Global prevalence and gender inequalities in at least 60 min of self-reported moderate-to-vigorous physical activity 1 or more days per week: An analysis with 707,616 adolescents.

BACKGROUND: Guidelines recommend that adolescents should accumulate an average of 60 min per day of moderate-to-vigorous physical activity (MVPA). However, using only this cut-off could hide important information. For instance, from a population-level point of view, increasing physical activity for those with no or low physical activity could provide more health benefits than increasing physical activity for those with intermediate levels. Also, including a more sensitive cut-point of ≥1 day per week could be an additional strategy for identifying those with low access/opportunities for physical activity practice. Thus, the current study aims to estimate the prevalence of ≥60 min of MVPA ≥1 days per week among adolescents globally, and to describe any relevant gender inequalities. METHODS: We used representative datasets from 146 countries/territories collected between 2003 and 2019. MVPA was self-reported. Participants were grouped into younger (≤14 years old) and older (>14 years old) adolescents. Crude Poisson regression models were used to identify the relative differences in ≥60 min of MVPA ≥1 days per week between boys and girls, and random-effects meta-analysis models were used to identify the pooled estimates. Analyses were stratified by country and region. RESULTS: Approximately 80% of both younger and older adolescents reported ≥60 min of MVPA ≥1 days per week. This prevalence was ≥94% in Europe and Central Asia and North America, while the estimates for the other regions were <77%. The prevalence of ≥60 min of MVPA ≥1 days per week was higher among boys than girls, with the largest differences occurring among the oldest adolescents (PR≤14y: 1.04 (95% confidence interval (95%CI): 1.03‒1.04) vs. PR>14y: 1.09 (95%CI: 1.08‒1.10)). CONCLUSION: Approximately 8 out of 10 adolescents reported accumulating ≥60 min of MVPA ≥1 day per week, with notable differences between regions. Gender differences were observed in several countries, especially among the oldest adolescents. Priorities for physical activity promotion among adolescents should include increasing access/opportunities for physical activity among those who do not achieve ≥60 min of MVPA ≥1 days per week and reducing gender inequalities.

Rural-urban differences in physical activity and TV-viewing in Brazil.

INTRODUCTION: This study aims to compare differences regarding physical activity (PA) indicators and TV viewing according to location of residence and sociodemographic variables in Brazil. METHODS: This cross-sectional study with individuals aged 18 years or older using data from the Brazilian National Health Survey was carried out in 2013. PA (total and domains) and TV viewing (≥3 hours) were measured by self-report. Stratifiers were location of residence, sex, age, wealth quintiles and regions of the country. RESULTS: This study included 60 202 individuals (49 245 from urban areas). In general, total PA was not different according to location of residence (urban 59.4%; rural 57.4%). Higher differences were found for leisure-time PA (urban 24.1%; rural 13.9%), work-based PA (urban 12.9%; rural 21.1%) and TV viewing of more than 3 hours (urban 30.1%; rural 21.4%). The differences between urban and rural areas were enhanced according to sex, age and wealth quintiles. CONCLUSION: The differences between urban and rural areas vary according to PA domains and population groups. To explore specific domains of PA in each location of residence may improve the understanding of the analyzed outcomes in different communities and consequently guide future interventions.

All are equal, but some are more equal than others: social determinants of leisure time physical activity through the lens of intersectionality.

BACKGROUND: To date, no research has investigated social determinants of leisure time physical activity through the lens of intersectionality in a low- and middle-income country. Therefore, the aim of this study was to explore the intersectionality in leisure time physical activity in a nationwide sample of Brazilian adults. METHODS: Data from the Brazilian National Health Survey conducted in 2013 were analysed (N = 58,429). Prevalence of sufficient leisure time physical activity (150+ minutes per week in moderate-to-vigorous physical activity) was estimated according to gender, racial identity, education and income, and according to multiple combinations of these sociodemographic characteristics (i.e., multiple jeopardy index). RESULTS: The prevalence of sufficient leisure time physical activity was 22.9% (95%CI: 22.3 to 23.6). Overall, the prevalence of sufficient leisure time physical activity was highest among men, individuals with white skin colour, and among those in the highest group of education and income. Among men, white, with a university degree and in the highest quartile of income (3% of the population), the prevalence of sufficient leisure time physical activity was 48%. Among non-white women with low education and low income (8.1% of the population), the prevalence of sufficient leisure time physical activity was 9.8%. CONCLUSION: Informed by the theory of intersectionality, findings of this study have shown that intersections of gender, racial identity and socioeconomic position of the Brazilian society strongly influence leisure time physical activity at the individual level. Targeted interventions to increase leisure time physical activity should address the complexities of social status intersections.

Personal Activity Intelligence e-Health Program in People with Type 2 Diabetes: A Pilot Randomized Controlled Trial.

INTRODUCTION: Innovative strategies are needed to enable people with type 2 diabetes (T2D) to self-manage physical activity (PA). Personal Activity Intelligence (PAI) is a new metric that uses the heart rate response to PA to inform the user as to whether they are doing enough PA to reduce the risk of premature mortality. The PAI score reflects PA over the previous 7 d with the goal to maintain a score ≥100. The aim of this study was to investigate the feasibility, acceptability, and efficacy of the PAI e-Health Program in people with T2D. METHODS: Thirty participants with T2D who were not meeting PA guidelines were randomly assigned to 12 wk of either 1) PAI e-Health Program or 2) PA attention control. The PAI e-Health Program consisted of receiving a wrist-worn heart rate monitor and an app with the PAI metric, and attending 4 × 2 h·wk-1 sessions of exercise and counseling. Feasibility and acceptability of the program were evaluated by achievement of a PAI score ≥100 and participant feedback. Efficacy was determined from changes in glycemic control, cardiorespiratory fitness, exercise capacity (time-on-test), body composition, sleep time, and health-related quality of life. RESULTS: Program participants in the PAI e-Health Program had a mean ± SD PAI score of 119.7 ± 60.6 and achieved ≥100 PAI on 56.4% of the days. The majority of participants (80%) intended to continue to use PAI monitoring. Compared with control, the PAI group significantly improved their exercise capacity (mean difference, 95% confidence interval) (63 s, 17.9-108.0 s), sleep time (67.2 min, 7.2-127.1 min), total percent body fat (-1.3%, -2.6% to -0.1%), and gynoid fat percent (-1.5%, -2.6 to -0.5). CONCLUSIONS: The PAI e-Health Program is feasible, acceptable, and efficacious in people with T2D.

Stepped-down intervention programs to promote self-managed physical activity in military service veterans: A systematic review of randomised controlled trials.

OBJECTIVES: A stepped-down program is one where clients transition from the care of a health professional to self-managed care. This study reviewed the effectiveness of stepped-down interventions to promote self-managed physical activity for health in military service veterans. DESIGN: Systematic review. METHODS: Literature searches of 11 electronic databases were performed (up to 28th April 2020) to identify randomised controlled trials that assessed self-managed physical activity interventions in military service veterans. Data were extracted on study characteristics, intervention programs (with strategies mapped against a taxonomy of behaviour change techniques), and physical activity outcomes; secondary outcomes were physical fitness/function, psychosocial health, and cost effectiveness. Study quality was assessed using a 15-item checklist adapted from the TESTEX scale. RESULTS: Searches identified 26 studies (all from the United States; N = 45 to 531 participants) representing 17 intervention programs. Studies were of good quality (M = 10.7; SD = 2.3). More than half (54%) reported positive between-group intervention effects for physical activity outcomes (mean increase of 80 min/week in self-reported physical activity at 10-12 months). Physical fitness/function outcomes improved in 38% of studies, but no studies found significant intervention effects for psychosocial health or cost effectiveness outcomes. Behaviour change techniques most frequently used to elicit physical activity changes were education, goal setting, goal review and self-monitoring. CONCLUSIONS: Stepped-down programs that include specific behaviour change techniques have the potential to promote self-management of physical activity in military service veterans. Multi-national randomised controlled trials that use objective physical activity measures are needed to further build the evidence base.

Associations between indicators of energy intake and expenditure with excess weight and obesity among women in sedentary and less-sedentary jobs.

The aim of this study was to compare the associations between indicators of energy intake and expenditure with excess weight and obesity in women who work full-time in sedentary and less sedentary jobs. Data were from 3444 participants the Australian Longitudinal Study on Women's Health, who reported their weight, dietary intake, physical activity and occupation in 2009 (baseline), and weight in 2012 (follow-up). Participants were categorised as being in a 'less sedentary' or 'sedentary' job, based on occupational activity patterns. Odds of excess weight (BMI ≥ 25) at baseline and of being obese (BMI ≥ 30) at follow-up, by indicators of energy intake and expenditure, were compared in the two occupational groups. In multivariate analyses, high non-work sitting time and saturated fat intake were associated with increased odds of obesity at 3-year follow-up in both occupational groups. In the sedentary job group, high physical activity (in leisure and transport) was associated with a 51% reduction in odds of obesity (OR 0.49, 95%CI 0.25-0.97). In the less-sedentary job group, energy intake and high soft drink consumption were associated with markedly increased odds of obesity (OR 1.67 95%CI 1.07-2.61; OR 2.08 95%CI1.42-3.05, respectively). In this cohort of young Australian women, sedentariness at work did not markedly affect the prevalence of excess weight or obesity. Indicators of high energy intake and low energy expenditure were associated with increased odds of both excess weight and obesity, regardless of sedentariness of occupational group.

Twelve year trajectories of physical activity and health costs in mid-age Australian women.

BACKGROUND: Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women. METHODS: Data from 6953 participants in the Australian Longitudinal Study on Women's Health (born in 1946-1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013-2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs. RESULTS: Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443-3013) and AUD578 (95%CI: 426-729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49-360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232-545). CONCLUSION: Maintaining 'active' PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.

Validity assessment of a portable anthropometer to measure length in 24-month children from the 2015 Pelotas Birth Cohort.

OBJECTIVE: This study aimed to assess the validity of a portable anthropometer against the gold standard among 2-year-old infants from the 2015 Pelotas (Brazil) Birth Cohort. DESIGN: Birth cohort study. SETTING: A fixed Harpenden® infant anthropometer was considered as the gold standard for measuring infant length due to its greater precision and stability. The portable SANNY® (model ES2000) anthropometer was the instrument to be validated. The acceptable mean difference in length between the anthropometers was 0·5 cm. In order to compare length estimates, the interviewers carried out two length measures for each of the anthropometers (fixed and portable) and for each child. The mean of the two lengths was calculated for each anthropometer, and their difference was calculated. PARTICIPANTS: A subsample of 252 24-month-old members of the 2015 Pelotas (Brazil) birth cohort study. RESULTS: Children's mean age was 23·5 months. According to Bland-Altman plot, there were no differences in overall lengths between the portable and the fixed anthropometers, or in lengths according to sex. There was a high overall concordance between the length estimates of the fixed and portable anthropometers (ρ = 0·94; 95 % CI 0·92, 0·95). CONCLUSIONS: The portable anthropometer proved to be accurate to measure the length of 24-month-old infants, being applicable to studies using the same standardised protocol used in the present study.

Prenatal and birth predictors of objectively measured physical activity and sedentary time in three population-based birth cohorts in Brazil.

Physical inactivity is a global pandemic with no signs of improvement. Prolonged sitting time is an emerging risk factor that exacerbates the health consequences of physical inactivity. Both behaviours are influenced by various individual and environmental factors but it remains unknown whether early-life exposures "program" these behaviours in later life. The current evidence is limited by a small number of studies which were primarily conducted in high-income countries, and a narrow range of early-life variables examined. Using data from three population-based Brazilian birth cohorts (analytical samples: n = 2740 for 1982 cohort, aged 30 years; n = 3592 for 1993 cohort, aged 18; n = 2603 for 2004 cohort, aged 6), we show that being female and higher family socioeconomic status at birth are strong and consistent predictors of lower physical activity and higher sedentary time from childhood to adulthood. Meanwhile, higher birth weight and lower birth order may also predict lower physical activity and higher sedentary time. Our findings are distinct from evidence from high-income countries, suggesting the importance of broader socioeconomic context in determining individual's activity patterns through the life- course. Such evidence is essential for understanding the biological etiology and socioeconomic context of physical activity and sedentary behaviour at an early stage in life.

Physical activity and the prevention of chronic illness in the BRICS nations: Issues relating to gender equality.

•More than 70% of all deaths in the BRICS countries are attributable to noncommunicable diseases.•There have been marked changes in physical activity levels, time use, and energy expenditure in these nations over the last 20 years.•There are marked gender differences in physical activity in 4 of the 5 BRICS nations, which largely reflect the overall gender inequalities in these countries.

Trends and inequalities in maternal and child health in a Brazilian city: methodology and sociodemographic description of four population-based birth cohort studies, 1982-2015.

BACKGROUND: Few low-middle-income countries have data from comparable birth cohort studies spanning over time. We report on the methods used by the Pelotas cohorts (1982, 1993, 2004 and 2015) and describe time trends in sociodemographic characteristics of the participant families. METHODS: During the four study years, all maternity hospitals in the city were visited daily, and all urban women giving birth were enrolled. Data on socioeconomic and demographic characteristics were collected using standardized questionnaires, including data on maternal and paternal skin colour, age and schooling, maternal marital status, family income and household characteristics. The analyses included comparisons of time trends and of socioeconomic and ethnic group inequalities. RESULTS: Despite a near 50% increase in the city's population between 1982 and 2015, the total number of births declined from 6011 to 4387. The proportion of mothers aged ≥35 years increased from 9.9% to 14.8%, and average maternal schooling from 6.5 [standard deviation (SD) 4.2] to 10.1 (SD 4.0) years. Treated water was available in 95.3% of households in 1982 and 99.3% in 2015. Three-quarters of the families had a refrigerator in 1982, compared with 98.3% in 2015. Absolute income-related inequalities in maternal schooling, household crowding, household appliances and access to treated water were markedly reduced between 1982 and 2015. Maternal skin colour was associated with inequalities in age at childbearing and schooling, as well as with household characteristics. CONCLUSIONS: During the 33-year period, there were positive changes in social and environmental determinants of health, including income, education, fertility and characteristics of the home environment. Socioeconomic inequality was also reduced.

Descriptive Epidemiology of Uruguayan Adults' Leisure Time Physical Activity.

Policymakers rely on information for describing and monitoring levels of physical activity among the population. However, in Uruguay there is no research presenting physical activity practices nationwide. The present study aims to describe the leisure time physical activity levels and their unequal distribution among Uruguayan adults. Data from the 2014 Uruguayan National Health Survey (n = 3543 adults aged > 15 years) were analysed. Physical activity was measured by questionnaire, with participants reporting the number of days and time spent doing physical activity during leisure time in a typical week. Only 25.1% of the participants met the international recommendations for physical activity. Males were twice as active as females in early adulthood in terms of time. The absolute socioeconomic gap between the poorest and wealthiest income quintiles was around 20 percentage points, and participants with the highest physical activity levels were within the wealthiest and highest-educational levels. A low proportion of the population met the proxy of the international recommendations for physical activity. Important socioeconomic inequalities have been found in physical activity practices and must be considered in public health interventions.

Overall and Leisure-Time Physical Activity Among Brazilian Adults: National Survey Based on the Global Physical Activity Questionnaire.

BACKGROUND: To describe overall physical activity prevalence measured by the Global Physical Activity Questionnaire as well as inequalities in leisure-time physical activity among Brazilian adults (15 y and older). METHODS: Data from the Brazilian Survey on Medicine Access, Utilization, and Rational Use of Medicines were analyzed. The study was carried out between September 2013 and February 2014. Physical activity was measured through Global Physical Activity Questionnaire and classified according to the recommendations of the World Health Organization. Additional analysis determined the contribution of each physical activity domain to the total amount of physical activity. Inequalities in terms of sex, age, and socioeconomic position were explored. RESULTS: About one-third of the participants (37.1%; 95% confidence interval, 35.5-38.8) were physically inactive. Work-based activities were responsible for 75.7% of the overall physical activity. The prevalence of participants achieving physical activity guidelines considering only leisure-time activities was 17.8% (95% confidence interval, 16.7-19.2). Females and older participants were less active than their counterparts for both overall and leisure-time physical activity; socioeconomic status was positively associated to leisure-time physical activity. CONCLUSIONS: Major overall physical activity is attributed to work-related physical activity. Leisure-time physical activity, a key domain for public health, presents important gender and socioeconomic inequalities.

Socioeconomic position and sedentary behavior in Brazilian adolescents: A life-course approach.

Socioeconomic position (SEP) is a potential correlate of sedentary behavior in adolescents. The aim of this study was to examine the associations between SEP and self-reported and objective measures of sedentary behavior in adolescents, using a life-course approach. Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed (N=5249). Cross-sectional and longitudinal associations between multiple SEP indicators (maternal education, family income, SEP composite, cumulative family income) at birth, 11, 15 and 18years, and five sedentary behavior outcomes (≥4h/day screen time; ≥4h/day TV; ≥2h/day computer; ≥2h/day video game; ≥12.7h/day objectively measured sedentary time) at 11, 15 and 18years, were examined. In cross-sectional analyses, higher SEP was positively associated with more screen time at ages 11 and 15years. There was a consistent and positive association between higher SEP with time spent using a computer, and with sedentary time assessed through accelerometry. SEP at birth had a positive and direct effect on screen, computer and total sedentary time at 18years. Participants in the highest cumulative income group had higher odds of high sedentary behavior in screen (OR: 2.40; 95% CI: 1.50-3.54), computer (OR: 7.35; 95% CI: 4.19-12.89) and total sedentary time (OR: 5.40; 95% CI: 3.53-10.35), respectively, compared with their counterparts with lower cumulative income. Our findings showed that SEP is an early determinant of sedentary behavior in adolescents.

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.

Socioeconomic Correlates of Sedentary Behavior in Adolescents: Systematic Review and Meta-Analysis.

BACKGROUND: The body of evidence on associations between socioeconomic status (SES) and sedentary behaviors in adolescents is growing. OBJECTIVES: The overall aims of our study were to conduct a systematic review and meta-analysis of this evidence and to assess whether (1) the associations between SES and sedentary behavior are consistent in adolescents from low-middle-income and from high-income countries, (2) the associations vary by domain of sedentary behavior, and (3) the associations vary by SES measure. METHODS: We performed a systematic literature search to identify population-based studies that investigated the association between SES and sedentary behavior in adolescents (aged 10-19 years). Only studies that presented risk estimates were included. We conducted meta-analyses using random effects and univariate meta-regression and calculated pooled effect sizes (ES). RESULTS: Data from 39 studies were included; this provided 106 independent estimates for meta-analyses. Overall, there was an inverse association between SES and sedentary behavior (ES 0.89; 95 % confidence interval [CI] 0.81-0.98). However, the direction of the association varied: in high-income countries, SES was inversely associated with sedentary behavior (ES 0.67; 95 % CI 0.62-0.73), whereas in low-middle-income countries, there was a positive association between SES and sedentary behavior (ES 1.18; 95 % CI 1.04-1.34). In high-income countries, the associations were strongest for screen time (ES 0.68; 95 % CI 0.62-0.74) and television (TV) time (ES 0.58; 95 % CI 0.49-0.69), whereas in low-middle-income countries, the associations were strongest for 'other' screen time (i.e., computer, video, study time, but not including TV time) (ES 1.38; 95 % CI 1.07-1.79). All indicators of SES were negatively associated with sedentary behavior in high-income countries, but only resources (income and assets indexes) showed a significant positive association in low-middle-income countries. CONCLUSION: The associations between SES and sedentary behavior are different in high- and low-middle-income countries, and vary by domain of sedentary behavior. These findings suggest that different approaches may be required when developing intervention strategies for reducing sedentary behavior in adolescents in different parts of the world.

Health promoting practices and personal lifestyle behaviors of Brazilian health professionals.

BACKGROUND: This study was conducted to examine the lifestyle behaviors and health promoting practices of physicians, nurses, and community health workers in Brazil. METHODS: A random sample of primary health care units in Brazil was selected, and a pretested questionnaire was administered via phone interviews, in 2011, to 182 physicians, 347 nurses, and 269 community health workers, totaling 798 health professionals. The total initial sample included 1600 eligible health professionals. Variables measured included physical activity, alcohol intake, hours of sleep, diet, and perceived self-efficacy to provide preventive counseling on related lifestyle behaviors. RESULTS: More than 25 % of physicians, nurses, and community health workers reported eating 0-2 portions of fruits and vegetables per day. In terms of cervical and breast cancer, nurses reported to be 'very prepared' to advise patients on these topics more frequently than physicians. The prevalence of smoking ranged from 4.9 % among nurses to 7.4 % among community health workers. The proportion of physical inactivity ranged from 40.3 % among nurses to 52.1 % among community health workers. CONCLUSION: A reasonably high proportion of physicians, nurses, and community health workers report not engaging in healthy lifestyle behaviors that impact chronic diseases, thus, they may be less likely to encourage such behaviors in their patients.

Brazilian adults' sedentary behaviors by life domain: population-based study.

BACKGROUND: There is rapidly-emerging evidence on the harmful health effects of sedentary behaviors. The aim of this paper was to quantify time in sedentary behaviors and document socio-demographic variations in different life domains among adults. METHODS: A population-based survey was carried out in 2012 through face-to-face interviews with Brazilian adults aged 20+ years (N = 2,927). Information about time spent sedentary in a typical weekday was collected for five different domains (workplace, commuting, school/university, watching TV, and computer use at home). Descriptive and bivariate analyses examined variations in overall and domain-specific sedentary time by gender, age, educational attainment and socioeconomic position. RESULTS: On average, participants reported spending 5.8 (SD 4.5) hours per day sitting. The median value was 4.5 (interquartile range: 2.5-8) hours. Men, younger adults, those with higher schooling and from the wealthiest socioeconomic groups had higher overall sedentary scores. TV time was higher in women, older adults and among those with low schooling and socioeconomic position. Sedentary time in transport was higher in men, younger adults, and participants with high schooling and high socioeconomic position. Computer use at home was more frequent among young adults and those from high socioeconomic groups. Sitting at work was higher in those with higher schooling and from the wealthiest socioeconomic groups. Sedentary behavior at school was related inversely to age and directly to schooling. CONCLUSION: Patterns of sedentary behavior are different by life domains. Initiatives to reduce prolonged sitting among Brazilian adults will be required on multiple levels for different life domains.