Background: Understanding environmental correlates of physical activity can inform

INTRODUÇÃOA relação entre atividade física, saúde, qualidade de vida e envelhecimento vem sendo cada vez mais discutida e analisada cientificamente. Atualmente é praticamente um consenso entre os profissionais da área da saúde que a atividade física é um fator determinante no sucesso do processo do envelhecimento. É o objetivo desta revisão estabelecer os principais fatores determinantes do nível de atividade física durante o envelhecimento e os benefícios do estilo de vida ativo na prevalência de doenças crônicas não transmissíveis, na mortalidade e na manutenção da capacidade funcional durante esse processo.Alguns dos conceitos que serão utilizados ao longo da discussão dos assuntos aqui tratados têm sido adequadamente definidos e compilados pelos melhores especialistas da área, que em reunião especial chegaram a alguns consensos 1 . Dentre aqueles, os conceitos que merecem especial atenção são: a) Atividade física: definida como qualquer movimento corporal produzido em conseqüência da contração muscular que resulte em gasto calórico. b) Exercício: definido como uma subcategoria da atividade física que é planejada, estruturada e repetitiva; resultando na melhora ou manutenção de uma ou mais variá-veis da aptidão física. c) Aptidão física: é considerada não como um comportamento, mas uma característica que o indivíduo possui ou atinge, como a potência aeróbica, endurance muscular, força muscular, composição corporal e flexibilidade.Desta forma poderíamos também considerar a própria definição dos autores 1 , de epidemiologia da atividade físi-ca, como a parte da epidemiologia que se preocupa com: a) a associação entre os comportamentos da atividade físi-ca e a doença; b) a distribuição e determinantes dos comportamentos da atividade física em populações específi-cas; e c) a associação entre atividade física e outros comportamentos. Nível de atividade física, barreiras e motivação nos adultos de maior idadeDentre essas associações propostas pela epidemiologia da atividade física, têm surgido pesquisas tentando estabelecer o padrão do nível de atividade física em diferentes populações de indivíduos de maior idade. Em 1994, Caspersen et al. 1 compilaram informação de cinco grandes levantamentos realizados na população do sexo masculino maior de 65 anos da Inglaterra, Estados Unidos e Holanda. De acordo com aquelas pesquisas, a caminhada foi uma das atividades mais realizadas, variando de 38% a 72%, seguida pela jardinagem, que foi prevalente entre 37% e 67%. Já atividades como correr, trotar, jogar tênis e golfe foram realizadas por menos que um em cada dez indiví-duos.Dados provenientes de 2.783 homens e 5.018 mulheres maiores de 65 anos de idade da Pesquisa Nacional de Saú-de dos Estados Unidos de 1990 2 determinaram a prevalên-cia de atividade física regular, que naquele estudo foi definida como a participação em atividades físicas no tempo livre por três ou mais vezes por semana e por mais de 30 minutos nas últimas duas semanas. Com esses parâmetros os autores encontraram uma prevalência de atividade físi-ca re...

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.

BackgroundIncreasing empirical evidence supports associations between neighborhood environments and physical activity. However, since most studies were conducted in a single country, particularly western countries, the generalizability of associations in an international setting is not well understood. The current study examined whether associations between perceived attributes of neighborhood environments and physical activity differed by country.MethodsPopulation representative samples from 11 countries on five continents were surveyed using comparable methodologies and measurement instruments. Neighborhood environment × country interactions were tested in logistic regression models with meeting physical activity recommendations as the outcome, adjusted for demographic characteristics. Country-specific associations were reported.ResultsSignificant neighborhood environment attribute × country interactions implied some differences across countries in the association of each neighborhood attribute with meeting physical activity recommendations. Across the 11 countries, land-use mix and sidewalks had the most consistent associations with physical activity. Access to public transit, bicycle facilities, and low-cost recreation facilities had some associations with physical activity, but with less consistency across countries. There was little evidence supporting the associations of residential density and crime-related safety with physical activity in most countries.ConclusionThere is evidence of generalizability for the associations of land use mix, and presence of sidewalks with physical activity. Associations of other neighborhood characteristics with physical activity tended to differ by country. Future studies should include objective measures of neighborhood environments, compare psychometric properties of reports across countries, and use better specified models to further understand the similarities and differences in associations across countries.

BackgroundNeighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants’ response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA.MethodsA Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5 ±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10–15 minutes walk of participants’ residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants’ response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country.ResultsA 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, “Overall Activity Supportive (52% of sample)”, “High Walkable and Unsafe with Few Recreation Facilities (16%)”, “Safe with Active Transport Facilities (12%)”, “Transit and Shops Dense with Few Amenities (15%)”, and “Safe but Activity Unsupportive (5%)”. Country representation differed by type (e.g., U.S. disproportionally represented “Safe but Activity Unsupportive”). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR= 2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR= 1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA.ConclusionsMeaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.

Background and purpose:There are few longitudinal studies to determine the effect of aging on physical fitness and functional capacity of physically active women. The purpose of this study was to compare the evolution of neuromotor profile and functional capacity in active elderly women in one-year period as related to chronological age at the base line. Methods: Sample consisted of 117 women from 50 to 79 years of age (x: 65 ± 6.6 years) engaged in an aerobic program, twice a week, 50 minutes per session during 5.4 ± 3.0 years and divided in three age groups: 50-59 (n: 23); 60-69 (n: 60); 70-79 (n: 34). Motor function and mobility tests included: lower and upper limb strength, agility, trunk flexibility, velocity of rising from a chair, static balance, gait speed and maximum gait speed. Results at the base line and in two evaluations made at six-month interval were compared using a Two Way ANOVA, with a post-hoc Bonferroni. Results: There were no differences regarding neuromotor performance, although velocity of rising from a chair and gait speed evidenced significant differences in groups 50-59 and 60-69 years, showing better results (10-20%); and for maximum gait speed there was an increase (8%) in 60-79 age groups. Conclusion: Present results suggest that physical fitness and functional capacity evolution had a similar pattern among physically active women, regardless of chronological age. This evo-

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