Jesus Soares

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.

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.

Stand-alone mass media campaigns to increase physical activity: a Community Guide updated review.

CONTEXT The goal of the systematic review described in this summary was to determine the effectiveness of stand-alone mass media campaigns to increase physical activity at the population level. This systematic review is an update of a Community Guide systematic review and Community Preventive Services Task Force recommendation completed in 2001. EVIDENCE ACQUISITION Updated searches for literature published from 1980 to 2008 were conducted in 11 databases. Of 267 articles resulting from the literature search, 16 were selected for full abstraction, including the three studies from the original 2001 review. Standard Community Guide methods were used to conduct the systematic evidence review. EVIDENCE SYNTHESIS Physical activity outcomes were assessed using a variety of self-report measures with duration intervals ranging from 6 weeks to 4 years. Ten studies using comparable outcome measures documented a median absolute increase of 3.4 percentage points (interquartile interval: 2.4 to 4.2 percentage points), and a median relative increase of 6.7% (interquartile interval: 3.0% to 14.1%), in self-reported physical activity levels. The remaining six studies used alternative outcome measures: three evaluated changes in self-reported time spent in physical activity (median relative change, 4.4%; range of values, 3.1%-18.2%); two studies used a single outcome measure and found that participants reported being more active after the campaign than before it; and one study found that a mass media weight-loss program led to a self-reported increase in physical activity. CONCLUSIONS The findings of this updated systematic review show that intervention effects, based wholly on self-reported measures, were modest and inconsistent. These findings did not lead the Task Force to change its earlier conclusion of insufficient evidence to determine the effectiveness of stand-alone mass media campaigns to increase physical activity. This paper also discusses areas needing future research to strengthen the evidence base. Finally, studies published between 2009 and 2011, after the Task Force finding was reached, and briefly summarized here, are shown to support that finding.

Examining variations of resting metabolic rate of adults: a public health perspective.

PURPOSE There has not been a recent comprehensive effort to examine existing studies on the resting metabolic rate (RMR) of adults to identify the effect of common population demographic and anthropometric characteristics. Thus, we reviewed the literature on RMR (kcal·kg(-1)·h(-1)) to determine the relationship of age, sex, and obesity status to RMR as compared with the commonly accepted value for the metabolic equivalent (MET; e.g., 1.0 kcal·kg(-1)·h(-1)). METHODS Using several databases, scientific articles published from 1980 to 2011 were identified that measured RMR, and from those, others dating back to 1920 were identified. One hundred and ninety-seven studies were identified, resulting in 397 publication estimates of RMR that could represent a population subgroup. Inverse variance weighting technique was applied to compute means and 95% confidence intervals (CI). RESULTS The mean value for RMR was 0.863 kcal·kg(-1)·h(-1) (95% CI = 0.852-0.874), higher for men than women, decreasing with increasing age, and less in overweight than normal weight adults. Regardless of sex, adults with BMI ≥ 30 kg·m(-2) had the lowest RMR (<0.741 kcal·kg(-1)·h(-1)). CONCLUSIONS No single value for RMR is appropriate for all adults. Adhering to the nearly universally accepted MET convention may lead to the overestimation of the RMR of approximately 10% for men and almost 15% for women and be as high as 20%-30% for some demographic and anthropometric combinations. These large errors raise questions about the longstanding adherence to the conventional MET value for RMR. Failure to recognize this discrepancy may result in important miscalculations of energy expended from interventions using physical activity for diabetes and other chronic disease prevention efforts.

Monoamine responses to acute and chronic aerobic exercise in normotensive and hypertensive subjects

OBJECTIVES The purpose of the present study was to compare the plasma and serum monoamine levels in sedentary, untrained normotensive and hypertensive men at rest with levels measured after an acute bout of exercise and to compare similar measurements following a 12-week aerobic training program. PLACE OF STUDY: The data obtained for this study was collected from a clinic for the prevention of heart disease and cardiac rehabilitation (FITCOR) and analyzed in the Federal University of São Paulo (EPM), Laboratory of Experimental Neurology. SUBJECTS Two groups of untrained male subjects, i.e., normotensive (N = 16) and hypertensive (N = 19), were submitted to an acute bout of exercise to analyze the acute effect of exercise on the monoamine levels. To study the chronic effect of exercise (physical training program), some individuals of each group were arranged in two other groups; normotensive (N = 11) and hypertensive (N = 8). MEASUREMENT Plasma catecholamines and serum serotonin levels were determined by high performance liquid chromatography coupled with electrochemical detection. RESULTS A significant reduction in diastolic blood pressure at rest was observed in the hypertensive group after the physical training program (p < 0.05). Only the mean plasma noradrenaline concentration increased significantly post-exercise in all groups of individuals (acute effect of exercise--p < 0.01 for untrained normotensive and hypertensive; chronic effect of exercise--p < 0.001 for untrained and trained normotensive, p < 0.01 for untrained and trained hypertensive). CONCLUSION These data show the beneficial effect of physical exercise in reducing the blood pressure in hypertensive patients, which does not seem to be related to changes in circulating monoamines.

Analysis of Physical Activity Mass Media Campaign Design

BACKGROUND Mass media campaigns are a necessary tool for public health practitioners to reach large populations and promote healthy behaviors. Most health scholars have concluded that mass media can significantly influence the health behaviors of populations; however the effects of such campaigns are typically modest and may require significant resources. A recent Community Preventive Services Task Force review on stand-alone mass media campaigns concluded there was insufficient evidence to determine their effectiveness in increasing physical activity, partly due to mixed methods and modest and inconsistent effects on levels of physical activity. METHODS A secondary analysis was performed on the campaigns evaluated in the Task Force review to determine use of campaign-building principles, channels, and levels of awareness and their impact on campaign outcomes. Each study was analyzed by 2 reviewers for inclusion of campaign building principles. RESULTS Campaigns that included 5 or more campaign principles were more likely to be successful in achieving physical activity outcomes. CONCLUSION Campaign success is more likely if the campaign building principles (formative research, audience segmentation, message design, channel placement, process evaluation, and theory-based) are used as part of campaign design and planning.

Effect of Health Information Technologies on Glycemic Control Among Patients with Type 2 Diabetes.

Purpose of ReviewThis study was to present meta-analysis findings across selected clinical trials for the effect of health information technologies (HITs) on glycemic control among patients with type 2 diabetes.Recent FindingsHITs may be promising in diabetes management. However, findings on effect size of glycated hemoglobin level (HbA1c) yielded from HITs varied across previous studies. This is likely due to heterogeneity in sample size, adherence to standard quantitative method, and/or searching criteria (e.g., type of HITs, type of diabetes, specification of patient population, randomized vs. nonrandomized trials).SummaryWe systematically searched Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the Cochrane Library for peer-reviewed randomized control trials that studied the effect of HITs on HbA1c reduction. We also used Google Scholar and a hand search to identify additional studies. Thirty-four studies (40 estimates) met the criteria and were included in the analysis. Overall, introduction of HITs to standard diabetes treatment resulted in a statistically and clinically reduced HbA1c. The bias adjusted HbA1c reduction due to the combined HIT interventions was − 0.56 [Hedges’ g = − 0.56 (− 0.70, − 0.43)]. The reduction was significant across each of the four types of HIT intervention under review, with mobile phone-based approaches generating the largest effects [Hedges’ g was − 0.67 (− 0.90, − 0.45)]. HITs can be an effective tool for glycemic control among patients with type 2 diabetes. Future studies should examine long-term effects of HITs and explore factors that influence their effectiveness.

Effect of Exercise on Cognitive Performance in Community-Dwelling Older Adults: Review of Intervention Trials and Recommendations for Public Health Practice and Research: EXERCISE FOR COGNITION IN OLDER ADULTS

There is evidence from observational studies that increasing physical activity may reduce the risk of cognitive decline in older adults. Exercise intervention trials have found conflicting results. A systematic review of physical activity and exercise intervention trials on cognition in older adults was conducted. Six scientific databases and reference lists of previous reviews were searched. Thirty studies were eligible for inclusion. Articles were grouped into intervention–outcome pairings. Interventions were grouped as cardiorespiratory, strength, and multicomponent exercises. Cognitive outcomes were general cognition, executive function, memory, reaction time, attention, cognitive processing, visuospatial, and language. An eight‐member multidisciplinary panel rated the quality and effectiveness of each pairing. Although there were some positive studies, the panel did not find sufficient evidence that physical activity or exercise improved cognition in older adults. Future research should report exercise adherence, use longer study durations, and determine the clinical relevance of measures used.