Sandra Matsudo

How many steps/day are enough? For older adults and special populations

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.

Neighborhood environments and physical activity among adults in 11 countries.

BACKGROUND Understanding environmental correlates of physical activity can inform policy changes. Surveys were conducted in 11 countries using the same self-report environmental variables and the International Physical Activity Questionnaire, allowing analyses with pooled data. METHODS The participating countries were Belgium, Brazil, Canada, Colombia, China (Hong Kong), Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S., with a combined sample of 11,541 adults living in cities. Samples were reasonably representative, and seasons of data collection were comparable. Participants indicated whether seven environmental attributes were present in their neighborhood. Outcomes were measures of whether health-related guidelines for physical activity were met. Data were collected in 2002-2003 and analyzed in 2007. Logistic regression analyses evaluated associations of physical activity with environmental attributes, adjusted for age, gender, and clustering within country. RESULTS Five of seven environmental variables were significantly related to meeting physical activity guidelines, ranging from access to low-cost recreation facilities (OR=1.16) to sidewalks on most streets (OR=1.47). A graded association was observed, with the most activity-supportive neighborhoods having 100% higher rates of sufficient physical activity compared to those with no supportive attributes. CONCLUSIONS Results suggest neighborhoods built to support physical activity have a strong potential to contribute to increased physical activity. Designing neighborhoods to support physical activity can now be defined as an international public health issue.

Physical activity in adults from two Brazilian areas: similarities and differences

Lack of comparability has been a major limitation in studies on physical activity, due to the utilization of different methodological instruments and inconsistent cut-off points. This study aims to compare the levels of physical activity in adults from two Brazilian areas: (a) São Paulo, the richest State in the country; (b) Pelotas, a medium-sized southern Brazilian city. Both sites used cross-sectional population-based designs, with multiple-stage sampling strategies. Level of physical activity was assessed with the short version of the International Physical Activity Questionnaire. Prevalence of sedentary lifestyle was three times higher in Pelotas than in São Paulo. On the other hand, the proportion of very active subjects was significantly higher in Pelotas. The proportion of insufficiently active individuals (sedentary + irregularly active) was almost identical between the sites. Socioeconomic status was inversely related to level of physical activity in both sites. Among the insufficiently active subjects, those living in São Paulo are at least engaged in a limited amount of activity. On the other hand, among sufficiently active people, those living in Pelotas are more active.

Time Trends in Physical Activity in the State of São Paulo, Brazil: 2002-2008

PURPOSE To document time trends in physical activity in the state of São Paulo, Brazil (2002-2008). In addition, we discuss the role of Agita São Paulo at explaining such trends. METHODS Cross-sectional surveys were carried out in 2002, 2003, 2006, and 2008 in the state of São Paulo, Brazil, using comparable sampling approaches and similar sample sizes. In all surveys, physical activity was measured using the short version of the International Physical Activity Questionnaire. Separate weekly scores of walking and moderate- and vigorous-intensity physical activities were generated; cutoff points of 0 and 150 min·wk were used. Also, we created a total physical activity score by summing these three types of activity. We used logistic regression models for adjusting time trends for the different sociodemographic compositions of the samples. RESULTS The prevalence of no physical activity decreased from 9.6% in 2002 to 2.7% in 2008, whereas the proportion of subjects below the 150-min threshold decreased from 43.7% in 2002 to 11.6% in 2008. These trends were mainly explained by increases in walking and moderate-intensity physical activity. Increases in physical activity were slightly greater among females than among males. Logistic regression models confirmed that these trends were not due to the different compositions of the samples. CONCLUSIONS Physical activity levels are increasing in the state of São Paulo, Brazil. Considering that the few data available in Brazil using the same instrument indicate exactly the opposite trend and that Agita São Paulo primarily incentives the involvement in moderate-intensity physical activity and walking, it seems that at least part of the trends described here are explained by the Agita São Paulo program.

Perceived neighborhood environment and physical activity in 11 countries: Do associations differ by country?

BackgroundIncreasing empirical evidence supports associations between neighborhood environments and physical activity. However, since most studies were conducted in a single country, particularly western countries, the generalizability of associations in an international setting is not well understood. The current study examined whether associations between perceived attributes of neighborhood environments and physical activity differed by country.MethodsPopulation representative samples from 11 countries on five continents were surveyed using comparable methodologies and measurement instruments. Neighborhood environment × country interactions were tested in logistic regression models with meeting physical activity recommendations as the outcome, adjusted for demographic characteristics. Country-specific associations were reported.ResultsSignificant neighborhood environment attribute × country interactions implied some differences across countries in the association of each neighborhood attribute with meeting physical activity recommendations. Across the 11 countries, land-use mix and sidewalks had the most consistent associations with physical activity. Access to public transit, bicycle facilities, and low-cost recreation facilities had some associations with physical activity, but with less consistency across countries. There was little evidence supporting the associations of residential density and crime-related safety with physical activity in most countries.ConclusionThere is evidence of generalizability for the associations of land use mix, and presence of sidewalks with physical activity. Associations of other neighborhood characteristics with physical activity tended to differ by country. Future studies should include objective measures of neighborhood environments, compare psychometric properties of reports across countries, and use better specified models to further understand the similarities and differences in associations across countries.

Patterns of neighborhood environment attributes related to physical activity across 11 countries: a latent class analysis

BackgroundNeighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants’ response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA.MethodsA Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5 ±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10–15 minutes walk of participants’ residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants’ response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country.ResultsA 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, “Overall Activity Supportive (52% of sample)”, “High Walkable and Unsafe with Few Recreation Facilities (16%)”, “Safe with Active Transport Facilities (12%)”, “Transit and Shops Dense with Few Amenities (15%)”, and “Safe but Activity Unsupportive (5%)”. Country representation differed by type (e.g., U.S. disproportionally represented “Safe but Activity Unsupportive”). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR= 2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR= 1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA.ConclusionsMeaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.

Television viewing and its association with overweight in Colombian children: results from the 2005 National Nutrition Survey: A cross sectional study

BackgroundThere has been an ongoing discussion about the relationship between time spent watching television and childhood obesity. This debate has special relevance in the Latin American region were the globalization process has increased the availability of screen-based entertainment at home. The aim of this study is to examine the association between television viewing and weight status in Colombian children.MethodsThis cross sectional investigation included children aged 5 to12 yrs from the National Nutrition Survey in Colombia (ENSIN 2005). Weight and height were measured in 11,137 children in order to calculate body mass index. Overweight was defined by international standards. Time spent viewing television was determined for these children through parental reports. Multiple logistic regression analyses were conducted for different subgroups and adjusted for potential confounders in order to study the association between television viewing and weight status in this population.ResultsAmong the surveyed children, 41.5% viewed television less than two hours/day; 36.8% between two and 3.9 hours/day and 21.7% four or more hours/day. The prevalence of overweight (obesity inclusive) in this population was 11.1%. Children who were classified as excessive television viewers (between two and 3.9 hours/day or 4 or more hours/day) were more likely to be overweight (OR: 1.44 95% CI: 1.41–1.47 and OR: 1.32 95% CI: 1.30–1.34, respectively) than children who reported to watch television less than 2 hours/day. Stratified analyses by age, gender and urbanization levels showed similar results.ConclusionTelevision viewing was positively associated with the presence of overweight in Colombian children. A positive association between urbanization level and television viewing was detected. Considering that the majority of Colombian children lives in densely populated cities and appear to engage in excessive television viewing these findings are of public health relevance for the prevention of childhood obesity.

Adaptação transcultural: tradução e validação de conteúdo da versão brasileira do Commitment Exercise Scale

CONTEXTO: O Commitment Exercise Scale (CES) avalia o comprometimento, o comportamento e a atitude de pacientes com transtornos alimentares em relacao ao exercicio fisico. OBJETIVO: Traducao e adaptacao transcultural do CES para o idioma portugues (BRA), validacao de conteudo e analise da consistencia interna. METODOS: Envolveu cinco etapas: (1) traducao; (2) retraducao; (3) revisao tecnica e avaliacao semântica; (4) validacao de conteudo por profissionais da area - juizes; (5) avaliacao do instrumento por uma amostra de estudantes, por meio da avaliacao do grau de compreensao e analise da consistencia interna do instrumento pelo coeficiente a de Cronbach. RESULTADOS: A escala foi traduzida e adaptada, sendo considerada de facil compreensao (grau de compreensao de 4,3 a 4,9), e demonstrou valores do coeficiente aceitaveis (a de Cronbach: 0,60 a 0,79). CONCLUSAO: A partir do processo de adaptacao transcultural, os resultados satisfatorios possibilitam a recomendacao da versao brasileira do CES. Sao necessarias analises de validacao de construto, fatorial e de reprodutibilidade.

Evolução do perfil neuromotor e capacidade funcional de mulheres fisicamente ativas de acordo com a idade cronológica

BACKGROUND AND PURPOSE: There are few longitudinal studies to determine the effect of aging on physical fitness and functional capacity of physically active women. The purpose of this study was to compare the evolution of neuromotor profile and functional capacity in active elderly women in one-year period as related to chronological age at the base line. METHODS: Sample consisted of 117 women from 50 to 79 years of age (: 65 ± 6.6 years) engaged in an aerobic program, twice a week, 50 minutes per session during 5.4 ± 3.0 years and divided in three age groups: 50-59 (n: 23); 60-69 (n: 60); 70-79 (n: 34). Motor function and mobility tests included: lower and upper limb strength, agility, trunk flexibility, velocity of rising from a chair, static balance, gait speed and maximum gait speed. Results at the base line and in two evaluations made at six-month interval were compared using a Two Way ANOVA, with a post-hoc Bonferroni. RESULTS: There were no differences regarding neuromotor performance, although velocity of rising from a chair and gait speed evidenced significant differences in groups 50-59 and 60-69 years, showing better results (10-20%); and for maximum gait speed there was an increase (8%) in 60-79 age groups. CONCLUSION: Present results suggest that physical fitness and functional capacity evolution had a similar pattern among physically active women, regardless of chronological age. This evolution supports the hypothesis of regular physical activity as a powerful tool to promote health, being of utmost importance to a healthy aging.FUNDAMENTOS Y OBJETIVO: Pocos estudios longitudinales han sido realizados en mujeres fisicamente activas para determinar el impacto del envejecimiento de la aptitud fisica y la capacidad funcional. El objetivo de este estudio fue comparar la evolucion del perfil neuromotor y la capacidad funcional de mujeres activas en el periodo de un ano de acuerdo con la edad cronologica. METODOS: La muestra estuvo compuesta por 117 mujeres de 50 a 79 anos de edad (: 65 ± 6,6 anos) participantes de un programa de ejercicios aerobicos, dos veces por semana, 50 minutos por sesion durante 5,4 ± 3,0 anos y divididas por la edad: 50-59 (n: 23); 60-69 (n: 60); 70-79 (n: 34). Los tests neuromotores y de movilidad incluyeron: fuerza muscular de los miembros inferiores y superiores, agilidad, flexibilidad de tronco, velocidad de levantarse de la silla, equilibrio estatico, velocidad normal de andar y velocidad maxima de andar. Los resultados iniciales de las dos evaluaciones siguientes, realizadas intervalos de 6 meses, fueron comparados usando ANOVA two way, con post-hoc Bonferroni. RESULTADOS: En un ano no hubo ninguna alteracion del desempeno neuromotor, ya que la velocidad de levantar de la silla y la velocidad de andar no evidenciaron diferencias significativas en los grupos de 50-59 e 60-69 anos, presentando resultados un 10-20% mejores; en cuanto a la velocidad maxima de andar hubo una mejora (8%) en los grupos de 60 a 79 anos. CONCLUSION: La evolucion de la aptitud fisica y la capacidad funcional tuvo un comportamiento similar, en mujeres fisicamente activas independientemente de la edad cronologica. Esta evolucion fortalece la hipotesis de un efecto favorable de la actividad fisica regular en la promocion de la salud, estrategia fundamental del envejecimiento saludable.

A força muscular de mulheres idosas decresce principalmente após oito semanas de interrupção de um programa de exercícios com pesos livres

Este estudo teve como objetivo verificar o efeito da interrupcao de um programa de exercicios com pesos livres sobre a forca muscular de mulheres idosas atraves do teste de uma repeticao maxima (1-RM). Para tanto, a amostra foi constituida por oito mulheres idosas saudaveis (x: 64,3 ± 7,6 anos) que foram envolvidas, previamente a interrupcao, em um programa de exercicios com pesos livres durante 12 semanas, tres vezes por semana, tres series de 10 repeticoes a 50% 1-RM para seis tipos de exercicios para os membros superiores e inferiores. O teste 1-RM foi realizado imediatamente apos a interrupcao do programa e subsequentemente a cada quatro semanas (4a, 8a e 12a semanas). Os valores demonstraram decrescimo estatisticamente significativo na forca muscular de ambas as extremidades corporais, principalmente apos a 8a semana de pausa. O decrescimo percentual na 12a semana variou de 27,5% a 35,1% para a forca muscular de membros inferiores e superiores, respectivamente; aconteceu, principalmente, nos membros superiores. Os membros inferiores preservaram mais a capacidade de manutencao da forca muscular apos a interrupcao do treinamento (22,9% a 71,9%) que os membros superiores (-14,8% a 16,1%) quando os valores absolutos finais do periodo de destreinamento foram comparados com os valores iniciais do treinamento. Esses resultados permitem concluir que a interrupcao de um programa de exercicios com pesos livres produz efeito negativo na forca muscular de mulheres idosas, especialmente apos a 8a semana.