Health-related fitness in medical students: a curricular intervention in Bogota, Colombia.

OBJECTIVE: To evaluate the impact of a curricular intervention to promote health-related fitness (HRF) among medical students in Bogota, Colombia. METHOD: The study was conducted between May 2014 and December 2015 as part of the medical physiology course, in which 208 medical students were enrolled.The curricular intervention included two lectures on physical activity (PA) and student-led group presentations on the physiological effects of exercise on human physiology. An academic incentive (10% of final grade) was given to students who reported and documented regular PA practice during the semester. This study assessed students' HRF variables, perceptions of the curriculum intervention, and PA practices using quantitative and qualitative approaches. RESULTS: 55% of the students were female, with a mean age of 19.5 years. Body fat, estimated maximum oxygen consumption (VO2max), handgrip, and sit-up strength showed statistically significant improvements at the end of the intervention. Students reported that PA practice was positively influenced by the curriculum intervention, particularly the academic incentive and the HRF tests. Students reported a wide variety of PA practices, which were mainly done with friends, classmates, or family members. Lack of time was the main reported barrier to PA practice. CONCLUSION: The curricular intervention was effective in improving HRF and promoting PA. It remains to be investigated whether these gains are sustained over time.

Curricular and pedagogical approaches for physical activity prescription training: a mixed-methods study of the "Exercise is Medicine" workshops in Colombia.

BACKGROUND: The physical activity (PA) prescription workshop for physicians, through the global health initiative "Exercise is Medicine" (EIM), has trained more than 4000 health care professionals (HCPs) in Latin America. It has shown to be effective in increasing PA prescription knowledge and awareness among HCPs. The purpose of this paper is to evaluate the curricular and pedagogical approach used by EIM Colombia at the PA prescription workshops implemented between 2014 and 2015. METHODS: A mixed methods study, with a sequential explanatory design was implemented among a convenience sample of HCPs attending twenty-six PA prescription workshops. HCPs health status, PA personal habits, and medical practices were collected using a questionnaire at baseline among 795 participants (pre-test measurement), and subsequently quantitatively analyzed. A workshop satisfaction survey was administered after the completion of the workshop among 602 HCPs. The curricular and pedagogical approach of the workshop, the designers' and students' contextual factors, and perceptions about the workshop were measured using qualitative methods (analysis of the procedures manual, two workshop observations, three semi-structured interviews, and one focus group including 8 HCPs). RESULTS: The workshop is student-centered and guided by an expert with an academic and clinical background. Learning was achieved with theoretical and practical components using authentic performance and collaborative learning. An active teaching and learning approach was used with strategies such as interactive lectures, hands-on elements, and role-playing (patient-counselor). The workshop emphasized an individual approach when prescribing PA integrating in clinical practice not only health benefits but also patient´s beliefs, motivations, needs, and barriers. CONCLUSIONS: Evidence-based practices and authentic performance were the most salient pedagogical elements used by EIM Colombia at the PA prescription workshop. A knowledge assessment that includes the practical aspect is suggested for future workshops. The curricular and pedagogical approach of the PA prescription workshop implemented in Colombia is well received by the medical community and a useful continuing medical education intervention with a potential contribution to current, and future health promotion needs.

Breast cancer related perceptions and practices of health professionals working in Brazil's network of primary care units.

In 2004 the Brazilian National Cancer Institute (INCA) established breast cancer screening guidelines for women in Brazil: annual clinical breast exam for women age 40-49 and biennial mammogram for women age 50-69. Healthcare provider's adherence to these guidelines is currently unknown. The objective of this study is to describe the perceptions and practices related to breast cancer screening among physicians, nurses, and health unit coordinators working in the network of primary healthcare units (HCUs) in Brazil. In 2011, 1600 primary HCUs were randomly sampled from all regions in Brazil. At each HCU the coordinator and one health professional were asked to participate in a telephone survey to gathered information on their knowledge, attitudes, and practices related to breast cancer screening. Participation rates for coordinators, physicians, and nurses were 78%, 34%, and 65% respectively. Health unit coordinators identified numerous barriers that prevent patients from receiving appropriate screening, many (44%) were unaware of INCA cancer screening guidelines. Despite a high perceived impact of INCA guidelines, a majority of physicians and nurses did not follow them. Most physicians and nurses recommended mammograms on an annual basis (~75%) and 50.9% of nurses and 25.1% of physicians initiated routine breast cancer screening in women under age 40. Physicians and nurses in Brazil screen at younger ages and more frequently than recommended by INCA guidelines. Given that primary HCUs are the source of health care for many women, interventions that educate healthcare providers on the appropriate ages and intervals for breast cancer screening may prove useful.

The Recreovía of Bogotá, a Community-Based Physical Activity Program to Promote Physical Activity among Women: Baseline Results of the Natural Experiment Al Ritmo de las Comunidades.

Community-based physical activity (PA) programs in Latin America have been recognized because of the use of available environmental resources to offer PA classes. Yet, the evaluation of programs focused on PA classes involving dancing in public spaces is limited. The aim of this study was to assess the physical activity levels, park use, and the contextual characteristics of public parks with and without the Recreovía in Bogotá in Colombia. Al Ritmo de las Comunidades is a natural experiment conducted in nine parks (3 parks implementing new Recreovías, 3 control parks and 3 parks with existing Recreovías) during 2013. We used the System for Observing Play and Recreation in Communities to evaluate park use (gender, age, and physical activity level) and target areas. A total of 4925 people were observed during 702 observation visits to parks. The percentage of women was higher in parks with Recreovía, compared to parks without Recreovía (53% vs. 40% vs. 33%; p < 0.001). Women using parks with Recreovía compared to women in parks without Recreovía were less likely to be sedentary (25% vs. 39%; p < 0.0001) and more likely to engage in moderate-to-vigorous activity (75% vs. 61%; p < 0.0001). Among men, the activity pattern was the opposite. The Recreovía is a promising strategy to promote park use and PA, especially among women who are less likely to meet PA recommendations during their leisure time. The provision of a cost-free community program may be an effective approach and a good investment for health.

Logic model of the Recreovía: a community program to promote physical activity in Bogota / Modelo lógico da Recreovia: um programa para a promoção da atividade física em Bogotá

This study aimed to develop the logic model of the Recreovía program in Bogota, Colombia. The logic model was developed based on the manual of the Center of Disease Control and Prevention (CDC), with indicators of resources, activities and short- and long-term results. Mixed methods were used for data collection and analysis. Human, physical and financial resources, as well as collaborators of the program, were identified, besides the activities defined according to the program aims. In conclusion, the program emphasizes the processes and actors for their operation and maintenance, and recognizes future challenges for physical activity promotion in Bogota.

Este estudo objetivou desenvolver o modelo lógico do programa Recreovía de Bogotá, Colômbia. O modelo lógico foi desenvolvido com base no manual do Centro de Controle e Prevenção de Doença (CDC), com indicadores de recursos, atividades e resultados a curto, médio e longo prazo. Foram utilizados métodos mistos convergentes para a coleta e análise dos dados. Foram identificados os recursos humanos, físicos, financeiros e colaboradores do programa, além das atividades realizadas e resultados definidos de acordo com os objetivos do programa. Em conclusão, o programa ressalta os processos e atores para o seu funcionamento e manutenção, assim como identifica os desafios futuros para a promoção da atividade física em Bogotá.

Start small, dream big: Experiences of physical activity in public spaces in Colombia.

Multi-sectoral strategies to promote active recreation and physical activity in public spaces are crucial to building a "culture of health". However, studies on the sustainability and scalability of these strategies are limited. This paper identifies the factors related to the sustainability and scaling up of two community-based programs offering physical activity classes in public spaces in Colombia: Bogotá's Recreovía and Colombia's "Healthy Habits and Lifestyles Program-HEVS". Both programs have been sustained for more than 10years, and have benefited 1455 communities. We used a mixed-methods approach including semi-structured interviews, document review and an analysis of data regarding the programs' history, characteristics, funding, capacity building and challenges. Interviews were conducted between May-October 2015. Based on the sustainability frameworks of Shediac-Rizkallah and Bone and Scheirer, we developed categories to independently code each interview. All information was independently analyzed by four of the authors and cross-compared between programs. Findings showed that these programs underwent adaptation processes to address the challenges that threatened their continuation and growth. The primary strategies included flexibility/adaptability, investing in the working conditions and training of instructors, allocating public funds and requesting accountability, diversifying resources, having community support and champions at different levels and positions, and carrying out continuous advocacy to include physical activity in public policies. Recreovía and HEVS illustrate sustainability as an incremental, multi-level process at different levels. Lessons learned for similar initiatives include the importance of individual actions and small events, a willingness to start small while dreaming big, being flexible, and prioritizing the human factor.

One-day workshop-based training improves physical activity prescription knowledge in Latin American physicians: a pre-test post-test study.

BACKGROUND: The physical inactivity pandemic and related non-communicable diseases have made it imperative for medical doctors (MDs) to effectively provide lifestyle counseling as part of prevention and treatment plans for patients. A one-day certification workshop was designed to improve MDs PA prescription knowledge, as part of the Exercise is Medicine® (EIM®) global health initiative. The objective was to determine knowledge gain of MDs participating in a standardized, one-day PA prescription workshop performed throughout Latin America (LA). METHODS: A 20-question multiple-choice test on PA topics, based on international guidelines, was completed before and after the workshop. Pre and post-test analyses, without a control group, were performed on 1044 MDs after the 8-h workshop that was delivered 41 times across 12 LA countries, from January 2014 to January 2015. Knowledge improvement was determined using the class-average normalized gain and individual relative gain. T-tests with 95% confidence interval levels were conducted to analyze differences between MD specialties. RESULTS: Test scores improved on average from 67 to 82% after the workshop (p <0.001). The average total individual relative gain was 29% [CI: 26 to 32%]. Relative gain by country ranged from 9.3% [CI: 2 to 16%; Nicaragua] to 73% [CI: 47 to 98%; Dominican Republic]. The mean of the 41 workshops' class-average normalized gain was 46% [CI: 42 to 51%]. The largest groups of participants were general practitioners (GPs) (33%; n = 348), internal medicine (19%; n = 194), and family medicine (9%n = 92) specialists. Relative gain for GPs was not different than for all grouped primary care specialties (30% vs. 27%, p =0.48). The knowledge gain was higher for the workshop modules on screening/risk stratification and prescription (43% [CI: 39-48%] and 38% [CI: 34-42%], than for the module on PA benefits and risks (26% [CI: 23-28%]). CONCLUSION: This one-day workshop had a positive impact on the knowledge gain of MD's on the topic of PA prescription. Although all groups of specialties increased knowledge, GPs and family medicine MDs benefited the most. This short course is an effective continuing education strategy for teaching PA assessment, counseling and prescription to MDs in Latin America, a topic rarely included in the training of MD's in the region and the world. Further follow-up is needed to ascertain impact on PA counseling practices.

Results From Colombia's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Physical activity (PA) is vital to the holistic development of young people. Regular participation in PA is associated with substantial benefits for health, cognitive function, and social inclusion. Recognizing the potential of PA in the context of the current peace process in Colombia, the purpose of this article is to present the methodology and results of Colombia's second Report Card on PA for children and youth. METHODS: A group of experts on PA graded 14 PA indicators based on data from national surveys and policy documents. RESULTS: National and departmental policy indicators received a grade of B, while organized sport participation, overweight, obesity, community influence, and nongovernment initiatives indicators received a grade of C. Overall PA levels, active transportation, sedentary behaviors, and school influence received a grade of D. Active play, low physical fitness, and family influence received an Incomplete grade. CONCLUSIONS: PA levels are low and sedentary behaviors are high in Colombian children and youth, with notable geographic differences. A broad policy framework translated into specific actions could provide unique opportunities to bridge the gap between knowledge and practice, and contribute to social integration goals in a postconflict setting.

Bridging the gap between research and practice: an assessment of external validity of community-based physical activity programs in Bogotá, Colombia, and Recife, Brazil.

For more than a decade, physical activity classes have been offered in public places at no cost to the participants in some Latin American cities, however, internal and external validity evidence of these programs is limited. The goals of this study were to assess, report, and compare the external validity of the Recreovia program (RCP) in Colombia, and the Academia da Cidade program (ACP) in Brazil. Interviews to assess external validity of the RCP and ACP were conducted in 2012. The interview guide was developed based on the RE-AIM framework. Seventeen key informants were selected to participate in the study. Interviews were recorded and transcribed verbatim. Transcripts were analyzed using a constant comparative qualitative method and experts validated common themes. RCP and ACP key informants reported that both programs reach underserved population. There is no information available about effectiveness. Both programs take place in public spaces (e.g., parks and plazas), which are selected for adoption mainly based on community demand. RCP and ACP offer free physical activity classes with educational and cultural components, have a strong organizational structure for implementation, and differ on schedule and content of classes. Funding sources were reported to play an important role on long-term maintenance. Facilitators and barriers were identified. Programs are similar in the reach and adoption elements; the main differences were found on implementation and maintenance, whereas information on effectiveness was not found. Reporting external validity of these programs is useful to bridge the gap between research and practice.

Associations between time spent traveling in motor vehicles and physical activity in Colombian adults from urban areas.

Sedentary behaviors are associated with less physical activity. Little evidence exists about this association and its relation with commuting time in Latin America. This study examined the association between time spent traveling in motor vehicles and physical activity levels in the domains of leisure time physical activity and transportation, among Colombian adults in urban areas. A secondary data analysis of the 2010 National Nutrition Survey was conducted. Time spent traveling in motor vehicles and physical activity were assessed using the International Physical Activity Questionnaire. Binary logistic regressions were conducted. Time spent traveling in motor vehicles for 120 minutes or more was reported among 27.6% of the sample. The prevalence of walking and bicycling as a means of transportation for at least 150 minutes per week was 34% and 4.4%, respectively. Achieving at least 150 minutes of leisure time physical activity a week was reported by 18.4% of the sample. This study suggests negative associations between time spent traveling in motor vehicles and active transport, with significant trend associations in stratified analyses. No significant associations were found between time spent traveling in motor vehicles and leisure time physical activity.

Results from Colombia's 2014 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Physical activity (PA) is central to the global agenda for the prevention on noncommunicable diseases (NCDs). Although 80% of NCDs occur in low-to-middle-income countries, the evidence on PA comes mainly from high-income countries. In this context, the report card for Colombia is an advocacy tool to help in the translation of evidence into concrete actions. The aims of this paper were two-fold: to present the methodology used to develop the first Report Card on Physical Activity in Colombian Children and Youth and to summarize the results. METHODS: Twelve indicators of PA were graded using numerical grades (5, highest, to 1, lowest) based on data from national surveys and policy documents. RESULTS: National policy and obesity indicators were graded "4," while departmental policy and overweight indicators were graded "3." Overall PA levels, sports participation, sedentary behaviors and nongovernment initiatives were graded "2," and school influence was graded "1." Active transportation, active play, low cardiorespiratory fitness, and family and community influence received an incomplete. CONCLUSION: PA levels are low and sedentary behaviors are high in Colombian children and youth. Although the prevalence of obesity in Colombia is lower compared with other Latin American countries, it is increasing. A rich legal framework and availability of institutional arrangements provide unique opportunities to bridge the gap between knowledge and practice that need to be evaluated.

Associations between time spent traveling in motor vehicles and physical activity in Colombian adults from urban areas / Asociaciones entre el tiempo de viaje en vehículos motorizados y la actividad física en adultos colombianos de zonas urbanas / Associações entre o tempo gasto em viagens em veículos motorizados e atividade física em adultos colombianos de áreas urbanas

Sedentary behaviors are associated with less physical activity. Little evidence exists about this association and its relation with commuting time in Latin America. This study examined the association between time spent traveling in motor vehicles and physical activity levels in the domains of leisure time physical activity and transportation, among Colombian adults in urban areas. A secondary data analysis of the 2010 National Nutrition Survey was conducted. Time spent traveling in motor vehicles and physical activity were assessed using the International Physical Activity Questionnaire. Binary logistic regressions were conducted. Time spent traveling in motor vehicles for 120 minutes or more was reported among 27.6% of the sample. The prevalence of walking and bicycling as a means of transportation for at least 150 minutes per week was 34% and 4.4%, respectively. Achieving at least 150 minutes of leisure time physical activity a week was reported by 18.4% of the sample. This study suggests negative associations between time spent traveling in motor vehicles and active transport, with significant trend associations in stratified analyses. No significant associations were found between time spent traveling in motor vehicles and leisure time physical activity.

Comportamientos sedentarios se asocian con una menor actividad física. Existen pocas evidencias sobre esta asociación en relación con el tiempo de viaje en América latina. Se examinó la asociación entre el tiempo de viaje en vehículos motorizados y los niveles de actividad física en los dominios de actividad física en el tiempo libre y transporte, en adultos colombianos de zonas urbanas. Se realizó un análisis de datos secundarios de la Encuesta Nacional de Nutrición de 2010. El tiempo de viaje en vehículos motorizados y actividad física se evaluó a través del Cuestionario Internacional de Actividad Física. Se llevaron a cabo regresiones logísticas binarias. Tiempo de viaje en vehículos motorizados durante 120 minutos o más, fue reportado por el 27,6% de la muestra. La prevalencia de caminar y montar en bicicleta como medio de transporte fue de 34% y 4,4%, respectivamente. Realizar por lo menos 150 minutos a la semana de actividad física en el tiempo libre fue reportado por el 18,4% de la muestra. Este estudio sugiere asociaciones negativas entre tiempo de viaje en vehículos motorizados y transporte activo, con tendencias significativas en análisis estratificados. No hubo diferencias significativas entre tiempo de viaje en vehículos motorizados y actividad física en el tiempo libre.

Comportamentos sedentários estão associados com menos atividade física. Pouca evidência existe sobre esta associação relacionada ao tempo de viagem na América Latina. Este estudo analisou a associação entre o tempo gasto viajando em veículos a motor e os níveis de atividade física, nos domínios e atividade física de lazer e transporte entre adultos Colombianos em áreas urbanas. Uma análise secundária da Pesquisa Nacional de Nutrição de 2010 foi realizada. O tempo gasto viajando em veículos a motor e atividade física foram avaliados utilizando Questionário Internacional de Atividade Física. Regressões logísticas binárias foram realizados. O tempo gasto viajando em veículos a motor por 120 minutos ou mais foi relatado em 27,6% da amostra. A prevalência de caminhar ou andar de bicicleta para o transporte de pelo menos 150 minutos por semana foi de 34,0% e 4,4%, respectivamente. Alcançar pelo menos 150 minutos de atividade física de lazer em uma semana foi relatado em 18,4% da amostra. Este estudo sugere associações negativas entre tempo gasto viajando em veículos a motor e transporte ativo, com associações significativas de tendências na análise estratificada. Não houve diferenças significativas encontradas entre tempo gasto viajando em veículos a motor e atividade física de lazer.

Conglomeración de precursores de tensión arterial elevada en adolescentes / Conglomeration of high blood pressure precursors in adolescents

Introducción: La tensión arterial elevada y los precursores de enfermedad cardiovascular, pueden iniciarse en la infancia y mantenerse hasta la adultez. Estos precursores ocurren frecuentemente en conglomerado. Objetivos: Analizar la conglomeración de precursores de tensión arterial alta en adolescentes y determinar la asociación de la frecuencia acumulada de estos con la tensión arterial elevada. Métodos: Estudio transversal en una muestra de 546 escolares de 11 a 18 años de la ciudad de Montería. Se tomaron medidas de tensión arterial, índice de masa corporal, perímetro abdominal, capacidad cardiorrespiratoria, niveles de actividad física y comportamientos sedentarios. Las asociaciones entre tensión arterial elevada y frecuencia acumulada de precursores fueron exploradas con modelos de regresión logística. Resultados: La combinación de precursores más frecuente fue la presencia de dos precursores, inactividad física y tiempo excesivo de televisión (30,3%). Le siguen la aparición simultánea de tres precursores, baja capacidad cardiorrespiratoria, inactividad física y tiempo excesivo de televisión (18,3%). Aquellos adolescentes con dos o más precursores presentaron cifras de tensión arterial significativamente más altas en comparación con aquellos en quienes se encontró una acumulación menor de precursores. La tensión arterial elevada se asocia de manera significativa con la acumulación de precursores. Conclusión: La conglomeración de dos o más precursores se asoció de manera significativa con la tensión arterial elevada, hallazgos que indican que se requieren intervenciones para reducir la presencia y acumulación de los precursores estudiados y así prevenir la adquisición de cifras de tensión arterial elevada en los adolescentes de Montería.

Introduction: High blood pressure and cardiovascular disease precursors may start in childhood and continue until adulthood. Usually these precursors occur in cluster. Objectives: The objectives of the study were to analyze the cluster of high blood pressure precursors and to analyze the association of the cumulative frequency of these precursors with high blood pressure. Methods: Cross-sectional study in a sample of 546 students aged 11 to 18 years in the city of Montería. Blood pressure, body mass index, waist circumference, cardiorespiratory fitness, physical activity and sedentary lifestyle were measured. The associations between high blood pressure and the cumulative frequency of precursors were explored with logistic regression models. Results: The most frequently found combination of precursors was the presence of two precursors, physical inactivity and excessive TV time (30.3%). It follows the simultaneous occurrence of three precursors: low cardiorespiratory fitness, physical inactivity, and excessive TV time (18.3%). Those adolescents with two or more precursors showed a significantly higher occurrence of high blood pressure compared to those in whom a lower accumulation of precursors was found. The occurrence of high blood pressure is significantly associated with the accumulation of precursors. Conclusion: The conglomeration of two or more precursors was significantly associated with the occurrence of high blood pressure. These findings indicate that interventions are needed to reduce the occurrence and accumulation of precursors studied, as well as to prevent the acquisition of high blood pressure in adolescents of Montería.

Association between the perceived environment and physical activity among adults in Latin America: a systematic review.

BACKGROUND: Activity friendly environments have been identified as promising strategies to increase physical activity levels in the population. Associations between perceived environmental attributes and physical activity in Latin America may vary from those observed in high income countries. The objective of this systematic review is to identify which perceived environmental attributes are associated with physical activity in Latin America. METHODS: Systematic literature search of articles published in English, Portuguese, and Spanish in four databases was conducted (PubMed, Virtual Health Library, EBSCO, and Web of Science). Associations with environmental attributes were analyzed separately for physical activity domains. Fifteen articles were included in the analysis. RESULTS: All studies had cross-sectional designs. The majority of associations were statistically non-significant, and only four associations were found in the unexpected direction. Leisure-time and transport-related physical activity were the domains most frequently included in the studies and had higher number of associations in the expected direction. Leisure-time physical activity showed a convincing association in the expected direction with safety during the day. Transport-related physical activity had a convincing association with presence of street lighting. CONCLUSIONS: This study shows that perceived environmental attributes and their relationship with physical activity appears to be domain, and context specific. In addition, findings from this study show inconsistencies with the information gathered from high-income countries.