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.

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.

This study aimed to analyze the independent associations of accelerometer-determined sedentary behavior, physical activity, and steps/day with body composition variables in Brazilian children. 485 children wore accelerometers for 7 days. Variables included time in sedentary behavior and different physical activity intensities (light, moderate, vigorous, or moderate-to-vigorous) and steps/day. Body fat percentage was measured using a bioelectrical impedance scale, and BMI was calculated. Children spent 55.7% of the awake portion of the day in sedentary behavior, 37.6% in light physical activity, 4.6% in moderate physical activity, and 1.9% in vigorous physical activity. Moderate-to-vigorous physical activity and steps/day were negatively associated with body composition (BMI and body fat percentage) variables, independent of sex and sedentary behavior. Beta values were higher for vigorous physical activity than moderate physical activity. Vigorous physical activity was negatively associated with BMI (β-.1425) and body fat percentage (β-.3082; p < .0001). In boys, there were significant negative associations between moderate, vigorous, and moderate-to-vigorous physical activity and steps/day with body composition, and in girls, there was only a negative association with vigorous physical activity, independent of sedentary behavior. Moderate-to-vigorous physical activity and steps/day (in boys), but especially vigorous physical activity (in boys and girls), are associated with body composition, independent of sedentary behavior. Sedentary behavior was not related with any of the body composition variables once adjusted for moderate-to-vigorous physical activity.

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Objective:To analyze the associations between socioeconomic status (SES) indicators and physical activity and overweight/obesity in children.Methods:485 children wore accelerometers for 7 days. Variables included time in sedentary behavior and moderate-to-vigorous physical activity (MVPA), and steps/day. Children were further categorized as meeting or not meeting guidelines of ≥60min/day MVPA and ≥12,000 steps/day. Body mass index (BMI) and body fat percentage (BF%) were measured using bioelectrical impedance. Overweight/obesity was defined as BMI >+1 SD and BF% ≥85th percentile. Parents answered questionnaires that questioned total annual household income, parental education level, parental employment status and automobile ownership.Results:Children averaged 59.5min/day in MVPA (44.1% met MVPA guidelines), and 9639 steps/day (18.4% met steps/day guidelines). 45.4% and 33% were overweight/obese classified by BMI and BF% respectively. Higher relative total annual household income level (Odds Ratio 0.31; 95% confidence interval=0.15-0.65), and relatively higher maternal (OR=0.38; 95%CI=0.20-0.72) and paternal (OR=0.36; 95%CI=0.17-0.75) education levels were associated with lower odds of children meeting MVPA guidelines. Household automobile ownership was associated with lower odds of children meeting MVPA (OR=0.48; 95%CI=0.31-0.75) and steps/day guidelines (OR=0.44; 95%CI=0.26-0.74).Conclusions:SES indicators were not associated with overweight/obesity, but higher SES was associated with lower odds of children meeting MVPA guidelines.