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...

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.

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

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Introduction: Cardiac output increases during incremental-load exercise to meet metabolic skeletal muscle demand. This response requires a fast adjustment in heart rate and stroke volume. The heart rate is well known to increase linearly with exercise load; however, data for stroke volume during incremental-load exercise are unclear. Our objectives were to (a) review studies that have investigated stroke volume on incremental load exercise and (b) summarize the findings for stroke volume, primarily at maximal-exercise load.Methods: A comprehensive review of the Cochrane Library’s, Embase, Medline, SportDiscus, PubMed, and Web of Sci-ence databases was carried out for the years 1985 to the present. The search was performed between February and June 2014 to find studies evaluating changes in stroke volume during incremental-load exercise. Controlled and uncontrolled trials were evaluated for a quality score. Results:The stroke volume data in maximal-exercise load are inconsistent. There is evidence to hypothesis that stroke volume increases during maximal-exercise load, but other lines of evidence indicate that stroke volume reaches a plateau under these circumstances, or even decreases.Conclusion:The stroke volume are unclear, include contradictory evidence. Additional studies with standardized reporting for subjects (e.g., age, gender, physical fitness, and body position), exercise test protocols, and left ventricular function are required to clarify the characteristics of stroke volume during incremental maximal-exercise load.

BackgroundFibromyalgia (FM) is a syndrome most prevalent in women, in whom it is characterized mainly by chronic pain. An important issue is that many patients with FM are reported to have temporomandibular dysfunction (TMD), and the coexistence of these pathologies generates a clinical outcome of high complexity. The literature is unclear regarding an effective therapy for reducing pain in patients with both comorbidities. Exercise training and phototherapy (low-level laser therapy with light-emitting diode) are two of the approaches used to treat pain. Thus, the aim of this study is to assess the potential role of exercise training plus phototherapy in reducing chronic pain in women with FM and TMD. A further aim is to determine whether the interventions can improve quality of life and modulate endogenous serotonin.Methods/DesignA randomized controlled clinical trial will be conducted. It will involve 60 women ≥ 35 years of age with a diagnosis of FM and TMD. After recruitment, patients will be randomly allocated to one of four groups: a control group (no intervention), a group that will receive a phototherapy intervention (PHO), a group that will be prescribed muscle-stretching, aerobic, and facial exercises (EXT), or a group that will receive phototherapy plus exercise interventions (PHO + EXT). The trial will last 10 weeks, and the following outcomes will be evaluated on two separate occasions (baseline and within 24 h after the last day of the protocol). Pain intensity will be analyzed using a visual analogue scale and the McGill Pain Questionnaire, and pain thresholds will be punctuated using a digital algometer. FM symptoms will be assessed using the Fibromyalgia Impact Questionnaire, and quality of life will be determined with the 36-item Short Form Health Survey. Serotonin levels will be evaluated in salivary samples using a competitive enzyme-linked immunosorbent assay.DiscussionThis is the first randomized controlled trial in which the role of phototherapy, exercise training, and a combination of these interventions will be evaluated for chronic pain in patients with FM and TMD. The results will offer valuable clinical evidence for objective assessment of the potential benefits and risks of procedures.Trial registrationClinicalTrials.gov Identifier: NCT02279225. Registered 27 October 2014.

We analyzed the relationship between performance on the 6-min walk test (6MWT) and health-related quality of life (HRQoL) in older subjects. Our secondary aim was to determine the distance to be completed on the 6MWT for the subject to achieve a score of 50 on the Short Form (36) Health Survey (SF-36). Associations were tested using linear correlation and multivariate linear regression. Participants were 130 healthy older individuals. The predictive performance of the 6MWT based on an SF-36 score of 50 was assessed using a receiver operating characteristic curve and its area under curve (AUC). Associations were observed between physical functioning, role-emotional, social functioning, vitality, general health score, and 6MWT performance in women, after adjusting for confounding variables (coefficients: 0.57, 0.38, 0.40, and 0.46, respectively; p < 0.05). No association was found for men. The distance for the 6MWT to predict an SF-36 score of 50 was 481 m for men in the physical functioning (AUC: 0.79) and role-physical (AUC: 0.84) domains, and 420 m for women in role-emotional (AUC: 0.75), role-physical (AUC: 0.80), and general health (AUC: 0.80) domains. Our results indicate that superior 6MWT performance may be associated with better HRQoL in several domains in only healthy older women. No association between 6MWT performance and role-emotional, mental health, or vitality domains was found. We suggest that a score of 50 is represented by a 6MWT distance of 481 m for men and 420 m for women, at least in the role-physical domain.

Este estudo teve como objetivo verificar o declínio na força de membros inferiores e superi­ores e na agilidade em mulheres praticantes de atividade física. Para tanto foram avaliadas 129 senhoras praticantes de atividades físicas regu­lares, divididas em cinco grupos: A (30-39 anos; n=13), B (40-49 anos; n=36), C (50-59 anos; n=40), D (60-69 anos; n=32), E (70-73 anos; n=08), que se submeteram às medidas de peso, altura, média de 3 dobras cutâneas (tríceps, subescapular e suprailíaca), impulsão vertical sem (IVS) e com auxílio dos braços (IVC), impulsão horizontal (IH), agilidade (SR) e dinamometria manual (DIN). Para análise estatística dos dados foi utilizado delta percentual (%), e a ANOVA “one way ”. Os dados deste estudo sugerem que: a) ape­sar da prática de atividade física com o passar da idade, as mulheres apresentaram piora progressi­va nos resultados de agilidade (66,3%), de força dos membros inferiores: na impulsão vertical sem (53,2%) e com auxílio dos braços (57,1%), impulsão horizontal (47,8%) e de força dos membros superiores (26,7%); b) este declínio foi mais intenso na agilidade e na força de membros infe­riores, sendo menos evidente na força dos mem­bros superiores.