Recommendation and physical activity practice in Brazilians with chronic diseases

Silva, Paulo Sergio Cardoso da; Lima, Tiago Rodrigues de; Botelho, Lúcio José; Boing, Antonio Fernando

doi:10.1590/1806-9282.20200753

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Brasil

Revista da Associação Médica Brasileira

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Brasil

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Sumário

ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 67 (3) • Mar 2021 • https://doi.org/10.1590/1806-9282.20200753 copy

Recommendation and physical activity practice in Brazilians with chronic diseases

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

To analyze the prevalence and factors associated with professional recommendation and leisure-time physical activity (LTPA) in Brazilian individuals diagnosed with hypertension (HBP), diabetes, and/or hypercholesterolemia.

METHODS:

This is a cross-sectional population-based study with a representative sample of the Brazilian population (aged ≥20 years) in 2013, with self-reported HBP (n=11.098), diabetes (n=3.176), and/or hypercholesterolemia (n=7.252). Prevalence and gross odds ratios were estimated and adjusted for both outcomes.

RESULTS:

Professional recommendation and LTPA were more prevalent in individuals who received recommendation and presented with hypercholesterolemia (85.9 and 23.4%, respectively). Adjusted analysis showed an association in people 40 to 59 years of age and public programs in most diseases. Higher educational level was associated with receiving recommendations in all non-communicable diseases (NCDs). LTPA was associated in people 40 to 59 years of age for HBP and diabetes and in all investigated NCDs, higher educational level, positive perception of health, and a favorable environment in those who received recommendation.

CONCLUSIONS:

Education presented the greatest magnitude in the associations, clearly showing the need for equitable methods to increase recommendation and LTPA levels for the most vulnerable population. Further studies analyzing other variables and NCD are needed, corroborating the Ministry of Health.

KEYWORDS:
Physical activity; Adherence, patient; Chronic disease; Non-communicable; Health surveys; Health personnel

Variables	Received PAP recommendation			LPAP in individuals who received a recommendation
Variables	Hypertension	Diabetes	Hypercholesterolemia	Hypertension	Diabetes	Hypercholesterolemia
	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI
Total sample	81.8 (80.5–83.1)	83.9 (81.8–86.0)	85.9 (84.4–87.3)	18.2 (16.8–19.5)	18.0 (15.4–20.6)	23.4 (21.5–25.3)
Sex
Female	81.9 (80.4–83.5)	83.5 (81.1–85.8)	86.0 (84.4–87.7)	17.5 (15.8–19.2)	18.7 (16.0–21.4)	22.9 (20.7–25.0)
Male	81.7 (79.7–83.6)	84.5 (82.0–87.0)	85.6 (83.1–88.1)	19.3 (17.2–21.3)	17.0 (13.8–20.2)	24.4 (21.2–27.7)
Age group (years)
20–39	84.8 (82.6–87.0)	90.1 (87.7–92.6)	89.2 (86.1–92.3)	19.8 (16.6–23.0)	22.0 (18.5–25.4)	29.0 (24.4–33.6)
40–59	84.8 (82.9–86.7)	89.8 (87.7–91.9)	87.3 (85.5–89.1)	20.6 (18.3–22.9)	22.5 (18.7–26.4)	24.4 (21.7–27.1)
≥60	78.0 (76.0–80.0)	78.6 (75.8–81.3)	82.3 (80.0–84.7)	15.0 (13.2–16.8)	13.4 (10.7–16.2)	19.0 (16.5–21.5)
Race/skin color
Black	79.4 (75.8–83.0)	77.6 (73.6–81-5)	84.9 (81.8–88.0)	14.2 (10.7–17.8)	16.2 (13.1–19.4)	17.5 (13.0–21.9)
Brown	79.9 (78.2–81.7)	82.9 (80.8–84.9)	84.3 (81.7–86.9)	18.7 (16.8–20.6)	16.1 (13.6–18.7)	23.3 (20.6–26.1)
White	83.9 (82.2–85.5)	85.7 (82.6–88.8)	87.5 (85.7–89.3)	18.5 (16.5–20.5)	19.2 (15.3–23.2)	24.1 (21.5–26.8)
Marital status
Separated/divorced/widowed	79.4 (77.0–81.8)	83.1 (80.2–85.9)	81.9 (79.0–84.8)	16.3 (14.3–18.4)	16.4 (13.4–19.4)	21.6 (18.6–26.7)
Single	79.4 (77.1–81.7)	83.7 (81.8–85.6)	85.8 (83.5–88.2)	17.9 (15.7–20.1)	14.4(11.6–17.2)	25.0 (21.2–28.7)
Married	83.8 (82.1–85.4)	84.4 (81.6–87.2)	87.4 (85.3–89.4)	19.0 (17.2–20.9)	20.0 (16.5–23.5)	23.4 (21.0–25.9)
Education
No education	71.1 (68.4–73.7)	72.9 (69.6–76.1)	76.7 (73.6–79.8)	11.3 (9.2–13.5)	11.4 (8.2–14.7)	13.0 (10.5–15.6)
Completed elementary education	80.0 (78.0–82.0)	84.2 (81.7–86.6)	82.4 (79.8–85.0)	15.0 (13.2–16.7)	14.0(11.2–16.9)	17.2 (14.7–19.7)
Completed high school education	89.0 (87.2–90.9)	92.4 (90.1–94.7)	91.2 (89.4–92.9)	22.1 (19.2–25.0)	26.8 (20.0–33.7)	25.8 (22.6–29.1)
Completed higher education	94.6 (92.9–96.2)	92.2 (88.0–96.3)	95.7 (94.5–96.9)	30.8 (26.3–35.3)	29.3 (24.7–33.9)	41.5 (36.8–46.2)
Self-perception of health
Negative	79.1 (77.4–80.8)	82.6 (80.4–84.8)	83.2 (81.3–85.1)	14.3 (12.5–16.1)	15.1 (12.3–18.0)	15.8 (13.7–17.9)
Positive	85.6 (83.6–87.6)	87.1 (83.4–90.9)	88.9 (87.1–90.7)	23.2 (21.0–25.4)	24.8 (21.1–28.5)	31.5 (28.5–34.5)
Public space for PAP
No	78.2 (76.3–80.0)	81.4 (78.4–84.4)	83.7 (81.9–85.6)	13.9 (12.4–15.5)	15.1 (12.0–18.2)	17.5 (15.3–19.7)
Yes	86.8 (85.2–88.5)	87.3 (84.8–89.8)	88.5 (86.8–90.2)	23.5 (21.2–25.8)	21.7 (17.8–25.6)	30.2 (27.2–33.2)
Public programs that stimulate PAP
No	79.9 (78.4–81.4)	82.8 (80.5–85.1)	83.8 (82.0–85.5)	15.8 (14.4–17.2)	15.1 (12.5–17.7)	20.3 (18.2–22.4)
Yes	88.3 (86.2–90.3)	87.6 (84.3–90.8)	92.2 (90.2–94.3)	25.4 (22.8–28.0)	27.4 (23.1–31.7)	32.2 (28.8–35.6)

Variables	Hypertension				Diabetes				Hypercholesterolemia
Variables	Crude		Adjusted^A		Crude		Adjusted^B		Crude		Adjusted^C
	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI
Sex
Female	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Male	0.98	(0.83–1.16)	0.88	(0.74–1.05)	1.08	(0.79–1.48)	0.92	(0.65–1.29)	0.97	(0.75–1.24)	0.78	(0.60–1.01)
Age group (years)
≥60	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
40–59	1.57	(1.30–1.91)	1.27	(1.03–1.56)	2.40	(1.65–3.51)	2.05	(1.34–3.14)	1.48	(1.15–1.89)	1.12	(0.86–1.46)
20–39	1.58	(1.23–2.02)	1.16	(0.87–1.55)	2.49	(1.21–5.14)	1.60	(0.85–4.49)	1.77	(1.20–2.63)	1.05	(0.66–1.69)
Race/skin color
Black	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Brown	1.04	(0.80–1.34)	1.03	(0.80–1.33)	1.40	(0.95–2.06)	1.41	(0.93–2.12)	0.96	(0.61–1.49)	0.88	(0.57–1.38)
White	1.35	(1.04–1.75)	1.14	(0.88–1.47)	1.73	(1.12–2.66)	1.60	(1.03–2.48)	1.24	(0.82–1.88)	0.95	(0.63–1.45)
Marital status
Separated/divorced/widowed	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Single	1.00	(0.81–1.24)	0.86	(0.68–1.10)	1.05	(0.70–1.56)	0.78	(0.48–1.26)	1.34	(0.97–1.85)	1.17	(0.79–1.73)
Married	1.34	(1.11–1.61)	1.15	(0.95–1.40)	1.10	(0.80–1.51)	0.82	(0.59–1.15)	1.53	(1.13–2.07)	1.46	(1.07–1.98)
Education
No education	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Completed elementary education	1.63	(1.36–1.96)	1.40	(1.15–1.70)	1.98	(1.43–2.73)	1.68	(1.19–2.37)	1.42	(1.06–1.91)	1.29	(0.97–1.72)
Completed high school education	3.30	(2.59–4.22)	2.49	(1.91–3.26)	4.54	(2.69–7.65)	3.12	(1.79–5.48)	3.14	(2.25–4.39)	2.78	(1.95–3.97)
Completed higher education	7.11	(4.85–10.43)	5.00	(3.31–7.55)	4.39	(1.56–12.37)	2.93	(1.04–8.29)	6.81	(4.50–10.29)	5.40	(3.14–8.53)
Self-perception of health
Negative	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Positive	1.57	(1.29–1.90)	1.21	(0.99–1.49)	1.43	(0.93–2.19)	1.14	(0.73–1.78)	1.62	(1.28–2.05)	1.07	(0.83–1.39)
Public space for PAP
No	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Yes	1.85	(1.53–2.22)	1.47	(1.20–1.79)	1.58	(1.13–2.20)	1.39	(0.98–1.97)	1.50	(1.17–1.91)	1.11	(0.85–1.45)
Public programs that stimulate PAP
No	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Yes	1.89	(1.52–2.36)	1.40	(1.11–1.77)	1.46	(0.92–2.33)	1.07	(0.65–1.76)	2.29	(1.67–3.14)	1.89	(1.33–2.67)

	HBP				Diabetes				Hypercholesterolemia
Variables	Crude		Adjusted^A		Crude		Adjusted^B		Crude		Adjusted^C
	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI
Sex
Female	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Male	1.13	(0.94–1.36)	1.05	(0.87–1.28)	0.89	(0.63–1.26)	0.73	(0.51–1.03)	1.09	(0.87–1.37)	0.97	(0.77–1.22)
Age group (years)
≥60	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
40–59	1.47	(1.20–1.81)	1.26	(1.00–1.59)	1.86	(1.35–2.60)	1.66	(1.13–2.43)	1.37	(1.10–1.72)	1.13	(0.88–1.45)
20–39	1.40	(1.05–1.86)	1.08	(0.80–1.47)	1.81	(1.04–3.17)	1.72	(0.91–3.24)	1.74	(1.29–2.34)	1.03	(0.74–1.43)
Race/skin color (3)
Black	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Brown	1.38	(0.97–1.99)	1.45	(0.99–2.13)	0.99	(0.62–1.58)	0.99	(0.59–1.66)	1.44	(0.93–2.21)	1.30	(0.82–2.06)
White	1.37	(0.96–1.94)	1.20	(0.84–1.72)	1.23	(0.75–2.01)	1.10	(0.65–1.85)	1.50	(0.99–2.27)	1.07	(0.69–1.66)
Marital status
Separated/divorced/widowed	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Single	1.11	(0.85–1.46)	0.99	(0.73–1.33)	0.85	(0.53–1.39)	0.71	(0.40–1.26)	1.21	(0.89–1.64)	0.97	(0.71–1.32)
Married	1.20	(0.97–1.49)	1.01	(0.80–1.27)	1.27	(0.85–1.91)	1.14	(0.73–1.77)	1.11	(0.87–1.41)	0.99	(0.75–1.30)
Education
No education	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Completed elementary education	1.38	(1.06–1.80)	1.18	(0.90–1.55)	1.26	(0.80–2.00)	0.90	(0.57–1.42)	1.39	(0.97–1.99)	1.19	(0.81–1.74)
Completed high school education	2.22	(1.64–2.99)	1.63	(1.19–2.22)	2.84	(1.67–4.82)	1.91	(1.11–3.31)	2.32	(1.61–3.36)	1.66	(1.11–2.48)
Completed higher education	3.48	(2.50–4.85)	2.49	(1.76–3.51)	3.21	(1.82–5.66)	2.07	(1.14–3.75)	4.74	(3.24–6.94)	3.07	(2.03–4.64)
Self-perception of health
Negative	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Positive	1.81	(1.48–2.21)	1.48	(1.21–1.81)	1.85	(1.29–2.65)	1.62	(1.13–2.32)	2.45	(1.98–3.03)	1.75	(1.38–2.22)
Public space for PAP
No	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Yes	1.90	(1.57–2.29)	1.59	(1.29–1.95)	1.56	(1.11–2.20)	1.42	(0.99–2.03)	1.56	(1.11–2.20)	1.56	(1.25–1.97)
Public programs that stimulate PAP
No	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–	1.00	–
Yes	1.81	(1.50–2.19)	1.49	(1.21–1.83)	2.12	(1.41–3.21)	1.85	(1.19–2.89)	1.87	(1.51–2.31)	1.64	(1.30–2.07)

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[1] * Corresponding author: pauloscs85@gmail.com