Physical activity programs for elderly persons: an evaluation of Brazilian scientific production using the RE-AIM framework

Squarcini, Camila Fabiana Rossi; Rocha, Saulo Vasconcelos; Munaro, Hector Luiz Rodrigues; Benedetti, Tânia Rosane Bertoldo; Almeida, Fabio Araujo

doi:10.1590/1809-9823.2015.14103

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Revista Brasileira de Geriatria e Gerontologia

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Review Article • Rev. bras. geriatr. gerontol. 18 (4) • Dec 2015 • https://doi.org/10.1590/1809-9823.2015.14103 copy

Physical activity programs for elderly persons: an evaluation of Brazilian scientific production using the RE-AIM framework

Authorship SCIMAGO INSTITUTIONS RANKINGS

The RE-AIM framework is a model that analyzes both the external and internal validity of health programs. It proposes that programs should be evaluated based on five key dimensions: reach, effectiveness/efficiency, adoption, implementation and maintenance. The aim of the present study was to conduct a systematic review of physical activity programs for elderly persons published in Brazilian scientific literature using the RE-AIM framework. A total of 26 articles included in four scientific databases from 1993 to 2013 were identified and coded using a validated 52-item RE-AIM abstraction tool. Using the RE-AIM dimensions, indicators of reach (47.2%), effectiveness (36.3%), and implementation (27.5%) were reported more often than indicators of adoption (6.4%) and maintenance (4.7%). Only two articles were included in all five RE-AIM dimensions. Despite the increasing number of interventions targeting the elderly, few address the dimensions proposed by the RE-AIM framework, reducing their potential generalizability outside their original settings, and their overall external validity.

Physical Exercise; Elderly; Health

Author	Type of study	Control Group	n	Study location	Study region
Benedetti et al.(2012)¹⁸18. Benedetti TRB, Schwingel A, Gomez LSR, Chodzko-Zajko W. Programa "VAMOS" (Vida Ativa Melhorando a Saúde): da concepção aos primeiros resultados. Rev Bras Cineantropom Desempenho Hum 2012;14(6):723-37.	Quantitative-Qualitative	Yes	100	Community	South
Bonganha et al.(2012)¹⁹19. Bonganha V, Modeneze DM, Madruga VA, Vilarta R. Effects of resistance training (RT) on body composition, muscle strength and quality of life (QoL) in post menopausal life. Arch Gerontol Geriatr 2012;54(2):361-5.	Quantitative	Yes	32	University	Southeast
Burke et al.(2010)²⁰20. Burke TN, França FJ, Ferreira de Meneses SR, Cardoso VI, Marques AP. Postural Control in Elderly persons with osteoporosis: efficacy of an intervention program to improve balance and muscle strength: a randomized controlled trial. Am J Phys Med Rehabil 2010;89(7):549-56.	Quantitative	Yes	33	University	Southeast
Canonici et al.(2012)²¹21. Canonici AP, Andrade LP, Gobbi S, Santos-Galduroz RF, Gobbi LT, Stella F. Functional dependence and caregiver burden in Alzheimer's disease: a controlled trial on the benefits of motor intervention. Psychogeriatrics 2012;12(3):186-92.	Quantitative	Yes	32	Laboratory	Southeast
Caromano et al.(2006)²²22. Caromano FA, Ide MR, Kerbauy RR. Manutenção na prática de exercícios por idosos. Rev Dep Psicol UFF 2006;18(2):177-92.	Quantitative	Yes	20	Laboratory	Southeast
Castro et al.(2007)²³23. Castro PC, Tahara N, Rebelatto JR, Driusso P, Aveiro MC, Oishi J. Influência da universidade aberta da terceira idade (UATI) e do programa de revitalização (REVT) sobre a qualidade de vida de adultos de meia-idade e idosos. Braz J Phys Ther 2007;11(6):461-7.	Quantitative	No	70	Community	Southeast
Cavalcante et al.(2011)²⁴24. Cavalcante CL, Gonçalves MC, Cavalcanti AL, Da Costa SF, Asciutti LS. Nutritional intervention program associated with physical activity: discourse of obese elderly women. Ciênc Saúde Coletiva 2011;16(5):2383-90.	Qualitative	No	18	Community	Northeast
De Araújo et al.(2013)²⁵25. De Araújo TB, De Oliveira RJ, Martins WR, De Moura Pereira M, Copetti F, Safons MP. Effects of hippotherapy on mobility, strength and balance in elderly. Arch Gerontol Geriatr 2013;56(3):478-81.	Quantitative	Yes	28	Community	Centre-west
Fernandes et al.(2012)²⁶26. Fernandes AMBL, Ferreira JJA, Stolt LROG, De Brito GEG, Clementino ACCR, De Sousa NM. Efeitos da prática de exercício físico sobre o desempenho da marcha e da mobilidade funcional em idosos. Fisioter Mov 2012;25(4):821-30.	Quantitative	No	8	-	Northeast
Ferreira et al.(2008)²⁷27. Ferreira SR, Gimeno SG, Hirai AT, Harima H, Matsumura L, Pittito BA. Effects of an intervention in eating habits and physical activity in Japanese-Brazilian women with a high prevalence of metabolic syndrome in Bauru, São Paulo State, Brazil. Cad Saúde Pública 2008;24(Supl 2):294-302.	Quantitative	No	401	Community	Southeast
Fonseca et al.(2012)²⁸28. Fonseca CC, Gama EF, Thurm BE, Pereira ES, Limongelli AMA, Miranda MLJ. Benefícios da estimulação perceptual corporal no esquema corporal de idosos. Rev Bras Geriatr Gerontol 2012;15(2):353-64.	Quantitative-Qualitative	No	21	Community	Southeast
Gobbi et al.(2009)²⁹29. Gobbi LT, Oliveira-Ferreira MD, Caetano MJ, Lirani-Silva E, Barbieri FA, Stella F, et al. Exercise programs improve mobility and balance in people with Parkinson's disease. Parkinsonism Relat Disord 2009;15(Suppl 3):49-52.	Quantitative	No	34	Laboratory	Southeast
Hernandez et al.(2010)³⁰30. Hernandez SSS, Coelho FGM, Gobbi S, Stella F. Efeitos de um programa de atividade física nas funções cognitivas, equilíbrio e risco de quedas em idosos com demência de Alzheimer. Braz J Phys Ther 2010;14(1):68-74.	Quantitative	Yes	16	Laboratory	Southeast
Ide et al. (2005)³¹31. Ide MR, Belini MA, Caromano FA. Effects of an aquatic versus non-aquatic respiratory exercise program on the respiratory muscle strength in healthy aged persons. Clinics 2005;60(2):151-8.	Quantitative	Yes	59	University	South
Lustosa et al. (2011)³²32. Lustosa LP, Silva JP, Coelho FM, Pereira DS, Parentoni AN, Pereira LS. Impact of resistance exercise program on functional capacity and muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial. Braz J Phys Ther 2011;15(4):318-24.	Quantitative	Yes	32	-	Southeast
Lustosa et al. (2013)³³33. Lustosa LP, Máximo Pereira LS, Coelho FM, Pereira DS, Silva JP, Parentoni AN, et al. Impact of an Exercise Program on Muscular and Functional Performance and Plasma Levels. Arch Phys Med Rehabil 2013;94(4):660-6.	Quantitative	Yes	32	Laboratory	Southeast
Machado et al. (2013)³⁴34. Machado CH, Do Carmo AS, Horta PM, Lopes ACS, Dos Santos LC. Efetividade de uma intervenção nutricional associada à prática de atividade física. Cad Saúde Pública 2013;21(2):148-53.	Quantitative	No	20	Community	Southeast
Nascimento et al. (2013)³⁵35. Nascimento CMC, Ayan C, Cancela JM, Pereira JR, De Andrade LP, Garuffi M, et al. Exercícios físicos generalizados capacidade funcional e sintomas depressivos em idosos brasileiros. Rev Bras Cineantropom Desempenho Hum 2013;15(4):486-97.	Quantitative	Yes	42	Laboratory	Southeast
Raso et al. (2007)³⁶36. Raso V, Benard G, Silva Duarte AJS, Naale VM. Effect of resistance training on immunological parameters of healthy elderly women. Med Sci Sports Exerc 2007;39(12):2152-9.	Quantitative	No	14	Laboratory	Southeast
Renno et al. (2005)³⁷37. Renno ACM, Granito RN, Driusso P, Costa D, Oishi J. Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: a pilot study. Physiotherapy 2005;91(2):113-8.	Quantitative	No	20	Community	Centre-west
Sá et al. (2012)³⁸38. Sá AC, Bachion MM, Menezes RL. Physical exercises to prevent falls: a clinical trial with institutionalized elderly in the city of Goiânia in Brazil. Ciênc Saúde Coletiva 2012;17(8):2117-27.	Quantitative	Yes	32	Laboratory	Southeast
Santana et al. (2012)³⁹39. Santana MG, De Lira CA, Passos GS, Santos CA, Silva AH, Yosjida CH, et al. Is the six-minute walk test appropriate for detecting changes in cardiorespiratory fitness in healthy elderly men? J Sci Med Sport 2012;15(3):259-65.	Quantitative	Yes	32	Laboratory	Southeast
Stella et al. (2011)⁴⁰40. Stella F, Canonici AP, Gobbi S, Galduroz RF, Cação JC, Gobbi LT. Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial. Clinics 2011;66(8):1353-60.	Quantitative	Yes	20	Laboratory	Southeast
Tanaka et al. (2009)⁴¹41. Tanaka K, Quadros AC Jr, Santos RF, Stella F, Gobbi LT, Gobbi S. Benefits of physical exercise on executive functions in older people with Parkinson's disease. Brain Cogn 2009;69(2):435-41.	Quantitative	No	94	Laboratory	Southeast
Ueno et al. (2012)⁴²42. Ueno DT, Gobbi S, Teixeira CVL, Sebastião E, Prado AKG, Costa JLR, et al. Efeitos de três modalidades de atividade física na capacidade funcional de idosos. Rev Bras Educ Fís Esp 2012;26(2):273-81.	Quantitative	Yes	27	Laboratory	Southeast
Vale et al. (2009)⁴³43. Vale RG, De Oliveira RD, Pernambuco CS, Meneses YP, Novaes JS, De Andrade AF. Effects of muscle strength and aerobic training on basal serum levels of IGF-1 and cortisol in elderly women. Arch Gerontol Geriatr 2009;49(3):343-7.	Quantitative	Yes	35	University	Northeast

Reach	%
Description of the target population	30.8
Demographic and behavioral information regarding the target population	26.9
Method of identification of the target population	50.0
Recruitment strategies	42.3
Inclusion criteria	96.2
Exclusion criteria	96.2
Number of personseligible forand invitedto recruitment	42.3
Sample size	100
Participation rate	34.6
Cost of recruitment	0
Use of qualitative methods to assess reach	0

Effectiveness/Efficiency	%
Report of primary results	100
Report of mediators	100
Report ofmoderators	24.0
Intention of treatment or monitoring	26.9
Quality of life measurements	26.9
Measurement of unintended consequences (negative) in the results	0
Percentage of dropouts (at the program's conclusion)	34.6
Cost-effectiveness	0
Use of qualitative methods to assess the effectiveness/efficiency	20.0

Adoption	%
Organizational Level
Number of persons eligible and invited	3.8
Number ofparticipants	19.2
Participation rate	0
Description of the target site	15.4
Criteria for inclusion/exclusion of scenarios	7.7
Description of the site of the intervention	7.7
Method of identification of the scenario	7.7
Average number of people served by the scenario	0
Staff Level
Number of persons eligible and invited	3.8
Members of the total group who agreed to participate	7.7
Participation rate	0
Method for identification of the delivery agent to the destination	3.8
Agent's knowledge level	15.4
Criteria for inclusion/exclusion of agents	3.8
Measurement of adoption cost	0

Implementation	%
Theories	7.7
Number of contacts of the intervention	76.9
Period of the contacts	68.0
Durationof the contacts	60.0
Measure of whether the protocol was performed as expected	3.8
Consistency in implementation across scenarios and enforcement officers	0
Rates of attendance/completion of the participants	19.2
Measures of cost	3.8
Use of qualitative methods to measure implementation	7.7

Maintenance	%
Individual Level
Was individual behavior evaluated at some point after the intervention's completion? (duration of observation)	7.7
Drop outs	15.4
Use of qualitative methods to assess individual maintenance	7.7
Organizational Level
Report regarding alignment with the organization's mission	3.8
Is the program still in operation?	3.8
If no: Reasons for discontinuation	0
If yes: was the program has been modified? Be specific	3.8
Was the program institutionalized?	0
Waste	0

References	R (%)	E (%)	Ao (%)	As (%)	I (%)	Mi (%)	Mo (%)
Benedetti et al.(2012)¹⁸18. Benedetti TRB, Schwingel A, Gomez LSR, Chodzko-Zajko W. Programa "VAMOS" (Vida Ativa Melhorando a Saúde): da concepção aos primeiros resultados. Rev Bras Cineantropom Desempenho Hum 2012;14(6):723-37.	63.6	66.7	75.0	71.4	66.7	66.7	50.0
Bonganha et al.(2012)¹⁹19. Bonganha V, Modeneze DM, Madruga VA, Vilarta R. Effects of resistance training (RT) on body composition, muscle strength and quality of life (QoL) in post menopausal life. Arch Gerontol Geriatr 2012;54(2):361-5.	45.5	33.3	0	0	33.3	0	0
Burke et al.(2010)²⁰20. Burke TN, França FJ, Ferreira de Meneses SR, Cardoso VI, Marques AP. Postural Control in Elderly persons with osteoporosis: efficacy of an intervention program to improve balance and muscle strength: a randomized controlled trial. Am J Phys Med Rehabil 2010;89(7):549-56.	54.6	44.4	12.5	0	33.3	0	0
Canonici et al.(2012)²¹21. Canonici AP, Andrade LP, Gobbi S, Santos-Galduroz RF, Gobbi LT, Stella F. Functional dependence and caregiver burden in Alzheimer's disease: a controlled trial on the benefits of motor intervention. Psychogeriatrics 2012;12(3):186-92.	27.3	33.3	0	0	44.4	0	0
Caromano et al.(2006)²²22. Caromano FA, Ide MR, Kerbauy RR. Manutenção na prática de exercícios por idosos. Rev Dep Psicol UFF 2006;18(2):177-92.	27.3	33.3	0	0	0	100	0
Castro et al.(2007)²³23. Castro PC, Tahara N, Rebelatto JR, Driusso P, Aveiro MC, Oishi J. Influência da universidade aberta da terceira idade (UATI) e do programa de revitalização (REVT) sobre a qualidade de vida de adultos de meia-idade e idosos. Braz J Phys Ther 2007;11(6):461-7.	45.5	33.3	0	0	11.1	0	0
Cavalcante et al.(2011)²⁴24. Cavalcante CL, Gonçalves MC, Cavalcanti AL, Da Costa SF, Asciutti LS. Nutritional intervention program associated with physical activity: discourse of obese elderly women. Ciênc Saúde Coletiva 2011;16(5):2383-90.	45.5	55.6	0	0	22.2	0	0
De Araújo et al.(2013)²⁵25. De Araújo TB, De Oliveira RJ, Martins WR, De Moura Pereira M, Copetti F, Safons MP. Effects of hippotherapy on mobility, strength and balance in elderly. Arch Gerontol Geriatr 2013;56(3):478-81.	36.4	22.2	0	0	33.3	0	0
Fernandes et al.(2012)²⁶26. Fernandes AMBL, Ferreira JJA, Stolt LROG, De Brito GEG, Clementino ACCR, De Sousa NM. Efeitos da prática de exercício físico sobre o desempenho da marcha e da mobilidade funcional em idosos. Fisioter Mov 2012;25(4):821-30.	36.4	33.3	0	0	44.4	0	0
Ferreira et al.(2008)²⁷27. Ferreira SR, Gimeno SG, Hirai AT, Harima H, Matsumura L, Pittito BA. Effects of an intervention in eating habits and physical activity in Japanese-Brazilian women with a high prevalence of metabolic syndrome in Bauru, São Paulo State, Brazil. Cad Saúde Pública 2008;24(Supl 2):294-302.	81.8	44.4	12.5	14.3	22.2	66.7	0
Fonseca et al.(2012)²⁸28. Fonseca CC, Gama EF, Thurm BE, Pereira ES, Limongelli AMA, Miranda MLJ. Benefícios da estimulação perceptual corporal no esquema corporal de idosos. Rev Bras Geriatr Gerontol 2012;15(2):353-64.	63.6	33.3	0	0	0	0	0
Gobbi et al.(2009)²⁹29. Gobbi LT, Oliveira-Ferreira MD, Caetano MJ, Lirani-Silva E, Barbieri FA, Stella F, et al. Exercise programs improve mobility and balance in people with Parkinson's disease. Parkinsonism Relat Disord 2009;15(Suppl 3):49-52.	9.1	22.2	12.5	0	33.3	0	0
Hernandez et al.(2010)³⁰30. Hernandez SSS, Coelho FGM, Gobbi S, Stella F. Efeitos de um programa de atividade física nas funções cognitivas, equilíbrio e risco de quedas em idosos com demência de Alzheimer. Braz J Phys Ther 2010;14(1):68-74.	36.4	33.3	0	0	11.1	0	0
Ide et al.(2005)³¹31. Ide MR, Belini MA, Caromano FA. Effects of an aquatic versus non-aquatic respiratory exercise program on the respiratory muscle strength in healthy aged persons. Clinics 2005;60(2):151-8.	54.6	44.4	12.5	0	33.3	0	0
Lustosa et al.(2011)³²32. Lustosa LP, Silva JP, Coelho FM, Pereira DS, Parentoni AN, Pereira LS. Impact of resistance exercise program on functional capacity and muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial. Braz J Phys Ther 2011;15(4):318-24.	54.6	33.3	12.5	0	33.3	0	0
Lustosa et al.(2013)³³33. Lustosa LP, Máximo Pereira LS, Coelho FM, Pereira DS, Silva JP, Parentoni AN, et al. Impact of an Exercise Program on Muscular and Functional Performance and Plasma Levels. Arch Phys Med Rehabil 2013;94(4):660-6.	27.3	22.2	0	0	33.3	0	0
Machado et al.(2013)³⁴34. Machado CH, Do Carmo AS, Horta PM, Lopes ACS, Dos Santos LC. Efetividade de uma intervenção nutricional associada à prática de atividade física. Cad Saúde Pública 2013;21(2):148-53.	72.7	66.7	50.0	0	0	0	0
Nascimento et al.(2013)³⁵35. Nascimento CMC, Ayan C, Cancela JM, Pereira JR, De Andrade LP, Garuffi M, et al. Exercícios físicos generalizados capacidade funcional e sintomas depressivos em idosos brasileiros. Rev Bras Cineantropom Desempenho Hum 2013;15(4):486-97.	54.6	33.3	0	0	11.1	0	0
Raso et al.(2007)³⁶36. Raso V, Benard G, Silva Duarte AJS, Naale VM. Effect of resistance training on immunological parameters of healthy elderly women. Med Sci Sports Exerc 2007;39(12):2152-9.	45.5	33.3	0	0	33.3	0	0
Renno et al.(2005)³⁷37. Renno ACM, Granito RN, Driusso P, Costa D, Oishi J. Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: a pilot study. Physiotherapy 2005;91(2):113-8.	81.8	33.3	0	0	22.2	0	0
Sá et al.(2012)³⁸38. Sá AC, Bachion MM, Menezes RL. Physical exercises to prevent falls: a clinical trial with institutionalized elderly in the city of Goiânia in Brazil. Ciênc Saúde Coletiva 2012;17(8):2117-27.	54.6	44.4	12.5	28.6	33.3	0	0
Santana et al.(2012)³⁹39. Santana MG, De Lira CA, Passos GS, Santos CA, Silva AH, Yosjida CH, et al. Is the six-minute walk test appropriate for detecting changes in cardiorespiratory fitness in healthy elderly men? J Sci Med Sport 2012;15(3):259-65.	36.4	22.2	0	0	22.2	0	0
Stella et al.(2011)⁴⁰40. Stella F, Canonici AP, Gobbi S, Galduroz RF, Cação JC, Gobbi LT. Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial. Clinics 2011;66(8):1353-60.	36.4	44.4	0	0	33.3	33.3	0
Tanaka et al.(2009)⁴¹41. Tanaka K, Quadros AC Jr, Santos RF, Stella F, Gobbi LT, Gobbi S. Benefits of physical exercise on executive functions in older people with Parkinson's disease. Brain Cogn 2009;69(2):435-41.	36.4	33.3	0	14.3	44.4	0	0
Ueno et al.(2012)⁴²42. Ueno DT, Gobbi S, Teixeira CVL, Sebastião E, Prado AKG, Costa JLR, et al. Efeitos de três modalidades de atividade física na capacidade funcional de idosos. Rev Bras Educ Fís Esp 2012;26(2):273-81.	54.6	22.2	0	0	11.1	0	0
Vale et al.(2009)⁴³43. Vale RG, De Oliveira RD, Pernambuco CS, Meneses YP, Novaes JS, De Andrade AF. Effects of muscle strength and aerobic training on basal serum levels of IGF-1 and cortisol in elderly women. Arch Gerontol Geriatr 2009;49(3):343-7.	27.3	33.3	0	0	33.3	0	0
Total (%)	46.5	36.8	7.7	5.0	26.9	10.3	1.9

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[1] Correspondence Camila Fabiana Rossi Squarcini E-mail:csquarcini@gmail.com