Isabela C. Ribeiro

Physical Activity Interventions in Latin America A Systematic Review

BACKGROUND Recommendations for physical activity in the Guide to Community Preventive Services (the Community Guide) have not been systematically examined or applied in developing countries such as those in Latin America. The aim of this systematic review was to assess the current evidence base concerning interventions to increase physical activity in Latin America using a modified Community Guide process and to develop evidence-based recommendations for physical activity interventions. METHODS In 2006, a literature review of both peer-reviewed and non-peer-reviewed literature in Portuguese, Spanish, and English was carried out to identify physical activity interventions conducted in community settings in Latin America. Intervention studies were identified by searching ten databases using 16 search terms related to physical activity, fitness, health promotion, and community interventions. All intervention studies related to physical activity were summarized into tables. Six reviewers independently classified the intervention studies by the categories used in the Community Guide and screened the studies for inclusion in a systematic abstraction process to assess the strength of the evidence. Five trained researchers conducted the abstractions. RESULTS The literature search identified 903 peer-reviewed articles and 142 Brazilian theses related to physical activity, of which 19 were selected for full abstraction. Only for school-based physical education classes was the strength of the evidence from Latin America sufficient to support a practice recommendation. CONCLUSIONS This systematic review highlights the need for rigorous evaluation of promising interventions to increase physical activity in Latin America. Implementation and maintenance of school physical education programs and policies should be strongly encouraged to promote the health of Latin American children.

Perceived environmental correlates of physical activity for leisure and transportation in Curitiba, Brazil

BACKGROUND Physical activity (PA) has consistently been associated with perceived environmental characteristics. OBJECTIVE To examine the association between perceived environmental attributes and various forms of PA in Curitiba, Brazil. METHODS A cross-sectional phone survey of adults was conducted in 2008 (n=2097). The questionnaire included environmental perceptions and PA. Principal components analysis was used to identify groups of perceived environmental attributes. Multivariate methods tested the associations of PA with perceived environment characteristics. RESULTS Perceptions of moderate and high personal safety were positively associated with walking for transportation (53.0%, 53.1% vs. 47.3%, both adjusted ORs [aOR]=1.5). Number of destinations within a 10-minute walk (4 and >6 vs. <3) was positively associated with bicycling for transportation (7.8%, 9.9% vs.4.8%, aOR=2.5). Perception of high accessibility was positively associated with MVPA during leisure time (35.1% vs. 19.1, aOR=1.7) and meeting recommendations for total PA (58.7% vs. 45.1%, aOR=1.4). Perception of high quality of the pedestrian space (57.3% vs. 46.5%, aOR=1.4) and moderate levels of personal safety (54.3% vs. 47.6%, aOR=1.3) were also positively associated with meeting recommendations for total PA. CONCLUSIONS Different environmental attributes were associated with different PA outcomes, suggesting that these relationships are complex and may differ from those in high-income countries.

Assessing Physical Activity in Public Parks in Brazil Using Systematic Observation

OBJECTIVES We assessed park use in Recife, Brazil, and differences in physical activity and occupation rates in public parks with and without the Academia da Cidade Program (ACP), which provides cost-free, supervised physical activity classes. METHODS We used the System for Observing Play and Recreation in Communities (SOPARC) in 128 targeted areas in 10 park sites (5 ACP sites, 5 non-ACP sites) to obtain data on the number of users and their physical activity levels and estimated age. Each area was assessed 4 times a day for 11 days over a 4-week period. RESULTS A total of 32 974 people were observed during 5589 observation visits to target areas. People using ACP parks were more likely to be seen engaging in moderate-to-vigorous (64% vs 49%) and vigorous (25% vs 10%) physical activity. Relatively more participants in ACP sites than in non-ACP sites were females (45% vs 42% of park users) and older adults (14.7% vs 5.7% of park users). CONCLUSIONS On the basis of systematic observation, ACP appears to be a useful strategy in promoting park use and physical activity among the population in Recife.

School-based physical education programs: evidence-based physical activity interventions for youth in Latin America

This article focuses on results of the systematic review from the Guide for Useful Interventions for Activity in Latin America project related to school-based physical education (PE) programs in Latin America. The aims of the article are to describe five school-based PE programs from Latin America, discuss implications for effective school-based PE recommendations, propose approaches for implementing these interventions, and identify gaps in the research literature related to physical activity promotion in Latin American youth. Following the US Community Guide systematic review process, five school-based PE intervention studies with sufficient quality of design, execution and detail of intervention and outcomes were selected for full abstraction. One study was conducted in Brazil, two studies were conducted in Chile and two studies were conducted on the US/Mexico border. While studies presented assorted outcomes, methods and duration of interventions, there were consistent positive increases in physical activity levels for all outcomes measured during PE classes, endurance and active transportation to school in all three randomized studies. Except for one cohort from one study, the non-randomized studies showed positive intervention effects for moderate and vigorous physical activity levels during PE classes. The core elements of these five interventions included capacity building and staff training (PE specialists and/or classroom teachers); changes in the PE curricula; provision of equipment and materials; and adjustment of the interventions to specific target populations. In order to translate the strong evidence for school-based PE into practice, systematic attention to policy and implementation issues is required.

Physical activity interventions in Latin America: expanding and classifying the evidence.

Context Systematic reviews of public health interventions are useful for identifying effective strategies for informing policy and practice. The goals of this review were to (1) update a previous systematic review of physical activity interventions in Latin America which found that only school-based physical education had sufficient evidence to recommend widespread adoption; (2) assess the reporting of external validity elements; and (3) develop and apply an evidence typology for classifying interventions. Evidence acquisition In 2010–2011, community-level, physical activity intervention studies from Latin America were identified, categorized, and screened based on the peer-reviewed literature or Brazilian theses published between 2006 and 2010. Articles meeting inclusion criteria were evaluated using U.S. Community Guide methods. External validity reporting was assessed among a subset of articles reviewed to date. An evidence rating typology was developed and applied to classify interventions along a continuum based on evidence about their effectiveness in the U.S. context, reach, adoption, implementation, institutionalization, and benefits and costs. Evidence synthesis Thirteen articles published between 2006 and 2010 met inclusion criteria and were abstracted systematically, yet when combined with evidence from articles from the previous systematic review, no additional interventions could be recommended for practice. Moreover, the reporting of external validity elements was low among a subset of 19 studies published to date (median=21% of elements reported). By applying the expanded evidence rating typology, one intervention was classified as evidence-based, seven as promising, and one as emerging. Conclusions Several physical activity interventions have been identified as promising for future research and implementation in Latin America. Enhanced reporting of external validity elements will inform the translation of research into practice.