Effect of hemodiafiltration on measured physical activity: primary results of the HDFIT randomized controlled trial.

BACKGROUND: Dialysis patients are typically inactive and their physical activity (PA) decreases over time. Uremic toxicity has been suggested as a potential causal factor of low PA in dialysis patients. Post-dilution high-volume online hemodiafiltration (HDF) provides greater higher molecular weight removal and studies suggest better clinical/patient-reported outcomes compared with hemodialysis (HD). METHODS: HDFIT was a randomized controlled trial at 13 clinics in Brazil that aimed to investigate the effects of HDF on measured PA (step counts) as a primary outcome. Stable HD patients (vintage 3-24 months) were randomized to receive HDF or high-flux HD. Treatment effect of HDF on the primary outcome from baseline to 3 and 6 months was estimated using a linear mixed-effects model. RESULTS: We randomized 195 patients (HDF 97; HD 98) between August 2016 and October 2017. Despite the achievement of a high convective volume in the majority of sessions and a positive impact on solute removal, the treatment effect HDF on the primary outcome was +538 [95% confidence interval (CI) -330 to 1407] steps/24 h after dialysis compared with HD, and was not statistically significant. Despite a lack of statistical significance, the observed size of the treatment effect was modest and driven by steps taken between 1.5 and 24.0 h after dialysis, in particular between 20 and 24 h (+197 steps; 95% CI -95 to 488). CONCLUSIONS: HDF did not have a statistically significant treatment effect on PA 24 h following dialysis, albeit effect sizes may be clinically meaningful and deserve further investigation.

Impact of hemodialysis and post-dialysis period on granular activity levels.

BACKGROUND: Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing. METHODS: We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days. RESULTS: Among 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p < 0.001), and 4926 ± 3413 on second non-HD days (p = 0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p < 0.001). Patients took 276 more steps and had highest rates of steps/hour 2-h post-HD versus same times on first non-HD days (all p < 0.05). Consistent findings were observed on second non-HD days. CONCLUSIONS: PA was higher within 2-h of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments. TRIAL REGISTRATION: HDFIT was prospectively registered 20 April 2016 on ClinicalTrials.gov (NCT02787161).

Design and methodology of the impact of HemoDiaFIlTration on physical activity and self-reported outcomes: a randomized controlled trial (HDFIT trial) in Brazil.

BACKGROUND: End stage renal disease (ESRD) patients require a renal replacement therapy (RRT) to filter accumulated toxins and remove excess water, which are associated with impaired physical function. Hemodialysis (HD) removes middle-molecular weight (MMW) toxins less efficiently compared to hemodiafiltration (HDF); we hypothesized HDF may improve physical function. We detailed the design and methodology of the HDFIT protocol that is testing whether changing from HD to HDF effects physical activity levels and various outcomes. METHODS: HDFIT is a prospective, multi-center, unblinded, randomized control trial (RCT) investigating the impact of dialysis modality (HDF verses HD) on objectively measured physical activity levels, self-reported quality of life, and clinical/non-clinical outcomes. Clinically stable patients with HD vintage of 3 to 24 months without any severe limitation ambulation were recruited from sites throughout southern Brazil. Eligible patients were randomized in a 1:1 ratio to either: 1) be treated with high volume online HDF for 6 months, or 2) continue being treated with high-flux HD. This study includes run-in and randomization visits (baseline), 3- and 6-month study visits during the interventional period, and a 12-month observational follow up. The primary outcome is the difference in the change in steps per 24 h on dialysis days from baseline to the 6-month follow up in patients treated with HDF versus HD. Physical activity is being measured over one week at study visits with the ActiGraph ( www.actigraphcorp.com ). For assessment of peridialytic differences during the dialysis recovery period, we will analyze granular physical activity levels based on the initiation time of HD on dialysis days, or concurrent times on non-dialysis days and the long interdialytic day. DISCUSSION: In this manuscript, we provide detailed information about the HDFIT study design and methodology. This trial will provide novel insights into peridialytic profiles of physical activity and various self-reported, clinical and laboratory outcomes in ESRD patients treated by high volume online HDF versus high-flux HD. Ultimately, this investigation will elucidate whether HDF is associated with patients having better vitality and quality of life, and less negative outcomes as compared to HD. TRIAL REGISTRATION: Registered on ClinicalTrials.gov on 20 April 2016 ( NCT02787161 ).

Neighborhood safety and physical inactivity in adults from Curitiba, Brazil.

BACKGROUND: Neighborhood safety is one of the environmental aspects that can influence physical activity. We analyzed the association between perceived neighborhood safety and physical inactivity (PI) in adults and examined effect modification according to sociodemographic variables. METHODS: A cross-sectional study was conducted with 1,261 adults (62% women), age 18-69 years from Curitiba, Brazil. RESULTS: The perception of unsafe neighborhood was higher among women, older participants, those classified in the high socioeconomic (SES) group, overweighed and also among those reporting to have PA equipments and children. The association between perception safety of walking during the day and walking for leisure (women PR=1.12 CI95%=1.02-1.22; men PR=0.82 CI95%=0.64-1.05; interaction term PR=1.38 CI95%=1.03-1.83) and safe perception was associated with PI, just in the highest SES group (PR=1.09; CI95%=1.00-1.19; p trend=0.032) when compared with their counterparts (low SES PR=0.99; CI95%=0.90-1.04; p trend=0.785; interaction term PR=1.09; CI95%=1.03-1.15; p trend=0.007). CONCLUSION: The perception of safety in the neighborhood was associated with PI in transport, but this association varies across of sociodemographic variables.

[Projeto ESPAÇOS de Curitiba, Brazil: applicability of mixed research methods and geo-referenced information in studies about physical activity and built environments]. / Projeto ESPAÇOS de Curitiba, Brasil: aplicabilidade de métodos mistos de pesquisa e informações georreferenciadas em estudos sobre atividade física e ambiente construído.

OBJECTIVE: To describe the methods employed to assess the built environment and physical activity (PA) as part of a multicenter international study, and to discuss the challenges faced to obtain the necessary data in the Brazilian context. METHODS: In 2010 a household survey was conducted with adults aged from 20 to 65 years in the city of Curitiba, Brazil. The study involved the used of geo-referenced information to measure walkability in all 2 125 census sectors in Curitiba. Census sectors were categorized by walkability and income, taking into consideration the average income of heads of the family in each sector. Physical activity was assessed by self- report and using an objective measure (accelerometers). RESULTS: Sixteen high walkability and 16 low walkability sectors were studied, with eight high-income and eight low-income sectors in each category. A total of 699 subjects were interviewed and 381 wore accelerometers. The response rate was 66.4% for the interviews and the compliance with accelerometer use was 85.8% (n = 327). CONCLUSIONS: The results show that it is feasible to conduct high-quality studies on physical activity and built environment in the Brazilian context in accordance with international standards.

Methodological design for the assessment of physical activity and sedentary time in eight Latin American countries - The ELANS study.

Worldwide studies of physical activity and sedentary time have historically under-represented low- and middle-income countries due to the lack of surveillance data. The purpose of this paper is to describe the methods and procedures used for the assessment of physical activity and sedentary time in the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud; ELANS). ELANS is a multicentre, cross-sectional and surveillance study of a nationally representative sample from eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela. Two instruments were used to evaluate different domains and intensities of physical activity and sedentary time: self-reported data and a triaxial accelerometer (model GT3X+). ELANS will generate important self-reported and objective information for the Latin American populations, namely:•evidence on the distribution of physical activity and sedentary time across population subgroups (e.g. sex, age, socioeconomic- and educational level). These sets of information will increase the evidence base and can help to inform future intervention strategies in Latin America;•self-reported and objective information on physical activity and sedentary time.

[Accessibility to public spaces for leisure and physical activity in adults in Curitiba, Paraná State, Brazil]. / Acessibilidade a espaços públicos de lazer e atividade física em adultos de Curitiba, Paraná, Brasil.

The study aimed to analyze the association between accessibility to public spaces for leisure activities, availability of equipment for physical exercise in these spaces, and leisure-time physical activity (PA) in adults. A household survey was conducted with 699 adults from 32 census tracts selected according to income and "walkability". Accessibility to public spaces for leisure activities was determined by geoprocessing according to proximity to public spaces for leisure activities and the amount of such spaces within radiuses of 500 and 1,000 meters around the participants' homes. Presence of equipment for physical exercise in these public spaces was assessed by the observation method and classified as: (a) without equipment for physical exercise; (b) with equipment for physical exercise; (c) equipment for physical exercise for adults; and (d) with three or more pieces of equipment for physical exercise. PA was self-reported, and walking was analyzed separately from moderate-vigorous PA, classified in two levels (≥ 10 minutes/week and ≥ 150 minutes/week). The amount of public spaces for leisure activities in a 500-meter radius with one or more pieces of equipment for physical exercise was negatively associated with walking (OR = 0.84, based on ≥ 150 minutes/week). The amount of public spaces for leisure activities in a 1,000-meter radius was positively associated with moderate-vigorous PA (OR = 1.03). The distance to a public space for leisure activities with three or more pieces of equipment for physical exercise (OR = 0.95) was inversely associated with moderate-vigorous PA. Proximity and amount of public spaces for leisure activities are associated with higher levels of moderate-vigorous PA in adults. The combination of methods can help reveal the contribution that access to (and quality of) public spaces for leisure activities can make to PA.

O objetivo do estudo foi analisar a associação entre acessibilidade a espaços públicos de lazer, disponibilidade de equipamentos para atividade física (AF) nestes locais e a prática de atividade física no lazer em adultos. Foi conduzido um inquérito domiciliar com 699 adultos de 32 setores censitários selecionados segundo a renda e "walkability". A acessibilidade a espaços públicos de lazer foi determinada por geoprocessamento segundo a proximidade até os espaços e a quantidade de espaços públicos de lazer contidos nos raios de 500 e 1.000 metros no entorno dos domicílios dos participantes. A presença de equipamentos para AF nos espaços públicos de lazer foi avaliada por método observacional e classificada em: (a) sem equipamento para AF; (b) com equipamento para AF; (c) equipamento para atividade física de adultos; e (d) com três ou mais equipamentos para AF. Essa atividade foi autorreportada e a caminhada analisada separadamente das atividades físicas de intensidade moderada a vigorosa sendo classificada em dois níveis (≥ 10 minutos/semana e ≥ 150 minutos/semana). A quantidade de espaços públicos de lazer, em um raio de 500 metros, com um ou mais equipamentos para AF foi negativamente associada com a prática da caminhada (OR = 0,84, considerando ≥ 150 minutos/semana). A quantidade de espaços públicos de lazer em um raio de 1.000 metros foi positivamente associada com atividades físicas de intensidade moderada a vigorosa (OR = 1,03). A distância até espaços públicos de lazer com três ou mais equipamentos para AF (OR = 0,95) foi inversamente relacionada com atividades físicas de intensidade moderada a vigorosa. A proximidade e a quantidade de espaços públicos de lazer estão associadas com maiores níveis de AF de intensidade moderada a vigorosa de adultos. A combinação de métodos de avaliação pode ajudar a revelar a contribuição que o acesso e a qualidade dos espaços públicos de lazer podem ter para a AF.

El objetivo del estudio fue analizar la asociación entre accesibilidad a espacios públicos de ocio, disponibilidad de equipamientos para actividad física (AF) en estos lugares, y la práctica de actividad física durante el ocio en adultos. Se realizó una encuesta domiciliaria con 699 adultos de 32 sectores censitarios, seleccionados según su renta y "walkability" (transitabilidad). La accesibilidad a los espacios públicos de ocio se determinó mediante geoprocesamiento, conforme la proximidad hasta los espacios públicos de ocio y la cantidad de espacios públicos de ocio contenidos en un radio de 500 y 1.000 metros alrededor de los domicilios de los participantes. La presencia de equipamientos para AF en los espacios públicos de ocio se evaluó mediante el método observacional, y fue clasificado en: (a) sin equipamiento para AF; (b) con equipamiento para AF; (c) equipamiento para AF para adultos; e incluso (d) con tres o más equipamientos para AF. La AF fue autoinformada y las caminatas fueron analizadas separadamente de las AF de intensidad moderada a vigorosa, estando clasificadas en dos niveles (≥ 10 minutos/semana y ≥ 150 minutos/semana). La cantidad de espacios públicos de ocio, en un radio de 500 metros, con uno o más equipamientos para AF estuvo negativamente asociada con la realización de caminatas (OR = 0,84, considerando ≥ 150 minutos/semana). La cantidad de espacios públicos de ocio en un radio de 1000 metros estuvo positivamente asociada con AF de intensidad moderada a vigorosa (OR = 1,03). La distancia hasta espacios públicos de ocio con tres o más equipamientos para actividad física (OR = 0,95) estuvo inversamente relacionada con actividades físicas de intensidad moderada a vigorosa. La proximidad y la cantidad de espacios públicos de ocio están asociadas con mayores niveles de AF de intensidad moderada a vigorosa de adultos. La combinación de métodos de evaluación puede ayudar a revelar la contribución que el acceso y la calidad de los espacios públicos de ocio pueden tener para la AF.

Individual and environmental correlates of objectively measured physical activity and sedentary time in adults from Curitiba, Brazil.

OBJECTIVES: This study assessed the association of individual and neighborhood environment characteristics and objectively measured physical activity (PA) and sedentary time (ST) in adults from Curitiba, Brazil. METHODS: A population-based cross-sectional study was conducted through face-to-face household interviews in 2010. The analytic sample included 305 adults aged 20-65 years recruited from 32 census tracts selected according to neighborhood walkability and socioeconomic status. Individual and environmental PA correlates were evaluated through standardized and valid self-reported measures, including the Neighborhood Environment Walkability Scale. Minutes per week of PA and ST were assessed through accelerometry. Multi-level regression models were used in the analyses. RESULTS: After adjusting for confounders the strongest individual and environmental correlates associated with ST was residential density (B = 0.14; p = 0.008), light-intensity PA was being a father/mother (B = 35.71; p = 0.025) and moderate-to-vigorous PA was sex (B = 0.91; p < 0.001) and number of cars (one car, B = -1.05; two cars, B = -1.14; p < 0.001). CONCLUSIONS: The associations found with individual and environmental correlates varied accordingly across all outcomes. Future changes in policies and infrastructure should consider the social context of the community and improvements to promote a safer environment in the neighborhood.

Acessibilidade a espaços públicos de lazer e atividade física em adultos de Curitiba, Paraná, Brasil / Accessibility to public spaces for leisure and physical activity in adults in Curitiba, Paraná State, Brazil / Accesibilidad a espacios públicos de ocio y actividad física en adultos de Curitiba, Paraná, Brasil

Resumo: O objetivo do estudo foi analisar a associação entre acessibilidade a espaços públicos de lazer, disponibilidade de equipamentos para atividade física (AF) nestes locais e a prática de atividade física no lazer em adultos. Foi conduzido um inquérito domiciliar com 699 adultos de 32 setores censitários selecionados segundo a renda e "walkability". A acessibilidade a espaços públicos de lazer foi determinada por geoprocessamento segundo a proximidade até os espaços e a quantidade de espaços públicos de lazer contidos nos raios de 500 e 1.000 metros no entorno dos domicílios dos participantes. A presença de equipamentos para AF nos espaços públicos de lazer foi avaliada por método observacional e classificada em: (a) sem equipamento para AF; (b) com equipamento para AF; (c) equipamento para atividade física de adultos; e (d) com três ou mais equipamentos para AF. Essa atividade foi autorreportada e a caminhada analisada separadamente das atividades físicas de intensidade moderada a vigorosa sendo classificada em dois níveis (≥ 10 minutos/semana e ≥ 150 minutos/semana). A quantidade de espaços públicos de lazer, em um raio de 500 metros, com um ou mais equipamentos para AF foi negativamente associada com a prática da caminhada (OR = 0,84, considerando ≥ 150 minutos/semana). A quantidade de espaços públicos de lazer em um raio de 1.000 metros foi positivamente associada com atividades físicas de intensidade moderada a vigorosa (OR = 1,03). A distância até espaços públicos de lazer com três ou mais equipamentos para AF (OR = 0,95) foi inversamente relacionada com atividades físicas de intensidade moderada a vigorosa. A proximidade e a quantidade de espaços públicos de lazer estão associadas com maiores níveis de AF de intensidade moderada a vigorosa de adultos. A combinação de métodos de avaliação pode ajudar a revelar a contribuição que o acesso e a qualidade dos espaços públicos de lazer podem ter para a AF.

Abstract: The study aimed to analyze the association between accessibility to public spaces for leisure activities, availability of equipment for physical exercise in these spaces, and leisure-time physical activity (PA) in adults. A household survey was conducted with 699 adults from 32 census tracts selected according to income and "walkability". Accessibility to public spaces for leisure activities was determined by geoprocessing according to proximity to public spaces for leisure activities and the amount of such spaces within radiuses of 500 and 1,000 meters around the participants' homes. Presence of equipment for physical exercise in these public spaces was assessed by the observation method and classified as: (a) without equipment for physical exercise; (b) with equipment for physical exercise; (c) equipment for physical exercise for adults; and (d) with three or more pieces of equipment for physical exercise. PA was self-reported, and walking was analyzed separately from moderate-vigorous PA, classified in two levels (≥ 10 minutes/week and ≥ 150 minutes/week). The amount of public spaces for leisure activities in a 500-meter radius with one or more pieces of equipment for physical exercise was negatively associated with walking (OR = 0.84, based on ≥ 150 minutes/week). The amount of public spaces for leisure activities in a 1,000-meter radius was positively associated with moderate-vigorous PA (OR = 1.03). The distance to a public space for leisure activities with three or more pieces of equipment for physical exercise (OR = 0.95) was inversely associated with moderate-vigorous PA. Proximity and amount of public spaces for leisure activities are associated with higher levels of moderate-vigorous PA in adults. The combination of methods can help reveal the contribution that access to (and quality of) public spaces for leisure activities can make to PA.

Resumen: El objetivo del estudio fue analizar la asociación entre accesibilidad a espacios públicos de ocio, disponibilidad de equipamientos para actividad física (AF) en estos lugares, y la práctica de actividad física durante el ocio en adultos. Se realizó una encuesta domiciliaria con 699 adultos de 32 sectores censitarios, seleccionados según su renta y "walkability" (transitabilidad). La accesibilidad a los espacios públicos de ocio se determinó mediante geoprocesamiento, conforme la proximidad hasta los espacios públicos de ocio y la cantidad de espacios públicos de ocio contenidos en un radio de 500 y 1.000 metros alrededor de los domicilios de los participantes. La presencia de equipamientos para AF en los espacios públicos de ocio se evaluó mediante el método observacional, y fue clasificado en: (a) sin equipamiento para AF; (b) con equipamiento para AF; (c) equipamiento para AF para adultos; e incluso (d) con tres o más equipamientos para AF. La AF fue autoinformada y las caminatas fueron analizadas separadamente de las AF de intensidad moderada a vigorosa, estando clasificadas en dos niveles (≥ 10 minutos/semana y ≥ 150 minutos/semana). La cantidad de espacios públicos de ocio, en un radio de 500 metros, con uno o más equipamientos para AF estuvo negativamente asociada con la realización de caminatas (OR = 0,84, considerando ≥ 150 minutos/semana). La cantidad de espacios públicos de ocio en un radio de 1000 metros estuvo positivamente asociada con AF de intensidad moderada a vigorosa (OR = 1,03). La distancia hasta espacios públicos de ocio con tres o más equipamientos para actividad física (OR = 0,95) estuvo inversamente relacionada con actividades físicas de intensidad moderada a vigorosa. La proximidad y la cantidad de espacios públicos de ocio están asociadas con mayores niveles de AF de intensidad moderada a vigorosa de adultos. La combinación de métodos de evaluación puede ayudar a revelar la contribución que el acceso y la calidad de los espacios públicos de ocio pueden tener para la AF.

Sedentary time and perceived neighborhood environment in adolescents aged 12-17 years / Tempo sedentário e ambiente percebido sobre o bairro em adolescentes de 12 a 17 anos

Abstract The environment around the residence could contribute to attenuate or increase time spent in sedentary activities, and in low energy expenditure activities (1.5 METS) in adolescents. The aim of this study was to analyze the association between sedentary time and perceived neighborhood environment in adolescents aged 12-17 years living in southern Brazil. This was an observational cross-sectional study conducted from August 2013 to May 2014, with a sample of adolescents (12-17 years), recruited from 32 census tracts in Curitiba, Brazil. All census tracts were selected according to walkability and income characteristics. Perceived environment was assessed through the NEWS-Y questionnaire, and sedentary time along seven days was obtained through accelerometers (GT1M, GT3x and GT3x+). Linear regression models were used to test the associations, and included age, nutritional status, socioeconomic level and education level as confounding variables. All analyses were performed considering p-value <0.05 through SPSS software 20.0. The analytical sample included 364 adolescents (girls=50.5%; mean age=14.7, SD=1.7) with valid accelerometry data, showing on 489.6 minutes/day (SD=99.5) spent in sedentary time activities. After adjusting for confounding variables, only the perception of places for walking and cycling remained associated with sedentary time for both boys (B=-23.402, p=0.016) and girls (B=-15.572; p=0.079). Perception of places for walking and cycling has an inverse relationship with sedentary time among adolescents living in places with extremes of walkability and income.

Resumo O ambiente no entrono da residência pode contribuir para atenuar ou acentuar o tempo em atividades sedentárias em adolescentes. Objetivou-se avaliar a associação entre o tempo sedentário e a percepção do ambiente sobre o bairro em adolescentes de 12 a 17 anos residentes no sul do Brasil. Este foi um estudo transversal realizado entre os meses Agosto, 2013 e Maio, 2014, em uma amostra de adolescentes, recrutados em 32 setores censitários da cidade de Curitiba-PR, Brasil. Os setores foram selecionados de acordo com as características de walkability e renda. O ambiente percebido foi avaliado com o questionário NEWS-Y. O tempo sedentário foi avaliado de maneira objetiva por meio de acelerômetros (GT1M, GT3x e GT3x+) durante sete dias consecutivos. Modelos de regressão linear foram empregados para testar as associações, sendo consideradas como variáveis de confundimento a idade, o estado nutricional, o nível socioeconômico e a escolaridade. As análises foram realizadas considerando o valor de p<0,05 através do software SPSS 20,0. A amostra analítica contou com 364 adolescentes com dados válidos de acelerômetros (meninas=50,5%; idade média=14,7 anos, DP=1,7 anos), tendo apresentando 489,6 minutos/dia (DP=99,5 minutos/dia) de tempo em atividades sedentárias. Após ajuste para as variáveis de confundimento apenas a percepção de lugares para caminhar e para pedalar manteve-se associada com tempo sedentário tanto para meninos (B=23,402; p=0,016) quanto para meninas (B=-15,572; p=0,079). A percepção de locais para caminhar e pedalar tem relação inversa com tempo sedentário entre adolescentes residentes em locais com extremos de walkability nível socioeconômico.

Perceived neighborhood environment and leisure time physical activity among adults from Curitiba, Brazil / Ambiente percebido do bairro e atividade física no lazer em adultos de Curitiba, Brasil

Abstract The aim of this study was to analyze the association between perceived neighborhood characteristics and leisure time physical activity (PA) and the moderator effect of gender, age, schooling and time spent working/studying on perceived environment and leisure PA in adults. This is a cross-sectional study conducted with 699 adults (53.1% women), distributed from 32 census tracts selected according to walkability and neighborhood income characteristics in Curitiba. Perceived neighborhood characteristics were assessed using the Brazilian version of the Neighborhood Environment Walkability Scale-Abbreviated (A-NEWS). Leisure time PA was evaluated through the long-version IPAQ and walking and moderate to vigorous physical activity (MVPA) were analyzed separately. PA classification considered ≥10 minutes/week and ≥150 minutes/week of walking or MVPA. Associations were tested using a multilevel logistic binary model. After adjusting for potential confounders, aesthetics perception was associated with ≥10 minutes/week of walking. Additionally, access to public places for leisure remained associated with ≥10 minutes/week and ≥150 minutes/week of MVPA. The relationship between perceived access to public spaces, walking and MVPA were stronger in women and younger adults. It is concluded that a better perception of neighborhood aesthetics was associated with the practice of walking and access to public spaces with the practice of MVPA, respectively.

Resumo Objetivou-se analisar a associação entre características percebidas do ambiente do bairro e a prática de atividades físicas (AF) no lazer e verificar o efeito moderador do gênero, faixa etária, escolaridade e tempo no trabalho/escola na relação entre a percepção do ambiente e AF no lazer em adultos. Estudo transversal com 699 adultos (53,1% mulheres), residentes em 32 setores censitários com diferentes características ambientais em Curitiba (walkability e renda). As características percebidas do ambiente do bairro foram avaliadas pela versão em português do Neighborhood Environment Walkability Scale-Abbreviated (A-NEWS). A AF no lazer foi avaliada pelo IPAQ longo e a caminhada foi analisada separadamente da prática de atividades físicas moderadas à vigorosas (AFMV). A classificação da AF no lazer considerou as pessoas que "realizam" ≥10 minutos/semana e ainda aquelas realizam ≥150 minutos/semana de caminhadas ou AFMV. As associações foram testadas com um modelo logístico binário multinível. Após ajuste para as potenciais variáveis de confundimento, observou-se que melhor percepção de estética foi associada a maior chance de adultos caminharem ≥10 minutos/semana no lazer. Além disto, maior percepção de acesso a espaços públicos de lazer foi associado a maior chance dos adultos realizarem ≥10 minutos/semana e ≥150 minutos/semana de AFMV. As associações entre acesso a espaços públicos de lazer com caminhada e AFMV foram mais fortes entre mulheres e adultos mais jovens. Conclui-se que melhor percepção da estética do bairro foi associada à prática da caminhada e o acesso a espaços públicos com a prática de AFMV.

Combined physical activity and sitting time and their contribution to body mass index in adults / Atividade física e tempo sentado combinados e sua contribuição no índice de massa corporal em adultos

Abstract The aim of this study was to analyze the contribution of physical activity (PA) and sedentary time (ST) to Body Mass Index (BMI) in adults. The study was conducted in 2009, in Curitiba, Parana, Brazil with adults aged 18-65 years (1,411). A multidimensional questionnaire was used in which BMI, weekly minutes of PA and ST were obtained from self-reports. PA and ST were combined to determine the following independent variables: a) “active and not sedentary”; b) “active and sedentary”; c) “not active and not sedentary” and d) “not active and sedentary”. Multinomial logistic regressions were used to test the associations between PA, ST and BMI. The adjusted regression model showed that PA, regardless of ST, lowered the likelihood of participants being classified as obese by 34% and 55%, respectively. In addition, PA at recommended levels (≥150 minutes/ week), while not being sedentary, lowered by 85% the likelihood of being classified in the underweight category. Finally, ≥10 minutes/week of PA, while reporting higher ST levels, reduced the likelihood of being classified as overweight by 37%. PA is associated with BMI regardless of TS. In addition, PA at recommended levels is inversely related to obesity and overweight.

Resumo O objetivo do estudo foi analisar a contribuição da atividade física (AF) e do tempo sedentário (TS) no Índice de Massa Corporal (IMC). O estudo foi conduzido em 2009, em Curitiba, Paraná, Brasil com adultos de 18 à 65 anos (n=1.411). Foi aplicado um questionário multidimensional em que o IMC, AF e TS foram obtidos de forma autorreportada. AF e TS foram combinados para determinar as variáveis independentes: a) “ativo e não sedentário”; b) “ativo e sedentário”; c) “não ativo e não sedentário” e d) “não ativo e sedentário”. A regressão logística multinominal foi empregada para testar as associações entre AF, TS e IMC. As análises ajustadas demonstraram que AF, independente do TS, reduz entre 34% e 55% as chances dos participantes serem classificados como obesos. Além disto, praticar ≥150 minutos/semana de AF e não ser sedentário reduziu em 85% as chances dos participantes serem classificados com baixo peso. Por fim, praticar ≥10 minutos/semana de AF, mesmo apresentando TS elevado, reduziu em 37% a chance de classificação em sobrepeso. A prática de AF está associada com IMC independente do TS. Além disto, AF em níveis recomendados tem relação inversa com a obesidade e sobrepeso.

Projeto ESPAÇOS de Curitiba, Brasil: aplicabilidade de métodos mistos de pesquisa e informações georreferenciadas em estudos sobre atividade física e ambiente construído / Projeto ESPAÇOS de Curitiba, Brazil: applicability of mixed research methods and geo-referenced information in studies about physical activity and built environments

Objetivo. Descrever os métodos empregados para avaliar o ambiente construído e a atividadefísica em um estudo multicêntrico internacional e discutir os desafios enfrentados paraobter os dados necessários no contexto brasileiro.Métodos. Em 2010, foi conduzido um inquérito domiciliar com adultos entre 20 e 65 anosde idade na Cidade de Curitiba, Estado do Paraná. O estudo envolveu o uso de informaçõesgeorreferenciadas para identificar locais que facilitem a caminhada como forma de deslocamento(walkability) em todos os 2 125 setores censitários de Curitiba. Os setores censitáriosforam categorizados de acordo com walkability e renda, a qual considerou a renda média dosresponsáveis pelos domicílios contidos em cada setor. A atividade física foi avaliada de maneiraautorrelatada e objetiva (acelerômetro).Resultados. Foram incluídos 16 setores de alto walkability e 16 de baixo walkability,sendo oito de baixa renda e oito de renda elevada em cada categoria. Foram entrevistados 699sujeitos e 381 utilizaram acelerômetros. A taxa de respostas para as entrevistas foi de 66,4%.O sucesso no uso de acelerômetros foi de 85,8% (n = 327).Conclusões. Os resultados demonstram que é possível desenvolver estudos de elevada qualidadesobre AF e ambiente construído no contexto brasileiro, seguindo padrões internacionaisde investigação.

Objective. To describe the methods employed to assess the built environment andphysical activity (PA) as part of a multicenter international study, and to discuss thechallenges faced to obtain the necessary data in the Brazilian context.Methods. In 2010 a household survey was conducted with adults aged from 20 to65 years in the city of Curitiba, Brazil. The study involved the used of geo-referencedinformation to measure walkability in all 2 125 census sectors in Curitiba. Census sectorswere categorized by walkability and income, taking into consideration the averageincome of heads of the family in each sector. Physical activity was assessed by selfreportand using an objective measure (accelerometers).Results. Sixteen high walkability and 16 low walkability sectors were studied, witheight high-income and eight low-income sectors in each category. A total of 699 subjectswere interviewed and 381 wore accelerometers. The response rate was 66.4% forthe interviews and the compliance with accelerometer use was 85.8% (n = 327).Conclusions. The results show that it is feasible to conduct high-quality studies onphysical activity and built environment in the Brazilian context in accordance withinternational standards.

Validade e Fidedignidade de um instrumento para avaliar o ambiente doméstico relacionado à atividade física em idosas / Validity and reliability of a questionnaire to evaluate physical activity related to home environment in older women

O objetivo deste estudo foi testar a validade e fidedignidade de um questionário para avaliar a presença de equipamentos para a prática de atividade física (AF) no ambiente doméstico. O questionário foi desenvolvido através de revisão da literatura e da opinião de especialistas. Após análise da matriz, obteve-se um instrumento com 26 questões dicotômicas que registram a presença ou ausência destes equipamentos. Participaram do estudo 40 idosas. Para testar a validade de construto, foram levantadas informações sobre (AF) com dois instrumentos: acelerômetro e o Questionário Internacional de Atividades Físicas (IPAQ). Para testar a fidedignidade o instrumento desenvolvido foi aplicado duas vezes com um intervalo de 7 dias entre as entrevistas. Ao todo 25 questões apresentaram concordância superior a 82,5%. Entre as 26 questões, 10 apresentaram índice de concordância kappa (k) considerados ?bons? (k=0,40- 0,74) e 0 apresentaram valores de kappa ?excelentes? (k=0,75-1,00). O escore total do instrumento apresentou coeficiente de correlação intraclasse de 0,85 (IC95%=0,73 ? 0,92). Houve associação positiva e significativa entre o escore total com as medidas de AF obtidas por acelerômetros (r=0,34) e pelo IPAQ (r=0,34). O instrumento apresentou fidedignidade adequada. A validade de construto foi aceitável e consistente para avaliar a presença de equipamentos no ambiente domestico para a prática de AF.

The objective of this study was to test the validity and reliability of a questionnaire to evaluate the presence of physical activity (PA) equipments in home environment. The questionnaire was developed through literature review and experts? opinion. After the content analysis, an instrument with 26 questions was obtained to register the presence or absence of these PA equipments. Participants of the study were 40 elderly women. Construct validity was analyzed comparing instrument?s scores with PA measures obtained by two instruments: accelerometers and the International Questionnaire of Physical (IPAQ). To test the reliability the questionnaire was applied twice with 7 days interval. Overall 25 questions presented agreement above 82.5%. Among the 26 questions, 10 presented kappa agreement index (k) considered good (k=0.40-0.74) and 10 presented excellent kappa values (k=0.75 ? 1.00). The total score showed intraclass correlation index of 0.85 (IC95%=0.73?0.92). There was a positive and significant association between total score with PA measures obtained by accelerometers (rho=0.34) and IPAQ (rho=0.34). The instrument presented adequate reliability and construct validity was acceptable and consistent with other studies. The questionnaire has appropriate characteristics to evaluate the presence of PA equipments in the home environment.