Physical activity levels, cardiovascular risk, and self-perceived barrier to physical activity in people living with HIV in Maranhão, Brazil: a short report.

The aim of this research was to investigate the existence of associations between habitual physical activity and cardiovascular risk in people living with HIV; and to identify self-perceived barriers to physical activity. The sample of 104 subjects was composed of people living with HIV and treatment for at least 6 months in a Specialized Care Service. Baeck's survey, a self-perceived barrier questionnaire, medical records, and equations from Framingham's Cardiovascular Disease were used. Linear regression models were used to investigate the association between Habitual Physical Activity score (HPA) and predicted cardiovascular risk, and descriptive statistics to investigate prevalence of self-perceived barriers. In the first model (r² = 0.212, F = 4.34, p < 0.001), increasing 1 point in the HPA score predicts the decrease by 1.04 percentage points (p.p.) Cardiovascular risk for the next 10 years. In the second model (r2 = 0. 244, F = 4. 99, p < 0.001), increase one point the HPA score decreases by 3.729 p.p. Predicted cardiovascular risk for the next 30 years. The results confirmed an inverse association between HPA and predicted cardiovascular risk in PLHIV.

The effect of family history of hypertension and polymorphism of the ACE gene (rs1799752) on cardiac autonomic modulation in adolescents.

This study aims to analyze the behaviour of cardiac autonomic modulation in adolescents with a family history of hypertension along with polymorphism of the ACE gene (rs1799752). The study involved 141 adolescents, with a mean age of 14.89, divided into the following six groups: offspring of normotensive parents (ONP): DD, DI and II; and offspring of hypertensive parents (OHP): DD, DI and II. Blood pressure, body composition, family history of hypertension, sleep disorder, and sexual maturation were assessed for the groups' characterization. Afterwards, an electrocardiogram was performed, and oral mucosal cells were collected to analyze heart rate variability and genotypic research of angiotensin-converting enzyme. The main finding of this study was the decrease of vagal action in group OHP (genotype DD) relative to group ONP (genotype II): LF (%), 54.25 ± 3.14 vs 39.33 ± 3.80; HF (%), 45.74 ± 3.14 vs 60.66 ± 3.80; LF/HF, 1.48 ± 0.23 vs 0.68 ± 0.19. The results also showed changes in the variable diastolic blood pressure (DBP) in OHP (genotype DI) to ONP (genotype II) groups: 72.99 ± 2.33 vs 63.27 ± 1.72; and OHP (genotype DI) to ONP (genotype DD) groups. Adolescents with genotype DD and a family history of arterial hypertension present chances in cardiac autonomic modulation, the cardiac parasympathetic modulation is lower in these adolescents in comparison to participants of ONP + II group.

Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus.

OBJECTIVE: To evaluate whether an interdisciplinary intervention program on lifestyle results in better quality of life (QoL) and lower frequencies of depression and binge eating disorder (BED) in individuals at risk for type 2 diabetes mellitus. METHODS: A total of 177 individuals (32.2% men, age 55.4 ± 12.5 years) at risk for diabetes were allocated to a 9-month traditional (TI) or intensive interdisciplinary intervention (II) on dietary habits and physical activity including psychoeducative groups. They were submitted to questionnaires and clinical and laboratory examinations. Predictors of non-adherence were analyzed by logistic regression. RESULTS: Only individuals submitted to II had blood pressure and plasma glucose levels reduced. Frequencies of depression reduced in both interventions but of BED only in II (28.0-4.0%, P < 0.001). Increments in the scores of SF-36 domains (physical functioning: 11.1 ± 14.0 vs. 5.3 ± 13.0, role-emotional: 20.4 ± 40.2 vs. 6.2 ± 43.8, P = 0.05) were greater in the II than in TI, respectively. Changes in SF-36 correlated with decreases in anthropometry, blood pressure and glucose levels, depression and BED scores. Male gender was independently associated with non-adherence to the II. CONCLUSIONS: In addition to metabolic benefits, an interdisciplinary approach may induce desirable extrametabolic effects, favoring the control of psychiatric disorders and improving the QoL of individuals at risk for diabetes.

Influence of previous experience on resistance training on reliability of one-repetition maximum test.

The 1-repetition maximum test (1RM) has been widely used to assess maximal strength. However, to improve accuracy in assessing maximal strength, several sessions of the 1RM test are recommended. The aim of this study was to analyze the influence of previous resistance training experience on the reliability of 1RM test. Thirty men were assigned to the following 2 groups according to their previous resistance training experience: no previous resistance training experience (NOEXP) and more than 24 months of resistance training experience (EXP). All subjects performed the 1RM tests in bench press and squat in 4 sessions on distinct days. There was a significant session × group effect in bench press (F = 3.09; p < 0.03) and squat (F = 2.76; p < 0.05) showing that only the NOEXP increased maximal strength between the sessions. Significant increases (p < 0.05) in maximal strength occurred in the NOEXP between session 1 and the other sessions in bench press (session 1 vs. 2 = +3.8%; session 1 vs. 3 = +7.4%; session 1 vs. 4 = +10.1%), and squat (session 1 vs. 2 = +7.6%; session 1 vs. 3 = +10.1%; session 1 vs. 4 = +11.2%). Moreover, in bench press, maximal strength in sessions 3 and 4 were significantly higher than in session 2. The results of the present study suggest that the reliability of the 1RM test is influenced by the subject's previous experience in resistance training. Subjects without experience in resistance training require more practice and familiarization and show greater increases in maximal strength between sessions than subjects with previous experience in resistance training.

Interventions for Promoting Physical Activity Among Individuals With Spinal Cord Injury: A Systematic Review.

BACKGROUND: Engaging in physical activity (PA) can bring many benefits to individuals with spinal cord injury (SCI) and understanding the best interventions to promote PA is essential. The objective of this study was to systematically review the literature to check the effectiveness of interventions aimed at increasing the PA level in SCI individuals. METHODS: The bibliographic search was performed in the PubMed, LILACS, Web of Science, and SPORTDiscus databases, including randomized controlled trials involving humans, in which PA level was the primary or secondary outcome, and with samples composed entirely or partially of individuals with SCI. The articles were analyzed by 2 researchers using descriptive statistics and the quality of the studies was assessed using the CONSORT criteria. RESULTS: Seven articles were selected. The studies used different strategies of intervention. Six out of the 7 studies included in the analysis proposed interventions that were effective in increasing PA level (action plans/coping strategies, home exercises, behavioral intervention, elaboration of intentions, workshops, and education for the promotion of PA). In only 1 study, the proposed strategy was not effective (reading a guideline). CONCLUSION: It is concluded that these 6 interventions are effective in increasing the PA level in SCI individuals.

Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System.

OBJECTIVE: To assess the effect of interventions on the levels of physical activity of healthy adults, users of the Brazilian Unified Health System and attended by the Family Health Strategy. METHODS: Non-randomized experimental study with 157 adults allocated in three groups: 1) physical exercise classes (n = 54), 2) health education (n = 54), 3) control (n = 49). The study lasted for18 months, with 12 months of interventions and six months of follow-up after intervention. Assessments took place at the beginning, in the 12 months, and in the 18 months of study. Physical activity has been assessed by questionnaires and accelerometry. For the analyses, we have used the intention-to-treat principle and generalized estimating equations. RESULTS: After 12 months, both intervention groups have increased the minutes of weekly leisure time physical activity and annual scores of physical exercise, leisure and transport-related physical activity. The exercise class group has obtained the highest average annual physical exercises score when compared to the other groups (p < 0.001). In the follow-up period, the exercise class group reduced its annual score (average: -0.3; 95%CI -0.5--0.1), while the health education group increased this score (average: 0.2; 95%CI 0.1-0.4). There have been no differences in the levels of physical activity measured by accelerometry. CONCLUSIONS: The interventions have been effective in increasing the practice of physical activity. However, we have observed that the health education intervention was more effective for maintaining the practice of physical activity in the period after intervention. We recommend the use of both interventions to promote physical activity in the Brazilian Unified Health System, according to the local reality of professionals, facilities, and team objectives. OBJETIVO: Avaliar o efeito de intervenções nos níveis de atividade física de adultos saudáveis, usuários do Sistema Único de Saúde e atendidos pela Estratégia de Saúde da Família. MÉTODOS: Estudo experimental, não randomizado, com 157 adultos alocados em três grupos: 1) classes de exercícios físicos (n = 54); 2) educação em saúde (n = 54); 3) controle (n = 49). O estudo teve duração de 18 meses, sendo 12 meses de intervenções e seis meses de acompanhamento pós-intervenção. As avaliações ocorreram no início, nos 12 e nos 18 meses de estudo. A atividade física foi avaliada por questionários e por acelerometria. Para as análises, utilizaram-se o princípio de intenção de tratar e equações de estimativas generalizadas. RESULTADOS: Após 12 meses, ambos os grupos de intervenção aumentaram os minutos semanais de atividade física no lazer e os escores anuais de exercícios físicos, de lazer e de deslocamento. O grupo das classes de exercícios físicos obteve maior média de escore anual de exercícios físicos em comparação com os outros grupos (p < 0,001). No período pós-intervenção, o grupo de classes de exercícios físicos reduziu o escore anual de exercícios físicos (média: -0,3; IC95% -0,5--0,1), enquanto o grupo de educação em saúde aumentou este escore (média: 0,2; IC95% 0,1-0,4). Não houve diferenças nos níveis de atividade física mensurados por acelerometria. CONCLUSÕES: As intervenções foram efetivas para aumentar a prática de atividade física. No entanto, observou-se que a intervenção de educação em saúde foi mais efetiva para a manutenção da prática de atividade física no período pós-intervenção. Recomenda-se a utilização de ambas as intervenções para a promoção da atividade física no Sistema Único de Saúde, de acordo com as realidades locais de profissionais, instalações e objetivos das equipes.

Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews.

OBJECTIVE: To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents. DATA SOURCE: Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed. SUMMARY OF THE FINDINGS: Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation. CONCLUSIONS: Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.

Nível de atividade física e fatores relacionados em universitários da área da saúde: um estudo longitudinal / Level of physical activity and related factors in university health areas: a longitudinal study

RESUMO A inatividade física ocupa o quarto lugar entre os principais fatores de risco de mortalidade a nível mundial. Objetivou- se relacionar a mudança ou aumento do nível de atividade física com variáveis socioeconômicas e do estilo de vida no período de seis meses em universitários da área da saúde. Trata-se de um estudo longitudinal, constituído por 167 universitários da área da saúde do nordeste brasileiro. Utilizou-se como instrumento o questionário " Mapa de Atividade Física e Saúde- MAFIS". Os dados foram analisados por meio de estatística descritiva em forma de frequência e percentual, teste de Qui quadrado, com posterior montagem do modelo de regressão logística. Os resultados mostram que ss universitários que responderam serem "pouco capazes" de acordar uma hora mais cedo para fazer atividade física estão protegidos em 78% (OR: 0,217; IC: 0,056- 0,83) contra a pratica de AFLAZ comparado aos que se consideram "bastante capazes". Conclui-se que a disposição para acordar 1 hora mais cedo se relaciona a fazer atividade física em um período de seis meses em universitários da área da saúde.

ABSTRACT Physical inactivity ranks fourth among the main risk factors for mortality worldwide. Aim to relate a change or increase in the level of physical activity with socioeconomic variables and lifestyle over a six-month period in university students in the health field. This is a longitudinal study, consisting of 167 university students in the health area in northeastern Brazil. Use the "Map of Physical Activity and Health-MAFIS" as an instrument or questionnaire. The data were analyzed using descriptive statistics in the form of frequency and percentage, square test, posterior assembly of the logistic regression model. The results show that the university students who responded are "barely able" to wake up an hour earlier to perform protected physical activities by 78% (OR: 0.217; CI: 0.056-0.83) against the practice of AFLAZ compared to those who consider " quite capable ". It was concluded that the willingness to wake up 1 hour earlier is related to doing physical activity over a period of six months in health students.

Pensar, gostar e considerar importante a prática de atividade física aumentam as chances de ser ativo no lazer? / Do thinking, enjoying, and considering important the practice of physical activity increase the chances of being active at leisure?

RESUMO: Embora reconhecida como comportamento de extrema importância na saúde da população, a prática de atividade física regular ainda é um grande desafio. Objetivo: verificar o nível de atividade física no lazer e possíveis fatores correlatados em uma comunidade acadêmica do nordeste brasileiro. Metodologia: trata-se de um estudo transversal, constituído por discentes, docentes e técnicos administrativos, utilizou-se como instrumento "Mapa de Atividade Física e Saúde-MAFIS", realizou-se estatística descritiva, teste de Qui quadrado, com posterior montagem do modelo de regressão logística. Resultados: 52,1% atingiram as recomendações de atividade física (AF), os homens apresentam 65,3% (OR: 1,65; IC95%: 1,29-2,11) mais chance de serem ativos, quem gosta de AF tem duas (OR: 2,02; IC95%: 0,82-4,96) a 4,8 (OR: 4,84; IC95%: 1,99-11,8) vezes mais chance de praticar AF, achar importante fazer AF (OR: 2,23; IC95%: 0,48-10,4) e menos dias sentado aumenta de 48,3% (OR: 1,48; IC95%: 1,032- 2,130) a 53,3% (OR: 1,53; IC95%: 1,09-2,13) a chance de fazer AF e quem pensa em fazer AF (OR: 0,362; IC: 0,203-0,645) tem menos chance de ser ativo. Conclusão: Gostar, considerar importante e menos dias sentados aumentam as chances de fazer atividade física, já pensar sempre em fazer, diminui a chance de ser ativo no lazer. (AU)

ABSTRACT: Although recognized as extremely important behavior in the health of the population, the practice of a regular physical activity is still a major challenge. Aim: verifying the level of leisure-time physical activity and possible correlated factors in an academic community in northeastern Brazil. Materials and methods: this is a cross-sectional study, consisting of stu-dents, professors, and administrative technicians. The instrument "Map of Physical Activity and Health-MAFIS" was used, as well as descriptive statistics, Chi-square test, with the subsequent assembly of the logistic regression model. Results: 52.1% reached the recommendations for physical activity (PA), men were 65.3% (OR: 1.65; 95% CI: 1.29 - 2.11) more likely to be active, those who like PA were two (OR: 2.02; 95% CI: 0.82- 4.96) to 4.8 (OR: 4.84; 95% CI: 1.99-11.8) times more likely to practice PA, finding it important to do AF (OR: 2.23; 95% CI: 0.48-10.4) and spending fewer days sitting increased by 48.3% (OR: 1.48; 95% CI: 1,032 - 2,130) to 53.3% (OR: 1 , 53; 95% CI: 1.09 - 2.13) the chance of doing PA and those who think about doing PA (OR: 0.362; CI: 0.203 - 0.645) are less likely to be active. Conclusion:Enjoying, considering important, and spending fewer days sitting increase the chances of doing physical activity, on the other hand, just thinking about doing it decreases the chances of being active at leisure. (AU)

Atividade física na prevenção de doenças crônicas não transmissíveis em homens / Physical activity in the prevention of chronic noncommunicable diseases in men

RESUMO: Introdução: A promoção da atividade física (AF) é uma das prioridades das políticas públicas de atenção básica à saúde, especialmente para o público masculino. Objetivo: Avaliar a associação da prática de atividade física com o estilo de vida e presença doenças crônicas não transmissíveis (DCNTs) em usuários do sexo masculino de Unidade Básica de Saúde (UBS). Métodos: Participaram do estudo 119 homens na faixa etária de 20 a 59 anos. A associação entre a prática de atividade física com variáveis sociodemográficas, etilismo, tabagismo, uso de medicamento, presença de doenças crônicas não transmissíveis e conhecimento da política de saúde do homem foi realizada por Regressão Logística com um α=5%. Resultados: A prevalência de atividade física foi de 58,8%, entretanto 36,7% dos participantes faziam uso de medicações diariamente e 70,6% não conhecem a Política Nacional de Atenção Integral à Saúde do Homem. Além disso, fazer atividade física demonstrou como um fator de proteção contra as doenças crônicas não transmissíveis (OR = 2,97; IC 95% 1,03 ­ 8,55; p = 0,043). Conclusão: A prática de atividade física em homens, independentemente da idade, tabagismo e etilismo foi associada à prevenção de doenças crônicas não transmissíveis.(AU)

ABSTRACT: Introduction: The promotion of physical activity (PA) is one of the priorities of public policies for primary health care, especially for the male audience. Objective: To evaluate the association between physical activity and life-style and presence of chronic noncommunicable diseases (NCDs) in male users of the Basic Health Unit (BHU). Methods: 119 men, aged between 20 and 59 years, participated in the study. The association between the practice of physical activity with sociodemographic variables, alcoholism, smoking, use of medication, presence of chronic noncommunicable diseases and knowledge of men's health policy was carried out by Logistic Regression with an α= 5%. Results: The prevalence of physical activity was 58.8%, however 36.7% of the participants used medica-tions daily and 70.6% did not know the National Policy for Comprehensive Attention to Men's Health. In addition, physical activity proved to be a protective factor against chronic non-communicable diseases (OR= 2,97; IC 95% 1,03 ­ 8,55; p = 0,043). Conclusion: The practice of physical activity in men, regardless of age, smoking and alcohol consumption was associated with the prevention of chronic noncommunicable diseases. (AU)

Atividade física nos programas de promoção à saúde do homem / Physical activity in men's health promotion programs

Objetivo: buscou-se analisar os programas que incluem a atividade física como ferramenta para a promoção à saúde do homem. Método: trata-se de uma revisão de literatura, tipo revisão integrativa, realizada a partir de buscas nas bases de dados Cochrane Library, MEDLINE via PubMed, Web of Knowledge, LILACS, SPORTDiscus e Biblioteca Virtual em Saúde. Apresentaram-se os resultados em forma de tabelas e figuras. Resultados: encontrou-se um total de 720 estudos, entretanto somente 15 corresponderam aos critérios de inclusão e exclusão. Verifica-se que esses estudos compreenderam amostras de pessoas com idades entre 18 e 59 anos e que a abordagem mais predominante foi a qualitativa, analisando a baixa adesão do sexo masculino aos serviços de saúde; todavia, a atividade física foi considerada uma estratégia de promoção à saúde dos homens. Conclusão: conclui-se que, embora existam estratégias de promoção à saúde do homem, a adesão da população masculina continua desafiadora, fazendo-se, portanto, necessária a inclusão de atividades físicas nos programas de saúde do homem.(AU)

Objective: it was sought to analyze programs that include physical activity as a tool for the promotion of human health. Method: This is an integrative literature review based on searches in the following databases: Cochrane Library, MEDLINE via PubMed, Web of Knowledge, LILACS, SPORTDiscus, and Virtual Health Library. Tables and figures are presented. Results: a total of 720 studies were found, but only 15 met the inclusion criteria. It was verified that these studies comprised samples of people between the ages of 18 and 59 years and that the most predominant approach was qualitative, and the articles analyzed the low adherence of men to health services. However, physical activity was considered a strategy for promotion of men's health. Conclusion: it is concluded that, although there are strategies to promote the health of men, the adherence of the male population remains challenging, making it necessary to include physical activities in programs aimed at men's health.(AU)

Objetivo: analizar los programas que incluyen la actividad física como herramienta para la promoción de la salud del hombre. Método: se trata de una revisión de la literatura, clasificada como revisión integradora, conducida mediante búsquedas en las bases de datos Cochrane Library, MEDLINE vía PubMed, Web of Knowledge, LILACS, SPORTDiscus y Biblioteca Virtual en Salud. Los resultados se presentaron en forma de tablas y figuras. Resultados: se encontró un total de 720 estudios; sin embargo, solo 15 correspondían a los criterios de inclusión y exclusión. Se comprueba que estos estudios abarcaron muestras de personas de entre 18 y 59 años y que el enfoque más prevalente era cualitativo, analizando la baja adhesión del sexo masculino a los servicios de salud; sin embargo, la actividad física se consideró una estrategia de promoción de la salud de los hombres. Conclusión: se concluye que, aunque existen estrategias para promover la salud del hombre, la adhesión de la población masculina sigue siendo desafiante, por lo que es necesario incluir las actividades físicas en los programas de salud del hombre.(AU)

Physical activity and its relationship with perceived environment among adults living in a region of low socioeconomic level.

BACKGROUND: The environment has a great influence on people's lifestyles and their capacity to choose healthy habits. The aim of this study was to investigate the association between perceived environment and physical activity among adults living in the city of São Paulo, Brazil. METHODS: This was a cross-sectional population-based study conducted with 890 people age 18 years or over. Physical activity was measured through the International Physical Activity Questionnaire (IPAQ; long version) and perceived environment was evaluated using the Neighborhood Walkability Scale (NEWS) adapted. Poisson's regression was used for statistical analyses and prevalence ratios were calculated. The outcome variable was the attainment of at least 150 minutes per week of physical activities. The independent variables consisted of perceived environment variables and control variables (sex, age, schooling, time living in the home, and number of cars per household). RESULTS: The perceived environment variables that explained physical activity were: receiving invitations from friends for activities (P = .012), low environmental pollution scores (p trend = 0.030) and high general safety scores (P-trend = 0.039). CONCLUSIONS: These results suggest that physical activity promotion in regions like this should be envisaged as a complex phenomenon and investments in public safety, prevention and combating of environmental pollution and social support networks are needed.

Factors associated with physical inactivity in transportation in Brazilian adults living in a low socioeconomic area.

BACKGROUND: Physical inactivity in transportation is negatively related to many health outcomes. However, little is known about the correlates of this condition among people living in regions of low socioeconomic level. METHODS: Cross-sectional study aimed to assess factors associated with physical inactivity in transportation among adults in the Eastern Zone of São Paulo, Brazil. Home-based interviews were conducted between May 2007 and January 2008 on a probabilistic sample of the adult population (≥18 years), totaling 368 men and 522 women. Factors associated with physical inactivity in transportation (less than 10 minutes per week of walking or cycling) were assessed using multivariate Poisson regression with hierarchical selection of variables. RESULTS: Physical inactivity in transportation was associated with the presence of vehicles in the household in men (PR = 2.96) and women (PR = 2.42), with linear trend for both sexes (P < .001 and P = .004, respectively), even after adjusting for age, schooling level and chronic diseases (this last factor, only among women). CONCLUSIONS: Presence of vehicles in the household was associated positively with physical inactivity in transportation, both for men and for women. This should be taken into consideration in drawing up public policies for promoting physical activity.

[Implementation of a structured healthy lifestyle program to reduce cardiometabolic risk]. / Implementação de programa estruturado de hábitos de vida saudáveis para redução de risco cardiometabólico.

The objective this study was to describe the methodology and implementation of lifestyle change program in individuals at cardiometabolic risk seen at the public health system in Sao Paulo. The Programa de Prevenção de Diabetes Mellitus (PDM) aims at improving the overall metabolic profile of individuals with prediabetes or metabolic syndrome without diabetes; its goals were > 5% weight loss, dietary fiber intake > 20 g per day, saturated fatty acids intake < 10% per day, and > 150 minutes of physical activity per week. The first edition of the PDM lasted 18 months and involved an interdisciplinary team (endocrinologist, psychologist, nutritionist, and physical educator) to plan and conduct group sessions with the participants. The structure and systematic of the sessions were planned using a psychoeducative approach in order to facilitate the process of lifestyle changes. Based on the Experience with the PDM, some reflections and recommendations are made. This study may indicate ways for health professionals to tailor local care conditions and promote a healthy lifestyle, working with a new perspective.

Cardiometabolic risk reduction through lifestyle intervention programs in the Brazilian public health system.

UNLABELLED: Public health strategies to reduce cardiovascular morbidity and mortality should focus on global cardiometabolic risk reduction. The efficacy of lifestyle changes to prevent type 2 diabetes have been demonstrated, but low-cost interventions to reduce cardiometabolic risk in Latin-America have been rarely reported. Our group developed 2 programs to promote health of high-risk individuals attending a primary care center in Brazil. This study compared the effects of two 9-month lifestyle interventions, one based on medical consultations (traditional) and another with 13 multi-professional group sessions in addition to the medical consultations (intensive) on cardiometabolic parameters. Adults were eligible if they had pre-diabetes (according to the American Diabetes Association) and/or metabolic syndrome (International Diabetes Federation criteria for Latin-America). Data were expressed as means and standard deviations or percentages and compared between groups or testing visits. A p-value < 0.05 was considered significant. RESULTS: 180 individuals agreed to participate (35.0% men, mean age 54.7 ± 12.3 years, 86.1% overweight or obese). 83 were allocated to the traditional and 97 to the intensive program. Both interventions reduced body mass index, waist circumference and tumor necrosis factor-α. Only intensive program reduced 2-hour plasma glucose and blood pressure and increased adiponectin values, but HDL-cholesterol increased only in the traditional. Also, responses to programs were better in intensive compared to traditional program in terms of blood pressure and adiponectin improvements. No new case of diabetes in intensive but 3 cases and one myocardial infarction in traditional program were detected. Both programs induced metabolic improvement in the short-term, but if better results in the intensive are due to higher awareness about risk and self-motivation deserves further investigation. In conclusion, these low-cost interventions are able to minimize cardiometabolic risk factors involved in the progression to type 2 diabetes and/or cardiovascular disease.

Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System / Avaliação da efetividade de intervenções de promoção da atividade física no Sistema Único de Saúde

ABSTRACT OBJECTIVE To assess the effect of interventions on the levels of physical activity of healthy adults, users of the Brazilian Unified Health System and attended by the Family Health Strategy. METHODS Non-randomized experimental study with 157 adults allocated in three groups: 1) physical exercise classes (n = 54), 2) health education (n = 54), 3) control (n = 49). The study lasted for18 months, with 12 months of interventions and six months of follow-up after intervention. Assessments took place at the beginning, in the 12 months, and in the 18 months of study. Physical activity has been assessed by questionnaires and accelerometry. For the analyses, we have used the intention-to-treat principle and generalized estimating equations. RESULTS After 12 months, both intervention groups have increased the minutes of weekly leisure time physical activity and annual scores of physical exercise, leisure and transport-related physical activity. The exercise class group has obtained the highest average annual physical exercises score when compared to the other groups (p < 0.001). In the follow-up period, the exercise class group reduced its annual score (average: -0.3; 95%CI -0.5--0.1), while the health education group increased this score (average: 0.2; 95%CI 0.1-0.4). There have been no differences in the levels of physical activity measured by accelerometry. CONCLUSIONS The interventions have been effective in increasing the practice of physical activity. However, we have observed that the health education intervention was more effective for maintaining the practice of physical activity in the period after intervention. We recommend the use of both interventions to promote physical activity in the Brazilian Unified Health System, according to the local reality of professionals, facilities, and team objectives.

RESUMO OBJETIVO Avaliar o efeito de intervenções nos níveis de atividade física de adultos saudáveis, usuários do Sistema Único de Saúde e atendidos pela Estratégia de Saúde da Família. MÉTODOS Estudo experimental, não randomizado, com 157 adultos alocados em três grupos: 1) classes de exercícios físicos (n = 54); 2) educação em saúde (n = 54); 3) controle (n = 49). O estudo teve duração de 18 meses, sendo 12 meses de intervenções e seis meses de acompanhamento pós-intervenção. As avaliações ocorreram no início, nos 12 e nos 18 meses de estudo. A atividade física foi avaliada por questionários e por acelerometria. Para as análises, utilizaram-se o princípio de intenção de tratar e equações de estimativas generalizadas. RESULTADOS Após 12 meses, ambos os grupos de intervenção aumentaram os minutos semanais de atividade física no lazer e os escores anuais de exercícios físicos, de lazer e de deslocamento. O grupo das classes de exercícios físicos obteve maior média de escore anual de exercícios físicos em comparação com os outros grupos (p < 0,001). No período pós-intervenção, o grupo de classes de exercícios físicos reduziu o escore anual de exercícios físicos (média: -0,3; IC95% -0,5--0,1), enquanto o grupo de educação em saúde aumentou este escore (média: 0,2; IC95% 0,1-0,4). Não houve diferenças nos níveis de atividade física mensurados por acelerometria. CONCLUSÕES As intervenções foram efetivas para aumentar a prática de atividade física. No entanto, observou-se que a intervenção de educação em saúde foi mais efetiva para a manutenção da prática de atividade física no período pós-intervenção. Recomenda-se a utilização de ambas as intervenções para a promoção da atividade física no Sistema Único de Saúde, de acordo com as realidades locais de profissionais, instalações e objetivos das equipes.

Perception of the environment and practice of physical activity by adults in a low socioeconomic area.

OBJECTIVE: To analyze the association between practice of physical activity and the perception of the community environment among adults. METHODS: A cross-sectional study of 890 adults carried out in Ermelino Matarazzo district in São Paulo, Southeastern Brazil, 2007. The dependent variables were the practice of at least 150 minutes per week in leisure time physical activity and walking for commuting. Independent variables concerned the environment, and adjustment variables were sex, age, education and length of time living in the neighborhood. RESULTS: Variables associated with leisure time physical activity were: invitation from friends/neighbors, the presence of facilities less than ten minutes walking from the house and the absence of bars within ten minutes walking distance of the house. Public safety was associated with walking for commuting. CONCLUSIONS: To promote physical activity in areas of low socioeconomic status, it is fundamental to invest in public safety and facilities for physical activity, in addition to promoting social support networks.

Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews / A atividade física e a educação nutricional no ambiente escolar visando a prevenção da obesidade infantil: evidências de revisões sistemáticas

ABSTRACT OBJECTIVE: To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents. DATA SOURCE: Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed. SUMMARY OF THE FINDINGS: Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation. CONCLUSIONS: Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.

RESUMO OBJETIVO: Organizar os principais achados e relacionar as recomendações mais frequentes das revisões sistemáticas de intervenções desenvolvidas no ambiente escolar com fins na redução do excesso de peso em crianças e adolescentes. FONTE DOS DADOS: Buscas por revisões sistemáticas disponíveis até 31 de dezembro de 2014 foram feitas em cinco bases de dados eletrônicas: Cochrane, PubMed, SciELO, SPORTDiscus e Web of Science. Buscas manuais por referências cruzadas também foram desenvolvidas. SÍNTESE DOS DADOS: Das 2.139 referências iniciais, 33 revisões sistemáticas responderam adequadamente aos critérios de inclusão e compuseram a síntese descritiva. Nesse conjunto, identificaram-se como recomendações mais frequentes e efetivas intervenções que têm períodos de tempo superior a seis meses de duração (nove revisões) e o envolvimento dos pais nos conteúdos e/ou ações previstas (seis revisões). Além disso, observou-se que meninos respondem de forma mais efetivas às intervenções estruturais, enquanto as meninas às intervenções comportamentais. De modo consistente entre as revisões incluídas, nenhuma conseguiu fazer inferências sobre a base teórica usada nas intervenções, uma vez que, aparentemente, os responsáveis pelas intervenções desconsideraram esse componente em sua elaboração. CONCLUSÕES: Embora a síntese tenha identificado evidências com aplicações importantes em termos de saúde coletiva, ainda existem lacunas a serem preenchidas nesse campo do conhecimento, tais como a efetividade de diferentes modelos teóricos, o reconhecimento das melhores estratégias em relação ao sexo e à idade dos participantes e, por fim, a identificação de variáveis moderadoras para potencializar os benefícios proporcionados pelas intervenções.

Perception of the environment and leisure-time physical activity in the elderly.

OBJECTIVE: To analyze the association between leisure-time physical activity and perception of the environment in the elderly. METHODS: Cross-sectional study performed with 385 elderly individuals aged 60 years or older, living in the district of Ermelino Matarazzo, in the city of São Paulo, Southeastern Brazil, in 2007. The long version of the International Physical Activity Questionnaire, in addition to specific questions for the study, was used to assess leisure-time physical activity. Assessment of the environment was performed using a perception scale adapted from the Neighborhood Environment Walkability Scale. For statistical analysis, multiple logistic regression models were stratified by sex and controlled by level of education. The cut-off point of 150 minutes of physical activity per week was used to classify individuals who were active during leisure time. RESULTS: The proportion of elderly individuals active during leisure time was 15.2% (19.1% and 12.5% for men and women, respectively). Presence of sports courts (OR=2.95), banks (OR=3.82) and health clinics (OR=3.60), good perception of safety during the day (OR=4.21) and invitation from friends to exercise (OR=3.13) were associated with leisure-time physical activity in men. Presence of churches or religious temples (OR=5.73), gyms (OR=2.49) and squares (OR=3.63) were associated with leisure-time physical activity in women. CONCLUSIONS: Programs to promote physical activities for the elderly population must consider the variables associated with public and private structures (gyms, squares, sports courts, health clinics and banks), places where there are social gatherings (churches), social support (invitation from friends to exercise) and perception of safety.

Association between leisure-time physical activity and long-term medication use in adults from a low socioeconomic region / Associação entre prática de atividade física no tempo de lazer e medicação permanente em adultos de uma região de baixo nível socioeconômico

Few studies have investigated the association between leisure-time physical activity and long-term medication use in Brazilian populations, especially those of low socioeconomic status. The objective of this study was to analyze the association between the need for long-term medication and leisure-time physical activity in adults from the Ermelino Matarazzo district, a low-income region in São Paulo, Brazil. A population-based cross-sectional study was conducted in 2007 and involved 890 subjects aged 18 years or older. Data regarding the need for long-term medication and types of medications used were collected using a questionnaire. Leisure-time physical activity was measured using the long version of the International Physical Activity Questionnaire. Descriptive analysis, chi-square test, and simple and multiple binary and multinomial logistic regression analysis were used. Among the subjects studied, 29.2% reported the need for long-term medication and 10% required at least two different types of medications. After adjustment for gender, age, education level and Body Mass Index, subjects who did not perform at least 150 min/week of leisure-time physical activity presented 2.78 (95% confidence interval - 95%CI: 1.45; 5.30) and 4.69 (95%CI: 1.90; 11.53) times the odds of requiring long-term medication and two or more types of medications rather than none, respectively, than those who did. Broader discussion of the interaction between medication, leisure-time physical activity and social and economic aspects is needed to reduce inequalities and to improve the health of individuals of low socioeconomic status.

Poucos trabalhos estudaram a associação entre prática de atividade física no tempo de lazer e medicação permanente em brasileiros, especialmente, de baixo nível socioeconômico. O objetivo do estudo foi analisar a associação entre necessidade de medicação permanente e prática de atividade física no tempo de lazer em adultos do distrito de Ermelino Matarazzo, região de baixo nível socioeconômico do município de São Paulo, SP. Estudo transversal de base populacional, realizado em 2007, com 890 pessoas com 18 anos ou mais de idade. Dados sobre necessidade de medicação permanente e tipos de medicamentos foram coletados por questionário. Informações sobre a atividade física de lazer foram obtidas por meio do International Physical Activity Questionnaire (IPAQ), versão longa. Análise descritiva, teste do qui-quadrado e regressões logísticas binárias e multinomiais, simples e múltiplas, foram utilizadas. Observou-se que 29,2% relataram necessitar de medicação permanente e 10% necessitavam dois ou mais tipos diferentes de medicamentos. Após ajustes para sexo, idade, escolaridade e índice de massa corporal, pessoas que não realizavam, pelo menos, 150 min/sem de atividade física no lazer apresentaram odds 2,78 (intervalo de confiança de 95% - IC95%: 1,45; 5,30) e 4,69 (IC95%: 1,90; 11,53) vezes daqueles que realizavam ao menos esse volume de necessitar medicação permanente e de necessitar dois ou mais tipos de medicamentos do que nenhum, respectivamente. Reflexão mais ampla sobre a interação entre medicação, prática de atividade física no lazer e aspectos sociais e econômicos deve ser feita a fim de reduzir desigualdades e melhorar a saúde de pessoas com menores níveis socioeconômicos.