Correlates of Physical Activity and Degree of Pain among Older Adults

Objective: To determine the degree of pain presented by the people selected in the present study and to establish a possible relation between this first variable with other socio-demographic ones (age, gender, civil status and occupation), as well as whether or not they practice physical activity, and if so, what type of activity; To check the relationship between the practice and type of physical activity, with the socio-demographic factors; age, gender, civil status and occupation. Methology: 564 participants, with an average age of 61.05 years and an age range between 40 and 88 years from the Sabah, Malaysia, was made by a sampling technique intended to provide a natural composition with a criterion of inclusion, that is to say, people aged 40 or older. Various measuring instruments were chosen (pain scale and questionnaire) to collect the variables selected. Results: The results indicated that 80.9% of the participants presented with a moderate degree of pain, the cervical area and knees being the structures most affected. On the other hand, 73.2% of the sample population habitually carried out physical and sporting tasks, with no differences according to gender, but showing differences according to age and occupation. The most common activities were walking (88.64%) and keep fit (25.65%). There was no correlation between physical activity and the degree of pain. Conclusion: The main conclusions highlight the need to create exercise and health protocols and programmes with a multidisciplinary approach, adapted to the individual needs of each person and the promotion of the construction of new, modern sporting facilities in rural areas so that people may enjoy better sporting opportunities.


Introduction
There is no one who would not grow old.Every being on the earth inevitably follows the cycle, determined by nature that takes him/her through variegated phases of childhood, adolescence, adulthood and maturity.Each stage has its own vigour, its set of responsibilities and its particular problems.Generally, with the advancement of age, the entire scenario undergoes a drastic change.The aging of the population and the lifestyle in the world encourage the development of new needs within the psychosocial context, bringing about what can be called a new "culture of longevity": special importance is given here to the improvement in the quality of life, that is to say, to live both longer and, above all, with better quality.All across Asia, the population in 65 age group will increase by 314 percent-from 207 million in 2000 to 857 million in 2050 (Future of Population in Asia, 2008).It is calculated that by the year 2020, 9.8 % of the Malaysian population will be more than 60 years old (Mohamed, 2000).This situation has strengthened the development of a new "grey market, that of the older person", many aspects of which are still unknown and, on occasions, this attitude can prejudice the adequate care and protection of our "older people" (Brewer et al., 1995;Carbonell, 1994;Cockerell, 1993).There is no doubt of the relationship that nowadays society establishes between old people and aging.Hernandez (2008) sets out three criteria to consider that a person is "old": chronological, social and physical.In turn these aspects can be influenced by a multitude of factors and variables.
When people age, they do so progressively little by little, due to several factors such as sex -for example, a woman has a greater predisposition to lose bony mass (Medina, 1997) people develop a series of physical limitations and mental deficits inherent in the aging process (Armadans et al., 1996).At the physical level, anatomical and physiological changes are produced, as for example the reduction in the transport of oxygen (McArdle, 2002), which makes daily activities more difficult.In this connection, Saltin (1990) speaks of the difficulties of getting up or sitting in a chair after the age of 50; by the eighties, it is sometimes practically impossible.Bassols et al. (1999) and Catala et al. (2002) both indicate that the presence of pain is very frequent in the older adult.
Since the 1980s special attention has been paid to concept of aging, exercise and quality of life.Among others, Hagberg et al. (2001) have commented on the similarity between the effect due to the passing of time and those resulting from a sedentary life.There are also many studies that show the influence of physical exercise (P.E) in people of retirement age; thus, Blair (1984) indicates that the effect of P.E. in old age is an important factor in the prevention of illnesses and the promotion of good health.Bruce (1984) also highlights the exceptional performances that sportspersons of middle and advanced age can achieve, and Costil et al. (1998), Gutierrez et al. (1997) and Zurita et al. (2008) confirmed the positive effect of the practice of long-term, regular physical activity on the adequate functioning of the body's physical and physiological processes.
In addition, the influence of exercise in the prevention of chronic illnesses must not be forgotten (Lamb, 1985;Herr et al., 2001).
Based on this, we have proposed a series of aims to be considered in this research:  To determine the degree of pain presented by the people selected in the present study and to establish a possible relation between this first variable with other socio-demographic ones (age, gender, civil status and occupation), as well as whether or not they practise physical activity, and if so, what type of activity.
 To check the relationship between the practice and type of physical activity, with the socio-demographic factors; age, gender, civil status and occupation.

Design
A quantitative descriptive and transversal design

Participants
Relevant variables obtained from a sample of 564 people with an average age of 61.05 years (ranging between 40 and 88 years), from city, towns and villages in the Sabah, Malaysia.Subsequently a correlation study was developed to analyse the degree of dependence between the different variables of the study.

Variables
The participants were selected using techniques of stratification, proportionality and randomness in the following variables:  Age Groups.

Instruments
The variables of this study were recorded by two evaluation instruments:  Modified questionnaire used by Gonzalez et al. (2008) and Jimenez-Beatty et al. (2003).Apart from the variable of habitability, this questionnaire recorded the socio-demographic variables described in that section later in this article  EVA scale; this is a Likert type of scale with numbers from 1 (minimum pain) to 10 (intense pain), which registered the intensity of pain experienced by each participant (Castel et al., 2007;Fernandez et al., 2008).Furthermore, when the person indicated some type of pain, we suggested that the specific part of the body where that pain was felt should be noted down.

Procedure
The population used in this research was taken from city, towns and villages in the Sabah, Malaysia.The urban and rural characteristics were studied; through the selection of these latter variables a personal interview was arranged with the respondent.
We explained the whole procedure to follow in a letter-request asking for the collaboration of people interested.The definitive selection was made by consecutive sampling, following the natural composition and with a criterion of inclusion, namely, to be 40 years or older.

Results
Of the 564 people analyzed, 9.2% (n=52) were men and 90.8 % (n=512) were women.The sample was divided into five age groups, each of 10 natural years, observing proportional heterogeneity among the various groups.
The occupations of the sample are set out in figure 2, of the five groups, number 2, retired people and pensioners, is the biggest (48.8%) and the smallest that of the students; 0.2% (n=1).
The breakdown of the civil status of the sample showed that 71.3% (n=399) of the participants were married or living with a partner, 19.3% were widows or widowers, 6.4% were single and 3% (n=17) were separated.Of the total of people analyzed, 456 referred to pain in some part of the body (80,9%) at that time, while the rest, that is to say, 108 people (19,1%) claimed to be pain-free.The results obtained in relation to the scale of pain are set out in table 1.
Highlighting here the most representative data, 36.6% (n=167) of the individuals had moderate pain and 15.6% (n=71) very intense pain, table 2. It should be mentioned that the strongest pain was felt in the lumbar area (n=170; 30.64%), followed by the cervical zone and the knees (n=126; 22.34% and n=119; 21.09% respectively).On the other hand, forearms and thighs were the areas where fewest people experienced it with 3(0.53%) and 12 (2.12%)participants respectively.
The results showed that 73.2% (n=413) of the people surveyed habitually took some form of P. E. with only 26.8% (n=151) not doing so.By gender, the numbers obtained in relation to this variable are fairly similar; women 73.4% (n=376) and men 71.2% (n=37).The statistically significant differences found between the variable for the level of physical activity and the age group 60-69 years should be noted (p= 0.002).
The fact that walking (88.6%; n=366) and keep fit (25.65%; n=106) were the most frequently indicated activities should be taken into account.Both activities, in numerous cases, were found to be related to the practice of other exercises (table 3).Only 9 people, 2.17% of the total, did any exercise distinct from those already mentioned.The correlation analysis showed that the results obtained indicate that there are no significant differences between the degree of pain and the variables of civil status and occupation (p=0.308 and p=0.222) (figure 3&4).
Moreover, both the individual's civil status and occupation yielded no significant differences in relation to the variable of the type of physical activity undertaken (p=0.449 and p=0.066) (figure 5&6).Gender was also not significant in the latter variable (p=0.0080).However, differences were found in the variable for age group and type of physical activity (p=0.000),fundamentally due to the large number of participants who based their PA on walking.It should be pointed out that, with rare exceptions, when dealing with the older age ranges, the participants did not usually carry out any other type of PA distinct from those referred to, except in the case of walking (figure 7).
When examining the relation between occupation and type of physical activity, in all occupations (with the exception of the student), walking becomes the most common type of activity with values higher than 66% in all cases; statistically we found no significant differences between the distinct activities and occupation groups (p=0.232)(figure 8).

Discussion
In the first place, looking at the variable of degree of pain, 80.9% (n=456) of the participants stated that they suffered moderate pain.The data in this study agree with the findings of Bassols et al. (1999) and Catala et al. (2002) in a study with patients aged over 65.In this sense, other authors such as Weiner et al. (1999) and Herr et al. (2004) equally found a prevalence of moderate pain close to 80%, and intense pain in some 20% of the cases.However, Gibson et al. (2001) indicated that in their research half of the participants suffered intense pain, while Miro et al. (2007) confirmed that in a population of older people 94.2% suffered chronic pain.All these data indicate the high prevalence of moderate and intense pain in old people, which has negative repercussions in carrying out the normal activities basic to daily life.It is interesting to note that the areas of the body where the participants refer with greatest frequency to intense pain are the cervical column and the knee joint.Authors like Robaina (1998) and Torreblanca et al. (2002) indicated that both structures usually present more degenerative problems than other areas of the body, which may explain this finding.The presence of pain does not show significant differences in socio-demographic variables (p= 0.371 in gender and age, p=0.222 in occupation and p=0.308 in civil status).It should be mentioned that the data obtained in this study do not agree with those given by Crook et al. (1984), Brattberg et al. (1989) and Bassols et al. (1999) when they claim that the prevalence of pain increases with age, above all in women.In any event, the fact that our study did not include a sufficient number of men has to be taken into account, and this situation has not enabled conclusive results to be drawn when comparing both genders.Dealing with the variable of physical activity, only 26.8% of the participants took no continuous physical or sporting exercise, as against 73.2% who did so regularly.Navas et al. (2006) obtained an even higher prevalence and Croft et al. (1999) found that 95% of their participants systematically undertook physical activity.On the other hand, Armadans et al. (1996) stated that only 50% of their participants practiced P.E.One of the reasons that people give as a main reason for not practising physical activity was that they were not accustomed to it.With respect to this fact, Gonzalez et al. (2008) commented that the lack of sporting tradition in rural areas was often caused by the lack of sufficient and adequate sporting facilities, the lack of sporting habits and social, working and organic factors (Alexandris et al., 2003;Wang et al., 1997).Similar values for the socio-demographic and physical practice variables were obtained for both men and women (73.4% and 71.2% respectively).The similarity of these results may be consistent with the contribution of Martinez et al. (2009) when he states that, although in the first stages of the lifecycle, males enjoy sporting practice more than women, on reaching old age there are a significant number of women (more than men) who incorporate weekly physical activity into their lifestyle.It may be said that in this sense that as they get older women adopt a more "sporting culture" in their lives (Puig et al., 2004).
Another aspect to consider in relation with physical activity is the significance found in the variable of age group (p=0.002),specifically in the 40-49 year age range, where 40.3% of people practise no P.E.These data may result from the possible influence of working in the mornings, with the limitations of space and time restricted timetables, in the regular practice of PA.This idea, however, does not accord with the findings of Jimenez-Beatty et al. and Graupera et al. who observed greater indices of P.E. in morning hours.
Another aspect to consider in relation with physical activity is the significance found in the variable of age group (p=0.002),specifically in the 40-49 year age range, where 40.3% of people practise no P.E.These data may result from the possible influence of working in the mornings, with the limitations of space and time -restricted timetables - (Martinez et al., 2009), in the regular practice of PA.This idea, however, does not accord with the findings of Jiménez-Beatty et al. (2003) and Graupera et al. (2003) who observed greater indices of P.E. in morning hours.
Equally, no significance was found between civil status and occupation in relation to physical activity (p=0,449 y p=0,066).The retired, the unemployed and housewives had the highest values, over 71%, for taking exercise (the group of students is not mentioned as there was only one representative), fundamentally due to their having more free time available, so coinciding with what Jimenez-Beatty et al. (2007) had said previously.Among the 413 participants who routinely took physical activity, walking was the most practised activity, both alone and combined with another type.88.64% of the participants analysed did this type of PA (above all, people in the 80-89 year-old age range -90%-); this figure is higher than that given by Molero et al. (2002) and Valero et al. (2007).This suggests that the practice of walking makes it possible to carry out a non-aggressive, aerobic type of exercise, with social benefits, where the participants choose the time and place for doing it (Wang, 1997).Here Almeria's excellent climate is also a factor that encourages and predisposes people to practise open air activities.Looking at the variable of keep fit, we found it is practised by 25.65% of the population as an exercise by itself or in combination with others (18.63%), agreeing with the findings of Garcia (2006).One of the reasons why the people in this study practised this sport (notably housewives with 32.6%), may be due, among other things, to its enjoyable character and previous medical advice ( Barnett et al., 2009).This type of activity may delay the natural degenerative processes of the organism (Wark, 1996;Delgado et al., 2009).When considering the variables of the degree of pain and the type of physical activity there are very significant statistical differences (p=0,019).Thus, of the 456 individuals who referred to distinct forms of pain, only 29.16% (n=133) undertook no physical activity, while of those who claimed to have no pain (n=108), 16.66% (n=18) admitted doing no P.A; these data show the lack of any connection between pain and the practice of P.A, since both groups (those who referred to pain and those who did not) there were similar percentages for the practice of physical activity; however, we found the lack of this association is determined by the high number of participants who chose walking as against other physical-sporting activities.

Conclusions 
80.9% of the target population studied suffered from generalized pain, with the knees and the cervical zone being the most affected structures.Therefore, it seems evident that it is necessary to design programmes of physical exercise with positive and efficient effects on health, adapted to each individual, to lessen the painful symptoms associated with old age. 73.2% of the population carries out physical-sporting activities, above all walking.This significant datum highlights the need and the interest in the creation of new sporting infrastructures that promote other physical activities; the information obtained indicates that walking is probably not an adequate activity for all participants.


The lack of a relationship between the degree of pain and the level of physical activity must be emphasized.This datum confirms even more the need to adapt the type and form of exercise to the individual needs of each person.Furthermore, it should be understood that the degree of pain is a variable that is not totally determined by whether or not a person practises P.E.In this case, in relation to the previous conclusions, we would stress the importance of the development of protocols and action programmes with a multidisciplinary and holistic perspective.

Figure 2 .
Figure 2. Occupation of the sample

Table 1 .
Degree of pain according to gender and age (p=0.371).

Table 2 .
Distribution of the degree of pain in the population

Table 3 .
Distribution of the variable of level of physical activity in relation to age range.(p=0.002) Figure 1.Percentage of participants by age range