Social distancing was the strategy adopted by several countries to slow down the spread of Covid-19 [18]. After the number of cases in Brazil escalated, the real fear of a little-known virus facilitated the compliance with measures that involved the reduction of personal interactions within the community at the beginning of the pandemic. However, there was a clear decrease in adherence over time, since the percentage of older adults who fulfilled the recommendations in the first month (78.7%) decreased significantly compared to the first six months (37.7%) and the last six months (54.1%), corroborating with studies that demonstrate a reduction in containment measures all over the world [21, 14]. Furthermore, the results of the present study showed an association between the evaluation period and social restriction [p = 0.000].
The study sample demonstrated a considerable percentage of older adults (16.4%) with no formal education and 18% with only elementary education. The low level of education can be considered as an aggravating factor for the non-adherence to compliance with social restriction measures, as revealed in a study [15]. However, the level of education is not the only factor observed in research responsible for interfering with adherence to measures of social distancing. The individual's sex and income can also influence adherence to restrictive measures [17, 22]. 47.5% of the participants in this study received from 3 to 4 minimum wages while 52.5% received from 1 to 2 minimum wages. This fact is likely to justify the decrease in adherence to measurements over time in the evaluated sample, since the fear around the economic risk has pressured a large parcel of the population to continue many of their activities [23].
Another important result is that 80.3% of the participants performed physical activity before the initiation of social restriction measures. In the first month, 67.2% of the older adults performed physical exercises, in the first six months 65.6% whereas in the last six months only 52.5% reported the practice of physical exercises. Among the exercises mentioned were gymnastics with guidance, exercises in the pool, walking in the yard, Pilates, stretching and muscle strengthening with professional guidance.
Considering that the vaccination against COVID-19 did not start in the first month of evaluation and that there are no effective pharmacological therapies available for Covid-19 yet, healthy habits are essential (for example, healthy eating and exercise) and beneficial for vulnerable populations, such as the older adults [24, 11]. Studies published in 2020 showed the importance of physical exercise for the older adults during the pandemic period, which can help to maintain muscle function and improve the immune response promoted by exercise [11, 25]. That means that an active lifestyle during social restriction is indispensable to prevent physical problems and even psychological impacts, especially in this population [26, 27, 28]. However, it is important to highlight that the reduction of physical activity and the increase in sedentary behavior in the older adults can cause greater risk of frailty and fractures resulting from falls [12, 29].
We observed that the proportion of older adult people who fell in the 12-month period was 24.6%, with an absolute number of 15 fallers, of which 3 presented a fall in the six months preceding the evaluations. 72% of these falls happened at home while 28% outside home. In total, there were 25 falls and the main causes were: imbalance (60%), stumbling (28%) and dizziness (12%). In this context, studies have demonstrated that exposure to falls is not associated only with the aging process, but also with the environment in which the older adults are inserted [29]. In addition, the pandemic scenario can intensify the effects of several factors, such as physical inactivity [30], which increases the risk of falls in the older adults. Studies have already indicated the importance of physical exercise to prevent falls in this population [31].
Although self-reported fear of being infected did not show much difference in percentage when we observed the three periods in the graph (first month 67.2%, first six months 54.1% and last six months 60.7%), it is possible to identify a significant increase in self-reported risk of infection by study participants over time (first month 23%, first six months 47.5 % and last six months 59%). In addition, there was a significant association between the evaluation period and the risk of being infected [p = 0.000].
It is likely that the increase in the participant’s perception level of contamination risk after 6 months could have some relationship with the decrease in compliance with measures of social restriction, due to the increased social exposure, and consequently the feeling of greater risk. Furthermore, knowing close people who were infected may also have contributed to this increase. In the last 6 months, the participant’s perception level of contamination risk kept elevated and the compliance of social restriction also increased, which may be associated with the discovery of a new COVID-19 virus variant.
A recent cross-sectional study carried out with 756 participants has shown the prevalence and associated factors with the fear perception of being infected by the new coronavirus [32]. This study has identified that 64% of the total sample reported feeling very afraid of being contaminated. In addition to the self-perception of the risk of being infected, other elements were associated with the perception of fear, such as the perception of health and the adoption of preventive measures against Covid-19 [32]. In our results, more than half of the participants indicated fear of being infected, although the objective assessment of fear is difficult to perform because the feeling of fear is a subjective and adaptive characteristic [33].
It is important to highlight that the difference observed in the accomplishment of the social distancing measures over time may be related to the existence of a decentralized process of adopting these measures in Brazil and also to the absence of a national social distancing policy. In addition, it is possible that long periods of isolation lead to “fatigue” of the population and non-accomplishment of these measures [34] Additionally, the risk of developing emotional problems such as depression, anxiety, cognitive damage and also physical problems resulting from the prolonged period of social restriction [35, 36] may have influenced the reduction of the social restriction compliance. However, further studies are needed to confirm this hypothesis. Therefore, it is necessary to address the pros and cons regarding the offering of supervised physical exercise to the older population, following the biosecurity protocols (limited number of participants, social distancing, outdoor activities in a large space, mask use, clean hands and objects and surfaces frequently disinfected) and also whether it should be a public health strategy to keep the population active and minimize the virus contamination.