Rafaela Costa Martins

The Lancet Physical Activity Observatory: promoting physical activity worldwide

2 years ago, at the time of the London 2012 Olympic and Paralympic Games, The Lancet launched a Series on the worldwide pandemic of physical inactivity. The Series showed that a third of adults and 80% of adolescents around the world do not reach recommended levels for daily physical activity (30 min and 60 min of physical activity of moderate-to-vigorous intensity per day for adults and adolescents, respectively). Physical inactivity was shown to be responsible for 5·3 million deaths per year worldwide. If inactivity decreased by only 10%, half a million deaths could be averted every year. There is reasonable understanding on why some people are active and others are not, and several interventions, within and outside the health sector, are known to be eff ective at increasing physical activity in the population. As for every pandemic, our Series identifi ed urgent action that is needed to address physical inactivity. Together with publication of the Series, we launched The Lancet Physical Activity Observatory, which aims to keep track of progress in the fi eld since publication of the Series. The Observatory defi ned four primary goals to be achieved by 2016. The fi rst is to reduce the global prevalence of inactivity in adults from 31% to 28%. The second goal is to increase the prevalence of adolescents who engage in at least 60 min per day of moderate-to-vigorous intensity physical activity from 21% to 24%. The third goal is to reduce by 10% the proportions of coronary heart disease, type 2 diabetes, breast cancer, colon cancer, and premature deaths worldwide that are attributable to physical inactivity. The fourth goal is to increase by 10% the proportion of peer-reviewed scientifi c publications on physical activity that come from low-income and middle-income countries among the total number of publications worldwide. The Observatory also prepared a list of secondary research, surveillance, and policy goals. We are now halfway through this period and have hosted the Observatory as a council of the International Society of Physical Activity and Health, and created a logo for the Observatory. We have also developed our contacts in each country using information from existing Physical Activity Regional Networks. However, our main task has been to prepare country cards on the status of physical activity in each country of the world. Country cards are to be launched in November, 2014. Each country card summarises a country’s research, surveillance, and policy on physical activity and health. The cards also present socio-demographics, alongside morbidity and mortality patterns for each country. For most indicators, we present absolute and weighted values, as well as the ranking of the country. The main indicators are summarised in the panel. The country cards will serve as the baseline for future evaluation of physical activity status in each country, so that we can follow up progress in achieving the goals of the Observatory. The information in the country cards will highlight specifi c research, surveillance, and policy gaps in each country. Additionally, the country cards will serve as an advocacy tool that will help governments, researchers, and society in each country to feel accountable for improving health through the promotion of physical activity. Another Observatory-related task was to bring together a team of researchers to develop a second Lancet Series on physical activity that will be published around the time of the Rio de Janeiro 2016 Olympic and Paralympic Games. The fi rst paper in the new Series will include an update on research, surveillance, and policy on physical activity worldwide using data from The Lancet Physical Activity Observatory.

127 Steps Toward a More Active World.

Pratt (michael.pratt@emory.edu) is with the Hubert Dept of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Ramirez and Martins are students with the Post-graduate program in Epidemiology, Universidade Federal de Pelotas, Brazil. Bauman is with the Sydney School of Public Health, University of Sydney, Australia. Heath is with the University of Tennessee College of Medicine Chattanooga. Kohl is with the Dept of Kinesiology and Health Education, Michael and Susan Dell Center for Healthy Living, University of Texas at Austin. Lee is with the School of Medicine, Harvard Medical School, and the Harvard T.H. Chan School of Public Health, Brigham and Women’s Hospital, Boston, MA. Powell is with the Division of Public Health, Georgia Dept of Human Resources, Atlanta, GA. Hallal is with the Post-graduate program in Epidemiology, Universidade Federal de Pelotas, Brazil. Journal of Physical Activity and Health, 2015, 12, 1193 -1194 http://dx.doi.org/10.1123/jpah.2015-0569

Calibration of raw accelerometer data to measure physical activity: A systematic review

Most of calibration studies based on accelerometry were developed using count-based analyses. In contrast, calibration studies based on raw acceleration signals are relatively recent and their evidences are incipient. The aim of the current study was to systematically review the literature in order to summarize methodological characteristics and results from raw data calibration studies. The review was conducted up to May 2017 using four databases: PubMed, Scopus, SPORTDiscus and Web of Science. Methodological quality of the included studies was evaluated using the Landis and Kochs guidelines. Initially, 1669 titles were identified and, after assessing titles, abstracts and full-articles, 20 studies were included. All studies were conducted in high-income countries, most of them with relatively small samples and specific population groups. Physical activity protocols were different among studies and the indirect calorimetry was the criterion measure mostly used. High mean values of sensitivity, specificity and accuracy from the intensity thresholds of cut-point-based studies were observed (93.7%, 91.9% and 95.8%, respectively). The most frequent statistical approach applied was machine learning-based modelling, in which the mean coefficient of determination was 0.70 to predict physical activity energy expenditure. Regarding the recognition of physical activity types, the mean values of accuracy for sedentary, household and locomotive activities were 82.9%, 55.4% and 89.7%, respectively. In conclusion, considering the construct of physical activity that each approach assesses, linear regression, machine-learning and cut-point-based approaches presented promising validity parameters.

Worldwide Surveillance, Policy, and Research on Physical Activity and Health: The Global Observatory for Physical Activity

BACKGROUND The Global Observatory for Physical Activity (GoPA!) was launched in response to the physical inactivity pandemic. The aim of this article is to present current information about surveillance, policy, and research on physical activity (PA) and health worldwide. METHODS Information was collected for 217 countries. For 139 of these nations we identified a contact who confirmed informations accuracy and completeness. Associations were calculated among surveillance, policy and research categories. RESULTS Of the 139 countries, 90.6% reported having completed 1 or more PA survey, but less than one-third had 3 or more. 106 included PA on a national plan, but only one-quarter of these were PA-specific. At least 1 peer reviewed publication was identified for 63.3% of the countries. Positive associations (P < .001) were found between research and policy (ρ = 0.35), research and surveillance (ρ = 0.41), and surveillance and policy (ρ = 0.31). Countries with a standalone plan were more likely to have surveillance. Countries with more research were more likely to have a standalone plan and surveillance. CONCLUSIONS Surveillance, policy, and research indicators were positively correlated, suggesting that action at multiple levels tends to stimulate progress in other areas. Efforts to expand PA-related surveillance, policy, and research in lower income countries are needed.

Is Brazil going to achieve the road traffic deaths target? An analysis about the sustainable development goals

Objective To describe the temporal relationship between the road traffic mortality rate and gross domestic product (GDP) per capita in Brazil, and make an annual prediction of the evolution of both indicators until 2020, the end of the Sustainable Development Goals (SDGs) monitoring period. Methods Brazilian road traffic mortality rate official data were described from 2000 to 2015, while the GDP per capita official data were described from 2000 to 2013. GDP per capita and traffic mortality rate predictions were performed until 2020 using fractional polynomial analysis. Correlations were assessed using Pearson’s correlation coefficient. Results From 2000 to 2015, there were over 446 000 road crashes fatal victims in Brazil. The road traffic mortality rate was positively related to the Brazilian GDP per capita, with a strong correlation (r=0.89; p<0.001) from 2000 to 2013 and a mild correlation (r=0.55; p<0.001) considering the whole period (2000–2020). The predictions show a reduction on the road traffic mortality rates in Brazil; however, if this same reduction pace continues, we estimate that the country will reach 12.4 road crash deaths per 100 000 inhabitants in 2020, a reduction of only 13.4% compared with 2015. Conclusion If the same mortality reduction pace continues in Brazil, the country will not reach the proposed SDG, which is to reduce by half the number of deaths per 100 000 inhabitants. In addition, an intertwined conciliation between economical growth, sustainable development and public policies is needed in order to meet such an overwhelming goal.

One-year Stability of Objectively Measured Physical Activity in Young Brazilian Adults

BACKGROUND To evaluate the 1-year stability of objectively measured physical activity among young adults living in South Brazil, as well as assessing the influences of temperature, humidity and precipitation on physical activity. METHODS A longitudinal study was conducted over 12 consecutive months (October 2012 to September 2013). Sixteen participants (8 men) used GT3X+ accelerometers 1 week per month for the entire year. Climate variables were obtained from an official climate information provider. RESULTS Physical activity was remarkably stable over the year-the proportion of the day spent in moderate-to-vigorous intensity physical activity (MVPA) was around 5% in every month. Average temperature (ρ = -0.64; P = .007), humidity (ρ = -0.68; P = .004) and rain (ρ = -0.67; P = .004) were inversely correlated to MVPA in the Summer. Rain was also inversely correlated to MVPA in the Spring (ρ = -0.54; P = .03). CONCLUSIONS Objectively measured physical activity was stable over a 1-year period. Climate variables consistently influenced physical activity practice in the Summer, but not in the other seasons.

Population-based study in a rural area

ABSTRACT OBJECTIVE To describe the planning, sampling, operational aspects of the field, and the sample obtained during a research conducted in a rural area, specifying and discussing the main logistical difficulties unique to these places and the solutions adopted. METHODS We carried out a population-based, cross-sectional survey between January and June 2016, with a representative sample of the population aged 18 years or over living in the rural area of Pelotas (approximately 22,000 individuals), State of Rio Grande do Sul, Brazil. We collected demographic, socioeconomic, and health-related information, such as alcohol consumption, cigarette consumption, depressive symptoms, quality of diet, quality of life, physical activity, satisfaction with the health unit, overweight or obesity, and sleep problems. RESULTS In the 720 domiciles sampled, 1,697 individuals were identified and 1,519 were interviewed (89.5%). The study initially drew 24 census tracts and proposed the visit to 42 households per tract; however, we need to adjust the method, such as decreasing the number of households per census tract (from 42 to 30) and identifying housing centers in each tract. The main reasons for these changes were difficulty accessing the area, large distances between households, misconceptions in the satellite data available (which did not fit the reality), and high cost of the field work. CONCLUSIONS The previous detailed recognition of the research environment was crucial for decision making as the maps and territory had geographical inconsistencies. The strategies and techniques used in studies for the urban area are not applicable to the rural area given the outcomes observed in Pelotas. The decisions taken, keeping the methodological rigor, were essential to ensure the timely execution of the study with the financial resources available.RESUMO OBJETIVO Descrever o planejamento, a amostragem, os aspectos operacionais do campo e a amostra obtida durante pesquisa realizada na zona rural, especificando e discutindo as principais dificuldades logisticas peculiares a esses locais e as solucoes adotadas. METODOS Entre janeiro e junho de 2016, foi realizado inquerito transversal de base populacional, com amostra representativa da […]

Metabolic equivalent of task (METs) thresholds as an indicator of physical activity intensity

The purpose of the study was to identify and compare validity parameters of different absolute intensity thresholds in METs, using relative intensity classification as criterion measure. Convenience sampling was used to recruit total of 112 adults. The participants carried out an incremental maximal cycle ergometer test and asked to perform nine free-living activities. The oxygen uptake was measured by a VO2000® gas analyser throughout the tests. The intensity thresholds were identified using Receiver Operator Characteristic (ROC) curve analysis, having relative intensity categories as criterion measure. A total of 103 participants attended the two visits. Among 54 men and 49 women, the mean (± SD) ages were 36.1 (± 11.1) and 33.9 (± 10.6) years, respectively. The intensity thresholds identified were 4.9 METs for moderate and 6.8 METs for vigorous physical activity. In conclusion, the physical activity thresholds, generated according to the entire sample, were higher and presented improved specificity when compared to thresholds currently recommended. Moreover, these parameters presented relatively high accuracy, even when applied to specific groups such as sex, age, nutritional status and physical fitness.

Temporal Trends of Physical Activity and Sedentary Behavior Simultaneity in Brazilian Students

OBJECTIVE To evaluate trends in physical activity and sedentary behavior simultaneity among Brazilian students from 2009 to 2015 and its association with independent variables. METHODS This study presents a panel of 3 cross-sectional studies carried out in 2009, 2012, and 2015 (Pesquisa Nacional de Saúde do Escolar-PeNSE). The population was comprised of ninth-grade public and private schools students from Brazilian capitals. Physical activity and sedentary behavior variables were combined to create the outcome of simultaneity of these risk factors. RESULTS A large proportion of students were simultaneously inactive and sedentary in the 3 surveys. However, it was possible to observe a downward trend (2009: 56.4%; 95% confidence interval, 55.7-57.1; 2012: 53.7%; 95% confidence interval, 53.0-54.4; 2015: 51.9%; 95% confidence interval, 51.2-52.7). In 2015, estimates of physical inactivity and sedentary behavior simultaneity were greater than 48% for 20 out of 27 of the Brazilian states. Significant declining trends were observed among mideast residents, females, nonwhite, and those attending private schools. Only around 5%-7% of the adolescents were both active and nonsedentary in the 3 surveys. CONCLUSION Despite of a slight decreasing trend in the proportion of Brazilian students simultaneously inactive and sedentary throughout the period, the prevalence remained elevated across the surveys.