Food consumption scale validation in VAMOS Program: a proposal to assess eating behavior changes in Brazil.

This study aimed to validate the frequency consumption scale (FCS) and establish cut-off points to assess changes in the eating behavior of participants in the VAMOS Program. The study was based on a community intervention conducted in 2019 in 70 Brazilian cities, with 458 adults from Primary Care. The questionnaire consisted of 12 questions about food frequency consumption. The questions were inserted into the analytical workflow, divided into the descriptive analysis, exploratory and confirmatory factor analysis (EFA), item response theory (IRT) modeling, and construction and validity of an applied questionnaire score. EFA indicated a two-factor structure, with three "healthy" (raw vegetables, fruits, and cooked vegetables) and three "unhealthy" (sugary drinks, sweets, and the replacement of meals with snacks) eating items. Items responses' probabilities indicate a daily consumption of two healthy and once or nonweekly consumption of unhealthy items. Finally, the four categories proposed for FCS can respond over time. Therefore, the FCS proposal can be used effectively for program nutrition evaluation. Furthermore, it is possible to attribute behavior change in Brazilian primary care users with six items.

Sociodemographic determinants of multimorbidity in Brazilian adults and older adults: a cross-sectional study.

BACKGROUND: Multimorbidity due to non-communicable chronic diseases (NCDs) constitutes a significant challenge for healthcare systems. To attenuate its impacts, it is essential to identify the sociodemographic determinants of this condition, which can discriminate against population segments that are more exposed. OBJECTIVE: To identify associations between multimorbidity conditions and sociodemographic indicators among Brazilian adults and older adults. DESIGN AND SETTING: Cross-sectional telephone-based survey in 26 Brazilian state capitals and the federal district. METHODS: The Vigitel 2013 survey was used, with data collected via a questionnaire. The outcome was multimorbidity (2, 3 or 4 NCDs), and the exposures were sociodemographic indicators (age, sex, skin color, marital status and education). The analysis consisted of multinomial logistic regression (odds ratio), stratified by age. RESULTS: Among adults, multimorbidity comprising two, three or four diseases was associated with advancing age (P < 0.001); two and three diseases, with having a partner (P = 0.004 and P < 0.001, respectively); and two, three or four diseases, with lower education (P < 0.001). Among older adults, two, three or four diseases were associated with female sex (P < 0.001); three diseases, with living with a partner (P = 0.018); two diseases, with black skin color (P = 0.016); and two or three diseases, with lower education (P < 0.001). CONCLUSIONS: To control and prevent multimorbidity, strategies for individuals with existing chronic diseases, with partners and with lower education levels are needed. Particularly for adults, advancing age should be considered; and for older adults, being a woman and having black skin color.

Evaluating the implementation of the active life improving health behavior change program "BCP-VAMOS" in primary health care: Protocol of a pragmatic randomized controlled trial using the RE-AIM and CFIR frameworks.

Introduction: The effective translation of evidence-based interventions has contributed to implementing actions that impact public policies and the population's health. However, there is a gap in the literature regarding the factors associated with the successful implementation of these interventions. The Active Life Improving Health Behavior Change Program (BCP-VAMOS) uses behavioral strategies to promote an active and healthy lifestyle in the community. Characterized as a health innovation, it also provides health professionals with online training to implement the program in Primary Health Care (PHC). Our study describes a pragmatic trial that aims to evaluate the implementation of BCP-VAMOS, version 3.0, in PHC in southern Brazil. Methods and analysis: A pragmatic randomized controlled trial (PRCT) of two arms comparing a group of PHC professionals who will participate in a traditional didactic approach (control group) vs. a group that will receive ongoing support (intervention group) for the implementation of BCP-VAMOS. The intervention will be available to adults (≥18 years old) registered at PHC. Program recipient's will be assessed at baseline and post-intervention (9 months after) to measure markers of physical activity and eating behavior (primary outcomes). Program's implementation process will be monitored for 12 months and will be evaluated using the RE-AIM and Consolidated Framework for Implementation Research (CFIR) frameworks. Discussions: The survey findings can be used widely throughout Brazil, guiding the work of health professionals, service planners and policy-makers. Also, the results may help to inform the national health promotion policy to plan interventions and improve the implementation of programs in PHC. This research results will provide practical guidance for researchers to develop similar protocols to implement and adapt public health interventions. Ethics and dissemination: Ethics approval has been granted by the Human Research Ethics Committee of the Federal University of Santa Catarina (UFSC), Brazil, under no. 1394492. Results will be published in full as open access in the UFSC library and main trial results and associated papers in high-impact peer-reviewed journals. Trial registration number: RBR-2vw77q-Brazilian Registry of Clinical Trials - ReBEC (http://www.ensaiosclinicos.gov.br).

Barriers and facilitators for physical activity domains in Brazil: a systematic review. / Barreiras e facilitadores para a prática de atividade física em diferentes domínios no Brasil: uma revisão sistemática.

This study aimed to systematically review scientific evidence on the barriers and facilitators of physical activity (PA) among the Brazilian population, considering different domains (leisure, travel, work/study, and household). The search was conducted in the MEDLINE/PubMed, ISI Web of Science, SCOPUS, BIREME/LILACS, and APA PsycNET databases and was limited to papers published between 2010 and 2020. A manual search of the Brazilian Journal of Physical Activity & Health was also conducted. The selection process consisted of screening titles and abstracts, followed by the analysis of full texts. Each paper was assessed by two independent reviewers, and when discrepancies arose, a third reviewer was consulted. Leisure, environmental barriers and facilitators were the most investigated domains in the 78 included studies. There was consistency in the positive associations between six different intrapersonal and social facilitators for leisure PA and one environmental factor for travel. There have been a small number of investigations on the work/study and household domains, and future investigations on intrapersonal and social barriers and facilitators in the travel domain are important.

O objetivo foi revisar sistematicamente as evidências científicas sobre as barreiras e os facilitadores para a prática de atividade física (AF) na população brasileira, considerando os diferentes domínios (lazer, deslocamento, trabalho/estudo e tarefas domésticas). A busca foi conduzida nas bases de dados MEDLINE/PubMed, ISI Web of Science, Scopus, BIREME/LILACS e APA PsycNET, considerando o período de 2010 a 2020. Posteriormente, foi incluída a busca na Revista Brasileira de Atividade Física e Saúde. O processo de seleção consistiu na leitura de títulos e resumos, seguida de textos na íntegra. A avaliação foi realizada por pares e, mediante discrepância, um terceiro revisor era consultado. O domínio do lazer e as barreiras e os facilitadores ambientais foram os mais investigados nos 78 artigos incluídos. Houve consistência nas associações positivas de seis diferentes facilitadores pessoais e sociais para o lazer e um fator ambiental para o deslocamento. Encontrou-se um número reduzido de investigações sobre os domínios de trabalho/estudo e tarefas domésticas, sendo importante o incentivo a futuras investigações acerca das barreiras e dos facilitadores pessoais e sociais relacionados à AF de deslocamento.

Physical activity and sedentary behavior as multimorbidity discriminators among elderly Brazilians: a cross-sectional study.

BACKGROUND: Associations between behaviors and individual chronic diseases have been demonstrated. However, the relationship between time spent on sedentary behavior and multimorbidity remains less clear. OBJECTIVE: To identify the predictive power of various intensities of physical activity versus sedentary behavior, as discriminatory factors for cardiometabolic multimorbidity (cardiovascular diseases and diabetes) in the elderly. DESIGN AND SETTING: Cross-sectional study in different residential census tracts and residential households in Florianópolis (SC). METHODS: The participants were 425 elderly people (65% women) from the EpiFloripa Aging study in 2014. Sociodemographic variables and self-reported incidence of cardiovascular diseases and diabetes were obtained via a questionnaire. Light physical activity (LPA), moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) were measured using accelerometers. The analyses were stratified according to sex and included a diagnosis for interpretation. Behaviors were taken into consideration if their predictive power in terms of area under the receiver operating characteristic (ROC) curve was greater than 0.50. The time cutoff point was defined from sensitivity and specificity. RESULTS: For older adult men with diabetes, the predictive value of MVPA for absence of multi-morbidity was an area of 0.75 (95% confidence interval, CI: 0.538-0.962), and a cutoff of 17 minutes per day. Older adult women with diabetes had an area of 0.71 (95% CI: 0.524-0.866) and a cutoff of 10 minutes per day. LPA and SB did not present predictive values. CONCLUSION: The time spent on MVPA is a predictor of absence of multimorbidity in elderly people with diabetes, for both sexes.

Re-thinking Physical Activity Programs for Older Brazilians and the Role of Public Health Centers: A Randomized Controlled Trial Using the RE-AIM Model.

Background: Explored the role of public health centers in the delivery of physical activity programs to older Brazilians. Methods: Total of 114 older adults (81% women) from public health centers across the city of Florianopolis, Brazil, were randomized into three groups: behavior change group (n = 36), traditional exercise group (n = 52), and control group (n = 26). The behavioral change group included 12 weekly meetings (2 h each). The traditional exercise group offered a 12-week exercise class. Individuals in the control group participated only in measurements. Program evaluation included a mixed-methods approach following the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). Trained interviewers conducted 12 focus groups and 32 interviews with participants in the program, professionals delivering the programs, community health workers, and local and city administrators overseeing public health centers. Participants completed health, quality of life, and fitness assessments at four time points. Results: The study reached 11.5% of the eligible population in the community. Older adults' resistance to change and limited understanding of behavior change science by public health center staff hindered program reach. Physician encouraging patient participation and personal invitations by community health workers were perceived as favorable factors. Results of program effectiveness and maintenance suggest that behavior change strategies may be better suited than traditional exercise classes for decreasing sedentary time and increasing moderate-to-vigorous physical activity, as well as improving participants' quality of life. Only 14% of public health centers in the city adopted the programs. Heavy workload of health educators delivering the programs and limited physical space for program delivery were barriers for adoption. The fidelity of program delivery was high and indicates that the programs are culturally-appropriate for the Brazilian context and feasible for implementation by local health educators. Conclusions: Our findings support the potential for dissemination of behavior change and traditional exercise programs to older adults through public health centers in Brazil. REBEC: RBR-9pkxn2 (retrospectively registered) Register April 20, 2019.

Efficacy of a behavior change program on cardiovascular parameters in patients with hypertension: a randomized controlled trial.

OBJECTIVE: To investigate the efficacy of a behavior change program named Vida Ativa Melhorando a Saúde on cardiovascular parameters in hypertensive patients. METHODS: Ninety hypertensive patients aged over 40 years were randomly allocated to one of two groups: Vida Ativa Melhorando a Saúde or Control (n=45 respectively). Patients in the Vida Ativa Melhorando a Saúde group took part in a behavior change program aimed to encourage changes in physical activity levels and eating habits, according to the Social Cognitive Theory. The program consisted of 90-minute weekly group meetings conducted by a physical therapist and a dietitian. One chapter of the educational material (workbook) provided was discussed per meeting. Participants in the Control Group attended a single educative lecture on lifestyle changes. Brachial and central blood pressure, arterial stiffness and endothelial function parameters were measured pre- and post-intervention. RESULTS: Vida Ativa Melhorando a Saúde led to reduction of brachial (131.3±15.8mmHg to 125.1±17.3mmHg; p<0.01) and central (123.6±16.3mmHg to 119.0±20.6mmHg; p=0.02) systolic and brachial diastolic (123.6±16.3mmHg to 119.0±20.6mmHg; p<0.01) blood pressure values, and improvement of post-occlusive reactive hyperemia (from 5.7±2.5mL·100mL-1 to 6.5±2.1mL·100mL-1 tissue·min-1; p=0.04). No changes in body composition, heart rate and arterial stiffness parameters were detected in both groups (p>0.05). CONCLUSION: Vida Ativa Melhorando a Saúde program improved blood pressure and microvascular reactivity in hypertensive patients. Trial registration: ClinicalTrials.gov: NCT02257268.

Knowledge and attitude towards type 2 diabetes among older adults: a population-based study. / Conhecimento e atitude sobre a diatebes tipo 2 em idosos: estudo de base populacional.

The aim of this study was to identify the factors associated with knowledge and attitude towards type 2 diabetes mellitus among older adults with the disease. A cross-sectional population-based study was conducted on 204 older adults from the public healthcare network of Passo Fundo, RS. Sociodemographic data were collected and the DKN-A, ATT-19 and IPAQ were used for the assessment of diabetes knowledge, psychological attitudes towards diabetes and physical activity, respectively. Logistic regression was applied to evaluate the association with sociodemographic and health variables and indicators of body adiposity. Crude and adjusted analyses were performed with a 95% confidence interval. The results showed that good knowledge is associated with age ≥ 70 years (OR = 0.44; 95%CI: 0.18-1.08), having a positive attitude towards diabetes treatment (OR = 8.9; 95%CI: 4.3-18.9), and being physically active (OR = 10.1; 95%CI: 6.34-20.1). In conclusion, good knowledge and a positive attitude towards diabetes are associated with age older than 70 years and being physically active.

Esta pesquisa teve por objetivo verificar os fatores associados entre o conhecimento e a atitude sobre diabetes mellitus tipo 2 em idosos com a doença. Realizou-se um estudo transversal de base populacional com 204 idosos da rede pública de saúde de Passo Fundo, RS. Para a coleta de dados utilizou-se os questionários: sociodemográfico, de conhecimento DKN-A, de atitudes psicológicas do diabetes ATT-19 e o IPAQ para atividade física. Foi utilizada a regressão logística para as variáveis sociodemográficas, de saúde e os indicadores de adiposidade corporal. Foram realizadas análises brutas e ajustadas com um intervalo de confiança de 95%. Os resultados deste estudo identificaram que o bom conhecimento está associado com a idade maior ou igual 70 anos (OR = 0,44; IC95%: 0,18-1,08), ter atitude positiva para o tratamento da diabetes (OR = 10,4 IC95%: 4,20-18,70) e ser ativo fisicamente (OR = 12,7; IC95%: 6,8-30,10). Na associação com a atitude positiva se manteve associada significativamente a idade maior ou igual 70 anos (OR = 0,35; IC95%: 0,15-0,78), ter um bom conhecimento da diabetes (OR = 8,9; IC95%: 4,30-18,9) e ser ativo fisicamente (OR = 10,1; IC95%: 6,34-20,1). Portanto, o bom conhecimento e a atitude positiva estão associados à idade de 70 anos a mais e ser ativo fisicamente.

Public open spaces and physical activity: disparities of resources in Florianópolis.

OBJECTIVE: To analyze the association between sociodemographic characteristics of census tracts and the presence/quality of public open spaces and physical activity facilities. METHODS: A cross-sectional study was conducted in 643 census tracts in Florianópolis, Brazil, the presence and quality of public open spaces and physical activity facilities were objectively analyzed and the data by census tracts using Geographic Information Systems was treated. Outcomes were analyzed considering the census tracts as having: ≥ 1 public open spaces; ≥ 1 public open spaces with high quality; ≥ 2 physical activity facilities and high-quality physical activity facilities. Sociodemographic characteristics were the independent variables. Logistic regression analysis was performed. RESULTS: Census tracts with a medium-income (OR = 1.8; 95%CI 1.1-3.0) and high-income (OR = 2.4; 95%CI 1.4-4.0), in those with medium (OR = 1.7; 95%CI 1.0-2.7) and high residential density (OR = 2.0; 95%CI 1,2-3.3), and with higher proportions of older adults (OR = 3.3; 95%CI 1.9-5.7) had a higher proportion of public open spaces. Census tracts with higher proportions of children/adolescents (OR = 0.3; 95%CI 0.2-0.6) and non-white residents (OR= 0.6; 95%CI 0.3-0.9) were less likely to contain public open spaces. The tracts with medium (OR = 4.0; 95%CI 1.4-11.3) and high-income (OR = 3.6; 95%CI 1.2-10.2) were more likely to contain public open spaces with ≥ 2 structures for physical activity, compared with those with low-income. We observed the inverse in sectors with a high proportion of non-white residents (OR = 0.3; 95%CI 0.1-0.9). CONCLUSIONS: Census tracts with higher proportions of children or adolescents, non-white individuals and those in the low-income strata had lower odds of containing public open spaces and physical activity facilities.

Effectiveness of the VAMOS Strategy for Increasing Physical Activity and Healthy Dietary Habits: A Randomized Controlled Community Trial.

This study aimed to evaluate the effectiveness of the VAMOS strategy (Health-Improving Active Life) in improving physical activity (PA), dietary habits, and anthropometric variables of primary health care (PHC) users in Brazil. A randomized controlled community trial was conducted at two units of the Health Academy Program (HAP; a service provided by PHC), which were randomly assigned either to control group (CG) or intervention group (IG). Participants in both groups (CG = 156 and IG = 135) took part in physical activity classes provided by HAP facilities with those in IG also participating in the VAMOS strategy for 12 weeks. This strategy is based on social cognitive theory. The main behavioral constructs addressed were self-efficacy, goal setting, self-monitoring, identification of social support and barriers, and solutions for the identified barriers. Physical activity was measured with accelerometers, and nutritional status was assessed using dietary habits questionnaires and anthropometric measurements. Intention-to-treat analysis revealed that participants in IG increased the daily time of moderate-vigorous PA and the frequency of raw vegetable intake, while the intake of ultra-processed foods was reduced. Weight loss among participants who were classified as overweight/obese at baseline was observed in the intervention group compared to control. These results suggest that the VAMOS strategy was effective in increasing PA, healthy dietary habits, and decreasing weight among PHC users. Therefore, VAMOS could be used as a strategy to strengthen individuals' autonomy regarding healthy choices and improve their overall health.

Incidence and prevalence of diabetes self-reported on elderly in south of Brazil: results of EpiFloripa Ageing Study.

This study investigated the prevalence and incidence of diabetes self-referred in the elderly. Longitudinal population-based study (EpiFloripa Ageing Study), with 1.702 elderly in 2009/10 and 1.197 in 2013/14 of Florianópolis, SC. Self-reported and anthropometric data were collected at home. The prevalence of diabetes self-referred in 2009/10 was 22.1% (95%CI 20.1-24.1). The characteristics were: no formal schooling (2.30; CI95% 1.32-4.00); 5 to 8 years of schooling (OR = 1.70, CI95% 1.07-2.69); increased waist circumference (OR = 3.31, CI95% 2.05-5.34) and hypertension (OR = 2.38, CI95%: 1.68-3.36). The incidence of diabetes self-reported after four years of follow-up was 8.3% (95% CI, 6.7-10.3). After adjustment: increased waist circumference (OR= 2.23, CI95% 1.09-4.57) at baseline was associated with the incidence of diabetes. The prevalence and incidence of diabetes were high among the elderly. Interventions must be performed especially with elderly with low and without formal schooling, with increased waist circumference and hypertension, thus they were the subgroups with higher odds ratio of reporting and developing diabetes.

Concurrent validity of the assessment tool for a health promotion program in Primary Health Care via telephone: a multilevel analysis / Validade concorrente do instrumento de avaliação de um programa de promoção de saúde na Atenção Primária à Saúde por telefone: uma análise multinível

This study aims to verify the concurrent validity of the paper, and the telephone versions of the instrument used to evaluate the effectiveness of the Vida Ativa Melhorando a Saúde (VAMOS) Pro-gram participants. The VAMOS Program is a community-based intervention aiming at motivating people to adopt an active and healthy lifestyle. The study population was adults registered at the Basic Health Units in the state of Santa Catarina, and the sample for the validity test was two groups that concluded the program. To compare each variable provided by paper and telephone format, multi-level generalized linear and logistic models were carried out, adjusted by age, sex, and educational level. As a result, it was possible to identify the validity of most of the questions, with variations in the frequency of cooked vegetable consumption, method of preparing animal meat, frequency of physical activity, and waist circumference. We concluded that the use of the telephone survey could be considered for VAMOS Program effectiveness evaluation

Este estudo teve como objetivo verificar a validade concorrente das versões papel e ligação telefônica do ins-trumento utilizado para avaliar a efetividade do Programa Vida Ativa Melhorando a Saúde ( VAMOS). O Programa VAMOS é uma intervenção de base comunitária, com o objetivo de motivar as pessoas a adotarem um estilo de vida ativo e saudável. A população do estudo foi de adultos registrados nas Unidades Básicas de Saúde do estado de Santa Catarina, e a amostra para o teste de validade considerou dois grupos que concluí-ram o programa. Para comparar cada variável fornecida pelo formato papel e telefone, foram realizados mo-delos lineares e logísticos generalizados multiníveis, ajustados por idade, sexo e nível de escolaridade. Como resultado, foi possível identificar a validade da maioria das questões, com variações na frequência de consumo de hortaliças cozidas, modo de preparo da carne animal, frequência de atividade física e circunferência da cintura. Concluímos que o uso da coleta por telefone pode ser considerado para a avaliação da efetividade do Programa VAMOS.

Accelerometer-Measured Physical Activity and Sedentary Behavior: A Cross-Sectional Study of Brazilian Older Adults.

BACKGROUND: To examine the level of physical activity and sedentary behavior (SB), measured with accelerometers, in older adults from a city in southern Brazil according to sociodemographic and health characteristics. METHODS: The sample consisted of 425 older adults (≥63 y) from the EpiFloripa Aging Study. Light physical activity (LPA), moderate to vigorous physical activity (MVPA), and SB were measured with accelerometers over a period of 7 days. RESULTS: The older adults spent two-thirds of the time of use in SB, one-third in LPA, and only 2.1% (95% confidence interval, 1.8-2.2) in MVPA. In the final adjusted model, lower levels of MVPA were observed for women, as well as higher SB and lower LPA and MVPA for those with higher age. There were also trends toward prolonged SB and lower LPA when participants had a higher educational level and toward lower MVPA with higher body mass index. CONCLUSIONS: Constant monitoring of physical activity levels and SB using objective measures is recommended and interventions should be directed at the groups most exposed to excessive SB and low levels of MVPA.

Food consumption scale validation in VAMOS Program: a proposal to assess eating behavior changes in Brazil / Validação da escala de consumo alimentar no Programa VAMOS: uma proposta para avaliar as mudanças no comportamento alimentar no Brasil

Abstract This study aimed to validate the frequency consumption scale (FCS) and establish cut-off points to assess changes in the eating behavior of participants in the VAMOS Program. The study was based on a community intervention conducted in 2019 in 70 Brazilian cities, with 458 adults from Primary Care. The questionnaire consisted of 12 questions about food frequency consumption. The questions were inserted into the analytical workflow, divided into the descriptive analysis, exploratory and confirmatory factor analysis (EFA), item response theory (IRT) modeling, and construction and validity of an applied questionnaire score. EFA indicated a two-factor structure, with three "healthy" (raw vegetables, fruits, and cooked vegetables) and three "unhealthy" (sugary drinks, sweets, and the replacement of meals with snacks) eating items. Items responses' probabilities indicate a daily consumption of two healthy and once or nonweekly consumption of unhealthy items. Finally, the four categories proposed for FCS can respond over time. Therefore, the FCS proposal can be used effectively for program nutrition evaluation. Furthermore, it is possible to attribute behavior change in Brazilian primary care users with six items.

Resumo Este estudo teve como objetivo validar a escala de consumo de frequência (ECF) e estabelecer pontos de corte para avaliar mudanças no comportamento alimentar dos participantes do Programa VAMOS. O estudo baseou-se em uma intervenção comunitária realizada em 2019 em 70 cidades brasileiras, com 458 adultos da Atenção Básica. O questionário era composto por 12 questões sobre o consumo de frequência alimentar. As questões foram inseridas no fluxo de trabalho analítico, divididas em análise descritiva, análise fatorial exploratória e confirmatória (EFA), modelagem da teoria de resposta ao item (TRI) e construção e validade de um escore de questionário aplicado. EFA indicou uma estrutura de dois fatores, com três itens alimentares "saudáveis" (vegetais crus, frutas e vegetais cozidos) e três "não saudáveis" (bebidas açucaradas, doces e a substituição de refeições por lanches). As probabilidades das respostas dos itens indicam um consumo diário de dois itens saudáveis e um consumo único ou não semanal de itens não saudáveis. Por fim, as quatro categorias propostas para o ECF podem fornecer respostas ao longo do tempo. A proposta do ECF pode ser usada efetivamente para avaliação nutricional do programa. Além disso, é possível atribuir a mudança de comportamento em usuários da atenção básica brasileira com seis itens.

Sociodemographic determinants of multimorbidity in Brazilian adults and older adults: a cross-sectional study

ABSTRACT BACKGROUND: Multimorbidity due to non-communicable chronic diseases (NCDs) constitutes a significant challenge for healthcare systems. To attenuate its impacts, it is essential to identify the sociodemographic determinants of this condition, which can discriminate against population segments that are more exposed. OBJECTIVE: To identify associations between multimorbidity conditions and sociodemographic indicators among Brazilian adults and older adults. DESIGN AND SETTING: Cross-sectional telephone-based survey in 26 Brazilian state capitals and the federal district. METHODS: The Vigitel 2013 survey was used, with data collected via a questionnaire. The outcome was multimorbidity (2, 3 or 4 NCDs), and the exposures were sociodemographic indicators (age, sex, skin color, marital status and education). The analysis consisted of multinomial logistic regression (odds ratio), stratified by age. RESULTS: Among adults, multimorbidity comprising two, three or four diseases was associated with advancing age (P < 0.001); two and three diseases, with having a partner (P = 0.004 and P < 0.001, respectively); and two, three or four diseases, with lower education (P < 0.001). Among older adults, two, three or four diseases were associated with female sex (P < 0.001); three diseases, with living with a partner (P = 0.018); two diseases, with black skin color (P = 0.016); and two or three diseases, with lower education (P < 0.001). CONCLUSIONS: To control and prevent multimorbidity, strategies for individuals with existing chronic diseases, with partners and with lower education levels are needed. Particularly for adults, advancing age should be considered; and for older adults, being a woman and having black skin color.

Effectiveness of a Behavior Change Program on Physical Activity and Eating Habits in Patients With Hypertension: A Randomized Controlled Trial.

BACKGROUND: This study aimed to analyze the effect of a behavior change program, called Vida Ativa Melhorando a Saúde (VAMOS), on physical activity, eating habits, and quality of life in patients with hypertension. METHODS: A randomized controlled trial was carried out in 90 patients with hypertension (57.8 ± 9.9 y). They were randomly assigned to 2 groups: VAMOS group (n = 45) and control group (n = 45). The VAMOS group participated in a behavioral change program aimed at motivating changes in physical activity and nutrition behavior for 12 weeks. Physical activity, eating habits, quality of life, self-efficacy, and social support were evaluated at preintervention and postintervention. RESULTS: The control group increased sedentary time (407 ± 87 vs 303 ± 100 min/d; P < .05) and sedentary bouts (434 ± 86 vs 336 ± 98 min/d; P < .05) and reduced total physical activity (553 ± 87 vs 526 ± 86 min/d; P < .05). The VAMOS group improved the general healthy eating habits score (36.9 ± 6.6 vs 43.4 ± 5.8; P < .05) and quality of life (44% vs 92%; P < .05). CONCLUSION: The VAMOS program was effective in improving eating habits and quality of life in patients with hypertension.

Barreiras e facilitadores para a prática de atividade física em diferentes domínios no Brasil: uma revisão sistemática / Barriers and facilitators for physical activity domains in Brazil: a systematic review

Resumo O objetivo foi revisar sistematicamente as evidências científicas sobre as barreiras e os facilitadores para a prática de atividade física (AF) na população brasileira, considerando os diferentes domínios (lazer, deslocamento, trabalho/estudo e tarefas domésticas). A busca foi conduzida nas bases de dados MEDLINE/PubMed, ISI Web of Science, Scopus, BIREME/LILACS e APA PsycNET, considerando o período de 2010 a 2020. Posteriormente, foi incluída a busca na Revista Brasileira de Atividade Física e Saúde. O processo de seleção consistiu na leitura de títulos e resumos, seguida de textos na íntegra. A avaliação foi realizada por pares e, mediante discrepância, um terceiro revisor era consultado. O domínio do lazer e as barreiras e os facilitadores ambientais foram os mais investigados nos 78 artigos incluídos. Houve consistência nas associações positivas de seis diferentes facilitadores pessoais e sociais para o lazer e um fator ambiental para o deslocamento. Encontrou-se um número reduzido de investigações sobre os domínios de trabalho/estudo e tarefas domésticas, sendo importante o incentivo a futuras investigações acerca das barreiras e dos facilitadores pessoais e sociais relacionados à AF de deslocamento.

Abstract This study aimed to systematically review scientific evidence on the barriers and facilitators of physical activity (PA) among the Brazilian population, considering different domains (leisure, travel, work/study, and household). The search was conducted in the MEDLINE/PubMed, ISI Web of Science, SCOPUS, BIREME/LILACS, and APA PsycNET databases and was limited to papers published between 2010 and 2020. A manual search of the Brazilian Journal of Physical Activity & Health was also conducted. The selection process consisted of screening titles and abstracts, followed by the analysis of full texts. Each paper was assessed by two independent reviewers, and when discrepancies arose, a third reviewer was consulted. Leisure, environmental barriers and facilitators were the most investigated domains in the 78 included studies. There was consistency in the positive associations between six different intrapersonal and social facilitators for leisure PA and one environmental factor for travel. There have been a small number of investigations on the work/study and household domains, and future investigations on intrapersonal and social barriers and facilitators in the travel domain are important.

Análise bibliométrica das produções científicas brasileiras na temática atividade física e envelhecimento / Bibliometric analysis of the Brazilian scientific productions about physical activity and aging

A análise de conteúdo e de redes de colaboração pode contribuir para as reflexões e estudos sobre o fluxo informacional. O objetivo do presente estudo é realizar uma análise bibliométrica das produções científicas brasileiras na temática atividade física e envelhecimento. O banco de dados foi construído utilizando-se a base de dados Web of Science (WoS), selecionando-se a Coleção SciELOBrazil. Os termos utilizados na busca foram relacionados com "atividade física" e "envelhecimento". Foram coletadas variáveis de autoria, número/ média de publicações, número/média de citações, quantidade de publicações realizadas por instituição e palavras-chave citadas nos estudos. Posteriormente, os dados foram analisados no software VOS viewer, onde mapas de rede foram criados. Foram encontrados 19 clusters de autores, sendo identificadosaqueles que mais publicam na área da atividade física e envelhecimento no Brasil. Com relação às instituições, verificou-se uma concentração de publicações em Universidades do Sul e Sudeste, com destaque para São Paulo. Com relação às palavras-chave, verificou-se que as mais utilizadas nos estudos foram: qualidade de vida, força muscular, fatores de risco, obesidade e hipertensão. Em conclusão, a temática apresentou expansão com o passar dos anos, identidade própria e consistência nas redes de produção e colaboração entre autores.(AU)

The analysis of content and collaboration networks can contribute to the reflections and studies on the information flow. The objective of the present study is to perform a bibliometric analysis of the Brazilian scientific productions about the physical activity and aging. The database was built using the Web of Science (WoS) database, selecting the SciELO Brazil Collection. The terms used in the search were related to "physical activity" and "aging". Authors' variables, number/average of publications, number/average of cita- tions, number of publications per institution and keywords cited in the studies were collected. Subsequently, the data were analyzed in the VOSviewer software where network maps were created. We found 19 clusters of authors, being identified the ones that publish the most in the area of physical activity and aging in Brazil. With regard to the institutions, there was a concentration of publications in Southern and Southeastern Universities, especially in São Paulo. Regarding the keywords, it was verified that the most used in the studies were: quality of life, muscular strength, risk factors, obesity, and hypertension. In conclusion, the theme presented expansion over the years, its own identity and consistency in the networks of production and collaboration between authors.(AU)

Physical activity and sedentary behavior as multimorbidity discriminators among elderly Brazilians: a cross-sectional study

ABSTRACT BACKGROUND: Associations between behaviors and individual chronic diseases have been demonstrated. However, the relationship between time spent on sedentary behavior and multimorbidity remains less clear. OBJECTIVE: To identify the predictive power of various intensities of physical activity versus sedentary behavior, as discriminatory factors for cardiometabolic multimorbidity (cardiovascular diseases and diabetes) in the elderly. DESIGN AND SETTING: Cross-sectional study in different residential census tracts and residential households in Florianópolis (SC). METHODS: The participants were 425 elderly people (65% women) from the EpiFloripa Aging study in 2014. Sociodemographic variables and self-reported incidence of cardiovascular diseases and diabetes were obtained via a questionnaire. Light physical activity (LPA), moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) were measured using accelerometers. The analyses were stratified according to sex and included a diagnosis for interpretation. Behaviors were taken into consideration if their predictive power in terms of area under the receiver operating characteristic (ROC) curve was greater than 0.50. The time cutoff point was defined from sensitivity and specificity. RESULTS: For older adult men with diabetes, the predictive value of MVPA for absence of multi-morbidity was an area of 0.75 (95% confidence interval, CI: 0.538-0.962), and a cutoff of 17 minutes per day. Older adult women with diabetes had an area of 0.71 (95% CI: 0.524-0.866) and a cutoff of 10 minutes per day. LPA and SB did not present predictive values. CONCLUSION: The time spent on MVPA is a predictor of absence of multimorbidity in elderly people with diabetes, for both sexes.

Promoting healthy lifestyles in Brazil: design and method of "VAMOS Program" in public health system / Promoção de estilos de vida saudáveis no Brasil: design e método do "Programa VAMOS" no sistema público de saúde

The "Programa Vida Ativa Melhorando a Saúde ­ VAMOS" (Active Life Improving Health) is a community intervention with a behavioral approach. It uses educational strategies to assist health professionals in support the population about the importance of adherence and maintenance of healthy lifestyles. This descriptive study shows the design and method of the VAMOS Program version 2.0. The intervention is for adults and older adults' users of Brazilian public health and aims to motivate them to adopt an active and healthy lifestyle regarding physical activity and eating. The program follows an intervention design that considers the dimensions of the RE-AIM framework. The VAMOS Program version 2.0 has the potential to be offered as a health promotion tool in the Brazilian public health system by using available resources and accessible and healthy behavioral strategies

O "Programa Vida Ativa Melhorando a Saúde ­ VAMOS" é uma intervenção comunitária com abordagem comportamental. Utiliza estratégias educativas para auxiliar os profissionais de saúde a orientar a população sobre a importância da adesão e manutenção de estilos de vida saudáveis. Este estudo descritivo apresenta o design e método do Programa VAMOS, versão 2.0. A intervenção é voltada para adultos e idosos usuários da saúde pública brasileira e visa motivá-los a adotarem um estilo de vida ativo e saudável no que diz respeito à atividade física e à alimentação. O programa segue um design de intervenção que considera as dimensões da ferramenta RE-AIM. O Programa VAMOS, versão 2.0, tem potencial para ser oferecido como ferramenta de promoção da saúde no sistema público de saúde brasileiro por meio da utilização de recursos disponíveis e acessíveis e estratégias comportamentais saudáveis