Mapping recommended strategies to promote active and healthy lifestyles through physical education classes: a scoping review.

BACKGROUND: Understanding which strategies have been recommended for the promotion of active and healthy lifestyles through physical education (PE) classes can guide PE policies and practice. Therefore, we summarized worldwide recommendations regarding strategies for PE classes that have aimed to promote active and healthy lifestyles among school-aged children and adolescents. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were utilized. A literature search was carried out in June 2020 in eight peer-reviewed literature databases, in addition to searches in institutional and personal libraries. The eligibility criteria included any online document that included recommendations targeting any dimension of PE classes (e.g., policy and environment, curriculum, appropriate instruction, student assessment, and strategies that interact with PE) published since 2000. RESULTS: In total, 2,408 potentially eligible documents were screened. Of these, 63 were included in the final analysis. The recommended strategies were as follows: six referred to policy and environment (valuing PE, higher frequency and duration of classes, inclusive PE classes, mandatory daily classes, evaluation of PE classes, and qualified teachers), five to curriculum (structure, type of content, cross-cutting themes, and components that improve PE classes), four to appropriate instruction (promotion of physical activities, inclusion of social issues, employment of the use of innovative technologies, and organization of the teaching-learning process), and three to student assessment (understanding human movement concepts, evaluation of contents, and assessment methods to develop an active and healthy lifestyle). CONCLUSION: Twenty-one strategies recommended for PE classes linked to five dimensions aimed at different target populations were identified. Over half were linked to the dimensions of policy and environment and appropriate instruction. PE is recommended to be mandatory and valued at all educational levels, with weekly frequency that contributes to an active and healthy lifestyle. This review shows that guaranteeing different experiences beyond sports, improving social inclusion, using innovative technologies, and providing adequate materials and spaces to be important challenges and ways to guide policies, programs, and new research in this field of knowledge. Open Science Framework Registration: https://osf.io/harwq/.

Physical activity levels objectively measured among older adults: a population-based study in a Southern city of Brazil.

BACKGROUND: Low levels of physical activity are currently observed in all age groups around the world. Among older adults physical activity is even lower, potentially influencing quality of life, incidence of diseases and premature mortality. The aim of this study was to describe objectively measured physical activity levels among older adults residents in a Southern city of Brazil. METHODS: A population-based study was carried out including people aged 60+ years living in the urban area of Pelotas. Face-to-face interviews, anthropometric measures and triaxial accelerometry (non-dominant wrist) were used to collect sociodemographic, anthropometric and physical activity, respectively. For descriptive purposes, overall physical activity was expressed as daily averages of acceleration. Time spent in light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) using different bout criteria (non-bouted, and in 1-, 5- and 10-min bouts) were calculated. Crude and adjusted analyses were performed using simple linear regression to examine the association between physical activity and exposure variables. RESULTS: Overall, 971 individuals provided valid accelerometry data. Women spent on average more time on LPA (136.2 vs. 127.6 min per day). Men and women respectively accumulated, in average, 64.5 and 56.7 min per day of non-bouted MVPA, while these daily averages were 14.9 and 9.46 min using 5-min, and 8.1 and 4.5 min using 10-min bout MVPA. In adjusted analyses, men aged 80 years or more spent in average 45 min less LPA per day when compared to men 60-69 years and, among women, this difference was 65 min. Considering time in 5-min MVPA bouts, the youngest age group and those with a better self-perceived health accumulated more MVPA. Specifically among men, socioeconomic status was inversely associated with 5-min bout MVPA. CONCLUSION: The present study showed low levels of physical activity among Brazilian older adults, even lower in more advanced ages, and a different pattern for physical activity intensity between men and women.

Physical activity throughout adolescence and body composition at 18 years: 1993 Pelotas (Brazil) birth cohort study.

BACKGROUND: Adolescence is a period of accelerated development and increases in body composition. Physical activity (PA) practice has been associated with the development of major components of body composition (bone, muscle and fat). However, the longitudinal effects of PA of different intensities during adolescence are still not well understood. Thus, the main goal this study has investigate the association between practice of moderate- and vigorous-intensity physical activity throughout adolescence and body composition, specifically lean mass (LM) and fat mass (FM), at age 18. METHODS: In this cohort study, physical activity was measured at 11, 15 and 18 years, using questionnaires. Thresholds of 300, 150 and 75 min per week, were used for MVPA, moderate- and vigorous-intensity physical activity, respectively. Consistent physical activity was defined as reaching the thresholds at the three follow-ups. FM and LM at age 18 were assessed by DXA and expressed as fat mass (FMI) and lean mass (LMI) indexes. To verify the association between the trajectories of MVPA, moderate- and vigorous-intensity physical activity in adolescence and FM and LM at 18, multivariate analyses were performed through multiple linear regressions adjusted for co-variables. RESULTS: A total of 3,176 adolescents were evaluated. The consistent practice of moderate- and vigorous-intensity physical activity according to thresholds during adolescence were directly related to the LMI in boys (moderate-intensity - ß = 0.40 and CI95 % 0.13; 0.68 and vigorous-intensity - ß = 0.95 and CI95 % 0.69; 1.21) and girls (Moderate-intensity - ß = 0.23 and CI95 % 0.02; 0.45 and vigorous-intensity - ß = 0.80 and CI95 % 0.29; 1.32). Practice of vigorous-intensity physical activity alone showed to be inversely associated with the FMI in boys (ß = -0.53 and CI95 % -0.96;-0.10). CONCLUSION: Consistent physical activity practice during adolescence was associated with greater lean mass in both sexes. In boys, vigorous-intensity physical activity was associated with less fat mass.

Is Binge Drinking Associated With Specific Types of Exercise and Free Time Sports? A Pooled Analysis With 718,147 Adults.

OBJECTIVE: To verify the association between exercise and free time sport types and binge drinking in a large sample of adults. METHODS: Data of 718,147 adults from the "Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey" were used. We described the demographic and behavioral variables, and negative binomial regression analyzed the association between exercise and free time sport types and binge drinking adjusted by demographics variables, body mass index status, and television time. RESULTS: Outdoor walking/running was the most common exercise reported (20.0%, 95% confidence interval [CI], 19.8%-20.2%), followed by team sports (8.1%; 95% CI, 8.0%-8.2%) and strengthening (8.0%; 95% CI, 7.9%-8.1%). The prevalence of binge drinking for each exercise and free time sport type ranged from 6.9% (water aerobics) to 31.9% (team sports). Participants engaging in strengthening (prevalence ratio = 1.12; 95% CI, 1.04-1.21, P = .002) and team sports (prevalence ratio = 1.11; 95% CI, 1.07-1.17, P < .001) were more likely to binge drink more frequently in the past 30 days than inactive participants. CONCLUSIONS: It appears that the participants' profile plays an important role in the underlying social context of this association. Participants with more frequent strengthening and less frequent team sports practice, who were primarily younger and single, were more likely to binge drink frequently.

Physical Education for Health Among School-Aged Children and Adolescents: A Scoping Review of Reviews.

BACKGROUND: Physical education (PE) classes in schools are considered relevant to implement interventions, especially focused on physical activity. However, evidence overviews on how PE classes contribute to general health (physical, social, affective, and cognitive domains) are still needed. Thus, we summarized evidence synthesis (eg, systematic reviews) that addressed the contribution of PE classes to the health of school-aged children and adolescents. METHODS: We performed a scoping review with searches in 8 databases and institutional websites to find systematic reviews or meta-analyses that answered this review's research question. Data charting form included the identification of the study, health outcomes, and PE classes' strategies (policies and environment, curriculum, appropriate instructions, and evaluation). An interactive process was performed to build the evidence summary. RESULTS: An initial search yielded 2264 titles, and 49 systematic reviews (including 11 with meta-analysis) were included in this review. Most documents reported the main benefits of PE classes on physical domain outcomes (eg, physical activity, cardiorespiratory fitness, body mass index, and fundamental motor skills). However, evidence on the benefits of PE classes in affective (eg, enjoyment, motivation, and autonomy); social (eg, cooperation, problem-solving, and making friends); and cognitive (eg, memory, attention, concentration, and decision making) domains were found. Strategies on PE classes for health benefits were highlighted. CONCLUSIONS: These elements were detailed in the evidence summary, which may be considered to guide researchers, teachers, and practitioners to define research and practice priorities on PE class interventions for health in the school context.

Efeitos dos modelos pedagógicos do esporte sobre desfechos cognitivos e de habilidades motoras: uma revisão sistemática / Effects of model-based sport teaching on students' cognitive and motor skills outcomes: a systematic review

RESUMO A presente revisão sistemática tem por objetivo identificar e sumarizar estudos que analisaram os efeitos de intervenções que utilizaram modelos de ensino do esporte (MEE) em aulas de educação física sobre desfechos cognitivos e habilidades motoras. Foram definidas seis bases como fontes de dados: (a) SportDiscus; (b) Scielo; (c) Web of Science; (d) Scopus; (e) ERIC e (f) PsycInfo. A pesquisa inicial foi realizada com os seguintes termos: "Pedagogical Model" OR, "Education Model" OR, "Teaching Games" AND, "Sports" AND, "Physical Education". Os 24 artigos analisados atenderam aos seguintes critérios: (a) estudos de intervenção com análise quantitativa ou mista; (b) realizados durante aulas de educação física; e, (c) com objetivo de verificar os efeitos dos modelos sobre os desfechos cognitivos ou de habilidades motoras. A análise de viés/qualidade dos estudos foi realizada a partir da escala PEDro. Foram encontradas intervenções com o Sport Education Model (SEM - 41,7%), Teaching Games for Understanding (TGfU - 33,3%), Tactical Games (TG - 4,2%) e Modelos Híbridos (MH - 20,8%). Os resultados indicam efeitos positivos dos três modelos (SEM, TGfU/TG e MH) sobre a performance no jogo e tomada de decisão. O SEM ainda apresentou efeito positivo sobre envolvimento no jogo, conhecimento e execução de habilidades, sendo o MEE com mais desfechos com resultados positivos. Futuras investigações devem ter em conta os seguintes fatores intervenientes: sexo, nível de habilidade, grupos de ensino, experiência docente, tempo e conteúdo da unidade.

ABSTRACT This systematic review aims to identify and summarize studies that analyzed the effects of interventions that used sports teaching models (STM) in physical education classes on cognitive and motor skills outcomes. Six bases were defined as data sources: (a) SportDiscus; (b) Scielo; (c) Web of Science; (d) Scopus; (e) ERIC and (f) PsycInfo. The initial search was carried out with the following terms: "Pedagogical Model" OR, "Education Model", OR, "Teaching Games" AND, "Sports" AND, "Physical Education". The 24 articles analyzed met the following criteria: (a) intervention studies with quantitative or mixed analysis; (b) performed during physical education classes; and, (c) aim to verify the effects of STM on cognitive or motor skills outcomes. The analysis of bias/quality of the studies was performed based on the PEDro scale. Interventions were found with the Sport Education Model (SEM - 41.7%), Teaching Games for Understanding (TGfU - 33.3%), Tactical Games (TG - 4.2%) and Hybrid Models (HM - 20.8%). The results indicate positive effects of the three models (SEM, TGfU/TG and HM) on game performance and decision-making. SEM still had a positive effect on game involvement, knowledge and skill execution, with STM with more outcomes with positive results. Future investigations should consider intervening factors such as sex, skill level, teaching groups, teacher experience, time and unit content.

Metabolic equivalent of task (METs) thresholds as an indicator of physical activity intensity.

The purpose of the study was to identify and compare validity parameters of different absolute intensity thresholds in METs, using relative intensity classification as criterion measure. Convenience sampling was used to recruit total of 112 adults. The participants carried out an incremental maximal cycle ergometer test and asked to perform nine free-living activities. The oxygen uptake was measured by a VO2000® gas analyser throughout the tests. The intensity thresholds were identified using Receiver Operator Characteristic (ROC) curve analysis, having relative intensity categories as criterion measure. A total of 103 participants attended the two visits. Among 54 men and 49 women, the mean (± SD) ages were 36.1 (± 11.1) and 33.9 (± 10.6) years, respectively. The intensity thresholds identified were 4.9 METs for moderate and 6.8 METs for vigorous physical activity. In conclusion, the physical activity thresholds, generated according to the entire sample, were higher and presented improved specificity when compared to thresholds currently recommended. Moreover, these parameters presented relatively high accuracy, even when applied to specific groups such as sex, age, nutritional status and physical fitness.

Inequalities in multimorbidity among elderly: a population-based study in a city in Southern Brazil.

Lower socioeconomic level is positively related to multimorbidity and it is possible that the clustering of health conditions carries the same association. The aim of this study was to identify prevalence of multimorbidity and clusters of health conditions among elderly, as well the underlying socioeconomic inequalities. This was a cross-sectional population-based study carried out with 60-year-old individuals. Multimorbidity was defined as the presence of 2+, 3+, 4+ or 5+ health conditions in the same individual. Schooling levels and the National Economic Index were used to investigate inequalities in the prevalence of multimorbidities among elderly. Slope and concentration indexes of inequality were used to evaluate absolute and relative differences. A factorial analysis was performed to identify disease clusters. In every ten older adults, about nine, eight, seven and six presented, respectvely, 2+, 3+, 4+ and 5+ health conditions. Three clusters of health conditions were found, involving musculoskeletal/mental/functional disorders, cardiometabolic, and respiratory factors. Higher inequalities were found the higher amount of health conditions (5+), when considering economic level, and for 3+, 4+ and 5+, when considering educational level. These findings show high multimorbidity prevalence among elderly, highlighting the persistence of health inequalities in Southern Brazil. Strategies by the health services need to focus on elderly at lower socioeconomic levels.

Calibration of raw accelerometer data to measure physical activity: A systematic review.

Most of calibration studies based on accelerometry were developed using count-based analyses. In contrast, calibration studies based on raw acceleration signals are relatively recent and their evidences are incipient. The aim of the current study was to systematically review the literature in order to summarize methodological characteristics and results from raw data calibration studies. The review was conducted up to May 2017 using four databases: PubMed, Scopus, SPORTDiscus and Web of Science. Methodological quality of the included studies was evaluated using the Landis and Koch's guidelines. Initially, 1669 titles were identified and, after assessing titles, abstracts and full-articles, 20 studies were included. All studies were conducted in high-income countries, most of them with relatively small samples and specific population groups. Physical activity protocols were different among studies and the indirect calorimetry was the criterion measure mostly used. High mean values of sensitivity, specificity and accuracy from the intensity thresholds of cut-point-based studies were observed (93.7%, 91.9% and 95.8%, respectively). The most frequent statistical approach applied was machine learning-based modelling, in which the mean coefficient of determination was 0.70 to predict physical activity energy expenditure. Regarding the recognition of physical activity types, the mean values of accuracy for sedentary, household and locomotive activities were 82.9%, 55.4% and 89.7%, respectively. In conclusion, considering the construct of physical activity that each approach assesses, linear regression, machine-learning and cut-point-based approaches presented promising validity parameters.

[Simultaneity of risk factors for chronic non-communicable diseases in the elderly in Pelotas, Rio Grande do Sul State, Brazil]. / Simultaneidade de fatores de risco para doenças crônicas não transmissíveis entre idosos da zona urbana de Pelotas, Rio Grande do Sul, Brasil.

This study aimed to describe the simultaneity of risk factors for chronic non-communicable diseases among the elderly (≤ 60 years) in a city in Southern Brazil. This was a cross-sectional, population-based study of 1,451 elderly in 2013. Cluster analysis was applied to selected risk factors (smoking, alcohol consumption, excess weight, and physical inactivity). Logistic regression was used to assess the association between simultaneity of risk factors and socio-demographic variables. The most frequent cluster in men (18.1%) and women (30.7%) was physical inactivity + excess weight. The cluster alcohol consumption + excess weight exceeded the expected level in men (O/E = 1.27; 95%CI: 1.01; 1.59) and women (O/E = 1.72; 95%CI: 1.35; 2.20). The presence of two or more risk factors in the elderly population (88.1%) points to the need for specific interventions for this population to fight risk factors simultaneously rather than separately.

Educação física escolar: Guia de Atividade Física para a População Brasileira / Physical Education: Physical Activity Guidelines for the Brazilian Population

As aulas de educação física (EF) escolar representam um momento propício para conhecer e viven-ciar a pluralidade do movimento humano, favorecendo a promoção de uma vida ativa e saudável. A importância da EF escolar foi reconhecida pelo Guia de Atividade Física para a População Brasileira (Guia), que dedicou um capítulo para orientar a comunidade escolar sobre os benefícios à saúde e as estratégias de sucesso adotadas nas aulas de EF escolar. O objetivo deste estudo é apresentar o processo de elaboração das recomendações brasileiras de EF escolar para a população brasileira, mais especificamente os estudantes, professores, pais e responsáveis, e gestores. Esse capítulo do Guia foi desenvolvido por dez pesquisadores brasileiros, incluindo um representante do Ministério da Saúde. Três sínteses de evidências, escutas ao público-alvo e consulta pública foram realizadas para a construção das recomendações. Dados de 49 revisões sistemáticas sobre os benefícios da EF escolar à saúde e de 22 intervenções nas aulas de EF escolar com estudantes brasileiros foram sumarizados. Ainda, foram sintetizados 63 documentos nacionais e internacionais com estratégias recomendadas para a EF escolar, com foco nas dimensões: política e ambiente; currículo; instrução apropriada; avaliação; e estratégias que interagem com a EF escolar. Os grupos focais e a consulta pública fun-damentaram a elaboração e o aprimoramento da versão final das recomendações. Espera-se que estas recomendações alicercem a criação de políticas públicas, melhorem a conscientização sobre a importância da prática de atividade física na EF escolar e enfatizem a necessidade de realizar estudos futuros nesta área de conhecimento

Physical Education (PE) classes represent an appropriate time to know and experience the plurality of the human movement, favoring the promotion of a healthy and active life. The importance of PE was recognized by the Physical Activity Guide for the Brazilian Population, which dedicated a chapter to guide the school community on the health benefits and successful strategies adopted in PE classes. This study aimed to show the process of elaborating Brazilian recommendations for PE for the Brazilian population, more specifically students, teachers, parents and guardians, and managers. This chapter of the Guide was developed by ten Brazilian researchers, including a spokeswoman of the Ministry of Health. Three syntheses of evidence, focus groups/interviews and public consultation were carried out to construct the recommendations. Data from 49 systematic reviews on the health benefits of PE and 22 interventions in PE classes with Brazilian students were summarized. Also, 63 documents were synthesized with strategies recommended for PE classes, focusing on the dimensions: politics and environment; curriculum; appropriate instruction; evaluation; and strategies that interact with PE. The focus groups and the public consultation were the basis for the elaboration and improvement of the final version of the recommendations. It is expected that these recommendations can assist the creation of public policies, the improvement of practice PE and the need to conduct future studies in this area of knowledge

Longitudinal Association Between Physical Activity and Body Fat During Adolescence: A Systematic Review.

BACKGROUND: Physical activity (PA) practice has been inversely associated to body fat (BF) and recommended as a way to reduce and prevent obesity. The objective of this study was to conduct a systematic review on the association of PA and BF in adolescence. METHODS: The review includes 18 longitudinal studies found in the PubMed database, comprising papers published from January 1990 to July 2014. Studies assessing BF only through body mass index were excluded. RESULTS: Among the outcomes analyzed, waist circumference, skinfolds, and absolute and relative fat mass measurement were identified. Questionnaires were the more predominant way to evaluate PA. Most studies showed that PA promotes a protective effect against a higher BF gain. CONCLUSION: It was concluded that PA has a protective effect against BF with differences between the genders and according to the BF marker or measurement assessed; higher intensity PA leads to a greater effect against BF gain in both genders; and the maintenance or increase of PA level on BF observed through analysis of change in PA level yielded more consistent findings in the relation between PA and BF.

Physical Activity at 11 Years of Age and Incidence of Mental Health Problems in Adolescence: Prospective Study.

AIM: To evaluate the longitudinal association between physical activity behavior at 11 years of age and the incidence of mental health problems from 11 to 15 years of age. METHODS: Individuals born in the city of Pelotas, Brazil, in 1993 have been followed up since birth. At 11 and 15 years of age, mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ). At 11 years of age, physical activity was assessed through a validated questionnaire. The continuous SDQ score at 15 years was used as the outcome variable. The main exposure was physical activity behavior at 11 years of age divided into 3 categories (0, 1-299, ≥ 300 min/wk). RESULTS: The incidence of mental health problems from 11 to 15 years was 13.6% (95% CI, 12.4-14.9). At 11 years, 35.2% of the adolescents achieved 300 min/wk of physical activity. In the unadjusted analysis, physical activity was inversely related to mental health problems (P = .04). After adjustment for confounders, the association was no longer significant in the whole sample but was still significant among boys. CONCLUSION: Physical activity appears to be inversely related to mental health problems in adolescence, but the magnitude of the association is weak to moderate.

Longitudinal and cross-sectional associations of physical activity with triglyceride and HDLc levels in young male adults.

BACKGROUND: The purpose of this study was to evaluate cross-sectional and longitudinal associations between physical activity and triglyceride and HDLc levels in young male adults. METHODS: We used information about males belonging 1982 Pelotas Birth Cohort. Physical activity in 4 domains (leisure time, transportation, household, and occupation) was assessed by self-report in participants of the cohort at ages of 18 and 23 years. Subjects were active if reached the recommendation of 150 min/week of moderate to vigorous physical activity. At 23 years of age, blood sample was collected, and triglycerides and HDLc levels estimated. Multivariate linear and Poisson regression were used to adjust the estimates for confounders. RESULTS: Males who were inactive at 18 and active at 23 years had 41% lower risk (ß = 0.59; 95% confidence interval: 0.40; 0.89) for borderline-high triglycerides (≥ 150 mg/dL) as compared with those who were inactive at both follow-ups. No association was found between changes of physical activity and HDLc level. In cross-sectional analyses, greater HDLc levels were found in active subjects in 4 domains, whereas there was no difference in HDL levels according physical activity during leisure time. CONCLUSION: Becoming active from adolescence to early adulthood reduced the risk for high triglycerides. Current physical activity was associated with greater HDLc levels.

Physical activity levels in three Brazilian birth cohorts as assessed with raw triaxial wrist accelerometry.

BACKGROUND: Data on objectively measured physical activity are lacking in low- and middle-income countries. The aim of this study was to describe objectively measured overall physical activity and time spent in moderate-to-vigorous physical activity (MVPA) in individuals from the Pelotas (Brazil) birth cohorts, according to weight status, socioeconomic status (SES) and sex. METHODS: All children born in 1982, 1993 and 2004 in hospitals in the city of Pelotas, Brazil, constitute the sampling frame; of these 99% agreed to participate. The most recent follow-ups were conducted between 2010 and 2013. In total, 8974 individuals provided valid data derived from raw triaxial wrist accelerometry. The average acceleration is presented in milli-g (1 mg = 0.001g), and time (min/d) spent in MVPA (>100 mg) is presented in 5- and 10-min bouts. RESULTS: Mean acceleration in the 1982 (mean age 30.2 years), 1993 (mean age 18.4 years) and 2004 (mean age 6.7 years) cohorts was 35 mg, 39 mg and 60 mg, respectively. Time spent in MVPA was 26 [95% confidence interval (CI) 25; 27], 43 (95% CI 42; 44) and 45 (95% CI 43; 46) min/d in the three cohorts, respectively, using 10-min bouts. Mean MVPA was on average 42% higher when using 5-min bouts. Males were more active than females and physical activity was inversely associated with age of the cohort and SES. Normal-weight individuals were more active than underweight, overweight and obese participants. CONCLUSIONS: Overall physical activity and time spent in MVPA differed by cohort (age), sex, weight status and SES. Higher levels of activity in low SES groups may be explained by incidental physical activity.

Atividade física e estresse psicológico em adolescentes: revisão sistemática / Physical activity and psychological stress in adolescents: systematic review

O objetivo do estudo foi revisar sistematicamente a literatura sobre a associação entre a prática de atividade física e estresse em adolescentes. Foram analisadas as bases de dados da PubMed/MEDLINE, Web of Science, SPORTDiscus, LILACS, PsycInfo, e ADOLEC. Foi realizada a avaliação da qualidade metodológica dos artigos e todo o processo de revisão foi realizado por pares. Foram identificados 19.460 títulos, onde 176 resumos foram analisados e 104 artigos apreciados na íntegra. Ao final do processo, 11 artigos foram incluídos, cuja avaliação da qualidade metodológica apresentaram em média 9,0 (DP 1,5) pontos de 14 itens avaliados. Independente da direcionalidade, os estudos indicaram uma associação inexistente ou de pequena magnitude entre a prática de atividade física e o estresse (ou estresse psicológico) entre adolescentes investigados com delineamentos observacionais distintos. Estudos experimentais parecem demonstrar um efeito positivo da atividade física sobre o estresse. Maiores evidências sobre o tema ainda são necessárias, considerando diferentes aspectos do contexto familiar e do ambiente, temporalidade das associações e maior diversidade de práticas de atividade física nos estudos experimentais.(AU)

The objective of this study was to systematically review the literature on the association between the practice of physical activity and stress in adolescents. The databases were analyzed of PubMed/MEDLINE, Web of Science, SPORTDiscus, LILACS, PsycInfo, and ADOLEC. The assessment of the methodological quality of the articles and the entire process of review was performed by peers. 19,460 titles were identified, where 176 abstracts were analyzed and 104 articles assessed in full. At the end of the process, 11 articles were included, whose assessment of the methodological quality presented on average 9.0 (DP 1.5) 14 items points. Regardless of directionality, the studies indicated a nonexistent or small magnitude association between the practice of physical activity and stress (or psychological stress) among adolescents investigated with observational distinct designs. Experimental studies seem to demonstrate a positive effect of physical activity on stress. Major evidence on the subject are still required, considering different aspects of family and environmental context, timeliness of associations and greater diversity of practice of physical activity in experimental studies.(AU)

Inequalities in multimorbidity among elderly: a population-based study in a city in Southern Brazil / Desigualdades na ocorrência de multimorbidade entre idosos: um estudo populacional em um município no Sul do Brasil / Desigualdades en multimorbilidad entre ancianos: estudio basado en la población de una ciudad del sur de Brasil

Lower socioeconomic level is positively related to multimorbidity and it is possible that the clustering of health conditions carries the same association. The aim of this study was to identify prevalence of multimorbidity and clusters of health conditions among elderly, as well the underlying socioeconomic inequalities. This was a cross-sectional population-based study carried out with 60-year-old individuals. Multimorbidity was defined as the presence of 2+, 3+, 4+ or 5+ health conditions in the same individual. Schooling levels and the National Economic Index were used to investigate inequalities in the prevalence of multimorbidities among elderly. Slope and concentration indexes of inequality were used to evaluate absolute and relative differences. A factorial analysis was performed to identify disease clusters. In every ten older adults, about nine, eight, seven and six presented, respectvely, 2+, 3+, 4+ and 5+ health conditions. Three clusters of health conditions were found, involving musculoskeletal/mental/functional disorders, cardiometabolic, and respiratory factors. Higher inequalities were found the higher amount of health conditions (5+), when considering economic level, and for 3+, 4+ and 5+, when considering educational level. These findings show high multimorbidity prevalence among elderly, highlighting the persistence of health inequalities in Southern Brazil. Strategies by the health services need to focus on elderly at lower socioeconomic levels.

O nível socioeconômico baixo está relacionado diretamente à multimorbidade, e é possível que a aglomeração de morbidades apresente a mesma associação. O estudo teve como objetivo identificar a prevalência da multimorbidade e de clusters de morbidades entre idosos, além das desigualdades socioeconômicas subjacentes. Este foi um estudo transversal de base populacional em indivíduos com 60 anos ou mais. Multimorbidade foi definida como a presença de 2+, 3+, 4+ ou 5+ condições de saúde no mesmo indíviduo. O nível de escolaridade e o Índice Econômico Nacional foram usados para medir desigualdades na prevalência de multimorbidade entre idosos. Foram utilizados os índices de desigualdades slope e concentration para avaliar as diferenças absolutas e relativas. A análise fatorial foi realizada para identificar clusters de doenças. Em cada dez idosos, nove, oito, sete e seis apresentavam 2+, 3+, 4+ e 5+ condições de saúde, respectivamente. Foram identificados três clusters de morbidades, correspondendo aos transtornos musculoesqueléticos/mentais/funcionais e doenças cardiometabólicas e respiratórias. Maiores desigualdades foram encontradas para o maior número de condições de saúde (5+), considerando nível economômico, e para 3+, 4+ e 5+, considerando nível de escolaridade. Os achados revelam a alta prevalência de multimorbidade entre idosos, destacando a persistência de desigualdades de saúde no Sul do Brasil. As estratégias dos serviços de saúde devem priorizar os idosos de nível socioeconômico mais baixo.

Un nivel socioeconómico más bajo está positivamente relacionado con la multimorbilidad y es posible que la acumulación de estos problemas de salud provenga de esta misma asociación. El objetivo de este estudio fue identificar la prevalencia de multimorbilidad y los grupos de afecciones de salud entre ancianos, así como sus inequidades socioeconómicas subyacentes. Se trata de un estudio transversal, basado en población, que se llevó a cabo con personas de 60 años. Multimorbilidad se definió como la presencia de 2+, 3+, 4+ ó 5+ condiciones de salud en el mismo individuo. Los niveles de escolaridad y el Índice Económico Nacional fueron utilizados para investigar inequidades en la prevalencia de multimorbilidad entre ancianos. Los índices de inequidad slope y concentration se usaron para evaluar las diferencias absolutas y relativas. Se realizó un análisis factorial para identificar los grupos de enfermedades. En cada diez ancianos, nueve, ocho, siete y seis tenían 2+, 3+, 4+ y 5+ condiciones de salud, respectivamente. Se encontraron tres grupos de afecciones de salud, que conllevaban enfermedades musculoesquelético/mental/funcionales, cardiometabólicas, además de factores respiratorios. Se encontraron mayores desigualdades para el mayor número de condiciones de salud (5+), cuando se consideraba el nivel económico, y para 3+, 4+ y 5+, cuando se tenía en consideración el nivel educativo. Estos hallazgos mostraron una alta prevalencia de multimorbilidad entre adultos de avanzada edad, resaltando la persistencia de inequidades de salud en el sur de Brasil. Las estrategias por parte de los servicios de salud necesitan centrarse en ancianos con niveles socioeconómicos más bajos.

[Methodological description of accelerometry for measuring physical activity in the 1993 and 2004 Pelotas (Brazil) birth cohorts]. / Descrição metodológica do uso de acelerometria para mensurar a prática de atividade física nas coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 1993 e 2004.

The aim of this study was to characterize the methodology of data collection on physical activity using accelerometry in two birth cohorts (2004 and 1993) in Pelotas, Rio Grande do Sul State, Brazil, at the 6-7 and 18-year follow-up visits, respectively. During visits to the study headquarters for a health evaluation, cohort subjects received the accelerometer to be worn on the wrist for 5 to 8 days, after which the device was retrieved at their homes. Genea and GENEActiv triaxial estimators of gravity (g) acceleration were employed. Accelerometry data were collected from 3,331 children (93.7% of those included in follow-up) and 3,816 adolescents (99% of those in follow-up). The study characterizes the data collection methodology in more than 7,000 individuals and discusses issues in its implementation. It thus provides a methodological framework aimed at helping to plan future population-based studies with the use of such technology and to improve understanding of physical activity in the context of epidemiological studies.

Simultaneidade de fatores de risco para doenças crônicas não transmissíveis entre idosos da zona urbana de Pelotas, Rio Grande do Sul, Brasil / Simultaneity of risk factors for chronic non-communicable diseases in the elderly in Pelotas, Rio Grande do Sul State, Brazil / Simultaneidad de factores de riesgo para enfermedades crónicas no transmisibles entre ancianos de la zona urbana de Pelotas, Río Grande do Sul, Brasil

Resumo: O objetivo do estudo foi descrever a simultaneidade de fatores de risco para doenças crônicas não transmissíveis em idosos (60 anos ou mais), residentes em uma cidade do Sul do Brasil. Trata-se de um estudo transversal, de base populacional, realizado em 1.451 idosos em 2013. Com uma abordagem de análise de clusters, foi avaliado o agrupamento entre os fatores de risco em estudo (tabagismo, consumo de álcool, excesso de peso e inatividade física). Para a avaliação da associação da simultaneidade dos fatores de risco com variáveis sociodemográficas, foi utilizada regressão logística. O agrupamento mais frequente entre os homens (18,1%) e mulheres (30,7%) foi inatividade física + excesso de peso. As combinações consumo de álcool + excesso de peso excederam o esperado entre os homens (O/E = 1,27; IC95%: 1,01; 1,59) e mulheres (O/E = 1,72; IC95%: 1,35; 2,20). A presença de dois ou mais fatores de risco na população idosa (88,1%) aponta para a necessidade de intervenções específicas para esta população voltadas ao combate simultâneo dos fatores de risco e não de forma isolada.

Abstract: This study aimed to describe the simultaneity of risk factors for chronic non-communicable diseases among the elderly (≤ 60 years) in a city in Southern Brazil. This was a cross-sectional, population-based study of 1,451 elderly in 2013. Cluster analysis was applied to selected risk factors (smoking, alcohol consumption, excess weight, and physical inactivity). Logistic regression was used to assess the association between simultaneity of risk factors and socio-demographic variables. The most frequent cluster in men (18.1%) and women (30.7%) was physical inactivity + excess weight. The cluster alcohol consumption + excess weight exceeded the expected level in men (O/E = 1.27; 95%CI: 1.01; 1.59) and women (O/E = 1.72; 95%CI: 1.35; 2.20). The presence of two or more risk factors in the elderly population (88.1%) points to the need for specific interventions for this population to fight risk factors simultaneously rather than separately.

Resumen: El objetivo del estudio fue describir la simultaneidad de factores de riesgo para enfermedades crónicas no transmisibles en ancianos (60 años o más), residentes en una ciudad del Sur de Brasil. Se trata de un estudio transversal, de base poblacional, realizado en 1.451 ancianos en 2013. Con un enfoque de análisis de clusters, fue evaluado el agrupamiento entre los factores de riesgo en un estudio (tabaquismo, consumo de alcohol, exceso de peso e inactividad física). Para la evaluación de la asociación de la simultaneidad de los factores de riesgo con variables sociodemográficas, se utilizó la regresión logística. El agrupamiento más frecuente entre los hombres (18.1%) y mujeres (30,7%) fue inactividad física + exceso de peso. Las combinaciones consumo de alcohol + exceso de peso excedieron lo esperado entre los hombres (O/E = 1,27; IC95%: 1,01; 1,59) y mujeres (O/E = 1,72; IC95%: 1,35; 2,20). La presencia de dos o más factores de riesgo en la población anciana (88,1%) apunta la necesidad de intervenciones específicas para esta población dirigidas al combate simultáneo de los factores de riesgo y no de forma aislada.

Overweight/obesity and physical fitness among children and adolescents.

BACKGROUND: Physical fitness is strongly associated with several positive health indicators among adolescents. However, its association with body mass index status is inconsistent. The aim of this study was to explore the association between overweight/obesity and physical fitness among children and adolescents. METHODS: The design consisted of a cross-sectional study comprising 519 Brazilian students age 7 to 15 years. BMI status was assessed according to sex- and age-specific growth charts. Physical fitness was assessed using 8 tests: sit-and-reach, stationary long jump, 1-minute curl-up, modified pull-up, medicine-ball throw, 9-minute run, 20-m run, and 4-m shuttle-run. RESULTS: Prevalence of overweight and obesity was 24% and 12%, respectively. Boys performed better than girls in all tests, except flexibility. Normal weight students performed better than overweight and obese students in all tests, except the sit-and-reach and the medicine-ball throw. Cardiorespiratory fitness had the strongest association with BMI status. The prevalence of obese subjects classified as "most fit" was less than 10%. CONCLUSIONS: Higher values of body mass index were associated with declines in physical fitness, independent of age. The majority of obese children and adolescents and almost a half of those overweight were classified in the third tertile of physical fitness (least fit).