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Promoting Physical Activity Through Community-Wide Policies and Planning: Findings From Curitiba, Brazil

Rodrigo S. Reis, Pedro C. Hallal, Diana C. Parra, Isabela C. Ribeiro, Ross C. Brownson, Michael Pratt, Christine M. Hoehner, and Luiz Ramos

Background:

Community programs have been suggested to be an important and promising strategy for physical activity (PA) promotion. Limited evidence is available regarding knowledge of and participation in these programs in Latin America.

Objective:

To describe participation in and knowledge of community PA programs and to explore associations with leisure-time PA in the city of Curitiba, Brazil.

Methods:

A cross sectional telephone survey was conducted among adults in Curitiba, Brazil (n = 2097). The International Physical Activity Questionnaire was used to determine levels of PA, and specific questions were used to evaluate the extent to which respondents knew about or participated in the programs conducted by the municipality. Logistic regression was used to assess the meeting of PA recommendations in leisure time based on program knowledge and participation.

Results:

Knowledge of PA programs was high (91.6%) and 5.6% of population participated in the programs. After adjusting for individual characteristics, exposure to Curitiba's PA community programs was associated with leisure-time PA (POR = 2.9, 95% CI = 2.9−3.0) and walking for leisure (POR = 2.4; 95% CI = 2.3−2.4). The associations were stronger among men than among women.

Conclusions:

Knowledge and participation in Curitiba's community PA programs were associated with meeting recommended levels of PA in leisure time.

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Physical Activity Interventions in Latin America: What Value Might Be Added by Including Conference Abstracts in a Literature Review?

Christine Hoehner, Jesus Soares, Diana C. Parra, Isabela C. Ribeiro, Michael Pratt, Mario Bracco, Pedro C. Hallal, and Ross C. Brownson

Background:

This review assessed whether conference abstracts yield useful information on the types and effectiveness of community-based physical activity (PA) interventions in Latin America, beyond that from interventions included in a recent systematic review of peer-reviewed literature.

Methods:

Abstracts from 9 conferences were searched for community-based interventions to promote PA in Latin America and summarized. Three reviewers classified and screened abstracts. Evaluated interventions that were not included in the previous review were assessed.

Results:

Search of abstracts from 31 proceedings of 9 conferences identified 87 abstracts of studies on community-based interventions focused on increasing PA. Only 31 abstracts reported on studies with a control group and an outcome related to PA. Ten of these abstracts represented interventions that had not been included in the previous review of peer-reviewed literature, but the abstracts were insufficient in number or detail to make a practice recommendation for any single intervention.

Conclusions:

This review highlighted the challenges and low added value of including conference abstracts in a systematic review of community PA interventions in Latin America. Stronger evaluation design and execution and more published reports of evaluated interventions are needed to build an evidence base supporting interventions to increase PA in Latin America.

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Physical Activity and Safety From Crime Among Adults: A Systematic Review

Inacio C. M. da Silva, Valerie L. C. Payne, Adriano Akira Hino, Andrea Ramirez Varela, Rodrigo S. Reis, Ulf Ekelund, and Pedro C. Hallal

Background:

The aim of this study was to review the evidence to date on the association between physical activity and safety from crime.

Methods:

Articles with adult populations of 500+ participants investigating the association between physical activity and safety from crime were included. A methodological quality assessment was conducted using an adapted version of the Downs and Black checklist.

Results:

The literature search identified 15,864 articles. After assessment of titles, abstracts and full-texts, 89 articles were included. Most articles (84.3%) were derived from high-income countries and only 3 prospective articles were identified. Articles presented high methodological quality. In 38 articles (42.7%), at least one statistically significant association in the expected direction was reported (ie, safety from crime was positively associated with physical activity). Nine articles (10.1%) found an association in the unexpected direction and 42 (47.2%) did not find statistically significant associations. The results did not change when we analyzed articles separately by sex, age, type of measurement, or domains of physical activity evaluated.

Conclusions:

The current evidence, mostly based on cross-sectional studies, suggests a lack of association between physical activity and safety from crime. Prospective studies and natural experiments are needed, particularly in areas with wide crime variability.

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Association Between Perceived Environmental Attributes and Physical Activity Among Adults in Recife, Brazil

Pedro C. Hallal, Rodrigo S. Reis, Diana C. Parra, Christine Hoehner, Ross C. Brownson, and Eduardo J. Simões

Background:

To evaluate the association between perceived environmental factors and leisure-time and transport-related physical activity.

Methods:

A random-digit-dialing telephone cross-sectional survey in Recife, Brazil, was conducted among individuals aged 16 years or older (n = 2046). Leisure-time and transport-related physical activity were measured using the long version of the International Physical Activity Questionnaire. Three outcome variables were used: leisure-time physical activity (min/wk), transport-related physical activity (min/wk), and walking for leisure (min/wk). A cutoff of 150 min/wk was used for all outcome variables. The environmental module of the questionnaire was based on the short version of the Neighborhood Environment Walkability Scale (A-NEWS), and included 12 environmental items.

Results:

The proportions of subjects reaching the 150-minutes per week threshold were 30.6% for leisure-time physical activity, 26.6% for transport-related physical activity and 18.2% for walking for leisure. Lack of sidewalks and low access to recreational facilities were associated with a lower likelihood of performing 150 minutes per week or more of leisure-time physical activity. Lack of sidewalks was associated with low levels of walking for leisure. Neighborhood aesthetics was inversely associated with transport-related physical activity.

Conclusions:

Lack of sidewalks and low access to recreational facilities were predictors of low levels of leisure-time physical activity, suggesting that policy strategies aimed at improving these environmental features may be warranted.

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Project GUIA: A Model for Understanding and Promoting Physical Activity in Brazil and Latin America

Michael Pratt, Ross C. Brownson, Luiz Roberto Ramos, Deborah Carvalho Malta, Pedro C. Hallal, Rodrigo S. Reis, Diana C. Parra, and Eduardo J. Simões

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A Longitudinal Evaluation of Physical Activity in Brazilian Adolescents: Tracking, Change and Predictors

Samuel C. Dumith, Denise P. Gigante, Marlos R. Domingues, Pedro C. Hallal, Ana M.B. Menezes, and Harold W. Kohl III

This study aimed to: 1) describe the change in leisure-time physical activity (LTPA) during early-to-mid adolescence; 2) analyze the tracking of LTPA; 3) identify the predictors of LTPA change. 4,120 adolescents were from 11 to 15 years old. Outcome was self-reported LTPA (min/wk). Boys increased their LTPA level over the four years (mean: 75 min/wk; 95%CI: 49,100), whereas a decrease was observed among girls (mean: -42 min/wk; 95%CI: -57,-28). Likelihood to be active at 15 years of age was 50% higher (95%CI: 39–62) among those who were active at 11 years. The main predictor of LTPA change was the number of physical activities performed at baseline. Regular physical activity early in life can predict this behavior afterward.

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Association Between Knowledge and Practice in the Field of Physical Activity and Health: A Population-Based Study

Thiago T. Borges, Pedro C. Hallal, Inacio Crochemore Mohnsam da Silva, Grégore Iven Mielke, Airton J. Rombaldi, and Fernando C. Barros

Background:

The aim of the current study was to evaluate the association between knowledge about physical activity (PA) recommendations (in terms of duration and frequency) and physical activity practice in a population-based sample of adults and adolescents.

Methods:

Crosssectional survey, conducted in Pelotas, Brazil. Participants (10+ years) were included in the sample and reported their perception about the minimum number of days and duration of PA to achieve health benefits. Those who reported PA practice ≥ 150 min/wk (adults) and ≥ 300 min/wk (adolescents) were considered active.

Results:

The sample included 1696 adults and 399 adolescents. More than one-third (38.6%) of the adult population reported that < 150 minutes of PA per week would be sufficient to obtain health benefits. Moreover, 76.1% of the adolescents reported that < 300 minutes per week were sufficient to obtain health benefits. Among adolescents, those who were active tended to report that higher amounts of PA were needed to obtain health benefits.

Conclusions:

Despite global recognition of the role of PA for improving health, knowledge about the minimum frequency and duration for achieving health benefits is still low in Brazil, particularly among adolescents.

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Promoting Physical Activity and Quality of Life in Vitoria, Brazil: Evaluation of the Exercise Orientation Service (EOS) Program

Rodrigo S. Reis, Adriano Akira F. Hino, Danielle K. Cruz, Lourival Espiridião da Silva Filho, Deborah C. Malta, Marlos R. Domingues, and Pedro C. Hallal

Background:

The purpose of this study was to evaluate associations between exposure to the Exercise Orientation Service (EOS) program and physical activity (PA) and quality of life (QoL) in adults from Vitoria, Brazil.

Methods:

A phone survey was conducted with 2023 randomly selected participants (≥ 18 years) to measure awareness about the program, participation in the program, PA levels, and QoL. The associations were tested using Poisson and Linear regression models.

Results:

31.5% reported awareness about the program, 1.5% reported current participation, and 5.8% reported previous participation. Participation was higher among women (2.1%), older subjects (2.8%), and those reporting morbidities (2.4%). Awareness was higher among middle-aged persons (36.0%) and highly educated participants (37.1%). Current participation (PR = 2.22; 95% CI = 1.65–2.99) and awareness (PR = 1.15; 95% CI = 1.02–1.30) were associated with leisure-time PA (LTPA).

Conclusion:

Exposure to the program was not associated with QoL but was consistently associated with sufficient levels of LTPA among adults from Vitoria, Brazil.

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Validity and Reliability of the Telephone-Administered International Physical Activity Questionnaire in Brazil

Pedro C. Hallal, Eduardo Simoes, Felipe F. Reichert, Mario R. Azevedo, Luiz R. Ramos, Michael Pratt, and Ross C. Brownson

Purpose:

To evaluate the validity and reliability of the telephone-administered long IPAQ version.

Methods:

The questionnaire was administered by telephone to adults on days 1 and 6. On day 1, the same questionnaire was administered by face-to-face interview, and accelerometers were delivered to subjects. Reliability was measured by comparing data collected using the telephone questionnaire on days 1 and 6. Validity was measured by comparing the telephone questionnaire data with (a) face-to-face questionnaire and (b) accelerometry.

Results:

Data from all instruments were available for 156 individuals. The Spearman correlation coefficient for telephone interview reliability was 0.92 for the leisure-time section of IPAQ, and 0.87 for the transport-related section of IPAQ. The telephone interview reliability kappa was 0.78. The Spearman correlation between the telephone-administered and the face-to-face questionnaire was 0.94 for the leisure-time and 0.82 for the transport-related section. The kappa was 0.69. There was a positive association between quartiles of accelerometer data and total telephone-administered IPAQ score (P < .001). The Spearman correlation was 0.22.

Conclusions:

The telephone-administered IPAQ presented almost perfect reliability and very high agreement with the face-to-face version. The agreement with accelerometer data were fair for the continuous score, but moderate for the categorical physical activity variables.

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Lessons Learned After 10 Years of IPAQ Use in Brazil and Colombia

Pedro C. Hallal, Luis Fernando Gomez, Diana C. Parra, Felipe Lobelo, Janeth Mosquera, Alex A. Florindo, Rodrigo S. Reis, Michael Pratt, and Olga L. Sarmiento

Background:

To describe the lessons learned after 10 years of use of the International Physical Activity Questionnaire (IPAQ) in Brazil and Colombia, with special emphasis on recommendations for future research in Latin America using this instrument.

Methods:

We present an analytical commentary, based on data from a review of the Latin American literature, as well as expert consultation and the authors' experience in administering IPAQ to over 43,000 individuals in Brazil and Colombia between 1998 and 2008.

Results:

Validation studies in Latin America suggest that the IPAQ has high reliability and moderate criteria validity in comparison with accelerometers. Cognitive interviews suggested that the occupational and housework sections of the long IPAQ lead to confusion among respondents, and there is evidence that these sections generate overestimated scores of physical activity. Because the short IPAQ considers the 4 physical activity domains altogether, people tend to provide inaccurate answers to it as well.

Conclusions:

Use of the leisure-time and transport sections of the long IPAQ is recommended for surveillance and studies aimed at documenting physical activity levels in Latin America. Use of the short IPAQ should be avoided, except for maintaining consistency in surveillance when it has already been used at baseline.