Adaptação da Escala de Indução Subjetiva do Esforço (SEIS-3) para exercícios de força: uma aplicação clínica para idosos com síndrome demencial

Abstract

Dementia affects millions worldwide. Strength exercises have made recommendations to elderly people in general to maintain functional autonomy. One of the ways to check the intensity in this type of exercise is through Ratings of Perceived Exertion (RPE) scales. For elderly people with dementia, the use of scales with various intensity gradations is unfeasible, due to the difficulty in understanding the instrument. The Subjective Effort Induction Scale (SEIS-3) has shown promise in assessing subjective effort in cognitively healthy older adults, but its applicability to people with dementia has not yet been tested. Adaptation of this scale is critical to optimize exercise interventions for this population. This study was designed to review, adapt and test evidence of validity of the SEIS-3 for prescribing strength training for elderly people with dementia syndrome, evaluating its reliability and stratifying the results according to the stage of the disease. This is a cross-sectional study conducted in two phases: Phase 1 involved reviewing the development of the SEIS-3 instrument and making the necessary adaptations based on international guidelines. Phase 2 included testing the adapted SEIS-3 instrument on elderly people with dementia syndrome, recruited from a Long-Term Care Facility for the Elderly and a hospital. 32 elderly individuals with a mean age of 77.1±8.7 years were evaluated. The main inclusion criterion was that participants had a diagnosis of dementia. A modern version of SEIS-3 (SEIS-3D) was proposed. Strength assessment involved handgrip strength measurements using an electronic dynamometer, with intra- and inter-rater reliability analyzed by calculating the Intraclass Correlation Coefficient (ICC). The CCI also tested reliability according to the stages of dementia syndrome, using the Clinical Dementia Rating (CDR). The Bland-Altman method was utilized to examine agreement and systematic bias, while Standard Error of Measurement (SEM) calculations determined measurement accuracy. There was a significant difference in handgrip (p<0.01) for the three subjective gradations of induced effort (weak<medium<strong). The ICC showed high instrument reliability (R>0.90; p<0.01), with R>0.80 for the mean of measurements in most analyzes for intra-rater agreement (high reliability) and R≥0.73 for inter-rater reliability (substantial reliability). The SEM consequences were not significantly influenced by systematic error. The SEIS-3D proved to be valid and reliable for use in prescribing strength training for aging people with different degrees of dementia. Older adults with dementia can distinguish three gradations of effort (weak, medium and strong), even those with the disease in an advanced stage.