Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System

Ribeiro, Evelyn Helena Corgosinho; Garcia, Leandro Martin Totaro; Salvador, Emanuel Péricles; Costa, Evelyn Fabiana; Andrade, Douglas Roque; Latorre, Maria do Rosario Dias de Oliveira; Florindo, Alex Antonio

doi:10.1590/S1518-8787.2017051006654

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.1590/S1518-8787.2017051006654 copy

Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To assess the effect of interventions on the levels of physical activity of healthy adults, users of the Brazilian Unified Health System and attended by the Family Health Strategy.

METHODS

Non-randomized experimental study with 157 adults allocated in three groups: 1) physical exercise classes (n = 54), 2) health education (n = 54), 3) control (n = 49). The study lasted for18 months, with 12 months of interventions and six months of follow-up after intervention. Assessments took place at the beginning, in the 12 months, and in the 18 months of study. Physical activity has been assessed by questionnaires and accelerometry. For the analyses, we have used the intention-to-treat principle and generalized estimating equations.

RESULTS

After 12 months, both intervention groups have increased the minutes of weekly leisure time physical activity and annual scores of physical exercise, leisure and transport-related physical activity. The exercise class group has obtained the highest average annual physical exercises score when compared to the other groups (p < 0.001). In the follow-up period, the exercise class group reduced its annual score (average: -0.3; 95%CI -0.5–-0.1), while the health education group increased this score (average: 0.2; 95%CI 0.1–0.4). There have been no differences in the levels of physical activity measured by accelerometry.

CONCLUSIONS

The interventions have been effective in increasing the practice of physical activity. However, we have observed that the health education intervention was more effective for maintaining the practice of physical activity in the period after intervention. We recommend the use of both interventions to promote physical activity in the Brazilian Unified Health System, according to the local reality of professionals, facilities, and team objectives.

Adult; Motor Activity; Outcome Assessment (Health Care); Health Behavior; Health Promotion; Unified Health System; Randomized Controlled Trial

Variable	12 months		18 months		p*₁₂	p*₁₈

	Assessed	Not assessed	Assessed	Not assessed

	n = 114	n = 43	n = 110	n = 47
Transport-related physical activity (min/week)	41.38 (42.88)	50.91 (46.26)	47.19 (44.15)	36.49 (42.80)	0.25	0.15
Annual score of physical exercises	2.00 (0.51)	1.91 (0.62)	2.01 (0.54)	1.89 (0.54)	0.30	0.17
Annual score of leisure and transport activities	2.23 (0.53)	2.27 (0.55)	2.25 (0.56)	2.22 (0.47)	0.85	0.67
Sum of annual scores of physical exercises and leisure and transport activities	4.25 (0.78)	4.18 (0.96)	4.27 (0.85)	4.12 (0.77)	0.56	0.25

Variable	Total		Physical Exercise		Education		Control		p*

	n = 157		n = 54		n = 54		n = 49

	n	%	n	%	n	%	n	%
Gender
Male	50	31.8	19	35.2	16	29.6	15	30.6	0.81
Female	107	68.2	35	64.8	38	70.4	34	69.4	0.81
Age group (years)
18–39	100	63.7	40	74.1	34	63.0	26	53.1	0.09
≥ 40	57	36.3	14	25.9	20	37.0	23	46.9	0.09
Education level (years)
≥ 8	71	45.2	28	51.9	25	46.3	18	26.7	0.30
≥ 9	86	54.8	26	48.1	29	53.7	31	63.3	0.30
Work
Yes	96	61.1	35	64.8	34	63.0	27	55.1	0.57
No	61	38.9	19	35.2	20	37.0	22	44.9	0.57
Race
White	58	36.9	14	25.9	19	35.2	25	51.0	0.03
Non-white	99	63.1	40	74.1	35	64.8	24	49.0	0.03
Marital status
With partner	101	64.3	40	74.1	33	61.1	28	57.1	0.17
No partner	56	35.7	14	25.9	21	38.9	21	42.9	0.17
BMI
< 25 kg/m²	77	49.0	32	59.3	22	40.7	23	46.9	0.15
≥ 25 kg/m²	80	51.0	22	40.7	32	59.3	26	53.1	0.15

Groups	Baseline × 12 months^b		12 months × 18 months^c

	Average	95%CI	Average	95%CI
Leisure time physical activity (min/week)
Exercise	53	20–86^e	-31	-64–3
Education	35	3–67^e	6	-13–25
Control	28	-1–56	-9	-49–30
Transport-related physical activity (min/week)^d
Physical exercise	90	42–138^e	-56	-102– -9^e
Education	105	49–161^e	-7	-40–54
Control	45	13–77^e	22	-6–50
Leisure and transport-related physical activity (min/week)^d
Exercise	141	91–191^e	-84	-140– -28^e
Education	141	72–210^e	-1	-48–46
Control	73	27–118^e	13	-38–63
Annual score of physical exercises
Exercise	0.6	0.3–0.8^e	-0.3	-0.5– -0.1^e
Education	0.1	-0.1–0.3	0.2	0.1–0.4^e
Control	-0.1	-0.2–0.1	0.1	-0.1–0.3
Annual score of leisure and transport activities^d
Exercise	0.3	0.1–0.5^e	-0.2	-0.4–0.1
Education	0.3	0.1–0.4^e	0.1	-0.1–0.2
Control	0.2	-0.1–0.3	0.1	-0.2–0.2
Annual scores of physical exercises and leisure and transport activities^d
Exercise	0.8	0.5–1.2^e	-0.5	-0.8– -0.1^e
Education	0.4	0.2–0.7^e	0.3	-0.1–0.6
Control	0.1	-0.1–0.3	0.1	-0.2–0.4
Moderate to vigorous activities (min/day)³
Exercise	-	-	2	-1–5
Education	-	-	3	-2–9
Control	-	-	1	-2–4

Groups	Baseline	12 months^b	18 months^c	p _group^e,f	p _time^e,g	p _interaction^e,h
Leisure time physical activity (min/week)
Exercise	-	54 (27–81)	23 (7–39)	0.409	< 0.001	0.194
Education	-	26 (10–62)	42 (14–69)
Control	-	29 (6–52)	19 (-2–41)
Transport-related physical activity (min/week)^d
Exercise	50 (39–61)	140 (102–179)	85 (67–103)	0.655	< 0.001	< 0.001
Education	32 (20–43)	137 (88–185)	130 (95–164)
Control	47 (35–60)	93 (68–118)	114 (85–144)
Leisure and transport-related physical activity (min/week)^d
Exercise	50 (39–61)	191 (150–232)ⁱ	107 (82–133)	0.358	< 0.001	0.002
Education	32 (20–43)	173 (113–233)	172 (123–232)
Control	47 (35–60)	120 (84–156)	132 (98–167)
Annual score of physical exercises
Exercise	2.0 (1.9–2.2)	2.6 (2.4–2.8)^i,j	2.3 (2.2–2.5)ⁱ	0.003	< 0.001	< 0.001
Education	1.9 (1.8–2.0)	2.1 (1.9–2.2)	2.3 (2.1–2.5)
Control	2.0 (1.8–2.2)	1.9 (1.7–2.1)	2.0 (1.8–2.2)
Annual score of leisure and transport activities^d
Exercise	2.3 (2.2–2.5)^j	2.6 (2.5–2.8)	2.4 (2.3–2.6)	0.139	< 0.001	0.097
Education	2.1 (2.0–2.2)	2.4 (2.2–2.5)	2.4 (2.3–2.6)
Control	2.2 (2.1–2.4)	2.4 (2.2–2.6)	2.4 (2.2–2.6)
Sum of annual scores of physical exercises and leisure and transport activities^d
Exercise	4.4 (4.1–4.6)	5.2 (4.9–5.5)^i,j	4.7 (4.5–5.0)	0.006	< 0.001	< 0.001
Education	4.0 (3.8–4.2)	4.4 (4.1–4.7)	4.7 (4.4–5.0)
Control	4.3 (4.0–4.5)	4.4 (4.1–4.6)	4.4 (4.1–4.7)
Moderate and vigorous activities (min/day)^d
Exercise	-	32 (25–39)	34 (26–42)	0.766	0.071	0.712
Education	-	28 (20–36)	31 (22–41)
Control	-	30 (24–36)	31 (23–36)

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Alex Antonio Florindo. Rua Arlindo Béttio, 1000. Ermelino Matarazzo, 03828-000 São Paulo, SP, Brasil. E-mail: aflorind@usp.br