Economics of physical activity in low-income and middle- income countries: a systematic review

Increasing Health Behaviors and Psychological Measures with an Adapted Version of the ACCELERATION Program

BACKGROUND

Recent evidence highlights the importance of interventions tackling physical inactivity and unhealthy eating in lower-income countries. The purpose of this study was to examine the effectiveness of the Canadian ACCELERATION lifestyle program adapted to Brazilians. The main outcomes of the study were changes in the engagement in weekly moderate-to-vigorous physical activity (MVPA) and in the daily consumption of fruits/vegetables.

METHODS

The adapted intervention consisted of a 12-week quasi-randomized controlled trial delivered through email. The data from the original Canadian experimental group (CE, n = 194) and the two groups of Portuguese-speaking Brazilians living in Canada in the adapted program - Brazilian experimental (BE, n = 41) and Brazilian control (BC, n = 35) - were assessed at baseline and post-intervention. The data of the 270 participants were analyzed using two-way repeated measures factorial ANCOVA (group x time) for ratio variables and Chi-square and McNemar tests for the categorical variables.

RESULTS

The BE group had a significant increase in MVPA (mean difference, 95% CI: 86.3, 38.1-134.4 min/week) and fruits/vegetables intake (3.2, 1.4-5.1 servings/day) after the intervention (both p < 0.001). The proportion of participants engaging in ≥ 150 min of MVPA increased from 4.9% to 73.2%, while adoption of a healthy diet increased from 4.9% to 53.7% in the BE group (both p < 0.001). The CE group also improved on these variables (p < 0.05) with no difference vs the BE group (p > 0.05), whereas BC did not show changes (p > 0.05).

CONCLUSION

The Brazilian version of the ACCELERATION program effectively promoted positive health behavior changes in its participants and has the potential to contribute to the fight against risk factors for chronic diseases in Brazilians.

"Balancing work and movement": barriers and enablers for being physically active at Indian workplaces - findings from SMART STEP trial

BACKGROUND

Non-communicable diseases are rising rapidly in low- and middle-income countries, leading to increased morbidity and mortality. Reducing sedentary behavior (SB) and increasing physical activity (PA) offer numerous health benefits. Workplaces provide an ideal setting for promoting SB/PA interventions; however, understanding the barriers and enablers is crucial for optimizing these interventions in workplace environments.

METHODS

Nested within a cluster randomised controlled trial (the SMART-STEP trial), the present study employed in-depth interviews with 16 office workers who have completed 24 weeks of two distinct (technology assisted and traditional) workplace SB/PA interventions. Using a deductive analysis, semi-structured interviews were administered to explore the barriers and enablers to the SB/PA interventions at individual, interpersonal and organisational level using the socio-ecological model.

RESULTS

Several individual (poor goal setting, perceived health benefits & workload, attitude, intervention engagement), interpersonal (lack of peer support) and organisational (task prioritisation, lack of organisational norm and material or social reward) barriers were identified. Indian women engaged in desk-based office jobs often find themselves burdened with intense home and childcare responsibilities, often without sufficient support from their spouses. A primary concern among Indian office workers is the poor awareness and absence of cultural norms regarding the health risks associated with SB.

CONCLUSIONS

Raising awareness among workplace stakeholders-including office workers, peers, and the organization-is crucial before designing and implementing SB/PA interventions in Indian workspaces. Personalized interventions for Indian female office workers engaged in desk-bound work are warranted.

Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis

BACKGROUND

Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults?

METHOD

Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary -physical activity level -and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects.

RESULTS

The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I2=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I2=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I2=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes.

CONCLUSION

Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals.

TRIAL REGISTRATION

Registration Number: INPLASY202230118.

Unmet needs and the effect of healthcare system generosity on prevention activity - A multilevel analysis

INTRODUCTION

Maintaining a healthy lifestyle and obtaining preventive care (hereafter, prevention-activity) usually have an inverse association with poverty status and unmet needs. We seek to estimate the extent to which the effect of individual unmet needs status on prevention-activity is moderated by the generosity of the healthcare system.

MATERIALS AND METHODS

Two datasets were combined: Pre-Covid Wave-8 (2019-2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE, Release 8.0.0), with 46,500 individuals aged 50+ from 27 countries (26 European countries and Israel) and 12 healthcare generosity variables obtained from the OECD Health Statistics Library. An econometric two-level model was used in three sequentially models. Outcome variables included five prevention-activities align over a continuum (sports, smoking, flu vaccinations, mammography, and colon cancer screening) and unmet needs status, defined as the lack of resources necessary to meet basic human and medical needs.

RESULTS

We found that unmet needs at the individual level had a significant negative fixed effect in all of the prevention-activity models including a healthy lifestyle, primary prevention and secondary prevention. Sources of intra-country variation were social/public insurance, health expenditure and number of nurses, which have had a significant and positive effect on an individual's prevention-activities (except years of smoking). Nonetheless, the gaps in generous countries between people reporting on unmet need and others were larger or similar to those in less generous countries, suggesting that disparities increase with the generosity of the health system.

CONCLUSIONS

The study provides insight into the effect of health system generosity on socioeconomic inequalities in healthy lifestyle and prevention care. Our findings suggest that the state has an important and decisive role to play in ensuring that prevention services are accessible to the entire population, particularly those reporting unmet needs.

The economic cost of obstructive sleep apnea: A systematic review

Obstructive sleep apnea (OSA) is a common disease associated with a high prevalence of costly comorbidities and accidents that add to the disease's economic impact. Although more attention has been focused on OSA in recent years, no previous systematic reviews have synthesized findings from existing studies that provide estimates of the economic cost of OSA. This study aims to summarize the findings of existing studies that provide estimates of the cost of OSA. Two bibliographic databases, PubMed and Scopus, were used to identify articles on the costs of OSA. The systematic literature review identified 5,938 publications, of which 31 met the inclusion criteria. According to the results, adjusted for inflation and converted to euros, the annual cost per patient ranged from €236 (the incremental cost of OSA) for New Zealand to €28,267 for the United States. The total annual cost per patient in Europe ranged from €1,669 to €5,186. OSA causes a significant burden on society, and OSA-related costs increase many years before the diagnosis and remain elevated for a long time after the diagnosis. Despite some well-conducted studies, the cost estimates for OSA are uncertain and specific to the context in which the study was conducted.

Integrating the wrist-worn tracker in cardiac rehabilitation programmes: a scoping review

Background/Aims

Physical activity has been recommended as a secondary prevention strategy to reduce the risk of recurrent adverse events and improve health. While it can be challenging for health practitioners to motivate patients to remain physically active, wrist-worn activity trackers can assist in monitoring adherence. The aim of this study was to identify and summarise the existing scientific literature on wrist-worn activity trackers monitoring physical activity among patients undergoing cardiac rehabilitation. The authors also aimed to identify evidence gaps that require further investigation.

Methods

A systematic search was conducted in the electronic databases in PubMed, Web of Science, Scopus, SPORTDiscus and the Cumulative Index to Nursing and Allied Health Literature. Method quality was appraised using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews instrument. The study focused on any physical activity data collected by wrist-worn activity trackers in cardiac rehabilitation.

Results

A total of 19 relevant records were identified. Wrist-worn activity trackers generally improved the patient's physical activity and the validity of heart rate and step count measurements was acceptable. Some studies demonstrated improvements in exercise capacity and health-related quality of life.

Conclusions

Wrist-worn activity trackers can help to monitor patients' physical activity in cardiac rehabilitation, with potential benefits for exercise capacity and health-related quality of life. Further research is necessary to strengthen the evidence that wrist-worn activity trackers may be beneficial to evaluate clinical outcomes, determine the intervention cost, acceptability of patients and allied health professionals, as well as explore feedback, including technical issues.

Habitual physical activity minimizes healthcare costs resulting from comorbidities among adults with cardiovascular diseases

BACKGROUND

Habitual physical activity (HPA) can be used as a non-pharmacological strategy to prevent and control chronic diseases, as well as playing a role in minimizing healthcare costs.

OBJECTIVE

To verify the impact of HPA on healthcare costs at different levels of care, over 24 months, in an adult population with cardiovascular diseases (CVD), including individuals with or without comorbidities.

METHODS

Two-hundred and seventy-eight adults with CVD, aged between 30 and 65 years, participated in the study. Information on healthcare costs was obtained from medical records and included primary, secondary, and tertiary levels. Comorbidities such as diabetes, dyslipidemia, arterial hypertension, and obesity were registered. HPA was measured using the Baecke questionnaire. Comparisons between groups were performed using Student's t (

RESULTS

The presence of comorbidities increased healthcare costs (p<0.05). HPA provided savings ranging from US$ 22.5/24 months to US$ 63.9/24 months with primary healthcare services, regardless of the presence of comorbidities.

CONCLUSION

Considering adults with CVD, HPA significantly minimizes healthcare costs in the primary care in Brazil, even in the presence of comorbidities, such as diabetes, dyslipidemia, arterial hypertension, and obesity.

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Key Words

• Brazilian national health system
• Exercise
• Obesity
• Primary health care

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MESH Headings

• Adult
• Humans
• Middle Aged
• Aged
• Cardiovascular Diseases/epidemiology
• Health Care Costs
• Obesity
• Hypertension
• Diabetes Mellitus
• Exercise
• Dyslipidemias

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Affiliation(s)

Monique Yndawe Castanho Araujo Post-graduation Program in Movement Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil; Group of Studies in Health, Physical Activity, and Economy (GESAFE), Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil.
Eduardo Kokubun Post-graduation Program in Movement Sciences, Universidade Estadual Paulista (UNESP), Rio Claro, São Paulo, Brazil
Maria Carolina Castanho Saes Norberto Post-graduation Program in Movement Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil; Group of Studies in Health, Physical Activity, and Economy (GESAFE), Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil
André Lucas Servo Bento Group of Studies in Health, Physical Activity, and Economy (GESAFE), Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil
Bruna Camilo Turi-Lynch Department of Physical Education and Exercise Science, Lander University, Greenwood, South Carolina, USA
Jamile Sanches Codogno Post-graduation Program in Movement Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil; Group of Studies in Health, Physical Activity, and Economy (GESAFE), Universidade Estadual Paulista (UNESP), Presidente Prudente, São Paulo, Brazil

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National policies on physical activity from 64 countries with different economies: a scoping review with thematic analysis

In 2018, the World Health Organization (WHO) launched a Global Action Plan on Physical Activity (PA), which included 20 policy actions for creating active societies, environments, people and systems. The objective of this scoping review was to summarize the themes/contents of national PA policies/plans conforming to the WHO's proposals and the country's economy. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. A systematic search of electronic databases (Web of Science, Medline/PubMed, LILACS, PsycINFO, Scopus and SPORTDiscus) and 441 government documents/websites from 215 countries/territories was conducted (February 2021). Documents on national-level policies, published in English, Spanish and Portuguese since 2000, were eligible. The information on content and structure was systematically extracted and summarized into dimensions proposed by the WHO: active societies, environments, people and systems. The search identified 888 article references and 586 potentially relevant documents. After the screening, 84 policy documents from 64 countries were eligible. Most documents (n = 46) provided detailed PA policies/plans amid other health topics (e.g. non-communicable diseases, named 'general documents'), and 38 were PA-specific. The content analysis merged 54 visions, 65 missions, 108 principles, 119 objectives, 53 priorities, 105 targets, 126 indicators and 1780 actions/strategies from 38 PA-specific and 46 general documents. Among the PA-specific documents, the active system's dimension was the most contemplated in the principles (n = 43), priorities (n = 51) and action/strategies (n = 530) elements. At the same time, the objectives (n = 39), targets (n = 52) and indicators (n = 58) presented contents more frequently related to the active people dimension. For the general documents, all principles (n = 4), objectives (n = 14) and priorities (n = 7) were related to the dimension of active people, while target (n = 51), indicator (n = 53) and actions/strategies (n = 292) elements presented content related to all dimensions. The increase in countries with national PA policies/plans should be followed by improving the current ones because important dimensions seem to be not considered in these documents. This will facilitate a global PA agenda that considers the complexity and multidimensionality of PA promotion.

Incidence and Predictors of Physical Inactivity Among Malaysian Community-Dwelling Older Persons

The aim of this study was to determine the incidence of physical inactivity and identify the predictors for low physical activity among community-dwelling older persons living in Malaysia in 3 years follow-up. In this prospective study, physical activity levels were measured using the Physical Activity Scale for the Elderly. The arbitrary cutoff for Physical Activity Scale for the Elderly in this study was ≤70.9 for low and >141 for high physical activity levels. Out of the 955 physically active participants at baseline, 555 of them (mean [SD] age 68.82 [4.92] years) were successfully followed up to 3 years. Cumulative incidence of being physically inactive was 21% with rate of 7 per 100 person-years. It was found that being older (<.001), from Malay ethnic group (<.05), smokers (<.01), having lower gait speed (<.001), and lower cognitive status (<.05) were predictors for physical inactivity among Malaysian community-dwelling older persons in 3 years follow-up. These factors should be taken into consideration when planning for intervention and promotion strategies to increase physical activity levels among Malaysian older persons.

Impact of economic growth on physical activity and sedentary behaviors: a Systematic Review

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.

Low physical activity is associated with adverse health outcome and higher costs in Indonesia: A national panel study

Aims

To assess the association between low physical activity, cardiovascular disease (CVD) and risk factors, health service utilization, risk of catastrophic health expenditure, and work productivity in Indonesia.

Methods

In this population-based, panel data analysis, we used data from two waves of the Indonesian Family Life Survey (IFLS) for 2007/2008 and 2014/2015. Respondents aged 40-80 years who participated in both waves were included in this study (n = 5,936). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ-SF). Multinomial logistic regression model was used to examine factors associated with physical activity levels (low, moderate, and high). We applied a series of multilevel mixed-effect panel regression to examine the associations between physical activity and outcome variables.

Results

The prevalence of low physical activity increased from 18.2% in 2007 to 39.6% in 2014. Compared with those with high physical activity, respondents with low physical activity were more likely to have a 10-year high CVD risk (AOR: 2.11, 95% CI: 1.51-2.95), use outpatient care (AOR: 1.26, 95% CI: 1.07-1.96) and inpatient care (AOR 1.45, 95% CI: 1.07-1.96), experience catastrophic health expenditure of 10% of total household expenditure (AOR: 1.66, 95% CI: 1.21-2.28), and have lower labor participation (AOR: 0.24, 95% 0.20-0.28).

Conclusions

Low physical activity is associated with adverse health outcomes and considerable costs to the health system and wider society. Accelerated implementation of public health policies to reduce physical inactivity is likely to result in substantial population health and economic benefits.

Development of the Brazilian Version of a Pan-Canadian Behavior Change Program and Its Health and Fitness Outcomes

Chronic diseases are a major health problem worldwide, especially in lower-income jurisdictions. Considering this scenario, the World Health Organization has recently established, as a research priority, preventive interventions for populations from lower-income countries, such as the middle-income country of Brazil. The purpose of this article is to describe the components of a pan-Canadian lifestyle program adapted to Brazilians and to report its health and fitness outcomes. A 12-week program called ACCELERATION was translated and culturally adapted to Brazilians. A quasi-randomized controlled trial was designed, consisting of weekly emails and educational videos addressing risk factors for chronic disease. Health and fitness measures included body composition, cardiovascular variables, aerobic fitness, and muscular strength. The Brazilian experimental group showed maintenance in heart rate, blood pressure, and VO2max values while presenting an improvement of 3.3% in body fat percentage (p = 0.040, d = −0.325) and 5.1% in muscular strength (p = 0.039, d = 0.328). Overall, these results were similar to the Canadian intervention. Based on these findings, the Brazilian version of the program has the potential to contribute to the fight against chronic diseases in Brazil.

The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample

Background

Indonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia.

Methods

Secondary analyses were conducted of cross-sectional data from adults aged ≥ 40 years (n = 12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity.

Results

Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p < 0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p < 0.05) and work absenteeism (21% increase, P < 0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p < 0.05), being overweight was negatively associated with CHE incidences (50% decrease, p < 0.05).

Conclusion

Combined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for individuals and the wider society in Indonesia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08546-6.

Does Regular Physical Activity Improve Personal Income? Empirical Evidence from China

A lack of adequate exercise threatens human health, weakening human capital accumulation. The relationship between exercise and income has become the focus of attention in health economics. In terms of reducing body weight and improving physical fitness, diet and physical exercise are intertwined and become effective ways to shape a healthy state. Based on individual-level survey data from China, this study quantified the economic returns of habitual exercise behavior by using an endogenous switching regression model (ESRM) to eliminate selection bias. The study shows that (1) participants in the group with regular exercise behavior increased their income by 3.79% compared with those not exercising regularly; (2) for the group with no regular exercise behavior, regular exercise increased their income by 13.36% compared with those not exercising regularly. Additionally, empirical evidence shows that both drinking and smoking can significantly increase individual income, despite unhealthy habits. These results suggest that the habit of regular physical activity plays a vital role in increasing individual income and improving overall national health, and the effect of individual behavior on income is affected by national culture. The outcomes are empirical evidence for the Chinese government to promote Healthy China Action and support developing countries worldwide to enable habitual exercise, stimulating a policy of exercise behavior.

"I feel too lethargic to do physical activity": Perceptions of Iranian adults on the barriers to perform regular physical activity

Background: Despite the intention to perform physical activity (PA), a number of individuals cannot manage to have PA program on a regular basis. In this study we explored the barriers of regular PA behavior among healthy adults in Tabriz, Iran.

Methods: This qualitative study with a conventional content analysis approach, was carried out from June to September 2020. Nineteen 30-59 years old individuals, were purposefully (purposive sampling) selected to participate in the study. The participants were formerly registered as "physically inactive" in the health records of Tabriz Health System. Individual semi-structured interviews were conducted until data saturation. Data were managed using MAXQDA-10 software.

Results: The barriers of regular PA that emerged from our data were being listless and lethargic, non-supportive environment, disintegration in PA education chain, and restrictive social norms.

Conclusion: Our findings uncover several PA barriers that are less discussed in the literature. Poor level of regular PA among adults in Iran, as a developing context, is rooted in perceptions with social and economic origins, which should be taken into account by public health policy makers while planning PA promotion programs in such communities. To promote regular PA among healthy adults in developing countries, regular PA programs should be tailored to bridge the gap between their recognition of PA barriers and subsequent behavior change through creating group dynamics highlighting the measures to diminish the behavior.

Time trends of physical activity for leisure and transportation in the Brazilian adult population: results from Vigitel, 2010-2019

This time-series study examined a 10-year historical series of the physical activity prevalence for leisure and transportation in the Brazilian adult population. Information from 512,969 adults interviewed from the Vigitel between 2010 and 2019 was analyzed. Individuals who reported practicing at least 150 minutes/week of moderate-intensity physical activity or at least 75 minutes/week of vigorous-intensity physical activity were considered active during leisure time. Individuals who reported walking or cycling to/from work, course, or school at least 30 minutes/day, equivalent to at least 150 minutes/week of moderate-intensity physical activity, were considered active during transportation. The prevalence of physical activity for leisure and transportation was calculated annually and stratified by sex, age group, schooling, and race/skin color. The segmented regression model was applied to analyze the time series. Annual percent change and average annual percent change were calculated. Over time, the prevalence of physical activity for leisure increased, and the prevalence of physical activity for transportation decreased. The highest prevalence of physical activity for leisure was observed among males, young individuals, and those with high education. Older adults, those with high education, and white people presented the lowest prevalence of active transport. Policymakers should propose strategies that encourage and facilitate physical activity for leisure in women, individuals aged ≥ 35 years, and those with less education (< 12 years), and physical activity for transportation among older adults (≥ 60 years), those with high education (≥ 12 years), and white people.

Socio-demographic Determinants of Low Physical Activity in Peruvian Adults: Results of a Population-based Survey Performed in 2017-2018

Objectives

The objective of this study was to determine the prevalence of low physical activity (PA) in Peruvian adults and to identify associated factors.

Methods

An analytical study was performed using data from the 2017-2018 Nutritional Food Surveillance by Life Stages survey. The outcome variable was low PA (yes or no), assessed using the International Physical Activity Questionnaire-short form. Prevalence ratios were estimated as a measure of association.

Results

Among the 1045 persons included in the analysis, the age-standardized prevalence of low PA was 61.9%. The adjusted model showed that being female and migrating from a rural to an urban area in the last 5 years were associated with a higher probability of having low PA than males and individuals who had not migrated, while residing in rural highlands and jungle areas was associated with a reduced probability of having low PA compared to people residing in other geographic domains.

Conclusions

Being a female and migration from a rural to an urban area in the last 5 years were associated with a higher likelihood of having low PA. Therefore, promotion and prevention strategies related to PA are required, especially in the female and migrant populations.

A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security

In light of new evidence on the prevention of chronic diseases and the elevated rates of overweight and obesity in Brazil and Canada, this critical review aims to interpret and synthesize current aspects regarding dietary and physical activity initiatives in both countries and make future recommendations. The pioneering work presented in the last Brazilian dietary guidelines has been called a model that can be applied globally, given its conceptualization of healthy eating that translates easily to practical guidance. The new Canadian Food Guide has incorporated similar aspects, also putting the country as a leader in dietary guidance. With these new recommendations, citizens in both Brazil and Canada have access to impactful evidence-informed nutritional guidelines. Both documents propose eating patterns that focus not only on health benefits, such as chronic disease prevention, but also incorporate well-being concerning cultural, economic, sociodemographic, biological, and ecological dimensions. A similar approach is required for physical activity to allow individuals to have attainable health and life goals and thereby fully enjoy their lives, regardless of geographical location, health status, and socioeconomic condition, a concept recently described as physical activity security. The wholistic dietary guidelines from both countries represent a change in paradigm in public health. Likewise, national evidence-based policies are warranted to reduce disparities in physical activity, allowing healthier and more active lifestyles for everyone.

Translation, Cultural Adaptation, and Reproducibility of the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+): The Brazilian Portuguese Version

Background: The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) is the international standard for pre-participation risk stratification and screening. In order to provide a practical and valid screening tool to facilitate safe engagement in physical activity and fitness assessments for the Brazilian population, this study aimed to translate, culturally adapt, and verify the reproducibility of the evidence-based PAR-Q+ to the Brazilian Portuguese language.

Method: Initially, the document was translated by two independent translators, before Brazilian experts in health and physical activity evaluated the translations and produced a common initial version. Next, two English native speakers, fluent in Brazilian Portuguese and accustomed to the local culture, back-translated the questionnaire. These back translations were assessed by the organization in charge of the PAR-Q+, then a final Brazilian version was approved. A total of 493 Brazilians between 5 and 93 yr (39.9 ± 25.4 yr), 59% female, with varying levels of health and physical activity, completed the questionnaire twice, in person or online, 1–2 weeks apart. Cronbach's alpha was used to calculate the internal consistency of all items of the questionnaire, and the Kappa statistic was used to assess the individual reproducibility of each item of the document. Additionally, the intraclass correlation coefficient and its 95% confidence interval (CI) were used to verify the general reproducibility (reliability) of the translated version.

Results: The Brazilian version had an excellent internal consistency (0.993), with an almost perfect agreement in 93.8% of the questions, and a substantial agreement in the other 6.2%. The translated version also had a good to excellent total reproducibility (0.901, 95% CI: 0.887–0.914).

Conclusion: The results show this translation is a valid and reliable screening tool, which may facilitate a larger number of Brazilians to start or increase physical activity participation in a safe manner.