IMPACT OF PARA-ATHLETICS ON THE QUALITY OF LIFE: A CROSS-SECTIONAL SURVEY COMPARING HIGH-PERFORMANCE, AMATEUR ATHLETES AND SEDENTARY HEALTHY PEOPLE

The present study analyzed the quality of life of athletes with physical disabilities participated in para-athletics and compared them persons sedentary. Methods: Participants were matched by gender and age (n=228) and divided into four groups: G1 participating in high performance para-athletics (n=57); G2 participating in amateur para-athletics (n=57); G3 – sedentary people with physical disabilities (n=57); G4 – sedentary healthy people (n=57). Results: Athletes with physical disabilities who participate in high performance para-athletics (G1) had the highest scores on all the WHOQOL-BREF domains. Conclusions : Physically disabled athletes reported having a better quality of life in comparison with non-athlete people


INTRODUCTION
The WHO defines quality of life (QoL) as ''individual perceptions of their position in life, within the context of culture and value system in which they live, and in relation to their goals, expectations, standards, and concerns ' (Anon. 1995). People with physical disabilities, may have different implications for the levels of quality of life, especially in relation to the physical, psychological and social domains (França et al., 2011;Grzebień et al., 2017;Young et al., 2019) i.e., people's perceptions of their physical, psychological, and social well-being (Grzebień et al., 2017;Tengland, 2006).
In a literature review study, persons with spinal cord injury (SCI) had a lower perception of QoL compared to healthy controls of the healthy people (Boakye;Leigh;Skelly, 2012). Another study of QOL that compared non-disabled persons in the general population to patients with tumors in the locomotor apparatus also showed that impairment in locomotion had a negative impact on QoL (Paredes et al., 2008). These findings suggest that people with physical disabilities may present changes in the domains of QoL (Young et al., 2019). This perspective, sports participation has been used in physical rehabilitation (Greer et al., 2019;Nakanishi et al., 2021), and it plays an important role person's with physically disabilities integration into society (Diaz et al., 2019;LAPE et al., 2018;Frontera, 2020).
Although the literature has many studies on QoL, few have evaluated the impact of sports practice on the QoL of people with physical disabilities (Diaz et al., 2019;Mendonça et al., 2017;Oh;So, 2022;Peacock et al., 2019).
In this context, the present study innovates by comparing the QoL between amateur athletes and high-performance athletes with physical disabilities. This study will consider high-performance of para-athletics athletes, those participating in ranked-national competitions and amateur para-athletics athletes, those participating of regional competitions which are not ranked. The initial hypothesis is that there could be a difference in the QoL between these two groups of athletes, because they have different characteristics related to sports practice.
In this sense, the aim of this study was analyzed the QoL of athletes with physical disabilities who participated in para-athletics at different levels of competitiveness (High-performance para athletics and amateur para athletics) and compared them persons with physical disabilities and sedentary, as well as sedentary healthy people.

METHODS
This cross-sectional, observational study was approved by the Research Ethics Committee of Federal University of Uberlândia (Final analysis Nº 423/11 for CEP/UFU registration protocol 062/11).

PARTICIPANTS
Individuals of both sexes, with ages between 15 and 54 years-old were invited to this study, contingent upon their meeting the inclusion criteria for each group. The four groups were matched on a 1:1 ratio by sex, age, and physical disability (congenital or acquired).
The G1 group was composed of 57 athletes of para-athletics athletes, were interviewed during a stage of a national competition held in the city of São Paulo, Brazil. Based on sample size of 57 athletes obtained by G1, hence, the remaining groups consisted of 57 participants matched by sex and age.
Group G2 was composed by amateur athletes with physical disabilities, were recruited during a regional competition of para-athletics. Athletes were approached about participating in the study at competition venues.
The Group G3 was composed of healthy, sedentary people with physical disabilities who were not engage any form of sports or physical exercises. Volunteers were recruited in the institutions of reference in the care of people with disabilities in the city of Uberlândia, state of Minas Gerais /Brazil. The data collection was conducted at the institutions after scheduling by phone.
The Group G4 was formed by healthy people, sedentary, without physical disability. The data collection was conducted either at participants' homes after scheduling by phone.

DATA COLLECTED
Data from all participants (G1, G2, G3 and G4) were obtained through questionnaires, applied as an interview by the researchers. All participants were informed about the purpose of the study and provided written consent to participate in it.
At first, a questionnaire was used to collect demographic data (sex, age, income, education, and marital status), clinical data (congenital or acquired disability and type of sequela), and data on sports participation (years of participating in the sport, frequency of weekly practice, number of competitions per year, and receiving cash grants for participation).
In a second moment, the quality of life was measured with the brief version of the Quality-of-Life World Health Organization (WHOQOL-BREF) scale, which was developed by the World Health 4 Organization (The Whoqol Group, 1998) and validated for use with the Brazilian population. The WHOQOL-BREF consists of 26 items, and of these, the first two items assess general QoL and general health status; the other 24 items are divided into four domains: physical (7 items), psychological (6), social (4), and environmental (8). The reliability of the WHOQOL-BREF in this study, as measured by Cronbach's alpha coefficient, varied from 0.50 to 0.68 across the four groups.

STATISTICAL ANALYSES
Descriptive statistical analyses were used to summarize the participants' demographic, clinical, and sports-activity characteristics and to determine their WHOQOL-BREF scores. The chisquare test was used to analyze group differences in the frequency of their answers on items Q1 and Q2 of the WHOQOL-BREF, their marital status and whether the athletes received cash grants (groups G1 and G2). Group differences in WHOQOL-BREF scores were compared using analysis of variance (ANOVA) with the Bonferroni correction. Cohen's d was used to measure effect size (the ratio of the mean group difference to its standard deviation), which indicates the magnitude of the differences in QoL scores among the four groups. The obtained d values were considered high when equal to or higher than 0.80, moderate from 0.40 to 0.79, and small when below 0.40. Power analysis was performed to determine the ability of the statistical tests to find significant differences. Pearson's correlation coefficient was used to measure the association of WHOQOL-BREF scores with the sports data of groups G1 and G2. The significance level was set at p < 0.05. Statistical analyses were performed using SPSS software 18.0 (Chicago, IL).

RESULTS
The four groups in the study each contained 57 volunteer participants, for a total of 228 individuals, who were matched by gender and age on a 1:1 ratio. Each group consisted of 41 (71.93%) males and 16 (28.07%) females; their mean age was 31 years-old.
Group G3 reported the lowest family income compared to the other groups (p = 0.01). There was a significant difference in level of education only between groups G3 and G4 (p = 0.00). Group G4 reported the highest number of common-law marriages (n = 28, 49.12%), whereas G3 reported the lowest number of common-law marriages of the four groups (n = 18, 31.58%) (p = 0.00) (   The first aspect of the WHOQOL-BREF analyzed was the self-assessment of QoL (item Q1).
Most participants reported their QoL was "very good," with group G2 having the same percent of "very good" and "good" answers; participants in groups G3 and G4 mostly considered their QoL to be "good" (p = 0.00).
The second aspect was the satisfaction with the own health. Most participants in groups G1 and G2 reported being "very satisfied" with their health (Q2), with G1 participants giving this response more frequently than G2 participants did. Most of the participants in groups G3 and G4 reported being "satisfied" with their health (p = 0.00).
Athletes with physical disabilities who participate in high performance para-athletics (G1) had the highest scores on all the WHOQOL-BREF domains, and their scores were significantly higher than the scores of sedentary people with physical disabilities (G3) on all four domains (p = 0.00). In

RECIMA21 -REVISTA CIENTÍFICA MULTIDISCIPLINAR ISSN 2675-6218 IMPACT OF PARA ATHLETICS ON THE QUALITY OF LIFE: A CROSS-SECTIONAL SURVEY COMPARING HIGH-PERFORMANCE, AMATEUR ATHLETES AND SEDENTARY HEALTHY PEOPLE Robson da Silva Medeiros, Thiago Montes Fidale, Luiz Duarte de Ulhôa Rocha Júnior, Jalusa Andreia Storch Díaz, Elmiro Santos Resende, Rogério Melo Costa Pinto, Carlos Henrique Martins da Silva, Nívea de Macedo Oliveira Morales
RECIMA21 -Ciências Exatas e da Terra, Sociais, da Saúde, Humanas e Engenharia/Tecnologia v.4, n.9, 2023 6 comparison to G4, G1's scores were significantly higher on the psychological domain (p = 0.00). The G2 means were higher than the G3 means, except on the environmental domain. G2's mean was also higher than G4's mean on the psychological domain (p = 0.00). Group G4 had higher scores than the G3 group on the physical and social relations domains (p = 0.00). There were no significant differences between groups G1 and G2 (Table 2).

-Physically Disabled Sedentary People; G4= Group 4-Non-disabled Sedentary people
Within-group comparisons did not show significant differences in WHOQOL-BREF scores between participants with a congenital and acquired disability (G1 -p = 0.10; G2 -p = 0.22; G3 -p = 0.25). There was also no significant difference regarding the predominant motor physical disability   (Alves, 1999;Yazicioglu et al., 2012), archery, air-rifle shooting, and amputee football (Yazicioglu et al., 2012) and the physically disabled sedentary individuals, found that athletes had a better QoL.

RECIMA21 -REVISTA CIENTÍFICA MULTIDISCIPLINAR ISSN 2675-6218 IMPACT OF PARA ATHLETICS ON THE QUALITY OF LIFE: A CROSS-SECTIONAL SURVEY COMPARING HIGH-PERFORMANCE, AMATEUR ATHLETES AND SEDENTARY HEALTHY PEOPLE Robson da Silva Medeiros, Thiago Montes Fidale, Luiz Duarte de Ulhôa Rocha Júnior, Jalusa Andreia Storch Díaz, Elmiro Santos Resende, Rogério Melo Costa Pinto, Carlos Henrique Martins da Silva, Nívea de Macedo Oliveira
This study found significant differences in QoL with respect to sports participation. Sedentary people with physical disabilities and persons without physical disabilities, healthy and sedentary reported a lower QoL in comparison to athletes with physical disabilities who participated in highperformance and amateur para-athletics competitions.
Although other studies previously reported benefits of sports participation for athletes with disabilities (Diaz et al., 2019;Goraczko et al., 2020;Mendonça et al., 2017;Oh;So, 2022;Peacock et al., 2019), the comparison of QoL between sports participants and non-participants have been poorly studied. The present research included a considerably larger sample of volunteers than the samples used in previous studies, used pairing criteria of the samples, and the results demonstrated the importance at the para-athletics participation on QoL among high performance athletes and amateur athletes with physical disabilities.
The present research evaluated sports participation at two performance levels in paraathletics, distinguishing between high-performance and amateurs athletes.
Additionally, good sports performance can generate financial support and opportunities for national or international travels (Rodrigues;Eliane, 2001). As for athletes with disabilities who practice sports at the amateur level, the simple fact of being engaged in sport already changes their paradigms. The practice of sports allows the person with disabilities to see and feel in a more positive way (Marin-Urquiza; Ferreira; Van Biesen, 2018), favors social integration and adaptation to their physical condition Frontera, 2020;Puce et al., 2017) and also improves mood, regardless of competitive level (Campbell, 1995).
Comparison of QoL between athletes of these two categories had been recommended in previous studies (Mcveigh;Hitzig;Craven, 2009;Yazicioglu et al., 2012), but had not yet been performed. This research compared QoL between high-performance athletes and amateurs of paraathletics and found no significant differences.
It is noteworthy that the two groups of para-athletics athletes (high-performance and amateur) had better overall perception with QoL and overall health satisfaction when compared with sedentary 8 healthy people. The para-athletics high-performance and amateur athletes were also significantly superior in the psychological domain compared to the healthy sedentary group.
When comparing QOL between sedentary people with physical disabilities and sedentary healthy people, we found that people with physical disabilities had worse QoL scores in all WHOQOL-BREF domains, with significant differences in physical domains and social relationships. These results reinforce findings already mentioned in previous studies, where people with physical disabilities had a lower perception of QOL compared to healthy controls (Boakye;Leigh;Skelly, 2012;Paredes et al., 2008).
Positive QoL perception of athletics practitioners (high-performance and amateur) may be associated with involvement with this sport. Regular practice of sporting activities enables people with physical disabilities to enjoy a fuller life, which may enhance body image perception, boost selfesteem, help social integration and adapt to their physical condition (Filipcic et al., 2021). These psychological benefits obtained through sport generally reflect the working relationships, affective and social life of people with physical disabilities.

CONCLUSIONS
Para-athletics athletes (high performance and amateur) had a better QoL in comparison to sedentary people. The results reinforce benefits of sports participation, particularly para-athletics, on the QoL of people with physical disabilities, regardless of their competitive level.