Interrelationship between arterial hypertension, health service costs, therapeutic treatment and physical activity.

BACKGROUND: Arterial hypertension is a high prevalence disease that increase healthcare costs and affects physical activity level. This study aimed to analyse the interrelationship between arterial hypertension, health service costs, therapeutic treatment, and physical activity in patients with cardiovascular diseases. METHOD: Cross-sectional study that evaluated 306 patients from a hospital in Presidente Prudente-Brazil. Based on their medical diagnosis, they were classified into multiple groups to access primary care and hospital-related costs variations. Then, using data from medical records and face to face interviews, they were examined on their treatment adherence and physical activity practice. Healthcare costs were accessed using medical records. Finally, the generalised linear model was used to analyse the interrelationship between treatment adherence, physical activity, health care costs and arterial hypertension. The data were analysed with Stata/MP4 16, and a p-value of less than 5% was used to determine statistical significance. RESULTS: The group that adhered to the arterial hypertension treatments but were physically inactive presented higher costs with consultation (US$=24.1, 95%CI = 1.90;46,3)​​ medication (US$=56.60, 95%CI = 1.65; 111.5) and total primary health care costs (US$=71.60, 95%CI = 19.2; 123.9) even after adjusting for confounding variables, meanwhile those participants that adhered to the treatments and were physical active did not present difference in healthcare cost when compared to normotensive and physical active participants. CONCLUSION: To be adherent to hypertension treatment were related to higher health care costs meanwhile been physical activity were related to lower health care costs and the combination of both showed that be adherent and physical activity represent the same cost with health than those normotensive and active emphasizing the importance of adherence and physical activity in the hypertensive treatment.

Physical training improves physical activity levels but is associated with amplification of sedentary behavior in older women.

Physical activity level (PAL) and sedentary behavior (SB) are independent predictors of mortality. It is unclear how these predictors interact with each other and health variables. Investigate the bidirectional relationship between PAL and SB, and their impact and health variables of women aged 60 to 70 years. One hundred forty-two older adults women (66.3 ± 2.9 years) considered insufficiently active were submitted to 14 weeks of multicomponent training (MT), multicomponent training with flexibility (TMF), or the control group (CG). PAL variables were analyzed by accelerometry and QBMI questionnaire, physical activity (PA) light, moderate, vigorous and CS by accelerometry, 6 min walk (CAM), SBP, BMI, LDL, HDL, uric acid, triglycerides, glucose and cholesterol total. In linear regressions, CS was associated with glucose (B:12.80; CI:9.31/20.50; p < 0.001; R2:0.45), light PA (B:3.10; CI:2, 41/4.76; p < 0.001; R2:0.57), NAF by accelerometer (B:8.21; CI:6.74/10.02; p < 0.001; R2:0.62), vigorous PA (B:794.03; CI:682.11/908.2; p < 0.001; R2:0.70), LDL (B:13.28; CI:7.45/16.75; p < 0.002; R2:0.71) and 6 min walk (B:3.39; CI:2.96/8.75; p < 0.004; R2:0.73). NAF was associated with mild PA (B:0.246; CI:0.130/0.275; p < 0.001; R2:0.624), moderate PA (B:0.763; CI:0.567/0.924; p < 0.001; R2:0.745), glucose (B:-0.437; CI:-0.789/-0.124; p < 0.001; R2:0.782), CAM (B:2.223; CI:1.872/4.985; p < 0.002; R2:0.989) and CS (B:0.253; CI: 0.189/0.512; p < 0.001; R2:1.94). The NAF can enhance CS. Build a new look at how these variables are independent but dependent simultaneously, being able to influence the quality of health when this dependence is denied.

Development and Psychometric Evaluation of a Lifestyle Evaluation Instrument for Older Adults.

Brazil is experiencing an accelerated period of population aging, with important implications for individuals, families, and the society at large. Lifestyles for the elderly can have both positive and negative health effects and are characterized by behaviors that individuals constantly reproduce in day-to-day life. However, few assessment instruments are aimed at evaluating lifestyles, and this has hampered research development. Thus, our aim in this study was to develop and evaluate the psychometric qualities of a new instrument to assess older adults' lifestyles. We developed this single scale to assess the lifestyles of older men and women using the sequential mixed method. Individuals over 60 years old of both sexes participated in this study of several phases. In Phase 1, we produced a 96-item single scale instrument, based on a literature review, previous scales, and qualitative research. In Phase 2, we verified the scale's content validity with help from 12 experts and 20 members of a target audience, aged between 60-84 years, deleting some items and reworking others. In Phase 3, we analyzed the psychometric qualities of the new scale in a sample of 700 older adults, aged 60 and above, from the five regions of Brazil, using both exploratory and confirmatory factor analysis. Our completed "Older Adult Lifestyle Scale" (OALS) is composed of 19 items divided into four subscales. The OALS has shown good psychometric qualities for Brazilian older adults over 60 years of age, and we can now recommend its use in this population.

25-hydroxyvitamin D in older adults: Which factors really matter?

BACKGROUND AND OBJECTIVES: This study investigated the interaction between a set of factors commonly associated with vitamin D production and nutritional intake and serum 25(OH)D levels among older adults. METHODS: Cross-sectional study on 346 adults over 60 years. Serum 25(OH)D levels were measured following routine biochemical laboratory protocols. Multivariable logistic regression investigated which factors were independently associated with vitamin D deficiency. RESULTS: The prevalence of vitamin D deficiency and insufficiency was 35.3% and 44.2%, respectively. The multivariable logistic regression showed gender and BMI as independent adjustment measures for serum 25(OH)D levels; all other associations were non-significant. CONCLUSIONS: Sex and BMI prevail as principal determinants of serum 25(OH)D levels among older adults. BMI seems to have a more pronounced influence on serum 25(OH)D levels of females compared to males. Healthcare professionals should consider active screening for changes in serum 25(OH)D levels in older obese adults, especially females.

Studies About Physical Activity Interventions Including Follow-Up Analysis: A Systematic Review.

BACKGROUND: Some studies have used the follow-up method to analyze real behavioral changes in research involving physical activity (PA) interventions. This has great scientific value; however, it is hard to apply without satisfactory resources and research funding. Little is known about how many studies have used this method to analyze PA interventions in low-income and middle-income countries, especially Brazil. PURPOSE: To describe Brazilian studies using follow-up analysis after PA interventions. METHODS: A systematic review was performed including Brazilian studies with follow-up analysis after PA interventions; the analyzed papers were from the previous 10 years. The search was carried out in Portuguese, English, and Spanish in the following databases: SciELO, Latin American and Caribbean Health Science Literature, PubMed, and Scopus. The Preferred Reporting Items for Systematic Review and Meta-Analysis method was used. RESULTS: In total, 6 of the 7 studies analyzed were from the southeast region, with the intervention time ranging from 2 to 12 months, carrying out follow-up every 5.3 months with 2.2 observations on average. The interventions had a behavioral approach and were generally carried out in universities, hospitals, and ambulatory care. CONCLUSION: Studies on PA interventions using follow-up analysis are scarce. Considering the relevance of follow-up studies to measure behavior changes, the results suggest that more studies about this topic are essential in Brazil.

Evaluating the impact of a walking program in a disadvantaged area: using the RE-AIM framework by mixed methods.

BACKGROUND: The positive health impact of physical activity (PA) is well known, yet a large proportion of the world's population remains sedentary. General PA programs are common as health promotion initiatives. However, effectiveness evaluations of such PA programs on individual and organizational aspects, which could inform the decision-making process of public health bodies are still lacking, particularly in the most socially disadvantaged areas, where health promotion schemes are particularly needed. The aim of this study was to assess the effectiveness of a Guided Walking Program in a high social vulnerability context. METHODS: A quasi-experimental, mixed methods study was conducted. The program had a duration of 6 months and a 6-month follow-up period after the intervention. Session frequency was five times a week, where sessions consisted of supervised PA combined with educational sessions. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was followed to assess the program. The International Physical Activity Questionnaire (IPAQ) and accelerometers were used to measure levels of PA. Focus groups were conducted to gain a comprehensive insight on the implementation domain. RESULTS: Most subjects in the intervention (IG) (n = 74) and control (CG) (n = 74) groups were female (IG:90.5%; CG:95.9%), aged 18-49 years (IG:44.6%; CG:43.2%), received less than 1 minimum wage (IG:74.3%; CG:83.7%) and had 0-4 years of formal education (IG:52.1%; CG:46.1%). The reach of the intervention was 0.3%. The IG showed increased levels of PA at post-intervention and 6-month follow-up. However, the difference between groups was not statistically significant. Adoption data revealed that 89.5% of the professionals in the Primary Health Care Center (health center) team perceived the benefits of the program for the population. The program was independently promoted by the health center team for a further 4 months post-intervention. The qualitative data revealed that the program was discontinued due to participants' low adherence and human resource limitations in the unit's operational dynamics. CONCLUSIONS: A health promotion intervention in a socially deprived setting faces challenges but can be effective and feasible to implement. The present study informs the development of future health promotion initiatives in this context. TRIAL REGISTRATION: NCT02857127 . Registered: 30 July 2016 (retrospectively registered).