The purpose of this paper is to present key points of an intervention programme (Agita São Paulo Program) to promote physical activity in a developing country. Agita is a multi-level, community-wide intervention designed to increase knowledge about the benefits and the level of physical activity in a mega-population of 34 million inhabitants of São Paulo State, Brazil. The main message was taken from the Centers for Disease Control/American College of Sports Medicine (CDC/ACSM) recommendation that: 'everyone should accumulate at least 30 minutes of physical activity, on most days of the weeks, of moderate intensity, in one single or in multiple sessions'. Activities were encouraged in three settings: home, transport and leisure time. Focus groups were students from elementary schools through to college, white and blue collar workers, and elderly people. Innovative aspects included: (1) a research centre leading the process, (2) scientific and institutional partnerships (over 160 groups), (3) a feasible approach -the 'one-step-ahead' model, (4) empowerment, (5) inclusion, (6) non-paid media, (7) social marketing, and (8) culture-linked. Data were obtained from 645 random, home-based questionnaires over four years -stratified by sex, age, education and socio-economic level. These data show that the Agita message reached 55.7% of the population, and among these, 23.1% knew the main message. Recall of Agita and knowledge of its purpose were well distributed among different socioeconomic levels, being known by 67% of the most educated. The prevalence of people reaching the recommendation was 54.8% (men 48.7%, women 61%); and risk of being sedentary was quite smaller among those who knew the Agita message (7.1%) compared with those who did not know (13.1%). In conclusion, based upon the Agita São Paulo experience, it appears that a multi-level, community-wide intervention to promote physical activity may obtain good results if the model contains the items listed above. Keywords Health promotion Physical activity Programme interventionPromoting an active lifestyle in the general population as an important tool to prevent the multiple consequences of metabolic syndrome has been difficult in the past. The purpose of this paper is to present some of the experiences of the Agita São Paulo Program, a multi-level, communitywide, physical activity intervention programme that was created in Brazil 1,2 . The programme was especially addressed to the people in the state of São Paulo. Brazil is in the middle of the epidemiological transition, as shown by an increase in deaths from cardiovascular diseases (CVDs) 3,4 and obesity prevalence 5 while experiencing a decrease in infectious and parasitic diseases. CVDs are responsible for the deaths of about 300 000 Brazilians a year, representing one death every two minutes 6 . The rate in São Paulo State (30.8%) is higher than the national average 7 . This can be explained, in part, by the results of several surveys that have indicated a large proportion of Brazilians are not m...

Objective: To describe the prevalence of physical inactivity and associated factors among high school students from state's public schools in the city of São Paulo, state of São Paulo, Brazil.Methods: Sixteen state's public schools were randomly selected according to the geographic areas of the city (North, South, East, and West). The sample consisted of 3,845 high school students in 2006. Physical inactivity was measured using the International Physical Activity Questionnaire (short IPAQ) and was defined as practicing moderate and/or vigorous physical activity for a period of less than 300 minutes per week. The independent variables analyzed were: gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita São Paulo" program, participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Three-level Poisson regression was used for assessing the variables, with a significance level of p < 0.05. Results:The general prevalence of physical inactivity among adolescents in São Paulo was 62.5% (95%CI 60.5-64.1). The factors associated with physical inactivity were gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita São Paulo" program, non-participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Conclusion:It was concluded that the prevalence of physical inactivity among adolescents in São Paulo was high in all the geographic areas evaluated, and that sociodemographic and behavioral factors contributed significantly to physical inactivity.J Pediatr (Rio J). 2009;85(4):301-306: Adolescence, physical activity, health promotion.

Lack of comparability has been a major limitation in studies on physical activity, due to the utilization of different methodological instruments and inconsistent cut-off points. This study aims to compare the levels of physical activity in adults from two Brazilian areas: (a) São Paulo, the richest State in the country; (b) Pelotas, a medium-sized southern Brazilian city. Both sites used cross-sectional population-based designs, with multiple-stage sampling strategies. Level of physical activity was assessed with the short version of the International Physical Activity Questionnaire. Prevalence of sedentary lifestyle was three times higher in Pelotas than in São Paulo. On the other hand, the proportion of very active subjects was significantly higher in Pelotas. The proportion of insufficiently active individuals (sedentary + irregularly active) was almost identical between the sites. Socioeconomic status was inversely related to level of physical activity in both sites. Among the insufficiently active subjects, those living in São Paulo are at least engaged in a limited amount of activity. On the other hand, among sufficiently active people, those living in Pelotas are more active.

Objective: To describe the prevalence of physical inactivity and associated factors among high school students from state's public schools in the city of São Paulo, state of São Paulo, Brazil.Methods: Sixteen state's public schools were randomly selected according to the geographic areas of the city (North, South, East, and West). The sample consisted of 3,845 high school students in 2006. Physical inactivity was measured using the International Physical Activity Questionnaire (short IPAQ) and was defined as practicing moderate and/or vigorous physical activity for a period of less than 300 minutes per week. The independent variables analyzed were: gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita São Paulo" program, participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Threelevel Poisson regression was used for assessing the variables, with a significance level of p < 0.05. Results:The general prevalence of physical inactivity among adolescents in São Paulo was 62.5% (95%CI 60.5-64.1). The factors associated with physical inactivity were gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita São Paulo" program, non-participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Conclusion:It was concluded that the prevalence of physical inactivity among adolescents in São Paulo was high in all the geographic areas evaluated, and that sociodemographic and behavioral factors contributed significantly to physical inactivity.

The "Agita São Paulo" Program applies a multilevel intervention approach to promoting physical activity among the 37 million inhabitants of the state of São Paulo, Brazil. The verb "agita" means to move the body, but the term also suggests changing the way of thinking and becoming a more active citizen. Since being launched in 1996, the Program has been widely copied throughout Brazil and in other countries of Latin America, and the World Health Organization has characterized it as a model for other developing countries. The Program aims to disseminate a clear and simple message to the community as well as establish partnerships with governmental and nongovernmental organizations and other entities. The Agita São Paulo message encourages people to adopt an active lifestyle by accumulating at least 30 minutes of moderate physical activity per day, on most days of the week. The Program has three main target groups: students, workers, and the elderly. The Program organizes "mega-events" that simultaneously reach and involve large numbers of people, and it also conducts ongoing activities with institutions that become partners of the Program. Intervention studies that the Program has carried out on specific, small groups have found both changes in behavior and an increasing awareness of the Program's name and message. In addition, surveys have found that a growing number of persons in the state of São Paulo have become aware of the Program and its message and have changed their physical activity level. A number of the special features of and lessons learned from the Agita São Paulo Program may have contributed to its success, including: a multisectorial approach; broad use of partnerships; the inclusion principle (avoiding messages or attitudes that might exclude any social group); the scientific basis for all the Program activities; the extensive free media coverage that the Program has received; a "two-hats" approach, using either governmental or nongovernmental methodologies to promote physical activity, depending on the circumstances; cultural adaptation (using local culture to disseminate the message and make its assimilation easier); encouraging activities that are pleasurable; the clear, simple, feasible message of promoting physical activity; and evaluation of the various Program efforts. These distinctive characteristics help make the Agita São Paulo Program a model that could be used in other countries as an effective way to promote health through physical activity.

Physical activity levels are increasing in the state of São Paulo, Brazil. Considering that the few data available in Brazil using the same instrument indicate exactly the opposite trend and that Agita São Paulo primarily incentives the involvement in moderate-intensity physical activity and walking, it seems that at least part of the trends described here are explained by the Agita São Paulo program.

Background, Structure, and Message to Promote Physical Activity A sedentary lifestyle, which affects 50-80% of the world's population, 1-3 is associated with the main risk factors for chronic diseases. For this reason stimulating an active lifestyle is critical to control and prevent these illnesses. In Brazil, as in other developing countries, there are few available data to determine the physical activity (PA) level of the population. 4 The first national household survey in Brazil to include PA was the Living Standards Measurement Survey conducted from March 1996 to February 1997. In that survey 11,033 people (over 20 years of age) were evaluated concerning their leisure-time physical activities (LTPA). According to the results only 13% of the Brazilians surveyed reported performing 30 min or more of LTPA on 1 or more days of the week, and only 3.3% reported doing the recommended minimum of 30 min on 5 or more days of the week. 5 In the State of São Paulo, data published in 1990 showed that a sedentary lifestyle was prevalent among 69.3% males and females (aged 18 to 70). 4 Another important issue is the cost of this lifestyle in the health system, which is estimated by the Centers for Disease Control and Prevention (CDC) to represent about 70% of all health expenses. According to 2002 data (CELAFISCS & CDC, unpublished data), 4% (US$37.5 million) of the direct cost in public health in the State of São Paulo is related to a sedentary lifestyle. The Agita São Paulo Program (the Program) was developed to address this problem. The Program is a multilevel plan that promotes messages about the health benefits of PA and coordinates activities and interventions for broader PA opportunities among more than 37 million inhabitants of the

The training was effective in improving knowledge and attitudes toward counseling on physical activity among community health workers.