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Adapted Physical Activity Policies for Children and Adolescents in Brazil: Extension of the Para Report Card Brazil

Diego Augusto Santos Silva and Carolina Fernandes da Silva

Brazil is a country member of the Para Report Card, and Brazilian researchers have frequently published information on physical activity of children and adolescents. The current study aimed to analyze the policies for the promotion of adapted physical activity to Brazilian children and adolescents with disabilities. Official government information on adapted physical activity was analyzed from the official websites. Policies were analyzed based on the Para Report Card benchmarks, and after that we used the principles of SWOT (strengths, weaknesses, opportunities, and threats) to analyze the information. Adapted physical activity is not the main focus of any of the many policies to promote physical activity for children and adolescents. Based on the Para Report Card initiative, the score for this indicator in Brazil is D. Brazil needs to develop specific policies to promote physical activity adapted to the pediatric population with disabilities.

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Factor Structure of Responses to the Portuguese Version of Questions About Screen Time–Based Sedentary Behavior Among Adolescents

Diego Augusto Santos Silva, Katie E. Gunnell, and Mark Stephen Tremblay

Background: This study aimed to examine the factor structure of responses to the Portuguese version of questions related to screen time–based sedentary behavior among adolescents. Methods: This cross-sectional study with a sample of 1083 adolescents aged 14–19 years was conducted in Brazil. The sample was randomly divided into 2 groups for an exploratory factor analysis and for a confirmatory factor analysis. Screen time was investigated by a Portuguese version of questions about time sitting in front of television, computer, and video games on weekdays and weekends. Results: Scree plots showed 2 factors with eigenvalues above 1. One factor was formed by items about television and computer use, and the other factor was formed by items about video game use. The exploratory factor analysis with 2 factors resulted in factor loadings above .60. A second model with 1 factor was estimated and resulted in factor loadings above .55. A confirmatory factor analysis was estimated based on the 2-factor exploratory factor analysis and goodness-of-fit statistics were adequate. Confirmatory factor analysis with 1 factor had goodness-of-fit statistics adequate. Conclusions: The Portuguese language version of self-report screen time had 2 possible factor solutions, and items demonstrated good factor structure with reasonable reliability making it suitable for use in the future studies.

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Low Physical Activity Levels and Associated Factors in Brazilian Adolescents From Public High Schools

Roberto Jerônimo dos Santos Silva, Diego Augusto Santos Silva, and Antônio C. Oliveira


Several studies have shown that physical activity levels have declined in many countries, even with the regular practice of physical education in schools. The purpose of this study was to identify the prevalence of low physical activity levels and associated factors in adolescents enrolled in public high schools in Northeastern Brazil.


The sample was composed of 2259 adolescents (62.3% female) aged 16.26 ± 1.1 years. A questionnaire was applied to collect data on physical activity levels, sociodemographic information, tobacco use and alcohol consumption, nutritional status and sedentary behavior. Descriptive statistics and Poisson regression hierarchized model with Prevalence Rate (PR) and P ≤ .05 were used.


Higher prevalence of low physical activity level (89.1%) was observed. It was observed that 19.6% of individuals did not attend physical education classes regularly. Association was identified between low physical activity level and older girls (P = .02) and not attending physical education classes (P < .01). In males, the group most likely to have that low physical activity level was those whose parents studied until three years (P = .04).


Low physical activity level was present in most adolescents, more evident in girls. Lifestyle changes are needed, with substitution of sedentary activities for physical and sport activities in schools.

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Association Between Aerobic Fitness and High Blood Pressure in Adolescents in Brazil: Evidence for Criterion-Referenced Cut-Points

Diego Augusto Santos Silva, Mark Tremblay, Andreia Pelegrini, Roberto Jeronimo dos Santos Silva, Antonio Cesar Cabral de Oliveira, and Edio Luiz Petroski


Criterion-referenced cut-points for health-related fitness measures are lacking. This study aimed to determine the associations between aerobic fitness and high blood pressure levels (HBP) to determine the cut-points that best predict HBP among adolescents.


This cross-sectional school-based study with sample of 875 adolescents aged 14–19 years was conducted in southern Brazil. Aerobic fitness was assessed using the modified Canadian Aerobic Fitness Test (mCAFT). Systolic and diastolic blood pressure were measured by the oscillometric method with a digital sphygmomanometer. Analyses controlled for sociodemographic variables, physical activity, body mass and biological maturation.


Receiver Operating Characteristic (ROC) curves demonstrated that mCAFT measures could discriminate HBP in both sexes (female: AUC = 0.70; male: AUC = 0.63). The cut-points with the best discriminatory power for HBP were 32 mL·kg-1·min-1 for females and 40 mL·kg-1·min-1 for males. Females (OR = 8.4; 95% CI: 2.1, 33.7) and males (OR: 2.5; CI 95%: 1.2, 5.2) with low aerobic fitness levels were more likely to have HBP.


mCAFT measures are inversely associated with BP and cut-points from ROC analyses have good discriminatory power for HBP.

Open access

Results From Brazil’s 2018 Report Card on Physical Activity for Children and Youth

Diego Augusto Santos Silva, Diego Giulliano Destro Christofaro, Gerson Luis de Moraes Ferrari, Kelly Samara da Silva, Nelson Nardo, Roberto Jerônimo dos Santos Silva, Rômulo Araújo Fernandes, and Valter Cordeiro Barbosa Filho

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Aerobic Fitness and Moderate to Vigorous Physical Activity in Children and Adolescents Living with HIV

Luiz Rodrigo Augustemak de Lima, Diego Augusto Santos Silva, Kelly Samara da Silva, Andreia Pelegrini, Isabela de Carlos Back, and Edio Luiz Petroski


To examine aerobic fitness, total moderate to vigorous physical activity (MVPA) and also patterns in terms of MVPA between children and adolescents with human immunodeficiency virus (HIV) and controls, and to determine whether differences, if any, are associated with HIV, sex and highly active antiretroviral therapy (HAART).


A cross-sectional analysis was carried out with 130 children and adolescents, aged between 8 and 15 years, divided into two groups (HIV group= 65 patients, control group= 65 healthy participants). Total MVPA was measured by accelerometers and 5 and 10-min bouts were estimated. The peak oxygen uptake (peak VO2) was measured by breath-by-breath respiratory exchange in an incremental cycle ergometer test.


HIV-positive participants had lower peak VO2 (39.2 ± 6.8 vs. 44.5 ± 9.1, lower bouts of MVPA of 5-min (19.7 ± 16.6 vs. 26.6 ± 23.5) and 10-min (3.6 ± 3.9 vs. 5.8 ± 7.2), but similar total MVPA (49.5 ± 28.9 vs. 49.1 ± 30.6 HIV infection in untreated, nonprotease inhibitors (PI)- based HAART and PI-based HAART patients was associated with lower 8.5 (95%CI= 12.5–4.6), 7.1 (95%CI= 10.6–3.6) and 4.5 (95%CI= 7.0–2.0) of peak VO2.


Children and adolescents with HIV demonstrated lower aerobic fitness compared with the controls and the absence of HAART may increase peak VO2 impairment. Lower bouts of MVPA were also observed in HIV group despite the similar values of total MVPA of controls.

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Physical Activity Questionnaire for Children: Validity and Cut-Points to Identify Sufficient Levels of Moderate- to Vigorous-Intensity Physical Activity Among Children and Adolescents Diagnosed With HIV

João Antônio Chula de Castro, Luiz Rodrigo Augustemak de Lima, Richard Larouche, Mark S. Tremblay, and Diego Augusto Santos Silva

Purpose: To investigate the validity of the Physical Activity Questionnaire for Older Children (PAQ-C) to assess the moderate- to vigorous-intensity physical activity (MVPA) level of children and adolescents diagnosed with HIV and propose cut-points, with accelerometer measures as the reference method. Method: Children and adolescents, aged 8–14 years (mean age = 12.21 y, SD = 2.09), diagnosed with HIV by vertical transmission, participated in the study. MVPA was investigated through the PAQ-C and triaxial accelerometer (ActiGraph GT3X+). Receiver operating characteristic curve and sensitivity and specificity values were used to identify a cut-point for PAQ-C to distinguish participants meeting MVPA guidelines. Results: Fifty-six children and adolescents participated in the study. Among those, 16 met MVPA guidelines. The PAQ-C score was significantly related to accelerometry-derived MVPA (ρ = .506, P < .001). The PAQ-C score cut-point of 2.151 (sensitivity = 0.625, specificity = 0.875) was able to discriminate between those who met MVPA guidelines and those that did not (area under the curve = 0.751, 95% confidence interval, 0.616–0.886). Conclusion: The PAQ-C was useful to investigate MVPA among children and adolescents diagnosed with HIV and to identify those who meet MVPA guidelines.

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Can Postural Control Asymmetry Predict Falls in People With Parkinson’s Disease?

Victor Spiandor Beretta, Fabio Augusto Barbieri, Diego Orcioli-Silva, Paulo Cezar Rocha dos Santos, Lucas Simieli, Rodrigo Vitório, and Lilian Teresa Bucken Gobbi

This study aimed to determine the relationship between postural asymmetry and falls in Parkinson’s disease (PD). In total, 28 patients with PD were included. Postural control was analyzed in bipedal, tandem, and unipedal standing. Center of pressure (CoP) parameters were calculated for both limbs, and asymmetry was assessed using the asymmetry index. Logistic regression was used to predict/classify fallers through postural asymmetry. The Spearman correlation was performed to relate asymmetry and falls number. Poisson regression models were created to predict the number of falls in each condition. The results demonstrated that asymmetry can classify 75% of fallers and nonfallers. Asymmetry in anteroposterior-mean velocity of CoP in unipedal standing was related to the number of falls. Poisson regression showed that anteroposterior-mean velocity of CoP predicts falls in PD, indicating that increased asymmetry results in a greater number of falls. Anteroposterior-mean velocity of CoP seems to be a sensitive parameter to detect falls in PD, mainly during a postural challenging task.

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“WOT” Do We Know and Do About Physical Activity of Children and Adolescents With Disabilities? A SWOT-Oriented Synthesis of Para Report Cards

Yeshayahu Hutzler, Sharon Barak, Salomé Aubert, Kelly Arbour-Nicitopoulos, Riki Tesler, Cindy Sit, Diego Augusto Santos Silva, Piritta Asunta, Jurate Pozeriene, José Francisco López-Gil, and Kwok Ng

The purpose was to synthesize information gathered from the interpretation and conclusion sections of the Global Matrix of Para Report Cards on the physical activity of children and adolescents with disabilities. The synthesis was based on the strengths, weaknesses, opportunities, and threats framework. The procedure consisted of three stages: (a) the application of the International Classification of Functioning, Disability and Health as the theoretical framework; (b) identifying and aligning Global Matrix indicators and benchmarks with the International Classification of Functioning, Disability and Health components through a Delphi approach; and (c) using content analysis to identify themes from specific report cards. Outcomes reveal that further attention toward including children and adolescents with disabilities in fitness assessments is needed as well as adapted assessment methods. Program availability, equipment and facilities, and professional training emerged as strengths but need further development to overcome weaknesses. Paralympic inspiration was an opportunity, whereas extreme weather conditions presented potential threats to physical activity participation among children and adolescents with disabilities.

Open access

Economic Freedom, Climate Culpability, and Physical Activity Indicators Among Children and Adolescents: Report Card Grades From the Global Matrix 4.0

Eun-Young Lee, Patrick Abi Nader, Salomé Aubert, Silvia A. González, Peter T. Katzmarzyk, Asaduzzaman Khan, Wendy Y. Huang, Taru Manyanga, Shawnda Morrison, Diego Augusto Santos Silva, and Mark S. Tremblay

Background: Macrolevel factors such as economic and climate factors can be associated with physical activity indicators. This study explored patterns and relationships between economic freedom, climate culpability, and Report Card grades on physical activity-related indicators among 57 countries/jurisdictions participating in the Global Matrix 4.0. Methods: Participating countries/jurisdictions provided Report Card grades on 10 common indicators. Information on economic freedom and climatic factors were gathered from public data sources. Correlations between the key variables were provided by income groups (ie, low- and middle-income countries/jurisdictions and high-income countries/jurisdictions [HIC]). Results: HIC were more economically neoliberal and more responsible for climate change than low- and middle-income countries. Annual temperature and precipitation were negatively correlated with behavioral/individual indicators in low- and middle-income countries but not in HIC. In HIC, correlations between climate culpability and behavioral/individual and economic indicators were more apparent. Overall, poorer grades were observed in highly culpable countries/jurisdictions in the highly free group, while in less/moderately free groups, less culpable countries/jurisdictions showed poorer grades than their counterparts in their respective group by economic freedom. Conclusions: Global-level physical activity promotion strategies should closely evaluate different areas that need interventions tailored by income groups, with careful considerations for inequities in the global political economy and climate change.