IJCS | Volume 32, Nº6, November / December 2019

554 executive functions. 8,9 Besides, physical exercise can also act as a non-pharmacological treatment for chronic degenerative conditions, such as hypertension, diabetes mellitus and osteroporosis. 11 Moderate-intensity aerobic exercise has been widely recommended for the elderly, due to considerable evidence suggesting it as a safe approach, able to control cardiovascular risks. 12,13 This is reinforced by the American College of Sports and Medicine (ACSM), which states that walking training can have these effects in elderly individuals, and should easily be included as part of their usual daily activities. 14,15 Walking training has beneficial psychological and physical effects. 16-18 Studies have reported improvement in the QOL, depressive symptoms and physical pain in elderly subjects undergoing moderate-intensity aerobic exercise protocols. 19-22 However, few studies have controlled baseline characteristics of volunteers, especially for QOL, pain and depressive symptoms. The present study aimed to investigate the effects of moderate intensity walking training on depressive symptoms and physical pain in elderly individuals with a good quality of life. Methods Study design and ethical aspects This is a prospective longitudinal study aiming at investigating the effects of a 12-week exercise program including moderate-intensity walking on depressive symptoms and physical pain in elderly individuals with a good quality of life. All volunteers were instructed about the study and then signed the consent form. The study was approved and conducted according to the Ethics Committee of the University of Sao Paulo ethical standards (approval number 0562/11) and performed according to the Brazilian National Health Council resolution (196/96). Patients All patientswere recruited froman elderlyCommunity Center in São Paulo, Brazil. Inclusion criteria were: a) medical clearance from the assistant physician for participation in the study; b) age > 60 years; c) > 150 minutes per week of physical activity according to the International Physical Activity Questionnaire (IPAQ) recommendations; 23 d) a score between 1 and 7 in the Lequesne algofunctional index for hip and knee osteoarthritis, 24 and scores ≥ 40 in the World Health Organization Quality of Life (WHOQOL)-BREF and WHOQOL-OLD questionnaires. Exclusion criteria were absence of one or more evaluations, hormone replacement and/or psychotropic drugs, cardiovascular disease (acute myocardial infarction, stroke, peripheral artery disease and transient ischemic attack), metabolic diseases (type 1 or type 2 diabetes mellitus), pulmonary diseases (emphysema), psychiatric or neurologic diseases (Alzheimer’s or Parkinson’s disease), muscular disorders, skeletal disorders, comorbidities associated with higher risk of falls, clinical diagnosis of diseases associated with physical pain (low back pain) and response rates ≥ 5 in the short form of the Geriatric Depression Scale (GDS). A total of 165 patients were invited to participate in the study; 96 were excluded: 22 declined to participate, 19 did not answer the invitations, and four had functional impairment. Therefore, 69 volunteers were considered eligible to participate in the study and were randomized by an assistant researcher, using a simple randomization system, a table of random numbers, and categorized in two groups – training group (TG; n = 40) and control group (CG; n = 29) (Figure 1). All volunteers were blinded to the intervention. Assessments All assessmentswere performedby an investigatorwho was blinded to the group. Participantswere asked to refrain fromexercise during the 96 hours before themeasurement, and from consuming caffeinated, alcoholic and energy beverages. Although energy intake was not controlled, all volunteers were asked to maintain their usual diet during the study period. No volunteer participated in any other exercise program during the study. All tests and experimental sessions were carried out at Unifesp Psychobiology Laboratory, under a controlled temperature between 22 and 24º C and relative humidity of 51%. All interviews were in-person and individualized. If the interviewee did not understand the question, the interviewer repeated it slowly, until three times. WHOQoL-OLD and WHOQUoL-BREF The WHOQOL is an instrument recommended to assess the QOL of elderly individuals. This questionnaire is composed of 24 items, organized in six major domains. Alabarse et al. Depression and pain in healthy active elderly Int J Cardiovasc Sci. 2019;32(6):553-562 Original Article