Is rest-activity rhythm prospectively associated with all-cause mortality in older people regardless of sleep and physical activity level? The 'Como Vai?' Cohort study.

OBJECTIVE: This study aims to test the association of rest-activity rhythm (intradaily variability and interdaily stability) with all-cause mortality in an older adult cohort in Brazil. It also assesses whether the amount of time spent at each intensity level (i.e., physical activity and nocturnal sleep) interferes with this association. METHODS: This cohort study started in 2014 with older adults (≥60 years). We investigated deaths from all causes that occurred until April 2017. Rest-activity rhythm variables were obtained using accelerometry at baseline. Intradaily variability indicates higher rhythm fragmentation, while interdaily stability indicates higher rhythm stability. Cox proportional-hazard models were used to test the associations controlling for confounders. RESULTS: Among the 1451 older adults interviewed in 2014, 965 presented valid accelerometry data. During the follow-up period, 80 individuals died. After adjusting the analysis for sociodemographic, smoking, morbidity score, and number of medicines, an increase of one standard deviation in interdaily stability decreased 26% the risk of death. The adjustment for total sleep time and inactivity did not change this association. On the other hand, the association was no longer significant after adjusting for overall physical activity and moderate to vigorous physical activity. CONCLUSION: Rest-activity rhythm pattern was not associated with mortality when physical activity was considered, possibly because this pattern could be driven by regular exercise. Promoting physical activity remains a relevant strategy to improve population health.

Accelerometer-based sleep metrics and gut microbiota during adolescence: Association findings from a Brazilian population-based birth cohort.

BACKGROUND: Sleep and gut microbiota are emerging putative risk factors for several physical, mental, and cognitive conditions. Sleep deprivation has been shown to be linked with unhealthy microbiome environments in animal studies. However, in humans, the results are mixed. Epidemiological studies evaluating the effect of accelerometer-based sleep measures on gut microbiome are scarce. This study aims to explore the relationship between sleep duration and efficiency with the gut microbiota in adolescence. METHODS: A subsample of 352 participants from the 2004 Pelotas (Brazil) Birth Cohort Study with sleep and fecal microbiota data available were included in the study. Sleep duration and sleep efficiency were obtained from actigraphy information at 11 years old whereas microbiota information from fecal samples was collected at 12 years. The fecal microbiota was analyzed via Illumina MiSeq (16S rRNA V3-V4 region) and the UNOISE pipeline. Alpha was assessed in QIIME2. Association measures for sleep variables and microbial α-diversity, and bacterial relative abundance were assessed through generalized models (linear and logistic regression), adjusting for maternal and child variables confounders. RESULTS: Adjusted models showed that sleep duration was positively associated with Simpson index of α-diversity (ß = 0.003; CI95 %: 0.00004; 0.01). Both sleep duration (OR = 0.43; CI95 % 0.25; 0.74) and efficiency (OR = 0.55; CI95 % 0.38; 0.78) were associated with lower Bacteroidetes abundance. CONCLUSION: Our results suggest that sleep duration and efficiency are linked to gut microbiota diversity and composition even with 1-2 years gap from exposure to outcome. The findings support the role of sleep in the gut-brain axis as well as provide insights on how to improve microbiota health.

Leisure-Time Physical Activity in a Southern Brazilian City (2004-2021): Applying an Equity Lens to Time-Trend Analyses.

BACKGROUND: This study aimed to verify leisure-time physical activity trends over 15 years and monitor inequalities according to gender, self-reported skin color, and socioeconomic position in a Southern Brazilian city. A secondary aim is to evaluate intersectionalities in physical activity. METHODS: Trend analysis using 3 population-based surveys carried out in 2004, 2010, and 2021. Main outcome assessed was the prevalence of physical activity according to recommendations (150 min/wk). Inequalities dimensions measured were sex, self-reported skin color, and wealth. Intersectionalities were evaluated using Jeopardy index combining all inequality dimensions. Trend analysis was performed using least-squares weighted regression. RESULTS: We included data from 3090, 2656, and 5696 adults in 2004, 2010, and 2021, respectively. Prevalence of physical activity remains stable around 25% in the 3 years. In the 3 periods evaluated, men presented a prevalence in average 10 percentage points higher than women (SII2004 = -11.1 [95% confidence interval, CI, -14.4 to -7.8], SII2021 = -10.7 [95% CI, -13.7 to -7.7]). Skin color inequalities did not present a clear pattern. Richest individuals, in general presented a prevalence of leisure-time physical activity level 20pp higher than poorest ones (SII2004 = 20.5 [95% CI, 13.7 to 27.4]; SII2021 = 16.7 [95% CI, 11.3 to 22.0]). Inequalities were widely marked, comparing the most privileged group (represented by men, the wealthiest, and White) and the most socially vulnerable group (represented by women, the poorest, and Black/Brown). The Slope Index of Inequality for intersectionalities was -24.5 (95% CI, -31.1 to -17.9) in 2004 and -18.8 in 2021 (95% CI, -24.2 to -13.4). CONCLUSIONS: Our analysis shows that women, Black/Brown, and poor present lower leisure-time physical activity level. This group is often neglected regarding other health and social outcomes.

Health inequalities in Brazilian adolescents: Measuring and mapping gaps in a cross-sectional school-based survey.

Background and Aims: This study aims to describe inequalities in health indicators according to gender, area of residence, and socioeconomic position among Brazilian adolescents. Methods: Cross-sectional study using data from a school-based survey carried out in Brazil in 2019. Twelve health outcomes were evaluated. Dimensions of inequality assessed were gender, area of residence, wealth and subnational region. Results: This study comprises a sample of 124,898 adolescents. The most prevalent outcome was physical inactivity (71.9%) followed by thinking life is worthless (52.6%) and bullying (51.8%). Gender inequalities were more marked for physical inactivity and thinking life is worthless with girls presenting a prevalence more than 20 p.p. higher than boys. In zero-dose HPV, however, the prevalence in girls was 17.7 p.p. lower than in boys. Area of residence and wealth inequalities were smaller than gender disparities. Context presented a relevant role in inequality with analysis stratified by states of the country, revealing high variability in estimates. Conclusions: We highlight the need for attention to disparities between subgroups of the adolescent population, especially for gender inequalities that were the most marked for this age group.

Accelerometry Measured Movement Behaviors in Middle-Aged and Older Adults: Cross-Sectional Analysis of the ELSA-Brasil Study.

BACKGROUND: Little investigation of accelerometry assessed movement behaviors and physical inactivity was carried out in middle-aged and older adults in low-middle-income countries. OBJECTIVE: Describe accelerometry-measured movement behaviors and prevalence of physical inactivity in middle-aged and older adults. METHODS: We collected raw accelerometry data during the third visit (2017-2019) of ELSA-Brasil, a large-scale multicenter Brazilian cohort. Participants wore an ActiGraph wGT3X-BT on the waist for 24 hours for 7 days and documented sleep in a diary. RESULTS: Nine thousand two hundred and seventy-nine participants had valid data (73.4% of the eligible cohort). Overall activity was higher for men (11.82mg; 95% confidence interval [CI], 11.7 to 11.93) than women (10.69mg; 95% CI, 10.6 to 10.77) and lower in older groups-women (-0.12mg/y; 95% CI, -0.13 to -0.11), men (-0.16mg/y; 95% CI, -0.17 to -0.14). Participants were more active from noon to midnight. Distribution of movement behaviors varied with sex and age, and sleep duration was longer in older individuals. Overall, 14.4% (95% CI, 13.7 to 15.1) were inactive, with inactivity being more frequent in women (16.4%; 95% CI, 15.4 to 17.4) than men (12.2%; 95% CI, 11 to 13). Higher rates were observed in the oldest. Retirement was associated with a higher prevalence of physical inactivity in both sexes. CONCLUSION: Women were less active than men. Older individuals showed a high prevalence of physical inactivity, probably related to transition into retirement. These findings strengthen evidence for public policies promoting physical activity by emphasizing the need to target women, older individuals, and those transitioning to retirement to improve and/or maintain physical activity levels throughout the course of their lives.

Physical Activity and Chronic Stress in Early Life: Findings From the 2015 Pelotas (Brazil) Birth Cohort.

BACKGROUND: The association of physical activity through early childhood on children's chronic stress still is unclear. Therefore, the aim of the present study is to test the association of physical activity through early childhood (1-4 y) with chronic stress, measured by hair cortisol at age 4. METHODS: Longitudinal study including children from the 2015 Pelotas (Brazil) Birth Cohort. Cortisol at age 4 was measured using a hair sample, which provided cortisol concentration from the past months. Physical activity was measured using accelerometers at 1, 2, and 4 years. Linear regression models were used to assess the association between physical activity and chronic stress. Trajectory models were also applied to examine chronic stress in relation to physical activity patterns throughout early childhood. RESULTS: Children with valid physical activity and hair cortisol data were included in the analyses (N = 1475). Three groups of physical activity trajectories between 1 and 4 years were identified: low, medium, and high. No association between physical activity at 1, 2, and 4 years and chronic stress at age 4 was observed. However, children in the "high" physical activity trajectory presented low cortisol concentration; the magnitude of the regression coefficient was slightly larger in girls (ß = -0.125; 95% confidence interval, -0.326 to 0.074) than boys (ß = -0.051; 95% confidence interval, -0.196 to 0.09). CONCLUSION: There was no clear association between physical activity and chronic stress in early childhood. Trajectories models suggest that higher activity throughout early childhood may positively impact chronic stress; however, more studies are needed to confirm that hypothesis.

Bi-directional associations between physical activity and growth indicators of pre-school aged children.

Physical activity for young children provides a wealth of benefits for health and development. However, little is known about the inter-relationship of physical activity and growth indicators. The aim of this study was to test the bi-directional associations of physical activity and growth indicators in children under five years of age. This prospective study included 1,575 children with data on physical activity and growth indicators at ages 12, 24 and 48 months. Accelerometers were used to measure physical activity. Z-scores for length/height-for-age, weight-for-length/height, weight-for-age and body mass index (BMI)-for-age were calculated. Bi-directional associations between physical activity and growth indicators were evaluated using cross-lagged panels based on Generalized Estimating Equations and cross-lagged structural equation models. Physical activity was consistently associated with lower weight-related growth indicators: BMI-for-age: ß=-0.12; Weight-for-age: ß=-0.11; Weight-for-length/height: ß=-0.12. Higher BMI-for-age indicated lower physical activity (ß=-0.06). When the exposure was lagged, the association of physical activity on weight-related growth indicators remained, but weight-related growth indicators showed a negative association on physical activity. A bi-directional association between physical activity and weight-related growth indicators was observed. The magnitude of associations were stronger when physical activity was modelled as exposure. These results reinforce the importance of physical activity since early years.

Trajectories of Device-Measured Physical Activity During Early Childhood and Its Determinants: Findings From the 2015 Pelotas (Brazil) Birth Cohort Study.

BACKGROUND: The objective was to describe trajectories of physical activity (PA) measured by accelerometry during early childhood and to test associations with sociodemographic, gestational, maternal, and perinatal determinants. METHODS: Data from 1798 children from the 2015 Pelotas (Brazil) Birth Cohort were analyzed. PA was measured with wrist accelerometers at 1, 2, and 4 years. PA trajectories were estimated using group-based trajectory modeling, and associations with determinants were tested using Poisson regression with robust variance. RESULTS: Two trajectories were identified: Moderate and high PA, both showing a linear increase in PA in the first years but differing in volume. Girls (prevalence ratio [PR]: 0.91; 95% confidence interval [CI], 0.88-0.94), highly educated mothers (PR: 0.93; 95% CI, 0.88-0.97), and high birth weight children (PR: 0.91; 95% CI, 0.85-0.97) showed less probability of high PA trajectory. Birth order ≥3 (PR: 1.06; 95% CI, 1.01-1.11) was associated with higher likelihood of high PA trajectory. CONCLUSIONS: Children showed an increase in PA during the first years, with 2 trajectories that differ in PA levels. Female sex, high maternal schooling, and high birth weight reduced the probability of having a high PA trajectory, while higher birth order increased this probability. These characteristics should be considered when planning PA interventions for children in early childhood.

The inverse equity hypothesis in the implementation of NASF-AB in municipalities of Southern Brazil. / A hipótese da equidade inversa na implementação do NASF-AB em municípios do Sul do Brasil.

The present study aimed to analyze the evolution of the implementation of Family Health and Primary Health Care Expanded Support Centers (NASF-AB, in Portuguese) in the municipalities of Southern Brazil, from 2008 to 2019, in light of the inverse equity hypothesis. This was an ecological study, considering 1,188 municipalities of Southern Brazil. The analyses were separated by state, with municipalities divided into quartiles of Municipal Human Development Index - Income (MHDI-Income). Our study calculated the cumulative percentage of the implementation of NASF-AB within the given period and the inequality between Q1 (richest) and Q4 (poorest), assessed by the absolute and relative inequality measures. In Paraná, Q1 presented a higher coverage of NASF-AB than did Q4, and, although the inequality had decreased at the end of the period, it was still quite distinct, according to the "top inequality" pattern. In Santa Catarina, the predictions of the hypothesis were confirmed, with inequalities found in the beginning of the period and a near 90% decline once NASF-AB had been implemented in the municipalities of Q1, characterizing the "bottom inequality" pattern. In Rio Grande do Sul, the hypothesis was refuted observing that since 2014 there was a greater implementation in Q4 as compared to Q1 was observed.

O objetivo foi verificar a evolução da implementação do Núcleo Ampliado de Saúde da Família e Atenção Básica (NASF-AB) nos municípios da região Sul do Brasil, de 2008 a 2019, sob à luz da hipótese da equidade inversa. Estudo ecológico considerando 1.188 municípios do Sul do Brasil. As análises foram separadas por estado, com os municípios divididos em quartis de Índice de Desenvolvimento Humano Municipal - Renda. Foi calculado o percentual acumulativo de implementação do NASF-AB no período e a desigualdade entre Q1 (mais rico) e Q4 (mais pobre) verificada por medidas de desigualdade absoluta e relativa. No Paraná o Q1 apresentou maior cobertura do NASF-AB do que o Q4 e, apesar da desigualdade ter reduzido ao final do período, ainda estava bem demarcada, seguindo padrão "top inequality". Em Santa Catarina ocorreu o que prevê a hipótese, com aumento das desigualdades no início e posterior redução quando já existia NASF-AB em cerca de 90% dos municípios do Q1, caracterizando "botton inequality". No Rio Grande do Sul a hipótese foi refutada ao observar, a partir de 2014, maior implementação no Q4 em relação ao Q1.

Prospective Association of Occupational and Leisure-Time Physical Activity With Cardiovascular Risk Factors in Early Adulthood: Findings From Pelotas (Brazil) 1982 Birth Cohort.

BACKGROUND: The benefits of physical activity in health outcomes are well established. However, recent evidence suggests that benefits may differ by domain and population. Thus, we aimed to investigate the prospective association of occupational (OPA) and leisure-time physical activity (LTPA) with cardiovascular risk factors. METHODS: In 1982, the maternity hospitals of Pelotas were visited daily; those live births whose families lived in urban areas were evaluated, and their mothers were later interviewed (n = 5914). In the 2004/5 follow-up (23 y old), both OPA and LTPA were measured in 4295 participants using their respective sections of the International Physical Activity Questionnaire. In the 2012 follow-up (30 y old), the following cardiovascular risk factors were collected: high-density lipoprotein (in milligrams per deciliter), low-density lipoprotein (in milligrams per deciliter), triglycerides (in milligrams per deciliter), glucose (in milligrams per deciliter), and blood pressure (in millimeters of mercury). Multivariable linear regressions were performed to evaluate associations between OPA and LTPA with these specific cardiovascular risk factors. RESULTS: In total, 3241 participants were analyzed. Our main findings suggest that there was no association between OPA and LTPA with high- and low-density lipoprotein. There were inverse associations between OPA and lower levels of triglycerides among males (ß = -0.002; 95% confidence interval, -0.003 to -0.000) and positive associations between LTPA and higher levels of diastolic blood pressure among females (ß = 0.111; 95% confidence interval, 0.005-0.216). CONCLUSION: In conclusion, our findings suggest that there was no association, or association with limited clinical relevance, of OPA and LTPA with cardiovascular risk factors in early adulthood.

A hipótese da equidade inversa na implementação do NASF-AB em municípios do Sul do Brasil / The inverse equity hypothesis in the implementation of NASF-AB in municipalities of Southern Brazil

Resumo O objetivo foi verificar a evolução da implementação do Núcleo Ampliado de Saúde da Família e Atenção Básica (NASF-AB) nos municípios da região Sul do Brasil, de 2008 a 2019, sob à luz da hipótese da equidade inversa. Estudo ecológico considerando 1.188 municípios do Sul do Brasil. As análises foram separadas por estado, com os municípios divididos em quartis de Índice de Desenvolvimento Humano Municipal - Renda. Foi calculado o percentual acumulativo de implementação do NASF-AB no período e a desigualdade entre Q1 (mais rico) e Q4 (mais pobre) verificada por medidas de desigualdade absoluta e relativa. No Paraná o Q1 apresentou maior cobertura do NASF-AB do que o Q4 e, apesar da desigualdade ter reduzido ao final do período, ainda estava bem demarcada, seguindo padrão "top inequality". Em Santa Catarina ocorreu o que prevê a hipótese, com aumento das desigualdades no início e posterior redução quando já existia NASF-AB em cerca de 90% dos municípios do Q1, caracterizando "botton inequality". No Rio Grande do Sul a hipótese foi refutada ao observar, a partir de 2014, maior implementação no Q4 em relação ao Q1.

Abstract The present study aimed to analyze the evolution of the implementation of Family Health and Primary Health Care Expanded Support Centers (NASF-AB, in Portuguese) in the municipalities of Southern Brazil, from 2008 to 2019, in light of the inverse equity hypothesis. This was an ecological study, considering 1,188 municipalities of Southern Brazil. The analyses were separated by state, with municipalities divided into quartiles of Municipal Human Development Index - Income (MHDI-Income). Our study calculated the cumulative percentage of the implementation of NASF-AB within the given period and the inequality between Q1 (richest) and Q4 (poorest), assessed by the absolute and relative inequality measures. In Paraná, Q1 presented a higher coverage of NASF-AB than did Q4, and, although the inequality had decreased at the end of the period, it was still quite distinct, according to the "top inequality" pattern. In Santa Catarina, the predictions of the hypothesis were confirmed, with inequalities found in the beginning of the period and a near 90% decline once NASF-AB had been implemented in the municipalities of Q1, characterizing the "bottom inequality" pattern. In Rio Grande do Sul, the hypothesis was refuted observing that since 2014 there was a greater implementation in Q4 as compared to Q1 was observed.

Absolute intensity thresholds for tri-axial wrist and waist accelerometer-measured movement behaviors in adults.

AIM: This study was aimed to: (1) compare raw triaxial acceleration data from GENEActiv (GA) and ActiGraph GT3X+ (AG) placed on the non-dominant wrist; (2) compare AG placed on the non-dominant and dominant wrist, and waist; (3) derive brand- and placement-specific absolute intensity thresholds for inactive and sedentary time, and physical activity intensity in adults. METHODS: Eighty-six adults (44 men; 34.6 ± 10.8 years) performed nine activities while simultaneously wearing GA and AG on wrist and waist. Acceleration (in gravitational equivalent units; mg) was compared with oxygen uptake (measured with indirect calorimetry). RESULTS: Increases in acceleration mirrored increases in intensity of activities, regardless of device brand and placement. Differences in acceleration between GA and AG worn at the non-dominant wrist were small but tended to be high at lower intensity activities. Thresholds for differentiating inactivity (<1.5 MET) from activity (≥1.5 MET) ranged from 25 mg (AG non-dominant wrist; sensitivity 93%, specificity 95%) to 40 mg (AG waist; sensitivity 78%, specificity 100%). For moderate intensity (≥3 METs), thresholds ranged from 65 mg (AG waist; sensitivity 96%, specificity 94%) to 92 mg (GA non-dominant; sensitivity 93%, specificity 98%); vigorous intensity (≥6 METs) thresholds ranged from 190 mg (AG waist; sensitivity 82%, specificity 92%) to 283 mg (GA non-dominant; sensitivity 93%, specificity 98%). CONCLUSION: Raw triaxial acceleration outputs from two widely used accelerometer brands may have limited comparability in low intensity activities. Thresholds derived in this study can be utilized in adults to reasonably classify movement behaviors into categories of intensity.

Inequalities in the association between adherence to the Mediterranean diet and physical fitness in the young population during the COVID-19 lockdown / Desigualdades en la asociación entre la adherencia a la dieta mediterránea y la condición física en la población joven durante el confinamiento de la COVID-19

Objective: this study analyzed the association between adherence to the Mediterranean diet and proxy-reported physical fitness among Spanish and Brazilian youths during the COVID-19 lockdown according to several inequality indicators. Methods: we conducted a cross-sectional study with parents and guardians of children and adolescents from Spain and Brazil. The evaluation process was through the use of online questionnaires. Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Quality Index in Children and Adolescents. Proxy-reported physical fitness was determined using the International Fitness Scale. Inequality indicators (gender, nationality, socioeconomic status, and parents/guardians’ education level) were evaluated with a survey completed by the participants’ parents/guardians. Binary logistic regression models estimated the association between adherence to the Mediterranean diet and proxy-reported physical fitness, with stratification according to inequality variables. A total sample of 1,099 Spanish and Brazilian individuals (47.6% girls, aged 3 to 17 years) were included in the analysis. Results: compared to the “improvement needed to Mediterranean diet” category, the “optimal Mediterranean diet” group was significantly associated with “very good” physical fitness in boys (OR = 1.5; 95 % CI: 1.0-2.1) and in participants with parents/legal guardians’ education level without university studies (OR = 1.5; 95 % CI: 1.0-2.4). Conclusions: gender and parents/guardians’ education level plays a significant role in the association between the “optimal Mediterranean Diet” and “very good” physical fitness level in Spanish and Brazilian children and adolescents. Future prospective studies are needed to investigate the role of inequality indicators in this relationship. (AU)

Objetivo: este estudio analizó la asociación entre la adherencia a la dieta mediterránea y la aptitud física autoinformada entre jóvenes españoles y brasileños durante el confinamiento de COVID-19 según varios indicadores de desigualdad. Métodos: se realizó un estudio transversal con padres y tutores de niños y adolescentes de España y Brasil. El proceso de evaluación fue a través del uso de cuestionarios online. La adherencia a la dieta mediterránea se evaluó mediante el Índice de Calidad de la Dieta Mediterránea en Niños y Adolescentes. La aptitud física declarada por los padres se determinó mediante la Escala Internacional de Aptitud Física. Los indicadores de desigualdad (género, nacionalidad, estatus socioeconómico y nivel educativo de los padres/tutores) se evaluaron con una encuesta completada por los padres/tutores de los participantes. Los modelos de regresión logística binaria estimaron la asociación entre la adherencia a la dieta mediterránea y la aptitud física informada por los progenitores, estratificando según las variables de desigualdad. Se incluyó en el análisis una muestra total de 1099 individuos españoles y brasileños (47,6 % niñas, de 3 a 17 años). Resultados: en comparación con la categoría de “necesidad de mejorar la dieta mediterránea”, la de “dieta mediterránea óptima” se asoció significativamente con una aptitud física “muy buena” en los chicos (OR = 1,5; IC del 95 %: 1,0-2,1) y en los participantes con nivel educativo de los padres/tutores sin estudios universitarios (OR = 1,5; IC del 95 %: 1,0-2,4). Conclusiones: el género y el nivel educativo de los padres/tutores legales desempeñan un papel significativo en la asociación entre la “dieta mediterránea óptima” y el nivel de condición física “muy bueno” en niños y adolescentes españoles y brasileños. Se necesitan futuros estudios prospectivos para investigar el papel de los indicadores de desigualdad en esta relación. (AU)

Prevalence and Sociodemographic Correlates of Meeting the 24-Hour Movement Guidelines Among Low-Income Brazilian Older Adults With Chronic Diseases.

This study examined the prevalence and sociodemographic correlates of meeting individual behavior and 24-hr movement behavior guidelines among Brazilian older adults with chronic diseases. The sample comprised 273 older adults aged ≥60 years (80.2% women) with chronic diseases from Recife, Pernambuco, Brazil. Sociodemographic variables were self-reported, while 24-hr movement behaviors were assessed by accelerometry. Participants were classified as meeting (or not meeting) individual and integrated recommendations for moderate-to-vigorous physical activity (MVPA), sedentary behavior, and sleep duration. No participant met the 24-hr movement behavior guidelines, while only 8.4% met integrated MVPA/sleep recommendations. The prevalence of meeting recommendations of MVPA, sedentary behavior, and sleep was 28.9%, 0.4%, and 32.6%, respectively. Discrepancies according to sociodemographic variables on meeting MVPA recommendations existed. The findings show the need for dissemination and implementation strategies to foster adoption of the 24-hr movement behavior guidelines among Brazilian older adults with chronic diseases.

Prática de atividade física e desigualdades em idosos antes e após a COVID-19 / Physical activity and inequalities in older adults before and after COVID-19

O objetivo do estudo foi verificar modificações na prevalência de atividade física (AF) e desigual-dades em idosos acompanhados antes e após o período de distanciamento social causado pela CO-VID-19. Trata-se de estudo prospectivo conduzido na zona urbana da cidade de Pelotas-Rio Grande do Sul, onde idosos foram acompanhados no ano de 2019/20 e 2021/22. A prevalência de AF foi avaliada através do IPAQ nos domínios do lazer e deslocamento avaliados de forma conjunta. Foram classificados como ativos fisicamente aqueles que realizavam ≥ 150 min/sem. As covariáveis/estra-tificadores avaliadas foram sexo, idade, cor da pele, classe econômica, escolaridade e morbidades. As desigualdades simples foram avaliadas através das diferenças e das razões da prevalência de AF e as desigualdades complexas através do índice de desigualdade (SII) e o índice de concentração (CIX). Os resultados indicaram que houve redução da prevalência de AF de 2019/20 para 2021/22 e que essas modificações ocorreram em todos os grupos populacionais, variando em termos de magnitude de declínio. O SII mostrou aumento da desigualdade entre os mais pobres em comparação aos mais ricos e redução da desigualdade em relação à idade, escolaridade e morbidades. Concluiu-se que a redução da AF ocorreu em todos os grupos populacionais. Em termos de desigualdades, houve aumento em termos de classe econômica e, nos casos de redução da desigualdade, tal mudança foi em virtude da diminuição de AF entre as categorias que eram mais ativas, sendo necessário políticas de saúde para resgatar níveis adequados de AF na população estudada

This study aimed to verify the modification in the physical activity prevalence (PA) and possible inequalities in older individuals monitored before and after social distancing due to COVID-19. This is a prospective study conducted in the urban area of Pelotas-Rio Grande do Sul, where the elderly was followed up in 2019/20 and 2021/22. The prevalence of PA was assessed using the IPAQ in the domain of leisure time and commuting evaluated together. Older people who performed ≥150 min/week were classified as physically active. The covariates/stratifiers assessed were sex, age, skin color, economic class, schooling, and morbidity. Simple inequalities were assessed through differences and ratios for the prevalence of PA and complex ine-qualities through the inequality index (SII) and the concentration index (CIX). The results indicated that there was a reduction in the prevalence of PA among the participants from 2019/20 to 2021/22 and that these changes occurred regardless of population characteristics. The SII showed an increase in PA inequality among the poorest compared to the richest individuals and a reduction in inequalities about age, education, and morbidities. It is concluded that the reduction in PA occurred similarly regardless of the covariates/stratifiers evaluated, that there was an increase in inequality in PA among the less economically favored, and that the reduction in inequality occurred especially from the reduction in PA, requiring health policies to rescue adequate levels of PA in the studied population

Projeto Vida Ativa Pelotas: Percepção das coordenadoras sobre a implantação dos núcleos no ano de 2019 / Project Vida Ativa Pelotas: Perception of the coordinators on the implantation of the nucleus in the year 2019

O objetivo deste estudo foi descrever o processo de implantação dos núcleos do Projeto Vida Ativa no município de Pelotas, Rio Grande do Sul. O projeto é uma política de governo, desenvolvida desde 2013, financiado e executado pela prefeitura municipal, que estimava atender em 2019 cerca de 4.000 pessoas, promovendo atividades físicas e esportivas. Optou-se por uma abordagem qualitativa e um recorte transversal no ano de 2019. Foram realizadas oito entrevistas semiestruturadas com a dois níveis de coordenação do projeto. Para análise dos dados obtidos foi utilizada a técnica de análise de conteúdo. Os principais resultados da análise apontaram que o projeto apresentava desafios a serem enfrentados como a sustentabilidades dos processos, financiamento para adequação dos núcleos e ampliação desses locais, continuidade nos processos de capacitações com os profissionais, monito-ramento e avaliação do projeto. Apesar das dificuldades enfrentadas de acordo com a percepção das coordenadoras, o projeto apresentava-se como uma iniciativa progressista na forma como estava sendo implementando seus núcleos e atividades físicas e esportivas, sobretudo por dialogar com demandas locais, e contar com apoio da população participante, mantendo-se ao longo das trocas de governo

The aim of this study was to describe the implantation process of the of the Projeto Vida Ativa in the city of Pelotas (Brazil). The project is a government policy, developed since 2013, financed and executed by the mu-nicipal government, which estimates to serve around 4000 people promoting physical activities and sports. We conducted qualitative research and opted to address the year 2019 as a time frame. In the collection, eight semi-structured interviews were carried out with the project's coordination. For data analysis, the content analysis technique was used. The main results of the analysis indicate that the project has weaknesses that need to be addressed as the sustainability of the processes, funding for the adequacy of the centers, expansion of these locations, continuity in training processes, and implementation of monitoring and evaluation. Despite the difficulties faced by the coordination and professionals who carry out the actions, the project presents itself as a positive initiative in the way the centers and physical activities and sports are being implemented. Further positive aspects included the local-domand attended and the population support for the continuity of the project despite changes in the government

Describing physical activity in public open spaces in Brazil: Active City, Healthy City Program / Descrevendo a atividade física em espaços públicos abertos no Brasil: Programa Cidade Ativa, Cidade Saudável

This study aimed to describe the physical activity (PA) in public open spaces (POS) in a medi-um-sized city in Brazil. The System for Observing Play and Recreation in Communities (SOPARC) was applied to evaluate a representative sample of users in 10 POS which received actions from the Active City, Healthy City Program. The places were evaluated four days a week (Tuesday, Wednes-day, Saturday, and Sunday) at four times (8 am, 10 am, 2 pm, and 4 pm). The proportion of users by gender, age group, skin color, and PA level was compared between the POS using the chi-square test for heterogeneity in the STATA software (p<0.05). As main results, 32,768 scans were performed in 64 target areas and identified 8,634 individuals. The highest proportion of people were males (58%), adults (38%), with white skin color (97%), and in light or moderate PA (76%). Except for skin color, there was a significant difference in the proportion of all other variables between the POS (p < 0.05). In conclusion, the POS was more commonly used by men, adults, and people of white skin color for light and moderate PA. Based on the results, program managers could reallocate resources to increase utilization and PA at each place

O objetivo deste estudo foi descrever a atividade física (AF) em espaços públicos abertos (EPA) em uma cidade de médio porte do Brasil. O System for Observing Play and Recreation in Communities (SOPARC) foi utilizado para avaliar uma amostra representativa de frequentadores de 10 EPA que receberam ações do programa Cidade Ativa, Cidade Saudável. Os locais foram avaliados quatro dias da semana (terça-feira, quarta-feira, sábado, domingo) em quatro horários (8h, 10h, 14h, 16h). A proporção de frequentadores por sexo, faixa etária, cor de pele e nível de AF foi comparada entre os EPA pelo teste do qui-quadrado para heterogeneidade no software STATA (p < 0,05). Como resultados principais, foram realizados 32.768 scans em 64 áreas-alvo e 8.634 frequentadores foram identificados. Foi observada maior proporção de pessoas do sexo masculino (58%), adultos (38%), de cor de pele branca (97%) e em AF de intensidade leve ou moderada (76%). Com exceção da cor da pele, houve diferença significante na proporção das demais variáveis entre os EPA (p < 0,05). Em conclusão, os EPA são mais comumente utilizados por homens, pessoas adultas, de cor de pele branca e para a prática de AF de intensidade leve e moderada. Com base nos resultados, os gestores do programa poderiam realocar recursos para aumentar a utilização e a AF em cada local

Inequalities in the association between adherence to the Mediterranean diet and physical fitness in the young population during the COVID-19 lockdown.

Introduction: Objective: this study analyzed the association between adherence to the Mediterranean diet and proxy-reported physical fitness among Spanish and Brazilian youths during the COVID-19 lockdown according to several inequality indicators. Methods: we conducted a cross-sectional study with parents and guardians of children and adolescents from Spain and Brazil. The evaluation process was through the use of online questionnaires. Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Quality Index in Children and Adolescents. Proxy-reported physical fitness was determined using the International Fitness Scale. Inequality indicators (gender, nationality, socioeconomic status, and parents/guardians' education level) were evaluated with a survey completed by the participants' parents/guardians. Binary logistic regression models estimated the association between adherence to the Mediterranean diet and proxy-reported physical fitness, with stratification according to inequality variables. A total sample of 1,099 Spanish and Brazilian individuals (47.6% girls, aged 3 to 17 years) were included in the analysis. Results: compared to the "improvement needed to Mediterranean diet" category, the "optimal Mediterranean diet" group was significantly associated with "very good" physical fitness in boys (OR = 1.5; 95 % CI: 1.0-2.1) and in participants with parents/legal guardians' education level without university studies (OR = 1.5; 95 % CI: 1.0-2.4). Conclusions: gender and parents/guardians' education level plays a significant role in the association between the "optimal Mediterranean Diet" and "very good" physical fitness level in Spanish and Brazilian children and adolescents. Future prospective studies are needed to investigate the role of inequality indicators in this relationship.

Introducción: Objetivo: este estudio analizó la asociación entre la adherencia a la dieta mediterránea y la aptitud física autoinformada entre jóvenes españoles y brasileños durante el confinamiento de COVID-19 según varios indicadores de desigualdad. Métodos: se realizó un estudio transversal con padres y tutores de niños y adolescentes de España y Brasil. El proceso de evaluación fue a través del uso de cuestionarios online. La adherencia a la dieta mediterránea se evaluó mediante el Índice de Calidad de la Dieta Mediterránea en Niños y Adolescentes. La aptitud física declarada por los padres se determinó mediante la Escala Internacional de Aptitud Física. Los indicadores de desigualdad (género, nacionalidad, estatus socioeconómico y nivel educativo de los padres/tutores) se evaluaron con una encuesta completada por los padres/tutores de los participantes. Los modelos de regresión logística binaria estimaron la asociación entre la adherencia a la dieta mediterránea y la aptitud física informada por los progenitores, estratificando según las variables de desigualdad. Se incluyó en el análisis una muestra total de 1099 individuos españoles y brasileños (47,6 % niñas, de 3 a 17 años). Resultados: en comparación con la categoría de "necesidad de mejorar la dieta mediterránea", la de "dieta mediterránea óptima" se asoció significativamente con una aptitud física "muy buena" en los chicos (OR = 1,5; IC del 95 %: 1,0-2,1) y en los participantes con nivel educativo de los padres/tutores sin estudios universitarios (OR = 1,5; IC del 95 %: 1,0-2,4). Conclusiones: el género y el nivel educativo de los padres/tutores legales desempeñan un papel significativo en la asociación entre la "dieta mediterránea óptima" y el nivel de condición física "muy bueno" en niños y adolescentes españoles y brasileños. Se necesitan futuros estudios prospectivos para investigar el papel de los indicadores de desigualdad en esta relación.

[Temporal trends in inequalities of accumulated behavioral risk factors in Brazilian state capitals, 2008-2018]. / Tendências temporais das desigualdades no acúmulo de fatores de risco comportamentais nas capitais do Brasil, 2008-2018.

The aim of this study was to assess trends in inequalities regarding sex and educational levels in accumulated behavioral risk factors in the Brazilian state capitals. Repeated surveys from a Vigitel surveillance initiative carried out from 2008 to 2018 including adults (≥ 18 years) living in the 26 Brazilian state capitals and in the Federal District were analyzed (n = 569246). Accumulation of at least two behavioral risk factors including physical inactivity, inadequate diet, tobacco use and abusive alcohol consumption. Simple and complex measures of inequality were calculated according to sex and educational level, in addition to assessing intersectionality between age groups and regions of the country. The accumulated risk factor prevalence between 2008 and 2018 decreased from 51.6% to 41.2% among males and from 45.3% to 30.8% among females. Despite the observed decreasing trends in the prevalence of accumulated risk factors over time, inequalities of sex and educational levels persisted. Adult males and people with lower levels of education persistently presented higher prevalence of accumulated risk factors, highlighting not only the need for monitoring strategies of such inequalities, but also for actions aiming at reducing this trend.

O objetivo do estudo foi avaliar as tendências das desigualdades de sexo e escolaridade no acúmulo de fatores de risco comportamentais nas capitais brasileiras. Foram analisados repetidos inquéritos do Vigitel, entre os anos de 2008 e 2018, com adultos (≥ 18 anos) residentes nas capitais dos 26 estados brasileiros e no Distrito Federal (n = 569.246). O acúmulo de ao menos dois fatores de risco comportamentais contemplou inatividade física, alimentação inadequada, tabagismo e consumo abusivo de álcool. Foram utilizadas medidas simples e complexas de desigualdade (de sexo e escolaridade). As interseccionalidades de sexo e escolaridade por faixa etária e região também foram consideradas. Entre 2008 e 2018, a prevalência do acúmulo em adultos diminuiu de 51,6% para 41,2% entre os homens, e de 45,3% para 30,8% entre as mulheres. Embora uma tendência de redução do acúmulo dos fatores de risco ao longo do tempo tenha sido observada, as desigualdades de sexo e escolaridade em geral persistiram. Homens adultos e pessoas com menor escolaridade apresentam de forma sistemática maiores prevalências de acúmulo, reforçando a necessidade de monitoramento das desigualdades e de ações para sua redução.