Sistema Único de Saúde e Educação Física: Aproximações a partir do grupo de epidemiologia da atividade física - atenção básica

Trabalho apresentado no 31º SEURS - Seminário de Extensão Universitária da Região Sul, realizado em Florianópolis, SC, no período de 04 a 07 de agosto de 2013 - Universidade Federal de Santa Catarina.Com o aumento da expectativa de vida, e consequente aumento da população de idosos, as doenças crônico-degenerativas tendem a se manifestar de forma expressiva e, frequentemente, estão associadas à comorbidades, gerando incapacidades que podem comprometer a funcionalidade, dificultando ou impedindo o desempenho de atividades cotidianas de forma independente. Entre os principais fatores de risco contribuintes para a ocorrência dos agravos crônico-degenerativos, encontram-se a hipertensão arterial, a obesidade, o alto nível de colesterol, o consumo de álcool e de tabaco e o sedentarismo. Por outro lado, sabe-se que praticar Atividade Física (AF) regular é reconhecidamente um comportamento capaz de prevenir doenças crônicas e interage de forma positiva com outras estratégias comportamentais de promoção da saúde, tais como hábitos alimentares saudáveis, abandono do tabagismo, consumo de álcool e drogas. O objetivo do projeto é incluir o profissional de Educação Física na UBS de ensino Areal Leste da Universidade Federal de Pelotas (UFPel), de forma que atue no aconselhamento à comunidade e aos profissionais que nela atuam quanto à atividade física e na coordenação de programas de atividade física (AF). A intervenção é baseada em quatro atividades específicas: a) Estudo de Linha de base da população da área de abrangência da UBS; b) Atividade de divulgação da função do educador físico na sala de espera e aconselhamento a prática de AF; c) Aulas coletivas de AF à população; d) Atendimento ambulatorial a população da área de abrangência. É esperado que, ao final da intervenção, ocorra diminuição estatisticamente significativa em relação à prevalência de sedentarismo na população da área de abrangência das UBS assim como melhor da prevalência de aconselhamento feita aos usuários. Outro resultado esperado é a inclusão de área de estágio nas UBS para os estudantes do curso de educação Física da UFPel

Number of days required to estimate physical activity constructs objectively measured in different age groups: Findings from three Brazilian (Pelotas) population-based birth cohorts.

PURPOSE:The present study aims to estimate the minimum number of accelerometer measurement days needed to estimate habitual physical activity (PA) among 6- (2010), 18- (2011) and 30- (2012) year-old participants, belonging to three population-based Brazilian birth cohorts. METHOD:PA was assessed by triaxial wrist-worn GENEActiv accelerometers and the present analysis is restricted to participants with at least 6 consecutive days of measurement. Accelerometer raw data were analyzed with R-package GGIR. Description of PA measures (overall PA, moderate-to-vigorous PA (MVPA), light PA (LPA)) on weekdays and weekend days were conducted, and statistical differences were tested with chi-squared and Kruskal-Wallis tests. Spearman Brown Formulae was applied to test reliability of different number of days of accelerometer use. RESULTS:Differences between week and weekend days regarding LPA, MVPA and overall PA, were only observed among 30-year-olds. Higher levels of MVPA (p = 0.006) and overall PA (p0.70, two and three days of measurement were needed in adults and children, respectively. For LPA, a reliability coefficient >0.70 was achieved with five days in 6-year-old children, three days in 18-year-old young adults, and four days in 30-year-old adults. Considering MVPA, four days would be necessary to represent a week of measurement among all cohort groups. CONCLUSION:Our results show that four and five measurement days are needed to estimate all habitual PA constructs, for children and adults, respectively. Also, among 30-year-old adults, it is important to make efforts towards weekend days measurement

Physical activity levels objectively measured among older adults: a population-based study in a Southern city of Brazil

Abstract Background Low levels of physical activity are currently observed in all age groups around the world. Among older adults physical activity is even lower, potentially influencing quality of life, incidence of diseases and premature mortality. The aim of this study was to describe objectively measured physical activity levels among older adults residents in a Southern city of Brazil. Methods A population-based study was carried out including people aged 60+ years living in the urban area of Pelotas. Face-to-face interviews, anthropometric measures and triaxial accelerometry (non-dominant wrist) were used to collect sociodemographic, anthropometric and physical activity, respectively. For descriptive purposes, overall physical activity was expressed as daily averages of acceleration. Time spent in light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) using different bout criteria (non-bouted, and in 1-, 5- and 10-min bouts) were calculated. Crude and adjusted analyses were performed using simple linear regression to examine the association between physical activity and exposure variables. Results Overall, 971 individuals provided valid accelerometry data. Women spent on average more time on LPA (136.2 vs. 127.6 min per day). Men and women respectively accumulated, in average, 64.5 and 56.7 min per day of non-bouted MVPA, while these daily averages were 14.9 and 9.46 min using 5-min, and 8.1 and 4.5 min using 10-min bout MVPA. In adjusted analyses, men aged 80 years or more spent in average 45 min less LPA per day when compared to men 60-69 years and, among women, this difference was 65 min. Considering time in 5-min MVPA bouts, the youngest age group and those with a better self-perceived health accumulated more MVPA. Specifically among men, socioeconomic status was inversely associated with 5-min bout MVPA. Conclusion The present study showed low levels of physical activity among Brazilian older adults, even lower in more advanced ages, and a different pattern for physical activity intensity between men and women

The “Hypertension Approaches in the Elderly: a Lifestyle study” multicenter, randomized trial (HAEL Study): rationale and methodological protocol

Background: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. Methods: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. Discussion: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. Trial registration: NCT03264443. Registered on 29 August, 2017

Educational intervention with physical activity through the Unified Health System in a small-sized city in the Rio Grande do Sul

Since the reorganization of the Unified Health System (SUS), preventive actions began to be prepared in relation to the practice of physical activity and healthy lifestyle. The present thesis consists of an intervention consisting of educational content, including physical activity, healthy eating and stress control to be conducted in the SUS, through the Community Health Agents (ACS) in urban and rural areas of Dona Francisca/RS. The aim was to evaluate the effect of educational intervention on physical activity (PA) level of older adults residing in urban and rural areas of a city. Educational intervention took place, with person aged 50-80 years. All eligible (n=758) were invited to participate in study, which included two randomised controlled trials groups (A and B) and was composed of: i) individual meetings; II) six meetings on educational PA, food and stress; III) educational materials and gifts. Held three data collections between 2014 and 2016 containing sociodemographic, health questionnaires, self-reported PA (leisure and commuting) and half of the sample be drawn to use accelerometer for seven days (PA moderate to vigorous). The comparison of the level of PA was accomplished by generalised linear models considering the factors and groups. Were evaluated 649, 544 and 555 people, respectively, between 2014-2016. In 2014, the average age was 62.2±8.4 years and most were female. For self-reported PA leisure, there was differences between all times, with an increase in both groups. As for commuting between the first and the second year and the first and last year. In relation to the time spent in moderate to vigorous PA measured by accelerometer, there was an increase between 2014 and 2015 and fall in the year 2016. No differences were found between groups. It is concluded that there was an increase of PA and commuting between the years, while moderate to vigorous PA increased in 2015 and reduced in 2016.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESA partir da reorganização do Sistema Único de Saúde (SUS), ações preventivas começaram a ser elaboradas em relação à prática de atividade física e estilo de vida saudável. A presente tese consiste de uma intervenção composta por conteúdos educacionais, incluindo atividade física (AF), alimentação saudável e controle de estresse a ser conduzida no SUS, através dos Agentes Comunitários de Saúde (ACS) nas áreas urbanas e rurais de Dona Francisca/RS. Objetiva-se avaliar o efeito da intervenção sobre o nível de AF de adultos mais velhos residentes em áreas urbanas e rurais de uma cidade de pequeno porte. Realizou-se intervenção educacional, com pessoas com idade entre 50-80 anos residentes em Dona Francisca - RS. Todos os elegíveis (n=758) foram convidados a participar do estudo, que contou com dois grupos aleatorizados (A e B) e foi composta por: i) encontros individuais; ii) seis encontros educacionais sobre AF, alimentação e estresse; iii) material educativo e brindes. Realizou-se três coletas de dados entre 2014 a 2016, reunindo dados sociodemográficos, sobre saúde, AF autorreferida (lazer e deslocamento) e metade da amostra utilizou acelerômetros por sete dias para mensurar AF objetivamente. A comparação do nível de AF foi realizada através de modelos lineares generalizados considerando os fatores grupos e momentos. Foram avaliadas 649, 544 e 555 pessoas, respectivamente, entre 2014-2016. Em 2014, a média de idade foi de 62,2±8,4 anos e a maioria era do sexo feminino. Considerando AF lazer autorreferida, verificou-se diferenças entre todos os momentos, havendo um aumento em ambos os grupos. AF deslocamento também aumentou entre o primeiro e o segundo ano e o primeiro e o último ano. Em relação ao tempo despendido em AF moderada a vigorosa mensurada pelo acelerômetro, houve aumento entre 2014 e 2015 e queda no ano de 2016. Não foram encontradas diferenças entre grupos. Conclui-se que houve aumento da AF de lazer e deslocamento entre os anos, enquanto AF moderada a vigorosa aumentou em 2015 e reduziu em 2016

Patients with Diabetes Mellitus in Brazil: how many of them are aware about it, who they are, how is their health like and how they manage the disease?

Diabetes Mellitus (DM) is one of the fastest growing diseases in national and global level. Besides resulting in high morbidity and mortality, DM generates a high degree of pain and suffering to the individual and if such offense is costly to health systems, since diabetics tend to need medical applicants and using drugs continuously. This study aimed to indicate the prevalence of DM in Brazil, and describes who the patients are, how is their health like and how they manage the disease. In 2008, the National Survey by Household Sampling (PNAD) from households was conducted; it investigates general characteristics of the population. In 2008 it was incorporated into the Health Supplement, which is the main source of data for this study. The sample consisted of 391,868 Brazilians aged over 18 years. In this research the main analyzes are restricted to 13,108 subjects who reported physician-diagnosed DM. Analyses were conducted using Stata version 10.0 and information from the sample is incorporated. Results are presented by gender and region of the country. The prevalence of DM for the Brazilian population was 3.6%, with a significant increase after 60 years, especially among women. As for the regions, the highest prevalence was observed in the Southeast (5.9%) and South (5.3%) and lower rates in the Northeast (4.0%) and North (3.7%).O Diabetes Mellitus (DM) é uma das doenças que mais crescem em nível nacional e mundial. Além de resultar em altas taxas de morbidade e mortalidade, o DM gera alto grau de dor e sofrimento ao indivíduo e se constitui como agravo oneroso aos sistemas de saúde, dado que o diábetico tende a necessitar de cuidados médicos recorrentes e utilizar medicamentos de forma contínua. Este estudo objetivou indicar a prevalência de portadores de DM no Brasil, além descrever quem são, como estão de saúde e como manejam a doença. No ano de 2008 foi conduzida a Pesquisa Nacional por Amostra de Domicílios (PNAD) que, a partir dos domicílios, investiga características gerais da população brasileira. No ano de 2008 foi incorporado o Suplemento Saúde, o qual é fonte principal de dados para o presente estudo. A amostra foi constituída por 391.868 brasileiros, com idade igual ou superior a 18 anos. Nesta investigação as principais análises são restrita aos 13.108 sujeitos que relataram diagnóstico médico de DM. As análises foram conduzidas no programa estatístico Stata versão 10.0 e se incorporaram informações do plano amostral. Os resultados serão apresentados por sexo e regiões do país. A prevalência de DM para a população brasileira foi de 3,6%, havendo aumento importante a partir dos 60 anos, principalmente entre as mulheres. Quanto às regiões do país, se observaram maiores prevalências no Sudeste (5,9%) e Sul (5,3%) e menores índices no Nordeste (4,0%) e Norte (3,7%)

Depressive Symptoms in Women with Gestational Diabetes Mellitus: The LINDA-Brazil Study

This study aimed to assess the frequency and severity of depressive symptoms and their relationship with sociodemographic characteristics in women with gestational diabetes mellitus (GDM) who participated in the LINDA-Brazil study. We conducted cross-sectional analyses of 820 women with GDM who were receiving prenatal care in the public health system. We conducted structured interviews to obtain clinical and sociodemographic information and applied the Edinburgh Postnatal Depression Scale (EPDS) to assess depressive symptoms. We classified the presence and severity of depressive symptoms using scores of ≥12 and ≥18, respectively. We used Poisson regression to estimate prevalence ratios (PR). Most of the women lived with a partner (88%), 50% were between 30 and 39 years old, 39% had finished high school, 39% had a family income of 1-2 minimum wages, and 47% were obese before their pregnancies. The presence of depressive symptoms was observed in 31% of the women, and severe depressive symptoms were observed in 10%; 8.3% reported self-harm intent. Lower parity and higher educational levels were associated with lower EPDS score. Depressive symptoms were common and frequently severe among women with GDM, indicating the need to consider this situation when treating such women, especially those who are more socially vulnerable. This trial is registered with NCT02327286, registered on 23 December 2014

Ciência aberta e reprodutível - CAR00044 - Darling de Andrade Lourenço

Projeto Test

Number of days required to estimate physical activity constructs objectively measured in different age groups: Findings from three Brazilian (Pelotas) population-based birth cohorts.

PURPOSE:The present study aims to estimate the minimum number of accelerometer measurement days needed to estimate habitual physical activity (PA) among 6- (2010), 18- (2011) and 30- (2012) year-old participants, belonging to three population-based Brazilian birth cohorts. METHOD:PA was assessed by triaxial wrist-worn GENEActiv accelerometers and the present analysis is restricted to participants with at least 6 consecutive days of measurement. Accelerometer raw data were analyzed with R-package GGIR. Description of PA measures (overall PA, moderate-to-vigorous PA (MVPA), light PA (LPA)) on weekdays and weekend days were conducted, and statistical differences were tested with chi-squared and Kruskal-Wallis tests. Spearman Brown Formulae was applied to test reliability of different number of days of accelerometer use. RESULTS:Differences between week and weekend days regarding LPA, MVPA and overall PA, were only observed among 30-year-olds. Higher levels of MVPA (p = 0.006) and overall PA (p0.70, two and three days of measurement were needed in adults and children, respectively. For LPA, a reliability coefficient >0.70 was achieved with five days in 6-year-old children, three days in 18-year-old young adults, and four days in 30-year-old adults. Considering MVPA, four days would be necessary to represent a week of measurement among all cohort groups. CONCLUSION:Our results show that four and five measurement days are needed to estimate all habitual PA constructs, for children and adults, respectively. Also, among 30-year-old adults, it is important to make efforts towards weekend days measurement