PRACTICE OF PHYSICAL ACTIVITY BY ELDERLY FREQUENTERS OF BASIC HEALTH UNITS

ORIGINAL ARTICLE PRACTICE OF PHYSICAL ACTIVITY BY ELDERLY FREQUENTERS OF BASIC HEALTH UNITS Prática de atividade física por idosos frequentadores de unidades básicas de saúde Daniel Vicentini Oliveira a, Robson Lazzari de Brito b, Mateus Dias Antunes c, José Roberto Andrade do Nascimento Júnior d, Caio Rosas Moreira e, Dayane Capra de Oliveira a, Maria do Carmo Correia de Lima a, Sônia Maria Marques Gomes Bertolini c, Cláudia Regina Cavaglieri a ABSTRACT OBJECTIVES: This study aimed to identify the factors associated with the physical activity of elderly assisted at the basic health units (BHU) of the city of Matelândia, Paraná, Brazil. METHODS: This is a cross-sectional study, in which 343 elderly users of the BHU of this city were surveyed. A socio-demographic questionnaire, the International Physical Activity Questionnaire (IPAQ), and the questionnaire of barriers to physical activity practice were used. RESULTS: In relation to the level of physical activity, 88.9% of the elderlies were classified as active/very active. Higher level of physical activity was significantly associated with the amount of medication used (p = 0.024), reason to go to BHU (p = 0.037), and indication of physical activity by UBS (p = 0.040). Lack of energy (p = 0.048) was a more frequent and significant barrier for the active/very active elderly. CONCLUSION: There is a large number of active/very active elderly users of the BHU of Matelândia, Paraná, Brazil, and this was associated with lower age, lower medication use, going to BHU to withdraw medication/others and indication of physical activity by the BHU. For those who do not fit into these levels, lack of financial resources and insufficiently safe environment are the most common barriers to physical activity. KEYWORDS: aging; motor activity; health promotion. RESUMO OBJETIVO: O objetivo do presente estudo foi identificar os fatores associados à atividade física de idosos usuários das unidades básicas de saúde (UBS) do município de Matelândia, Paraná. MÉTODOS: Trata-se de um estudo transversal, no qual foram pesquisados 343 idosos usuários das UBS do município. Foi utilizado um questionário sociodemográfico, o International Physical Activity Questionnaire (IPAQ), e o questionário de barreiras para prática de atividade física. RESULTADOS: Em relação ao nível de atividade física, 88,9% dos idosos avaliados foram classificados como ativos/muito ativos. Maior nível de atividade física foi significativamente associado a quantidade de medicamentos utilizados (p = 0,024), motivo para ir à UBS (p = 0,037) e indicação de atividade física pela UBS (p = 0,040). A falta de energia (p = 0,048) foi é uma barreira mais frequente e significativa para os idosos ativos/muito ativos. CONCLUSÃO: É grande o número de idosos ativos/muito ativos usuários das UBS de Matelândia, Paraná, e este foi associado à menor faixa etária, ao menor uso de medicamentos, à ida à UBS para retirada de medicamento/outros e à indicação de atividade física pela UBS. Para aqueles que não se enquadram nesses níveis, a falta de recursos financeiros e o ambiente insuficientemente seguro são as barreiras mais frequentes para a prática de atividades físicas. PALAVRAS-CHAVE: envelhecimento; atividade motora; promoção da saúde. a Universidade Estadual de Campinas (UNICAMP) Campinas (SP), Brazil. b Faculdade Metropolitana de Maringá Maringá (PR), Brazil. c Centro Universitário de Maringá Maringá (PR), Brazil. d Universidade Federal do Vale do São Francisco Petrolina (PE), Brazil. e Universidade Estadual de Maringá Maringá (PR), Brazil. Correspondence data Daniel Vicentini Oliveira Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, Brasil. CEP: 13083-887 E-mail: d.vicentini@hotmail.com Received on: 06/18/2017. Accepted on: 08/02/2017 DOI: 10.5327/Z2447-211520171700049 116 Geriatr Gerontol Aging. 2017;11(3):116-23

Oliveira DV, Brito RL, Antunes MD, Nascimento Júnior JRA, Moreira CR, Oliveira DC, Lima MCC, Bertolini SMMG, Cavaglieri CR INTRODUCTION Programs of physical activity practice have been increasingly prioritized and implemented in the Brazilian Public Health System (Sistema Único de Saúde SUS), with the objective of broadening and qualifying basic health care to the population, from the perspective of health promotion. 1 Practicing physical activities is extremely important to the elderly, once it provides both physical and psychosocial benefits. 2 Encouragement to physical activity practice by public entities may result in greater savings in health, considering that the benefits it brings prevent the development of several chronic non-communicable diseases, systemic arterial hypertension (SAH), stroke, peripheral vascular diseases, obesity, type 2 diabetes mellitus, osteoporosis, and osteoarthritis. 3,4 The implementation of health promotion actions related to physical activity practice may be one form of health management due to its good cost-benefit ratio, preventing the deleterious effects of age in different chronic diseases, in addition to promoting social inclusion. 2,5 Thus, the factors associated to physical activity practice must be identified in the search for public health care, so that there is actual awareness about physical activity in old age. This is even more important in small cities, once that public investments in health in these regions are restricted. 6 Programs are being made available to the population with the objective of encouraging and promoting adherence to the practice of physical activity. These are developed in multiple locations, including the territories of basic health units (BHU) due to their favorable locations for this purpose and their easy access to basic health care by users. 7 In 2008, the Ministry of Health created the Family Health Support Center (Núcleo de Apoio à Saúde da Família NASF), which consisted of a multiprofessional health team, including the area of physical education, mainly with actions of educational nature and health promotion for both individuals and communities. 2 In Goiânia, Goiás, a study 8 was carried out in order to evaluate how NASF activities are being conducted and the interaction between professionals, prioritizing the performance of physical education professionals in the program. The results identified that these professionals are among the five most often hired to join the group and usually conducted guidance through lectures and interventions using physical exercises, promoting social interaction among participants in addition to physical benefits. Considering that the elderly population is the major group of users of health services, whose contingent is increasing exponentially, it is necessary to structure and qualify basic health services such as physical activity programs focused on this public, in order to better serve them according to their characteristics and needs. 2,9,10 By identifying the main factors associated with the pursuit of physical activity or their impediments, one may structure and act out with a better program that is also appropriate to a small town population, once impediments are different from those of big cities. 6 Therefore, the present study had the objective of identifying the factors associated to physical activities of elderly users of BHUs in Matelândia, Paraná, and verifying the main obstacles to their practice. METHODS This is a quantitative, observational and cross-sectional study. The sample was selected based on finite sample formula calculation, recommended by Richardson 11 for large samples, adopting a confidence level of 95%, estimated error of 5%, and expected ratio of 50%, with a required minimum sample of 334 elderly people. The study included elderly of both genders, aged 60 years old or older, users of BHU in the municipality of Matelândia, Paraná. In total, five BHUs were evaluated, that is, the totality of the municipality. Elderly patients with auditory acuity impairment were excluded, once it would make it impossible for the research protocol to be applied, as well as elderly patients in wheelchairs and those requiring ambulation aid. The sociodemographic questionnaire consisted of 12 questions regarding age (60 to 70 years old; over 70 years old), gender (male; female), education (illiterate; incomplete elementary school; complete elementary school; high school/college), smoking habit (never smoked; already smoked, currently smokes), marital status (separated/divorced; married/with a partner; single/widowed), monthly income in minimum wage regarding the year of 2016 (R$ 880,00) (up to 2; more than 2), retirement (yes; no), self-perception of health (excellent; good; regular; poor), chronic diseases (does not have diseases; 1 disease; 2 or more), medications used (does not use; 1 medication; 2 medications; 3 or more), reason to search for a BHU (medical consultation; prevention; search for medications; others), BHU s referral to physical activity (yes; no), and history of falls within the previous six months (yes; no). Subsequently, the short version of the International Physical Activity Questionnaire (IPAQ) was applied to evaluate the level of physical activity of each individual, divided into four categories: time of work, free time, time spent with chores and time in motion. 12 Questions covered Geriatr Gerontol Aging. 2017;11(3):116-23 117

Physical activity of elderly walks over ten minutes, moderate activities (not considering walks), vigorous activities and time spent in a seated position. Participants were then classified as sedentary/ irregularly active, active or very active. Finally, the barrier questionnaire was applied, which allows identifying the obstacles to engaging in behaviors that could help preventing diseases and improve health. 13 This questionnaire consists of a table with 20 questions on everyday issues such as daily work load, family commitments, absence of adequate climate, lack of space to perform physical activities, lack of equipment daily tasks, lack of companionship, lack of incentive, lack of financial resources, bad mood, fear of injuries, physical limitations, minor pain or malaise, lack of energy, lack of physical ability, lack of knowledge or orientation about physical activities, insecure environment (criminality), concern about physical appearance, and lack of interest. The study was approved by the Research Ethics Committee of Centro Universitário de Maringá (UNICESUMAR), No. 1.744.658/2016. Data collection was performed after authorization by the Health Department of the municipality of Matelândia, Paraná, from June to August, 2016. After the authorization was confirmed, the population researched (elderly) was informed about the reasons and objectives of the study. They all accepted and signed the Informed Consent Form Subjects were evaluated by two researchers who had been trained prior to the research. They would approach the elderly individually at BHUs and, then, perform the evaluation protocol in a room reserved for the research. Data analysis was performed in the SPSS 22.0 software, by a descriptive and inferential statistical approach. Frequency and percentage were used as descriptive measures for the categorical variables. As for numerical variables, the normality of data was initially verified by the Kolmogorov- Smirnov test. As the data did not present normal distribution, the characterization of results was made by median (Md) and quartiles (Q1; Q3). In the comparison between groups (sedentary/irregularly active and active/very active), the Mann-Whitney U test was used. The Pearson s χ 2 test was used to cover possible associations between sociodemographic variables and health conditions with level of physical activity. A Binary logistic regression (gross and adjusted analysis) was used in order to examine the magnitude of associations between sociodemographic variables and health conditions (independent variables) with active/very active physical activity levels (dependent variable). For the regression analysis, only variables with significance equal to or lower than 0.20 in the c 2 test were considered, being simultaneously inserted in a single block, without withdrawal after the analysis. Each exploratory variable with < 0.05 in Wald s test was considered associated to the study s outcomes. Model adjustment was verified by the Hosmer-Lemeshow test. RESULTS As for the level of physical activity, among 343 elderly people evaluated, 38 (11.1%) were classified as sedentary/ irregularly active, while 305 (88.9%) were classified as active/ very active. When analyzing the association of physical activity level and sociodemographic variables, significant association was found only as to age range (p = 0.027), indicating that lower age range was significantly associated with higher physical activity levels (Table 1). Unlike socioeconomic variables, most variables relating to health are significantly associated (p < 0.05) to the elderly physical activity levels in the city (Table 2). There was a significant association between the levels of physical activity and medications used (p = 0.024), the reason to seek BHU (p = 0.037) and indication of physical activities by the BHU (p = 0.040). It should be noted that use of fewer medications, going to a BHU to get medication/others, and indication of physical activities by the BHU are associated with the practice of physical activities. Gross odds ratio (OR) values in binary logistic regression analysis confirmed the results of the χ 2 test (Table 3). When the analysis was adjusted for all the variables in the model, it was observed a significant association between active/very active levels of physical activity and age range, reason to go to BHU, and the indication of physical activity by the BHU (p < 0.05). It is noteworthy that the elderly who go to BHUs to get medication have 3.458 (95%CI 1.018 12.172) times more chance of presenting active/very active levels when compared to those who go to BHUs for medical consultation and preventive exams. The age range from 60 to 70 years and the lack of indication for physical activity by BHUs were observed as protection factors, meaning that the elderly ged 60 to 70 (OR = 0.493; 95%CI 0.240 0.987) and who were not advised by the BHU to perform physical activities (OR = 0.489; 95%CI 0.243 0.985) had lower chances of having an active/very active level of physical activity. When comparing the obstacles to the practice of physical activities by the elderly and their actual level of physical activity (Table 4), a significant difference was seen as to obstacles imposed by the lack of financial resources (p = 0.001) and insufficiently safe environment (p = 0.046). This seems 118 Geriatr Gerontol Aging. 2017;11(3):116-23

Oliveira DV, Brito RL, Antunes MD, Nascimento Júnior JRA, Moreira CR, Oliveira DC, Lima MCC, Bertolini SMMG, Cavaglieri CR Table 1 Association of the level of physical activity with sociodemographic variables of elderly in basic health units in the municipality of Matelândia, Paraná, Brazil (n = 343). Variables Gender Level of physical activity Sedentary/ irregularly active (n = 38) ƒ (%) Active/very active (n = 305) ƒ (%) Male 12 (10.2) 106 (89.8) Female 26 (11.6) 199 (88.4) Age range (years old) 60 to 70 22 (8.8) 228 (91.2) More than 70 16 (17.2) 77 (82.8) Marital status Divorced/ separated Married/with partner 4 (8.0) 46 (92.0) 22 (10.7) 183 (89.3) Widowed 12 (13.6) 76 (86.4) Education Illiterate 5 (11.4) 39 (88.6) Incomplete elementary school Complete elementary school High School/ College Smoking Never smoked Already smoked Currently smokes Retirement 28 (11.2) 223 (88.8) 3 (13.6) 19 (86.4) 2 (7.7) 24 (92.3) 26 (12.3) 186 (87.7) 8 (8.5) 86 (91.5) 4 (10.8) 33 (89.2) No 11 (10.5) 94 (89.5) Yes 27 (11.3) 211 (88.7) Monthly income Up to 2 minimum wages ** More than 2 minimum wages 35 (10.9) 285 (89.1) 3 (13.0) 20 (87.0) ƒ: frequency; *significant association (p < 0.05) by the χ 2 test for proportions; **minimum wage in 2016: R$ 880.00 (US$ 275.50). χ 2 0.151 0.698 4.860 0.027* 1.087 0.297 0.106 0.745 0.432 0.511 0.056 0.813 0.097 0.756 to evidence that the financial situation and absence of safety where they carry out physical activities are obstacles often indicated by sedentary/irregularly active elderly compared to active/very active ones. There was also a difference (Table 1) in the obstacle of extensive study load (p = 0.001), indicating that student commitments are less commonly mentioned barriers to active/very active subjects than to sedentary/irregularly active ones. Another difference was the obstacle of lack of energy (p = 0.048), indicating that daily fatigue is an obstacle more commonly faced by active/very active elderly people. Table 2 Association of the level of physical activity with the variables related to the health of elderly in basic health units in the municipality of Matelândia, Paraná, Brazil (n = 343). Variables Level of physical activity Sedentary/ irregularly active (n = 38) ƒ (%) Self-perception of health Active/very active (n = 305) ƒ (%) Excellent 2 (11.8) 15 (88.2) Very good/ good 17 (9.1) 169 (90.9) Regular/poor 19 (13.6) 121 (86.4) Chronic diseases 0 to 1 14 (8.5) 151 (91.5) 2 or more 24 (13.5) 154 (86.5) Medications used 0 to 2 15 (7.7) 179 (92.3) 3 or more 23 (15.4) 126 (84.6) Reasons to go to the BHU Medical consultation Preventive exam Taking medicines/ others BHU advised for physical activity 23 (13.9) 142 (86.1) 12 (11.1) 96 (88.9) 3 (4.3) 67 (95.7) Yes 20 (8.7) 211 (91.3) No 18 (16.1) 94 (83.9) Falls within the last 6 months No 10 (11.4) 78 (88.6) Yes 28 (11.0) 227 (89.0) ƒ: frequency; BHU: basic health unit; *significant association (p < 0.05) by the χ 2 test for proportions. χ 2 1.020 0.312 2.171 0.141 5.078 0.024* 4.354 0.037* 4.208 0.040* 0.010 0.921 Geriatr Gerontol Aging. 2017;11(3):116-23 119

Physical activity of elderly DISCUSSION Considering the lack of scientific evidence regarding the use of BHUs in small cities located in the countryside of Brazilian States, the present research advances by presenting associations of physical activity with health and the obstacles found for the practice of physical activity by elderly users of BHUs in the city of Matelândia, Paraná State. In general, Table 3 Gross and adjusted chance ratio for the active/ very active level of physical activity and factors related to elderly in basic health units in the municipality of Matelândia, Paraná, Brazil (n = 343). Variables Age range (years) Gross OR (95%CI) Adjusted OR (95%CI) 60 to 70 1.00 1.00 Table 4 Comparison of obstacles for the practice of physical activity of elderly in the basic health units of the municipality of Matelândia, Paraná, Brazil, according to the level of physical activity. Variables Extensive work journey Extensive study journey Sedentary/ irregularly active (n = 38) Md (Q1;Q3) Active/very active (n = 230) Md (Q1;Q3) 5.0 (5.0; 5.0) 5.0 (3.0; 5.0) 0.438 5.0 (5.0; 5.0) 5.0 (4.0; 5.0) 0.008* Family commitment 5.0 (4.5; 5.0) 5.0 (4.0; 5.0) 0.424 Lack of appropriate climate Lack of available space 4.0 (3.0; 5.0) 4.0 (3.0; 5.0) 0.626 5.0 (3.0; 5.0) 5.0 (3.0; 5.0) 0.998 More than 70 0.464 (0.232 0.929) 0.030* 0.493 (0.240 0.987) 0.048* Lack of equipment 5.0 (2.0; 5.0) 5.0 (2.0; 5.0) 0.515 Chores 5.0 (5.0; 5.0) 5.0 (4.0; 5.0) 0.763 Chronic diseases 0 to 1 1.00 1.00 2 or more Medications 0.595 (0.297 1.194) 0.144 0.929 (0.361 2.391) 0.879 0 to 2 1.00 1.00 Lack of company 5.0 (4.5; 5.0) 5.0 (3.0; 5.0) 0.364 Lack of encouragement from family/friends Lack of financial resources 5.0 (5.0; 5.0) 5.0 (4.0; 5.0) 0.356 5.0 (5.0; 5.0) 5.0 (3.5; 5.0) 0.001* Bad mood 5.0 (5.0; 5.0) 5.0 (5.0; 5.0) 0.469 3 or more 0.459 (0.230 0.915) 0.027* 0.525 (0.205 1.346) 0.180 Fear of injuries 5.0 (3.0; 5.0) 3.0 (1.0; 5.0) 0.105 Physical limitations 3.0 (2.0; 5.0) 3.0 (2.0; 5.0) 0.829 Reasons to go to the BHU Medical consultation Preventive exam Taking medicines/ others 1.00 1.00 1.296 (0.615 2.728) 3.617 (1.049 12.471) BHU advised for physical activity 0.495 0.042* 1.344 (0.627 2.882) 3.458 (1.018 12.172) 0.448 0.047* Yes 1.00 1.00 No 0.495 (0.250 0.979) 0.043* 0.489 (0.243 0.985) 0.045* OR: odds ratio adjusted for all variables in the model; 95%CI: confidence interval of 95%; BHU: basic health unit; *significant association (p < 0.05) by binary logistic regression. Mild pain or discomfort 3.0 (1.0; 4.0) 3.0 (1.0; 5.0) 0.864 Lack of energy 3.0 (1.0; 5.0) 4.0 (2.0; 5.0) 0.048* Lack of physical abilities Lack of knowledge about physical activities Insufficiently safe environment Concerns about appearance during practice 4.0 (2.0; 5.0) 3.0 (2.0; 5.0) 0.974 5.0 (3.5; 5.0) 5.0 (5.0; 5.0) 0.123 5.0 (3.0; 5.0) 3.0 (1.0; 5.0) 0.046* 3.0 (2.5; 5.0) 4.0 (3.0; 5.0) 0.164 Lack of interest 3.0 (1.0; 4.5) 3.0 (1.0; 5.0) 0.333 Md: median; *significant difference (p < 0.05) by the Mann-Whitney U test. 120 Geriatr Gerontol Aging. 2017;11(3):116-23

Oliveira DV, Brito RL, Antunes MD, Nascimento Júnior JRA, Moreira CR, Oliveira DC, Lima MCC, Bertolini SMMG, Cavaglieri CR most elderly attending BHUs are regularly active or very active. Also, this characteristic is more present among younger elderly people (60 to 70 years of age), who take fewer medications, who attend BHUs mainly to get medication, and who are advised at such places to engage on physical activities. On the other hand, the lack of financial resources and an insufficiently safe environment seem to be factors contributing to impair the active life of the elderly. The data regarding IPAQ indicated that 88.9%, that is, over half of the interviewees are active or very active, which is beneficial for this population. Individuals with appropriate physical activity levels (active or very active) performed their daily life activities in a healthier way. 14 Studies show that regular physical activity practice is relevant for the individual and, when performed correctly and as recommended by a professional, it is able to reduce the use of medications. 4,15 It should always be noted that a decrease in levels of physical activity in relation to the adult age range group is commonly observed. 16-18 Knowing this, BHUs should be alerted to stimulate the practice of physical activity, not allowing the elderly population to onset sedentary or insufficiently active behaviors, considering that an active life style helps providing better quality of life. 9 Stimulating physical activity is essential at any stage of life in order to promote overall health. 19 Even for the elderly who already have established diseases, physical activity acts as a non-pharmacological treatment. 19-24 Having more disease has been associated to higher levels of physical activity. This finding may have been influenced by the information spread by the BHU team, encouraging more frequent physical activities. The Ministry of Health points out that regular practice of physical activities is one of the strategies that promote health that can collaborate with the prevention and control of chronic non-communicable diseases (CNCD). The implementation of physical activities for community residents has been carried out in different public contexts squares, beaches, parks, community centers, and basic health care in order to promote health benefits and a positive self-assessment of the participants. 24 In the present study, the elderly who were not advised to engage in physical activities by the BHU had lower chances to achieve active/very active levels of physical activity. Had they been advised to do so, it s assumed that they would have more chances to have high levels of physical activity. In this sense, the objective of the National Policy for Health Promotion is to promote quality of life and to reduce the vulnerabilities and risks related to their determinants. One of their priority actions are bodily practices and physical activities, since the inclusion of this priority understands physical inactivity is one of the main risk factors for worldwide mortality. 19 The absence of physical activity can cause the individual to feel ill, without energy and, consequently, reduce their abilities. This ends up producing a vicious cycle making the elderly inactive, which is explained in the literature as an obstacle for sedentary elderly, 20 however, in the present study, daily fatigue was pointed out as the most frequent obstacle for active/very active elderly people. The findings of most studies differ from the ones in the present study, once they verify the prevalence of physical inactivity increases with age due to a more sedentary lifestyle, usually adopted after retirement. However, in this study, elderly aged between 60 and 70 years old had lower chances of having active/very active levels of physical activity. These data are important to strengthen the importance of regular physical activity for health promotion, especially by the reduction of their levels with advanced age. 18 As for the use of health units, the medical consultation was the service most sought by active elderly in this study (Table 2), in agreement to a study 25 which analyzed 26 elderly people of 14 health units of the city of Rio Claro, São Paulo. Among the participants, 73.1% performed physical activities and 80.8% sought for basic health care due to medical consultation. The elderly who seek for more assistance have autonomy in the search for alternative networks for support and to access medication. In the present study, the access of elderly people to the BHU to get medication was associated to highest levels of physical activity, as they 3.458 times more chances of achieving active/very active levels of physical activity when compared to other reasons for going to a BHU. This aspect may be justified by primary care programs for the prevention and promotion of health, such as the Hyperday (Hiperdia), created to ensure the proper, facilitated and free supply of medication in a regular and systematic way to patients captured by these programs, increasing the bound of users, especially elderly ones, to BHUs. 17 It is worth mentioning that the BHUs are places widely used by the population with varied age, and especially by the elderly, in which their employees work in several guidance, treatment and rehabilitation areas. In these units, the health professional should stimulate the elderly population to develop and practice an active and healthy lifestyle. 26 Most elderly in the present study reported income of up to two minimum wages and low education (Table 1). Studies show that elderly with low purchasing power and education are associated to limited access to physical activities, worse perception of health and functional status, in addition Geriatr Gerontol Aging. 2017;11(3):116-23 121

Physical activity of elderly to the often insecure neighborhood with fewer transportation offers. 26-28 These results corroborate the findings of the present research in relation to the obstacles for physical activity practice among elderly (Table 3), as financial resources and the insufficiently safe environment seem to affect the practice of physical activity among them. The least frequent barrier was the heavy study load, an expected result once that this activity is very present in the routine of this profile of elderly subjects. A limitation factor to discuss this result is the lack of studies who used the same questionnaire. In the literature, other questionnaires about these obstacles are used, considering they do not present extensive study journeys as a studied variable. 29,30 This study has limitations that should be highlighted: the lack of a group of elderly people who practice physical activity to be compared to factors associated to this practice; the absence of a control group; the convenience of the sample. Thus, the results reported in this study suggest the measurement of physical activities in further studies is performed periodically for a given period of time in the follow-up of these elderly. CONCLUSION Given the results exposed, it may be concluded that the number of active/very active elderly users in BHUs of Matelândia, Paraná, is high and associated to the lower age range, use of fewer medications, and visits to a BHU to get medication/others and indication of physical activities by the BHU. For those who do not meet those levels, financial resources and insufficiently safe environment are obstacles more often observed for the practice of physical activity. ACKNOWLEDGEMENTS To the Instituto Cesumar de Ciência, Tecnologia e Inovação (ICETI) and to the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), for the granting of scholarships for research assistance. CONFLICT OF INTERESTS The authors declare no conflict of interests. REFERENCES 1. Salin MS, Mazo GZ, Cardoso AS, Garcia GS. Atividade física para idosos: diretrizes para implantação de programas e ações. Rev Bras Geriatr Gerontol. 2011;14(2):197-208. 2. Barros M, Guarda F, Feitosa W, Lemos E, Silva C. Programs and interventions for physical activity promotion in the Brazilian Unified Health System: a research object that starts to be unveiled. Rev Bras Ativ Fis Saúde. 2016;21(5):385-7. 3. Zaitune MPA, Barros MBA, César CLG, Carandina L, Goldbaum M. Fatores associados ao sedentarismo no lazer em idosos de Campinas - SP. Cad Saúde Pública. 2007;23(6):1329-38. 4. Morgan PJ, Young MD, Smith JJ, Lubans DR. Targeted health behavior interventions promoting physical activity: a conceptual model. Exer Sport Sci Rev. 2016;44(2):71-80. 5. Aslan D, Ozcebe H, Temel F, Takmaz S, Topatan S, Sahin A, et al. What influences physical activity among elders. A Turkish experience from Ankara, Turkey. Arch Gerontol Geriatr. 2008;46(1):79-88. 6. Soares RF, Clemente A, Freire FDS, Scarpin JE. Centralidade municipal e interação estratégica na decisão de gastos públicos em saúde. Rev Adm Pública. 2016;50(4):563-86. 7. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Atenção Básica. Brasília: Ministério da Saúde; 2012. 8. Martinez NJF, Silva AM, Silva MS. As diretrizes do NASF e a presença do profissional em educação física. Rev Motr. 2014;26(42):222-237. 9. Satariano WA, Guralnik JM, Jackson RJ, Marottoli RA, Phelan EA, Prohaska TR. Mobility and Aging: New directions for public health action. Am J Public Health. 2012;102(8):1508-15. 10. Warburton DE, Bredin SS. Reflections on physical activity and health: what should we recommend? Can J Cardiol. 2016;32(4):495-504. 11. Richardson RJ. Pesquisa social: métodos e técnicas. 3ª ed. São Paulo: Atlas; 2012. 12. Pitanga FJG. Epidemiologia: da atividade física, do exercício físico e da saúde. 3ª ed, São Paulo: Phorte; 2010. 13. Floriano AA, Hallal PC. Epidemiologia da atividade física. São Paulo: Atheneu; 2011. 14. Pellegrinotti IL. Atividade física e Esporte: a importância no contexto saúde e esporte. Rev Bras Ativ Fis Saúde. 1998;3(1):22-8. 15. Alencar NA, Souza Júnior JV, Aragão JCB, Ferreira MA, Dantas E. Nível de atividade física, autonomia funcional e qualidade de vida em idosas ativas e sedentárias. Rev Fisiot Mov. 2010;23(3):473-81. 16. Knuth AG, Malta DC, Dumith SC, Pereira CA, Morais Neto OL, Temporão JG, et al. Prática de atividade física e sedentarismo em brasileiros: resultados da Pesquisa Nacional por Amostra de Domicílios (PNAD) 2008. Ciênc Saúde Coletiva. 2011;16(9):697-705. 17. Paniz VMV, Fassa AG, Facchini LA, Bertoldi AD, Piccini RX, TomasiI E, et al. Acesso a medicamentos de uso contínuo em adultos e idosos nas regiões Sul e Nordeste do Brasil. Cad Saúde Pública. 2008;24(2):267 80. 18. Sebastião E, Christofoletti G, Gobbi S, Hamanaka AYY, Gobbi LTB. Atividade física, qualidade de vida e medicamentos em idosos: diferenças entre idade e gênero. Rev Bras Cineantropom Desempenho Hum. 2009;11(2):210-6. 19. Malta D, Silva M, Albuquerque G, Amorim R, Rodrigues G, Silva T, et al. Política Nacional de Promoção da Saúde, descrição da implementação do eixo atividade física e práticas corporais, 2006 a 2014. Rev Bras Ativ Fis Saúde. 2014;19(3):286-99. 20. Brazão MC, Hirayama MS, Gobbi S, Nascimento CMC, Roseguini AZ. Estágios de mudança de comportamento e barreiras percebidas à prática de atividade física em idosos residentes em uma cidade de médio porte do Brasil. Motriz. 2009;15(4):759-67. 21. LaCroix AZ, Rillamas-Sun E, Buchner D, Evenson KR, Di C, Lee IM, et al. The Objective Physical Activity and Cardiovascular Disease Health in Older Women (OPACH) Study. BMC Public Health. 2017;17(1):92. 22. Vancampfort D, Koyanagi A, Ward PB, Rosenbaum S, Schuch FB, Mugisha J, et al. Chronic physical conditions, multimorbidity and physical activity across 46 low-and middle-income countries. Int J Beh Nutr Phys Act. 2017;14:6. 23. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016;388(10051):1302-10. 122 Geriatr Gerontol Aging. 2017;11(3):116-23

Oliveira DV, Brito RL, Antunes MD, Nascimento Júnior JRA, Moreira CR, Oliveira DC, Lima MCC, Bertolini SMMG, Cavaglieri CR 24. Giraldo AED, Gomes GAO, Serafim THS, Zorzeto LP, Aquino DC, Kokubum E. Influência de um programa de exercícios físicos no uso de serviços de saúde na Atenção Básica de Saúde do município de Rio Claro, SP. Rev Bras Ativ Fis Saúde. 2012;18(2):186-96. 25. Dietz WH, Douglas CE, Brownson RC. Chronic disease prevention: tobacco avoidance, physical activity, and nutrition for a healthy start. Jama. 2016;316(16):1645-1646. 26. Saajanaho M, Rantakokko M, Portegijs E, Törmäkangas T, Eronen J, Tsai LT, et al. Personal goals and changes in life-space mobility among older people. Prev Med. 2015;81(1):163-7. 27. Grant TL, Edwards N, Sveistrup H, Andrew C, Egan M. Inequitable walking conditions among older people: examining the interrelationship of neighbourhood socio-economic status and urban form using comparative case studies. BMC Public Health. 2010;10:677. 28. Confortin SC, Schneider IJC, Antes DL, Cembranel F, Ono LM, Marques LP, et al. Condições de vida e saúde de idosos: resultados do estudo de coorte EpiFloripa Idoso. Epidemiol Serv Saúde. 2017;26(2):305-17. 29. Nascimento CMC, Gobbi S, Hirayama MS, Brasão MC. Nível de atividade física e as principais barreiras percebidas por idosos de Rio Claro. Rev Educ Fis UEM. 2008;19(1):109-18. 30. Oliveira JG, França SP. Barreiras percebidas para a prática regular de atividade física de idosos. Rev Geriatr Gerontol. 2016;11(3):165 70. Geriatr Gerontol Aging. 2017;11(3):116-23 123