Moving Together to Advance Physical Activity Research in Low- and Middle-Income Countries: The Case of Latin America

in Journal of Physical Activity and Health

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Deborah SalvoDepartment of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, TX, USA
People Health & Place Unit, Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA

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Andrea Ramírez VarelaSchool of Medicine, Universidad de los Andes, Bogotá, Colombia

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Alejandra JáureguiDepartment of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Mexico

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Physical inactivity has been defined as a global pandemic since 2012,1 given its high prevalence across borders and regions of the world. Unfortunately, physical inactivity remains a global health crisis, with approximately 1 in 4 adults and 8 in 10 adolescents not achieving minimum aerobic physical activity guidelines.24 This translates into an estimated 5 million attributable deaths per year,5 and yearly costs of over 53.8 billion international dollars globally.6

Evidence from the Global Observatory of Physical Activity (GoPA!) shows a strong positive correlation between physical activity research productivity, the existence of regular national physical activity surveillance systems, and the availability of national physical activity promotion plans.7 This underscores the importance of local research productivity as an essential element for effective physical activity and health promotion in local settings. Indeed, high research productivity is included as one of the 3 key components of the “pyramid for effective national physical activity promotion” (along with good surveillance and policies).7

Despite the fact that 84% of the global population live in low- and middle-income countries (LMICs),8 less than 20% of peer-reviewed physical activity and health publications are from LMICs.9 If the global physical activity research community is serious about reverting the physical inactivity pandemic, it is imperative to invest in enhancing research capacity in these settings. Although it is technically possible to increase research outputs (eg, published scientific articles) from LMICs without actually increasing local capacity, this “helicopter research” model is neither sustainable nor ethical.10 Conducting contextually relevant physical activity research requires the participation of local lead investigators.10

Over the past decade and a half, physical activity and health research from Latin America—a region composed almost in its entirety by LMICs—has experienced pronounced growth.9,10 Notably, less than a handful of countries are driving this trend, with work from Brazil, Colombia, Chile, and Mexico representing over 85% of all published physical activity and health research from LMICs in our field.10 Brazil is the regional leader for Latin America, and is among the top 5 producers of physical activity and health research globally.9,10 Indeed, Brazil has a solid history of high-quality physical activity research, with strong recognition of the importance of physical activity as part of health promotion efforts. Encouragingly, other countries are also emerging as potential new leaders in the region, including Ecuador and Uruguay.10

Multinational, collaborative research networks have played a critical role in supporting this trend. Since 2007, Latin American investigators and sites have contributed to large multisite, international studies. These include:

  1. 1.The Guide for useful interventions in Latin America Project (with participation from Brazil and Colombia).11
  2. 2.The International Physical Activity Environment Network adult and adolescent studies (with participation from Brazil, Colombia, and Mexico).12,13
  3. 3.The International Study of Childhood Obesity, Lifestyle, and the Environment Study (with participation from Colombia).14
  4. 4.Studies by the Our Voice Global Network (with participation from Mexico, Colombia, Chile, Brazil, and Paraguay).15
  5. 5.The SUNRISE Study (The International Study of Movement Behaviors in the Early Years).16
  6. 6.Research by the GoPA! network (with participation of 95.5% of the region’s countries).7
  7. 7.The Global Observatory of Healthy and Sustainable Cities project (with participation from Brazil and Mexico).17

By being active members in these high-profile collaborative research teams, some Latin American investigators have become well connected with leading physical activity and health experts from high-income countries (HICs). This has helped overcome some of the inherent challenges associated with conducting physical activity and health research in LMIC settings, including lack of specialized training programs (offset by direct mentoring with global experts in the field), or lack of funds for state-of-the-science equipment (offset by loan arrangements; eg, for accelerometer use across countries).18 Without a doubt, Latin American investigators have gained much through their integration to these international networks. Nevertheless, the field at large has also gained from their contributions. Latin American researchers have, for instance, helped attain a better understanding of the role of broad cultural, social, environmental, and policy contexts in shaping population patterns and drivers of physical activity across settings.19 Similarly, Latin American research teams have identified creative multilevel solutions to promote active travel and leisure beyond the realms of exercise, fitness, and sport promotion; by leaning into the themes of equity, inclusion, quality of life, and enjoyment—social constructs and principles that better align with Latin American culture.19

This type of engagement, and the empowerment and growth that has resulted from it among the cohort of Latin American investigators involved, has aided in increasing the recognition of physical inactivity as a critical risk factor for chronic disease prevention in the region. Altogether, this has led to the recent emergence of Latin American–centric international projects (ie, by Latin Americans, for Latin Americans), which further underscores the importance of multinational, network-based work for building and sustaining research capacity for physical activity and health in LMIC settings. Examples include the Estudio Latinoamericano de Nutrición y Salud study (ELANS; Latin American Study of Nutrition and Health), which collected accelerometer-based data from representative samples in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela20; and the Salud Urbana en America Latina consortium (SALURBAL; Urban Health in Latin America), a 5-year study involving multiple substudies in cities in Argentina, Brazil, Chile, Colombia, Guatemala, Mexico, and Peru.21

Perhaps the ultimate proof of the growth of physical activity research in Latin America is the successful celebration of the First Latin American Congress of Physical Activity and Health Research 1 year ago (June 21–24, 2021). The Congress, known as CLIAFS for its Spanish acronym (Congreso Latinoamericano de Investigación en Actividad Física y Salud), was originally poised to take place in Cuernavaca, Mexico, at the headquarter campus of the National Institute of Public Health of Mexico. COVID-19 disrupted the original plan, but the momentum built and demonstrated interest by the Latin American physical activity researcher community warranted its realization as a successful online Congress. CLIAFS provided a venue for high-quality scientific knowledge exchange for Latin America and filled a critical gap for the small but growing community of physical activity investigators across the region, which did not have a regional (Latin American–wide) research-centered meeting focused on physical activity and health research until this point. Importantly, the work by CLIAFS complements the critical labor of key regional and country-specific organizations: the Sociedade Brasileira de Atividade Física e Saúde (SBAFS; Brazilian Society for Physical Activity and Health), the Congresso Brasileiro de Atividade Física e Saúde (CBAFS; Brazilian Congress of Physical Activity and Health), and the Red de Actividad Física de las Américas (RAFA-PANA, or Physical Activity Network of the Americas; with strong focus on promotion and advocacy). CLIAFS was supported and/or endorsed by all of these groups, and also by the National Institutes of Health of the United States (funder), the International Society of Physical Activity and Health (funder and key partner), the International Society of Behavioral Nutrition and Physical Activity (key partner), GoPA! (key partner), and multiple academic organizations from across The Americas (see www.cliafs.org for the full list of partners).

The CLIAFS was attended by over 200 registered participants emanating from 11 Latin American countries. The majority self-identified as early-career investigators, reflecting that our field is still young in the region, and hence requires engaged nurturing to capitalize on its momentum. A critical next step for this purpose is the creation of the Latin American Society of Physical Activity and Health Research (Sociedad Latinoamericana de Investiacion en Actividad Fisica y Salud). As demonstrated by direct Congress participant feedback, some of the key elements of its success were as follows:

  1. 1.The program provided vast space for oral presentations to Latin American–based investigators.
  2. 2.The scientific committee was comprised of Latin Americans.
  3. 3.The organizing committee secured the participation of well-recognized global field leaders (many from HICs) as keynote and symposium speakers.
  4. 4.All live sessions included audio translations to Spanish, Portuguese, and English.
  5. 5.There were explicitly built-in opportunities for networking.
  6. 6.There was a free preconference workshop for early-career investigators, including the participation of leading global researchers (from Latin America and HICs).
  7. 7.The Congress fees were appropriately priced for LMIC participants.

While the growth of physical activity research in Latin America is promising, it is still not enough to respond appropriately to the physical inactivity crisis in the region. Approximately 1 in 3 Latin American adults are physically inactive; 11.4% of deaths in the region are attributable to physical inactivity5; and physical inactivity costs health care systems in Latin America 1.3 billion International Dollars per year.6 We call on the global physical activity community, and in particular, to our HIC colleagues, to turn their eyes, minds, and resources to help advance physical activity science in LMICs. We believe some of the successes observed in Latin America can serve as lessons to help accelerate the growth of our field in other LMIC regions. The CLIAFS 2021 motto was “moving together,” representing an urgent call to action to work as a united front toward a common goal: a more active and healthier world.

References

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    Varela AR, Pratt M, Harris J, et al. Mapping the historical development of physical activity and health research: a structured literature review and citation network analysis. Prev Med. 2018;111:466472. PubMed ID: 29709233 doi:10.1016/j.ypmed.2017.10.020

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    Salvo D, Parra DC, Jáuregui A, et al. Capacity for childhood obesity research in Latin American and US Latino populations: state of the field, challenges, opportunities, and future directions. Obes Rev. 2021;22(suppl 3):e13244. PubMed ID: 33825321 doi:10.1111/obr.13244

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    Pratt M, Brownson RC, Ramos LR, et al. Project GUIA: a model for understanding and promoting physical activity in Brazil and Latin America. J Phy Act Health. 2010;7(suppl 2):S131S134. PubMed ID: 20702900 doi:10.1123/jpah.7.s2.s131

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    Cain KL, Salmon J, Conway TL, et al. International physical activity and built environment study of adolescents: IPEN Adolescent design, protocol and measures. BMJ Open. 2021;11(1):e046636. PubMed ID: 33462102 doi:10.1136/bmjopen-2020-046636

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    Katzmarzyk PT, Barreira TV, Broyles ST, et al. The international study of childhood obesity, lifestyle and the environment (ISCOLE): design and methods. BMC Public Health. 2013;13(1):113. PubMed ID: 24079373 doi:10.1186/1471-2458-13-900

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    King AC, Winter SJ, Sheats JL, et al. Leveraging citizen science and information technology for population physical activity promotion. Transl J Am Coll Sports Med. 2016;1(4):30. PubMed ID: 27525309 doi:10.1249/TJX.0000000000000003

    • Search Google Scholar
    • Export Citation
  • 16.

    Okely AD, Reilly JJ, Tremblay MS, et al. Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol. BMJ Open. 2021;11(10):e049267. PubMed ID: 34697112 doi:10.1136/bmjopen-2021-049267

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Boeing G, Higgs C, Liu S, et al. Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities. The Lancet Glob Health. 2022;10(6):e907e918. PubMed ID: 35561725 doi:10.1016/S2214-109X(22)00072-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Salvo D, Reis RS, Sarmiento OL, Pratt M. Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America. Prev Med. 2014;69:S86S92. PubMed ID: 25456800 doi:10.1016/j.ypmed.2014.10.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Salvo D, Sarmiento OL, Reis RS, et al. Where Latin Americans are physically active, and why does it matter? Findings from the IPEN-adult study in Bogota, Colombia; Cuernavaca, Mexico; and Curitiba, Brazil. Prev Med. 2017;103:S27S33. PubMed ID: 27609744 doi:10.1016/j.ypmed.2016.09.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Fisberg M, Kovalskys I, Gomez G, et al. Latin American study of nutrition and health (ELANS): rationale and study design. BMC Public Health. 2015;16(1):111. PubMed ID: 26829928 doi:10.1186/s12889-016-2765-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Quistberg DA, Diez Roux AV, Bilal U, et al. Building a data platform for cross-country urban health studies: the SALURBAL study. J Urban Health. 2019;96(2):311337. PubMed ID: 30465261 doi:10.1007/s11524-018-00326-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Collapse
  • Expand
  • 1.

    Kohl HW 3rd, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294305. PubMed ID: 22818941 doi:10.1016/S0140-6736(12)60898-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Health. 2018;6(10):e1077e1086. PubMed ID: 30193830 doi:10.1016/S2214-109X(18)30357-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Hallal PC, Andersen LB, Bull FC, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247257. PubMed ID: 22818937 doi:10.1016/S0140-6736(12)60646-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Sallis JF, Bull F, Guthold R, et al. Progress in physical activity over the Olympic quadrennium. Lancet. 2016;388(10051):13251336. PubMed ID: 27475270 doi:10.1016/S0140-6736(16)30581-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Lee I-M, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219229. PubMed ID: 22818936 doi:10.1016/S0140-6736(12)61031-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Ding D, Lawson KD, Kolbe-Alexander TL, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016;388(10051):13111324. PubMed ID: 27475266 doi:10.1016/S0140-6736(16)30383-X

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Ramirez Varela A, Salvo D, Pratt M, et al. Worldwide use of the first set of physical activity country cards: the global observatory for physical activity-GoPA! Int J Behav Nutr Phys Activity. 2018;15:29. doi:10.1186/s12966-018-0663-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    The World Bank. World bank databank: population, total (population by countries). 2019. https://data.worldbank.org/indicator/SP.POP.TOTL. Accessed May 30, 2022.

    • Search Google Scholar
    • Export Citation
  • 9.

    Varela AR, Pratt M, Harris J, et al. Mapping the historical development of physical activity and health research: a structured literature review and citation network analysis. Prev Med. 2018;111:466472. PubMed ID: 29709233 doi:10.1016/j.ypmed.2017.10.020

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Salvo D, Parra DC, Jáuregui A, et al. Capacity for childhood obesity research in Latin American and US Latino populations: state of the field, challenges, opportunities, and future directions. Obes Rev. 2021;22(suppl 3):e13244. PubMed ID: 33825321 doi:10.1111/obr.13244

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Pratt M, Brownson RC, Ramos LR, et al. Project GUIA: a model for understanding and promoting physical activity in Brazil and Latin America. J Phy Act Health. 2010;7(suppl 2):S131S134. PubMed ID: 20702900 doi:10.1123/jpah.7.s2.s131

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Kerr J, Sallis JF, Owen N, et al. Advancing science and policy through a coordinated international study of physical activity and built environments: IPEN adult methods. J Phy Act Health. 2013;10(4):581601. PubMed ID: 22975776 doi:10.1123/jpah.10.4.581

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Cain KL, Salmon J, Conway TL, et al. International physical activity and built environment study of adolescents: IPEN Adolescent design, protocol and measures. BMJ Open. 2021;11(1):e046636. PubMed ID: 33462102 doi:10.1136/bmjopen-2020-046636

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Katzmarzyk PT, Barreira TV, Broyles ST, et al. The international study of childhood obesity, lifestyle and the environment (ISCOLE): design and methods. BMC Public Health. 2013;13(1):113. PubMed ID: 24079373 doi:10.1186/1471-2458-13-900

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    King AC, Winter SJ, Sheats JL, et al. Leveraging citizen science and information technology for population physical activity promotion. Transl J Am Coll Sports Med. 2016;1(4):30. PubMed ID: 27525309 doi:10.1249/TJX.0000000000000003

    • Search Google Scholar
    • Export Citation
  • 16.

    Okely AD, Reilly JJ, Tremblay MS, et al. Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol. BMJ Open. 2021;11(10):e049267. PubMed ID: 34697112 doi:10.1136/bmjopen-2021-049267

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Boeing G, Higgs C, Liu S, et al. Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities. The Lancet Glob Health. 2022;10(6):e907e918. PubMed ID: 35561725 doi:10.1016/S2214-109X(22)00072-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Salvo D, Reis RS, Sarmiento OL, Pratt M. Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America. Prev Med. 2014;69:S86S92. PubMed ID: 25456800 doi:10.1016/j.ypmed.2014.10.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Salvo D, Sarmiento OL, Reis RS, et al. Where Latin Americans are physically active, and why does it matter? Findings from the IPEN-adult study in Bogota, Colombia; Cuernavaca, Mexico; and Curitiba, Brazil. Prev Med. 2017;103:S27S33. PubMed ID: 27609744 doi:10.1016/j.ypmed.2016.09.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Fisberg M, Kovalskys I, Gomez G, et al. Latin American study of nutrition and health (ELANS): rationale and study design. BMC Public Health. 2015;16(1):111. PubMed ID: 26829928 doi:10.1186/s12889-016-2765-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Quistberg DA, Diez Roux AV, Bilal U, et al. Building a data platform for cross-country urban health studies: the SALURBAL study. J Urban Health. 2019;96(2):311337. PubMed ID: 30465261 doi:10.1007/s11524-018-00326-0

    • Crossref
    • Search Google Scholar
    • Export Citation
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