Grace Angélica de Oliveira Gomes

Physical activity counseling in primary health care in Brazil: a national study on prevalence and associated factors

BackgroundThe aim of this study was to determine the prevalence and correlates of physical activity counseling among physicians and nurses working in primary health care in Brazil.MethodsA phone survey was carried out in 2011 with professionals working in primary health care in Brazil. The target sample consisted of 1,600 randomly selected primary care units covering all regions of the country. We successfully interviewed 529 professionals within the sampled units; 182 physicians and 347 nurses. The overall response rate was 49.6%. Multivariable logistic regression was used to estimate correlates of counseling in the whole sample and separately for physicians and nurses.ResultsThe prevalence of regular physical activity counseling for at least six months was 68.9% (95% CI 64.9; 72.8) and was significantly higher among physicians compared to nurses (p < 0.05). Most professionals (93.2%) interviewed were unfamiliar with current physical activity recommendations for health. In the adjusted analysis, physical activity counseling was more frequent among those who report assessing patient’s physical activity (OR = 2.16; 95% CI 1.41; 3.29), those reporting that lack of time was not a barrier for counseling (OR = 0.62 95% CI 0.42-0.93), those who felt prepared to provide physical activity counseling (OR = 2.34; 95% CI 1.50-3.66), and those working at primary care units offering physical activity programs for patients (OR = 2.06; 95% CI 1.33-3.20). In the stratified analysis, only assessing patient’s physical activity was a significant correlate among physicians whereas assessing patient’s physical activity, feeling prepared to provide counseling and working in units with physical activity interventions were significant correlates among nurses.ConclusionsPhysicians and nurses deemed physical activity counseling of great importance in primary health care in Brazil. However, in order to increase the quality of counseling and the number of professionals engaging in this activity, these health teams require greater knowledge about physical activity (global recommendations for health) as well as training on the application of instruments for assessing physical activity. Moreover, sufficient time must be allowed during consultations for the counseling process, and physical activity promotion programs should be implemented within the primary health care units.

Relationship between lower-limb muscle strength and frailty among elderly people

CONTEXT AND OBJECTIVE Sarcopenia is the main factor involved in the development of frailty syndrome. The aims here were to investigate relationships between lower-limb muscle strength and the variables of sex, age and frailty criteria; compare lower-limb muscle strength with each frailty criterion; and assess the power of each criterion for estimating the risk of frailty among elderly outpatients. DESIGN AND SETTING Cross-sectional study at the Geriatrics Outpatient Clinic of a university hospital in Campinas. METHOD A non-probabilistic convenience sample of 150 elderly people of both sexes who were followed up as outpatients was assessed. Sociodemographic data (sex and age) and physical health data (frailty criteria and the five-times sit-to-stand test) were gathered. Descriptive, comparative and multivariate logistic regression analyses were performed. RESULTS The majority of the elderly people (77.3%) were 70 years of age or over, with predominance of females (64.2%) and had a low score for the five-times sit-to-stand test (81.4% scored 0 or 1); 55.3% of the elderly people presented three or more frailty criteria. A significant association was found between lower-limb muscle strength and the variables of age and number of frailty criteria. CONCLUSIONS Lower levels of lower-limb muscle strength were associated with advanced age and greater presence of signs of frailty. Moreover, lower-limb muscle strength was also associated with the criteria of reduced walking speed criteria and hand-grip strength.

Prevalence of health promotion programs in primary health care units in Brazil

OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.

Characteristics of physical activity programs in the Brazilian primary health care system

O objetivo foi descrever as caracteristicas dos programas de atividade fisica na atencao basica de saude de acordo com a presenca de Nucleo de Apoio a Saude da Familia (NASF) no municipio e por regioes do Brasil. Foi realizado um estudo transversal por inquerito telefonico com 1.251 coordenadores de unidades de saude. Foi aplicado um questionario sobre presenca de intervencoes com atividade fisica e suas caracteristicas de funcionamento. Quatro em cada dez unidades de saude relataram ter uma intervencao com atividade fisica, especialmente grupos de caminhada. A maior parte da atividade e realizada na manha uma vez ou duas vezes por semana, com sessoes de 30 minutos ou mais. Profissionais de educacao fisica sao os principais responsaveis por supervisionar as atividades. Os programas ocorrem na unidade de saude ou outros espacos comunitarios. Estas caracteristicas, de modo geral, foram semelhantes entre unidades com ou sem NASF no municipio e apresentaram variacao entre as regioes. Os resultados desse estudo irao permitir melhor direcionamento das proximas acoes de promocao de atividade fisica na atencao basica de saude.The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.

Physicians', nurses' and community health workers' knowledge about physical activity in Brazil: A cross-sectional study☆

Objectives To measure knowledge of current recommendations of physical activity and consequences of physical inactivity among healthcare providers throughout Brazil. Methods A phone survey of 1600 randomly selected primary healthcare units in Brazil was conducted between January and July 2011. At each unit, a physician, nurse or community healthcare worker (n = 798) responded to a 40-minute survey, eliciting information about demographics, knowledge, and health behaviors pertaining to physical activity. Results Among nurses and community healthcare workers, > 95% reported needing more information on physical activity guidelines. Among physicians this proportion was 80%. Nearly 40% of the professionals incorrectly believed 90-min of moderate-intensity physical activity per week is the recommended amount for health benefits; nearly 30% believed that 90-min of vigorous-intensity activity per week is needed for the same purpose. More than 75% of all groups reported that type II diabetes, hypertension, depression, and coronary heart disease might result from physical inactivity, but on average only 60% from each group are aware of osteoporosis as a possible consequence of physical inactivity. Conclusions Training health professionals in how to convey all relevant information about physical activity to their patients is critical for health promotion within the primary care system in Brazil.

Promotion of physical activity in primary health care settings: evaluation of the Saúde Ativa Rio Claro program

To evaluate the association between participation in the Saude Ativa Rio Claro (SARC) program and physical activity (PA) levels among adult women. A case control study was conducted in seven primary health care settings in Rio Claro, Sao Paulo, Brazil. The sample included 111 women participating in the intervention (mean age: 58±13 years). For each participant, we selected a non participant, matched to the intervention participant by age (± 5 years) and neighborhood. e program provides 1-hour multimodal exercise twice a week as well as general advice about health self-care. PA was measured using the International Physical Activity Questionnaire (IPAQ) long version. While 18.0% of the non participants reported practicing 150 min/wk of leisure-time PA (LTPA) or more, 61.3% of the participants achieved such threshold (OR= 7.2; IC95%: 3.8-13.3). Participants performed more minutes compared to non-participants, even omitting the 100 min/wk of PA pro- vided by the intervention (p<0.001). In addition to providing 100 min/wk of PA, SARC, an exercise promotion intervention in primary health care settings in Brazil, stimulates participants to increase PA levels in other settings.

Studies About Physical Activity Interventions Including Follow-Up Analysis: A Systematic Review

BACKGROUND Some studies have used the follow-up method to analyze real behavioral changes in research involving physical activity (PA) interventions. This has great scientific value; however, it is hard to apply without satisfactory resources and research funding. Little is known about how many studies have used this method to analyze PA interventions in low-income and middle-income countries, especially Brazil. PURPOSE To describe Brazilian studies using follow-up analysis after PA interventions. METHODS A systematic review was performed including Brazilian studies with follow-up analysis after PA interventions; the analyzed papers were from the previous 10 years. The search was carried out in Portuguese, English, and Spanish in the following databases: SciELO, Latin American and Caribbean Health Science Literature, PubMed, and Scopus. The Preferred Reporting Items for Systematic Review and Meta-Analysis method was used. RESULTS In total, 6 of the 7 studies analyzed were from the southeast region, with the intervention time ranging from 2 to 12 months, carrying out follow-up every 5.3 months with 2.2 observations on average. The interventions had a behavioral approach and were generally carried out in universities, hospitals, and ambulatory care. CONCLUSION Studies on PA interventions using follow-up analysis are scarce. Considering the relevance of follow-up studies to measure behavior changes, the results suggest that more studies about this topic are essential in Brazil.

Prevalence of Physical Inactivity and Associated Factors Among Older Caregivers of Older Adults

Objective: The aim of this study is to analyze the prevalence of physical inactivity (PI) and associated factors in older caregivers of older adults. Method: A cross-sectional study was conducted including 312 older caregivers. Sociodemographic, clinical, and care-related characteristics were considered the independent variables for the determination of associated factors with PI in the logistic regression model. Results: The prevalence of PI was 75.3% (95% confidence interval [CI] = [70.1%, 80.0%]). The following factors were associated with PI: being female (odds ratio [OR] = 2.8, 95% CI = [1.3, 5.9]), being older than 75 years of age (OR = 7.1, 95% CI = [2.2, 22.9]), not having a marital life (OR = 4.2, 95% CI = [1.1, 15.8]), being prefrail (OR = 6.2, 95% CI = [1.7, 21.9]), and being frail (OR = 14.8, 95% CI = [3.8, 57.7]). Discussion: The prevalence of PI was high and associated with the female sex, an advanced age, and not being married. Specific public policies considering these results should be created for older caregivers.

Correction to: Evaluating the impact of a walking program in a disadvantaged area: using the RE-AIM framework by mixed methods

Correction After publication of the article [1], it has been brought to our attention that the full funding acknowledgement is missing from the original article. It should read as below –. This study was financed by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (grant no 2014/ 17419–7). Alex Antonio Florindo receives a fellowship from the Brazilian National Council for Scientific and Technological Development (CNPq) (grant 306,635/2016–0).

Características de programas de atividade física na atenção básica de saúde do Brasil

O objetivo foi descrever as caracteristicas dos programas de atividade fisica na atencao basica de saude de acordo com a presenca de Nucleo de Apoio a Saude da Familia (NASF) no municipio e por regioes do Brasil. Foi realizado um estudo transversal por inquerito telefonico com 1.251 coordenadores de unidades de saude. Foi aplicado um questionario sobre presenca de intervencoes com atividade fisica e suas caracteristicas de funcionamento. Quatro em cada dez unidades de saude relataram ter uma intervencao com atividade fisica, especialmente grupos de caminhada. A maior parte da atividade e realizada na manha uma vez ou duas vezes por semana, com sessoes de 30 minutos ou mais. Profissionais de educacao fisica sao os principais responsaveis por supervisionar as atividades. Os programas ocorrem na unidade de saude ou outros espacos comunitarios. Estas caracteristicas, de modo geral, foram semelhantes entre unidades com ou sem NASF no municipio e apresentaram variacao entre as regioes. Os resultados desse estudo irao permitir melhor direcionamento das proximas acoes de promocao de atividade fisica na atencao basica de saude.The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.