interventions in the Geriatric Physical Therapy Group in neck pain was 67.6% and 66.2% and for low back pain it was 74.1% and 70.4%, compared to 51.9% and 42.6% for neck pain and 55% and 60% for low back pain in Therapeutic Exercise Group. Comparing both interventions in medium-term effect, the values of neck and low back pain are statistically significant (p<0.001). In relation to neck pain reduction, Geriatric Physical Therapy Group had a value of -2.05 (CI: -2.48; - 1.62) and in the Therapeutic Exercise Group the value was -1.50 (CI: -1.94; -1.05). For low back pain, the Geriatric Physical Therapy Group achieved a value of –2.00 (CI: -2.50; -1.50) and in the Therapeutic Exercise Group it was - 1.68 (CI: -2.06; -1.31). The comparison between both was not statistically significant. CONCLUSIONS: People who go voluntarily to a Geriatric Physical Therapy program are similar to the Spanish population over 60 years old. Seven out of ten participants in the Geriatric Physical Therapy Group reported a pain improvement and four out of ten improved their quality of life with clinical relevance, compared with five out of ten for pain improvement and quality Life in the Therapeutic Exercise Group. Therefore, the Geriatric Physical Therapy programs which include Therapeutic Exercise are affective for the control of pain in healthy elderly, and can improve the Health Related Quality of Life perception.