Effectiveness of exercise and health education interventions in Brazilian primary health care

Abstract

This study examined the effectiveness of two different behavioral change interventions to improve Physical Activity (PA) and to reduce Sedentary Behavior (SB) in a primary health care setting. Methods: This quasiexperimental study recruited and enrolled 31 users of a primary health care unit of the Brazilian Unified Health System aged 18 or more. Participants were allocated into two groups: Physical Exercise Group combined with Health Education (EHE) and Health Education Group (HE). The EHE group participated in 60 minutes of exercise, twice a week, and 20 minutes of counseling. The HE group participated in 40 minutes of counseling, once a week. Both programs were conducted for over 18 weeks. PA levels were self-reported (IPAQ) and PA and SB were objectively (accelerometer) assessed before and after the intervention period. Data were analyzed using intention-to-treat analysis with generalized estimating equations adopting p<0.05 for significance. Also, the individual PA and SB deltas were computed. Improvements in PA and SB were observed for both interventions (p<0.05). Results: Both groups increased the minutes of weekly leisure PA (p=0.006), time spent in light (p=0.003), and moderated-to-vigorous (p=0.042) PA and decreased the amount of SB, with a significant decrease in the HE group (p=0.010). Delta analyses further demonstrated the effectiveness of the interventions to increase PA in other domains (i.e., transportation, household) and maintenance of occupational PA. Conclusion: Behavioral change interventions in the primary health care context involving exercise and counseling seem to be effective in improving PA and SB in adults.

Physical Activity Counseling among Adults in Primary Health Care Centers in Brazil

“…Studies have shown a positive effect of counseling received and PA levels [ 12 , 16 , 17 ]. Thus, our findings can support specific actions to improve Primary Health Care counseling in Brazil, specifically in BHUs [ 44 , 45 ]. However, PA counseling could be directed towards disadvantaged and less physically active population groups, such as women, the elderly, married, those with less education, those at a low economic level, obese, and users with chronic disease.…”

Barriers to physical activity among adults in primary healthcare units in the National Health System: a cross-sectional study in Brazil

“…[13][14][15] This is an effective and low-cost initiative for promoting LTPA within primary healthcare, 11,12 and it has also been recognized as a health education action that has the potential to develop individuals' autonomy to face health-related behavioral change, such as increased active commuting and reduction of sedentary behavior. 16,17 Although the main barriers to LTPA in the Brazilian population are presented in the literature, few studies have explored them in relation to primary care unit users. Gomes et al 18 identified the barriers to LTPA among physically active women in Rio Claro (SP); Silva et al 19 assessed the barriers to participation in LTPA programs in Pernambuco; and Häfele and Siqueira evaluated the barriers to behavioral change after physical activity counseling among adults in Pelotas (RS).…”

“… 13 – 15 This is an effective and low-cost initiative for promoting LTPA within primary healthcare, 11 , 12 and it has also been recognized as a health education action that has the potential to develop individuals’ autonomy to face health-related behavioral change, such as increased active commuting and reduction of sedentary behavior. 16 , 17 …”