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Pereira FHF, Santos-de-Araújo AD, Pontes-Silva A, Marinho RS, Garcia-Araújo AS, Borghi-Silva A, Gonçalves MC, de Cássia Mendonça de Miranda R, Protazio JB, Pinheiro CAB, Dibai-Filho AV, Bassi-Dibai D. Regular Physical Exercise Adherence Scale (REPEAS): a new instrument to measure environmental and personal barriers to adherence to regular physical exercise. BMC Public Health 2023; 23:2491. [PMID: 38093228 PMCID: PMC10717144 DOI: 10.1186/s12889-023-17438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To create, develop, and validate a scale that identifies the environmental and personal barriers that make it difficult to adhere to the practice of physical exercise on a regular basis in a population of Brazilian adults. METHODS We include adult individuals, aged 18-59 years, practitioners or former practitioners of physical exercise, with Brazilian Portuguese as their mother tongue. In the development and validation phases of the process, 6 specialists in the field of the health assessed the content validity: firstly, the specialists were asked to freely list the questions they would ask to investigate the barriers to adherence to regulating physical activity. Secondly, after compiling all the suggestions listed and eliminating suggestions with similar content, the items suggested in the first round were sent to the specialists so that an evaluation of all questions using a 5-point Likert scale and the content validity coefficient was calculated. We then evaluated the structural validity, construct validity, reliability, internal consistency, and ceiling and floor effects of the Regular Physical Exercise Adherence Scale (REPEAS). RESULTS Sixteen items were proposed to measure the factors that make it difficult to adhere to the regular practice of physical exercise. The internal structure of the REPEAS initially tested was based on the theoretical proposal of creating the instrument with two domains. After the structural analysis, we used the modification indices to identify the redundant items of the instrument. Consequently, the final version of the REPEAS after factor analysis had 12 items. Thus, the structure with 2 domains and 12 items presented adequate fit indices. With regard to construct validity, the REPEAS scores were compared in two distinct groups: irregular practitioners/ex-practitioners versus regular practitioners of physical exercise, in which a significant difference could be observed between groups (p < 0.001) for both the domains. Acceptable reliability was observed for the environment and personal domains, with ICC values of 0.86 and 0.94, in the same order. For internal consistency, Cronbach's alpha value was 0.908 (environmental domain) and 0.915 (personal domain), these values being adequate for the REPEAS. CONCLUSION The REPEAS is a scale with a valid two-dimensional internal structure, consisting of 12 items, reliable and with a valid construct, which supports its use in the clinical, epidemiological, and research contexts in Brazil.
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Affiliation(s)
| | - Aldair Darlan Santos-de-Araújo
- Department of Physical Therapy, Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - André Pontes-Silva
- Department of Physical Therapy, Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Renan Shida Marinho
- Department of Physical Therapy, Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Adriana Sanches Garcia-Araújo
- Department of Physical Therapy, Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Department of Physical Therapy, Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | | | | | - Jhonata Botelho Protazio
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | | | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
- Postgraduate Program in Adult Health, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | - Daniela Bassi-Dibai
- Postgraduate Program in Environment, Universidade Ceuma, São Luís, Maranhão, Brazil.
- Postgraduate Program in Management of Health Services and Programs, Universidade Ceuma, São Luís, Maranhão, Brazil.
- Departament of Physical Therapy, Universidade Ceuma, São Luís, Maranhão, Brazil.
- Postgraduate Program in Dentistry, Universidade Ceuma, São Luís, Maranhão, Brazil.
- Programa de Pós-Graduação em Meio Ambiente, Universidade Ceuma, Rua Josué Montello, 1, Jardim Renascença. CEP 65075-120, São Luís, Maranhão, Brazil.
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Silva JID, Condessa LA, Costa DADS, Célio FDA, Malta DC, Andrade ACDS, Caiaffa WT. Which physical and social characteristics of Brazilian cities contribute to physical activity of adolescents? CIENCIA & SAUDE COLETIVA 2023; 28:3333-3345. [PMID: 37971015 DOI: 10.1590/1413-812320232811.15612022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/06/2023] [Indexed: 11/19/2023] Open
Abstract
This study aimed to analyze the association between adolescents' physical activity and the Brazilian capitals' built and social environment. The units of analysis of this ecological study were the 26 capitals and the Federal District, with data from the National Adolescent Health Survey (2012). The outcome variable was the reported regular physical activity (PA) of ninth graders in Brazilian schools. Exposure variables included characteristics of the natural environment, socioeconomic and educational indicators, urban infrastructure, urban violence, and sociocultural factors retrieved from several secondary sources of Brazilian databases. We adopted multiple linear regression to verify the association between PA and exposure variables. The percentage of active adolescents was 33.0% (95%CI: 32.1; 33.9). In the final model, higher PA was associated with lower temperature, higher Primary Education Development Index, the higher percentage of ramps for wheelchair users, and a higher percentage of leisure-time active adults. The data show that climatic and educational factors, the infrastructure, and the social environment of the capitals can contribute to Brazilian adolescents complying with the recommended weekly PA levels.
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Affiliation(s)
- Juliana Ilídio da Silva
- Instituto de Saúde Coletiva, Universidade Federal de Mato Grosso. R. Quarenta e Nove 2367, Boa Esperança. 78060-900 Cuiabá MT Brasil.
| | - Luciano Antonacci Condessa
- Observatório de Saúde Urbana de Belo Horizonte, Escola de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Dário Alves da Silva Costa
- Observatório de Saúde Urbana de Belo Horizonte, Escola de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Fabiano de Almeida Célio
- Division of Gastroenterology and Liver Diseases, Case Western Reserve University School of Medicine. Cleveland OHIO USA
| | | | - Amanda Cristina de Souza Andrade
- Instituto de Saúde Coletiva, Universidade Federal de Mato Grosso. R. Quarenta e Nove 2367, Boa Esperança. 78060-900 Cuiabá MT Brasil.
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Escola de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
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Yang H, An R, Clarke CV, Shen J. Impact of economic growth on physical activity and sedentary behaviors: a Systematic Review. Public Health 2023; 215:17-26. [PMID: 36608601 DOI: 10.1016/j.puhe.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/20/2022] [Accepted: 11/25/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study systematically reviewed scientific evidence regarding the impact of economic growth on physical activity (PA) and sedentary behaviors. METHODS A keyword and reference search was conducted in PubMed, Web of Science, Cochrane Library, Scopus, and EBSCO from the inception of an electronic bibliographic database to November 2021. Studies that met all of the following criteria were included in the review: (1) study designs: observational studies; (2) study subjects: people of all ages; (3) exposure: macroeconomic growth; (4) outcomes: PA or sedentary behaviors/sitting time. RESULTS 15 studies were identified. Eight among 12 studies found economic growth positively associated with at least one domain/measure of PA, whereas the remaining four found an inverse relationship. One of two studies examined the association of economic growth and physical inactivity found a positive relationship, while another found no significant relationship. Four studies examined the associations between economic growth and sedentary behaviors, and the results were inconclusive. The impact of economic growth on PA is through three main pathways-(a) building and maintaining parks and green spaces, (b) adoption of the modern workplace and high technology, and (c) motorized transportation. CONCLUSION Building and maintaining parks and green spaces can effectively promote leisure time physical activity and active commute in developed countries, whereas promoting workplace and transportation-related PA could be prioritized in developing nations. Future research calls for longitudinal study design and further exploration of macro-environmental factors. Policymakers and stakeholders should be informed about the potential PA reduction resulting from economic growth and develop preventive strategies to alleviate the problem.
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Affiliation(s)
- H Yang
- Department of Physical Education, Capital University of Economics and Business, China
| | - R An
- Brown School, Washington University in St. Louis, United States
| | - C V Clarke
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, United states
| | - J Shen
- Department of Physical Education, China University of Geosciences (Beijing), China.
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Sales D, Matsudo V, Fisberg M, Drenowatz C, Marques A, Ferrari G. Perception of the Neighborhood Environment, Physical Activity by Domain and Sitting Time in Brazilian Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15744. [PMID: 36497825 PMCID: PMC9740320 DOI: 10.3390/ijerph192315744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to examine the association between the neighborhood environment and domain-specific physical activity and sitting time in Brazilian adults. This cross-sectional study included 1803 adults (53.7% women) from Brazil's five regions (North, Northeast, Midwest, Southeast and South). The perception of the environment was evaluated via a questionnaire. We considered seven indicators of the neighborhood environment: land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic and safety from crime. Using the IPAQ, we evaluated physical activity (transport and leisure) and sitting time. Overall, land use mix-diversity (β = 3.22; 95% CI = 0.26, 6.19), land use mix-access (β = 2.27; 95% CI = 0.76, 3.79), and walking/cycling facilities (β = 2.42; 95% CI = 0.35, 4.49) were positively associated with leisure-time physical activity (min/week). On the other hand, only land use mix-diversity (β = 3.65; 95% CI = 0.63, 5.49) was positively associated with transport physical activity (min/week). No neighborhood environment indicator was associated with sitting time (min/day). Perception of the neighborhood environment was associated with physical activity (transport and leisure), while no significant associations occurred with sitting time among the five regions of Brazil. The neighborhood environment can be a viable component in the promotion of physical activity, but geographic diversity must be considered.
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Affiliation(s)
- Diego Sales
- Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS), São Caetano do Sul 09521-160, Brazil
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo 04023-061, Brazil
| | - Victor Matsudo
- Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS), São Caetano do Sul 09521-160, Brazil
| | - Mauro Fisberg
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo 04023-061, Brazil
- Instituto Pensi, Fundação José Luiz Egydio Setubal, Hospital Infantil Sabará, São Paulo 01228-200, Brazil
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, Pädagogische Hochschule Oberösterreich, 4020 Linz, Austria
| | - Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Lisbon, Portugal
- ISAMB, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Gerson Ferrari
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia 7500912, Chile
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Szwarcwald CL, Souza Júnior PRBD, Damacena GN, Stopa SR, Barros MBDA, Malta DC. Healthy lifestyle and recommendations in health care among hypertensive and diabetic patients in Brazil, 2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210017. [PMID: 34910071 DOI: 10.1590/1980-549720210017.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate prevalence of healthy behaviors among individuals aged 30 years or more, diagnosed with arterial hypertension and diabetes mellitus, using information from the National Health Survey, 2019. METHODS Cross-sectional study with cluster sampling and simple random sampling in three stages. Individuals were aggregated according the following conditions: having arterial hypertension; arterial hypertension only; diabetes mellitus; diabetes mellitus only; arterial hypertension and diabetes mellitus only; without chronic non-communicable diseases. Poisson regression models and crude and adjusted prevalence ratios for sex, age group, and schooling were used. The proportion of recommendations received by patients with arterial hypertension and diabetes mellitus was estimated by type of care (public/private). RESULTS A total of 69,285 individuals aged 30 years or more was analyzed. Compared to individuals without non-communicable diseases, prevalence of consumption of fruits and vegetables ≥5 days a week was significantly higher among individuals with arterial hypertension (39.9% - 95%CI 38.8-41.0) and those with diabetes mellitus (42.8% - 95%CI 40.7-44.9). However, estimates of not having consumed ultra-processed food were low, 19.7% (95%CI 18.9-20.6) and 21.9% (95%CI 20,3-23.5), respectively. Prevalence of not smoking reached values close to 90% and significant prevalence ratios, whereas the practice of physical activity had levels below 30% and non-significant prevalence ratios. The proportion of healthy eating recommendations reached 90%, but it was close to 70% for not smoking. CONCLUSIONS It is necessary to encourage the practice of healthy lifestyles and provide information about the benefits of physical activity and the harmful effects of unhealthy eating for well-being and aging with quality.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | | | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Sheila Rizzato Stopa
- Department of Health Analysis and Surveillance of Non-Communicable Diseases, Secretariat of Health Surveillance, Ministry of Health - Brasília (DF), Brazil
| | | | - Deborah Carvalho Malta
- Maternal Child Nursing and Public Health Department, Nursing School, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
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Silva PSCD, Boing AF. [Factors associated with leisure-time physical activity: analysis of Brazilians with chronic diseases]. CIENCIA & SAUDE COLETIVA 2021; 26:5727-5738. [PMID: 34852104 DOI: 10.1590/1413-812320212611.32432020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022] Open
Abstract
The scope of this study was to analyze the prevalence and the factors associated with sufficient leisure-time physical activity (LTPA) among Brazilians diagnosed with hypertension, diabetes and/or hypercholesterolemia. It involved a representative, cross-sectional population-based study for the entire Brazilian territory. Adults aged 20 years and over were interviewed. Prevalences were estimated and, by means of logistic regression, the crude and adjusted odds ratios (OR) of the outcome were calculated in accordance with each of the exploratory variables. The prevalence of sufficient LTPA was 15.9%, 15.3% and 21.4% among people with hypertension (n=12,228), diabetes (n=3,577) and hypercholesterolemia (n=7,124), respectively. These values were lower than those observed among adults who did not report one of the three diseases. Adjusted analysis showed that individuals with positive self-perception of health and with more schooling, who reported a public space near their homes for physical activity, the existence in the city of public programs that encourage physical activity and the recommendation of health professionals to practice LTPA, were associated with a greater chance of being sufficiently active.
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Affiliation(s)
- Paulo Sergio Cardoso da Silva
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Pública, Universidade Federal de Santa Catarina. R. Eng. Agronômico Andrei Cristian Ferreira s/n, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Antonio Fernando Boing
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Pública, Universidade Federal de Santa Catarina. R. Eng. Agronômico Andrei Cristian Ferreira s/n, Trindade. 88040-900 Florianópolis SC Brasil.
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Time Trends and Sociodemographic Inequalities in Physical Activity and Sedentary Behaviors Among Brazilian Adults: National Surveys from 2003 to 2019. J Phys Act Health 2021; 18:1332-1341. [PMID: 34548416 DOI: 10.1123/jpah.2021-0156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The authors analyzed time trends and sociodemographic inequalities in different physical activity and sedentary behavior domains between 2003 and 2019. METHODS A secondary analysis of data from 5 cross-sectional Brazilian epidemiological surveys (World Health Survey-2003, National Household Sample Survey-2008/2015, and Brazilian Health Survey-2013/2019) conducted among a nationally representative sample of Brazilian adults. The authors used data on different domains of physical activity (leisure, commute, total transport, and total physical activity) and sedentary behavior (TV viewing and other types of screens) that were available in the different surveys. Gender, age group, country region, ethnicity, type of area and city, and quintiles of income and educational achievement were used as sociodemographic correlates. RESULTS The prevalence of leisure-time physical activity increased over time (2008: 7.0% vs 2019: 26.5%). There was also an increased trend of social inequality in leisure-time physical activity. A trend of reduction was observed for active commuting (2008: 35.0% vs 2019: 21.8%), while total transport physical activity was stable (2013: 49.5% vs 2019: 49.6%). Directions of findings were opposite for sedentary behavior, with reduced trend for >3 hours per day of TV viewing (2008: 34.8% vs 2019: 21.8%) and increased trend for >3 hours per day of other types of screen time (2008: 6.4% vs 2019: 22.2%). CONCLUSION A positive trend exists in leisure-time physical activity, but there was also an increase in social inequalities for physical activity in Brazil.
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Dopp EVDO, Nascimento WG, Goulardins GS, Kokubun E, Nakamura PM. Public spaces leisure in Rio Claro - SP (Brazil): quality, distribution, and social vulnerability. MOTRIZ: REVISTA DE EDUCACAO FISICA 2021. [DOI: 10.1590/s1980-65742021022320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Eduardo Kokubun
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
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Werneck AO, Sadarangani KP, Ramírez-Vélez R, Baldew SS, Gomes TN, Ferrari G, Szwarcwald CL, Miranda JJ, Silva DR. Macroeconomic, demographic and human developmental correlates of physical activity and sitting time among South American adults. Int J Behav Nutr Phys Act 2020; 17:163. [PMID: 33317548 PMCID: PMC7737374 DOI: 10.1186/s12966-020-01068-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to investigate the association of macroeconomic, human development, and demographic factors with different domains of physical activity and sitting time among South American adults. METHODS We used data from nationally representative samples in Argentina (n = 26,932), Brazil (n = 52,490), Chile (n = 3866), Colombia (n = 14,208), Ecuador (n = 19,883), Peru (n = 8820), and Uruguay (n = 2403). Our outcomes included leisure time (≥150 min/week), transport (≥10 min/week), occupational (≥10 min/week), and total (≥150 min/week) physical activity, as well as sitting time (≥4 h/day), which were collected through self-reported questionnaires. As exposures, gross domestic product, total population, population density, and human development index indicators from the most updated national census of each country were used. Age and education were used as covariates. Multilevel logistic regressions with harmonized random effect meta-analyses were conducted, comparing highest vs. lowest (reference) tertiles. RESULTS Higher odds for transport physical activity were observed among the highest tertiles of total population (ORmen: 1.41; 95% CI: 1.23-1.62), ORwomen: 1.51; 95% CI:1.32-1.73), population density (ORmen: 1.36; 95% CI: 1.18-1.57, ORwomen: 1.49; 95% CI: 1.30-1.70), and gross domestic product (ORmen: 1.16; 95% CI: 1.00-1.35, ORwomen: 1.39; 95% CI: 1.20-1.61). For leisure physical activity, women living in departments with higher human development index presented 18% higher odds for being active, and for total physical activity a similar estimate in both sexes was observed among those who live in more populated areas. No consistent associations were found for occupational physical activity and sitting time. CONCLUSION Macroeconomic, demographic and human development indicators are associated with different domains of physical activity in the South American context, which can in turn guide policies to promote physical activity in the region.
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Affiliation(s)
- André O Werneck
- Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil.
| | - Kabir P Sadarangani
- Escuela de Kinesiología, Universidad Autónoma de Chile, Santiago, Chile
- Escuela de Kinesiología, Facultad de Salud y Odontología, Universidad Diego Portales, Santiago, Chile
| | - Robinson Ramírez-Vélez
- Department of Health Sciences, Public University of Navarra, Navarrabiomed-Biomedical Research Centre, IDISNA-Navarra's Health Research Institute, Complejo Hospitalario de Navarra, C/irunlarrea 3, 31,008, 31008, Pamplona, Navarra, Spain
| | - Se-Sergio Baldew
- Department of Physical Therapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Thayse N Gomes
- Department of Physical Education, Federal University of Sergipe - UFS, São Cristóvão, Brazil
| | - Gerson Ferrari
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | | | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Danilo R Silva
- Department of Physical Education, Federal University of Sergipe - UFS, São Cristóvão, Brazil
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