Motricidade © Edições Desafio Singular

2017, vol. 13, n. S1, pp. 31-41 CIAFIS 2017

Factors associated with lower limb strength and agility in the

elderly
Josiene de Oliveira Couto1, Izabella Cristina da Silva Santos1, Andressa Melo Alves1, Nara
Michelle Moura Soares2, Gilberto Santos Morais Júnior1, Danilo Barbosa Morais1, Roberto
Jerônimo dos Santos Silva1*
ARTIGO ORIGINAL | ORIGINAL ARTICLE

ABSTRACT
This study aims to verify the factors associated with strength and agility in the elderly. The sample consisted
of 224 elderly individuals aged 70.59 ± 6.3 years. The socioeconomic level and physical activity level were
observed from previously validated instruments. Anthropometric indexes were calculated and lower limb
strength and agility tests were applied. Binary Logistic Regression with robust estimator was used, with
significance level of 5%. It was verified that the factors that were associated to the best agility performance
were: age (OR = 6.3, 95% CI = 2.6-15.25), educational level (OR = 0.34, 95% CI = 0.15-0.76) and physical
activity level (OR = 2.86, 95% CI = 1.32-6.16). However, for the best lower limb strength performance,
the associated factors were reported physical limitation (OR = 0.41, 95% CI = 0.20 - 0.82) and physical
activity level (OR = 0.43, 95% CI = 0.21-0.86). It was concluded that younger elderly individuals, with
higher educational level and physically active perform well in the neuromotor agility variable. However,
elderly individuals with reported physical limitation and with low physical activity levels presented good
lower limb strength performance.
Keywords: Aging, Functional Fitness, Neuromotor Fitness

INTRODUCTION the health of the elderly population (Vasconcelos

Globally, there is a projection that the elderly
population segment will more than triple by
2100, increasing from 901 million in 2015 to 3.1
billion by 2100 (DESA, 2015). In Brazil it will not
be different, and official data have pointed out
that this is the fastest growing segment of the
population, with a 4% increase per year between
2012 and 2022, and that there should be an
increase of over 50 million of the population over
60 years in the period from 2000 to 2060 (Borges,
Campos & Silva, 2015).
The increasing aging of the population is
directly related to the demographic transition,
which is characterized by a decrease in the birth
rate and increase in life expectancy, which has
created new challenges for government agencies,
especially by changing the age pyramid and the
need for the development of policies to improve
& Gomes, 2012).
This change of the age pyramid has given rise
to wide debates related to variables that condition
the lifestyle of the Brazilian elderly population,
since with the advancement of age, a reduction in
the physical activity levels of this population has
been observed, leading to a consequent decrease
of physical fitness (Closs & Schwanke, 2012;
Farinatti, 2016).
From the health intervention point of view,
the concern to preserve and increase physical
fitness of elderly individuals is of fundamental
importance for their insertion and maintenance
in society, mainly due to the clear perception that
the reduction of the main determinants of
functional fitness such as strength, agility and
flexibility, will lead to limitations on the
functionality of their activities of the daily living
(Jacob Filho, 2006).

1
Federal University of Sergipe, São Cristóvão, Brazil
2
Tiradentes University, Aracaju, Brazil
* Corresponding author: Núcleo de Pesquisa em Aptidão Física, Saúde e Desempenho de Sergipe-NUPAFISE,
Departamento de Educação Física, Universidade Federal de Sergipe, Campus Universitário Prof. José Aloísio de
Campos – Av. Mal. Rondon s/n. Bairro Jd. Rosa Elze. CEP: 49100-000. São Cristóvão/SE, Brasil. Email:
rjeronimoss@ufs.br
32 | JO Couto, ICS Santos, AM Alves, NMM Soares, GS Morais Junior, DB Morais, RJS Silva
Elderly people with a high decline in lower
limb strength are more prone to falls, and may
have as a consequence fractures, disability and
even death (Cho, Bok, Kim, & Hwang, 2012;
Santos & Griep, 2013). In addition, agility is a
component that is linked to a better efficiency in
the performance of daily activities. The decline of
these determinants will cause a compromise of
functionality in the activities of the daily living
(Ferreira & Gobbi, 2003).
Therefore, reduction of strength and agility
leads to decreased ability to perform activities of
the daily living, loss of autonomy, dependence
and decline in the quality of life of this population
(Milanović et al., 2013).
Thus, assessing the strength and agility levels
in the elderly is of fundamental importance in
view that this information can serve as a tool to
characterize the profile of elderly individuals, to
promote actions in public health aimed at
preventing, remedying or mitigating associated
factors aiming at maintaining the autonomy of
elderly individuals (Campos, Almeida, Campos,
& Bogutchi, 2016).
In view of the above, the aim of this study was
to analyze the factors associated with the strength
and agility variables in elderly individuals in the
Municipality of Cedro de São João - SE.
METHOD
This is a descriptive research with cross-
sectional design. According to Thomas and
Nelson (2002), the descriptive research has the
objective of describing the set of information
presented by the sample, and the cross-sectional
design is characterized by the collection of data in
a single moment.
Participants
The population was composed of elderly
individuals aged 60-93 years, living in the
municipality of Cedro de São João - SE and
registered in the Unified Health System of the
municipality. The sampling process was carried
out from the periodic visits made to the homes of
individuals by Community Health Agents, who
invited them to voluntarily participate in the
study. Associated with these visits, there were
meetings in the Basic Health Units of the
municipality in order to invite elderly individuals
to participate in the study.
The sample consisted of 233 elderly people
enrolled in the municipal and federal coverage
system, HIPERDIA, a program whose objective is
the follow - up of people with hypertension and /
or diabetes mellitus treated in the outpatient
network of the Unified Health System - SUS.
For the sample selection, the inclusion criteria
were: to be registered in the Basic Attention
Information System - SIAB and to be 60 years or
older. As exclusion criteria, the presence of
physical or mental weakness, which impaired
answering the questionnaires applied or that
made physical tests impossible, as well as those
with questionnaires that did not answer
important questions such as gender, age and
those who did not fill 50% of questionnaires.
Instruments
The instrument used for data collection was
compiled from three validated questionnaires
added of sample characterization information to
estimate anthropometric indexes (AI) and the
tests that estimated strength and agility were
applied according to the Functional Fitness Test -
FFT (Rikli & Jones, 1999), as in table 1.
Procedures
Before data collection, Community Health
Agents of the municipality were trained for
familiarization and clarification regarding the
application of questionnaires and tests.
Data collection took place in two stages. The
first was individually performed at the residence
of individuals to explain the research objectives,
being asked to sign the Free and Informed
Consent Form, according to the Declaration of
Helsinky (World, 1964) and Brazilian
Legislation. Following, questions of individual
and socio demographic characterization were
applied in the form of interviews, the
socioeconomic questionnaire and physical
activity level. At that moment, a schedule was
made for the next stage.

In the second stage, physical evaluation was
performed in the following sequence: height,
body mass, abdomen and hip circumference, and
later the sitting and standing and raising and
walking tests were applied.
The research was approved by the Research
Ethics Committee of the Federal University of
Sergipe, under the approval number CAAE-
0213.0.107.000-11.
Statistical analysis
Descriptive analysis, Wald chi-square and
confidence interval (95% CI) were used to
interpret data. Binary logistic regression model
was developed from the identification of variables
that in a bivariate analysis obtained p<0.20.
These variables were grouped in an adjusted
model, favoring the identification of explanations
regarding the outcome. Whenever necessary, for
a better understanding of results, the inverse
odds ratio (1 / OR) was used to try to explain
associations, mainly due to the easy
understanding of this measure. Throughout the
analysis, significance level of p ≤ 0.05 was
considered. The statistical treatment was
performed in the SPSS software version 23.
RESULTS
A total of 233 participants were interviewed;
nine were excluded, two of them being <60 years
old and seven due to incomplete questionnaires,
and the sample was composed of 224 subjects.
The sample consisted of elderly men and
women, 66.5% women aged ≤ 70 (52%),
Neuromotor Variables in the Elderly | 33
presenting low socioeconomic level (47.1%) and
low educational level (68.3%) (Table 2).
Table 3 shows that for the multivariate
analysis, younger elderly individuals were five
times as likely of having good agility in relation
to the older ones. Regarding the educational
level, for a better understanding, the analysis of
the inverse odds ratio (1 / OR) was used, thus, it
was verified that individuals with higher
educational level were twice likely to have good
agility when compared to less educated elderly
subjects.
Table 3 also shows that regarding physical
activity level, it was observed that active
individuals were almost three times as likely of
having good agility.
Analyzing Table 4 and the inverse odds ratios,
it could be observed that individuals who
reported having physical limitation are two and a
half times as likely to present low strength levels
compared to those who did not report physical
limitation. Accordingly, it was found that elderly
individuals with low physical activity levels were
twice as likely to have better lower limb strength
levels.
When the adjusted model was observed, it
was verified that the significant variables
presented some variations in the odds, but the
condition verified in the univariate model was
confirmed, in which younger subjects with high
educational level and physically active are more
likely to have good agility and those who reported
physical limitation and who have low physical
activity levels presented better strength levels.
34 | JO Couto, ICS Santos, AM Alves, NMM Soares, GS Morais Junior, DB Morais, RJS Silva

Table 1
Analytical matrix for characterization and categorization of variables used in the study.
Variable Cutoff point Characterization
≤ 70 The median age distribution was used to categorize
Age group
>70 this variable.
High Socioeconomic level was assessed using the CCEB
Intermediate questionnaire, from the sum of the points obtained,
Socioeconomic
participants were classified into the following
level
Low socioeconomic levels: High (A1, A2, B1, B2),
Intermediate (C1, C2) and Low (D, E).
≤ 4 years It was dichotomized using the item educational
level of the CCEB questionnaire. Being considered
Educational level
> 4 years up to 4 years (item 1) and more than 4 years (items
2, 3, 4 and 5).
Normal weight/low It was dichotomized using as cutoff point: normal
BMI weight weight (≤ 24.9 ... kg / m2) and overweight (> 25
Overweight/high risk kg / m2).
Low risk It was dichotomized considering low risk women
with AC <80 cm and men with AC <94 and with
AC
High risk high risk women with AC> 80 cm and men with
AC> 94 cm.
Low risk It was dichotomized with cutoff point of WtHR ≥
WtHR
High risk 0.80 cm for women and ≥ 0.95 cm for men.
Reported Yes
Do you have any physical or motor limitations that
physical
No prevent you from developing your daily activities?
limitation
Yes Do you smoke or have smoked regularly? If so, how
Smoking
No long?
Yes Did you make or use alcohol regularly? If so, how
Alcohol
No long?
Active It was dichotomized considering active "active and
PAL very active" and low levels "insufficiently active and
LPAL
sedentary"
Good The distribution median was used to categorize this
Sitting and
variable because there is no classification by criteria
standing Poor
that classifies these variables in Brazil.
Good The distribution median was used to categorize this
Raising and
variable because there is no classification by criteria
walking Poor
that classifies these variables in Brazil.
BMI = Body mass index; AC = Abdomen circumference; WtHR = Waist / hip ratio; PAL = Physical activity level; LPAL = Low
physical activity level; CCEB = Economic Classification Criteria Brazil.
 Neuromotor Variables in the Elderly | 35
Table 2
Characteristics of the elderly population living in the municipality of Cedro de São João SE.
Variable n % IC95%
224 100
Sex
Female 149 66,5
0,27 - 0,39
Male 75 33,5
Age group
≤ 70 116 52
0,41 - 0,54
>70 107 48
Socioeconomic level
High 15 6,7
Intermediate 103 46,2 0,41 - 0,54
Low 105 47,1
Educational level
≤ 4 years 153 68,3
0,25 - 0,37
> 4 years 71 31,7
BMI
Normal weight 45 22,4
0,71 - 0,83
Overweight 156 77,6
AC
Low risk 54 26,9
0,66 - 0,79
High risk 147 73,1
WtHR
Low risk 13 6,5 0,90 - 0,96
High risk 188 93,5
Reported physical limitation
Yes 94 42 0,35 - 0,48
No 130 58
Smoking
Yes 48 21,4 0,16 - 0,26
No 176 78,6
Alcohol
Yes 27 12,1 0,07 - 0,16
No 197 87,9
PAL
Active 122 54,5 0,38 - 0,52
LPAL 102 45,5
Sitting and standing
Good 74 47,7 0,39 - 0,55
Poor 81 52,3
Raising and walking
Good 94 61,4 0,53 - 0,69
Poor 59 38,6
BMI = Body mass index; AC = Abdomen circumference; WtHR = Waist / hip ratio; PAL = Physical activity level; LPAL = Low
physical activity level.
36 | JO Couto, ICS Santos, AM Alves, NMM Soares, GS Morais Junior, DB Morais, RJS Silva
Table 3
Gross and adjusted Odds Ratio (OR) for association between independent variables and better agility performance
in the elderly.
Odds ratio
Gross Adjusted
Variables Categories
p≤0.05 p≤0.05
OR IC95% OR IC95%
Sociodemographic
Female 0,45 0,22 - 0,90 0,42 0,15 - 1,19
Sex 0,26 0,104
Male 1 1
≤ 70 5,4 2,53 - 11,51 6,3 2,6 - 15,25
Age group <0,001 <0,001
>70 1 1
High 0,59 0,17 - 2,06
Socioeconomic
Intermediate 0,92 0,47 - 1,79 0,468
level
Low 1
≤ 4 years 0,42 0,21 - 0,83 0,34 0,15 - 0,76
Educational level 0,013 0,009
> 4 years 1 1
Anthropometric
Normal weight 1,22 0,54 - 2,72
BMI 0,628
Overweight 1
Low risk 2,05 0,97 - 4,36 1,56 0,57 - 4,25
AC 0,6 0,379
Risk 1 1
Low risk 0,97 0,22 - 4,22
WtHR 0,969
Risk 1
Behavioral
No 1,86 0,91 - 3,77 1,76 0,73 - 4,22
Physical limitation 0,085 0,204
Yes 1 1
Alcoholic No 0,72 0,27 - 1,86
0,5
beverages Yes 1
No 0,59 0,26 - 1,35
Tobacco 0,215
Yes 1
Physical activity Active 2,86 1,40 - 5,85 2,86 1,32 - 6,16
0,004 0,007
level Low level 1 1
BMI= Body mass index; AC= Abdomen circumference; WtHR = Waist / hip ratio.
 Neuromotor Variables in the Elderly | 37
Table 4
Gross and adjusted Odds Ratio (OR) for association between independent variables and better performance of lower limb strength
in the elderly.
Odds ratio
Gross Adjusted
Variables Categories p≤0.05 p≤0.05
OR IC95% OR IC95%
Sociodemographic
Female 0,77 0,39 - 1,52
Sex 0,456
Male 1
≤ 70 0,57 0,30 - 1,09 0,70 0,35 - 1,40
Age group 0,09 0,316
>70 1 1
High 0,59 0,17 - 2,06
Socioeconomic
Intermediate 0,92 0,47 - 1,79 0,498
level
Low 1
≤ 4 years 1,65 0,85 - 3,18 1,65 0,82 - 3,30
Educational level 0,135 0,156
> 4 years 1 1
Anthropometric
Normal weight 1,11 0,50 - 2,46
BMI 0,78
Overweight 1
Low risk 1,15 0,55 - 2,40
AC 0,705
Risk 1
Low risk 2,84 0,55 - 14,53
WtHR 0,21
Risk 1
Behavioral
No 0,39 0,20 - 0,78 0,41 0,20 - 0,82
Physical limitation 0,008 0,012
Yes 1 1
Alcoholic No 0,89 0,34 - 2,30
0,818
beverages Yes 1
No 1,04 0,46 - 2,34
Tobacco 0,917
Yes 1
Physical activity Active 0,44 0,23 - 0,86 0,43 0,21 - 0,86
0,017 0,017
level Low level 1 1
BMI= Body mass index; AC= Abdomen Circumference; WtHR= Waist/hip ratio.

DISCUSSION that the best performance in agility is identified

As main results, the multivariate analysis in groups of elderly people classified as "younger"
showed that there was an association between (Nunes & Santos, 2009; Maciel, Quaresma,
age group, educational level and physical activity Barbosa, & Souza, 2015). These findings can be
level with good performance of elderly subjects in explained by the fact that, with advancing age,
the neuromotor agility variable. Regarding the there is a reduction in physical fitness levels and
good performance of lower limb strength, there neuromotor capacity (Mendonca, Pezarat-
was an association between reported physical Correia, Vaz, Silva, & Heffernan, 2016).
limitation and physical activity level.
Younger elderly individuals (≤ 70) were five
times as likely to perform well in the agility
variable. Studies aimed at agility using the same
test used by the present survey have concluded
38 | JO Couto, ICS Santos, AM Alves, NMM Soares, GS Morais Junior, DB Morais, RJS Silva
The inverse odds ratio indicated that older
adults with higher educational level were twice as
likely to have better performance in the
neuromotor agility variable. Studies that have
evaluated performance in daily life activities that
require agility have found that the best
performance in these activities was observed in
groups of older adults with higher educational
level (Rosa, Benício, Latorre, & Ramos, 2003;
Assis et al.., 2014).
As for the anthropometric indexes, no
association was found with neuromotor
variables. In this perspective, Roncato, Galarza,
Freire, Tiggemann, & Dias (2014) evaluated the
relationship between body composition, lower
limb strength and functional capacity using
anthropometric indexes and functional tests, and
verified no association between lower limb
strength and BMI.
On the other hand, a study by Gonçalves,
Guimarães, Souza, Ferreira, & Mainenti (2015)
that aimed to analyze the relationship between
body composition and functional autonomy in
the elderly, using another instrument of
evaluation, electrical bioimpedance, found a
correlation between higher body adiposity level
decrease in functional capacity.
The findings of the present study identified
that the body composition itself has no
association with neuromotor variables in the
elderly, but it is noteworthy that metabolic
disorders are associated with high body adiposity
levels and the onset of chronic non-
communicable diseases, and can interfere in the
neuromotor fitness in the elderly (Freitas et al.,
2012; da Silva, Barros, da Silva, & Ferreira, 2014).
Regarding the reported physical limitation,
elderly subjects who reported this condition were
twice as likely to have good strength levels.
However, studies that have verified lower limb
strength using the same instrument applied in
this research, found that the best performance in
lower limb strength levels was in the group of
elderly people who did not report physical
limitation or history of falls (Cho, Bok , Kim, &
Hwang, 2012; Santos et al., 2013).
Due to the reported physical limitation, the
results may have been influenced, since low
strength levels are associated with physical
limitation and consequent episodes of falls
(Streit, Mazo, Virtuoso, Menezes, & Gonçalves,
2012).
In the findings of the present study, there was
no association between use of alcoholic
beverages, cigarette and strength and agility
variables. Accordingly, in the study by Virtuoso-
Júnior, Tribess, Menezes, Meneguci, & Sasaki,
(2016) aimed to analyze the association between
behavioral and sociodemographic aspects related
to health and functional disability in elderly
people from different regions of Brazil found no
association between the use of cigarettes and
alcoholic beverages with functional disability.
Regarding the physical activity level, active
individuals had better performance in the agility
test; however, in the strength test, they presented
worse performance. In this sense, the study by
Ono, Schneider, Confortin, & d'Orsi, (2015) that
evaluated the prevalence and relationship
between functional deficiency and health-related
aspects in the elderly identified that being
physically active in leisure reduces the likelihood
of presenting some functional deficiency.
However, in the study by Ferreira, Ferreira, &
Escobar, (2015) who investigated the prevalence
and factors associated with impairment and
functional capacity found no association between
physical activity level and functional capacity.
It is noteworthy that even with this
contradiction in the outcomes, it is known that
physical activity helps maintaining muscle
strength, agility and intrinsic factors that are
linked to the preservation of neuromotor fitness
(World Health Organization [WHO], 2010).
The inverse odds ratio indicated that older
adults with higher educational level are twice as
likely to have better performance in the
neuromotor agility variable. Studies that have
evaluated performance in daily life activities that
require agility have found that the best
performance in these activities is perceived in
groups of individuals with higher educational

level (Rosa, Benício, Latorre, & Ramos, 2003;
Assis et al., 2014).
CONCLUSIONS
This study showed that younger elderly
individuals with higher educational level and
active have better performance in the neuromotor
agility variable. However, individuals who
reported physical limitation and low physical
activity levels presented higher lower limb
strength levels.
These findings highlight the importance of
community programs that encourage the practice
of physical exercise by the population studied,
considering that high physical activity levels are
presented as a protection and remediation factor
for the maintenance of functional capacity in the
elderly.
Acknowledgments:
Foundation for Research and Innovation Support of
Sergipe - FAPITEC; Institutional Program for Scientific
Initiation Scholarships - PIBIC / CNPq / UFS, PPSUS /
CNPq / FAPITEC
Conflict of interests:
Nothing to declare.
Funding:
PIBIC/CNPq/UFS and
PIBIC/PPSUS/FAPITEC/Sergipe
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