The impact of early sports participation on body fatness in adulthood is not mediated by current physical activity.

OBJECTIVE: The aim was to analyze the relationship between early sports participation (ESP) and body fatness (BF) in adults, as well as to identify whether this possible relationship is directly influenced by the current physical activity (PA) level. METHODS: This cross-sectional study combined baseline data of two cohort. The BF estimated by DXA. The ESP, the subjects reported the engagement in sports during childhood (7-10 years) and adolescence (11-17 years) through two yes/no questions and current PA (described as steps) was device-measured using pedometers. Were identified as potential covariates and therefore adjusted the multivariate models: age, ethnicity, alcohol consumption, smoking, and sleep quality. Statistical analysis consisted of the chi-square test, analysis of variance/covariance, and structural equation modeling (software BioEstat version 5.0; p-value < .05). RESULTS: Adults engaged in ESP had lower BF; among women, the variance in BF explained by ESP was 25.5%; among men, it was 9.2%. Sports participation in early life (r = -.436 [95% CI: -0.527 to -0.346]) and current PA (r = -.431 [95% CI: -0.522 to -0.340]) were inversely related to BF, as well as positively related to each other (r = .328 [95% CI: 0.226 to 0.430]). In the mediation model, current PA partially mediated (18.5%) the impact of ESP on BF, while current PA and ESP remained relevant determinants of BF. CONCLUSION: Early sports participation and current PA have a significant impact on BF in adulthood, which is of similar magnitude and independent of each other.

Relationship between vigorous physical activity and health care costs among adolescents: ABCD Growth Study.

BACKGROUND: The relationship between physical activity and health care costs among adolescents is not yet clear in the literature. OBJECTIVE: To analyze the relationship between physical activity and annual health care costs among adolescents. METHODS: The present sample was composed of 85 adolescents of both sexes with ages ranging from 11 to 18 years (mean age 15.6 ± 2.1). Health care costs were self-reported every month for 12 months, and information on health care values was verified with local pharmacies, private health care plans, and the National Health Service. The time spent in different physical activity intensities was objectively measured by accelerometers. Confounding variables were: sex, age, somatic maturation, body fatness, blood pressure, and components of dyslipidemia and insulin resistance. Multivariate models were generated using generalized linear models with gamma distribution and a log-link function. RESULTS: The overall annual health care cost was US$ 733.60/ R$ 2,342.38 (medication: US$ 400.46 / R$ 1,278.66; primary and secondary care: US$ 333.14 / R$ 1,063.70). The time spent in vigorous physical activity (minutes/day) was negatively related to health care costs (r = -0.342 [95% CI: -0.537,-0.139]; ß = -0.06 cents (95% CI: -0.089, -0.031). CONCLUSION: Vigorous physical activity seems to be associated with lower health care costs among adolescents.

Twelve year trajectories of physical activity and health costs in mid-age Australian women.

BACKGROUND: Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women. METHODS: Data from 6953 participants in the Australian Longitudinal Study on Women's Health (born in 1946-1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013-2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs. RESULTS: Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443-3013) and AUD578 (95%CI: 426-729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49-360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232-545). CONCLUSION: Maintaining 'active' PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.

Participation in Non-professional Sports and Cardiovascular Outcomes Among Adolescents: ABCD Growth Study.

OBJECTIVES: Sports are an important way to improve health during adolescence. However, it is still unclear whether the association between sports, blood pressure, and metabolic profile could be affected by sex, biological maturation, and trunk fatness. The aim of this study was to analyze the association between sports participation and the cluster of cardiovascular markers among adolescents of both sexes. METHODS: A cross-sectional study involving 285 adolescents aged from 11 to 17 years of age (202 boys and 83 girls). Cardiovascular variables were composed of systolic blood pressure (SBP), diastolic blood pressure (DBP), resting heart rate (RHR), and carotid (CIMT) and femoral (FIMT) intima-media thickness, which were used to calculate the CardiovascularZ score. Sports participation was assessed through a face-to-face interview. Age of peak height velocity (APHV) was used as a covariate. RESULTS: Among girls, the group engaged in sports presented lower values of RHR (sport: - 0.344 [95% CI - 0.650 to - 0.037] versus non-sport: 0.540 [95% CI 0.125 to 0.954]) and CardiovascularZ score (sport: - 0.585 [95% CI - 1.329 to 0.159] versus non-sport: 0.879 [95% CI - 0.127 to 1.884]), explaining 12.2% and 6.1% of all variance, respectively. Among boys, the group engaged in sports presented lower values of DBP (sport: - 0.158 [95% CI - 0.335 to 0.018] versus non-sport: 0.160 [95% CI - 0.091 to 0.412]) and FIMT (sport: - 0.128 [95% CI - 0.300 to - 0.044] versus non-sport: 0.211 [95% CI - 0.032 to 0.454]), explaining 2.2% and 2.6% of all variance, respectively. CONCLUSIONS FOR PRACTICE: Adolescents engaged in sports presented healthier cardiovascular parameters, and sports participation seems to affect cardiovascular health differently in boys and girls.

Sports Participation and Health Care Costs in Older Adults Aged 50 Years or Older.

The objective of the study was to analyze the relationship between sports participation and health care costs in older adults. The sample was composed of 556 participants (145 men and 411 women) who were followed from 2010 to 2014. The engagement in sports considered three different components (intensity, volume, and previous time). Health care costs were assessed annually through medical records. Structural equation modeling (longitudinal relationship between sport and costs) and analysis of variance for repeated measures (comparisons over time) were used. Health care costs increased significantly from 2010 to 2014 (analysis of variance; p value = .001). Higher baseline scores for intensity were related to lower health care costs (r = -.223, 95% confidence interval [-.404, -.042]). Similar results were found to volume (r = -.216, 95% confidence interval [-.396, -.036]) and time of engagement (r = -.218, 95% confidence interval [-.402, -.034]). In conclusion, higher sports participation is related to lower health care costs in older adults.

Body size dissatisfaction associated with dietary pattern, overweight, and physical activity in adolescents: A cross-sectional study.

This study analyzed the association of body size dissatisfaction with body mass index, dietary pattern, and physical activity in adolescents. A sample of 1074 participants between 10 and 17 years of age was recruited. Body size dissatisfaction was assessed with the silhouettes' scale. Dietary pattern, physical activity, and socioeconomic status were assessed with questionnaires. Body mass index was measured objectively. The prevalence of body size dissatisfaction was 77.0%, where 29.8% desired to increase body size and 47.2% desired to decrease body size. Adolescents who desired to increase body size were more likely to consume vegetables and sweets and less likely to be in the highest quartile of physical activity than satisfied adolescents. Adolescents who desired to reduce body size were more likely to report lower fruit and vegetable consumption than satisfied adolescents. Health actions aiming to reduce body dissatisfaction in adolescents should address improvement in dietary pattern and physical activity engagement, considering that desires to increase or decrease body size were differently associated in this study.

Body size dissatisfaction associated with dietary pattern, overweight, and physical activity in adolescents - a cross-sectional study.

This study analyzed the association of body size dissatisfaction with body mass index, dietary pattern, and physical activity in adolescents. A sample of 1,074 participants between 10-17years was recruited. Body size dissatisfaction was assessed by silhouettes scale. Dietary pattern, physical activity, and socioeconomic status were assessed by questionnaires. Body mass index was objectively measured. Body size dissatisfaction prevalence was 77.0%, where 29.8% desired to increase body size and 47.2% desired to decrease body size. Adolescents who desired to increase body size were more likely to consume vegetables and sweets, and less likely to be in highest quartile of physical activity than satisfied adolescents. Those adolescents who desired to reduce body size were more likely to have low fruit consumption and low vegetables consumption than satisfied adolescents. Health actions aiming to reduce body dissatisfaction in adolescents should address the improvement of dietary pattern and physical activity engagement, considering the desire to increase or to decrease body size, once were differently associated in this study. This article is protected by copyright. All rights reserved.

Sedentary behaviour is associated with diabetes mellitus in adults: findings of a cross-sectional analysis from the Brazilian National Health System.

BACKGROUND: Sedentary behaviour (SB) may contribute to the development of several chronic diseases, such as hypertension, diabetes mellitus (DM) and all-cause mortality. The aim of this study is to investigate the association between different domains of SB with diabetes among adult users of the Brazilian National Health System (NHS). METHODS: Cross-sectional study from the primary care system of the Brazilian NHS in the city of Bauru, Brazil. SB, physical activity (PA), DM and other chronic diseases were assessed by face-to-face interviews and medical records. As potential confounders in the adjusted model, we used gender, age, economic status, smoking status, hypertension, hypercholesterolaemia and PA. RESULTS: The study was composed of 147 men and 410 women. The fully adjusted model showed that Brazilian adults spending ≥3 h per day in television viewing (OR = 1.61 [95% CI: 1.11-2.33]) and overall SB (OR = 1.60 [95% CI: 1.09-2.36]) had increased prevalence of DM compared to those spending <3 h per day. CONCLUSIONS: TV viewing and overall SB was associated with higher prevalence of DM in Brazilian adults from the NHS, even after controlling for potential confounders including PA.

Impact of sports participation on mortality rates among Brazilian adults.

Objective: To analyze the possible dose-response association between components of sports participation (intensity, volume and previous engagement) and 4-year mortality rates among Brazilian adults. Methods: 679 males and females (mean age among men = 66.7 ± 9.3 years old and mean age among women = 64.8 ± 8.9 years old) composed the study sample. Sports participation was assessed using Baecke's questionnaire, which considers intensity, duration and previous engagement. Medical records were used to identify the cause of the death. Cox regression analysis was performed to determine the independent associations of exercise components and mortality. Results: Participants that reported exercising at moderate-vigorous intensity (Moderate/vigorous: 4.1% versus None/light: 10.3% [p-value = 0.012]; HR = 0.42 [0.1 to 0.94)] and for more than four months (≥4 months: 5.3% versus <4 months: 10.2% [p-value = 0.038]; HR = 0.47 [0.24 to 0.94]) had lower mortality risk. The percentage of survival according to all-cause mortality was significantly higher for participants engaged in sports at moderate-vigorous intensity (p-value = 0.014), as well as for those engaged in sports for periods superior than four months (p-value = 0.036). Conclusion: We found higher percentage of survival among adults engaged in sports at moderate-vigorous intensity and with at least four months of previous engagement.

Sports participation and adiposity do not mediate the relationship between birth weight and arterial thickness in adolescents: ABCD Growth Study.

OBJECTIVE: To analyse the relationship of altered birth weight with metabolic and cardiovascular outcomes among adolescents, as well as to identify if sports participation is able to attenuate or even eliminate the impact of birth weight on health outcomes. METHODS: Cross-sectional study (Analysis of Behaviours of Children During Growth [ABCD Growth Study]). Adolescents with age ranging from 11 to 18 years old (14.7±2.1) stratified according to normal (n = 230) and altered (n = 35) birth weight composed the sample. Birth weight was self-reported by adolescent's parents. Sports participation was assessed by face-to-face interview. Carotid intima-media thickness (CIMT) and femoral intima-media thickness (FIMT) were measured using an ultrasound device. C-reactive protein levels were used to assess the inflammatory status. Blood pressure, Z score of metabolic risk (dyslipidemia and glucose), adiposity, and insulin resistance were covariates. RESULTS: In the crude model, FIMT (p value = 0.037) and C-reactive protein (p value = 0.029) were affected by altered birth weight. In the adjusted models, altered birth weight affected FIMT (p value = 0.048; small effect size of 1.7%), independently of sports participation. For C-reactive protein, previous time of engagement in sports (p value = 0.001; small effect size of 4.8%) affected C-reactive protein, independently of birth weight. CONCLUSION: Vascular structure seems to be affected by birth weight in adolescents, while its impact on inflammation seems to be attenuated by the regular engagement in sports.

Impact of type 2 diabetes mellitus and physical activity on medication costs in older adults.

INTRODUCTION: The high prevalence of diabetes mellitus leads to high costs of medication for treatment and the practice of physical activity, as well as reducing the risks of diabetes mellitus is able to substantially mitigate costs. To investigate the impact of diabetes mellitus on costs of medication and identify whether physical activity can influence the relationship between diabetes mellitus and costs of medication. METHODS: The sample consisted of adults enrolled in five basic healthcare units. The presence of diabetes mellitus and habitual physical activity were assessed by a questionnaire, the quantity of medication used was evaluated according to the medical records, and medication costs, through receipts. FINDINGS: Individuals with diabetes mellitus from baseline presented higher body weight (P value = .001) and lower levels of physical activity (P value = .014). The presence of diabetes mellitus was positively related to costs of medication for diseases of the circulatory system (ß = 4.89), endocrine, nutritional, and metabolic diseases (ß = 109.72), and total costs of medication (ß = 113.41). The impact of diabetes mellitus was attenuated by physical activity. CONCLUSION: It was identified that diabetes mellitus has a significant impact on public costs with medication, and physical activity was effective in reducing health costs independently of diabetes mellitus by less than 1%.

Association of TV Viewing and All-Cause Mortality in Older Adults With Hypertension: A 6-Year Longitudinal Study.

The purpose of this study was to examine the longitudinal association between television (TV) viewing and all-cause mortality in older adults with hypertension. Sedentary behavior, physical activity, hypertension, and other chronic diseases were assessed by face-to-face interviews and confirmed by medical history. Mortality was reported by relatives and confirmed in medical records of the National Health System. The fully adjusted model showed a direct association between high TV viewing time and all-cause mortality; hazard ratio: 1.65 (95% confidence interval [1.02-2.68]). Women with high TV viewing were more likely to die than men. Higher TV viewing time was associated with all-cause mortality among those with diabetes and hypertension; hazard ratio: 3.54 (95% confidence interval [1.64-7.66]). The findings from this longitudinal study show that higher TV viewing time is associated with higher risk for all-cause mortality among older adults with hypertension, independently of physical activity, and other potential confounders.

Sport-based physical activity recommendations and modifications in C-reactive protein and arterial thickness.

We analyzed the effects of 1 year of engagement in ≥ 300 min/week of organized sports on inflammatory levels and vascular structure in adolescents. The sample was composed of 89 adolescents (11.6 ± 0.7 years old [43 boys and 46 girls]), stratified according to engagement in ≥ 300 min/week of sport practice during at least 12 months of follow-up (n = 15, sport practice; n = 74, non-sport practice). Arterial thickness (carotid and femoral) was assessed by ultrasound scan, while high sensitive C-reactive protein levels were used to assess inflammatory status. Trunk fatness (densitometry scanner), biological maturation (age at peak height velocity), blood pressure, and skipping breakfast were treated as covariates. Independently of body fatness and biological maturation, the group engaged in sports presented a higher reduction in C-reactive protein (mean difference -1.559 mg/L [95%CI -2.539 to -0.579]) than the non-sport group (mean difference -0.414 mg/L [95%CI -0.846 to 0.017]) (p = 0.040). There was a significant relationship between changes in C-reactive protein and changes in femoral intima-media thickness in the non-sport group (r = 0.311 [95%CI 0.026 to 0.549]). CONCLUSION: Inflammation decreased in adolescents engaged in organized sports, independently of trunk fatness and biological maturation. Moreover, inflammation was related to arterial thickening only in adolescents not engaged in sports. What is Known: • Intima media thickness is a relevant marker of cardiovascular disease in pediatric groups, being affected by obesity and inflammation. • The importance of monitoring inflammatory markers from childhood is enhanced by the fact that alterations in these inflammatory markers in early life predict inflammation and alterations in carotid IMT in adulthood. What is New: • Anti-inflammatory properties related to physical exercise performed at moderate intensity, on inflammation and alterations in IMT are not clear in pediatric groups. • Due to the importance that sport participation has assumed as a promoter of improvements in health and quality of life, it is necessary to understand its potential benefits for cardiovascular health during human growth.

Association between Sports Participation in Early Life and Arterial Intima-Media Thickness among Adults.

Background: Early sports practice is associated with several health benefits during childhood and adolescence, moreover, recent evidence also suggests that sports during childhood and adolescence can produce some benefits during adulthood. However, the association between early sports practice and arterial thickness is not clear. Thus, our aim was analyze the association between sports participation in childhood and adolescence, carotid/femoral intima⁻media thickness, and blood flow index in adulthood. Material and Methods: Sample was composed of 107 adults (64 males) between 30 years and 50 years, which were recruited from different gyms and university staff from São Paulo State University. Participants were divided according to sports participation in early life (engaged in sports during childhood and adolescence (n = 52) and no engagement in sports during childhood and adolescence (n = 55)). Carotid and femoral intima⁻media thickness were measured through Doppler ultrasonography method. Carotid and femoral index were estimated from ultrasonography measures. As covariates, the following were adopted: chronological age, sex, body fat (through dual-energy x-ray absorptiometry), c-reactive protein, HOMA, alcohol consumption, tobacco smoking, mean arterial pressure and current physical activity (pedometer). General estimating equations were used, adopting p < 0.05. Results: In the adjusted analyses, early sports participation was associated with lower carotid intima⁻media index (early sports participation: 0.64 mm ± 0.14 mm vs. no early sports participation: 0.71 mm ± 0.21 mm; p = 0.011), but not associated with femoral intima⁻media thickness, carotid resistive index and femoral resistive index after the adjustment by potential confounders. Conclusions: Sports participation in childhood and adolescence was associated with a reduced carotid intima⁻media thickness, independently of relevant confounders.

High blood pressure and sedentary behavior in adolescents are associated even after controlling for confounding factors.

OBJECTIVE: The aim of this study was to determine whether high blood pressure (HBP) is associated with sedentary behavior in young people even after controlling for potential confounders (gender, age, socioeconomic level, tobacco, alcohol, obesity and physical activity). METHODS: In this epidemiological study, 1231 adolescents were evaluated. Blood pressure was measured with an oscillometric device and waist circumference with an inextensible tape. Sedentary behavior (watching television, computer use and playing video games) and physical activity were assessed by a questionnaire. We used mean and standard deviation to describe the statistical analysis, and the association between HBP and sedentary behavior was assessed by the chi-squared test. Binary logistic regression was used to observe the magnitude of association and cluster analyses (sedentary behavior and abdominal obesity; sedentary behavior and physical inactivity). RESULTS: HBP was associated with sedentary behaviors [odds ratio (OR) = 2.21, 95% confidence interval (CI) = 1.41-3.96], even after controlling for various confounders (OR = 1.68, CI = 1.03-2.75). In cluster analysis the combination of sedentary behavior and elevated abdominal obesity contributed significantly to an increased likelihood of having HBP (OR = 13.51, CI 7.21-23.97). CONCLUSIONS: Sedentary behavior was associated with HBP, and excess fat in the abdominal region contributed to the modulation of this association.

Combined association of insufficient physical activity and sleep problems with healthcare costs: a longitudinal study.

BACKGROUND: The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs. OBJECTIVE: To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults. DESIGN AND SETTING: Adults aged ≥ 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014. METHODS: Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures. RESULTS: In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01. CONCLUSION: The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems.

Burden of metabolic syndrome on primary healthcare costs among older adults: A cross-sectional study.

BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.

Impact of cycling and walking on adiposity and healthcare costs among adults: longitudinal study.

Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face-to-face interview at four time-points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p-value = 0.028) and healthcare costs (p-value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p-value = 0.507) due to the impact of number of chronic diseases (p-value = 0.001). Cycling on leisure-time is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation.

The relationship between visceral fat thickness and bone mineral density in sedentary obese children and adolescents.

BACKGROUND: Among adults, obesity has been positively related to bone mineral density. However, recent findings have pointed out that abdominal obesity could be negatively related to bone density. The above mentioned relationship is not clear among pediatric populations. Therefore, this cross-sectional study analyzed the relationship between thickness of abdominal adipose tissue and bone mineral variables in sedentary obese children and adolescents. METHODS: One hundred and seventy five obese children and adolescents (83 male and 92 female) with ages ranging from 6 to 16 years-old were analyzed. Bone mineral content and density were estimated by dual-energy X-ray absorptiometry and ultrasound equipment which estimated the thickness of the abdominal adipose tissue. Pubertal stage was self-reported by the participants. RESULTS: The mean age was 11.1 (SD=2.6). Thickness of the abdominal adipose tissue was negatively related to bone mineral density (r=-0.17 [r95%CI: -0.03;-0.32]), independent of gender, pubertal stage and other confounders (ß=-0.134±0.042 [ß95%CI: -0.217; -0.050]). CONCLUSIONS: In sedentary obese children and adolescents abdominal obesity is negatively related to bone mineral density, suggesting a potential link between abdominal obesity and osteoporosis.

Comorbidities do not mitigate the effect of habitual physical activity on the reduction of healthcare costs among adults with cardiovascular diseases: A mediation analysis.

BACKGROUND: Habitual Physical activity (HPA) is a non-pharmacological strategy to prevent and control chronic diseases, and it plays an important role in minimizing healthcare costs. OBJECTIVES: This study aimed to investigate the relationship between HPA and healthcare costs from the perspective of the Brazilian National Healthcare System, and to establish the mediating role of comorbidities in this relationship among patients with cardiovascular diseases (CVD). DESIGN AND SETTING: This longitudinal study was conducted in a medium-sized Brazilian city and included 278 participants assisted by the Brazilian National Healthcare System. METHODS: Information on healthcare costs were obtained from medical records and included primary, secondary, and tertiary levels. Comorbidities (diabetes, dyslipidemia, and arterial hypertension) were self-reported, and obesity was confirmed with the percentage of body fat. HPA was measured using a questionnaire (Baecke questionnaire). Face-to-face interviews provided information on sex, age, and education level. Statistical analysis included linear regression and Structural Equation Modeling, significance was set at 5 % and the Stata software (version 16.0) was used to perform the analysis. RESULTS: The sample included 278 adults with a mean age of 54.49 (8.32) years. For each score of HPA, there was a reduction in healthcare costs of US$ 83.99/24 months (95 % CI: - 159.15; - 8.84), and the sum of comorbidities did not mediate this relationship. CONCLUSION: It is concluded that healthcare costs seem to be affected by HPA among patients with CVD, while this phenomenon seems not to be mediated by the sum of comorbidities.