Effectiveness of a scaled up physical activity intervention in Brazil: A natural experiment.

Physical inactivity causes 5.3 million deaths annually worldwide. We evaluated the impact on population leisure-time physical activity (LTPA) of scaling up an intervention in Brazil, Academia das Cidades program (AC-P). AC-P is a health promotion program classified as physical activity classes in community settings which started in the state of Pernambuco state in 2008. We surveyed households from 80 cities of Pernambuco state in 2011, 2012 and 2013, using monitoring data to classify city-level exposure to AC-P. We targeted 2370 individuals in 2011; 3824 individuals in 2012; and 3835 individuals in 2013. We measured participation in AC-P and whether respondents had seen an AC-P activity or heard about AC-P. We measured LTPA using the International Physical Activity Questionnaire. We estimated the odds of reaching recommended LTPA by levels of exposure to the three AC-P measures. For women, the odds of reaching recommended LTPA were 1.10 for those living in cities with AC-P activity for less than three years, and 1.46 for those living in cities with AC-P activity for more than three years compared to those living in cities that had not adopted AC-P. The odds of reaching recommended LTPA increased with AC-P participation and knowledge about AC-P. AC-P exposure is associated with increased population LTPA. Extending AC-P to all cities could potentially impact non-communicable diseases in Brazil.

Association of knowledge, preventive counseling and personal health behaviors on physical activity and consumption of fruits or vegetables in community health workers.

BACKGROUND: There is evidence that if a health professional is active and has a healthy diet, he/she is more likely to advise patients about the benefits of physical activity and healthy eating The aims of this study were to: (1) describe the personal physical activity, consumption of fruits and vegetables behaviors and nutritional status of community health workers; (2) evaluate the association between knowledge, delivery of preventive counseling and personal behaviors among community health workers. METHODS: This was a cross-sectional study conducted in a nationally sample of health professionals working in primary health care settings in Brazil in 2011. This survey was part of the second phase of the Guide for Useful Interventions for Activity in Brazil and Latin America project, and data were collected through telephone interviews of 269 community health workers from the Unified Health Care system of Brazil. We applied questionnaires about personal reported behaviors, knowledge and preventive counseling in physical activity and consumption of fruits and vegetables. We calculated the prevalence and associations between the variables with logistic regression. RESULTS: The proportion of community health workers that practiced 150 minutes per week of physical activity in leisure time or transportation was high (64.9%). Half of community health workers were overweight and only 26.2% reported consuming five portions/day of fruits or vegetables. Most community health workers reported counseling about physical activity for more than six months (59.7%), and most were not knowledgeable of the fruits and vegetables and physical activity recommendations. Meeting the fruits and vegetables recommendations was associated with correct knowledge (OR = 4.5; CI95% 1.03;19.7), with reporting 150 minutes or more of physical activity per week (OR = 2.0; CI95% 1.03;3.7) and with reporting physical activity in leisure time (OR = 2.0; CI95% 1.05;3.6). Regular physical activity counseling was associated with reporting 10-149 minutes per week (OR = 3.8; CI95% 1.1;13.3) and with more than 150 minutes of physical activity per week (OR = 4.9; CI95% 1.5;16.5). CONCLUSION: Actions to promote physical activity and healthy eating and to improve knowledge among community health workers within the health care system of Brazil could have a potential positive influence on delivery of preventive counseling to patients on this topic.

[Physical activity in young adults and the elderly in areas covered by primary health care units in municipalities in the South and Northeast of Brazil]. / Atividade física em adultos e idosos residentes em áreas de abrangência de unidades básicas de saúde de municípios das regiões Sul e Nordeste do Brasil.

Shifts in Brazil's demographic structure have expanded the country's elderly population and consequently increased the rates of chronic diseases. This paper describes the prevalence of sedentary lifestyle and associated factors in a cross-sectional study, including 4,060 non-elderly and 4,003 elderly adults in 41 cities in seven States of the country. Prevalence of sedentary lifestyle was 31.8% (95%CI: 30.4-33.2) in non-elderly adults and 58.0% (95%CI: 56.4-59.5) in the elderly; sedentary lifestyle was more frequent in the Northeast and among males. Low family income was associated with higher prevalence of sedentary lifestyle in both non-elderly and elderly adults, while low schooling was only observed among the elderly. There was an inverse association between self-reported health status and sedentary lifestyle. Mean prevalence of sedentary lifestyle was higher in areas covered by pre-PROESF units in comparison to other health system models. We conclude that sedentary lifestyle is highly prevalent and that disadvantaged socioeconomic groups are more likely to be sedentary.

[Habitual snoring and obstructive sleep apnea in adults: population-based study in Southern Brazil]. / Ronco habitual e apnéia obstrutiva observada em adultos: estudo de base populacional, Pelotas, RS.

OBJECTIVE: To estimate the prevalence of habitual snoring and obstructive sleep apnea and their factors associated. METHODS: Cross-sectional study with a representative sample comprising 3,136 adults (>20 years) living in the city of Pelotas, Southern Brazil, in 2005. A questionnaire was used to collect information on demographic, socioeconomic, behavioral and anthropometric variables and outcomes. Crude and adjusted statistical analysis using Fisher exact test and chi-square test for linear trend and a multivariate analysis through Poisson regression model were carried out, respectively. RESULTS: The prevalence of habitual snoring was 50.5% (95% CI: 48.1;52.8) and obstructive sleep apnea was 9.9% (95% CI: 8.7;11.2). After adjustment, the risk of habitual snoring was greater in males (prevalence ratio [PR]=1.25, 95% CI: 1.16;1.34), elderly people (PR=1.62, 95% CI: 1.46;1.80), current smokers (PR=1.15, 95% CI: 1.07;1.25), alcohol users (PR=1.17, 95% CI: 1.03;1.31) and obese people (PR=1.71, 95% CI: 1.55;1.88). The risk of obstructive sleep apnea was greater in males (PR=2.05, 95% CI: 1.67;2.52), elderly people (PR=2.23, 95% CI: 1.64;3.03), current smokers (PR=1.60, 95% CI: 1.25;2.05) and obese people (PR=2.61, 95% CI: 1.97;3.47). CONCLUSIONS: In the studied population, habitual snoring and obstructive sleep apnea were common symptoms. Well-known risk factors such as male gender and age between 40 and 60 years are not modifiable. However, smoking, alcohol use and obesity need to be identified and treated in general population.

[Prevalence of falls and associated factors in the elderly]. / Prevalência de quedas em idosos e fatores associados.

OBJECTIVE: Increased life expectancy and consequent growth of the elderly population has resulted in changes in the epidemiological morbidity and mortality profile. In the group of chronic degenerative diseases, falls are a prevailing among those preventable conditions. The objective of the study was to assess prevalence of falls in the elderly and to describe their associated factors. METHODS: Cross-sectional study comprising 4,003 elderly subjects (aged 65 years or more) living in areas covered by primary health care in 41 municipalities with more than 100,000 inhabitants from seven Brazilian states. Wald test for heterogeneity and linear trend were used for the estimation of significance level. Adjusted analysis was conducted using Poisson regression and adjusted prevalence rates were estimated. RESULTS: The prevalence of falls among the elderly was 34.8%, significantly higher in women (40.1%) than men. Among those who experienced falls, 12.1% had fractures as a consequence. The prevalence of falls was directly associated with older age, sedentary lifestyle, self-perception of poor health and more chronic drug use reported. The prevalence of falls was similar in the elderly attending different care services (basic health care units and Family Health Program). CONCLUSIONS: The prevalence of falls among elderly could be reduced through actions targeting their needs in health care units, especially regarding preventable associated factors.

Who, when, and how much? Epidemiology of walking in a middle-income country.

BACKGROUND: Physical inactivity is one of the leading causes of morbidity and mortality worldwide. Walking, an inexpensive and accessible activity, is protective against unhealthy outcomes. Little data on walking practices are available outside developed countries. This study estimated the prevalence and correlates of compliance with physical activity recommendations through leisure-time and all-domain (combined leisure time, commuting, and work-related) walking in individuals aged > or =20 years in a southern Brazilian city. METHODS: Data from two population-based surveys carried out in 2002 and 2003 in Pelotas, Rio Grande do Sul, were compared and analyzed in 2004. Multistage sampling procedures were undertaken in both surveys. Compliance with physical activity recommendations was defined as > or =150 minutes/week of walking during the previous week, although other cut-off points were estimated. The International Physical Activity Questionnaire was used in both studies. RESULTS: Samples comprised 3182 (2002 study) and 3100 (2003 study) individuals. Nonresponse rates were 5.6% and 3.5%, respectively. Both prevalence and correlates of leisure-time and all-domains walking were markedly different. Compliance with physical activity guidelines (> or =150 minutes/week) through walking was 40.6% (all domains) and 15.0% (leisure time). Poor and uneducated participants had a lower likelihood of walking than higher-income and more educated people, particularly in leisure time. Walkers were also more likely to practice other vigorous and moderate-intensity activities. CONCLUSIONS: Although the results derive from a single Brazilian city, they are likely to be relevant to similar environments/locales in middle-income countries, where the obesity epidemic is rapidly increasing. Due to the low levels of walking detected, particularly during leisure time, healthcare professionals are encouraged to recommend walking to their patients.

Conhecimento de profissionais que atuam em Unidades Básicas de Saúde no Brasil sobre a associação entre inatividade física e morbidades / Knowledge of professionals in Basic Health Units in Brazil on the association between physical inactivity and morbidities

Avaliar o conhecimento de profissionais de saúde sobre a existência ou não de associação entre inatividade física e oito morbidades (diabetes, hipertensão arterial, aids, osteoporose, câncer de pulmão, depressão, cirrose hepática e infarto agudo do miocárdio). Foi realizado um estudo transversal em uma amostra representativa de 1.600 unidades básicas de saúde do Brasil; a população elegível incluía 1/3 de médicos, 1/3 de enfermeiros e 1/3 de agentes comunitários de saúde. A média de acertos observada foi de 6,3 questões. A proporção de profissionais que acertaram sete ou oito questões foi de 68% (IC95%: 60-75) entre os médicos, 54% (IC95%: 48-59) entre enfermeiros e 43% (IC95%: 40-55) entre agentes comunitários de saúde. O percentual de acertos dos médicos foi estatisticamente superior (p<0,001) ao dos enfermeiros e agentes comunitários de saúde, mas a proporção de acertos não diferiu entre enfermeiros e agentes comunitários (p=0,16). O percentual de acertos não variou significativamente conforme sexo, idade e nível de atividade física. Políticas públicas voltadas à educação são indispensáveis para instrumentalizar profissionais que trabalham em unidades básicas de saúde no Brasil sobre os efeitos da inatividade física sobre a saúde.

We aimed to evaluate the knowledge of health professional on the existence or not of an association between physical inactivity and eight diseases (diabetes, hypertension, aids, osteoporosis, lung cancer, depression, cirrhosis and myocardial infarction). A cross-sectional study was conducted with a sample of 1,600 primary health care units in Brazil; the eligible population included 1/3 physicians, 1/3 nurses and 1/3 community health workers. On avergae, participants anweredcorreclyneraly six questions. The proportion of correct anwers was higher among physicians as compared to nurses and community health workers (p<0.001). On the other hand, nurses and community health workers were not different in terms of the prevalence of correct answers (p=0.16). The proportion of health professionals who answered correctly to seven or eight questions was 68% (95%CI: 60-75) among physicians, 54% (95%CI: 48-59) among nurses and 43% (95%CI: 40-55) among community health workers. The proportion of correct answers did not vary significantly according to sex, age or physical activity level of health professionals. Educational policies are essential for empowering health professionals who work in primary health care units on the effects of physical inactivity on health.

Prevalence and associated factors of back pain in adults from southern Brazil: a population-based study.

OBJECTIVES: To identify the prevalence of spinal pain and possible prognostic factors in a representative sample of Pelotas, RS, Brazil. METHODS: Cross-sectional study evaluated 972 adults aged between 20 and 69 years, of both sexes, residents in a urban area. The questionnaire included socio-economic, demographics, behavioral and health-related questions. Spinal pain was defined as any pain or discomfort in the spine somewhere in the last 12 months, either in the cervical, thoracic or lumbar area. RESULTS: The prevalence of spinal pain was 63.1% (95% CI 60.0 to 66.1) being lower back the most prevalent condition (40%). Female gender 1.24 (1.12 to 1.37) and poor health status(p<0.001) were the variables that remained associated with the presence of spinal pain in the final model. CONCLUSIONS: The prevalence of back pain is important as it is associated with activity limitation and with health care utilization.

Leisure-time physical activity among adult and elderly individuals in Brazil: a countrywide analysis.

BACKGROUND: No data on leisure-time physical activity (LTPA) are available in Brazil for a representative sample of the whole country. The current study describes LTPA levels of the Brazilian adult and elderly populations and explores its association with sex, age, and schooling. METHODS: A countrywide household-based cross-sectional study was carried out, including separate samples of adult and elderly individuals from 23 states in Brazil selected through a multistage approach. LTPA was assessed using the long version of the International Physical Activity Questionnaire. A cut-off point of 150 minutes per week was used. RESULTS: 12,402 adult and 6617 elderly individuals were interviewed in 100 cities. The proportion of individuals below the 150 minutes per week threshold in terms of LTPA was 82.6% (95% CI 81.9; 83.2) among the adults and 86.5% (95% CI 85.7; 87.3) among elderly individuals. Among adults, prevalence estimates were very consistent across regions. Elderly subjects living in states in the Northeast and North regions of the country were less active than those from the other regions. A clear positive dose-response association was observed between LTPA and schooling. CONCLUSION: Alarming rates of low levels of LTPA are found in Brazil, thus suggesting the need of urgent actions.

Prevalência de dor nas costas e fatores associados em adultos do sul do Brasil: estudo de base populacional / Prevalence and associated factors of back pain in adults from southern Brazil: a population-based study

OBJETIVOS: Determinar a prevalência de dor nas costas e fatores associados em uma amostra representativa da cidade de Pelotas, RS, Brasil. MÉTODOS: Estudo transversal que avaliou 972 adultos com idade entre 20 e 69 anos, de ambos os sexos, moradores da zona urbana do município. O questionário aplicado incluiu questões socioeconômicas, demográficas, comportamentais e de saúde. Dor nas costas foi definida como qualquer dor ou desconforto em algum local das costas nos últimos 12 meses, seja na região cervical, torácica ou lombar. RESULTADOS: A prevalência de dor nas costas foi de 63,1 por cento (IC95 por cento 60,0 a 66,1), sendo a região lombar a mais referenciada (40 por cento). Sexo feminino 1,24 (1,12 a 1,37) e percepção ruim de saúde (p<0,001) foram as variáveis que permaneceram associadas à presença de dor nas costas no modelo final. CONCLUSÕES: A prevalência de dor nas costas encontrada é importante e causa limitação e aumento na procura por serviços de saúde.

OBJECTIVES: To identify the prevalence of spinal pain and possible prognostic factors in a representative sample of Pelotas, RS, Brazil. METHODS: Cross-sectional study evaluated 972 adults aged between 20 and 69 years, of both sexes, residents in a urban area. The questionnaire included socio-economic, demographics, behavioral and health-related questions. Spinal pain was defined as any pain or discomfort in the spine somewhere in the last 12 months, either in the cervical, thoracic or lumbar area. RESULTS: The prevalence of spinal pain was 63.1 percent (95 percent CI 60.0 to 66.1) being lower back the most prevalent condition (40 percent). Female gender 1.24 (1.12 to 1.37) and poor health status(p<0.001) were the variables that remained associated with the presence of spinal pain in the final model. CONCLUSIONS: The prevalence of back pain is important as it is associated with activity limitation and with health care utilization.

Ronco habitual e apnéia obstrutiva observada em adultos: estudo de base populacional, Pelotas, RS / Habitual snoring and obstructive sleep apnea in adults: population-based study in Southern Brazil

OBJETIVO: Estimar a prevalência de ronco habitual e apnéia obstrutiva observada e fatores associados. MÉTODOS: Estudo transversal com amostra representativa de 3.136 adultos, com 20 anos ou mais, residentes em Pelotas, Rio Grande do Sul, em 2005. Informações sobre os desfechos e variáveis demográficas, socioeconômicas, comportamentais e antropométricas foram coletadas por meio de questionário. A análise estatística bruta e ajustada foi realizada utilizando-se teste exato de Fisher ou qui-quadrado de tendência linear e regressão de Poisson, respectivamente. RESULTADOS: A prevalência encontrada de ronco habitual foi de 50,5 por cento (IC 95 por cento: 48,1;52,8) e de apnéia obstrutiva de 9,9 por cento (IC 95 por cento: 8,7;11,2). Na análise ajustada, o relato de ronco foi maior nos homens (Razão de Prevalências - RP=1,25; IC 95 por cento: 1,16;1,34), nos idosos (RP=1,62; IC 95 por cento: 1,46;1,80), nos tabagistas (RP=1,15; IC 95 por cento: 1,07;1,25), nos alcoolistas (RP=1,17; IC 95 por cento: 1,03;1,31) e nos obesos (RP 1,71, IC95 por cento 1,55;1,88). O relato de apnéia obstrutiva foi maior nos homens (RP=2,05; IC 95 por cento: 1,67;2,52), nos idosos (RP=2,23; IC 95 por cento: 1,64;3,03), nos tabagistas (RP=1,60; IC 95 por cento: 1,25;2,05) e nos obesos (RP=2,61; IC 95 por cento: 1,97;3,47). CONCLUSÕES: Ronco habitual e apnéia obstrutiva foram sintomas comuns na população estudada. Fatores de risco conhecidos como sexo masculino e idade entre quarta e quinta décadas de vida não são modificáveis. Entretanto, tabagismo, alcoolismo e obesidade também associados aos desfechos, devem ser identificados e tratados na população geral.

OBJECTIVE: To estimate the prevalence of habitual snoring and obstructive sleep apnea and their factors associated. METHODS: Cross-sectional study with a representative sample comprising 3,136 adults (>20 years) living in the city of Pelotas, Southern Brazil, in 2005. A questionnaire was used to collect information on demographic, socioeconomic, behavioral and anthropometric variables and outcomes. Crude and adjusted statistical analysis using Fisher exact test and chi-square test for linear trend and a multivariate analysis through Poisson regression model were carried out, respectively. RESULTS: The prevalence of habitual snoring was 50.5 percent (95 percent CI: 48.1;52.8) and obstructive sleep apnea was 9.9 percent (95 percent CI: 8.7;11.2). After adjustment, the risk of habitual snoring was greater in males (prevalence ratio [PR]=1.25, 95 percent CI: 1.16;1.34), elderly people (PR=1.62, 95 percent CI: 1.46;1.80), current smokers (PR=1.15, 95 percent CI: 1.07;1.25), alcohol users (PR=1.17, 95 percent CI: 1.03;1.31) and obese people (PR=1.71, 95 percent CI: 1.55;1.88). The risk of obstructive sleep apnea was greater in males (PR=2.05, 95 percent CI: 1.67;2.52), elderly people (PR=2.23, 95 percent CI: 1.64;3.03), current smokers (PR=1.60, 95 percent CI: 1.25;2.05) and obese people (PR=2.61, 95 percent CI: 1.97;3.47). CONCLUSIONS: In the studied population, habitual snoring and obstructive sleep apnea were common symptoms. Well-known risk factors such as male gender and age between 40 and 60 years are not modifiable. However, smoking, alcohol use and obesity need to be identified and treated in general population.

Atividade física em adultos e idosos residentes em áreas de abrangência de unidades básicas de saúde de municípios das regiões Sul e Nordeste do Brasil / Physical activity in young adults and the elderly in areas covered by primary health care units in municipalities in the South and Northeast of Brazil

As mudanças na pirâmide demográfica brasileira e conseqüente envelhecimento populacional têm promovido aumento de doenças crônicas. Nesta realidade, as unidades básicas de saúde e a atividade física ganham importância. Em um estudo com delineamento transversal, avaliou-se a prevalência de sedentarismo e fatores associados em 4.060 adultos e 4.003 idosos, residentes em áreas de unidades básicas de saúde de 41 municípios com mais de 100 mil habitantes, em sete estados do Brasil. A prevalência de sedentarismo foi de 31,8 por cento (IC95 por cento: 30,4-33,2) e 58 por cento (IC95 por cento: 56,4-59,5) para adultos e idosos respectivamente, sendo sempre maior na Região Nordeste e nos homens. Baixa renda familiar foi fator de risco para sedentarismo nos adultos e idosos, enquanto a baixa escolaridade apresentou um efeito somente entre os idosos. Houve relação inversa entre autopercepção de saúde e sedentarismo para adultos e idosos. A prevalência média de sedentarismo foi maior na área de abrangência das unidades básicas de saúde Pré-PROESF em comparação aos outros modelos de atenção básica. Conclui-se que a prevalência de sedentarismo é muito elevada e que os grupos sócio-econômicos mais desfavorecidos apresentam nível menor de atividade física.

Shifts in Brazil's demographic structure have expanded the country's elderly population and consequently increased the rates of chronic diseases. This paper describes the prevalence of sedentary lifestyle and associated factors in a cross-sectional study, including 4,060 non-elderly and 4,003 elderly adults in 41 cities in seven States of the country. Prevalence of sedentary lifestyle was 31.8 percent (95 percentCI: 30.4-33.2) in non-elderly adults and 58.0 percent (95 percentCI: 56.4-59.5) in the elderly; sedentary lifestyle was more frequent in the Northeast and among males. Low family income was associated with higher prevalence of sedentary lifestyle in both non-elderly and elderly adults, while low schooling was only observed among the elderly. There was an inverse association between self-reported health status and sedentary lifestyle. Mean prevalence of sedentary lifestyle was higher in areas covered by pre-PROESF units in comparison to other health system models. We conclude that sedentary lifestyle is highly prevalent and that disadvantaged socioeconomic groups are more likely to be sedentary.

Prevalência de quedas em idosos e fatores associados / Prevalence of falls and associated factors in the elderly

OBJETIVO: O aumento da expectativa de vida e conseqüente crescimento da população de idosos têm gerado modificações em seu perfil de morbimortalidade. Das doenças crônico-degenerativas, as quedas são agravos prevalentes entre aqueles passíveis de prevenção. O objetivo do estudo foi analisar a prevalência de quedas em idosos e a influência de variáveis a elas associadas. MÉTODOS: Estudo transversal com amostra composta por 4.003 idosos (65 anos ou mais) cuja coleta de dados foi realizada em 2005. Os idosos residiam na área de abrangência de unidades básicas de saúde de 41 municípios, com mais de 100 mil habitantes, de sete estados do Brasil. Para cálculo do nível de significância dos dados foi usado o teste de Wald para heterogeneidade e tendência linear. A análise ajustada foi realizada por regressão de Poisson, com cálculo de razões de prevalência ajustadas. RESULTADOS: A prevalência de quedas entre os idosos foi de 34,8 por cento, significativamente maior nas mulheres (40,1 por cento). Entre os que sofreram quedas, 12,1 por cento tiveram fratura como conseqüência. A prevalência de quedas associou-se com idade avançada, sedentarismo, autopercepção de saúde como sendo ruim e maior número de medicações referidas para uso contínuo. Não houve diferença na ocorrência de quedas entre os idosos das diferentes modalidades da atenção (unidade de saúde tradicional e Programa Saúde da Família). CONCLUSÕES: A prevalência de quedas entre os idosos poderia ser diminuída com o planejamento de ações voltadas às suas necessidades nas unidades de saúde, especialmente em relação aos fatores associados passíveis de prevenção.

OBJECTIVE: Increased life expectancy and consequent growth of the elderly population has resulted in changes in the epidemiological morbidity and mortality profile. In the group of chronic degenerative diseases, falls are a prevailing among those preventable conditions. The objective of the study was to assess prevalence of falls in the elderly and to describe their associated factors. METHODS: Cross-sectional study comprising 4,003 elderly subjects (aged 65 years or more) living in areas covered by primary health care in 41 municipalities with more than 100,000 inhabitants from seven Brazilian states. Wald test for heterogeneity and linear trend were used for the estimation of significance level. Adjusted analysis was conducted using Poisson regression and adjusted prevalence rates were estimated. RESULTS: The prevalence of falls among the elderly was 34.8 percent, significantly higher in women (40.1 percent) than men. Among those who experienced falls, 12.1 percent had fractures as a consequence. The prevalence of falls was directly associated with older age, sedentary lifestyle, self-perception of poor health and more chronic drug use reported. The prevalence of falls was similar in the elderly attending different care services (basic health care units and Family Health Program). CONCLUSIONS: The prevalence of falls among elderly could be reduced through actions targeting their needs in health care units, especially regarding preventable associated factors.