Nutritional status, health risk behaviors, and eating habits are correlated with physical activity and exercise of brazilian older hypertensive adults: a cross-sectional study | BMC Public Health

This is the first examine that aimed to look into the marriage involving physical exercise and physical exercise participation in more mature Brazilian hypertensive adults with nutritional position (BMI), health and fitness possibility behaviors, consuming practices, and the presence of diabetic issues. The results showed that BMI, age, display time (only for physical activity), alcoholic beverages and tobacco usage, extremely-processed foodstuff intake scores, and owning diabetic issues decreased the odds of currently being workout practitioners or adequately active. On the other hand, male sex, a long time of analyze, and minimally processed foods enhanced the odds of older hypertensive older people remaining physical exercise practitioners or sufficiently lively. For that reason, this analyze improvements the investigation of hypertension and behavioral elements that are involved with physical exercise and physical action participation of older grown ups in a location so much not investigated (Brazil).

Previous findings indicated that better dietary position (chubby/being overweight) is related with reduce odds of compliance with exercise and actual physical action [21, 22, 31]. In this perception, a better nutritional status more than the perfect human body weight may be involved with lessen odds of adherence to training plans and diminished recurring bodily exercise [32]. As a result, deleterious behaviors are likely to mix and co-exist (for instance, greater sedentary conduct [increased exposure to cell phone, television, and computer; time sitting or lying] [33], alcohol [21], and tobacco intake [31]). Furthermore, inadequate taking in practices (with large consumption of extremely-processed foods) are inversely associated to adequate bodily activity stages (higher usage of ultra-processed foods and reduced physical exercise amounts) [34]. New findings claimed that insufficiently energetic topics take in 6{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} a lot more extremely-processed foods (in energy) in comparison to adequately energetic topics [34]. A single doable rationalization for this is that subjects with ample bodily action had a lot more satiety with lessen quantities of significant-density foods intake (e.g., ice product, quick noodles) when compared with insufficiently energetic subjects, who wanted a higher intake total (of extremely-processed foodstuff) to have satiety [35]. The will need to ingest larger amounts of ultra-processed foodstuff to fulfill satiety in insufficiently active subjects boosts their odds of likely over the day by day caloric harmony, favoring over weight and being overweight [36]. For that reason, the interaction in between nutritional position and involved hazard things (monitor time, use of licit medicine, and insufficient ingesting practices) compromises the odds of more mature hypertensive adults currently being practitioners of exercise and complying with the suggestions of physical action in every day life [37].

A further related acquiring from our research is the distribution of combinations of different training (non-practitioners/practitioners) and bodily exercise (insufficiently energetic/sufficiently energetic) characteristics of more mature hypertensive grownups. Some more mature hypertensive adults offered ample weekly bodily exercise but did not interact in work out (n = 404). Even more mature non-practitioners of exercise can be adequately lively by occupational and transportation functions. Leisure functions (i.e., exercise) are not the only way in which more mature people can be adequately lively. For that reason, these adequately active more mature grownups may well benefit from a extra energetic lifestyle in comparison to insufficiently energetic more mature adults, as regular physical activity lessens the risk of coronary coronary heart sickness, obesity, and some cancers [6, 22]. This will make it worthwhile to acquire very simple procedures to enhance all bodily activity that can be done when doable, these types of as employing the stairs as an alternative of the elevator, parking the automobile farther away, or finding off the bus in advance of the remaining halt to walk to the desired destination [30].

On the other hand, this analyze shown that some older hypertensive grown ups who engaged in workout packages were being classified as insufficiently active (39.6{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e}). Whilst exercising is nicely encouraged as an helpful non-pharmacological signify of controlling blood tension and lowering cardiovascular threat, it is essential to have an sufficient weekly quantity and frequency (Supplementary Chart 1) [37, 38]. The prescription of kinds of exercise (cardio, energy, or blended) and variables (intensity, volume, frequency, and period) should be assertively picked out by training professionals to increase the advantages of every single intervention [7, 9, 10, 37]. Thus, in addition to elevating recognition of the standard general performance of work out, the exercise prescription ought to be modified in quantity and weekly frequency to sustain superior wellbeing position for more mature hypertensive adults [39].

One particular toughness of this examine is the huge number of participants, with a fantastic sample illustration from all Brazilian areas. Knowledge collection through telephone interviews carried out by a remarkably capable team permitted apparent and specific explanations on every difficulty, keeping away from misunderstandings. The identification of outliers minimized the analyses biased outcomes (a discrepant value that could interfere with the confidence degree of the success), homogenizing the sample [40, 41]. Somehow, outliers can underneath/overestimate the outcomes of the examination. For example, we analyzed the data with out eradicating the outliers and the benefits furnished had been not comparable to the present-day results. When the outliers were being not removed, the OR of alcohol usage was > 1 to be an exercise practitioner or sufficiently lively in bodily activity (Supplementary Desk 2). In other phrases, alcohol intake was positively related with physical action and training. Having said that, when the outliers had been eradicated, the OR was < 1 (Table 2). Previous literature [42, 43] demonstrates that alcohol consumption has a negative influence on older adults being exercise practitioners or sufficiently active. Therefore, our caution in considering discrepant values was carried out.

Another strength is the regression model adjustment with a wide range of confounding factors that influence the odds of exercise and sufficient physical activity minimized analyses’ bias. As a result, this study is the first to suggest that nutritional status, health risk behaviors, eating habits, and the presence of diabetes have an association with the odds of older hypertensive adults being exercise practitioners and sufficiently active in a developing country [22]. The authors considered that adequate physical activity was independently associated with sex (male), age, self-independence, lower psychological distress, rural residence, not having diabetes, adequate minimally processed food intake, and speaking a language other than English at home [22]. In contrast, our study discusses barriers to physical activity and exercise practice, and our findings suggest that some behaviors are associated with sufficient physical activity and exercise practice. Considering the previous findings, and the lack of literature about the associated factors to sufficient physical activity and exercise practice of older hypertensive adults, our results are promising.

This study also had limitations. VIGITEL is a telephone survey, which may be influenced by its methodological effect Some examples of methodological effect include the sampling type (Brazilian), questions (under/overestimation of questions [e.g., physical activity level]), means of data collection (telephone [not smartphone] line), interview time (longer-interviews tend to have more errors in some questions), and duration of the survey (reduced time to collect more data). Despite being comprehensive and representative, the cross-sectional design did not allow the establishment of cause-effect relationships. The extrapolation of these findings to populations from other countries should be considered with caution, considering other differences that can impact the odds of older adults being exercise practitioners and sufficiently active. The lack of cognitive assessment before the interview is a limitation because some answers could be misunderstood by the participants. The use of BMI to determine nutritional status also limited the study due to BMI not distinguishing body composition components. However, it is the most used epidemiological index in the world, being adequate and feasible for representative samples [44]. Another limitation is the lack of information on the presence of antihypertensive drugs and blood pressure values (for adjustment of logistic regression models). This information could, in a way, change the association of the older adult being an exercise practitioner and sufficiently active, based on the use of medication (yes/no, or quantity) and blood pressure measurement (given continuously, e.g., 120 × 80 mmHg). Another limitation is the no determination of association between the amount of tobacco and alcohol consumption on physical activity and exercise, in terms of daily amount and exposure time in years. Moreover, our study considered these variables in a categorical way (i.e., tobacco, alcohol, and screen time), preventing the test of multicollinearity and interaction between themselves. However, a study with other population (adolescents) showed positive associations between these variables (tobacco, alcohol, and screen time) [45]. The 24-recall method applied in only one day has a poorer association with total energy intake (r = 0.31) measured by the doubly labeled water (gold standard method) compared to the same method applied more times (two or more days r between 0.39 and 0.47) [28]. Future studies need to consider more days of application of the 24-recall method. Finally, the physical activity assessment was carried out using a questionnaire from the VIGITEL study, which could under/overestimate the real level of physical activity performed by older adults. However, this questionnaire is validated against other common questionnaires (e.g., IPAQ BAECKE) for physical activity assessment [46].

As practical implications of this study’s findings, health professionals responsible for the treatment and control of hypertension in older adults can educate older adults about the associated factors of exercise and physical activity participation. The magnitude of positive and negative associations of each factor (nutritional status, health risk behaviors, eating habits, and the presence of diabetes) may help change the lifestyle of older hypertensive adults. Future research should explore the underlying reasons for the frequency of health risk habits in insufficiently active older hypertensive adults to help the development of public health interventions. In the public health field, helping older hypertensive adults reach the physical activity recommendations will contribute to the reduction of healthcare services expenses [47]. One possibility for health professionals to stimulate older adults is to install and use applications for smartphones that measure and encourage physical activity (e.g., steps daily count). Recent evidence suggests that these devices may be effective in increasing physical activity in older adults (although larger trials with longer follow-ups are needed to clarify if these devices provide clinically important effects) [48, 49]. If massive intervention would be practiced, screen time could have a positive OR to be sufficiently active in the future. Moreover, health professionals’ knowledge may help with adequate exercise prescription, even if this prescription is done gradually.

From a multifactorial approach, many reasons could be associated with a reduced chance of being an exercise practitioner. Beyond what is explored in our study, other factors including accessibility to exercise (adequate space to exercise practice), monthly income (could lead to access to adequate spaces for exercise, even personalized service), and public policies promoted by the government [50] could be discussed. However, our study did not investigate these factors, and we cannot generalize the adoption of means of physical activity and exercise for all contexts. Therefore, more studies are needed to clarify this multifaceted phenomenon.

Additionally, we suggest the longitudinal analysis (cohort or intervention studies) of the associated factors and levels of exercise and physical activity of older hypertensive older adults to establish the causal relationships between the factors analyzed in our study and recommended amounts of physical activity and exercise. We also suggest reproducing the study in other countries for greater external validity, and as a result, generalization across other populations.