IJCS | Volume 32, Nº6, November / December 2019

558 Figure 3 - Visual analogue scale scores before and after 12 weeks of walking training. EVA: visual analogue scale; TG: training group; CG: control group; p = 0.006* (Student’s t-test). Pre-training Post-training TG CG Discussion The main findings of the present study indicate that a moderate intensity, 12-week walking training reduces depressive symptoms and physical pain in elderly individuals. Interestingly, improvements seen occurred despite no change in QOL or aerobic fitness. Besides, Pearson correlation showed a significant association between depressive symptoms and pain score in TG. Data of the present study are in agreement with the literature, since there is considerable evidence showing that different types of training can reduce depressive symptoms in patients with and without depression. 32 Nevertheless, it is of note that only some studies evaluated the effect of walking training on depressive symptoms of non-depressive patients. In fact, similarly to our study, in the study by Pereira et al. 21 elderly patients underwent a moderate-intensity (65-80% of MaxHR) walking training, carried out three days a week for 10 weeks. According to the authors, participants showed a significant reduction in depressive symptoms after exercise, Branco et al. 19 reported a 37.5% reduction in depressive symptoms in elderly individuals undergoing a long-term training period (6 months). In another scenario, different from the data mentioned above, our study included physical pain as an outcome that could be associated with changes in depressive symptoms. In fact, this hypothesis is supported by many authors that indicated a strong association of physical pain with depressive symptoms, mainly in the context of chronic diseases (e.g., cancer). 20,33,34 Our results showed that GDS and VAS scores were moderately correlated (r = 0.30), suggesting a relationship between effects of aerobic exercise on depressive symptoms and alleviation of symptoms, i.e., a probable analgesic effect of the trainings, leading to pain reduction in elderly individuals. 20,33,34 It is worth mentioning that there is little evidence on the impact of physical training on depressive symptoms by pain alleviation, and most studies on the topic have been based on cross-sectional data and physical activity level. Sabiston et al., 34 for example, observed that physical pain was positively associated with depressive symptoms, and that higher levels of exercise had an inhibitory effect on this association in elderly breast cancer patients. Regarding the exercise protocol used in this study, volunteers of the study by Pennix et al., 20 showed a reduction in physical pain and depressive symptoms after a moderate-intensity walking training. This corroborates our findings showing a significant hypoalgesia in response to walking training, since we observed a 35% reduction in overall pain in our volunteers. These results Alabarse et al. Depression and pain in healthy active elderly Int J Cardiovasc Sci. 2019;32(6):553-562 Original Article